Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials

Agodoa, Lawrence; Estacio, Raymond O.; Schrier, Robert W.; Lubsen, Jacobus; Chalmers, John; Cutler, Jeff; Davis, Barry R.; Wing, Lindon; Poulter, Neil; Sever, Peter; Remuzzi, Giuseppe; Ruggenenti, Piero; Nissen, Steven; Lindholm, Lars; Fukui, Tsuguya; Ogihara, Toshio; Saruta, Takao; Black, Henry R.; Sleight, Peter; Lièvre, Michel; Suzuki, Hiromichi; Fox, Keith; Liu, Lisheng; Ohkubo, Takayoshi; Imai, Y.; Yusuf, Salim; Bulpitt, C; Lewis, Esmeralda A; Brown, Mark; Palmer, Colin N. A.; Wang, J.; Pepine, Carl J.; Ishii, Masao; Yui, Yoshiaki; Kuramoto, Kizuku; Er, Maslova; Asselbergs, Folkert W.; Gilst, Wiek H. van; Byington, Bob; Pitt, Bertram; Brenner, Barry M.; Remme, W. J.; Zeeuw, Dick de; Rahman, Mahboob; Viberti, Giancarlo; Teo, Koon; Zanchetti, Alberto; Malacco, Ettore; Mancia, Giuseppe; Staessen, Jan A.; Fagard, Robert; Holman, Rury R.; Hansson, L.; Kostis, John B.; Kanno, Yoshihiko; Lueders, Stephan; Matsuzaki, Masunori; Poole‐Wilson, P.A.; Schrader, Joachim; Rahimi, Kazem; Anderson, Craig S.; Chapman, Neil; Collins, Rory; MacMahon, Stephen; Neal, Bruce; Rodgers, Anthony; Whelton, Paul K.; Woodward, Mark

doi:10.1016/s0140-6736(14)61171-5

Cited by 47 publications

(15 citation statements)

References 39 publications

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“…Overweight and obesity are established risk factors for a number of chronic conditions, including type II diabetes, cardiovascular disease and various cancers [2, 3]. Moreover, obesity has been associated with less likely to have routine care [4].…”

Section: Introductionmentioning

confidence: 99%

Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study

et al. 2017

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BackgroundObesity has been linked to poor access to medical care. Although scientific evidence suggest that kidney transplantation improves survival and quality of life in obese patients with end-stage renal disease (ESRD), few data exist on the impact of obesity on access to kidney transplantation in this population.ObjectivesWe aimed to characterize the relationships between body mass index (BMI) at the start of dialysis, changes in BMI after the start of dialysis, and either access to kidney transplantation or overall mortality in dialysis or transplantation among ESRD patients.MethodsBetween 2002 and 2011, 19524 dialysis patients with ESRD were included in the study via the French nationwide Renal Epidemiology and Information Network. Data on sociodemographic factors, comorbidities and laboratory test results were recorded upon entry into the registry. BMI were obtained at the start of dialysis and then yearly. Cubic spline regression analyses provided a graphic evaluation of the relationships between BMI at the start of dialysis and outcomes. Joint models were used to evaluate the association between the change over time in BMI and outcomes.ResultsDuring a median follow-up of 20.3 months, 6634 patients underwent kidney transplantation. A BMI >31 kg/m2 at the start of the dialysis was associated with a lower likelihood of receiving a kidney transplant, and the likelihood decreased even further with higher BMI values. For patients with BMI ≥30kg/m2 at the start of the dialysis, a 1 kg/m2 decrease in BMI during follow-up was associated with a 9% to 11% increase in the likelihood of receiving a transplant. There was an L-shaped relationship between BMI at the start of dialysis and overall mortality. We showed that obese patients with ESRD face barriers to the receipt of a kidney transplant without valid reasons.ConclusionGreater attention to this issue would improve the fairness of the organ allocation process and might improve outcomes for obese patients with ESRD.

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Section: Introductionmentioning

confidence: 99%

Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study

et al. 2017

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“…Hypertension is the major contributing risk factor for kidney disease, 1,2 stroke, 3 preterm birth, 4 heart failure, 5 and cardiovascular diseases. 6,7 It is also the most important preventable part cause of mortality 8,9 and morbidity.…”

Section: Introductionmentioning

confidence: 99%

Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

Tang

Bishwajit

et al. 2016

Medicine

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Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS.A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg)Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56–3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively.Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients.

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“…There are numerous examples in the medical literature that demonstrate the value of IPD and what can be achieved through data sharing. This includes improving the reliability and robustness of comparative meta-analyses in cancer [ 7 ], cardiovascular disease [ 8 ] and epilepsy [ 9 ]; the reliable identification of subgroups of patients that benefit most from treatment [ 10 ]; aiding the development of new methodology [ 11 ]; and providing the best evidence to inform the development of clinical guidelines [ 12 ] and new clinical trials [ 13 ]. Greater access to IPD and clinical study reports has been incredibly useful to help overcome the problem of bias in the medical literature with high profile examples focussing on Tamiflu [ 14 ] and Paroxetine [ 15 ], in which more reliable and balanced information has been generated for patients and clinical practitioners.…”

Section: Introductionmentioning

confidence: 99%

How should individual participant data (IPD) from publicly funded clinical trials be shared?

Smith

Hopkins

Sydes

et al. 2015

BMC Med

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BackgroundIndividual participant data (IPD) from completed clinical trials should be responsibly shared to support efficient clinical research, generate new knowledge and bring benefit to patients. The Medical Research Council (MRC) Hubs for Trials Methodology Research (HTMR) has developed guidance to facilitate the sharing of IPD from publicly funded clinical trials.MethodsDevelopment of the guidance was completed over four phases which included a focussed review of policy documents, a web-based survey of the UK Clinical Research Collaboration (CRC) Registered Clinical Trials Units (CTU) Network, participation of an expert committee and an open consultation with the UKCRC Registered CTU Network. The project was funded by the MRC HTMR (MR/L004933/1-R39).ResultsGood practice principles include: (i) the use of a controlled access approach, using a transparent and robust system to review requests and provide secure data access; (ii) seeking consent for sharing IPD from trial participants in all future clinical trials with adequate assurance that patient privacy and confidentiality can be maintained; and (iii) establishing an approach to resource the sharing of IPD which would include support from trial funders, sponsor organisations and users of IPD. The guidance has been endorsed by Cancer Research UK, MRC Methodology Research Programme Advisory Group, Wellcome Trust and the Executive Group of the UKCRC Registered CTU Network. The National Institute for Health Research (NIHR) has confirmed it is supportive of the application of this guidance.ConclusionsImplementation of these principles will improve transparency, increase the coherent sharing of IPD from publicly funded trials, and help publicly funded trials to adhere to trial funder and journal requirements for data sharing.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0532-z) contains supplementary material, which is available to authorized users.

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Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials

Cited by 47 publications

References 39 publications

Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study

Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study

Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

How should individual participant data (IPD) from publicly funded clinical trials be shared?

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