Prognostic Value of Changes in Aortic Stiffness for Cardiovascular Outcomes and Mortality in Resistant Hypertension: a Cohort Study

Hypertension ◽  
2021 ◽  
Author(s):  
Claudia R.L. Cardoso ◽  
Gil F. Salles
Keyword(s):  
Resistant Hypertension ◽  
Aortic Stiffness ◽  
Cardiovascular Outcomes ◽  
Time Interval ◽  
Continuous Variables ◽  
Hazard Ratios ◽  
Prognostic Importance ◽  
Cox Analysis ◽  
Fourth Quartile

The prognostic importance of changes in aortic stiffness for the occurrence of adverse cardiovascular outcomes and mortality has never been investigated in patients with resistant hypertension. We aimed to evaluate it in a prospective cohort of 442 resistant hypertension individuals. Changes in aortic stiffness were assessed by 2 carotid-femoral pulse wave velocity (CF-PWV) measurements performed over a median time interval of 4.7 years. Multivariate Cox analysis examined the associations between changes in CF-PWV (evaluated as continuous variables and categorized into quartiles and as increased/persistently high or reduced/persistently low) and the occurrence of total cardiovascular events (CVEs), major adverse CVEs, and cardiovascular/all-cause mortalities. During a median follow-up of 4.1 years after the second CF-PWV measurement, there were 49 total CVEs (42 major adverse CVEs) and 53 all-cause deaths (32 cardiovascular). As continuous variables, increments in absolute and relative changes in CF-PWV were associated with higher risks of CVEs and major adverse CVEs occurrence, but not of mortality. Divided into quartiles of CF-PWV changes, risks increased in the third and fourth quartile subgroups in relation to the reference first quartile subgroup (those with greatest CF-PWV reductions) for all outcomes. Patients who either increased or persisted with high CF-PWV had excess risks of cardiovascular morbidity/mortality, with hazard ratios ranging from 2.7 to 3.0, in relation to those who reduced or persisted with low CF-PWV values. In conclusion, reducing or preventing progression of aortic stiffness was associated with significant cardiovascular protection in patients with resistant hypertension, suggesting that it may be an additional clinical target of antihypertensive treatment.

Abstract P226: D-Dimer Levels and Risk of Stroke: Findings from the EPICOR Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Augusto Di Castelnuovo ◽  
Claudia Agnoli ◽  
Amalia de Curtis ◽  
Maria Concetta Giurdanella ◽  
Sara Grioni ◽  
...  
Keyword(s):  
Cox Regression ◽  
Vascular Diseases ◽  
Reactive Protein ◽  
Cohort Design ◽  
Hazard Ratios ◽  
Potential Risk Factors ◽  
Age Range ◽  
Fourth Quartile ◽  
D Dimer

Background: Elevated D-dimer levels are reportedly associated with higher risk of vascular diseases. We investigated the association of baseline D-dimer levels with stroke events occurred in the European Prospective Investigation into Cancer and Nutrition-Italy cohort. Methods: Using a nested case-cohort design, a center-stratified random sample of 832 subjects (66% women, age range 35 to 71) was selected as subcohort and compared with 289 strokes in a mean follow-up of 9 years. D-dimer was measured on fresh citrated plasma by an automated latex-enhanced immunoassay (HemosIL-IL, Milan). The hazard ratios and 95% confidence intervals, adjusted by relevant confounders and stratified by center, were estimated by a Cox regression model using Prentice method. Results: Individuals in the second, third or fourth quartile compared with the lowest quartile of D-dimer had significantly higher risk of stroke (Table). The association was independent from several potential confounders, including C-Reactive protein (Table). It was evident starting from the second quartile (D-dimer >100 ng/ml) and persisted almost unchanged for higher D-dimer levels (Table). No differences were observed in men and women. The increase in risk was essentially the same both for ischemic and hemorrhagic strokes (Table). Conclusions: Our data provide a clear evidence that elevated levels of D-dimer are potential risk factors for ischemic or hemorrhagic strokes.

