scholarly journals Effects of Intensive Blood Pressure Control in Patients with and without Albuminuria

2020 ◽  
Vol 15 (8) ◽  
pp. 1121-1128 ◽  
Author(s):  
Alex R. Chang ◽  
Holly Kramer ◽  
Guo Wei ◽  
Robert Boucher ◽  
Morgan E. Grams ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Creatinine Ratio ◽  
Intervention Trial ◽  
Albumin Creatinine Ratio ◽  
The Absolute ◽  
Egfr Decline

Background and objectivesIt is unclear whether the presence of albuminuria modifies the effects of intensive systolic BP control on risk of eGFR decline, cardiovascular events, or mortality.Design, setting, participants, & measurementsThe Systolic Blood Pressure Intervention Trial randomized nondiabetic adults ≥50 years of age at high cardiovascular risk to a systolic BP target of <120 or <140 mm Hg, measured by automated office BP. We compared the absolute risk differences and hazard ratios of ≥40% eGFR decline, the Systolic Blood Pressure Intervention Trial primary cardiovascular composite outcome, and all-cause death in those with or without baseline albuminuria (urine albumin-creatinine ratio ≥30 mg/g).ResultsOver a median follow-up of 3.1 years, 69 of 1723 (4%) participants with baseline albuminuria developed ≥40% eGFR decline compared with 61 of 7162 (1%) participants without albuminuria. Incidence rates of ≥40% eGFR decline were higher in participants with albuminuria (intensive, 1.74 per 100 person-years; standard, 1.17 per 100 person-years) than in participants without albuminuria (intensive, 0.48 per 100 person-years; standard, 0.11 per 100 person-years). Although effects of intensive BP lowering on ≥40% eGFR decline varied by albuminuria on the relative scale (hazard ratio, 1.48; 95% confidence interval, 0.91 to 2.39 for albumin-creatinine ratio ≥30 mg/g; hazard ratio, 4.55; 95% confidence interval, 2.37 to 8.75 for albumin-creatinine ratio <30 mg/g; P value for interaction <0.001), the absolute increase in ≥40% eGFR decline did not differ by baseline albuminuria (incidence difference, 0.38 events per 100 person-years for albumin-creatinine ratio ≥30 mg/g; incidence difference, 0.58 events per 100 person-years for albumin-creatinine ratio <30 mg/g; P value for interaction =0.60). Albuminuria did not significantly modify the beneficial effects of intensive systolic BP lowering on cardiovascular events or mortality evaluated on relative or absolute scales.ConclusionsAlbuminuria did not modify the absolute benefits and risks of intensive systolic BP lowering.

Abstract 4351: Albuminuria is a Risk Factor for Adverse Events in Heart Failure Independent of the Presence of Chronic Kidney Disease

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Adheesh Agnihotri ◽  
Kalkidan Bishu ◽  
James Arnold ◽  
Gary Gustafson ◽  
Inder S Anand
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Adverse Events ◽  
Systolic Blood Pressure ◽  
Left Ventricular ◽  
Creatinine Ratio ◽  
Albumin Creatinine Ratio

Background : Chronic kidney disease (CKD) is a known risk factor for adverse events in patients with heart failure (HF). Whether albuminuria defined as urine albumin creatinine ratio ≥30 mg/g with or without CKD is also a risk factor for adverse events, is unclear. Methods : Data was abstracted from the electronic medical records of 442 patients admitted to the Minneapolis VA Medical Center with a primary diagnosis of HF, and an outpatient measurement of albumin creatinine ratio between September 2002 and March 2006. Multivariable Cox regression analysis was used to determine the impact of albuminuria on mortality and hospitalizations for HF at 1-year. Results : Albuminuria was seen in 54% (238/442) patients at baseline. Patients with albuminuria were more likely to have edema, higher systolic blood pressure, left ventricular hypertrophy, lower eGFR and use of beta-blockers (all p<0.05). Albuminuria correlated (p<0.05) with serum creatinine (rho=0.23), systolic blood pressure (0.37), and LVEF (0.13). The presence of albuminuria did not increase the risk of death (HR 0.65, 95% CI 0.38 –1.11), but was strongly associated with the risk of hospitalization for HF at 1-year (HR 1.77, 95% CI 1.11–2.82, p=0.017) independent of age, gender, h/o HTN, DM, CAD, PVD, COPD, CKD, atrial fibrillation, EF, use of ACE-I, spironolactone and beta-blocker. Conclusion : The presence of albuminuria is an independent prognostic marker for hospitalizations for heart failure.

