Contributors to a hypertensive response to exercise (HTR) according to sex and age have not been fully evaluated. The authors analyzed a database of supine bicycle exercise stress echocardiography findings. HTR was defined as peak systolic blood pressure ≥210 mmHg for men and ≥190 mmHg for women during exercise. A total of 797 patients (306 [38%] women) were analyzed, with a mean age of 64 ± 10 years. Female sex, hypertension; higher left ventricular ejection fraction, effective arterial elastance, and pulse wave velocity; and lower total arterial compliance were significantly related to HTR. Patients with HTR had higher relative wall thickness, ratio of early diastolic mitral inflow and annular velocity, and diastolic elastance (all P ≤ .05). In multivariable analysis, indices of arterial stiffness such as pulse wave velocity, arterial elastance, total arterial compliance, and systemic vascular resistance were more strongly related in women, while in men, index of sympathetic activation was additionally related to HTR (all P ≤ .05). Female sex and lower total arterial compliance in older patients (≥65 years) and higher systemic vascular resistance and left ventricular relative wall thickness in younger patients were more strongly related to HTR. In conclusion, HTR was related to arterial stiffness, sympathetic activation, and diastolic dysfunction; however, the associations were different according to sex and age, which might guide individualized therapy.
BackgroundThe real‐world outcomes of edoxaban treatment in patients with atrial fibrillation (AF) were analyzed in the ETNA‐AF (Edoxaban Treatment in Routine Clinical Practice) study involving data from multiple regional registries. This report addresses effectiveness and safety of edoxaban in the Korean ETNA‐AF population.MethodsOne‐year data from 1887 Korean ETNA‐AF participants were analyzed according to edoxaban dose and patient age and compared with results of other ETNA‐AF registries.ResultsApproximately 70% of patients received the recommended doses of edoxaban (60 mg/30 mg); non‐recommended 60 mg and 30 mg doses were prescribed to 9.6% and 19.8% of the patients, respectively. The proportions of reference age (<65 years), youngest‐old (65–74 years) and middle‐old/oldest‐old (≥75 years) groups were 21.4%, 40.2%, and 38.4%, respectively. Incidence of major or clinically relevant nonmajor bleeding was similar within dose (0.57%–1.71%) and age subgroups (1.26%–1.63%). Incidence of net clinical outcome, a composite of stroke, systemic embolic event, major bleeding, and all‐cause mortality, was also comparable among dose subgroups (1.14%–3.10%) and age subgroups (2.28%–2.78%). The percentage of Korean patients receiving non‐recommended 30 mg (19.8%) was over twice that of the European population (8.4%). However, the clinical outcomes were generally similar among different populations included in the ETNA‐AF study.ConclusionsThe outcomes in the Korean ETNA‐AF population are like those in the global ETNA‐AF population, with overall low event rates of stroke, major bleeding and all‐cause mortality across age and dose subgroups. Edoxaban can be used effectively and safely in specific populations of Korean AF patients, including the elderly.
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