Prognostic Impact of Home Blood Pressures for Adverse Cardiovascular Outcomes and Mortality in Patients With Resistant Hypertension: A Prospective Cohort Study

Hypertension ◽  
2021 ◽  
Author(s):  
Claudia R.L. Cardoso ◽  
Gil F. Salles
Keyword(s):  
Resistant Hypertension ◽  
Cardiovascular Events ◽  
Home Blood Pressure ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Prognostic Impact ◽  
Hazard Ratios ◽  
Blood Pressures ◽  
Ambulatory Blood Pressures

Home blood pressure (HBP) monitoring has been increasingly used in hypertension management. We aimed to evaluate the prognostic importance of HBP parameters in patients with resistant hypertension in relation to office and ambulatory blood pressures (BPs). Three hundred thirty-three patients with resistant hypertension performed 24-hour ambulatory and HBP monitoring at baseline and were followed up for a median of 5.6 years. Primary outcomes were total cardiovascular events, major adverse cardiovascular events, and all-cause and cardiovascular mortality. Associations between HBPs (total mean, morning and evening BPs, analyzed as continuous and as dichotomical variables) and outcomes were assessed by multivariable-adjusted Cox analyses. Improvement in risk discrimination with HBP was evaluated by C statistics and the Integrated Discrimination Improvement index. During follow-up, there were 48 cardiovascular events (42 major adverse cardiovascular events) and 43 all-cause deaths (26 cardiovascular). Continuous HBP parameters were associated with significantly higher risks of all adverse outcomes, with hazard ratios varying from 1.7 to 2.1, after adjustments for office and ambulatory BPs. In dichotomical analyses, uncontrolled HBP was associated with significantly higher risks of all outcomes, except for the evening HBP. Morning HBP was associated with the highest risks. HBP parameters improved risk discrimination, with increases in C statistics of up to 0.044 and relative Integrated Discrimination Improvements up to 42%, equivalent to those obtained from ambulatory BPs, except for all-cause and cardiovascular mortalities, in which ambulatory BPs provided greater improvements than HBPs. In conclusion, higher/uncontrolled HBP levels are predictive of adverse cardiovascular outcomes and mortality and improve risk discrimination in patients with resistant hypertension.

scholarly journals 4577 Resistant hypertension potentiates the risk of End-Stage Kidney Disease among African-Americans independent of APOL1 genotype in the Million Veteran Program

2020 ◽  
Vol 4 (s1) ◽  
pp. 36-36
Author(s):  
Elvis Akwo ◽  
Cassiane Robinson-Cohen ◽  
Cecilia P. Chung ◽  
Peter W.F. Wilson ◽  
Christopher O’Donnell ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
African Americans ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Incidence Rates ◽  
Cardiovascular Outcomes ◽  
End Stage Kidney Disease ◽  
Risk Alleles ◽  
End Stage

OBJECTIVES/GOALS: African-Americans have a 3-fold higher risk of end-stage kidney disease (ESKD) compared to Whites due in part to APOL1 risk alleles. Whether resistant hypertension (RH) magnifies the risk of ESKD among African Americans beyond APOL1 is not known. We examined the interaction between RH and race on ESKD risk and the independent effect of RH beyond APOL1. METHODS/STUDY POPULATION: We designed a retrospective cohort of 240,038 veterans with HTN, enrolled in the Million Veteran Program with an estimated glomerular filtration rate (eGFR) >30 ml/min/1.73m2. The primary exposure was incident RH (time-varying). The primary outcome was incident ESKD during a 13.5 year follow up: 2004-2017. Secondary outcomes were myocardial infarction (MI), stroke, and death. Incident RH was defined as failure to achieve outpatient blood pressure (BP) <140/90 mmHg with 3 antihypertensive drugs, including a thiazide, or use of 4 or more drugs. Poisson models were used to estimate incidence rates and test additive interaction with race and APOL1 genotype. Multivariable Cox models (with Fine-Gray competing-risks models as sensitivity analyses) were used to examine independent effects. RESULTS/ANTICIPATED RESULTS: The cohort comprised 235,046 veterans; median age was 60 years; 21% were African-American and 6% were women, with 23,010 incident RH cases observed over a median follow-up time of 10.2 years [interquartile range, 5.6-12.6]. Patients with RH had higher incidence rates [per 1000 person-years] of ESKD (4.5 vs. 1.3), myocardial infarction (6.5 vs. 3.0), stroke (16.4 vs. 7.6) and death (12.0 vs. 6.9) than non-resistant hypertension (NRH). African-Americans with RH had a 2.6-fold higher risk of ESKD compared to African-Americans with NRH; 3-fold the risk of Whites with RH, and 9.6-fold the risk of Whites with NRH [p-interaction<.001]. Among African-Americans, RH was associated with a 2.2-fold (95%CI, 1.86-2.58) higher risk of incident ESKD in models adjusted for APOL1 genotype and in the subset of African-Americans with no APOL1 risk alleles, RH was associated with an adjusted 2.75-fold (95% CI: 2.00-3.50) higher risk of incident ESKD. DISCUSSION/SIGNIFICANCE OF IMPACT: RH was independently associated with a higher risk of ESKD and cardiovascular outcomes, especially among African-Americans. This elevated risk is independent of APOL1 genotype. Interventions that achieve BP targets among patients with RH could curtail the incidence of ESKD and cardiovascular outcomes in this high-risk population. CONFLICT OF INTEREST DESCRIPTION: None.

