scholarly journals BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD

2017 ◽  
Vol 13 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Rita Magriço ◽  
Miguel Bigotte Vieira ◽  
Catarina Viegas Dias ◽  
Lia Leitão ◽  
João Sérgio Neves
Keyword(s):  
Mean Arterial Pressure ◽  
Treatment Group ◽  
Arterial Pressure ◽  
Kidney Function ◽  
Cardiovascular Events ◽  
Intensive Treatment ◽  
Number Needed To Treat ◽  
Pressure Reduction ◽  
Intensive Treatment Group ◽  
Kidney Function Decline

Background and objectivesIn the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic BP treatment (target <120 mm Hg) was associated with fewer cardiovascular events and higher incidence of kidney function decline compared with standard treatment (target <140 mm Hg). We evaluated the association between mean arterial pressure reduction, kidney function decline, and cardiovascular events in patients without CKD.Design, setting, participants, & measurementsWe categorized patients in the intensive treatment group of the SPRINT according to mean arterial pressure reduction throughout follow-up: <20, 20 to <40, and ≥40 mm Hg. We defined the primary outcome as kidney function decline (≥30% reduction in eGFR to <60 ml/min per 1.73 m2 on two consecutive determinations at 3-month intervals), and we defined the secondary outcome as cardiovascular events. In a propensity score analysis, patients in each mean arterial pressure reduction category from the intensive treatment group were matched with patients from the standard treatment group to calculate the number needed to treat regarding cardiovascular events and the number needed to harm regarding kidney function decline.ResultsIn the intensive treatment group, 1138 (34%) patients attained mean arterial pressure reduction <20 mm Hg, 1857 (56%) attained 20 to <40 mm Hg, and 309 (9%) attained ≥40 mm Hg. Adjusted hazard ratios for kidney function decline were 2.10 (95% confidence interval, 1.22 to 3.59) for mean arterial pressure reduction between 20 and 40 mm Hg and 6.22 (95% confidence interval, 2.75 to 14.08) for mean arterial pressure reduction ≥40 mm Hg. In propensity score analysis, mean arterial pressure reduction <20 mm Hg presented a number needed to treat of 44 and a number needed to harm of 65, reduction between 20 and <40 mm Hg presented a number needed to treat of 42 and a number needed to harm of 35, and reduction ≥40 mm Hg presented a number needed to treat of 95 and a number needed to harm of 16.ConclusionsIn the intensive treatment group of SPRINT, larger declines in mean arterial pressure were associated with higher incidence of kidney function decline. Intensive treatment seemed to be less favorable when a larger reduction in mean arterial pressure was needed to attain the BP target.

scholarly journals Analysis of the Performance of the Software/Hardware Product MyDiaBase+RxChecker for Assessing Treatment Regimens

2009 ◽  
Vol 3 (3) ◽  
pp. 533-535
Author(s):  
Danny Petrasek ◽  
Marissa Bidner
Keyword(s):  
Cardiovascular Risk ◽  
Treatment Group ◽  
Hemoglobin A1c ◽  
Science And Technology ◽  
Intensive Treatment ◽  
Tight Control ◽  
Treatment Regimens ◽  
Intensive Treatment Group

In 2008, the Action to Control Cardiovascular Risk in Diabetes trial was halted due to an unexpected number of deaths in the intensive treatment group (aiming for hemoglobin A1c levels less than 6%). Hypoglycemic episodes were thought by some to be a contributing cause, underscoring again the challenge of maintaining tight control while avoiding dangerous excursions into hypoglycemic territory. Albisser and colleagues present a set of articles in this issue of Journal of Diabetes Science and Technology that describe a clinical product developed specifically for this timeless clinical conundrum.

scholarly journals Association of Serum Erythropoietin With Cardiovascular Events, Kidney Function Decline, and Mortality

2016 ◽  
Vol 9 (1) ◽  
Author(s):  
Pranav S Garimella ◽  
Ronit Katz ◽  
Kushang V Patel ◽  
Stephen B Kritchevsky ◽  
Chirag R Parikh ◽  
...  
Keyword(s):  
Kidney Function ◽  
Cardiovascular Events ◽  
Kidney Function Decline ◽  
Serum Erythropoietin

scholarly journals Ambulatory blood pressure variability measures in hypertensive patients according to non-alcoholic fatty liver disease state

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Kakouri ◽  
D Konstantinidis ◽  
E Siafi ◽  
F Tatakis ◽  
D Polyzos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Liver Disease ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Fatty Liver ◽  
Fatty Liver Disease ◽  
Cardiovascular Events ◽  
Blood Pressure Variability ◽  
Alcoholic Fatty Liver ◽  
Hypertensive Patients

