Long-term effects of ibrutinib on blood pressure in patients with chronic lymphocytic leukemia (CLL).

e19009 Background: Ibrutinb is approved for treatment of CLL. Hypertension (HTN) has been reported as a side effect of ibrutinib in 1-23% of patients. We previously reported HTN in CLL patients after 6 months of treatment with ibrutinib. In this study we describe the effects of long-term treatment with ibrutinib on blood pressure (BP). Methods: We performed a retrospective study, evaluating 150 CLL patients on ibrutinib-based clinical trials from 2010 to 2015. Patient demographics, co-morbidities, tobacco use, anti-HTN therapy were recorded. BP was evaluated at baseline and sequentially for up to 5 yrs. New onset HTN was defined as systolic BP (SBP) of ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 80 on two separate visits with no prior HTN or anti-HTN therapy. An increase in baseline SBP by ≥10 and/or increase in DBP by ≥10 was considered significant regardless of the absolute BP. Univariate logistic regression analysis was performed to assess relationship of HTN risk factors and new HTN. Results: Patients’ median age was 65 yrs (68% male and 88% white). Median follow-up was 3 yrs. Pre-existing HTN was present in 44% of patients, 40% were on anti-HTN therapy prior to ibrutinib. New HTN developed in 65% of patients without prior diagnosis of HTN; 32 % of patients were started on anti-HTN therapy or received additional anti-HTN therapy. Of the patients who experienced an increase in BP, 33% experienced isolated systolic HTN. Median SBP was 130 at baseline, 132 at 1mo, 137 at 3mo, 135 at 6mo, 139 at 12mo, 138 at 3yrs, 144 at 5yrs (mean increase in SBP: 7.2, P < 0.001). In patients whose SBP was < 130 at baseline the median SBP was 119 at baseline, 122 at 1mo, 134 at 3mo, 130 at 6mo, 134 at 12mo, 135 at 3yrs and 141 at 5yrs (mean increase in SBP: 15.7, p < 0.001). 74% of patients experienced and increase in SBP ≥10. New HTN on ibrutinib was not associated with: tobacco use, obesity, chronic kidney disease or obstructive sleep apnea (p > 0.05). Conclusions: In this study we demonstrated a high rate of new HTN in patients on prolonged ibrutinib treatment. HTN in these patients is persistent, linear and independent of other risk factors. The increase in BP remained despite initiation of anti-HTN therapy. Additional studies are ongoing to define cardiovascular and renal complications associated with HTN in these patients.

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Tumor-necrosis Factor Inhibitors Improve Aortic Stiffness in Patients With Longstanding Rheumatoid Arthritis

10.21203/rs.3.rs-126056/v1 ◽

2020 ◽

Author(s):

Alessandro Giollo ◽

Giovanni Cioffi ◽

Federica Ognibeni ◽

Giovanni Orsolini ◽

Andrea Dalbeni ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Aortic Stiffness ◽

Term Treatment ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Long Term Treatment ◽

Necrosis Factor

Abstract Background. Major cardiovascular disease (CVD) benefits of disease-modifying anti-rheumatic drugs (DMARDs) therapy occur in early RA patients with treat-to-target strategy. However, it is unknown whether long-term DMARDs treatment in established RA could be useful to improve CVD risk profile.Methods. Ultrasound aortic stiffness index (AoSI) has to be considered a proxy outcome measure in established RA patients. We measured AoSI in a group of RA patients on long-term treatment with tumour necrosis factor inhibitors (TNFi) or conventional synthetic DMARDs (csDMARDs). Eligible participants were assessed at baseline and after 12 months; changes in serum lipids, glucose and arterial blood pressure were assessed. All patients were on stable medications during the entire follow-up. Results. We included 107 (64 TNFi and 43 csDMARDs) RA patients. Most patients (74%) were in remission or low disease activity and had some CVD risk factors (45.8% hypertension, 59.8% dyslipidemia, 45.3% smoking). The two groups did not differ significantly for baseline AoSI (5.95±3.73% vs 6.08±4.20%, p=0.867). Follow-up AoSI was significantly increased from baseline in the csDMARDs group (+1.00%; p<0.0001) but not in the TNFi group (+0.15%, p=0.477). Patients on TNFi had significantly lower follow-up AoSI from baseline than the csDMARD group (-1.02%, p<0.001; ANCOVA corrected for baseline AoSI, age and systolic blood pressure). Furthermore, follow-up AoSI was significantly lower in TNFi users with 1-2 or >2 CVD risk factors than in those without. Conclusion. Long-term treatment with TNFi was associated with reduced aortic stiffness in patients with established RA and several CVD risk factors.