scholarly journals Time to Relapse and Its Predictors among Children with Nephrotic Syndrome in Comprehensive Specialized Hospitals, Tigray, Ethiopia, 2019

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Miliete Gebrehiwot ◽  
Mekuria Kassa ◽  
Haftom Gebrehiwot ◽  
Migbar Sibhat
Keyword(s):  
Nephrotic Syndrome ◽  
Incidence Rate ◽  
Statistical Significance ◽  
Initial Diagnosis ◽  
Prolonged Treatment ◽  
Rank Test ◽  
Time Interval ◽  
Hazard Ratios ◽  
Relapse Time

Background. Relapse in children with nephrotic syndrome leads to a variety of complications due to prolonged treatment and potential dependency on steroids. However, there is no study conducted to determine the incidence and predictive factors of relapse for nephrotic syndrome in Ethiopia, especially in children. Thus, this study aimed to assess the incidence of relapse and its predictors among children with nephrotic syndrome in Ethiopia. Methods. A retrospective study was conducted by reviewing all charts of children with an initial diagnosis of the nephrotic syndrome in tertiary hospitals from 2011 to 2018. Charts of children with a diagnosis of steroid-resistant cases were excluded. The extraction tool was used for data collection, Epi-data manager V-4.4.2 for data entry, and Stata V-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, life table, and crude hazard ratios were used to describe the data and adjusted hazard ratios with 95% CI and P value for analysis. Median relapse time, incidence rate of relapse, and cumulative relapse probabilities at a certain time interval were computed. Bivariable and multivariate analyses were performed using the Cox proportional hazard regression to identify the factors associated with relapse. Any variable at P < 0.25 in the bivariable analysis was transferred to multivariate analysis. Then, the adjusted hazard ratio with 95% CI and P ≤ 0.05 was used to report the association and to test the statistical significance, respectively. Finally, texts, tables, and graphs were used to present the results. Results and Conclusion. Majority, 64.5% (40/66), of relapses were recorded in the first 12 months of follow-up. The incidence rate of relapse was 42.6 per 1000 child-month-observations with an overall 1454 child-month-observations and the median relapse time of 16 months. Having undernutrition [ AHR = 3.44 ; 95% CI 1.78-6.65], elevated triglyceride [ AHR = 3.37 ; 95% CI 1.04-10.90], decreased serum albumin level [ AHR = 3.51 ; 95% CI 1.81-6.80], and rural residence [ AHR = 4.00 ; 95% CI 1.49-10.76] increased the hazard of relapse. Conclusion and Recommendation. Relapse was higher in the first year of the follow-up period. Undernutrition, hypoalbuminemia, hypertriglyceridemia, and being from rural areas were independent predictors of relapse. A focused evaluation of those predictors during the initial diagnosis of the disease is compulsory.

scholarly journals The role of different lipid measures for incident hypertension during more than 12 years follow-up: Tehran Lipid and Glucose Study

