No reviews comparing temporal patterns of heart, brain, and blood vessel damage following hypertensive disorders of pregnancy have been found. Therefore, investigators sought to characterize heart, brain, and blood vessel damage due to hypertensive pregnancy from pregnancy through early and late postpartum periods, comparing changes that occur with variations in blood pressure. Cardiac changes were the primary outcome. Vascular changes, renal, and neural changes were secondary outcomes.

The investigators conducted a systematic review searching the EMBASE, Ovid/MEDLINE, and ClinicalTrials.gov databases from 2000 through February 2023 for articles in English concerning pregnancies and reporting on blood pressure trajectories or target organ damage during or after a hypertensive pregnancy. Primary research studies, trend studies, panel designs, cohort studies, and time-series designs were included. Abstracts, guidelines, reviews, and conference posters were excluded.

Articles were evaluated without meta-analysis (due to heterogeneity) using a vote-counting approach (comparing the number of positive studies with the number of negative studies) regardless of statistical significance. The investigators defined target organ damage as negative alterations affecting the function and structure of organ systems.

The investigators included 76 studies (over 1.7 million pregnancies) reporting on target organ damage or blood pressure trajectories during or after hypertensive pregnancy and found that, during hypertensive pregnancy, proteinuria and retinal microvasculature changes, white matter lesions, and left ventricular hypertrophy were first evident. Overall, during pregnancy and delivery, 7 studies reported systolic or diastolic dysfunction and 7 studies reported increased left ventricular remodeling. Temporally, 3 studies reported systolic or diastolic dysfunction and 4 studies reported increased left ventricular remodeling up to 1 year postpartum.

More than a decade postpartum, 1 study reported systolic or diastolic dysfunction and 2 studies reported increased left ventricular remodeling.

Overall, preeclampsia was the most common hypertensive disorder reported in the studies. Other disorders examined included low platelet count, elevated liver enzyme activity, gestational hypertension, and eclampsia. Risk of bias showed 18% of the studies with low risk and 82% of the included studies with moderate risk of bias according to the Newcastle-Ottawa scale.

Despite blood pressure reduction early in postpartum, retinal, cerebral, and cardiac changes were noted during early and late postpartum periods. The late postpartum period was the initial time cognitive dysfunction was reported.

Limitations of the study include a lack of meta-analysis narrowing conclusions that can be drawn, and the observational nature of the included studies prevents cause-and-effect inferences.

“The majority of target organ damage reported during a hypertensive pregnancy remains evident throughout the early and late postpartum period despite variation in blood pressure,” the investigators wrote. “Early peri-partum strategies may be required to prevent or reverse target organ damage in women who have had a hypertensive pregnancy.”

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The post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial; ClinicalTrials.gov Identifier: NCT01206062) trial sought to estimate the association between SBP TTR with incident AF and determine a more appropriate BP control performance measurement for preventing AF.

The multicenter, open-label, randomized controlled SPRINT trial compared the effects of an intensive SBP target of less than 120 mm Hg with a standard SBP target of less than140 mm Hg in patients with hypertension. The current analysis included SPRINT participants with 2 or more follow-up SBP measurements during the first 3 months of the trial and excluded those with missing or uninterpretable baseline ECG results, those without any follow-up ECG results, and those with AF at baseline.

The primary outcome was incident AF, which was the first occurrence of AF measured by standard 12-lead ECG at year 2, year 4, and at a close-out visit in SPRINT. SBP TTR was considered the proportion of time that SBP remains within target range and was calculated with use of Rosendaal linear interpolation method.

The analysis included 7939 participants, with a mean age of 68±9 years who were 35% women. The SBP TTR and mean SBP achieved in the first 3 months among all participants were 59% (IQR, 32%-84%) and 129±12 mm Hg, respectively.

For patients without baseline AF, 187 incident AF cases occurred during a median follow-up of 3.8 years (28,029 person-years; incident rate, 6.7 per 1000 person-years; 95% CI, 5.8-7.7).

Each 10% increase in SBP TTR had a significant association with a reduced risk for incident AF in the unadjusted model and the model adjusted for demographics. After further adjustment for treatment group, medical history, and baseline SBP, a 10% increase in TTR was significantly associated with a 7% decreased risk for incident AF (hazard ratio [HR], 0.93; 95% CI, 0.88-0.97; P =.003).

The fully adjusted model showed that HRs comparing the reference category of TTR of 0% to less than 32% vs TTR of 32% to less than 59%, 59% to less than 84%, and 84% to 100% were 0.82 (95% CI, 0.56-1.20), 0.55 (95% CI, 0.36–0.84), and 0.58 (95% CI, 0.37-0.90), respectively (P value for trend =.003).

Restricted cubic spline curve analysis revealed a linear and inverse association between SBP TTR and incident AF (P_nonlinearity =.338). The risk for AF had a steady decrease with increasing TTR between 0% and 83%.

In a sensitivity analysis, a consistent trend was observed for use of 110 to 140 mm Hg as the SBP target range for both treatment groups. When assessing the sensitivity using TTR in months 0 to 12 instead of months 0 to 3, increased SBP TTR continued to be significantly associated with a reduced risk for incident AF in the fully adjusted model (HR, 0.93 per 10%; 95% CI, 0.88-0.98; P =.010).

Among several limitations, it is possible that some nonpersistent or asymptomatic AF cases were not detected owing to intermittent screening rather than long-term or continuous monitoring. Also, the study excluded patients with diabetes or previous stroke and did not assess the effects of individual drugs and doses on AF.

“Efforts to attain an SBP range within 110 to 140 mm Hg over time may be an effective BP control strategy from the perspective of AF prevention,” wrote the investigators.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Previous comparisons of sacubitril/valsartan and olmesartan for the treatment of hypertension produced inconsistent results regarding effectiveness, which led investigators of the current study to compare the efficacy and safety of sacubitril/valsartan and olmesartan for the treatment of hypertension.

The investigators systematically searched the Cochrane Library, Embase, Web of Science, ClinicalTrials.gov, and PubMed databases through mid-November 2022 for randomized controlled trials, in which sacubitril/valsartan was administered to the experimental group and olmesartan administered to the control group to study their effects on blood pressure control, with recognized statistical significance with P values less than 0.05.

The review authors included 6 studies (N=4127 patients) among whom 2497 patients were treated with sacubitril/valsartan (83.8% Asian patients) and 1630 patients were treated with olmesartan (76.5% Asian patients). Included studies were all judged as high-quality by the Cochrane Collaboration tool for risk of bias, and the Egger test showed no significant publication bias.

The investigators found that sacubitril/valsartan vs olmesartan significantly decreased mean sitting systolic and diastolic blood pressure and sitting pulse pressure, as well as 24-hour ambulatory systolic and diastolic blood pressure. For different doses of sacubitril/valsartan, analysis of the antihypertensive effects showed mean ambulatory systolic blood pressure (maSBP) and mean ambulatory diastolic blood pressure were significantly reduced with sacubitril/valsartan 200 mg/d and 400 mg/d, although heterogeneity was very high among the studies showing maSBP.

Occurrence of the majority of adverse events (including nausea, back pain, abdominal pain, respiratory tract infection, and dizziness) showed no significant difference between sacubitril/valsartan and olmesartan. A decreased probability of headache was noted in patients treated with sacubitril/valsartan. Serious adverse events (including stroke, intracranial hemorrhage, coronary disease, and arrhythmia) were more effectively reduced with sacubitril/valsartan 400 mg/d than with olmesartan according to subgroup analysis.

Sensitivity analysis (using 1-by-1 elimination) showed no significant changes in the outcome indicators with relatively low heterogeneity.

Limitations of the study include the underpowered sample size for the verification of therapeutic effects comparison at different doses, the long-term antihypertensive effect of sacubitril/valsartan is not explained, and the inability to determine long-term side effects.

“Sacubitril/valsartan was better than olmesartan in controlling blood pressure in patients with hypertension, with relatively higher safety,” the investigators wrote. “The antihypertensive effect of LCZ696 [sacubitril/valsartan] was greater than that of olmesartan. According to the subgroup analysis, the antihypertensive effect of LCZ696 was directly related to the dose.”

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Betaxolol is a β1-selective adrenergic receptor blocking agent indicated for the management of hypertension. According to the Company, the affected product (NDC 10702-013-01; Lot 17853A; Expiration date June 2027), which was distributed to retail pharmacies, is being recalled out of an abundance of caution. 

Because the Betaxolol 10mg tablet and the Oxycodone 5mg tablet have a similar appearance, it is unlikely a regular user would be able to distinguish between them. The Betaxolol 10mg tablet has an imprint code of “K” and “13”, while the Oxycodone HCl 5mg tablet has an imprint code of “K” and “18”; both tablets are round and white.

Consumers who may have received the affected product should discontinue use immediately. Inadvertent administration of oxycodone HCl, an opioid agonist, may pose a significant health risk to certain individuals, including those with opioid use disorder, as well as patients with compromised heart and lung function. 

To date, the Company has not received any reports of foreign tablets in any bottle of Betaxolol 10mg Tablets. Adverse events and quality issues should be reported to the FDA’s MedWatch program.

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The USPSTF concluded with moderate certainty (grade B recommendation) that screening for hypertensive disorders in pregnancy with blood pressure measurements is associated with substantial net benefit.¹ The recommendation is intended for all pregnant persons without a known diagnosis of a hypertensive disorder of pregnancy or chronic hypertension.

The recommendation is based on an updated evidence report and systematic review by Henderson and colleagues² and is consistent with the 2017 recommendation statement on screening for preeclampsia.

A history of eclampsia or preeclampsia during a prior pregnancy, a previous adverse pregnancy outcome, and maternal comorbid conditions such as type 1 or type 2 diabetes before pregnancy, gestational diabetes, chronic hypertension, kidney disease, and autoimmune diseases are associated with an increased risk for preeclampsia.

The USPSTF advises that blood pressure measurements should be obtained in each prenatal care visit throughout pregnancy and that a higher blood pressure reading should be confirmed with repeated measurements. According to the task force, persons who screen positive should receive evidence-based management of hypertensive disorders of pregnancy.

“While it is known that risk continues into the immediate postpartum period, there is little evidence regarding screening during this period,” according to the USPSTF. “A pragmatic approach would be for patients to be counseled regarding signs and symptoms of preeclampsia at hospital discharge and for patients with hypertensive disorders to have subsequent blood pressure checks.”

In addition to screening, identifying hypertensive disorders of pregnancy requires adequate prenatal visits, surveillance, and evidence-based care for changing patient signs and symptoms during pregnancy and the postpartum period to improve health outcomes.

Effective management of patients with diagnosed hypertensive disorders of pregnancy should include fetal and maternal monitoring, antihypertension medications, and magnesium sulfate for seizure prophylaxis when indicated, as well as postpartum blood pressure measurement and clinical monitoring because preeclampsia mortality risks continue postdelivery, according to the task force.

Awareness of the racial and ethnic inequities in the incidence and severity of hypertensive disorders of pregnancy is also key for effectively managing patients. For example, Black and Hispanic/Latino persons have a twofold increased risk of stroke with hypertensive disorders of pregnancy compared with White persons.

“The use of standardized clinical bundles of best practices for disease management of hypertensive disorders of pregnancy could help ensure that all pregnant persons receive appropriate, equitable care,” the USPSTF stated.

The updated evidence report and systematic review included a literature search in MEDLINE and the Cochrane Central Register of Controlled Trials for studies that addressed the comparative effectiveness of screening for hypertensive disorders of pregnancy published between January 1, 2014, and January 4, 2022. A search also was conducted in ClinicalTrials.gov, along with ongoing surveillance of new studies through February 1, 2023.

The analysis included 6 fair-quality studies (5 randomized clinical trials [RCTs] and 1 nonrandomized study with a historical control; N=10,165). The studies compared usual screening with approaches that involved home blood pressure measurement (2 studies, n=2521), prenatal care schedules with less frequent office visits vs the usual number (3 studies), and urine screening tests in patients with specific clinical indications rather than routinely conducted tests (1 study). The included studies were conducted in the prenatal period, and no studies assessed screening for new-onset hypertensive disorders of pregnancy during the postpartum period.

Home blood pressure measurement in addition to office-based measurement was evaluated in 1 fair-quality RCT (n=2441) among individuals with an increased risk of a hypertensive disorder of pregnancy.³ The comparison group had routine office-based screening. A composite outcome of 1 or more serious maternal health complications associated with hypertensive disorders of pregnancy was not statistically different between the groups (relative risk [RR], 0.79; 95% CI, 0.40-1.55). The primary outcome of the mean difference between the groups in days to detection of a hypertensive disorder of pregnancy was less than 2 days (SD, 1.6) and not statistically significant (95% CI, -8.1 to 4.9).

Different prenatal visit schedules in individuals considered at low risk for pregnancy complications were compared in 3 fair-quality RCTs (n=5203). The intervention group had a reduction in prenatal care visits scheduled (6-9 visits) vs standard visits scheduled (approximately 14 visits). No differences were found between study groups regarding preterm delivery, perinatal mortality, placental abruption, or postpartum hemorrhage, or in the proportion diagnosed with preeclampsia. The studies were underpowered for rare, serious health outcomes.

A fair-quality nonrandomized study compared a historical control group with routine urine screening at each prenatal visit vs screening only when clinically indicated (based on weight loss, elevated blood pressure, urinary symptoms; n=2441).⁴ No difference was observed in the proportion of participants diagnosed with a hypertensive disorder of pregnancy after transitioning to indicated urine screening only (RR, 1.00; 95% CI, 0.74-1.36). A decreased risk for preterm delivery with indicated screening was found vs the historical comparison group that had routine screening (RR, 0.64; 95% CI, 0.45-0.90), and no other differences in health outcomes were observed.

“This review did not identify evidence that any alternative screening strategies for hypertensive disorders of pregnancy were more effective than routine blood pressure measurement at in-person prenatal visits,” stated Dr Henderson and colleagues. “Morbidity and mortality from hypertensive disorders of pregnancy can be prevented, yet American Indian/Alaska Native persons and Black persons experience inequitable rates of adverse outcomes. Further research is needed to identify screening approaches that may lead to improved disease detection and health outcomes.”

The USPSTF suggested several approaches to improve disparities in hypertensive disorders of pregnancy, including connections to community resources in the perinatal period, collaborative care provided in medical homes, multilevel interventions to address underlying health inequities that increase health risks in pregnancy, and the use of telehealth and remote monitoring in prenatal and postpartum care.

A draft version of the USPSTF’s recommendation statement was posted for public comment on the task force’s website from February 7, 2023, to March 6, 2023, and the USPSTF clarified its definition of hypertensive disorders of pregnancy in response to comments.

Disclosure: One of the study authors in the updated evidence report and systematic review article declared an affiliation with a pharmaceutical company. Please see the original references for a full list of authors’ disclosures.

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The cross-sectional study evaluated 154 eyes of 154 participants (77 patients with primary open-angle glaucoma [POAG]; mean age, 70.6±12.3 years), who visited a tertiary center’s glaucoma clinic between October 2020 to April 2021, and 77 sex- and age-matched individuals from a general ophthalmology clinic.

Researchers performed assessments using Schirmer testing, the Ocular Surface Disease Index (OSDI), and automated ocular surface analysis.

The investigators report that all the patients who used antihypertensive eyedrops for longer than 4 years had weaker surface function than patients in the control group. The proportion of patients meeting the Tear Film and Ocular Surface Society’s criteria for
DED was higher among the group who used drops to lower IOP than among those who did not (57.1% vs 15.6%, P <.001). The case group also had more participants complain of itching (48.1%) stinging (37.7%), gritty sensations (27.3%) and tearing (24.5%).

