Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data

Sundström, Johan; Arima, Hisatomi; Woodward, Mark; Jackson, Rod; Karmali, Kunal N.; Lloyd‐Jones, Donald M.; Baigent, Colin; Emberson, Jonathan; Rahimi, Kazem; MacMahon, Stephen; Patel, Anushka; Perkovic, Vlado; Turnbull, Fiona; Neal, Bruce

doi:10.1016/s0140-6736(14)61212-5

Cited by 460 publications

(162 citation statements)

References 44 publications

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“…Hypertension is a leading cause of CV events in the general population [26] and remains an important modi fiable risk factor in patients with end-stage renal disease (ESRD). According to Kidney Disease: Improving Global Outcomes (KDIGO) the target for blood pressure should be ≤ 130/80 mmHg irrespective of the presence of proteinuria [27] although the United Kingdom Renal…”

Section: Hypertensionmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

116

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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Section: Hypertensionmentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

116

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“…In this high‐risk group in particular, a more effective approach than the traditional target‐based BP treatment could be a risk‐based treatment model, incorporating global CVD risk scores. Support for this approach was established by the BPLTTC 31. In their meta‐analysis of nearly 52 000 individuals, the BPLTTC showed that while BP treatment led to the same relative risk reduction across all 4 risk categories, the greatest absolute benefit by number of CVD events prevented occurred in the highest baseline CVD risk category 31…”

Section: Jnc 8 Recommendationmentioning

confidence: 99%

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

Kovell

Ahmed

Misra

et al. 2015

JAHA

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“…Furthermore, high BP is strongly and progressively associated with risk of CHD, heart failure, peripheral vascular disease, and other serious health conditions [87,88]. The Prospective Studies Collaboration, a meta-analysis of data from 61 prospective studies in individuals aged 40-69 years, reported that each 20 mm of mercury increase in systolic BP above usual was associated with a more than 2-fold difference in stroke mortality and a 2-fold difference in CHD mortality [89].…”

Section: Safa Intake and Ischemic Strokementioning

confidence: 99%

“…The Prospective Studies Collaboration, a meta-analysis of data from 61 prospective studies in individuals aged 40-69 years, reported that each 20 mm of mercury increase in systolic BP above usual was associated with a more than 2-fold difference in stroke mortality and a 2-fold difference in CHD mortality [89]. A meta-analysis of 11 clinical trials of BP-lowering drugs showed that regardless of baseline cardiovascular risk, lowering the BP reduced the risk of cardiovascular events in all risk groups [87]. Overall, these data and many other studies support a causal relationship between BP and risk of CHD and stroke.…”

Section: Safa Intake and Ischemic Strokementioning

confidence: 99%

Saturated Fat Consumption and Risk of Coronary Heart Disease and Ischemic Stroke: A Science Update

Nettleton¹,

et al. 2017

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At a workshop to update the science linking saturated fatty acid (SAFA) consumption with the risk of coronary heart disease (CHD) and ischemic stroke, invited participants presented data on the consumption and bioavailability of SAFA and their functions in the body and food technology. Epidemiological methods and outcomes were related to the association between SAFA consumption and disease events and mortality. Participants reviewed the effects of SAFA on CHD, causal risk factors, and surrogate risk markers. Higher intakes of SAFA were not associated with higher risks of CHD or stroke apparently, but studies did not take macronutrient replacement into account. Replacing SAFA by cis-polyunsaturated fatty acids was associated with significant CHD risk reduction, which was confirmed by randomized controlled trials. SAFA reduction had little direct effect on stroke risk. Cohort studies suggest that the food matrix and source of SAFA have important health effects.

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Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data

Cited by 460 publications

References 44 publications

Cardiovascular risk factors following renal transplant

Cardiovascular risk factors following renal transplant

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

Saturated Fat Consumption and Risk of Coronary Heart Disease and Ischemic Stroke: A Science Update

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