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

Kovell, Lara C.; Ahmed, Haitham M.; Misra, Satish; Whelton, Seamus P.; Prokopowicz, Greg P.; Blumenthal, Roger S.; McEvoy, John W.

doi:10.1161/jaha.115.002315

Cited by 63 publications

(40 citation statements)

References 62 publications

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“…either 120-139 mmHg for the MESA study sample or 130-139 mmHg for the SPRINT-eligible subsample), 140-159 mmHg, and 160-179 mmHg. Then, to evaluate whether CAC can personalize risk assessment among subgroups of varying SBP and ASCVD risk estimates, these BP categories were further stratified on the basis of, first, ten-year ASCVD risk (<15% or ≥15% 5, 6,20 which was the median level of risk in our primary sample) and, second, CAC group (0, 1-100, >100). We compared crude event (incidence) rates, as well as Cox multivariable-adjusted hazard ratios, within each of these CAC strata.…”

Section: Methodsmentioning

confidence: 99%

Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of Antihypertensive Therapy

et al. 2017

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Background There is interest in using atherosclerotic cardiovascular disease (ASCVD) risk to personalize systolic blood pressure (SBP) treatment goals. Therefore, we studied whether Coronary Artery Calcium (CAC) can further guide the allocation of anti-hypertensive treatment intensity. Methods We included 3,733 participants from the Multi-Ethnic Study of Atherosclerosis with SBP between 120-179mmHg. Within subgroups categorized by both SBP (120-139, 140-159, 160-179mmHg) and estimated 10-year ASCVD risk (using the ACC/AHA pooled-cohort equations), we compared multivariable-adjusted hazard ratios (HRs) for the composite outcome of incident ASCVD or heart failure, after further stratifying by CAC (0, 1-100, or >100). We estimated 10-year number-needed-to-treat (NNT10) for an intensive SBP goal of 120mmHg by applying the treatment benefit recorded in meta-analyses to event rates within CAC strata. Results Mean age was 65 years. There were 642 composite events over a median of 10.2 years. In persons with SBP <160mmHg, CAC stratified risk for events. For example, among those with ASCVD risk <15% and who had SBP of either 120-139 or 140-159mmHg, respectively, we found increasing HRs for events with CAC 1-100 (1.7 [95% CI, 1.0-2.6] or 2.0 [1.1-3.8]) and CAC >100 (3.0 [1.8-5.0] or 5.7 [2.9-11.0]), all relative to CAC=0. There appeared to be no statistical association between CAC and events when SBP was 160-179mmHg, irrespective of ASCVD risk level. Estimated NNT10 for a SBP goal of 120mmHg varied substantially according to CAC levels when predicted ASCVD risk <15% and SBP <160mmHg (e.g. NNT10 of 99 for CAC=0 and 24 for CAC>100, when SBP 120-139mmHg). However, few participants with ASCVD risk <5% had elevated CAC. Furthermore, NNT10 estimates were consistently low and varied less among CAC strata when SBP was 160-179mmHg or when ASCVD risk was ≥15% at any SBP level. Conclusion Combined CAC-imaging and assessment of global ASCVD risk has potential to guide personalized SBP goals (e.g., choosing a traditional goal of 140 or a more intensive goal of 120 mmHg), particularly among adults with estimated ASCVD risk 5-15% and pre-hypertension or mild hypertension.

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Section: Methodsmentioning

confidence: 99%

Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of Antihypertensive Therapy

et al. 2017

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“…ACEi therapy is recommended as one of the first-line treatments for hypertension and heart failure in national and international guidelines [30,31]. Therefore, the worldwide number of patients exposed to ACEi is huge [9].…”