The patients who used antihypertensive eyedrops also had higher parameters compared with the participants in the control group regarding:

• Loss of meibomian gland (MG) area (16% vs 9%; P =.004).
• Tear film osmolarity (314 vs 306 mOsm/L; P =.003).
• OSDI score (19 vs 4; P <.001).
• Lipid layer thickness (69±26 vs 80±24; P =.006).
• Non-invasive tear break-up time (9.9±2.5 vs 11.0±2.7 seconds; P =.005).
• Tear meniscus height (0.23 vs 0.30 mm; P =.001).

No significant association arose between use of antihypertensive eyedrops with or without preservatives, or among OSDI scores and duration of drop use.

“To minimize the negative effects of ocular surface changes, it is fundamental that clinicians evaluate and address the DED in patients with glaucoma,” according to the investigators.

Prior studies on the effect of antihypertensive eyedrops have also found signals such as greater corneal staining, MG area loss, and higher OSDI. In other research, patients undergoing drop therapy attained comparable OSDI scores to individuals who had glaucoma surgery and no antihypertensive eyedrops for 1 year or longer — although surgery may impair surface health via alternate processes.

This analysis was limited by a control set that may not represent the general population, absence of eyes with glaucoma treated without antihypertensive eyedrops, and OSDI responses swayed by glaucoma severity.

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Researchers conducted a retrospective study to assess the risk for incident hypertension and statin initiation among patients receiving TAF- vs TDF-based HIV PrEP. Data were captured from 6824 adult patients (mean age, 33.9 years; 97% men) who initiated HIV PrEP between October 2019 and May 2022. The primary outcomes were incident hypertension and statin initiation, occurring between 30 days and 2 years following PrEP initiation. Incident hypertension was defined the occurrence of at least 2 abnormal outpatient blood pressure measurements; statin initiation was confirmed via outpatient pharmacy dispensing records.

The researchers divided patients into 2 cohorts, including those without hypertension at baseline (n=1855; hypertension cohort) and those with no history of prevalent statin use (n=6149; statin cohort). For both cohorts, propensity score matching was used to match patients receiving TAF-based PrEP 1:4 against those receiving TDF-based PrEP.

Among patients in the hypertension cohort, incident hypertension was more likely to occur among those receiving TAF- vs TDF-based PrEP (odds ratio [OR], 1.64; 95% CI, 1.05-2.56). However, results of a time-to-event analysis showed that TAF-based PrEP use was not significantly associated with incident hypertension (hazard ratio [HR], 1.63; 95% CI, 0.67-3.96).

Among patients in the statin cohort, those receiving TAF were more likely than those receiving TDF to initiate statins (OR, 2.33; 95% CI, 1.41-3.85). As with the hypertension cohort, the association between TAF use and statin initiation was not significant in the time-to-event analysis (HR, 2.26; 95% CI, 0.76-6.69).

Sensitivity analyses were conducted in both cohorts among patients aged 40 years and older at PrEP initiation. For patients in the hypertension cohort, receipt of TAF was associated with increased risk for incident hypertension (HR, 2.32; 95% CI, 1.12-4.81), though blood pressure measurements of 130/80 mm Hg constituted hypertension for this analysis. For patients in the statin cohort, the difference in risk between TAF vs TDF use and statin initiation was greater when compared with findings from the main analysis.

Study limitations include potential confounding by indication due to the observational design, the inability to account for PrEP adherence, and the relatively small number of TAF recipients.

Based on these findings, “Closer monitoring of blood pressure and lipid levels may be warranted if using TAF,” the researchers concluded.

Disclosures: Multiple study authors reported affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.

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Investigators sought to compare endocan levels in patients with hypertension vs normotensive healthy control individuals.

They conducted a systematic review and meta-analysis searching Web of Science, Embase, Scopus, and PubMed databases from inception to February 2023 for studies in English investigating endocan or plasma levels in patients with hypertension. They included 20 studies (N=3130) with hypertension (mean [SD] age, 50.48 [8.45] years; 33.48% men). Conference abstracts, reviews, case reports, and commentaries were excluded, as were studies without data for concentration of endocan levels. Half of the studies were conducted in Turkey. In most studies, endocan was assessed in blood serum. In 6 studies, it was evaluated in blood plasma.

The Newcastle-Ottawa Quality Assessment Scale, used to assess the quality of the included studies, indicated all 20 studies were good or very good quality. According to Egger’s test, there is a possibility of publication bias.

Patients with hypertension vs healthy control patients presented with higher circulating endocan levels (standard mean difference [SMD], 0.91; 95% CI, 0.44-1.38; P <.01). Significant heterogeneity exists in this meta-analysis of endocan levels in hypertensive patients vs healthy controls (I²=95.43%).

In subgroup analysis removing 3 studies evaluating endocan levels in patients with hypertension with different comorbidities or special populations, there were the same statistically higher endocan levels (SMD, 1.16; 95% CI, 0.66-1.65; P <.01). Significant heterogeneity exists in analysis of endocan levels in hypertensive patients without comorbidities vs healthy control patients (I²=94.90%).

Hypertensive patients with coronary artery disease (CAD) had significantly higher serum endocan levels vs those without CAD (P <.01). Patients with hypertension and chronic kidney disease (CKD) had significantly higher endocan levels vs those who were hypertensive or normotensive without CKD (P =.002 and P <.001, respectively).

Limitations of this study include inclusion of underpowered studies, potential subgroup bias, and the inability to establish the relationship between serum endocan and various stages of hypertension.

“Overall, this systematic review and meta-analysis indicated that in hypertensive patients circulating endocan levels are significantly elevated,” the investigators wrote. “…more studies should be conducted to solidify and support this association, compare endocan concentration in different stages of the disease and its prognostic value, and identify pitfalls, including synchronous comorbidities that cause the observed association to fail to be specified.”

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Luke J. Laffin, M.D., from the Cleveland Clinic Foundation, and colleagues compared the safety and efficacy of lorundrostat with placebo in a randomized trial among adults with uncontrolled hypertension taking two or more antihypertensive medications. An initial cohort of 163 participants with suppressed plasma renin (plasma renin activity [PRA] ≤1.0 ng/mL/h) and elevated plasma aldosterone (≥1.0 ng/dL) were enrolled and randomly assigned to placebo or one of five doses of lorundrostat; 37 participants with PRA greater than 1.0 ng/mL/h were subsequently enrolled and randomly assigned to placebo or lorundrostat 100 mg once daily.

The researchers observed changes in office systolic blood pressure of −14.1, −13.2, −6.9, and −4.1 mm Hg with 100, 50, and 12.5 mg once daily of lorundrostat and placebo, respectively, following eight weeks of treatment in participants with suppressed PRA. In individuals receiving twice-daily doses of 25 and 12.5 mg of lorundrostat, observed reductions in systolic blood pressure were −10.1 and −13.8 mm Hg, respectively. The least-squares mean difference in systolic blood pressure between placebo and treatment was −9.6 and −7.8 mm Hg, respectively, for the 50- and 100-mg once-daily dose. Systolic blood pressure decreased by 11.4 mm Hg among participants without suppressed PRA receiving 100 mg once-daily lorundrostat, which was similar to the blood pressure reduction with the same dose among those with suppressed PRA.

“The trial results support further study of lorundrostat as a treatment for uncontrolled hypertension,” the authors write.

Several authors disclosed ties to biopharmaceutical companies, including Mineralys Therapeutics, which manufactures lorundrostat and funded the trial.

Abstract/Full Text

Editorial

More Information

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Adovich S. Rivera, M.D., Ph.D., from Kaiser Permanente Southern California in Pasadena, and colleagues examined the risk for incident hypertension and statin initiation among adult health plan members initiating PrEP with TAF vs TDF in a retrospective cohort study. Propensity score matching was conducted to generate matched data sets (1:4 TAF:TDF) with balanced baseline covariates.

Data were included for 6,824 eligible individuals. Two cohorts were generated without baseline hypertension or statin use for matching: 5,523 for hypertension and 6,149 for statin. Researchers found that in a matched analysis adjusted for baseline covariates, the risk for incident hypertension was elevated in association with TAF use (odds ratio, 1.64). An elevated risk for statin initiation was also seen in association with TAF use (odds ratio, 2.33). Similar results with a larger risk difference in statin initiation were seen in a subgroup analysis restricted to individuals aged 40 years and older at PrEP initiation (odds ratio, 3.05).

“TAF has been a welcome addition to the products for PrEP due to its benefits on kidney and bone health and smaller pill size,” the authors write. “However, it may have unwanted impact on cardiometabolic health.”

Two authors disclosed ties to the pharmaceutical industry.

Abstract/Full Text

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Investigators sought to determine the association between alcohol consumption (particularly at low levels) and BP. Mean differences over time of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were the primary outcomes.

The investigators conducted a systematic review and meta-analysis searching the Embase and PubMed databases for longitudinal studies reporting on the association between alcohol intake and BP levels in healthy adults, published in English or Italian before May 2023. They included 7 cohort or case-cohort studies (N=19,548; 65% men; median follow-up, 5.3 years [range, 4-12 years]). Among the included studies, 3 were conducted in the United States, 3 in Japan, and 1 in South Korea. Cross-sectional studies and those enrolling participants with existing cardiovascular disease, diabetes, or cirrhosis or primarily recruiting alcoholics or binge drinkers were excluded.

There was no suggestion of an exposure-effect threshold and over time a positive linear association was found to exist between baseline alcohol intake and changes in SBP and DBP.  Average SBP was 1.25 mm Hg higher for 12 grams daily (g/d) of alcohol consumption and 4.90 mm Hg higher for 48 g/d consumption compared with no consumption. The corresponding differences for DBP were 1.14 mm Hg for 12 g/d alcohol consumption and 3.10 mm Hg for 48 g/d consumption.

Stratified by highest vs lowest alcohol intake, SBP and DBP showed an increased mean difference (4.3 mm Hg [95% CI, -2.76 to 5.85; I²=67.11%]; and 2.42 mm Hg [95% CI, 1.13-3.71; I²=78.45%], respectively).

An almost linear relationship was found to exist between baseline alcohol intake and SBP changes in men and women, remaining consistent for DBP in men. DBP in women had an inverted U-shaped association with alcohol intake. SBP difference in men for an alcohol intake of 12 g/d vs no alcohol consumption was 1.33 mm Hg and 4.95 mm Hg for an intake of 48 g/d. Corresponding DBP difference in men was 1.20 mm Hg for 12 g/d alcohol consumption and 3.41 mm Hg for 48 g/d.

SBP difference in women for an alcohol intake of 12 g/d vs no consumption was 0.82 mm Hg and 3.31 mm Hg for an intake of 48 g/d. Corresponding DBP difference in women was 1.45 mm Hg for 12 g/d alcohol consumption and -1.27 mm Hg for 48 g/d.

Subgroup analysis showed that, other than DBP in North American patients, alcohol intake was positively associated with BP changes in Asian and North American patients. Among the 7 included studies, 2 were rated as low risk of bias, 4 as moderate risk, and 1 as high risk (according to the Risk of Bias in Nonrandomized Studies of Exposure assessment tool).

Study limitations include the small number of included studies, relatively high heterogeneity, exposure misclassification, and the nonexperimental design.

“Our results suggest the association between alcohol consumption and SBP is direct and linear with no evidence of a threshold for the association, while for DBP the association is modified by sex and geographic location,” the investigators wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Researchers conducted a participant-level data meta-analysis to evaluate the effects of BP-lowering treatment on the risk for major CVD events with use of the Blood Pressure Lowering Treatment Trialists’ Collaborations (BPLTTC) data set.

The analysis included all trials with a minimum of 1000 person-years of follow-up in randomly assigned groups and trials that reported data on sex, age, and BP levels during randomization and follow-up. The primary outcome was the first major CVD event.

Analysis also was conducted according to baseline categories of systolic BP in 10-mm Hg increments from 120 to 170 mm Hg and the age categories of younger than 55, 55 to 64, 65 to 74, 75 to 84, and 85 years or older, as well as the interaction between treatment and sex in each category.

A total of 51 randomized controlled trials with 358,635 participants were included, and 41.6% of the participants (n=149,193) were women. The women had a mean (SD) age of 66.2 (9.8) years vs 64.2 (9.4) for the men.

The median follow-up was 4.2 years, and 43,350 major CVD events occurred. The incidence rate for the primary outcome was 8.7 (95% CI, 8.5-8.8) per 100,000 person-years in women and 11.1 (95% CI, 11.0-11.2) per 100,000 person-years in men.

The incidence rates of major CVD outcomes in the treatment and comparator groups among women were 7.8 (95% CI, 7.6-8.0) and 9.5 (95% CI, 9.3-9.7) per 100,000 person-years, respectively, compared with corresponding incidence rates in men of 10.4 (95% CI, 10.2-10.6) and 11.8 (95% CI, 11.6-11.9) per 100,000 person-years, respectively.

Hazard ratios associated with a 5-mm Hg decrease in systolic BP for risk for the primary outcome were 0.92 (95% CI, 0.89-0.95) in women vs 0.90 (0.88-0.93) in men, with no statistically significant heterogeneity of relative effect between sexes observed (all P for interaction, ≥0.38).

No heterogeneity of relative treatment effects was observed by sex for major CVD events in any age category (all P for interaction, ≥.54). In addition, no evidence was found that the relative effects were different between women and men by systolic BP at baseline (all P for interaction, ≥.57).

An analysis that included a stratified network meta-analysis showed no evidence of a difference in treatment effects between women and men for any of the drug classes.

Among several limitations, all eligible trials were not included in the meta-analysis, and some conditions, such as peripheral vascular diseases, were different between men and women for diagnosis and treatment. Also, the outcomes are defined based on a series of major CVD events and do not include other important vascular conditions, and information on menopause status was not available.

“This extensive study affirms the efficacy of BP-lowering interventions in reducing CVD risk across both sexes,” wrote the investigators. “It advocates for an approach to BP management that prioritizes individual cardiovascular risk profiles, challenging the reliance on a single determinant like age or sex.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Investigators sought to assess offspring from mothers who experienced HDP-affected pregnancies to determine the incidence of chronic hypertension and examine the effect of maternal chronic hypertension and HDP exposure in utero.

The investigators conducted a population-based cohort study using the Rochester Epidemiology Project medical records linkage system (links all medical records of providers in Olmsted County, Minnesota, US). The study included 8755 individuals with more than 1 year of follow-up born to 6658 unique mothers living in Olmsted County at the time of delivery from January 1976 through December 1982. Sufficient pregnancy records included at least 1 blood pressure reading to identify the possible presence of HDP. Diagnosis of HDP was attributed to either an HDP diagnostic code in medical records or at least 2 blood pressure measurements greater than 140/90 mm Hg.

Diagnostic codes in the Rochester Epidemiology Project were used to establish a diagnosis of chronic hypertension in mothers and offspring through December 2019.

A total of 655 offspring were born to mothers who experienced HDP during pregnancy. Among the 6658 unique mothers, 72.3% had 1 child in the cohort, 24.2% had 2 children in the cohort, and 3.5% had 3 or 4 children in the cohort (63 sets of twins total). Maternal age at delivery (26.7 years vs 26.9 years) showed no significant difference between mothers experiencing HDP vs those not experiencing HDP. Of the offspring born to mothers experiencing HDP, 48.7% were girls vs patients born to mothers not experiencing HDP, of which 48.1% were girls. Gestational age was at least 37 weeks for 91.8% of offspring born to mothers who experienced HDP vs 94.8% of offspring born to mothers who did not experience HDP.

