Abstract P180: Impact of Intensive Systolic Blood Pressure Treatment on Cardiovascular Disease and Mortality in the US Population

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Joshua D Bundy ◽  
Changwei Li ◽  
Jiang He
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Systolic Blood Pressure ◽  
Incidence Rates ◽  
Intensive Treatment ◽  
Baseline Risk ◽  
Mortality Data ◽  
The Us ◽  
The Impact

Introduction: Hypertension is the most important risk factor for cardiovascular disease (CVD), the leading cause of morbidity and mortality among US adults. Clinical trials suggest that intensive systolic blood pressure (BP) management significantly reduces risk of CVD and mortality in patients at high risk for CVD. However, the impact of intensive BP lowering in the US population is uncertain. Hypothesis: More intensive treatment of systolic BP provides great benefits in the reduction of CVD and total deaths in the US population aged ≥40 years. Methods: We pooled follow-up data in 31,851 individuals from four US cohort studies (ARIC, CHS, Framingham Heart Study, and MESA) to estimate annual incidence rates of major CVD (combined stroke, coronary heart disease, and heart failure) by sex, race (white and non-white), and age groups (40-49, 50-59, 60-69, and ≥70 years). We retrieved mortality data from annual death statistics reported by the CDC. We combined nationally-representative survey data from three NHANES cycles (2009-2010, 2011-2012, 2013-2014) to estimate the proportions of US adults aged ≥40 years in each of 10 systolic BP categories (range <120 to ≥160 mm Hg). A Bayesian network meta-analysis of antihypertensive clinical trials was used to estimate relative risks for CVD and mortality comparing each of the 10 systolic BP categories, after adjusting for baseline risk in included trials. Using these data sources, we calculated the population attributable fractions and number of events (and deaths) that could be reduced by treating systolic BP ≥140 mmHg to more intensive systolic BP targets in the US population. Results: Treating systolic BP to 120-124 mm Hg showed the largest reduction in number of CVD events and total deaths compared to higher targets (Table). Conclusions: In conclusion, intensive treatment of systolic BP could prevent a large number of CVD events and total deaths in the US population.

Abstract P206: The Risk for Cardiovascular Disease Attributable to Traditional Risk Factors Increases

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Susanne Rospleszcz ◽  
Barbara Thorand ◽  
Tonia de las Heras Gala ◽  
Christa Meisinger ◽  
Rolf Holle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Risk Factor ◽  
Systolic Blood Pressure ◽  
Population Attributable Risk ◽  
Temporal Trends ◽  
Cvd Risk ◽  
Traditional Risk Factors ◽  
The Impact

Background: Cardiovascular disease (CVD) is a major cause of mortality and morbidity. Traditional risk factors include systolic blood pressure, diabetes, adiposity, cholesterol and smoking. The prevalence and distribution of these risk factors in the population have changed within the last decades and CVD mortality rates have been declining. However, the impact of these changes on the contribution of the single risk factors to overall CVD risk remains to be investigated. Hypothesis: We assessed the hypothesis that the population attributable risk (PAR) of traditional risk factors changes from 1985 to 2000. Methods: The sample comprises N = 11 760 participants aged 30 - 65 years from four prospective population-based cohort studies enrolled in Southern Germany in 1985, 1990, 1995, and 2000. Participants were followed up for incident CVD events for ten years. We analyzed the traditional risk factors hypertension, defined as systolic blood pressure ≥ 140 mmHg or treatment with antihypertensive medication; diabetes mellitus; obesity, defined as a Body Mass Index ≥ 30 kg/m 2 ; hypercholesterolemia, defined as total cholesterol levels ≥ 200 mg/dL; and smoking. We calculated the PAR first according to Levin’s formula using both crude relative risks as well as adjusted hazard ratios and second as an average of all single sequential PARs according to the formulae by Ferguson. Results: Temporal trends in prevalence varied for the respective risk factors. The prevalence of hypertension decreased slightly for women (from 25.0% in 1985 to 23.0% in 2000) and increased slightly for men (32.3% to 33.3%), whereas the prevalence of diabetes and obesity increased for both women and men. Prevalence of hypercholesterolemia decreased slightly for women (from 73.4% to 71.4%) and more pronounced for men (80.5% to 74.5%). Prevalence of smoking increased for women (20% to 23.6%), but decreased for men (36.4% to 32.4%). CVD events occurred in 2.4% of women in 1985 and 2.3% in 2000; for men, event rates were and 6.2% and 6.3%, respectively. For both women and men the risk factor with the highest PAR in 1985 was hypertension (64.0% and 43.3%, respectively according to Levin’s formula). However, in 2000 the risk factor with the highest PAR was hypercholesterolemia (78.2% and 57.0%, respectively). The PAR for diabetes declined for women and increased for men. The PAR for smoking varied substantially between the studies without a discernible trend. According to Ferguson’s formulae, the PAR of all risk factors taken together increased from 74.3% to 84.2% in women and from 70.8% to 81.8% in men. Conclusion: In conclusion, the CVD risk attributable to traditional risk factors has increased within the last decades. However, different methods of calculating the PAR have to be taken into account. These trends might influence public health policies focusing on the management of these risk factors in order to effectively prevent CVD.