Inter-leg systolic blood pressure difference predicts cardiovascular events and mortality in incident hemodialysis patients

2019 ◽  
Vol 43 (4) ◽  
pp. 217-224
Author(s):  
Sawako Kato ◽  
Bengt Lindholm ◽  
Abdul Rashid Qureshi ◽  
Hideyuki Mukai ◽  
Yukio Yuzawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Relative Risk ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Pressure Difference ◽  
Cardiovascular Events ◽  
Hemodialysis Patients ◽  
Cumulative Number ◽  
Blood Pressure Difference ◽  
Increased Risk

Background: High inter-arm blood pressure difference, a marker of vascular disease, may be difficult to assess in hemodialysis patients with arm arteriovenous fistulae. We investigated if high inter-leg systolic blood pressure difference associates with cardiovascular events and increased mortality in hemodialysis patients. Methods: Among 118 incident Japanese dialysis patients, bilateral leg blood pressure, arm blood pressure, brachial–ankle pulse wave velocity, and ankle–brachial index were measured, and the relative risk associated with inter-leg systolic blood pressure difference and other indices of vascular status was analyzed. Results: During follow-up (median, 46 months), 18 deaths and 75 cardiovascular events occurred in 38 patients. Kaplan–Meier curves showed that higher inter-leg systolic blood pressure difference was associated with overall (log-rank 9.35, p = 0.002) and cardiovascular (log-rank 5.81, p = 0.02) mortality. The period from the start of dialysis therapy to the first cardiovascular event was shorter as inter-leg systolic blood pressure difference increased (log-rank 23.7, p < 0.0001). In Cox hazard models, inter-leg systolic blood pressure difference greater than median independently predicted deaths (relative risk, 3.8; 95% confidence interval, 1.3–13.9) and cardiovascular events (relative risk, 3.9; 95% confidence interval, 1.9–9.21) after adjustments for age, sex, nutritional status, and diabetes, whereas other indices were not related to the risks. For well-nourished, moderately malnourished, and severely malnourished patients, the cumulative number of cardiovascular events in the high–inter-leg systolic blood pressure difference patients were 4.96, 31.44, and 55.18 events per 100 patient-years. Conclusions: Higher inter-leg systolic blood pressure difference associated with increased risk of mortality and cardiovascular events suggesting that wider application of inter-leg systolic blood pressure difference measurements may be warranted in hemodialysis patients.

scholarly journals Intensive versus standard blood pressure control and vascular procedures: insights from the Systolic Blood Pressure Intervention Trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Byrne ◽  
M Pareek ◽  
D Rujic ◽  
M.L Krogager ◽  
K.H Kragholm ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Aneurysm ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Intervention Trial ◽  
Artery Disease ◽  
Vascular Procedure ◽  
Intensive Blood Pressure

Abstract Background The Systolic Blood Pressure Intervention Trial (SPRINT) found that intensive versus standard blood pressure control reduced cardiovascular (CV) morbidity and mortality. Previous studies have shown that control of blood pressure reduces the risk of stroke and is one of the most modifiable risk factors for carotid artery disease. On the other hand, data on effect of blood pressure control on peripheral artery disease are more diverse. In addition, it is unknown whether intensive blood pressure control affects the risk of vascular procedures. Purpose To assess the relationship between intensive blood pressure control and incident vascular procedures. Methods SPRINT was a randomized, controlled trial comprising 9,361 individuals ≥50 years of age at high CV risk but without diabetes who had a systolic BP (SBP) 130–180 mmHg. Patients were randomized to intensive (target SBP &lt;120mmHg) or standard antihypertensive treatment (target SBP &lt;140mmHg). The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from CV causes. The primary safety endpoint was the composite of serious adverse events. We examined the risk of composite and individual vascular procedures with intensive versus standard blood pressure control. We further examined subgroup heterogeneity using interaction analyses. Results During a median follow-up time of 3.3 years (range 0–5.5 years), a total of 174 (1.9%) composite vascular procedures were recorded. Intensive blood pressure control did not significantly reduce the risk of composite vascular procedures (intensive blood pressure control, 76 (1.6%) versus standard blood pressure control, 98 (2.1%), hazard ratio 0.76, 95% confidence interval, 0.57 to 1.03; P=0.08) (Figure 1). Similarly, the risks of the individual endpoints of carotid angioplasty, carotid endarterectomy, peripheral angioplasty or thrombolysis, lower extremity amputation for ischemia and gangrene, surgical or vascular procedure for abdominal aortic aneurysm, surgical or vascular procedure for thoracic aortic aneurysm, and surgical or vascular procedure for other problems were not significantly affected (P≥0.05 for all). Intensive blood pressure control reduced the risk of peripheral vascular surgery (intensive blood pressure control, 7 (0.2%) versus standard blood pressure control, 21 (0.5%), hazard ratio 0.33, 95% confidence interval, 0.14 to 0.77; P=0.01), though this was based on a small number of events. The safety and efficacy of intensive BP lowering was not modified by chronic kidney disease, age, sex, race, previous cardiovascular disease, or baseline systolic blood pressure tertile (P≥0.05 for all). Conclusions In SPRINT, intensive versus standard blood pressure control did not reduce the risk of composite incident vascular procedures. Figure 1. Vascular procedures Funding Acknowledgement Type of funding source: None