The investigators found that significantly increased risk for chronic hypertension in offspring was independently associated with HDP exposure (hazard ratio [HR], 1.50; 95% CI, 1.18-1.90). Chronic hypertension in offspring was significantly higher among offspring of mothers with HDP vs mothers without HDP (8.9% vs 5.5% in offspring 30 years of age; 22.5% vs 15.7% in offspring 40 years of age).

Among offspring not exposed to HDP in gestation, maternal chronic hypertension associated with 1.6-fold increased risk for chronic hypertension.

Maternal chronic hypertension as a covariate was associated with increased risk for hypertension in offspring (HR, 1.73, 95% CI, 1.48-2.02).

Multivariate analysis including both risk factors maintained a significant association with increased risk (2.4-fold increase) of hypertension in offspring.

Study limitations include the use of diagnostic codes to identify chronic hypertension instead of blood pressure measurements, unaccounted-for change over time in the definition of hypertension, and unadjusted-for obesity as a confounding variable.

“Offspring of mothers with chronic hypertension are at increased risk of hypertension in early adulthood,” the study authors wrote. “Those who were exposed to hypertensive disorders of pregnancy in gestation are at additional increased risk and thus may benefit from additional screening and close clinical follow-up.”

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The retrospective cohort study sought to create and validate predictive models using early pregnancy BP trajectory patterns before 20 weeks’ gestation.

Data were obtained for BP measurements; prepregnancy information; sociodemographic, clinical, social, and lifestyle risk factors; and perinatal outcomes for pregnancies longer than 20 weeks delivered from January 1, 2009, to December 31, 2019, from the Kaiser Permanente Northern California (KPNC) system.

The first index singleton live or still birth with BP measurements was selected for each participant. Of 249,892 eligible pregnant women, 30% were in the internal validation data set and 70% were included in the development data set .

Early-onset preeclampsia was classified as a diagnosis at 20 to less than 34 weeks’ gestation, later-onset preeclampsia was classified as a diagnosis at 34 weeks’ gestation or longer, and gestational hypertension was classified as a diagnosis after 20 weeks’ gestation. Patients without a HDP were the reference group.

The investigators identified 6 early pregnancy systolic BP trajectory groups, which were ordered based on increasing risk of HDP (ultra-low declining to elevated stable). The predictive models were fit with different combinations of variables included sequentially to quantify and assess the predictive value of the BP trajectory groups and other risk factors.

The mean (SD) maternal age at delivery was 30.9 years (5.3 years), and the mean gestational age at the start of prenatal care was 8.2 (2.0) weeks (range, 0-14 weeks).

For the development data set, 700 (0.4%), 7571 (4.3%), and 7981 (4.6%) of pregnancies had early-onset preeclampsia, later-onset preeclampsia, or gestational hypertension after 20 weeks’ gestation, respectively. The validation set had similar corresponding outcomes, which were 308 (0.4%), 3195 (4.3%), and 3533 (4.7%), respectively.

Multivariable, multinominal logistic regression models in the development dataset showed that the BP trajectory groups were independently associated with an increasing gradient of adjusted odds ratios (aORs) for early-onset preeclampsia, later-onset preeclampsia, and gestational hypertension.

The best prediction model included the 6 BP trajectory groups and all standard clinical risk factors (C-statistics) for early-onset preeclampsia (0.747; 95% CI, 0.719-0.775), later-onset preeclampsia (0.731; 95% CI, 0.723-0.740), and gestational hypertension (0.770; 95% CI, 0.762-0.778; all P <.001).

The models with the BP trajectory groups plus all risk factors had excellent calibration performance, and no evidence of poor fit based on Hosmer-Lemeshow was found (P =.99, .99, and .74 for early-onset preeclampsia, later-onset preeclampsia, and gestational hypertension, respectively).

A limitation of this study is that the researchers could not evaluate individual-level social determinants of health that may affect risk differences or identify individuals with previous gestational hypertension or those treated with artificial reproductive technology. Also, preeclampsia may have been underestimated for births before KPNC health plan membership, and the models were not assessed in an external validation population.

“Classification of early pregnancy systolic BP patterns based on BP changes from 0 through 16 to 20 weeks’ gestation in combination with other standard risk factors (clinical, social, and behavioral) can significantly improve individual risk stratification for early-onset and later-onset preeclampsia and gestational hypertension, allowing more targeted surveillance and potentially interventions to ameliorate hypertensive disorders of pregnancy and adverse outcomes, as well as avoidance of additional monitoring, or unnecessary interventions (ie, low-dose aspirin administration) in low-risk pregnancies,” wrote the study authors.

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A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. The eligible studies included cross-sectional studies that reported hepatic venous pressure gradient and SSM, utilizing transient elastography; 2-dimensional shear-wave elastography (2D-SWE); and point shear-wave elastography (p-SWE) in adults with compensated advanced chronic liver disease (ACLD).

The primary outcome was the performance of 2 SSM-based algorithms. These algorithms were evaluated based on their sensitivity, specificity, and summary negative predictive values (NPV) and positive predictive values (PPV) in comparison to the Baveno VII model.

A total of 1,245 patients were included across 17 studies that met the inclusion criteria. Of these, 11 studies were available in full-text format, while the remaining 6 studies were abstracts.

The main cohort for transient elastography included 600 patients (mean [SD] age, 58[12] years; men, 69%) with viral etiology. The median rate of SSM failure was 16% (95% CI, 7-24), and 27% of patients had large varices.

The Baveno VII algorithm was validated to effectively identify both the presence and absence of clinically significant portal hypertension.  It demonstrated a 100% sensitivity and NPV for ruling out this condition, while also achieving a 95% PPV and specificity for ruling it in. However, 48% (95% CI, 44-52) of patients had indeterminate results in the gray zone, while 57% (95% CI, 52-62) of patients with clinically significant portal hypertension fell within the rule-in zone.

The single cutoff model of Baveno VII-SSM demonstrated a high sensitivity of 93% (95% CI, 85-97) and a NPV of 85% (95% CI, 60-96) in effectively ruling out clinically significant portal hypertension. Furthermore, it exhibited a specificity of 86% (95% CI, 80-91) and a PPV of 92% (95% CI, 83-95) in accurately identifying cases of clinically significant portal hypertension. Notably, 88% (95% CI, 84-91) of patients with clinically significant portal hypertension fell within the rule-in zone, while 9% (95% CI, 7-12) of patients were categorized in the gray zone.

The dual cutoff model of Baveno VII-SSM exhibited favorable results in terms of NPV at 98% (95% CI, 58-100) and sensitivity at 100% (95% CI, 91-100). Additionally, it displayed a PPV of 93% (95% CI, 84-97) and specificity of 89% (95% CI, 84-93). The gray zone accounted for approximately 32% (95% CI 28-36) of patients, while the rule-in zone included 76% (95% CI 72-80) of patients with clinically significant portal hypertension.

Within the 2D-SWE cohort (n=225), all 3 algorithms identified clinically significant portal hypertension (PPV ≥90%). However, despite their effectiveness, these algorithms fell short in ruling out clinically significant portal hypertension, as their NPV was inadequate. Moreover, the available data were insufficient to evaluate the performance of SSM using p-SWE.

The study was limited due to the absence of individual patient data from four study groups, leading to the exclusion of certain eligible patients from the meta-analysis.

Researchers concluded, “Further studies are needed to assess if SSM-based diagnosis can identify patients who would benefit from non-selective β-blocker treatment.” 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Researchers sought to determine the incidence of and identify risk factors for new-onset persistent HTN after COVID-19 infection vs influenza, and compared them in both hospitalized and nonhospitalized patients.

A retrospective observational study was conducted and included 28,576 patients with COVID-19 (from March 2020 to August 2022) infection and 13,864 patients with influenza (from January 2018 to August 2022) without a medical history of HTN from the Montefiore health system in New York. Of the total patients with COVID-19 and patients with influenza, only 5562 and 619 were hospitalized, respectively.

The primary outcome was the development of new-onset persistent HTN from time of admission to the 6-month follow-up. This was defined as either a minimum systolic blood pressure (SBP) above 140 mm Hg or a diastolic blood pressure (DBP) above 90 mm Hg, a new ICD-10 HTN code diagnosis, or a new antihypertensive medication prescription at the follow-up visit. Risk factors for new-onset persistent HTN were assessed using a logistic regression model. The odds ratio was calculated and adjusted for age, sex, intensive care unit status, C-reactive protein, lactate dehydrogenase, and D-dimer test at admission.

At the 6-month follow-up visit, 1455 hospitalized patients and 5565 nonhospitalized patients with COVID-19 returned, and 147 hospitalized and 2400 nonhospitalized patients with influenza returned.

Compared with patients with influenza, both hospitalized (adjusted odds ratio [aOR], 2.23; 95% CI, 1.48-3.54; P <.001) and nonhospitalized (aOR, 1.52; 95% CI, 1.22-1.90; P <.01) patients with COVID-19 had a significantly higher incidence of new-onset persistent HTN at the 6-month follow-up visit. Incidence of new-onset persistent HTN in hospitalized patients with COVID-19 infection and influenza was 20.60% and 16.30%, respectively. Incidence of new-onset persistent HTN in nonhospitalized patients with COVID-19 infection and influenza was 10.85% and 4.40%, respectively.

The most significant risk factors for new-onset HTN in nonhospitalized and hospitalized patients with COVID-19 were age (P =.000), Black race (P =.000), chronic kidney disease (P =.005), chronic obstructive pulmonary disease (P =.008), and coronary artery disease (P =.015).

Among patients who later developed persistent hypertension, hospitalized patients with COVID-19 were more likely to be older, be men, be Black, have congestive heart failure or chronic kidney disease or coronary artery disease, and be prescribed corticosteroids and vasopressors during hospitalization (all P <.05). Nonhospitalized patients with COVID-19 were more likely to be older, men, White or Black, and less likely to be Hispanic (all P <.05). Hospitalized patients with influenza were more likely to be older, have higher SBP and DBP, and have lower respiratory rate during admission.

A sensitivity analysis was also conducted using a 130/80 mm Hg cutoff. The results were similar to the trend found in the primary outcome. The incidence of new-onset persistent HTN was higher in both hospitalized and nonhospitalized patients infected with COVID-19 compared with influenza (hospitalized patients, 34.8% vs 19.3%; nonhospitalized patients, 25.7% vs 9.1%).

A key study limitation is that the results for the incidence of HTN are restricted to only patients who returned for follow-up visit. Other factors that may affect the incidence of HTN (eg. vaccination rate, strain of SARS-CoV-2, testing rate, population profile, and disease severity) were not reliably recorded.

“…the incidence of new-onset persistent hypertension in patients with COVID-19 was significantly higher compared with patients with influenza,” the study authors wrote. “The mass number of people affected by COVID-19 suggests that new-onset persistent hypertension could be a major postinfection cardiovascular sequela at the population level.”

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Kaikai Lv, M.D., from The Chinese People’s Liberation Army General Hospital in Beijing, and colleagues conducted a two-sample Mendelian randomization (MR) study to examine the causality of metabolic syndrome (MetS) and its components on BPH using summary-level data from genome-wide association studies. Data were included for 26,358 BPH cases and 110,070 controls.

The researchers observed significant positive associations for genetically predicted waist circumference and DBP with BPH risk. No causal effect was seen for MetS, systolic blood pressure, triglycerides, high-density lipoprotein, or fasting blood glucose on BPH. The risk effect of DBP on BPH persisted after conditioning with waist circumference in the multivariable MR analysis, but no significant association for waist circumference was observed.

“Our MR study provides genetic evidence supporting the causal effect of DBP on BPH. However, the role of increased waist circumference in the risk of developing BPH requires further validation,” the authors write. “Our results suggest that the management of DBP may prevent BPH development.”

Abstract/Full Text (subscription or payment may be required)

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Investigators conducted a retrospective cohort study including patients aged at least 18 years with connective tissue disease-pulmonary arterial hypertension (CTD-PAH). They assessed clinical disease characteristics to aid clinicians in recognizing prognostic and survival predictors among patients with CTD-PAH.

The primary endpoints were prevalence of PAH among patients with CTD and the clinical characteristics of CTD-PAH. Secondary endpoints included prognostic factors and clinical outcomes among patients with systolic pulmonary arterial pressure (sPAP) greater than 35 mmHg and survival rates among patients with non-PAH-CTD, mild CTD-PAH, and moderate-severe CTD-PAH.

Out of 5142 patients with CTD, 144 patients (2.80%) were diagnosed with PAH and included in the analysis. The prevalence of PAH differed depending on the type of CTD, with the greatest prevalence found among patients with systemic sclerosis (15.32%), mixed connective tissue disease (14.10%), and primary biliary cholangitis (11.54%).

The median sPAP value was 52.5 (95% CI, 44.0-71.0) mmHg, 55.6% of patients received targeted drugs, and 27.5% received combination therapy.

Patients with CTD-PAH had worse cardiac function (P =.019), higher levels of N-terminal pro-B-type natriuretic peptide (NT-pro BNP; P =.022) and γ-globulin (P =.023), as well as lower levels of partial pressure of carbon dioxide (P =.045) compared against patients with non-PAH-CTD.

There was no significant difference in final follow-up sPAP greater than 35 mmHg among patients with non-PAH-CTD, mild CTD-PAH and moderate-severe CTD-PAH, though a notable difference in survival rates was observed. The investigators noted this finding demonstrates that baseline sPAP values affect survival rates.

Univariate analysis based on cut off values revealed that Hb (hazard ratio [HR], 2.48; 95% CI, 1.07-5.77; P =.035), pH (HR, 4.55; 95% CI, 1.78-11.62; P =.002), and NT-pro BNP (HR, 2.91; 95% CI, 1.2-7.05; P =.018) were found to be significantly associated with survival.

According to multivariate analysis, Hb greater than 109.0 g/L and pH greater than 7.457 were independent predictors of increased risk for mortality.

This study was limited by diagnosis of PAH via echocardiography instead of invasive right heart catheterization, which could lead to inaccuracies in PAH rates. Additionally, the small sample size analyzed may affect the strength of the results and confounding variables may be present.

The study authors noted, “Regular echocardiography monitor is recommended strongly in the CTD patients management to identify CTD-PAH as early as possible.”

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Investigators sought to evaluate visit-to-visit SBP variability in patients with type 2 diabetes mellitus (T2DM) with CKD or at high cardiovascular risk being treated with canagliflozin. Additionally, they aimed to assess the association of SBP variability with mortality, cardiovascular, and kidney outcomes.

They conducted a post-hoc analysis combining data from the CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation; ClinicalTrials.gov Identifier: NCT02065791) trial  and CANVAS (Canagliflozin Cardiovascular Assessment Study; ClinicalTrials.gov Identifiers: NCT01032629 and NCT01989754) Program. CREDENCE and CANVAS were multicenter, double-blind, placebo-controlled, randomized trials evaluating the effects of canagliflozin among patients (pooled N=14,543; mean age 63.1 years; 35.7% women; 60.3% prior cardiovascular disease) with T2DM with CKD or high cardiovascular risk. Previous pooled analyses have shown canagliflozin significantly reduced risk of cardiovascular and all-cause mortality, hospitalization for heart failure, and kidney failure over a median of 2.5 years follow-up.

In this analysis, the investigators evaluated the effect of canagliflozin on SBP variability among patients (N=11,551) with T2DM across 4 study visits spanning 1.5 years. They noted 3.9% of patients died due to cardiovascular disease or were hospitalized for heart failure, 3.8% died of any cause, and 5.4% experienced a major adverse cardiovascular event during median follow-up of 1 year.

