Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Hardy, Shakia T; Loehr, Laura R.; Butler, Kenneth R.; Chakladar, Sujatro; Chang, Patricia; Folsom, Aaron R.; Heiss, Gerardo; MacLehose, Richard F.; Matsushita, Kunihiro; Avery, Christy L.

doi:10.1161/jaha.115.002276

Cited by 154 publications

(121 citation statements)

References 57 publications

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“…Nevertheless, the effects on SBP are quite important because just 1 mmHg populationwide decrease in SBP would result in 13.3/100 000 person-years reduction in heart failure events. 43 SBP increased signifi cantly with the increment in outdoor L den among people using solid fuel/gas at home, and in L night among those with prior CVD, sleeping in a bedroom with a noisy façade, and exposed to lower PM 2.5 . The greatest increase in SBP was related to the orientation of the bedroom, which is important since elevated SBP at night (when it is supposed to dip) is a predictor of cardiovascular morbidity and mortality independently from daytime SBP.…”

Section: Findings On Noise and Blood Pressurementioning

confidence: 96%

Community Noise Exposure and its Effect on Blood Pressure and Renal Function in Patients with Hypertension and Cardiovascular Disease

Dzhambov¹,

Tokmakova²,

Gatseva³

et al. 2017

Folia Medica

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Citation: Dzhambov AM, Tokmakova MP, Gatseva PD, Zdravkov NG, Gencheva DG, Ivanova NG, Karastanev KI, Vladeva SV, Donchev AT, Dermendzhiev SM. Community noise exposure and its eff ect on blood pressure and renal function in patients with hypertension and cardiovascular disease.Folia Medica 2017;59(3): 344-356. doi: 10.1515/folmed-2017-0045 Background: Road traffi c noise (RTN) is a risk factor for cardiovascular disease (CVD) and hypertension; however, few studies have looked into its association with blood pressure (BP) and renal function in patients with prior CVD. Aim: This study aimed to explore the eff ect of residential RTN exposure on BP and renal function in patients with CVD from Plovdiv Province. Materials and methods:We included 217 patients with ischemic heart disease and/or hypertension from three tertiary hospitals in the city of Plovdiv (March -May 2016). Patients' medical history, medical documentation, and medication regimen were reviewed, and blood pressure and anthropometric measurements were taken. Blood samples were analyzed for creatinine, total cholesterol, and blood glucose. Participants also fi lled a questionnaire. Glomerular fi ltration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. All participants were asked about their annoyance by diff erent noise sources at home, and those living in the city of Plovdiv (n = 132) were assigned noise map L den and L night exposure. The eff ects of noise exposure on systolic blood pressure (SBP), diastolic blood pressure (DBP), and estimated glomerular fi ltration rate (eGFR) were explored using mixed linear models. Results: Traffi c noise annoyance was associated with higher SBP in the total sample. The other noise indicators were associated with non-signifi cant elevation in SBP and reduction in eGFR. The eff ect of L den was more pronounced in patients with prior ischemic heart disease/stroke, diabetes, obesity, not taking Ca-channel blockers, and using solid fuel/gas at home. L night had stronger eff ect among those not taking statins, sleeping in a bedroom with noisy façade, having a living room with quiet façade, and spending more time at home. The increase in L den was associated with a signifi cant decrease in eGFR among men, patients with ischemic heart disease/stroke, and those exposed to lower air pollution. Regarding L night , there was signifi cant eff ect modifi cation by gender, diabetes, obesity, and time spent at home. In some subgroups, the eff ect of RTN was statistically signifi cant. Conclusions: Given that generic risk factors for poor progression of cardiovascular diseases cannot be controlled suffi ciently at individual level, environmental interventions to reduce residential noise exposure might result in some improvement in the management of blood pressure and kidney function in patients with CVD.

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Section: Findings On Noise and Blood Pressurementioning

confidence: 96%

Community Noise Exposure and its Effect on Blood Pressure and Renal Function in Patients with Hypertension and Cardiovascular Disease

Dzhambov¹,

Tokmakova²,

Gatseva³

et al. 2017

Folia Medica

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“…Cardiovascular disease is the leading cause of death in patients with CD. 16 Consequences of cortisol excess that can contribute to cardiovascular disease include hypertension, truncal obesity, impaired glucose tolerance, insulin resistance, dyslipidaemia and hypercoagulability. 17 In our study, improvements in blood pressure, BMI and waist circumference were maintained for up to 3 years of pasireotide treatment.…”

Section: Discussionmentioning

confidence: 99%

Long‐term efficacy and safety of once‐monthly pasireotide in Cushing's disease: A Phase III extension study