2021 ◽  
pp. 1-32
Author(s):  
Amirreza Hadaegh ◽  
Samaneh Akbarpour ◽  
Maryam Tohidi ◽  
Niloofar Barzegar ◽  
Somayeh Hosseinpour-Niazi ◽  
...  
Keyword(s):  
Drug Users ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Continuous Variables ◽  
Incident Hypertension ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Regression ◽  
Lowering Drug

Abstract To examine the associations of different lipid measures and related indices with incident hypertension during a median follow-up of 12.89 years. Fasting levels of total cholesterol (TC), triglycerides (TG), high and low density lipoprotein cholesterol (HDL-C and LDL-C, respectively), and related indices (TC/HDL-C and TG/HDL-C) were determined in 7335 Iranian adults (men=3270) free of hypertension, aged 39.0 [standard deviation (SD):13.2] years. Multivariate Cox proportional hazard regression was applied and lipid parameters were considered either as categorical or continuous variables. During follow-up, 2413 (men=11260) participants experienced hypertension. Using the first quartile as reference, significant trends were found between quartiles of TG, HDL-C, TC/HDL-C, and TG/HDL-C in multivariate models; moreover considering these measures as continuous variables, a 1 SD increase in each of these parameters was significantly associated with risk of incident hypertension; the corresponding hazard ratios and confidence intervals were 1.06(1.02-1.10), 0.94(0.89-0.98), 1.04(1.01-1.09), and 1.04(1.01-1.07), respectively. The association between lipid measures and incident hypertension did not change after excluding lipid lowering drug users and those with type 2 diabetes mellitus and were independent of the baseline categories of blood pressure (P for interaction > 0.08). To take into account the nutrition data, a re-analysis on a subgroup (n=1705), showed that a 1-SD increase in TG and TG/HDL-C were associated with incident hypertension, after adjusting for dietary cofounders [1.15(1.08–1.24) and 1.03(1.01–1.04), respectively]. These findings indicate that TG, TG/HDL-C, and TC/HDL-C were independently associated with higher risk while HDL-C was associated with lower risk of incident hypertension.

scholarly journals Hb level, iron intake and mortality in Chinese adults: a 10-year follow-up study

2017 ◽  
Vol 117 (4) ◽  
pp. 572-581 ◽  
Author(s):  
Zumin Shi ◽  
Shiqi Zhen ◽  
Yonglin Zhou ◽  
Anne W. Taylor
Keyword(s):  
Iron Intake ◽  
Food Record ◽  
Chinese Adults ◽  
Hazard Ratios ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Weighed Food Record ◽  
Fourth Quartile ◽  
Cvd Mortality

AbstractAnaemia is prevalent in developing countries and is commonly Fe deficiency related. We aimed to assess the association between Fe status, Fe intake and mortality among Chinese adults. We prospectively studied 8291 adults aged 20–98 years with a mean follow-up of 9·9 years. All participants were measured for Hb at baseline in 2002. Food intake, measured by 3-d weighed food record (n 2832), and fasting serum ferritin were measured. We documented 491 deaths (including 192 CVD and 165 cancer deaths) during 81 527 person-years of follow-up. There was a U-shaped association between Hb levels and all-cause mortality. Compared with the second quartile of Hb (121 g/l), the first (105) and fourth quartile (144) had hazard ratios (HR) of 2·29 (95 % CI 1·51, 3·48) and 2·31 (95 % CI 1·46, 3·64) for all-cause mortality in women. In men, compared with third quartile of Hb (143 g/l), first (122) and fourth quartiles (154) had 61 and 65 % increased risk of all-cause mortality. Anaemia was associated with an increased risk of all-cause and CVD mortality in men but not in women after adjusting for potential confounders. Low and high Fe intake as percentage of Chinese recommended nutrient intake (RNI) were positively associated with all-cause mortality in women but not in men. In women, across quartiles of relative Fe intake, HR for all-cause mortality were 2·55 (95 % CI 0·99, 6·57), 1·00, 3·12 (95 % CI 1·35, 7·18) and 2·78 (95 % CI 1·02, 7·58). Both low and high Hb levels are related to increased risk of all-cause mortality. Both low and high intake of Fe as percentage of RNI was positively associated with mortality in women.