Heart failure events in a clinical trial of arterial hypertension. The acquittal of the SPRINT trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sobieraj ◽  
T Kahan ◽  
P.M Nilsson
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Standard Treatment ◽  
Intensive Treatment ◽  
Kaplan Meier

Abstract Introduction The Systolic Blood Pressure Intervention Trial (SPRINT) was a randomized trial showing that intensive lowering of systolic blood pressure (BP), as compared to standard treatment (i.e. &lt;120 vs &lt;140 mm Hg) was associated with a reduced risk (HR 0.75 [95% CI 0.64–0.79], p&lt;0.001) for the primary composite outcome (CE), defined as myocardial infarction, an acute coronary syndrome other than myocardial infarction, stroke, acute exacerbation of heart failure and cardiovascular death. primary outcome event in subjects at high cardiovascular risk. However, the primary endpoint events in the intensive treatment arm were only 76 fewer than in the standard treatment arm (243 vs 319 events), and he reduction in heart failure events was responsible for half of the effect (62 vs 100 events, i.e. 38 events fewer). Thus, several experts in hypertension argued that these results were mainly driven by a reduction of heart failure events, and questioned the main conclusion of the study. Aim To assess the effect of SPRINT intervention on a redefined CE: the primary SPRINT endpoint with HF events excluded. Material and methods We used limited SPRINT data, available from the NHLBI Biologic Specimen and Data Repository to assess the impact of BP intervention in SPRINT on a redefined CE excluding HF events. The Chi-square test, Cox proportional model and survival analysis were applied. Results Among 9361 SPRINT participants (mean age 67.9±9.5 years, 35.6% female, 20% with previous cardiovascular disease), there was 461 CE events. There were fewer CE events in the intensive treatment arm than in the standard treatment arm (204 [4.4%] vs 257 [5.5%], p=0.0117, respectively). Intensive systolic BP lowering was associated with lower risk for CE than standard treatment (HR 0.79 [95% CI 0.66–0.95], p=0.0115). Kaplan-Meier curves show that intensive treatment was associated with better outcome (Figure 1). Analyses in subgroups (age &gt;75 vs &lt;75 years, female vs male, black vs non-black, prior cardiovascular disease vs no cardiovascular disease, prior chronic kidney disease vs no chronic kidney disease) showed no difference in benefit of intensive treatment (p for interaction &gt;0.05 in all subgroup). Conclusion The reduction in cardiovascular events by intensive BP lowering in SPRINT was not explained by a difference in heart failure events. This supports the concept that more intensive BP reduction may provide benefit in reducing cardiovascular event risk. Figure 1. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

4879Is intensive blood pressure strategy effective and safe in patients with cardiovascular disease? The two sides of the coin