Fleseriu

Petersenn²,

Biller

et al. 2019

Clinical Endocrinology

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ObjectivesMany patients with Cushing's disease (CD) require chronic pharmacotherapy to control their hypercortisolism. We evaluated the efficacy and safety of long‐acting pasireotide during a long‐term extension study in patients with CD.DesignOpen‐label extension to a 12‐month Phase III study of long‐acting pasireotide in CD (N = 150; NCT01374906).PatientsPatients with mean urinary free cortisol (mUFC) ≤ upper limit of normal (ULN) or receiving clinical benefit at core study end could continue long‐acting pasireotide during the extension.ResultsEighty‐one of 150 (54.0%) enrolled patients entered the extension. Median overall exposure to pasireotide at study end was 23.9 months; 39/81 (48.1%) patients completed the extension (received ≥ 12 months’ treatment during the extension and could transit to a separate pasireotide safety study). mUFC was ≤ULN in 42/81 (51.9%), 13/81 (16.0%) and 43/81 (53.1%) patients at extension baseline, month (M) 36 and last assessment. Median mUFC remained within normal limits. Median late‐night salivary cortisol was 2.6 × ULN at core baseline and 1.3 × ULN at M36. Clinical improvements were sustained over time. Forty‐two (51.9%) patients discontinued during the extension: 25 (30.9%) before M24 and 17 (21.0%) after M24. Hyperglycaemia‐related AEs occurred in 39.5% of patients. Mean fasting glucose (FPG) and glycated haemoglobin (HbA1c) were stable during the extension, with antidiabetic medication initiated/escalated in some patients. Sixty‐six (81.5%) and 71 (88.9%) patients were classified as having diabetes (HbA1c ≥ 6.5%, FPG ≥ 7.0 mmol/L, antidiabetic medication use, or history of diabetes) at extension baseline and last assessment.ConclusionsLong‐acting pasireotide provided sustained biochemical and clinical improvements, with no new safety signals emerging, supporting its use as an effective long‐term therapy for CD.

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“…If the mean of 27 participants is used to compare reductions in SBP between time points, results would show a statistically non-significant reduction of -2.24 mmHg (Figure 1). Hardy et al 35 demonstrated that reductions of 2 mmHg in SBP were associated with reductions in the incidence of coronary artery disease, stroke, and heart failure events for African and white Americans. Furthermore, Lawes et al 36 demonstrated that a 10 mmHg reduction in SBP at mean age at baseline of 63 years was associated with a risk reduction in stroke of 31%.…”

Section: Discussionmentioning

confidence: 99%

New insights for statistical analysis of blood pressure response to exercise in elderly hypertensive women

et al. 2019

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RESUMOO objetivo principal do estudo foi apresentar procedimentos estatísticos para uma melhor interpretação dos dados sobre a responsividade, explicar como lidar com o efeito da regressão a média (RM) e descrever como determinar alterações clinicamente importantes na pressão arterial (PA) pelo cálculo da diferença clínica (DC). Vinte e sete mulheres idosas hipertensas foram incluídas e o treinamento resistido (TR) consistiu em um modelo linear periodizado. O TR durou 10 semanas, com duas sessões realizadas por semana. Os responsivos foram classificados com base nas diferenças da pressão arterial sistólica (PAS) entre os momentos T1 (primeiras 3 semanas) e T4 (semanas 9-10). As análises estatísticas no presente estudo foram realizadas utilizando a ANOVA de medidas repetidas, análise de covariância (ANCOVA) e modelo linear misto (MLM). Conclui-se que quando uma ANOVA de medidas repetidas é aplicada, os resultados mostram uma redução não significativa de -2,24 mmHg, mas a classificação dos participantes por responsividade fornece uma interpretação diferente dos resultados. Além disso, a PAS inicial foi o preditor mais potente da resposta pós-exercício da PAS, conforme analisado pela RM. Finalmente, as reduções de -2,24 mmHg não foram estatisticamente significativas e nem clinicamente importantes, mas caíram dentro do erro de medida. Palavras-chave: Responsividade, Regressão a média, Erro padrão de medida, Diferença clínica, Pressão arterial. ABSTRACTThe main goal was to present statistical procedures for a better data interpretation of responsiveness, explain how to deal with RTM effect, and describe how to determine clinically important changes in BP from significant real difference (SRD). Twenty-seven hypertensive elderly women were included, and RT consisted of a periodized linear model. The RT lasted 10 weeks, with two sessions performed per week. Responders were classified on the basis of SBP differences between timepoints T1 (first 3 weeks) and T4 (weeks 9-10). Statistical analyses were performed using One-Way Repeated Measures ANOVA, an analysis of covariance (ANCOVA), the linear mixed model (LMM) was used in the present study, and SRD was also calculated. In conclusion, when one-way repeated measure ANOVA was conducted to determine whether there was a statistically significant difference in SBP levels over the course of 10-week RT, results showed a non-significant reduction of -2.24 mmHg, while classifying subjects by responsiveness provides a different perspective of the results. Furthermore, initial SBP was the more powerful predictor of post-exercise SBP response, as analyzed by the regression to the mean effect. Finally, the reductions of -2.24 mmHg was not statistically significant nor clinically meaningful, but fell within the measurement error of the SBP measurements.

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Reducing the Blood Pressure–Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control

Cited by 154 publications

References 57 publications

Community Noise Exposure and its Effect on Blood Pressure and Renal Function in Patients with Hypertension and Cardiovascular Disease

Community Noise Exposure and its Effect on Blood Pressure and Renal Function in Patients with Hypertension and Cardiovascular Disease

Long‐term efficacy and safety of once‐monthly pasireotide in Cushing's disease: A Phase III extension study

New insights for statistical analysis of blood pressure response to exercise in elderly hypertensive women

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