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.

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.

Association of olfatory dysfunction with plasma lipids and blood pressure in a high cardiovascular risk population: sex-specific analysis

2021 ◽  
Vol 242 ◽  
pp. 170-171
Author(s):  
Rebeca Fernández-Carrión ◽  
Ignacio M. Gimenez-Alba ◽  
Oscar Coltell ◽  
Jose V. Sorlí ◽  
Olga Portolés ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Plasma Lipids ◽  
High Cardiovascular Risk ◽  
Risk Population ◽  
Specific Analysis

Cardiology and vascular disease

2014 ◽  
pp. 231-292
Author(s):  
Chantal Simon ◽  
Hazel Everitt ◽  
Françoise van Dorp ◽  
Matt Burkes
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Blood Pressure Measurement ◽  
Arterial System ◽  
System P ◽  
Symptoms And Signs

Symptoms and signs of CVD Examining the heart Examination of the arterial system Cardiac investigations Brief guide to common ECG changes Prevention of coronary heart disease Estimating cardiovascular risk Blood pressure measurement Hypertension Hyperlipidaemia Angina Drug treatment of angina After myocardial infarction Chronic heart failure...

scholarly journals Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Zoltán Jancsó ◽  
Imre Rurik ◽  
László Kolozsvári ◽  
Lajos Mester ◽  
Anna Nánási ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Diabetes Care ◽  
Structural Changes ◽  
Ldl Cholesterol ◽  
Diabetic Patients ◽  
High Cardiovascular Risk ◽  
Target Values ◽  
Euroaspire Iii

Abstract Background Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) III. and IV. studies. Methods Between 2010 and 2011, 679 patients with high cardiovascular risk were recruited in 20 Hungarian primary care practices and 628 patients were selected in 40 practices between 2015 and 2016. The actual national recommendations were used for classification, all based on European guidelines. Achievements of target levels for blood pressure, total-, LDL-and HDL-cholesterols, triglyceride, and HbA1c (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated. Results There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better in Hungary when compared to the results of EUROASPIRE III-IV. studies, while the previous advantage in diabetes care disappeared. A higher proportion of diabetic patients was above the target values in Hungary than the means of the European surveys. There was a higher proportion of smokers in the Hungarian samples, while the proportion of obese and overweight patients was similar to the European sample. Conclusions Primary care has a unique role in cardiovascular prevention. Although many of the patients are managed appropriately, there is a need to improve primary care services in Hungary, giving more competences to GPs in prescription and introducing structural changes in the healthcare system.

scholarly journals To whom recommend intensive treatment for hypertension?

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E167-E172 ◽  
Author(s):  
Massimo Volpe ◽  
Giovanna Gallo
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Antihypertensive Treatment ◽  
Pressure Control ◽  
Major Cardiovascular Events ◽  
Meta Analyses

Abstract Arterial hypertension is the main identifiable cardiovascular risk factor, and although the benefit of blood pressure reduction is universally acknowledged, the scientific community has long been divided over the therapeutic blood pressure targets to be reached, also considering the estimated overall cardiovascular risk and the presence of individual risk factors and associated comorbidities. During the last few years, numerous clinical studies and meta-analyses, in particular, the SPRINT study, have been published, demonstrating the advantages of an intensive antihypertensive treatment, over a target blood pressure value (&lt;140/90 mmHg), in the reduction of major cardiovascular events, myocardial infarction, stroke, heart failure, and all-causes cardiovascular mortality. Stemming from these results the major International Guidelines revisited the therapeutic objectives, recommending blood pressure value &lt;130/80 mmHg for the vast majority of hypertensive patients until the age of 65 and suggesting a reduction of the target also in the elderly. Numerous studies and meta-analyses demonstrated that the reduction of the risk of coronary or cerebral events, and of all-causes cardiovascular mortality, is independent from the baseline value of blood pressure and the individual estimated risk. It has been also demonstrated that an early institution of antihypertensive treatment is associated with a faster realization of the recommended targets, and consequent significant benefits in terms of reduction of the incidence of myocardial infarction, heart failure, and major cardiovascular events, particularly when blood pressure control is achieved during the first 6 months of treatment, and even better during first 3 months. Other studies outlined that combination therapy with two or more drugs, mainly in a single pill configuration, are superior in reaching the recommended therapeutic targets. This is the reason why this strategy is strongly supported by the European Society of Cardiology/European Society of Hypertension (ESC/ESH) 2018 Guidelines, specifically the use of renin–angiotensin–aldosterone system inhibitors [angiotensin-converting enzyme (ACE) inhibitors and Sartans], in combination with calcium antagonist and/or thiazide diuretics, with the option to add antagonist of mineralcorticoid receptors, when an adequate blood pressure control has not been reached, or other classes of drugs, such as beta-blockers, when specific clinical indications are present, first and foremost ischaemic cardiomyopathy or heart failure. The newly proposed therapeutic goals are particularly important in high-risk patients, such as patients with previous cardiovascular events, diabetes mellitus, renal insufficiency, and patients older than 65 years of age.