scholarly journals Association of Acute Kidney Injury with Cardiovascular Events and Death in Systolic Blood Pressure Intervention Trial

2019 ◽  
Vol 49 (5) ◽  
pp. 359-367
Author(s):  
Brad P. Dieter ◽  
Kenn B. Daratha ◽  
Sterling M. McPherson ◽  
Robert Short ◽  
Radica Z. Alicic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Intervention Trial ◽  
Major Cardiovascular Events

Rationale and Objective: In the Systolic Blood Pressure Intervention Trial, the possible relationships between acute kidney injury (AKI) and risk of major cardiovascular events and death are not known. Study Design: Post hoc analysis of a multicenter, randomized, controlled, open-label clinical trial. Setting and Participants: Hypertensive adults without diabetes who were ≥50 years of age with prior cardiovascular disease, chronic kidney disease (CKD), 10-year Framingham risk score > 15%, or age > 75 years were assigned to a systolic blood pressure target of < 120 mm Hg (intensive) or < 140 mm Hg (standard). Predictor: AKI episodes. Outcomes: The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or cardiovascular death. The secondary outcome was death from any cause. Analytical Approach: AKI was defined using the Kidney Disease: Improving Global Outcomes modified criteria based solely upon serum creatinine. AKI episodes were identified by serious adverse events or emergency room visits. Cox proportional hazards models assessed the risk for the primary and secondary outcomes by AKI status. Results: Participants were 68 ± 9 years of age, 36% women (3,332/9,361), and 30% Black race (2,802/9,361), and 17% (1,562/9,361) with cardiovascular disease. Systolic blood pressure was 140 ± 16 mm Hg at study entry. AKI occurred in 4.4% (204/4,678) and 2.6% (120/4,683) in the intensive and standard treatment groups respectively (p < 0.001). Those who experienced AKI had higher risk of cardiovascular events (hazard ratio [HR] 1.52, 95% CI 1.05–2.20, p = 0.026) and death from any cause (HR 2.33, 95% CI 1.56–3.48, p < 0.001) controlling for age, sex, race, baseline systolic blood pressure, body mass index, number of antihypertensive medications, cardiovascular disease and CKD status, hypotensive episodes, and treatment assignment. Limitations: The study was not prospectively designed to determine relationships between AKI, cardiovascular events, and death. Conclusions: Among older adults with hypertension at high cardiovascular risk, intensive treatment of blood pressure independently increased risk of AKI, which substantially raised risks of major cardiovascular events and death.

Screening Tests for Microalbuminuria in Non-Diabetic Elderly Subjects and Their Relation to Blood Pressure

1995 ◽  
Vol 88 (2) ◽  
pp. 185-190 ◽  
Author(s):  
M. A. James ◽  
M. D. Fotherby ◽  
J. F. Potter
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Urine Sample ◽  
Urinary Albumin Excretion ◽  
The Elderly ◽  
Urinary Albumin ◽  
Elderly Subjects ◽  
Urine Collection ◽  
Creatinine Ratio ◽  
Albumin Creatinine Ratio