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Long-term effects (>24 months) of multiple lifestyle intervention on major cardiovascular risk factors among high risk subjects: a meta-analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.253 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

H Bergum ◽

I Sandven ◽

TO Klemsdal

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Systolic Blood Pressure ◽

Total Cholesterol ◽

Cardiovascular Risk Factors ◽

Lifestyle Intervention ◽

Small Study ◽

Long Term Effects

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Norwegian health department Background The evidence of the long-term effects of multiple lifestyle intervention on cardiovascular risk is uncertain. We aimed to summarize the evidence from randomized clinical trials examining the efficacy of lifestyle intervention on major cardiovascular risk factors in subjects at high cardiovascular risk. Methods Eligible trials investigated the impact of lifestyle intervention versus usual care with minimum 24 months follow-up, reporting more than one major cardiovascular risk factor. A literature search updated April 15, 2020 identified 12 eligible studies. The results from individual trials were combined using fixed and random effect models, using the standardized mean difference (SMD) to estimate effect sizes. Small-study effect was evaluated, and heterogeneity between studies examined by subgroup and meta-regression analyses considering patient- and study-level variables. Results Small-study effect was not identified. Lifestyle intervention reduced systolic blood pressure modestly with an estimated SMD of -0.13, 95% confidence interval (CI): -0.21 to -0.04, with moderate heterogeneity (I² = 59%), corresponding to a mean difference of approximately 2 mmHg (MD = -1.86, 95% CI: -3.14 to -0.57, p = 0.0046). This effect disappeared in the subgroup of trials judged at low risk of bias (SMD = 0.02, 95% CI: -0.08 to 0.11). For the outcome total cholesterol SMD was -0.06, 95% CI: -0.13 to 0.00, with no heterogeneity (I² = 0%), indicating no effect of the intervention. Conclusion Lifestyle intervention resulted in only a modest effect on systolic blood pressure and no effect on total cholesterol after 24 months. Further lifestyle trials should consider the challenge of maintaining larger long-term benefits to ensure impact on cardiovascular outcomes.

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The crystal arthropathies

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738013499319 ◽

2013 ◽

Vol 6 (11) ◽

pp. 681-687 ◽

Cited By ~ 1

Author(s):

Robert A Jones ◽

Brian Quilty

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Inflammatory Arthritis ◽

Term Treatment ◽

Routine Practice ◽

Treatment Goals ◽

Crystal Arthropathies ◽

Long Term Treatment

Unlike many other forms of inflammatory arthritis, the crystal arthropathies are routinely diagnosed and managed in primary care. Gout, in particular, is relatively commonplace and rates of other types of crystal-related arthritis are predicted to increase. These are, therefore, conditions that GPs and trainees will regularly encounter during routine practice. While the clinical features and pathophysiology of gout and pseudo-gout are well described, the long-term treatment goals and options of management are often less well understood, and opportunities to assess for associated co-morbidities can easily be missed. GPs can be central in optimising management by promptly and appropriately addressing acute symptoms, preventing recurrent attacks, minimising disability and work absences, reducing cardiovascular risk factors, improving general health and enhancing quality of life.

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Blood Pressure Response During Long-Term Treatment With Magnesium Is Dependent on Magnesium Status

American Journal of Hypertension ◽

10.1093/ajh/4.8.674 ◽

1991 ◽

Vol 4 (8) ◽

pp. 674-679 ◽

Cited By ~ 45

Author(s):

L. Lind ◽

H. Lithell ◽

T. Pollare ◽

S. Ljunghall

Keyword(s):

Blood Pressure ◽

Blood Pressure Response ◽

Term Treatment ◽

Pressure Response ◽

Long Term Treatment ◽

Magnesium Status

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Abstract P053: Enhanced Exercise Capacity By Muscadine Grape Extract Treatment Is Only Evident In Older Hypertensive Female Rats And Is Independent Of Blood Pressure

Hypertension ◽

10.1161/hyp.76.suppl_1.p053 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Nildris Cruz Diaz ◽

A'ja V Duncan ◽

Wayne Graham ◽

Brian Westwood ◽

Patricia E. Gallagher ◽

...