Compared with placebo, canagliflozin reduced mean and maximum SBP in adjusted models (-4.04 mm Hg; 95% CI, -4.49 to -3.59; and -4.36 mm Hg; 95% CI, -4.90 to -3.82), respectively.

There was no effect on the coefficient of variation (0.02%; 95% CI, -0.12 to 0.16) or variability independent of the mean (0.08; 95% CI, -0.11 to 0.26 adjusting for correlation with mean SBP) with canagliflozin, though the standard deviation (SD) of SBP variability was slightly lowered (-0.25 mm Hg; 95% CI, -0.44 to -0.06).

Each standard deviation increase in SD of SBP variability independently associated with higher risk of all-cause mortality (12% increased risk; hazard ratio [HR], 1.12; 95% CI, 1.01-1.25), higher risk for hospitalization for heart failure (19% increased risk; HR, 1.19; 95% CI, 1.02-1.38), and higher risk of cardiovascular death or hospitalization for heart failure (14% increased risk; HR, 1.14; 95% CI, 1.03-1.27). These findings were consistent with results for the coefficient of variation and variability independent of the mean.

There was no association between increases in SBP variability with kidney outcomes.

Limitations of the study include availability of SBP data being only at study visits and a relatively short follow-up.

“In people with type 2 diabetes at high cardiovascular risk or with chronic kidney disease, higher visit-to-visit SBP variability is independently associated with risks of hospitalization for heart failure and all-cause mortality,” the study authors wrote.  “Canagliflozin has little to no effect on SBP variability, independent of its established SBP-lowering effect.”  They added, “Cardiorenal protection with sodium glucose cotransporter-2 inhibitors is unlikely to be substantively mediated by benefits on systolic blood pressure variability.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Wendy J. Bottinor, M.D., from Virginia Commonwealth University in Richmond, and colleagues assessed the incidence and predictors of left ventricular systolic dysfunction (LVSD) and hypertension among AYAs receiving VEGF inhibition. The analysis included 1,572 participants (103 AYAs aged 18 to 39 years) with nonmetastatic, high-risk renal cell cancer who were randomly assigned to sunitinib, sorafenib, or placebo.

The researchers found that during 54 weeks of treatment, the incidence of LVSD was not significantly different among AYAs (3 percent) versus non-AYAs (2 percent). Among AYAs, the incidence of hypertension was significantly lower versus non-AYAs in the placebo arm (8 versus 46 percent). The incidence of hypertension was 29 percent for AYAs versus 47 percent for non-AYAs in the sunitinib group and 54 versus 63 percent in the sorafenib group. A lower risk for hypertension was seen with AYA status (odds ratio, 0.48) and female sex (odds ratio, 0.74).

“The large number of AYAs who had high blood pressure during treatment with sunitinib or sorafenib suggests that even individuals without identifiable pre-existing factors — such as older age, obesity, and male gender — are also at significant risk for hypertension from these drugs,” Bottinor said in a statement.

Abstract/Full Text

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Using the Korean Organ Transplantation Registry (KOTRY), investigators identified 642 hypertensive and 4848 normotensive living kidney donors. Hypertensive donors had a significant 1.8-fold increased risk for proteinuria compared with normotensive donors, Hyeon Seok Hwang, MD, of Severance Hospital, Yonsei University College of Medicine, and colleagues reported. Proteinuria risk tended to increase even after 4-5 years, they noted.

Both before and after nephrectomy, hypertensive living donors had lower estimated glomerular filtration rates (eGFR) than normotensive donors. They had no greater risk of developing chronic kidney disease, however. The risk of eGFR falling below 60 or 45 mL/min/1.73 m² did not differ significantly between groups.

“Careful monitoring for proteinuria is required in hypertensive donors after nephrectomy,” Dr Hwang’s team concluded.

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Investigators aimed to assess incident hypertension at 48 weeks in virologically suppressed patients with HIV. Secondary outcomes were factors associated with incident hypertension, discontinuations and adverse events associated with high blood pressure, and changes in systolic (SBP) and diastolic (DBP) blood pressure.

They initiated a post-hoc analysis of the NEAT022 randomized trial, (ClinicalTrials.gov Identifier: NCT02098837) which was conducted between May 2014 and November 2015 across 6 European countries at 32 clinical sites. Individuals at least 18 years of age with plasma HIV RNA of less than 50 copies/mL for at least the previous 6 months and with a Framingham cardiovascular disease (CVD) risk score of greater than 10% at 10 years receiving 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus 1 boosted protease inhibitor (PI/r) and patients with HIV who were aged at least 50 years were eligible for the study.

Participants were randomly assigned 1:1 to treatment groups (open label) stratified by country and either switched PI/r therapy to dolutegravir immediately (DTG-I) or continued PI/r therapy for 48 weeks then switched to dolutegravir (delayed; DTG-D) with all participants continuing on dolutegravir for another 48 weeks (to week 96).

Incidence of new diagnosis of hypertension at 48 weeks was the primary endpoint of the study. Participants with hypertension or who were receiving antihypertensive drugs at baseline were excluded from the study. Hypertension was defined as at least 130 mm Hg SBP or at least 85 mm Hg DBP. All outcomes were analyzed on a modified intention-to-treat (mITT) basis.

Baseline factors independently associated with higher hypertension risk at week 48 included lack of daily exercise, Black race, male gender, and being over 60 years of age. Baseline factors independently associated with hypertension risk at week 96 included daily exercise, smoking status, female gender, and 10-year Framingham CVD risk score of greater than 15%.

The investigators found there were 412 patients with HIV who received at least 1 dose of dolutegravir (DTG-I, n=204; DTG-D, n=208). Among all participants, 191 (46.4%) had hypertension at baseline and 24 received antihypertensive medications for other reasons. Among the remaining 197 participants not receiving hypertensive medications at baseline or without hypertension (DTG-I, n=98; DTG-D, n=99) incident rates at 48 weeks for DTG-I vs DTG-D were 40.3 vs 34.7 per 100 person years (P =.5755) and at 96 weeks they were 36.3 vs 52.0 per 100 person years (P =.2347). Between baseline and 48 weeks, there were 56 participants in this population with incident hypertension and between 48 and 96 weeks there were 45 additional participants with incident hypertension.

There was no between-group difference in SBP or DBP changes. Significant increases were noted in the first 48 weeks of exposure to dolutegravir in DBP in the DTG-I group (mean, +2.78 mm Hg; 95% CI, 1.07-4.50; P =.0016) and in the DTG-D group (mean, +2.29 mm Hg; 95% CI, 0.35-4.23; P =.0211). Significant increases were noted from baseline to week 96 in DBP in the DTG-I group (mean, +3.28 mm Hg; 95% CI, 1.36-5.19; P =.0009) and in the DTG-D group (mean, +3.71 mm Hg; 95% CI, 1.78-5.64; P =.0002).

There was no independent association between treatment arms and incident hypertension at weeks 48 or 96.

Study drugs were discontinued by 3 participants receiving dolutegravir therapy and 1 receiving PI/r therapy due to adverse high blood pressure events. Overall, there were 19 participants who reported adverse events associated with high blood pressure or hypertension (DTG-I, 11 [all under dolutegravir exposure]; DTG-D, 8 [3 under dolutegravir exposure]).

Limitations of the study include the study population having a high risk for cardiovascular disease, which limits generalizability. There is also a lack of women and Black patients. Additionally, the study reduced the NEAT022 population by half for this analysis.

“…the population with HIV of the NEAT022 study at high risk for CVD showed a high prevalence of hypertension at baseline and a remarkably high incidence of hypertension during 96 weeks of follow-up,” the investigators wrote. “Switching to dolutegravir did not negatively impact on the incidence of hypertension relative to continue protease inhibitors.”

Disclosure: This research was supported by ViiV Healthcare. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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The systematic review and meta-analysis evaluated current evidence regarding the association between pre-eclampsia diagnosed during pregnancy and the risk for endometrial cancer.

Researchers conducted a literature search in the EMBASE, MEDLINE, and Web of Science databases from inception until March 2022. Titles and abstracts were screened independently, and relevant abstracts were reviewed independently by at least 2 reviewers.

Eligible studies reported a risk estimate and 95% confidence interval (CI) or sufficient information to calculate an estimate. The risk estimates and 95% CIs were converted to log values, and a random-effects model was used to statistically pool the findings.

The analysis included 7 studies, 3 conducted in Europe and 4 in Asia. Of these studies, 5 studies had a cohort design, 1 used a nested case-control approach, and 1 was a case-control study. A total of 714,286 women with 11,724 identified endometrial cancer cases were included in the analysis,.

The pooled analysis for all studies demonstrated no significant association between pre-eclampsia and the risk for endometrial cancer, with moderate heterogeneity (pooled hazard ratio [HR], 1.07; 95% CI, 0.79-1.46; I²=34.1%).

A subgroup analysis based on study quality yielded similar results (Newcastle-Ottawa Scale [NOS] score ≥7: pooled HR, 1.05; 95% CI, 0.72-1.54; I²=50.7%; NOS score <7: pooled HR, 0.90; 95% CI, 0.39-2.08; I²=0.0%).

A sensitivity analysis investigating the risk for any subtype of endometrial neoplasia found that pre-eclampsia was associated with an increased risk for carcinoma in situ,  atypical hyperplasia, or cancer, with a pooled HR of 1.34 (95% CI, 1.15-1.57) with moderate heterogeneity (I²=38.5%).

Among several limitations, only 7 studies are included, and misclassification of exposure is possible and may have affected the results. Also, varying definitions for pre-eclampsia are used, only observational studies are included, and all studies were conducted in European or Asian populations.

“Overall, the findings from this systematic review and meta-analysis suggested no association between pre-eclampsia and subsequent risk of endometrial cancer,” wrote the researchers. “To further elucidate the relationship between pre-eclampsia and endometrial cancer risk, future studies are required and should aim to include large prospective cohorts using validated data to investigate pre-eclampsia onset, as well as endometrial cancer type and precursor conditions.”

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Researchers used data from the National Health and Nutrition Examination Survey (NHANES) to determine the antihypertensive medication regimens used by US adults taking 2 or more antihypertensive medications and estimate the degree to which available FDC products meet the needs of real-world treatment patterns.

The analysis included NHANES participants aged 20 years or older with complete blood pressure and medication data available from 2015 to 2016 and 2017 to March 2020. Each participant’s antihypertensive medication regimen was categorized based on the medication classes used.

The primary outcome was the availability of the full antihypertensive medication regimen as 1 FDC product and was assessed at the class combination level.

The cohort included 2451 participants (weighted N=34.1 million) with hypertension who were taking 2 or more antihypertensive medications. Their mean age was 66.0 years, 52.8% were women, and 69.1% self-reported as non-Hispanic White race and ethnicity. A majority of the participants (60.6%) were taking 2 antihypertensive medications. The proportions of who were receiving medications from 3, 4, and 5 or more antihypertensive classes were 28.2%, 9.1%, and 1.6%, respectively.

Overall, 189 unique class regimens were defined by combinations of antihypertensive medication classes used. The most frequent 2-class regimen was an angiotensin-converting enzyme inhibitor or angiotensin-II receptor blocker and a thiazide (20.1%; 95% CI, 17.5%-22.7%), which was used by an estimated 6.9 million US adults (95% CI, 5.8-8.0 million).

Among the regimens used by US adults with hypertension who were taking 2 or more medications, 7 are available as a class-equivalent FDC product. Among the 31 two-class combinations and 58 three-class combinations that were used, 6 and 1, respectively, are available as a 1-class-equivalent FDC product. No FDC products containing 4 or more antihypertensive classes are available.

Overall, 39.2% (95% CI, 35.5%-43.0%; 13.4 million; 95% CI, 11.8-15.0 million) of US adults are using a regimen that is available as a 1-class-equivalent FDC product, and 60.8% of US adults (95% CI, 57.0%-64.5%; 20.7 million; 95% CI, 18.6-22.9 million) are not.

For individuals who are using only 2 antihypertensive classes, 62.8% (95% CI, 58.7%-66.8%; 13.0 million; 95% CI, 11.4-14.5 million) are able to receive their full regimen in a 1-class-equivalent FDC product, and 4.2% (95% CI, 1.6%-6.9%; 0.4 million; 95% CI, 0.1-0.7 million) of US adults who are using 3 antihypertensive medication classes can receive their complete regimen in an available class-equivalent FDC product.

Limitations of the study include the unavailability of medication doses in NHANES, and the researchers were unable to differentiate between use of FDCs with metoprolol tartrate vs succinate. Also, the cross-sectional study could not determine the regimen appropriateness for each participant.

“There is a substantial gap between the FDC products available on the market and the real-world treatment patterns among US adults with hypertension,” stated the investigators. “Significant improvements in clinician use of regimens currently available as an FDC and in the FDC product armamentarium are needed to realize the benefits of FDC products in clinical care.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

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The EARLY-NH study evaluated the nighttime home BP-lowering effect of esaxerenone in patients with uncontrolled nocturnal hypertension being treated with an ARB or CCB. The open-label, prospective, interventional study was conducted at 17 centers in Japan from April 2021 to March 2022.

The study included a 4-week observation period and a 12-week treatment period, with esaxerenone administered orally once daily. Participants were aged 20 years or older, received a constant dose of 1 ARB or 1 CCB for 4 weeks before initiation of esaxerenone, and had a nighttime systolic BP (SBP) of 120 mm Hg or higher measured with a brachial device.

Home BP was measured with use of a brachial (OMRON HEM-9700T) or wrist (OMRON HEM-9601T) home BP monitoring (HBPM) device. The primary endpoint was change in nighttime home SBP and diastolic BP (DBP) measured via the brachial device from baseline to end of treatment (EOT).

A total of 93 patients were included in the full analysis, 101 were included in the safety analysis, and 89 were included in the per-protocol set. The study was completed by 82 patients. Overall, participants had a mean age of 67.6 years and 50.5% were men.

A statistically significant decrease in nighttime home BP levels from baseline to EOT according to the brachial device occurred in the overall population (-12.9/-5.4 mm Hg, P <.001) and the CCB and ARB subcohorts (-10.0/-4.4 mm Hg and -16.2/-6.6 mm Hg, respectively; each P <.001). Nighttime home BP measured via the wrist device also demonstrated a significant decrease in the total population and ARB and CCB subcohorts. Comparable significant changes occurred in morning home BP, bedtime home BP, and office BP in the total population and ARB and CCB subcohorts.

The overall proportion of patients who met target BP levels at week 12 in the full analysis was 17.2% for nighttime home BP (brachial), 30.1% for nighttime home BP (wrist), 9.7% for morning home BP, and 25.8% for bedtime home and office BP, with similar results occurring in the ARB and CCB subcohorts.

Urinary albumin-to-creatinine ratio was significantly reduced in the total population (geometric percentage change from baseline to week 12, -26.2%; P <.001). N-terminal pro-brain natriuretic peptide levels decreased significantly in the overall and CCB subcohort (geometric percentage change from baseline to week 12, -18.5% and -18.6%, respectively; both P <.01).

Treatment-emergent adverse events (TEAEs) were reported in 39 patients, 3 of whom discontinued treatment. Serious TEAEs occurred in 1 patient (acute pyelonephritis), which was not related to esaxerenone treatment. Drug-related TEAEs occurred in 17 patients, of whom 3 discontinued treatment.

Limitations of the study include the small sample size, which may have led to insufficient statistical power. In addition, the study has a single-arm design that does not include a placebo, and generalizability of the results to other populations should be interpreted with caution.

“Esaxerenone may not only be an optimal treatment option for patients with nocturnal hypertension, but may also be useful in the total BP management,” wrote the investigators.