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 112 Safety and biochemical efficacy of sodium–glucose cotransporter 2 inhibitors based on cardiovascular risk profile and volume status in a real-world diabetic population

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Mauro Gitto ◽  
Alexios Kotinas ◽  
Riccardo Terzi ◽  
Angelo Oliva ◽  
Jorgele Zagoreo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Risk ◽  
Glycaemic Control ◽  
Real World ◽  
Glycated Haemoglobin ◽  
Diabetic Patients ◽  
World Population ◽  
High Cardiovascular Risk ◽  
Sodium Glucose Cotransporter ◽  
Tract Infections

Abstract Aims Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have become a first-line cardiovascular medication. However, their potential side effects still limit a widespread use in real-world clinical practice. Further, there is uncertainty about the mechanisms mediating SGLT2i-associated cardiovascular benefit. Methods We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral centre. Patients who completed at least 1 year of treatment were included in the data analysis. Changes in glycated haemoglobin, weight and haematocrit were evaluated and compared across two cardiovascular risk categories, defined through the inclusion criteria of three large randomized clinical trials. Additionally, a modified clinical score (mH2FPEF) was applied to detect the probability of heart failure with preserved ejection fraction (HFpEF). Results Of the 459 patients screened from 2015 to 2020, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%) and 55 were lost to follow-up (12.0%). The most common causes of drug discontinuation were genital or urinary tract infections (9.4%) and poor glycaemic control (5%). At 1 year, a significant reduction in glycated haemoglobin concentration (−0.6 ± 1.4%, P &lt; 0.001) and body weight (2.4 ± 4.6 Kg, P &lt; 0.001) was observed and was comparable between patients at high vs. low cardiovascular risk. Haematocrit increase at 1 year (2.3 ± 3.3%, P &lt; 0.001) was more marked in patients with high cardiovascular risk and low baseline haematocrit. Among patients with no established heart failure (N = 295), 156 (52.9%) had &gt;50% probability of HFpEF (mH2FPEF ≥3). Conclusions In a real-world population of diabetic patients, SGLT2i were well-tolerated at 1 year and led to improved glycaemic control and weight loss. Haematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating the potentially beneficial role of euvolemic restoration. More than half of these diabetic patients had a high likelihood of unrecognized HFpEF.

Resting heart rate and cardiovascular outcomes in diabetic and non-diabetic individuals at high cardiovascular risk analysis from the ONTARGET/TRANSCEND trials

2018 ◽  
Vol 41 (2) ◽  
pp. 231-238 ◽  
Author(s):  
Michael Böhm ◽  
Helmut Schumacher ◽  
Koon K Teo ◽  
Eva M Lonn ◽  
Felix Mahfoud ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Heart Rate ◽  
Primary Outcome ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Diabetic Patients ◽  
Resting Heart Rate ◽  
High Cardiovascular Risk ◽  
Patients With Diabetes

Abstract Aims Resting heart rate (RHR) has been shown to be associated with cardiovascular outcomes in various conditions. It is unknown whether different levels of RHR and different associations with cardiovascular outcomes occur in patients with or without diabetes, because the impact of autonomic neuropathy on vascular vulnerability might be stronger in diabetes. Methods and results We examined 30 937 patients aged 55 years or older with a history of or at high risk for cardiovascular disease and after myocardial infarction, stroke, or with proven peripheral vascular disease from the ONTARGET and TRANSCEND trials investigating ramipril, telmisartan, and their combination followed for a median of 56 months. We analysed the association of mean achieved RHR on-treatment with the primary composite outcome of cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, the components of the composite primary outcome, and all-cause death as continuous and categorical variables. Data were analysed by Cox regression analysis, ANOVA, and χ2 test. These trials were registered with ClinicalTrials.gov.number NCT00153101. Patients were recruited from 733 centres in 40 countries between 1 December 2001 and 31 July 2008 (ONTARGET) and 1 November 2001 until 30 May 2004 (TRANSCEND). In total, 19 450 patients without diabetes and 11 487 patients with diabetes were stratified by mean RHR. Patients with diabetes compared to no diabetes had higher RHRs (71.8 ± 9.0 vs. 67.9 ± 8.8, P &lt; 0.0001). In the categories of &lt;60 bpm, 60 ≤ 65 bpm, 65 ≤ 70 bpm, 70 ≤ 75 bpm, 75 ≤ 80 bpm and ≥80 bpm, non-diabetic patients had an increased hazard of the primary outcome with mean RHR of 75 ≤ 80 bpm (adjusted hazard ratio [HR] 1.17 (1.01–1.36)) compared to RHR 60 ≤ 65 bpm. For patients with in-trial RHR ≥80 bpm the hazard ratios were highest (diabetes: 1.96 (1.64–2.34), no diabetes: 1.73 (1.49–2.00), For cardiovascular death hazards were also clearly increased at RHR ≥80 bpm (diabetes [1.99, (1.53–2.58)], no diabetes [1.73 (1.38–2.16)]. Similar results were obtained for hospitalization for heart failure and all-cause death while the effect of RHR on myocardial infarction and stroke was less pronounced. Results were robust after adjusting for various risk indicators including beta-blocker use and atrial fibrillation. No significant association to harm was observed at lower RHR. Conclusion Mean RHR above 75–80 b.p.m. was associated with increased risk for cardiovascular outcomes except for stroke. Since in diabetes, high RHR is associated with higher absolute event numbers and patients have higher RHRs, this association might be of particular clinical importance in diabetes. These data suggest that RHR lowering in patients with RHRs above 75–80 b.p.m. needs to be studied in prospective trials to determine if it will reduce outcomes in diabetic and non-diabetic patients at high cardiovascular risk. Clinical Trial registration http://clinicaltrials.gov.Unique identifier: NCT00153101.

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