BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.
6This 8-week, randomized, double-blind, controlled study compared efficacy and tolerability of telmisartan ⁄ amlodipine (T ⁄ A) single-pill combination (SPC) vs the respective monotherapies in 858 patients with severe hypertension (systolic ⁄ diastolic blood pressure [SBP ⁄ DBP] !180 ⁄ 95 mm Hg). At 8 weeks, T ⁄ A provided significantly greater reductions from baseline in seated trough cuff SBP ⁄ DBP ()47.5 mm Hg ⁄ )18.7 mm Hg) vs T (P<.0001) or A (P=.0002) monotherapy; superior reductions were also evident at 1, 2, 4, and 6 weeks. Blood pressure (BP) goal and response rates were consistently higher with T ⁄ A vs T or A. T ⁄ A was well tolerated, with less frequent treatmentrelated adverse events vs A (12.6% vs 16.4%) and a numerically lower incidence of peripheral edema and treatment discontinuation. In conclusion, treatment of patients with substantially elevated BP with T ⁄ A SPCs resulted in high and significantly greater BP reductions and higher BP goal and response rates than the respective monotherapies. T ⁄ A SPCs were well tolerated. J Clin Hypertens (Greenwich). 2012;14:206-215. Ó2012 Wiley Periodicals, Inc.Based on evidence from a number of large antihypertensive trials, 1-9 most guidelines acknowledge that combination therapy is needed to reduce blood pressure (BP) successfully to goal in the majority of patients; only a minority of patients achieve their BP goal with a single agent.10-14 Also, the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) study showed a significant reduction of cardiovascular (CV) events and death in hypertensive patients at high CV risk treated with a combination of an angiotensin-converting enzyme (ACE) inhibitor and a calcium channel blocker (CCB).15 Nevertheless, despite rigorous and comprehensive guidelines, and a trend towards an increase in the use of combination therapy in treatment practice, 16 several studies have demonstrated the persistence of poor BP goal rates in treated patients. [17][18][19] The impact of poor BP control is compounded by the often high prevalence of other CV risk factors in hypertensive patients (eg, hypercholesterolemia, obesity, type 2 diabetes mellitus [T2DM], and smoking).13 Therefore, an urgent need still remains to improve the management of hypertension. One logical approach would be to use 2 drugs from different classes and complementary mechanisms of action in combination. Such combinations may result in additional BP decreases and improved goal rates, compared with either agent used alone. 20-23Furthermore, single-pill combinations (SPCs) are known to increase treatment adherence and reduce health care costs. [24][25][26][27] A combination of a CCB and an angiotensin II receptor blocker (ARB) is a rational approach for managing hypertension and there is increasing evidence that this combination is effective. 11,13,28,29 The aim of the current study was to compare the efficacy and tolerability of the SPC of telmisartan 80 mg ⁄ amlodipine 10 mg (T80 ⁄ A10) with that of...
В настоящее время хроническая обструктивная бо-лезнь легких (ХОБЛ) занимает лидирующую позицию в структуре смертности в мире [1]. Сердечно-сосудистые заболевания являются непосредственными причинами смерти при ХОБЛ почти в 30% случаев [2]. Негативное влияние на сердечно-сосудистую систему таких меха-низмов, как системное воспаление, оксидативный стресс, эндотелиальная дисфункция, гипоксия у боль-ных ХОБЛ приводит к развитию артериальной гипер-тензии (АГ), ишемической болезни сердца (ИБС), хронической сердечной недостаточности (ХСН), арит-мий. По некоторым данным фибрилляция предсердий (ФП) чаще встречается среди больных ХОБЛ, чем в об-щей популяции, и связана с тяжестью бронхообструк-ции и проаритмогенными эффектами ингаляционной терапии ХОБЛ [3,4]. Наличие ФП у больных ХОБЛ не-гативно влияет на исходы, учитывая высокий риск тромбоэмболических осложнений и ремоделирование сердца с развитием сердечной недостаточности [5,6]. Цель. Изучение взаимосвязи между клинико-функциональными характеристиками хронической обструктивной болезни легких (ХОБЛ) с различными показателями сердечно-сосудистой системы с выявлением факторов, ассоциированных с фибрилляцией предсердий (ФП). Материал и методы. Обследовано 94 больных ХОБЛ с обструкцией 2-4 степени (GOLD 2013) вне обострения ХОБЛ. Проводилась спирометрия, суточная пульсок-симетрия, суточное мониторирование ЭКГ (ХМ-ЭКГ) и артериального давления с измерением средней скорости пульсовой волны в аорте (срPWao), эхокардиогра-фия, оценивался уровень высокочувствительного С-реактивного белка (вч-СРБ). Результаты. У 46 больных были выявлены пароксизмы ФП, в том числе -у 22 пациентов впервые. По результатам множественного корреляционного анализа часто-та пароксизмов ФП коррелировала с объемом форсированного выдоха за 1 сек (FEV 1 ) (R=-0,348; p=0,013), минимальной сатурацией кислородом крови (мин%SpO 2 ) (R=-0,356; p=0,011), уровнем вч-СРБ (R=0,442; p=0,001), а также размером обоих предсердий (p<0,001), временем изоволюметрического расслабления (IVRT) левого желудочка (ЛЖ) (R=0,350; p=0,022), размером правого желудочка (R=0,478; p<0,001), систолическим давлением в легочной артерии (сДЛА) (p<0,001), срPWao (p=0,001). Выявлено влияние FEV 1 на индекс объема левого предсердия (ЛП) (χ 2 =7,0 p=0,008) и IVRT ЛЖ (χ 2 =7,9 p=0,005). Наблюдалась взаимосвязь мин%SpO 2 с IVRT ЛЖ и cpPWao. Заключение. Выраженная бронхообструкция, гипоксемия, системное воспаление c повышением жесткости сосудистой стенки (срPWao) и ремоделированием мио-карда (увеличением размеров обоих предсердий, систолического давления в легочной артерии, базального диаметра правого желудочка и диастолической дисфункцией ЛЖ) являются факторами, ассоциированными с ФП у больных ХОБЛ. Aim. To study the relationships between clinical and functional features of chronic obstructive pulmonary disease (COPD) and status of cardiovascular system with focus on identifying factors associated with the atrial fibrillation (AF) in patients with COPD. Material and methods. Patients (n=94) with COPD out of exacerbation and airways obstruction o...
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