Disclosure: The EARLY-NH study was supported by Daiichi Sankyo Co, Ltd. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

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The test can identify with 96 percent accuracy which women with sometimes-vague symptoms will develop preeclampsia within the following two weeks, The New York Times reported this week.

“It’s groundbreaking. It’s revolutionary,” Douglas Woelkers, M.D., a professor of maternal-fetal medicine at the University of California, San Diego, said of the test, according to The Times. “It’s the first step forward in preeclampsia diagnostics since 1900, when the condition was first defined.”

The blood test was created by Thermo Fisher Scientific. It is meant for women in the 23rd to 35th weeks of pregnancy. Those who do not test positive can be safely discharged from the hospital, while two-thirds of those with a positive result will advance to severe preeclampsia. Women who are positive may need to deliver their babies early.

“We don’t have a therapy that reverses or cures preeclampsia other than delivery of the baby, which is more like a last resort,” Woelkers said in the news report.

The test, which is already available in Europe, works by measuring the ratio of two proteins produced by the placenta. A study revealed those proteins were highly unbalanced in women who later developed severe preeclampsia. In that study, researchers tracked more than 1,000 pregnant women who were hospitalized at 18 medical centers between 2019 and 2021 with high blood pressure. The findings were published in NEJM Evidence.

The New York Times Article

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Pregnancy-related complications affect women from minoritized racial and ethnic groups at a substantially higher rate compared to non-Hispanic White women.

In May 2023, the American Heart Association (AHA) launched a campaign to address inequities in maternal health outcomes among Hispanic/Latina women in particular, with a focus on increasing awareness regarding the importance of managing blood pressure during pregnancy. As noted in the AHA press release describing this initiative, Hispanic/Latina women may develop hypertension at younger ages and have higher average blood pressure compared with women from other non-Black racial and ethnic groups.¹

Through social media outreach and other resources, the AHA’s awareness campaign aims to engage and educate Hispanic/Latina women on the topic and encourage them to visit their health care provider or pharmacy to check their blood pressure, continue to self-monitor, and follow established lifestyle guidance on maintaining healthy blood pressure.¹

We interviewed the following experts to further discuss disparities in cardiovascular and maternal outcomes in this patient population:

• AHA volunteer expert Johanna Contreras, MD, cardiologist and associate professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York, medical director of the Hispanic Heart Center at Mount Sinai

• Natalie Cameron, MD, internal medicine specialist and instructor of general internal medicine at Northwestern University Feinberg School of Medicine in Chicago, Illinois

• Aarthi Sabanayagam, MD, cardiologist and associate clinical professor of cardiology at the University of California San Francisco (UCSF) School of Medicine and co-director of the UCSF Pregnancy and Cardiac Treatment Program

• Nicole Mitchell, MD, obstetrician and gynecologist and faculty director of the OB/GYN Diversity and Inclusion Program at Keck School of Medicine at the University of Southern California in Los Angeles, California 

The AHA notes that “adverse outcomes related to cardiovascular diseases disproportionately affect Hispanic/Latina mothers.” What are some examples of these outcomes, and what factors may be driving these disparities?

Dr Contreras: Many factors are driving these disparities, including social determinants of health. Findings show a lack of prenatal care, as many Hispanic/Latina women do not have insurance² and often do not receive preventative medications before pregnancy. These women tend to have a lower level of education and socioeconomic status, and they have jobs or multiple jobs that usually do not provide health insurance. In some cases, they depend on insurance from their partner or husband, and many times those are absent.

There is also a higher incidence of hypertension, hypercholesterolemia, and diabetes in Hispanic/Latina women, which can vary by country of origin and immigration status.³ All of these factors are well known to be associated with an increased risk of cardiovascular disease (CVD). Often, during pregnancy or due to the stress of pregnancy, these factors can manifest or worsen during pregnancy, making them difficult to treat and control and likely increasing the risk of CVD—which is the leading cause of maternal mortality.⁴

Additionally, Hispanic/Latina women have been underrepresented at every level, including in clinical trials.

Dr Cameron: From 2019 to 2020, maternal mortality increased significantly—from 12.6 to 18.2 per 100,000 live births—among Hispanic individuals in the US, representing a 44% relative increase in just 1 year.⁵ Similar increases were not seen among non-Hispanic White individuals. Although we do not yet know the cause of this increase, the COVID-19 pandemic has likely played a key role.

Given that CVD is the leading cause of maternal mortality,⁴ understanding the influence of the pandemic on cardiometabolic complications of pregnancy, such as hypertensive disorders of pregnancy and gestational diabetes, in Hispanic individuals is essential.

From 2007 to 2019, Hispanic individuals showed the greatest annual percent change in the incidence of new-onset hypertensive disorders of pregnancy compared to other racial and ethnic groups, with a 7.7% increase per year among those in urban areas.⁶

In 2019, the risk of gestational diabetes was about 1.15 times higher among Hispanic women compared with non-Hispanic White women.⁷ We are still working to understand how the pandemic has influenced prevalence and disparities in these complications and maternal mortality.

Drivers of disparities in adverse pregnancy outcomes are complex and multifaceted. Key contributors are differences in access to healthy and affordable foods, safe places to exercise and play, health care access and health insurance coverage, and reliable interpretation services for those who do not speak English. Historical and structural racism have perpetuated these disparities.

Dr Mitchell: CVD affects 1% to 4% of nearly 4 million pregnancies in the US each year⁸ and is now the leading cause of death in pregnant and postpartum women, accounting for 26.5% of US pregnancy-related deaths, or 4.23 deaths per 100,000 live births. For comparison, that’s almost twice the rate found in the United Kingdom.⁴

The rising trend in maternal deaths due to CVD appears to be due to acquired rather than congenital heart disease, such as the effects of hypertension acquired during one’s lifetime. The most common conditions include heart failure, myocardial infarction, arrhythmia, and aortic dissection. 

Disparities are present amongst these statistics, especially when considering race/ethnicity and age. Per the American College of Obstetricians and Gynecologists (ACOG), non-Hispanic Black women have a 3.4 times higher risk of dying from CVD-related pregnancy complications compared with non-Hispanic White women, independent of other variables.⁹

Between 2011 and 2013, there were 43.5 pregnancy-related deaths per 100,000 live births for non-Hispanic Black women compared with 11.0 and 12.7 pregnancy-related deaths per 100,000 live births for Hispanic and non-Hispanic White women, respectively.⁹ Age older than 40 years increases the risk of myocardial infarction in pregnancy by 30 times compared to the risk for women younger than 20 years.¹⁰

Reasons for these disparities include a combination of structural, institutional, and systemic barriers such as racial and ethnic bias, access to care, and overt systemic racism.

Dr Sabanayagam: Some examples of these outcomes are pre-eclampsia around the peripartum period during pregnancy. When women are affected by adverse pregnancy outcomes such as pre-eclampsia, gestational diabetes mellitus, placental diseases, and low-birthweight babies, they are at increased risk for CVD later in life, such as stroke, myocardial infarction, and coronary artery disease.   

Factors that drive disparities in outcomes in both African American and Hispanic women are highly complex and multifactorial in nature. Some of the factors are age, educations levels, employment and insurance coverage, language literacy, and access to care both during pregnancy and in the postpartum period. The COVID-19 pandemic brought many of these disparities to the forefront, highlighting the importance of understanding the associated factors when providing care to these women.  

In addressing these disparities, why is the emphasis on managing blood pressure during pregnancy especially important?   

Dr Contreras: Hypertension is highly prevalent in Hispanic/Latina women and in certain countries, including Mexico and Puerto Rico, and it has been found to be a top risk factor for disease and for pre-eclampsia and eclampsia during pregnancy.

It is important that all adult women know their blood pressure before pregnancy and to understand what the numbers mean and how to manage blood pressure.  

Dr Cameron: Hypertensive disorders of pregnancy are important risk factors for maternal morbidity and mortality. Managing blood pressure before pregnancy, during pregnancy, and in the postpartum period may prevent other adverse pregnancy outcomes, such as maternal death and delivering a small for gestational age infant. Emerging evidence also suggests the potential for intergenerational transmission of poor cardiovascular health and high blood pressure from mother to baby.¹¹

Dr Mitchell: Controlling blood pressure is extremely important to begin addressing these statistics. Hypertension affects up to 10% of pregnancies, and severe and early-onset hypertension put women at increased risk of cardiac problems during pregnancy or postpartum.¹² For example, in pregnancies complicated by hypertension, the incidence of myocardial infarction and heart failure is 13-fold and 8-fold higher, respectively, than in healthy pregnancies.¹³

Dr Sabanayagam: Pre-eclampsia affects approximately 2% to 8% of pregnancies; however, it affects 30% of pregnancies in those with underlying chronic hypertension.^14,15 The recent CHAP (Chronic Hypertension and Pregnancy) trial from the University of Alabama showed a 20% reduction in pregnancy complications of pre-eclampsia and pre-term births in women who were treated for hypertension with stricter cutoffs of 140/90 mm Hg instead of 160/105 mm Hg.¹⁶ 

What are key recommendations for physicians in terms of addressing this issue and advising patients on reaching and maintaining healthy blood pressure?

Dr Contreras: Patients should be advised to know their numbers, take their blood pressure at home, and understand when it is high so they can seek treatment.

Providers should understand that many medications to control blood pressure are contraindicated during pregnancy, so it is important to change those when patients are looking to become pregnant or are pregnant.

Also, lifestyle modifications are very important to control blood pressure, such as exercise, low-salt diet, cholesterol control, stress reduction, no smoking, and adequate amounts of good-quality sleep.

Even during pregnancy, it is important to maintain a good level of activity, healthy diet, sufficient sleep, and support.

Dr Cameron: First, we need to move upstream to improve blood pressure control and cardiovascular health before pregnancy. In a recent study, we found that less than one-half of individuals enter pregnancy in favorable cardiometabolic health.¹⁷ Emphasizing the importance of optimizing cardiovascular health early in the life course, both at the physician and policy level, is key.

Second, pregnancy is a time of high health care utilization and, therefore, can be an opportunity to empower patients with knowledge regarding cardiovascular health optimization, blood pressure monitoring, and blood pressure goals. Screening for social determinants of health and identifying barriers to controlling blood pressure are essential steps to developing patient-centered plans of care anytime during the peripartum period.

Finally, it is essential to facilitate transitions of care from pregnancy to postpartum. Individuals with hypertension during pregnancy should be seen by a cardiologist or primary care physician for ongoing preventive care and blood pressure management after pregnancy. Unfortunately, many of these patients are lost to follow-up during the first year postpartum. Promoting team-based care and creating systems to facilitate follow-up are key steps to ensuring patients get timely and appropriate care.

Dr Mitchell: On the individual level, physicians should work to identify and mitigate biases during patient care and avoid gaslighting patients to avoid missed diagnoses or inappropriate treatment.

Dr Sabanayagam: Physicians are advised to care for these patients based on their risk profile longitudinally with a multidisciplinary team consisting of internists, cardiologists, obstetricians, and high-risk maternal fetal medicine as well as OB anesthesia, amongst others. ACOG currently recommends a stricter blood pressure target of 140/90 mm Hg during pregnancy, and women with higher blood pressures are advised to start antihypertensive therapy.¹⁸

Over the last decade, initiation of 81mg to 162 mg of aspirin up until delivery has also been advised in some women based on their risk profile, and as early as the 11th week of gestation to reduce the risk of pre-term pre-eclampsia.  

What are a few of the most critical measures needed to foster improvement in this area, such as public health efforts and topics of research to focus on? 

Dr Contreras: Some of the most pressing needs include early diagnosis, treatment, and medical access, blood pressure control, and addressing disparities and social determinants of health. There also needs to be an increased focus on cooking and eating healthy food.

It is important that all women have basic medical care, preventive medicines, increased health coverage during pregnancy and at least 1 year postpartum, as cardiovascular conditions can manifest during the postpartum period, and it is key to control these conditions to improve long-term patient outcomes. Also, if patients have cardiovascular health issues during pregnancy, they are more likely to develop CVD later in life, so care must continue throughout the patient’s life.

We need to empower women to understand how to take better care of their health. We need to increase our education efforts, and they need to be available in Spanish and culturally sensitive to our patients. We need to eliminate structural racism, discrimination, and unconscious bias in our current health care practices to provide better care to all our patients.

We also need to intensify our efforts to increase representation of Hispanic/Latina women in all aspects of care, especially in clinical trials. We need to understand how disease manifests in these populations and if there are differences that need to be understood and better treated. We do not even have any solid epidemiologic data in many countries, not even in the US, regarding CVD in Hispanic/Latina women.

Dr Cameron: The US has the highest maternal mortality rates among developed countries, with persistent disparities by race and ethnicity. Research must continue to identify the drivers of these disparities to help design targeted public health efforts that equitably improve cardiovascular health during the peripartum period. We must also continue to work with local communities to better understand both their assets and barriers to promoting maternal health, and form partnerships that empower communities to make lasting change.

Dr Mitchell: On the system level, we need to enhance multi-disciplinary education for OB/GYN, emergency, pediatric, and internal medicine to recognize and manage cardiac conditions pre-pregnancy and during pregnancy and postpartum, improve access of care—especially to higher-level specialty care—for patients with cardiac conditions, enhance translation services to address language barriers, enhance education for providers and systems regarding anti-racism and cultural humility and proficiency, and enhance community education programs to help aid in educating and treating cardiac-related conditions.

Dr Sabanayagam: The unfortunate rise in recent years in maternal morbidity and mortality is a public health emergency. There have been large efforts across many public health institutions and professional societies to understand these factors, including the social determinants of health, addressing disparities and the lack of access to care, as well investigating ways to improve early diagnosis and treatment of hypertensive disorders in pregnancy to mitigate both short-term and long-term adverse outcomes.   

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Roman Palitsky, Ph.D., from Brown University in Providence, Rhode Island, and colleagues examined hemodynamic responses to the grief recall and the relationship of grief severity to BP response. Analysis included 59 participants within one year of the loss of a close loved one.

The researchers found that systolic BP and diastolic BP increased significantly after grief recall (21.10 and 8.10 mm Hg, respectively). Grief severity predicted magnitude of increase after grief recall for systolic BP but not diastolic BP when adjusting for variables relevant to cardiovascular function and bereavement (e.g., antihypertensive medication use, days since death, gender, and age). There was no relationship observed between grief severity and BP recovery.

“It’s important for psychologists and therapists to encourage grieving clients to get their regular medical checkups,” a coauthor said in a statement. “Often, when we’ve been caring for a loved one who’s dying, we neglect our own health care.”

Abstract/Full Text (subscription or payment may be required)

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Hypertension and SBP variability have been associated with dementia risk. It remains unclear whether the novel metric SBP TTR may also be a predictor for dementia risk.

To evaluate this relationship, data were sourced from the Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension, (SPRINT MIND; ClinicalTrials.gov Identifier: NCT01206062) study, which was a multicenter, randomized, controlled, open-label trial comparing intensive and standard SBP targets. Cognitive outcomes among 8,298 patients were evaluated on the basis of SBP TTR between baseline and 3 months. The intensive SBP target was defined as 110-130 mmHg and the standard target as 120-140 mmHg.

The patients in the first (n=2,763), second (n=2,779), and third (n=2,757) tertiles of TTR were mean age, 68.4, 68.1, and 67.2 years (P <.001); 38.6%, 35.7%, and 30.3% were women (P <.001); 32.0%, 29.4%, and 30.4% were Black; they had a body mass index (BMI) of 29.7, 29.9, and 30.1 kg/m² (P =.011); 17.5%, 17.3%, and 15.0% had a history of cardiovascular disease (P =.024); and, 56.3%, 49.3%, and 44.8% were randomly assigned to the intensive SBP target group (P <.001), respectively.