Abstract Background Nonalcoholic fatty liver disease (NAFLD) represents the most frequent cause of chronic hepatic disease and independently determines hypertension and future cardiovascular events. Increased blood pressure variability (BPV) assessed by 24-hour blood pressure (BP) monitoring including mean arterial morning surge have been also associated with increased rates of cardiovascular events. Purpose To compare different BPV measures in hypertensive patients with and without NAFLD. Methods Consecutive newly diagnosed untreated hypertensive patients without history of cardiovascular disease underwent clinic and ambulatory BP measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. BPV was derived by assessment of standard deviation (SD) of systolic and diastolic BP (24-h, daytime and nighttime), average real variability (ARV) of systolic and diastolic BP, coefficient of variation (CV) of systolic BP (24-h, daytime), weighted SD (wSD) of systolic BP (24-h, daytime), maximum BP and mean arterial morning surge. Results Among 146 hypertensive patients (mean age 57±11 years, 64 men, 24-h mean systolic/diastolic BP 140±10/84±9 mmHg) those with NAFLD (n=76) compared to the non-NAFLD group (n=70) were younger (54.7±10.1 vs 58.6±11.2 years, respectively, p=0.03), male gender was more prevalent (42 vs 22 respectively, p=0.004), and body mass index was more increased (33.2±4.1 vs 27.0±3.5 kg/m2, p&lt;0.001). Moreover, NAFLD patients compared to those without NAFLD were characterized by higher levels of mean arterial pressure morning surge (12.4±8.9 vs 8.7±8.5 mmHg, p=0.03), but the remaining BPV measures were not different between the two groups. NAFLD was a determinant of both diastolic BP ARV (B=0.34, p=0.007) and mean arterial morning surge (B=0.47, p=0.006) after adjustment. Conclusions Mean arterial pressure morning surge was significantly higher in hypertensive patients with NAFLD compared to their non-NAFLD counterparts, while whole day BPV measures were not increased in NAFLD except for ARV of diastolic BP. Our findings may partially explain the increased cardiovascular risk of comorbid NAFLD in hypertension. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure

Hypertension ◽  
2021 ◽  
Vol 77 (1) ◽  
pp. 39-48
Author(s):  
Jesus D. Melgarejo ◽  
Wen-Yi Yang ◽  
Lutgarde Thijs ◽  
Yan Li ◽  
Kei Asayama ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Population Based ◽  
Model Fit ◽  
Major Adverse Cardiovascular Events ◽  
Test Model ◽  
Hazard Ratios ◽  
Stage 1

Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R 2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and ≥96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80–1.16), 1.32 (1.15–1.51), and 1.77 (1.59–1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk ( P <0.001). Considering the 24-hour measurements, R 2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R 2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.

scholarly journals The Effects of Intensive Blood Pressure Control on Cardiovascular Outcomes Based on 10-Year ASCVD Risk Score: An Analysis of a Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Alireza Alborzi ◽  
Armin Attar ◽  
Mehrab Sayadi ◽  
Fatemeh Nouri
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Treatment Group ◽  
Risk Score ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Intensive Treatment ◽  
History Of ◽  
Ascvd Risk ◽  
Intensive Blood Pressure

There is still controversy about whether clinicians should include cardiovascular disease (CVD) risk stratification into the consideration for treatment of hypertension. This was a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). A total of 9361 nondiabetic patients without a history of stroke were randomly assigned to the intensive-treatment group (with an SBP target of <120 mm Hg) and the standard-treatment group (with an SBP target of <140 mm Hg). The patients were categorized into four groups based on the Atherosclerotic Cardiovascular Disease (ASCVD) risk score. The groups contained participants with ASCVD < 7.5%, 7.5% ≤ ASCVD <10%, 10% ≤ ASCVD < 15%, and ASCVD ≥ 15%. The incidence of the primary outcome, secondary outcome, and serious adverse events was compared between the two groups. The primary outcome was a composite of nonfatal myocardial infarction (MI), acute coronary syndrome (ACS) not resulting in MI, stroke, acute decompensated heart failure (HF), or death from cardiovascular causes. The secondary outcomes consisted of the individual components of the primary outcome and all-cause death. Intensive blood pressure (BP) control significantly reduced the incidence of primary outcome event in patients with 10% ≤ ASCVD < 15% (hazard ratio (HR) 0.593; 95% confidence interval (CI) 0.361–0.975; P  = 0.039) and ASCVD ≥ 15% (HR 0.778; CI 0.644–0.940; P  = 0.009). Intensive BP control was also beneficial for the primary prevention of cardiovascular events in patients with an ASCVD risk of 7.5–10% (HR 0.187; 95% CI 0.040–0.862; P  = 0.032). However, intensive treatment was associated with higher incidence of hypotension and acute renal failure in participants with ASCVD ≥ 15%. In patients without diabetes mellitus and prior stroke who had a 10-year risk of cardiovascular events above 10% based on the ASCVD risk score, intensive BP control played an important role in the reduction of major cardiovascular events. Additionally, intensive treatment would be beneficial for primary prevention in patients with ASCVD ≥ 7.5% without previous history of any cardiovascular disorders. Trial registration: ClinicalTrials.gov number; the trial is registered with NCT01206062.

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