scholarly journals Urinary Albumin Excretion at Follow-Up Predicts Cardiovascular Outcomes in Subjects With Resistant Hypertension

2013 ◽  
Vol 26 (9) ◽  
pp. 1148-1154 ◽  
Author(s):  
A. Oliveras ◽  
P. Armario ◽  
C. Sierra ◽  
J. A. Arroyo ◽  
R. Hernandez-del-Rey ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Urinary Albumin Excretion ◽  
Cardiovascular Outcomes ◽  
Urinary Albumin ◽  
Albumin Excretion

scholarly journals Prognostic Importance of On-Treatment Clinic and Ambulatory Blood Pressures in Resistant Hypertension

Hypertension ◽  
2020 ◽  
Vol 75 (5) ◽  
pp. 1184-1194 ◽  
Author(s):  
Claudia R.L. Cardoso ◽  
Guilherme C. Salles ◽  
Gil F. Salles
Keyword(s):  
Resistant Hypertension ◽  
Cardiovascular Events ◽  
Heart Association ◽  
Major Adverse Cardiovascular Events ◽  
C Statistic ◽  
Treatment Clinic ◽  
Blood Pressures ◽  
Prognostic Importance ◽  
Ambulatory Blood Pressures

The prognostic importances of on-treatment clinic and ambulatory blood pressure (BP) levels have never been investigated in individuals with resistant hypertension. We aimed to evaluate them for the occurrence of incident cardiovascular and mortality outcomes in a prospective cohort of 1726 patients with resistant hypertension. Clinic and ambulatory BPs were measured at baseline and serially during follow-up (analyzed as time-varying and as mean cumulative BPs) and also categorized as controlled/uncontrolled as defined by the traditional and new 2017 American College of Cardiology/American Heart Association criteria. Multivariate Cox analyses examined the associations between BP parameters and the occurrence of total cardiovascular events, major adverse cardiovascular events, and cardiovascular and all-cause mortalities. C statistics and the integrated discrimination improvement indexes evaluated the improvement in risk discrimination. Over a median follow-up of 8.3 years, 417 total cardiovascular events occurred (358 major adverse cardiovascular events) and 391 individuals died (233 cardiovascular deaths). All single systolic BP (SBP) parameters significantly predicted all outcomes, but the associations were stronger for ambulatory SBPs than for clinic SBPs and for on-treatment SBPs (particularly for mean cumulative) than for baseline SBPs, and both improved risk discrimination (with increases in C statistic of up to 0.021 and integrated discrimination improvements of up to 19.7%). These findings were consistent for diastolic BPs. Uncontrolled ambulatory BPs were associated with higher risks for all outcomes, whereas uncontrolled clinic BPs were not. In conclusion, mean cumulative ambulatory BPs during follow-up were the best prognostic markers of adverse cardiovascular outcomes and mortality in patients with resistant hypertension. Serial ambulatory BP monitoring shall be more widely used in resistant hypertension management.

scholarly journals Associations Between Achieved Ambulatory Blood Pressures and Its Changes With Adverse Outcomes in Resistant Hypertension

Hypertension ◽  
2021 ◽  
Author(s):  
Claudia R.L. Cardoso ◽  
Gil F. Salles
Keyword(s):  
Cardiovascular Diseases ◽  
Resistant Hypertension ◽  
Cardiovascular Events ◽  
Adverse Outcomes ◽  
Myocardial Infarctions ◽  
Major Adverse Cardiovascular Events ◽  
Hazard Ratios ◽  
Blood Pressures ◽  
Ambulatory Blood Pressures