During a median follow-up of 5.05 years, the overall incidence rate (IR) of probable dementia was 0.77 per 100 person-years (py), mild cognitive impairment (MCI) was 1.63 per 100 py, and probable dementia or MCI was 2.18 per 100 py. In general, the rate of probable dementia was higher among individuals who spent less time in range.

In the fully adjusted model, SBP TTR associated with lower risk for probable dementia (adjusted hazard ratio [aHR], 0.86; 95% CI, 0.76-0.98; P =.023). Similar trends were observed when the target range was adjusted to 110-140 mmHg.

Stratified by TTR, compared with those who were in range less than 43% of the time, risk for probable dementia was lower for those in range 43%-<76% (hazard ratio [HR], 0.70; 95% CI, 0.53-0.93) and 76% or more (HR, 0.62; 95% CI, 0.45-0.84) of the time (P =.002).

No significant trends were observed for the risk for MCI or probable dementia or MCI with SBP TTR.

The limitations of this study included the post hoc design and the fact that patients with prior stroke or diabetes were excluded, making it unclear whether these findings are generalizable for those patient populations.

Researchers concluded, “In this post hoc analysis of SPRINT MIND, higher time in SBP target range was significantly associated with a lower risk of probable dementia, independent of mean SBP. Maintaining consistent BP within 110 to 140 mmHg over time may be beneficial for dementia prevention.”

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Investigators led by Zhiguo Mao, MD, of Changzheng Hospital, Second Military Medical University in Shanghai, China, conducted a network meta-analysis of drug combinations involving renin-angiotensin-aldosterone-system inhibitors (RAASi). The analysis was based on 27 studies involving 43,589 adults with diabetic kidney disease.

Angiotensin receptor blockers (ARB) significantly increased the odds of hyperkalemia 2.4-fold compared with placebo and 3.8-fold compared with angiotensin-converting enzyme inhibitors (ACEi). Renin inhibitors combined with ACEI or ARB were significantly associated with 2.7-fold increased odds of hyperkalemia.

An MRA added to ACEi or ARB significantly increased the odds of hyperkalemia 6.1-fold compared with placebo, Dr Mao’s team reported in the Clinical Journal of the American Society of Nephrology. MRA added to ACEi or ARB increased the odds of hyperkalemia by 3.1-, 2.6-, and 9.2-fold, respectively, compared with ACEi, ARB, or SGLT2i monotherapy, respectively. MRA combined with ACEi/ARB was significantly associated with 2.2-fold increased odds of hyperkalemia a compared with a renin inhibitor and ACEi/ARB. MRA plus ACEi/ARB was significantly associated with 4.1-fold increased odds of hyperkalemia compared with SGLT2i and ACEi/ARB.

The likelihood of hyperkalemia was highest with the steroidal MRA spironolactone followed by the nonsteroidal MRAs esaxerenone and finerenone in combination with ACEI/ARB: 9.5-, 6.3-, and 3.4-fold increased odds, respectively. Data on eplerenone were unclear.

SGLT2i significantly lowered the odds of hyperkalemia by 67%, 72%, 83%, 89%, and 76% compared with ACEi, ARB, ACEi plus ARB, MRA (finerenone or esaxerenone) plus ACEi/ARB, and renin inhibitors combined with ACEi/ARB, respectively.

Adding SGLT2i to the combination of MRA (finerenone or esaxerenone) and ACEi/ARB, significantly reduced the odds of hyperkalemia by 69% compared with MRA plus ACEi/ARB alone.

“Our study provided additional rationales for the combined use of SGLT2i, MRA, and ACEI/ARB in diabetic kidney disease,” Dr Mao’s team wrote.

The investigators could not rule out the influence of background medications.

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Severe OSA may trigger numerous pathways that are linked to increased BP and hypertension. Researchers sought to identify patients with OSA and untreated hypertension whose blood pressure could be reduced through CPAP treatment. The researchers hypothesized that patients with different levels of OSA-triggered BP surges would have different BP responses to CPAP therapy. Investigators defined a BP surge as the value of event-related systolic BP (SBP) elevation; the BP index was defined as the number of BP surge events that were at least 10 mm Hg per hour.

The researchers conducted a single-center, prospective observational study (ClinicalTrials.gov Identifier: NCT03246022) of patients aged 18 to 75 years with severe OSA and untreated hypertension who had never before used CPAP. Between April 2018 and July 2020, researchers compiled BP surge/index patient profiles. Participants all had an in-office BP consistently higher than 140/90 mmHg and an apnea-hypopnea index (AHI) of at least 30 events per hour. At baseline, participants had a mean (SD) office SBP of 151.3 (7.4) mmHg and a mean diastolic (D)BP of 95.9 (6.8) mmHg.

Participants (mean age, 44.3 [9.9] years; 8.5% women; mean AHI, 66 [17.6] events/hour) were stratified into high and low BP surge groups (n=65 for each group) according to the median BP index. Each group received CPAP for 4 weeks (average CPAP duration 6.2 [1.2] hours/night; mean CPAP pressure 10.2 [1.3] mmHg).

At the 4-week follow-up, researchers found a moderate but significant decrease in in-office and asleep BPs compared with baseline (decrease office SBP, 3.8 mmHg; 95% CI, 3.1-4.4; office DBP, 2.6 mmHg; 95% CI, 2.1-3.2; and asleep SBP, 5.5 mmHg; 95% CI, 4.3-6.7; asleep DBP, 3.0 mmHg; 95% CI, 2.4-3.6; all P <.05). Notably, the high surge group vs low surge group had a more significant decrease in in-office SBP (5.3 mmHg vs 2.2 mmHg; P =.003) and in-office DBP (4.0 mmHg vs 1.2 mmHg; P <.001). The disparity in decrease was more noticeable in the asleep SBP (9.0 mmHg vs 2.1 mmHg; P <.001). In the asleep DBP, there was no significant difference (4.1 mmHg vs 1.9 mmHg).

In the high BP surge group, 30 participants with a better BP response were subsequently followed-up at 24 months. CPAP compliance, sex, hypersomnolence, baseline BP, body mass index, and age — all factors affecting BP decrease during treatment with CPAP — were assessed with multiple linear regression models. Researchers found optimal BP control was reached in 60% of these patients and more than 83% achieved a BP of less than140/90 mmHg after 24 months of CPAP (notably, 5 patients did not complete follow-up). Baseline vs 24-month follow-up in-office SBP was 151.4 mmHg vs 129.7 mmHg and in office DBP was 98.0 mmHg vs 85.3 mmHg. BP decrease was significantly associated with BP index during CPAP treatment, according to linear regression. The researchers found no association between BP reductions and baseline BP values, hypersomnolence, CPAP use, or AHI.

Study limitations include selection bias, lack of generalizability beyond patients with severe OSA and untreated hypertension, and the use of a single-center observational design without randomized controls.

“In this study of 130 patients with severe OSA and untreated hypertension, we found that the impact of CPAP on BP control depended on the obstructive respiratory event-triggered BP surge profiles; only patients with high BP surge profiles could benefit from CPAP in terms of BP reduction,” researchers concluded. “Further randomized controlled trials in large samples are needed to confirm our findings,” the researchers added.

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Timothy S. Anderson, M.D., from Beth Israel Deaconess Medical Center in Boston, and colleagues conducted a retrospective cohort study involving patients aged 65 years or older hospitalized for noncardiovascular diagnoses and who experienced elevated BPs in the first 48 hours of hospitalization. Data were included for 66,140 patients, of whom 21.3 percent received intensive BP treatment in the first 48 hours of hospitalization.

The researchers found that compared with patients who did not receive early intensive treatment, those who received early intensive treatment continued to receive a greater number of additional antihypertensives during the remainder of their hospitalization (mean additional doses, 6.1 versus 1.6). Intensive treatment was associated with an increased risk for the primary composite outcome (inpatient mortality, intensive care unit transfer, stroke, acute kidney injury, B-type natriuretic peptide elevation, and troponin elevation; 8.7 versus 6.9 percent; weighted odds ratio, 1.28), with a greater risk seen for those receiving intravenous antihypertensives (weighted odds ratio, 1.90). The likelihood of experiencing each component of the composite outcome, except for stroke and mortality, was increased for intensively treated patients.

“Our findings do not support the pharmacologic treatment of elevated BPs without evidence of acute end organ damage in hospitalized older adults and highlight the need for adequately powered randomized clinical trials of BP treatment thresholds in the inpatient setting,” the authors write.

Abstract/Full Text (subscription or payment may be required)

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DIMS, which is associated with worse quality of life and mental health, is experienced by approximately 30% and 50% of individuals with OSA and sleep disturbances, compared with those with OSA alone. For the study, researchers sought to evaluate the possible associations between OSA and regular sleep disturbances with hypertension/blood pressure.

A total of 12,287 participants used a validated under-mattress sleep analyzer, “Withings”, to monitor sleep over approximately 6 months in their homes. During this time period, participants’ mean apnea-hypopnea index (AHI), sleep onset latency (SOL), and wake after sleep onset (WASO) were measured. The study used the following definitions:

• OSA: average AHI of ≥15 events per minute
• DIMS: average SOL of ≥30 minutes and/or WASO of ≥45 minutes

Participants were categorized into 1 of 4 groups:

• Those with neither condition (control group)
• OSA-alone group
• DIMS-alone group
• OAS-plus-DIMS group

A home monitor was utilized to measure participants’ BP. Hypertension was defined as a mean systolic BP (SBP) of ≥140 mm Hg and/or a mean diastolic BP (DBP) of ≥90 mm Hg. Regression analyses were used to examine the associations between OSA plus DIMS and hypertension, controlling for sex, age, and body mass index (BMI).

The mean participant age was 50±12 years. Overall, 88% of the individuals were men; the average BMI was 28±6 kg/m², which was considered overweight.  The prevalence of patients reported in each of the groups was 21% in the OSA-alone group, 10% in the DIMS-alone group, and 8% in the OA-plus-DIMS group.

Compared with the control group, OSA-alone was associated with a mean 4.5 mm Hg (95% CI, 4.1-5.0 mm Hg) higher SBP value and a mean 2.6 mm Hg (95% CI, 2.3-2.93 mm Hg) higher DBP value.

Further, compared with the control group, OSA plus DIMS was associated with 5.9 mm Hg (95% CI, 5.3-6.6 mm Hg) difference in SBP and a 3.7 mm Hg (95% CI, 3.3-4.2 mm Hg) difference in DBP. This increased difference was greater than that observed in the OSA-alone group (SBP, +1.4 mm Hg [95% CI, 0.8-2.0 mm Hg]; DBP, +1.12 mm Hg [95% CI, 0.7-1.6 mm Hg]; P <.001).

In addition, compared with the control group, OSA-alone and OSA plus DIMS were associated with a 37% (95% CI, 22%-54%) and a 60% (95% CI, 36%-88%) increase in prevalence of hypertension, respectively. Moreover, participants in the OSA-plus-DIMS group vs those in the OSA-alone group had a greater increase in the prevalence of hypertension (17% [95% CI, –1% to 38%]).

“OSA when combined with difficulties initiating and maintaining sleep, consistent with insomnia symptomology, was associated with higher blood pressure and increased hypertension prevalence compared to OSA-alone,” the researchers concluded.

This article originally appeared on Neurology Advisor.

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The risk for cognitive impairment is increased among older adults with hypertension and frailty. Previous studies have shown that choline supplementation can improve cognitive impairment. Researchers conducted a study to assess the effects of choline on endothelial dysfunction, a marker of hypertension and frail aging. 

The researchers tested the hypothesis that “cholINe alfosceraTE impRoVEs cogNiTIve perfOrmance iN fraIl hypertenSive paTients (INTERVENTIONIST).” The researchers enrolled older patients presenting with hypertension from March 2021 to June 2022 at the Italian Ministry of Health in Avellino, Italy.

The inclusion criteria were adults older than 65 years of age with a confirmed hypertension diagnosis and frailty. Participants had their global cognitive performance assessed and they all had a Montreal Cognitive Assessment (MoCA) score of less than 26. Frailty was diagnosed based on the Fried Criteria.

The participants were divided into 2 groups, with one group receiving 1,200 mg of choline alfoscerate (α-GPC) daily and one control group. 

There were 51 patients who completed the study and followed up at 6 months. Of these patients, 26 received α-GPC (78.2±7.4 years old) and 25 did not (77.1±7.1 years old). The body mass index (BMI), age, blood pressure, blood glucose, serum creatinine, and frailty were comparable between both groups. There were no major side effects reported for α-GPC.

The researchers used a wound-healing assay to assess cell migration and a network-like assay to examine angiogenesis. Attenuation of cell senescence was assessed by measuring p21 through reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR), immunoblot, immunofluorescence, and quantification of SA-β-gal. Cell proliferation was examined by quantifying Ki-67 expression. 

These assays were performed on human umbilical vascular endothelial cells (HUVECs). Results from a preliminary dose show that within 24 hours, 10 nM α-GPC significantly improved senescence caused by angiotensin II. The same concentration of α-GPC also improved cell proliferation, migration, and angiogenesis. 

“To our knowledge, this is the first study demonstrating the favorable effects of α-GPC on cognitive dysfunction in frail hypertensive older adults, also showing that α-GPC significantly attenuates Ang II [angiotensin II]-induced endothelial dysfunction,” the researchers noted.

They concluded, “These findings are relevant especially considering the previously reported fundamental role of Angiotensin II in the pathophysiology of cognitive impairment and vascular senescence.”

Study limitations included small samples sizes and only performing analysis in one cell type.

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Data for this analysis were sourced from the Avon Longitudinal Study of Parents and Children (ALSPAC) which was a prospective population-based pregnancy cohort that recruited women and children in the United Kingdom (UK) between 1991 and 1992. In this analysis, responses to breastfeeding questionnaires administered at 6 and 15 months postpartum were associated with long-term cardiometabolic profiles at 18 years among a cohort of 3598 women. Hypertensive disorders of pregnancy were defined using the 2001 guidelines from the International Society for the Study of Hypertension in Pregnancy.

Patients were stratified by breastfeeding duration and the cohorts were women who never breastfed (n=509) or breastfed for less than 1 (n=317), 1 to 3 (n=428), 3 to 6 (n=653), 6 to 9 (n=651), or 9 (n=1040) or more months. The cohorts had mean ages of 28.2 to 31.3 years at delivery and 96.2% to 97.5% were White.

The trends in HDP differed significantly between cohorts (P =.001), in which the rates of gestational hypertension were highest among those who did not breastfeed (15.5%) and lowest among the patients that breastfed the longest (11.0%). Preeclampsia was highest among those who breastfed for 1 to 3 months (4.2%) and lowest for the patients that breastfed the longest (1.3%).

At 18-years follow-up, significant changes to C-reactive protein were positively related with duration of breastfeeding, from -17.12% for less than 1 month of breastfeeding to -25.50% for 6 to 9 months of breastfeeding. In general, breastfeeding for 6 to 9 months was associated with the greatest improvement in cardiometabolic health markers, specifically with improvements in body mass index (mean difference [MD], -0.55; P <.05), waist circumference (MD, -1.32 cm; P <.05), high-density lipoprotein cholesterol (MD, 0.07 mmol/L; P <.05), triglycerides (MD, -0.07 mmol/L; P <.05), insulin (MD, -10.59%; P <.05), and proinsulin (MD, -8.26%; P <.05).