Keyword(s):

Blood Pressure ◽

Exercise Capacity ◽

Physical Performance ◽

Term Treatment ◽

Female Rats ◽

Sprague Dawley ◽

Grape Extract ◽

Long Term Treatment ◽

Muscadine Grape

Physical performance and systolic blood pressure (SBP) during aging in normotensive female Sprague-Dawley (SD) and hypertensive (mRen2)27 transgenic rats were assessed following long-term treatment with a Muscadine Grape Extract (MGE, Piedmont Research and Development Corp). MGE was administered at a dose of 0.2 mg/mL in the drinking water starting at 14 weeks (wks) of age with an endpoint at 70 wks of age (total time of treatment of 56 wks). At 20-, 40- and 70-wks of age, physical performance (exercise capacity in seconds and workload in grams - meters) was determined using a treadmill at a velocity of 17 cm/second with a 5% incline. SBP was determined by tail-cuff plethysmography in trained rats. There were no significant differences in physical performance between SD and (mRen2)27 female rats at any age despite the higher SBP in the (mRen2)27 rats at all ages. Long-term treatment with MGE had no significant effect on physical performance or SBP in SD rats at any age. In contrast, MGE treatment markedly increased exercise capacity (40 wks: 1615 ± 166 vs 4943 ± 442 seconds, p<0.01, n = 4-9; 70 wks: 2520 ± 374 vs 4117 ± 245 seconds, p<0.01, n = 4-8) and workload (40 wks: 4579 ± 490 vs 14730 ± 1353 grams - meters, p<0.01, n = 4-9; 70 wks: 8338 ± 1340 vs 13659 ± 933 grams - meters, p<0.01, n = 4-8) at the later ages in female (mRen2)27 rats, while there was no effect on SBP (20 wks: 167 ± 4 vs 173 ± 4 mm Hg, n = 4-6; 40 wks: 177 ± 8 vs 170 ± 7 mm Hg, n = 6-7; 70 wks:154 ± 6 vs 172 ± 6 mm Hg, n = 5) at any age. These data suggest that MGE treatment is effective in improving physical performance only in hypertensive female rats and may be independent of changes in blood pressure. The benefit of MGE in the older hypertensive female may reflect reductions in vascular stiffness and oxidative stress. Support: Chronic Disease Research Fund, Hypertension & Vascular Research Center

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Can Long-term Treatment of Obstructive Sleep Apnea With CPAP Improve Glycemia and Prevent Type 2 Diabetes?

Diabetes Care ◽

10.2337/dci20-0014 ◽

2020 ◽

Vol 43 (8) ◽

pp. 1681-1683

Author(s):

Sirimon Reutrakul ◽

Babak Mokhlesi

Keyword(s):

Type 2 Diabetes ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Term Treatment ◽

Obstructive Sleep ◽

Long Term Treatment

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From diagnosis to long-term treatment: the experiences of older New Zealanders with obstructive sleep apnoea

Journal of Sleep Research ◽

10.1111/jsr.67_12619 ◽

2017 ◽

Vol 26 ◽

pp. 58-58

Keyword(s):

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Term Treatment ◽

Obstructive Sleep ◽

Long Term Treatment ◽

New Zealanders

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Aspects of Long-Term Treatment with Neuroleptics Historical and Literature Review—Personal Experience with Fluspirilene and Penfluridol

Journal of International Medical Research ◽

10.1177/030006057500300210 ◽

1975 ◽

Vol 3 (2) ◽

pp. 114-124 ◽

Cited By ~ 1

Author(s):

Lucian Floru

Keyword(s):

Side Effects ◽

Literature Review ◽

Personal Experience ◽

Term Treatment ◽

Term Therapy ◽

Tabular Form ◽

Long Term Effects ◽

Long Term Treatment ◽

Long Term Therapy

The literature on neuroleptics with substance-specific long-term effects (fluspirilene, penfluridol) is reviewed in tabular form. This is followed by a report of personal investigations on 76 schizophrenics who were treated with fluspirilene initially within the hospital and later on an out-patient basis, on 86 patients who were treated with it exclusively at the out-patients' department, as well as on 123 schizophrenic psychoses treated with penfluridol in the out-patients' department. The side-effects caused by the two substances are compared. Pre-requisites for effective long-term therapy with a few complications are discussed.

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