1. Microalbumuria in non-diabetic elderly subjects is predictive of vascular disease and mortality, and related to levels of blood pressure. 2. This study was designed to examine whether more restricted periods of urine collection retained the relation to the prevailing level of blood pressure and successfully identified subjects with microalbuminura. 3. Fifty elderly subjects (aged over 60 years) made two consecutive 24-h urine collections for measurement of urinary albumin excretion, divided between daytime and night-time periods. Thirty-three subjects also provided a random ‘spot’ urine sample. Clinic and 24-h ambulatory blood pressure were also recorded. 4. Median 24-h urinary albumin excretion was 15.75 mg; 17 subjects had microalbuminuria. The median 24-h albumin—creatinine ratio was 1.91 mg/mmol. A threshold albumin—creatinine ratio of ≧ 3.0 mg/mmol in a random urine sample predicted microalbuminura with 92% sensitivity and 90% specificity. Alternatively, threshold values of 2.5 mg/mmol for men and 4.5 mg/mmol for women in an overnight urine collection predicted microalbuminuria with 88% sensitivity and 100% specificity. 5. The closest relation between albumin—creatinine ratio and blood pressure was that between spot albumin—creatinine ratio and clinic systolic blood pressure (r = 0.64, P < 0.001). Albumin—creatinine ratio was generally related to clinic systolic blood pressure, diastolic blood pressure and ambulatory systolic blood pressure. Microalbuminuric subjects had significantly higher levels of clinic and ambulatory systolic blood pressure than non-microalbuminuric subjects. 6. Microalbuminuria in the elderly is most closely related to clinic systolic blood pressure. Screening for microalbuminuria in the elderly can usefully be performed by the measurement of albumin—creatinine ratio in a random urine sample, with a threshold of ≧ 3.0 mg/mmol.

Long-term predictors of stroke in healthy middle-aged men

2017 ◽  
Vol 13 (3) ◽  
pp. 292-300 ◽  
Author(s):  
Erik Prestgaard ◽  
Christian Hodnesdal ◽  
Kristian Engeseth ◽  
Jan Erikssen ◽  
Johan Bodegård ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Hazard Ratio ◽  
Conduction Time ◽  
Middle Aged ◽  
Hemodynamic Variables

Background There are few data on risk factors for stroke during long-term follow-up of healthy individuals. Aims We aimed to investigate the long-term predictive impact on stroke risk of baseline variables including hemodynamic variables measured at rest and during exercise in middle-aged, healthy men. Methods We performed a prospective cohort study of 2014 healthy Norwegian men aged 40–59 years, recruited during the period 1972–1975 and followed until 2007. Participants underwent a comprehensive clinical assessment at baseline, including a bicycle exercise test. Data on stroke, transient ischemic attack, and death were collected on all participants from follow-up visits, medical records, and the National Cause of Death Registry. We used Cox regression for analysis and estimated hazard ratios with 95% confidence intervals, adjusting for traditional risk factors and hemodynamic variables measured at rest and during exercise. Results During 35 years’ follow-up, 316 participants (16%) had stroke, of which 287 (91%) were ischemic and 29 (9%) were hemorrhagic. Age (hazard ratio 2.70 per increase in one standard deviation, 95% confidence interval 2.13–3.43), resting systolic blood pressure (hazard ratio 1.24, 95% confidence interval 1.11–1.39), body mass index (hazard ratio 1.14, 95% confidence interval 1.02–1.29), and atrioventricular conduction time (hazard ratio 1.11, 95% confidence interval 1.03–1.19) were significantly associated with long-term risk of stroke, as were maximal systolic blood pressure and heart rate during exercise (hazard ratio 1.28, 95% confidence interval 1.13–1.46, and hazard ratio 0.86, 95% confidence interval 0.74–0.99, respectively). Conclusions Hemodynamic variables at rest and during exercise testing add to the predictive value of clinical variables in healthy, middle-aged men, and should be included in the assessment of long-term risk of stroke, when available.

scholarly journals Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register

2017 ◽  
Vol 14 (3) ◽  
pp. 226-235 ◽  
Author(s):  
Maria K Svensson ◽  
Henri Afghahi ◽  
Stefan Franzen ◽  
Staffan Björk ◽  
Soffia Gudbjörnsdottir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Renal Impairment ◽  
Confidence Interval ◽  
Systolic Blood Pressure ◽  
Hazard Ratio ◽  
All Cause Mortality ◽  
Diabetes Register

Background: Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. Aims: To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. Patients and methods: A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. Results: A time-updated systolic blood pressure < 130 mmHg was associated with a higher risk of all-cause mortality in patients both with and without a history of chronic heart failure (hazard ratio: 1.25, 95% confidence interval: 1.13–1.40 and hazard ratio: 1.26, 1.17–1.36, respectively). A time-updated decrease in systolic blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (−10 to −25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17–1.32). Conclusion: Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.

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