J-curve associations with adverse outcomes have never been examined in relation to ambulatory blood pressures (BPs). We aimed to investigate the associations between low-achieved BPs and large BP changes during follow-up with major adverse cardiovascular events and mortality in a cohort of 1474 patients with resistant hypertension who performed serial ambulatory BP monitoring. Multivariable Cox regressions with cubic splines examined associations between continuous BP parameters (time-weighted mean relative BP changes and time-updated achieved BPs) with primary (major adverse cardiovascular events and all-cause mortality) and secondary outcomes (cardiovascular mortality, myocardial infarctions, and strokes, separately). Categorical analyses were also performed (subgroups with the largest BP reductions and the lowest achieved BPs). During a median follow-up of 9 years, 299 major adverse cardiovascular events (128 myocardial infarctions and 109 strokes) and 316 all-cause deaths (187 cardiovascular) occurred. In analyses with continuous BP parameters, there were no nonlinear J -curve associations between achieved ambulatory BPs and outcomes ( P of the nonlinear terms >0.18); in general, low-achieved BPs were either neutral or protective (hazard ratios: 0.64–1.01). Otherwise, most of the associations between relative BP changes and outcomes were nonlinear with J - or U -curves. The excess risks of larger BP reductions were more evident in elderly (hazard ratios, 1.00–1.30) and in patients with preexistent cardiovascular diseases (hazard ratios, 1.33–1.52). Categorical analyses were confirmatory. In conclusion, in patients with resistant hypertension, achieving lower ambulatory 24-hour BPs (around 110/60 mmHg) seems safe and probably beneficial, but larger BP reductions might be deleterious, particularly in elderly and in patients with cardiovascular diseases.

Abstract 17983: Ankle-Brachial Index Predicts Progression of Aortic Stiffeness

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Zi Ye ◽  
Coutinho Thais ◽  
Iftikhar Kullo
Keyword(s):  
Aortic Stiffness ◽  
Subclinical Atherosclerosis ◽  
Characteristic Impedance ◽  
Ankle Brachial Index ◽  
Applanation Tonometry ◽  
Time Interval ◽  
Increased Risk ◽  
Wall Stiffness ◽  
The Impact

Background: Arterial stiffness is associated with increased risk for adverse cardiovascular outcome. Ankle-brachial index (ABI) is a measure reflective of systemic atherosclerosis. Whether it can predict central aortic stiffness and its progression is unknown. As such, we investigated the impact of ABI on carotid-femoral pulse wave velocity (cfPWV) and aortic characteristic impedance (Z c ) in apparently healthy adults from the community. Methods: Participants were from the GENOA study without cardiovascular disease at baseline (December 2000 to September 2006) and completed follow-up (September 2009 to December 2012) assessment (n=358, 63%women, 69% hypertensive). ABI was measured by standard protocol at baseline. cfPWV was measured by applanation tonometry. Difference in log-cfPWV between two visits ([[Unable to Display Character: &#8710;]]log-cfPWV) was used to estimate progression of aortic stiffness. Z c was ascertained at 2 nd visit using carotid tonometry followed by echocardiography (Cardiovascular Engineering Inc., Norwood). Results: After a mean follow-up of 8.5±0.9 years, cfPWV increased from 9.3±2.4m/s to 11.1±5.0m/s. After adjusted for age, sex and time-interval between two visits, lower ABI was associated with greater [[Unable to Display Character: &#8710;]]log-cfPWV (β±SE:-0.41±0.15), and increased risk for higher log-cfPWV (β±SE:-0.38±0.12) and higher log-Z c at 2 nd visit (β±SE:-0.38±0.18) (all P≤0.04). Diabetes and renal function at baseline were predictors for higher cfPWV and Z c ; hypertension and metabolic syndrome were only predictors of cfPWV; while age and male gender were major predictors for [[Unable to Display Character: &#8710;]]log-cfPWV (all P≤0.04). The association of ABI with cfPWV or Z c remained significant after adjustment for these covariates (both P<0.05). Greater [[Unable to Display Character: &#8710;]]log-cfPWV was associated with increased risk for higher log-Z c ; longer time-interval amplified this effect (both p for [[Unable to Display Character: &#8710;]]log-cfPWV and [[Unable to Display Character: &#8710;]]log-cfPWV x time-interval ≤0.03). Conclusions: Lower ABI predicts progression of aortic stiffness, leading to both increased aortic wall stiffness (PWV) and greater aortic area-flow mismatch (Z c ), suggesting the impact of subclinical atherosclerosis on proximal aortic stiffening.

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