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Vlachopoulos ◽  
D Terentes-Printzios ◽  
K Aznaouridis ◽  
N Ioakeimidis ◽  
P Xaplanteris ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Adverse Events ◽  
Beneficial Effect ◽  
Systolic Blood Pressure ◽  
Intensive Treatment ◽  
Stroke Incidence ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Electrolyte Abnormalities

Abstract Background/Lntroduction Recent data advocate the adoption of a more intensive treatment strategy for the management of blood pressure (BP). Purpose We sought to investigate whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients. Methods In the present post-hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to systolic blood pressure (SBP) target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mm Hg) baseline SBP on clinical endpoints. Results In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; P=0.0509) (Figure). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was an increased HR for study-related SAE in the intensive management group (HR: 2.00; 95% CI: 1.22 to 3.26; p=0.006), a greater incidence of acute renal failure (HR: 1.57; 95% CI: 1.01 to 2.44; P=0.044), electrolyte abnormalities (HR: 1.77; 95% CI: 1.03 to 3.02; P=0.038) and specifically hyponatremia (HR: 2.24; 95% CI: 1.13 to 4.46; p=0.021). In patients with low baseline SBP there was a beneficial effect on all-cause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; P=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; P=0.042). As far as adverse events are concerned, patients with SBP<150 mm Hg had increased risk only for study-related SAE and electrolyte abnormalities. Survival curves for the main endpoints Conclusions We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on other than serious adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke increases. Acknowledgement/Funding This manuscript was prepared using SPRINT_POP Research Materials obtained from the National Heart, Lung, and Blood Institute

scholarly journals Elevated peak exercise systolic blood pressure is not associated with reduced exercise capacity in subjects with Type 2 diabetes

2006 ◽  
Vol 101 (3) ◽  
pp. 893-897 ◽  
Author(s):  
Patrice Brassard ◽  
Annie Ferland ◽  
Valérie Gaudreault ◽  
Nadine Bonneville ◽  
Jean Jobin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Glycemic Control ◽  
Systolic Blood Pressure ◽  
Exercise Capacity ◽  
Hypoglycemic Agents ◽  
Peak Exercise ◽  
The Impact

Subjects with Type 2 diabetes without cardiovascular disease have a reduced exercise capacity compared with nondiabetic subjects. However, the mechanisms responsible for this phenomenon are unknown. The purpose of this study was to evaluate the impact of exercise systolic blood pressure (SBP) response on diverse exercise tolerance parameters in Type 2 diabetic subjects. Twenty-eight sedentary men with Type 2 diabetes were recruited for this study. Subjects were treated with oral hypoglycemic agents and/or diet. Evaluation of glycemic control and peak exercise capacity were performed for each subject. The subjects were divided into two groups according to the median value of peak SBP (210 mmHg) measured in each subject. We observed a 13, 13, and 16% reduction in the relative peak oxygen uptake (V̇o2 peak), absolute V̇o2 peak, and peak work rate in the low- compared with the high-peak SBP group [26.95 (SD 5.35) vs. 30.96 (SD 3.61) ml·kg−1·min−1, 2.5 (SD 0.4) vs. 2.8 (SD 0.6) l/min, and 169 (SD 34) vs. 202 (SD 32) W; all P < 0.05]. After adjusting for age, relative V̇o2 peak was still significantly different ( P < 0.05). There were similar peak respiratory exchange ratio (RER) [1.20 (SD 0.08) vs. 1.16 (SD 0.07); P = 0.24] and peak heart rate [160 (SD 20) vs. 169 (SD 15) beats/min; P = 0.18] between the low- compared with the high-SBP group. No difference in glycemic control was observed between the two groups. The results reported in this study suggest that in subjects with Type 2 diabetes without cardiovascular disease, an elevated exercise SBP is not associated with reduced exercise capacity and its modulation is probably not related to glycemic control.