Stratified by the presence of HDP, no significant changes in diastolic blood pressure, mean arterial pressure, low-density lipoprotein cholesterol (LDL-C), or glucose were observed at follow-up among those without HDP. For the HDP group, however, breastfeeding for 1 to 3 months was associated with improvements in mean arterial pressure (MD, -3.11; P <.05), LDL-C (MD, -0.41 mmol/L; P <.001), and glucose (MD, -4.78%; P <.05) whereas breastfeeding for 6 to 9 months was associated with improvements in diastolic blood pressure (MD, -4.87 mm Hg; P <.05), mean arterial pressure (MD, -4.61; P <.05) and LDL-C (MD, -0.40 mmol/L; P <.001).

In a sensitivity analysis which incorporated preterm birth, no significant differences in trends were observed. Similarly, accounting for parity did not affect trends.

These findings may be biased by the trends in pregnancy care and breastfeeding in the 1990s in the UK.

“Our results contribute to the evidence demonstrating that women with HDPs experience a similar or slightly enhanced cardioprotective benefit associated with breastfeeding as women who experienced a normotensive pregnancy,” the study authors wrote. “Because women who experience an HDP have excess risk of poor cardiometabolic health in the years following pregnancy, this high-risk group may derive the greatest benefit from breastfeeding should our results reflect a causal effect.”

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Jiao Luo, M.D., Ph.D., from Copenhagen University Hospital-Rigshospitalet in Denmark, and colleagues conducted a genetic association study using two-sample univariable and multivariable Mendelian randomization to examine potentially causal aspects of modifiable risk factors for AD. Independent genetic variants associated with modifiable risk factors were selected as instrumental variables. Outcome data were obtained from the European Alzheimer & Dementia Biobank (EADB).

The EADB-diagnosed cohort included 39,106 and 401,577 participants with clinically diagnosed AD and controls without AD, respectively. The researchers found that the odds of AD were increased in association with genetically determined HDL cholesterol concentrations (odds ratio, 1.10 per one standard deviation [one-SD] increase). After adjusting for diastolic blood pressure, genetically determined high systolic blood pressure was associated with an increased risk for AD (odds ratio, 1.22 per 10-mm Hg increase). In a second analysis to minimize bias due to sample overlap, the odds for AD were similar for HDL cholesterol and systolic blood pressure (odds ratios, 1.08 per one-SD unit increase and 1.23 per 10-mm Hg increase, respectively).

“These findings may inspire new drug targeting and improved early dementia prevention,” the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

Abstract/Full Text

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As many as 40% of patients with CTEPH may be considered inoperable. Investigators sought to detail a recently instituted single-center BPA program in the US for patients with CTEPH who are unwilling or unable to undergo pulmonary thromboendarterectomy (PTE).

The researchers conducted a retrospective, single-center observational cohort study from August 2018 to August 2021 at the Pulmonary Vascular Disease Clinic at the University of Washington Medical Center (UWMC) in Seattle. The study included 30 patients with CTEPH who, after evaluation, were deemed not to be candidates for PTE. Most of these patients (n=25) had segmental disease, 1 with subsegmental disease on the right side. There were 23 patients with segmental disease and 7 patients with subsegmental disease on the left side.

Patients (average [SD] age, 64.4 [14.8] years; 10 women; 26 White) were on anticoagulation therapy (22 with direct oral anticoagulant). Average body mass index was 29.2 [6.5] kg/m² at their first BPA, and 23 patients had been previously diagnosed with pulmonary embolism, with 23 patients treated with riociguat. There were 5 patients who had undergone prior PTE and experienced recurrent or residual disease.

In all, 135 BPA procedures were performed on 417 segments in a cardiac catheterization laboratory with moderate sedation. Heparin boluses were given during the procedure to all but 2 patients (goal activated clotting time ≥200 seconds). There were 23 patients who underwent more than 2 sessions. Patients completed 4.5 sessions on average (range, 2 to 8). Usually, either balloon tamponade or heparin reversal was used to treat the 20 procedural adverse events and 24 episodes of hemoptysis that occurred. Additionally, 10 wire or microcatheter pulmonary artery perforations occurred, as did 6 pulmonary artery balloon rupture events, most not requiring treatment. Post-procedure intubation was required with 4 events.

Among 26 patients who completed the series, investigators noted improvements in pulmonary compliance (-1.0mL/mmHg; 95% CI, -1.5 to -0.5; P =.0002), pulmonary vascular resistance (-1.9 Wood units; 95% CI, -2.9 to -1.0; P =.0002), and mean pulmonary artery pressure (-6mmHg; 95% CI, -9 to -4mmHg; P =.0001). There were 2 deaths during the study period, 1 peri-procedurally. The researchers noted improvement in walk distance and New York Heart Association functional classification (P =.01). There was no significant improvement in B-type natriuretic peptide and no significant change in creatinine or blood urea nitrogen.

Based on follow-up electrocardiograms available for 18 patients, the investigators noted significant improvement in right ventricular (RV) size and function (46.7% pre-procedure moderate-to-severe dilation vs 1% post-procedure; P =.01) and RV systolic function (36.7% pre-procedure moderately-to-severely reduced function vs 0.0% post-procedure; P =.05), as well as a non-statistically significant improvement in mean RV basal diameter (4.8 cm pre-procedure vs 4.0cm post-procedure; P =.06).

Study limitations include the lack of patient diversity and underpowered sample size.

“Overall, BPA is an acceptable less invasive approach to treating inoperable or high-risk CTEPH patients,” concluded the study authors. “This single-center US experience outlines the initial BPA experience at an established CTEPH center. Our results are similar to other larger cohorts published outside the US but may serve to illustrate the approach and expectations of BPA as this intervention rapidly becomes more widely adopted in North America,” the researchers noted.

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These findings are based on data from patients who were treated with antihypertensive medications (renin-angiotensin system combinations) from 2012 to 2018. Data for patients aged 18 years or older who were diagnosed with arterial hypertension were obtained from AOK PLUS, a German statutory health fund. These patients were analyzed and followed up for 1 year or longer.

Patients receiving single-pill combinations were matched 1:1 with those receiving multipill combinations for each of 4 drug combinations. All-cause mortality was the primary objective.

After propensity score matching, the data of 28,999 hypertensive patients with single-pill combinations were compared with data from 28,999 hypertensive patients with identical drug combinations administered as multipill combinations. The cohorts were the following:

• 10,801 patients received valsartan/amlodipine (VAL/AML)
• 1026 patients received candesartan/amlodipine (CAN/AML)
• 15,349 patients received ramipril/amlodipine (RAM/AML)
• 1823 patients received valsartan/amlodipine/hydrochlorothiazide (VAL/AML/HCT)

Participants’ ages ranged from 65 to 72 years, with slightly more women included.

A lower mortality rate was observed for the single-pill combinations in all 4 comparisons vs multipill combinations. The VAL/AML incidence rate ratio (IRR) was 0.761 (95% CI, 0.683-0.848; P <.001). The CAN/AML IRR was 0.538 (95% CI, 0.284-0.980; P =.031). The RAMI/AML IRR was 0.526 (95% CI, 0.463-0.596; P <.001). The VAL/AML/HCT IRR was 0.515 (95% CI, 0.375-0.709; P <.001).

Lower hazard ratios with single-pill combinations compared with multipill combinations (all P <.001) were observed in the 4 drug combination groups regarding the composite outcome of all-cause death and all-cause hospitalization. In a comparison of the 4 drug combination groups, patients receiving single-pill combinations had a significantly reduced incidence (P <.05) of cardiovascular events in 15 of 20 IRRs analyzed and a trend in favor of single-pill combination in 5 IRR analyses compared with multipill combinations.

At 1 year, the percentage of patients who were persistent to antihypertensive drug combinations was significantly increased for those receiving single-pill combinations vs multipill combinations. Compared with each single-pill combination group, the proportion of patients with persistent medication was 20% less in the AML/VAL group for multipill combination, 24% less in the RAM/AML group for multipill combination, 30% less in the CAN/AML group for multipill combination, and 49% less in the AML/VAL/HCH group for multipill combination.

Limitations include potential residual bias. In addition, many participants who received multipill combinations were excluded from the analyses, and claims-based proxies were mostly used to identify the outcomes of interest attributed to hypertension-associated cardiovascular complications, including stroke and coronary heart disease. Furthermore, diagnosis or outcome misclassification may have occurred.

“These results strongly support the ESC/ESH [European Society of Cardiology/European Society of Hypertension], American College of Cardiology/American Heart Association, and ISH [International Society of Hypertension] guidelines recommending the use of an SPC [single-pill combination] in favor of MPC [multipill combination],” wrote the investigators. “These recommendations should be more rigorously implemented into daily clinical practice to improve the prognosis of hypertensive patients further.”

Disclosure: This analysis was supported by APONTIS PHARMA GmbH & Co. KG, Monheim, Germany. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

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Ziliang Ye, from Southern Medical University in Guangzhou, China, and colleagues examined associations of mobile phone use for making or receiving calls and use frequency with new-onset hypertension in the general population. The analysis included data (median follow-up, 12.0 years) from 212,046 participants in the U.K. Biobank without prior hypertension.

The researchers found that compared with mobile phone nonusers, a significantly higher risk for new-onset hypertension was seen in mobile phone users (hazard ratio [HR], 1.07). Compared with those with a weekly usage time of mobile phones for making or receiving calls <5 minutes, there was a significantly higher risk for new-onset hypertension for participants with a weekly usage time of 30 to 59 minutes (HR, 1.08), one to three hours (HR, 1.13), four to six hours (HR, 1.16), and more than six hours (HR, 1.25). The highest risk for new-onset hypertension was seen for participants with both high genetic risks for hypertension and longer weekly usage time of mobile phones.

“It’s the number of minutes people spend talking on a mobile that matter for heart health, with more minutes meaning greater risk,” a coauthor said in a statement. “Years of use or employing a hands-free set-up had no influence on the likelihood of developing high blood pressure.”

Abstract/Full Text

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Emilie K. Frimodt-Møller, M.D., from the University of California in San Francisco, and colleagues examined the effectiveness of targeting intensive blood pressure control on the risk for developing left ventricular conduction disease. The analysis included 3,918 patients randomly assigned to standard treatment (<140 mm Hg systolic) and 3,956 to intensive treatment (<120 mm Hg systolic).

The researchers found that intensive treatment was associated with a lower risk for left ventricular conduction disease (hazard ratio, 0.74; 95 percent confidence interval, 0.56 to 0.98; P = 0.04). Results were similar when incident ventricular pacing was included in the outcome and when all-cause death was considered as a competing risk. There was no association observed between randomization assignment and the right bundle-branch block (hazard ratio, 0.95; 95 percent confidence interval, 0.71 to 1.27; P = 0.75).

“This analysis suggests that more aggressive blood pressure control might be a way to prevent this sort of common disease,” a coauthor said in a statement. “More broadly, the use of randomized controlled trial data provides compelling evidence that this common disease is not an immutable fate, but that the risk can be modified.”

One author disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text (subscription or payment may be required)

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This retrospective study evaluated patient records from Kobe University Hospital in Japan collected between 2011 and 2021. Patients (N=133) diagnosed with CTEPH that was determined to be nonoperable were evaluated for safety and efficacy outcomes on the basis of COPD status after receiving BPA. Patients with forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of less than 70% were diagnosed with COPD.

The study population comprised patients with a mean age of 68±11 years, 23% were men, with a BMI of 23.4±3.6, 71% had a New York Heart Association (NYHA) functional class III or IV, 32% had a previous acute pulmonary embolism, and 21% a previous deep vein thromboembolism. The patients with (n=32) and without (n=101) COPD were well-balanced at baseline, except more of the COPD group were current or past smokers, they had shorter walking distance in the 6-minute walking test, and more received inhalant therapy than the nonCOPD group (all P £.042).

Compared with baseline, after BPA significant improvements in mean pulmonary arterial pressure (PAP) and pulmonary vascular resistance (PVR) were observed in both groups (all P <.001) but the change in PAP (mean difference [MD], -14.4 vs -17.0 mm Hg; P =.226) and PVR (MD, -55.6% vs -58.9%; P =.495) from baseline did not differ significantly between the COPD and nonCOPD groups, respectively. Conversely, significant improvements in the percent predicted vital capacity (VC) were only observed among the group without COPD (P =.003) and FEV1/FVC improvements were only observed among the COPD group (P =.021).

The rates of severe lung injury with hemoptysis requiring mechanical ventilation were 1.6% for the COPD cohort and 3.0% for the nonCOPD group (P =.535).

At a median follow-up of 37.9 months, the mortality rates were 6.3% for patients with COPD and 6.9% for patients without COPD. Deaths occurred due to malignant tumor (n=4), pneumonia (n=1), sepsis (n=1), and severe aortic stenosis (n=1). In patients with COPD, 1-year survival rates were 100% and 5-year survival rates were 93.5%. In patients without COPD, 1-year survival rates were 98% and 5-year survival rates were 93%.

In the multivariate analysis, postBPA improvement in oxygenation among the patients with COPD was associated with percent predicted VC (b, 0.368; P =.024) and percent predicted diffusing capacity for lung carbon monoxide (b, 0.465; P =.028) at baseline.

The limitations of this study included the retrospective, single-center, observational study design.

“The efficacy and safety of BPA in patients with nonoperable CTEPH and concurrent COPD were similar to those in patients without COPD, and the hemodynamics nearly normalized despite comorbid COPD,” the study authors wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Kristen M. George, Ph.D., from the University of California Davis, and colleagues examined whether hypertension and blood pressure change in early adulthood are associated with late-life brain health. The analysis included 427 participants who were a median age of 28.9 years at the first checkup, 40.3 years at the last checkup, and 74.8 years at neuroimaging.

The researchers found that compared with participants who had normotension, those with hypertension and those who transitioned to hypertension had smaller cerebral volumes, with similar differences seen in cerebral gray matter volume, frontal cortex volume, and parietal cortex volume. Hypertension was also associated with smaller hippocampal volume, greater lateral and third ventricular volumes, larger free water volume, and lower fractional anisotropy versus those with normotension. A 5-mm Hg increase in systolic BP was associated with smaller temporal cortex volume, while a 5-mm Hg increase in diastolic BP was associated with smaller parietal cortex volume. In men (compared with women), the negative association of hypertension and BP change with regional brain volumes was stronger.

“Treatment for dementia is extremely limited, so identifying modifiable risk and protective factors over the life course is key to reducing disease burden,” George said in a statement.

Abstract/Full Text

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Jari A. Laukkanen, M.D., Ph.D., from the University of Eastern Finland in Kuopio, and colleagues used data from the Kuopio Ischemic Heart Disease study (2,682 men; ages, 42 to 61 years) to prospectively evaluate the relationship among systolic blood pressure, cardiorespiratory fitness (CRF), and cardiovascular disease-related mortality.

The researchers found that during a median 28.5 years of follow-up, for blood pressure alone, high blood pressure was associated with an increased risk for cardiovascular mortality (hazard ratio [HR], 1.39). For fitness alone, a low versus high level of fitness was associated with an elevated likelihood of cardiovascular death (HR, 1.74). However, men with high blood pressure and low fitness had more than a doubled risk for cardiovascular death versus participants with normal blood pressure and high fitness (HR, 2.35). Compared with men with normal blood pressure and high fitness, elevated cardiovascular risk remained but was diminished in men with high blood pressure and high fitness levels (HR, 1.55).

“These findings add to the emerging evidence that achieving and maintaining the highest level of CRF during adulthood is important for lowering the risk of chronic disease outcomes as well as death, and the most effective way of doing this is through regular and increased physical activity or exercise training,” the authors write.