Section: Introductionmentioning

confidence: 99%

Angioedemas associated with renin-angiotensin system blocking drugs: Comparative analysis of spontaneous adverse drug reaction reports

et al. 2020

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Introduction Angioedema is a subcutaneous swelling typically affecting the face, larynx or pharynx. It is a known adverse drug reaction (ADR) of ACE inhibitors (ACEi), angiotensin-II-receptor blockers (ARBs) and aliskiren (renin inhibitor). Several studies have reported pathophysiological mechanisms and risk factors of ACEi-associated angioedemas, whereas little is known for ARBs and aliskiren. The aim of the study was to analyze comparatively ACEi versus ARBs and aliskiren angioedema reports contained in the European ADR database EudraVigilance with regard to reported risk factors and clinical phenotypes. Methods All spontaneous angioedema reports received between 01/2010-06/2017 reporting either an ACEi, ARB, or aliskiren as "suspected/interacting" drug were identified using the Standardized MedDRA Query "angioedema (narrow)". In order to perform a comparative analysis, odds ratios (ORs) were calculated for angioedema reports of ACEi (n = 3.194) versus ARBs (n = 687) and aliskiren (n = 162). Results More patients with a history of allergy were included in angioedema reports of ARBs (6.8%) and aliskiren (13.6%) versus ACEi (4.3%). "Urticaria" as an ADR was reported more frequently in angioedema reports of ARBs (18.5%) and aliskiren (9.0%) versus ACEi (5.0%). ACEi-associated angioedemas were more often designated as "life-threatening" compared to ARBs (OR 2.2 [1.6-2.9]) and aliskiren-associated angioedemas (OR 14.2 (3.5-57.4). Concomitant therapy with mTOR inhibitors (OR 4.3 [1.0-17.9]) and fibrinolytics (OR 7.8 [1.1-57.2]) was reported more often in ACEi versus ARBs angioedema reports.

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“…We used JNC8 criteria for determining of hypertension as: systolic blood pressure (SBP) ≥ 140, or diastolic blood pressure (DBP) ≥ 90, or taking antihypertensive medications in subjects, aged < 60 years and SBP ≥ 150, or DBP ≥ 90 or taking antihypertensive medications in subjects, aged > 60 years [27].…”

Section: De Nitionsmentioning

confidence: 99%

The Association Between Dietary Glycemic and Insulin Indices with Incidence of Cardiovascular Disease: Tehran Lipid and Glucose Study

Teymoori

Farhadnejad

Mirmiran

et al. 2020

Preprint

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Background The aim of this study was to investigate the association of dietary insulin index (II), insulin load (IL), glycemic index (GI), and glycemic load (GL) with risk of cardiovascular disease (CVD) outcomes among adults. Methods This cohort study was conducted within the framework of the Tehran Lipid and Glucose Study on 2198 subjects, aged ≥19 years, who were followed-up for a mean of 4.7 years. Dietary GI, GL, II, IL were calculated using a food frequency questionnaire at baseline. Multivariate Cox proportional hazard regression models, adjusted for potential confounders, were used to estimate risk of CVD across quartiles of dietary insulin and glycemic indices. Results Mean±SD age of the study population (44.9% men) was 38.3±13.4 years. During an average of 2406 ± 417 person-years of follow-up, 76 (3.5%) new cases of CVD were ascertained. The Mean±SD of II, IL, GI, and GL of participants were 51.7±6.5, 235.8±90.2, 61.9±7.8, and 202.2±78.1, respectively. After adjusting for age, sex, smoking, physical activity, daily energy intake, body mass index, diabetes, and hypertension, the hazard ratio (HR) of the highest quartile of dietary GL was 2.77 (95%CI:1.00-7.69, P for trend:0.033) compared with the lowest one. However, there was no significant association between dietary GI, II, IL and risk for CVD incident. Conclusions Our findings suggest that high GL diet can increase the incidence of CVD, whereas high dietary II and IL was not associated with risk of CVD among adults.

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

Cited by 63 publications

References 62 publications

Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of Antihypertensive Therapy

Coronary Artery Calcium to Guide a Personalized Risk-Based Approach to Initiation and Intensification of Antihypertensive Therapy

Angioedemas associated with renin-angiotensin system blocking drugs: Comparative analysis of spontaneous adverse drug reaction reports

The Association Between Dietary Glycemic and Insulin Indices with Incidence of Cardiovascular Disease: Tehran Lipid and Glucose Study

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