Effects of Intensive Blood Pressure Control in Patients with Evident Cardiovascular Disease: An Investigation Using the SPRINT Study Data

2019 ◽  
Vol 17 (3) ◽  
pp. 298-306 ◽  
Author(s):  
Charalambos Vlachopoulos ◽  
Dimitrios Terentes-Printzios ◽  
Konstantinos Aznaouridis ◽  
Nikolaos Ioakeimidis ◽  
Panagiotis Xaplanteris ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Beneficial Effect ◽  
Harmful Effect ◽  
Adverse Outcomes ◽  
Intensive Treatment ◽  
Serious Adverse Events ◽  
Stroke Incidence ◽  
Increased Risk ◽  
All Cause Mortality

Background: Recent data advocate adoption of a more intensive treatment strategy for management of blood pressure (BP). </P><P> Objective: We investigated whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients. </P><P> Methods: In a post hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP) target of <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mmHg) baseline SBP on outcome. </P><P> Results: In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was increased risk for study-related SAE, acute renal failure and electrolyte abnormalities. In patients with low baseline SBP there was a beneficial effect on allcause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; p=0.042). </P><P> Conclusion: We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on specific adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke may increase.

scholarly journals Association between systolic blood pressure trajectories and hypertension risk at late adolescence: results from 10-year longitudinal follow-up in Chinese boys

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042594
Author(s):  
Xijie Wang ◽  
Bin Dong ◽  
Sizhe Huang ◽  
Zhaogeng Yang ◽  
Jun Ma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Late Adolescence ◽  
Population Based ◽  
Incidence Rates ◽  
Hypertension Risk ◽  
Logit Regression ◽  
Binomial Regression ◽  
Physical Examinations

ObjectiveTo identify various systolic blood pressure (SBP) trajectories in Chinese boys between 7 and 18 years of age, and to explore their high blood pressure (HBP) risk in their late adolescence years.Design and settingsA population-based cohort study in Guangdong, China.Participants4541 normal tensive boys who started primary school in 2005 in Zhongshan, Guangdong were included.OutcomesBlood pressure and relevant measurements were obtained by annual physical examinations between 2005 and 2016. HBP was defined by SBP or diastolic blood pressure ≥95th percentile for children under 13, and BP ≥130/80 mm Hg for children ≥13 years old. Logit regression for panel data and log-binomial regression model was used to estimate the risk of HBP among SBP trajectory groups.ResultsFour distinct SBP trajectory groups via group-based trajectory modelling: low stable (13.0%), low rising (42.4%), rising (37.4%) and high rising (7.3%). The overall incidence rates of HBP during the follow-up ranged from 40.24 (95% CI 36.68 to 44.19)/1000 person-years in the low stable group to 97.08 (95% CI 94.93 to 99.27)/1000 person-years in the high rising group. Compared with children with low stable SBP, those of other SBP trajectories suffered 3.05 (95% CI 2.64 to 3.46) to 4.64 (95% CI 4.18 to 5.09) times of higher risk of HBP in their late adolescence, regardless of their age, body mass index and BP level at baseline.ConclusionsSubgroups of SBP trajectories existed in Chinese boys, and are related to hypertension risk at late adolescence. Regular physical examinations could help identify those with higher risks at the beginning of pubertal growth.

scholarly journals Potential impact of a modest reduction in salt intake on blood pressure, cardiovascular disease burden and premature mortality: a modelling study

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000943 ◽  
Author(s):  
Leopold Ndemnge Aminde ◽  
Linda J Cobiac ◽  
J Lennert Veerman
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Heart Disease ◽  
Salt Intake ◽  
Sodium Intake ◽  
Premature Mortality ◽  
Relative Reduction ◽  
Life Years ◽  
Potential Impact ◽  
The Impact