Abstract/Full Text

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Using data from the Scientific Registry of Transplant Recipients, Ekamol Tantisattamo, MD, MPH, of the University of California Irvine in Orange, California, and colleagues retrospectively studied 174,359 living kidney donors who donated a kidney from June 1972 to September 2022. The cohort had a mean age of 41 years, and 70% were White, 11% Black, 13% Hispanic, and 3% Asian.

The incidence rate of systolic hypertension (130 mm Hg or higher) was 0.02 person-months. On multivariate analysis that adjusted for age, gender, pre-donation obesity status and other potential confounders, Black donors had a significant 17% higher risk for systolic hypertension compared with White donors, the investigators reported in a poster presentation. Asian donors had a significant 15% lower risk for systolic hypertension compared with White donors. Other races and ethnicities had no significant difference in risk.

A number of studies have documented that hypertension is a complication of living kidney donation. In a study comparing 1278 living kidney donors with a control group of 6359 healthy adults in Ontario, Canada, Amit X. Garg, MD, of the University of Western Ontario in London, Canada, and colleagues found that hypertension was diagnosed more frequently in the donor compared with control group (16.3% vs 11.9%), with donors at a significant 40% higher risk for hypertension. The authors published the study findings in Transplantation in 2008.

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Patients (N=18,444) who had BP and/or low-density lipoprotein cholesterol (LDL-C) levels higher than guideline recommendation limits and had at least 1 visit in the Mass General Brigham health network between 2018 and 2021 were invited to participate in this study. A subset of patients (n=10,803) received education about BP and cholesterol goals, a home BP device, and medication titration. Outcomes of this remote monitoring program were evaluated through 12 months.

The included patients had a mean age of 65 (SD, 11.4) years, 56% were women, and 72% were White. Overall, 3658 patients had hypertension, 8103 had high cholesterol, and 958 had both. Among the groups with high BP or LDL-C, 301 and 965 patients opted out of pharmacological management and only received education, respectively.

Overall, the hypertension program received 424,482 BP measurements and 59,867 laboratory results, distributed 15,047 new prescriptions, and each patient received 2.5 medication changes on average. The cholesterol program received 79,396 laboratory results, distributed 12,838 new prescriptions, and each patient received 1.7 medication changes on average.

Compared with patients who only received education, patients who received remote BP monitoring with pharmacologic management had greater changes to systolic BP from baseline at 6 months (mean change, -8.7 vs -1.5 mm Hg; P <.001) and 12 months (mean change, -9.7 vs 0.2 mm Hg; P <.001) and to diastolic BP at 6 months (mean change, -3.8 vs -0.7 mm Hg; P <.001) and 12 months (mean change, -5.2 vs -1.9 mm Hg; P <.001). Similarly, remote cholesterol monitoring with pharmacologic management better improved LDL-C levels at 6 months (mean change, -35.4 vs -9.3 mg/dL; P <.001) and 12 months (mean change, -37.5 vs -10.2 mg/dL; P <.001) compared with education alone.

At exit from the BP program, the average decrease in systolic BP was -15.6 mm Hg and diastolic BP was -5.8 mm Hg (P <.001). For the subset of patients who left the program prematurely (n=1697), the average decreases in systolic and diastolic BP from baseline were -7.4 mm Hg and -4.0 mm Hg, respectively. In the cholesterol program, the proportion of patients who achieved LDL-C targets was 94% among the subset of patients who entered the maintenance phase of the program.

The major limitation of this study is the nonrandomized design.

“The findings in this study indicated an association between remote health delivery at scale and improvements in chronic disease metrics in a large urban and suburban outpatient cohort and across racial, ethnic, and language populations historically underserved by health care,” the study authors wrote. “We believe that this program may serve as a model for health care professionals and systems aiming to enhance access, patient engagement, and health outcomes.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

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“Mechanistically, sustained midlife hypertension is hypothesized to act on cognitive impairment through increased risk of arteriolar-level cerebrovascular disease,” according to researchers. Yet, late-life hypertension has been inconsistently associated with dementia risk. National and global efforts to enhance research in this field can help inform public health and clinical recommendations when it comes to the prevention of cognitive decline and dementia via midlife blood pressure (BP) management.

Researchers conducted a systematic review of studies that reported population attributable fractions (PAFs) of dementia from hypertension; 2 conditions shown to be associated in an age-dependent manner. They hypothesized that incident dementia from hypertension would differ when assessed in midlife vs late-life age groups.

Prevalent hypertension was defined in terms of systolic BP (SBP) and diastolic BP (DBP), based on the 2017 American College of Cardiology/American Heart Association guidelines.

Normal BP: SBP <120 mm Hg and DBP <80 mm Hg

Elevated BP: SBP 120 to 129 mm Hg and DBP <80 mm Hg

Stage 1 Hypertension: SBP 130 to 139 mm Hg or DBP 80 to 80 mm Hg

Stage 2 Hypertension: SBP ≥140 mm Hg or DBP ≥90 mm Hg

If the SBP and DBP were in different categories, the higher category was used for classification purposes (eg, SBP of 140 mm Hg and DBP of 80 mm Hg was considered stage 2 hypertension).

Recognized risk factors for dementia obtained at baseline as covariates included:

• age,
• sex,
• combined race/ARIC center,
• years of education,
• apolipoprotein E (APOE) genotype,
• smoking status,
• alcohol consumption,
• leisure-time physical activity,
• body mass index,
• plasma total cholesterol level,
• plasma high-density lipoprotein cholesterol level, and
• presence of diabetes.

Researchers found that the percentage of individuals with hypertension increased with age. In the age 45-54, 55-64, 65-74, and 75-84 groups, the baseline prevalence of stage 2 hypertension was 28%, 42%, 61%, and 77%, respectively.

In all age groups, the participants with hypertension — in particular, those with stage 2 hypertension — were more likely to identify as Black and to have prevalent vascular risk factors, such as diabetes.

The median age at diagnosis of dementia was 81 years, with the number of cases of dementia increasing considerably among participants aged 80 to 90. At age 80, the total number of incident dementia cases identified were:

Ages 45-54: 736 cases (10%; median follow-up, 27.2 years);

Ages 55-64: 939 cases (8%; median follow-up, 18.3 years); and

Ages 65-74: 381 cases (6%; median follow-up, 7.4 years).

By age 90, the total number of incident dementia cases increased were:

Ages 45-54: 991 cases (13%; median follow-up, 29.0 years);

Ages 55-64: 2361 cases (19%; median follow-up, 20.9 years);

Ages 65-74: 1357 cases (20%; median follow-up, 8.9 years); and

Ages 75-84: 405 cases (18%; median follow-up, 6.1 years).

The occurrence of stages 1 and 2 hypertension in midlife (ie, age groups 45-54 and 55-64), and stage 2 hypertension in early late life (ie, age group 65-74), were associated with a significantly increased hazard for dementia by age 80. By age 90, although the associations were consistent in direction, they were smaller in magnitude.

By 80 years of age, the PAFs of dementia were consistent across midlife and early late life — at approximately 15% to 20% among those with non-normal BP (ie, combination of elevated BP, stage 1 hypertension, and stage 2 hypertension).

Stage 2 hypertension, which was associated with an excess percentage of dementia cases across all age-groups, increased with age:

Ages 45-54: 11.9%; 95% CI, 6.4%-16.2%;

Ages 55-64: 14.4%; 95% CI, 8.0%-19.8%; and

Ages 65-74: 21.3%; 95% CI, 2.8%-35.4%.

The PAFs for stage 1 hypertension, which were in the range of 2.3%-3.4%, were strongly supported only for those in the age group 55-64 (3.4%; 95% CI, 0.9%-5.5%). By age 90, the PAFs of dementia showed a trend that was consistent with dementia by age 80 across hypertension categories in midlife and early late life, although of a smaller magnitude. Overall, the PAFs from non-normal BP were:

Ages 45-54: 13.8%; 95% CI, 6.6%-20.0%;

Ages 55-64: 12.9%; 95% CI, 7.0%-18.2%;

Ages 65-74: 10.9%; 95% CI, 0.02%-21.0%; and

Ages 75-84: null.

Several limitations of the current study warrant mention. Regarding clinical assessment, these sources might capture individuals with more severe dementia and overlook those with milder stages of dementia. Further, when relative hazards were estimated, selective attrition of participants with hypertension who were at risk for dementia might have introduced an element of bias.

Researchers concluded, “Interventions targeting hypertension even in early life might reduce a sizeable proportion of dementia.”

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see original source for full list of disclosures.

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Previous research has revealed a connection between American football and the onset of hypertension among collegiate athletes. Professional American football players are at increased risk for repeated head injuries, leading to the question if recurrent concussions are related to the development of hypertension later in life.

Researchers participating in the Football Players Health Study at Harvard University conducted a survey of former professional American football players, obtaining self-reported data on concussion burden, severity, and symptom frequency to calculate the concussion symptom score (CSS) on a scale of 0-130. The researchers quantified concussion burden by the occurrence and severity of these common concussion symptoms: headaches, nausea, dizziness, confusion, loss of consciousness, memory problems, seizure, visual problems, disorientation, and feeling unsteady on one’s feet. They determined a diagnosis of hypertension according to physician prescription of antihypertensives.

Other collected data included information on National Football League career duration, position played, current smoking status, age, ethnicity, history of diabetes, body mass index (BMI), and years since last play.

A total of 4,168 former professional American football players (mean age, 51.8 years; 39.4% were Black; mean BMI was 31.3; and 33.9% were linemen) completed the study. Participants played for a mean of 6.7 seasons and were surveyed at 24.1 years post career completion. The reported median CSS was 23.

Out of 4,168 respondents, 1542 (37.3%) reported hypertension while 368 (8.8%) had diabetes. Following adjustments for known risk factors for hypertension including race, age, diabetes, smoking, and BMI, the researchers discovered a graded correlation between CSS and later onset of hypertension in these professional American football players. Higher concussion exposure correlated with prevalent hypertension.

When the researchers substituted loss of consciousness, a severe symptom of concussion, for CSS, results were similar.

“In this large cohort of former professional ASF players, we found a significant association between concussion symptom burden during years of active play and odds of post-career hypertension,” the researchers noted.

Hypertension has been shown to independently increase the risk for cognitive decline. The researchers highlight that “some element of cognitive decline among former ASF [American-style football] players may be attributable to hypertension, a disease that is responsive to lifestyle intervention and pharmacotherapy.” However, they warrant future studies should clarify the associations and casual pathways between brain injury, hypertension, and brain health.

“These results suggest that repetitive early-life brain injury may have later life implications for cardiovascular health,” they concluded.

Study limitations included self-reported concussion and hypertension data, potential selection bias, and confounding variables that may have also contributed to the development of hypertension following brain injury.

Disclosures: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see original source for full list of disclosures.

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Jing Huang, Ph.D., from Peking University in Beijing, and colleagues conducted a prospective population-based analysis in the U.K. Biobank to examine the correlations of long-term road traffic noise exposure with incident primary hypertension. Hazard ratios for an association were examined in a sample of more than 240,000 participants free of hypertension at baseline.

The researchers identified 21,140 incident primary hypertension cases during a median of 8.1 years of follow-up. For a 10-dB[A] increment in mean weighted average 24-hour road traffic noise level (L_den) exposure, the hazard ratio was 1.07. There was a dose-response relationship observed, with a hazard ratio of 1.13 for L_den >65 dB[A] versus ≤55 dB[A]. After adjustment for fine particles and nitrogen dioxide, the associations were all robust. The highest hypertension risk was seen with high exposure to both road traffic noise and air pollution.

“The data demonstrated in this article provide a higher quality of evidence to justify the potential to modify road traffic noise and air pollution from both individual and societal levels in improving cardiovascular health — namely, hypertension prevention,” write the authors of an accompanying editorial.

Abstract/Full Text

Editorial

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Investigators sought to assess the effect of intensive SBP control on cognitive outcomes and cerebral blood flow across various baseline levels of DBP.

They initiated a post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension; ClinicalTrials.gov Identifier: NCT01206062) study that randomly assigned participants to BP targets of either intensive (<120 mm Hg [n=4278]) or standard (<140 mm Hg [n=4385]). Participants were aged at least 50 years and those with history of dementia, heart failure, diabetes, or stroke were excluded. The analysis assessed BP intervention effects on cognitive outcomes and cerebral blood flow across various baseline DBP quartiles.

Regardless of DBP quartiles, participants in the intensive group had a lower incidence rate of mild cognitive impairment or probable dementia than participants in the standard group. There were similar results for mild cognitive impairment (P interaction=.80) and for probable dementia (P interaction=.06). Hazard ratios relating BP control with the risk for mild cognitive impairment in the lowest DBP quartile was 0.78 (95% CI, 0.61-1.00), and in the highest DBP quartile it was 0.70 (95% CI, 0.46-1.07). Hazard ratios relating BP control with the risk for probable dementia in the lowest DBP quartile was 1.05 (95% CI, 0.76-1.47), and in the highest DBP quartile it was 0.56 (95% CI, 0.29-1.07).

The intensive treatment effect on cerebral blood flow was not modified by baseline DBP (P interaction=.25). There was an increasing trend of annualized change in cerebral blood flow (+0.26 mL/100g/min; 95% CI, -0.72 to 1.24) with participants in the lowest DBP quartile, intensive vs standard BP treatment.

Participants with the lowest baseline DBP had the highest incidence rates of serious adverse events. No significant interactions were noted between intensive SBP reduction and baseline DBP quartile for any serious adverse event (all P interaction >.05).

Limitations of the study include the post hoc study design and it possibly being underpowered to detect the effect of BP intervention on cognitive outcomes. There was also significant loss to follow-up and the exclusion of patients with prior heart failure, diabetes, dementia, or stroke could lead to lack of generalizability.

 “…patients with lower DBP had a higher incidence of dementia or MCI (mild cognitive impairment),” the study authors wrote.  “…intensive BP control did not appear to have a detrimental effect on cognitive function and cerebral perfusion.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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Investigators compared the risk of cardiovascular events between 1192 White women and 1635 White men with nondialysis-dependent CKD from 40 Italian nephrology clinics who participated in 4 prospective cohort studies. Over 4 years, 517 cardiovascular deaths or non-fatal cardiovascular events requiring hospitalization (ie, myocardial infarction, congestive heart failure, stroke, revascularization, peripheral vascular disease, and non-traumatic amputation) occurred in 199 women and 318 men.

In an adjusted multivariable Cox regression analysis, women had a 27% lower risk of cardiovascular events compared with men, Roberto Minutolo, MD, PhD, of University of Campania Luigi Vanvitelli in Naples, Italy, and colleagues reported in Nephrology Dialysis Transplantation. However, they found a significant interaction between sex and systolic blood pressure. Women with systolic blood pressure levels less than 130 mmHg and 130-140 mmHg had significant 50% and 28% lower risks for cardiovascular events, respectively, compared with men. At systolic blood pressure levels above 140 mmHg, the cardiovascular risk advantage in women disappeared.

In adjusted models, women with high vs normal systolic blood pressure exhibited significantly increased risks of cardiovascular events, but men did not. The investigators observed no difference between the sexes in use of antihypertensive or cardioprotective drugs or regular nephrology care.

“Higher BP levels abolish the cardiovascular protection seen in female vs male patients with overt CKD. This finding supports the need for higher awareness of hypertensive burden in women with CKD,” Dr Minutolo’s team wrote.

Among the study’s limitations, the investigators could not explore the potential role of non-traditional risk factors, such as hypertensive pregnancy disorders, gestational diabetes, and radiation or chemotherapy for breast cancer. Since the entire cohort was White, results may not pertain to other racial and ethnic groups.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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