ObjectiveTo assess the potential impact of reduction in salt intake on the burden of cardiovascular disease (CVD) and premature mortality in Cameroon.MethodsUsing a multicohort proportional multistate life table model with Markov process, we modelled the impact of WHO’s recommended 30% relative reduction in population-wide sodium intake on the CVD burden for Cameroonian adults alive in 2016. Deterministic and probabilistic sensitivity analyses were conducted and used to quantify uncertainty.ResultsOver the lifetime, incidence is predicted to decrease by 5.2% (95% uncertainty interval (UI) 4.6 to 5.7) for ischaemic heart disease (IHD), 6.6% (95% UI 5.9 to 7.4) for haemorrhagic strokes, 4.8% (95% UI 4.2 to 5.4) for ischaemic strokes and 12.9% (95% UI 12.4 to 13.5) for hypertensive heart disease (HHD). Mortality over the lifetime is projected to reduce by 5.1% (95% UI 4.5 to 5.6) for IHD, by 6.9% (95% UI 6.1 to 7.7) for haemorrhagic stroke, by 4.5% (95% UI 4.0 to 5.1) for ischaemic stroke and by 13.3% (95% UI 12.9 to 13.7) for HHD. About 776 400 (95% UI 712 600 to 841 200) health-adjusted life years could be gained, and life expectancy might increase by 0.23 years and 0.20 years for men and women, respectively. A projected 16.8% change (reduction) between 2016 and 2030 in probability of premature mortality due to CVD would occur if population salt reduction recommended by WHO is attained.ConclusionAchieving the 30% reduction in sodium intake recommended by WHO could considerably decrease the burden of CVD. Targeting blood pressure via decreasing population salt intake could translate in significant reductions in premature CVD mortality in Cameroon by 2030.

scholarly journals Effects of Cranberry Juice Supplementation on Cardiovascular Disease Risk Factors in Adults with Elevated Blood Pressure: A Randomized Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2618
Author(s):  
Chesney K. Richter ◽  
Ann C. Skulas-Ray ◽  
Trent L. Gaugler ◽  
Stacey Meily ◽  
Kristina S. Petersen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Vascular Function ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Lipoprotein Profile ◽  
Cranberry Juice ◽  
Central Systolic Blood Pressure

Emerging cardiovascular disease (CVD) risk factors, including central vascular function and HDL efflux, may be modifiable with food-based interventions such as cranberry juice. A randomized, placebo-controlled, crossover trial was conducted in middle-aged adults with overweight/obesity (n = 40; mean BMI: 28.7 ± 0.8 kg/m2; mean age: 47 ± 2 years) and elevated brachial blood pressure (mean systolic/diastolic BP: 124 ± 2/81 ± 1 mm Hg). Study participants consumed 500 mL/d of cranberry juice (~16 fl oz; 27% cranberry juice) or a matched placebo juice in a randomized order (8-week supplementation periods; 8-week compliance break), with blood samples and vascular measurements obtained at study entry and following each supplementation period. There was no significant treatment effect of cranberry juice supplementation on the primary endpoint of central systolic blood pressure or central or brachial diastolic pressure. Cranberry juice significantly reduced 24-h diastolic ambulatory BP by ~2 mm Hg compared to the placebo (p = 0.05) during daytime hours. Cranberry juice supplementation did not alter LDL-C but significantly changed the composition of the lipoprotein profile compared to the placebo, increasing the concentration of large LDL-C particles (+29.5 vs. −6.7 nmol/L; p = 0.02) and LDL size (+0.073 vs. −0.068 nm; p = 0.001). There was no effect of treatment on ex vivo HDL efflux in the total population, but exploratory subgroup analyses identified an interaction between BMI and global HDL efflux (p = 0.02), with greater effect of cranberry juice in participants who were overweight. Exploratory analyses indicate that baseline C-reactive protein (CRP) values may moderate treatment effects. In this population of adults with elevated blood pressure, cranberry juice supplementation had no significant effect on central systolic blood pressure but did have modest effects on 24-hr diastolic ambulatory BP and the lipoprotein profile. Future studies are needed to verify these findings and the results of our exploratory analyses related to baseline health moderators.

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