Hypertension In Primary Prevention Research Articles

Association of Lp(a) (Lipoprotein[a]) and Hypertension in Primary Prevention of Cardiovascular Disease: The MESA.

This study explored the longitudinal relationship of Lp(a) (lipoprotein[a]) and hypertension to cardiovascular outcomes in a large multiethnic cohort free of baseline cardiovascular disease. Individuals from the MESA (Multi-Ethnic Study of Atherosclerosis; N=6674) were grouped as follows: group 1: Lp(a) <50 mg/dL and no hypertension; group 2: Lp(a) ≥50 mg/dL and no hypertension; group 3: Lp(a) <50 mg/dL and hypertension; and group 4: Lp(a) ≥50 mg/dL and hypertension. Kaplan-Meier curves and multivariable Cox proportional hazard models were used to assess the relationship of Lp(a) and hypertension with time to cardiovascular disease events. Mean follow-up time was 13.9 (5.0) years and 809 participants experienced a cardiovascular disease event. A statistically significant interaction was found between Log[Lp(a)] and hypertension status (P=0.091). Compared with the reference group (Lp[a] <50 mg/dL and no hypertension), those with Lp[a] ≥50 mg/dL and no hypertension had no increased risk for cardiovascular disease events (hazard ratio, 1.09 [95% CI, 0.79-1.50]). However, those with Lp(a) <50 mg/dL and hypertension or Lp(a) ≥50 mg/dL and hypertension demonstrated a statistically significant increase in risk compared to the reference group (hazard ratio, 1.66 [95% CI, 1.39-1.98]) and (hazard ratio, 2.07 [95% CI, 1.63-2.62]), respectively. Among those with hypertension, Lp(a) was associated with a significant increase in cardiovascular disease risk (hazard ratio, 1.24 [95% CI, 1.01-1.53]). Although the major contribution to cardiovascular risk was hypertension, elevated Lp(a) significantly modified the association of hypertension with cardiovascular disease. More research is needed to understand mechanistic links among Lp(a), hypertension, and cardiovascular disease.

Abstract 10239: Association of Lipoprotein(a) and Hypertension in Primary Prevention of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA)

Introduction: The presence of both dyslipidemia and hypertension is associated with considerable cardiovascular disease (CVD) risk, yet few studies have explored the relationship between elevated lipoprotein(a) (Lp(a)) and hypertension. This study explored the longitudinal relationship of Lp(a) and hypertension to cardiovascular outcomes in a large multiethnic cohort free of baseline CVD. Methods: Individuals from the Multi-Ethnic Study of Atherosclerosis (MESA) (n- 6,674) were grouped as follows: Group 1: Lp(a) &lt; 50 mg/dL and no hypertension; Group 2: Lp(a) ≥ 50 mg/dL and no hypertension; Group 3: Lp(a) &lt; 50 mg/dL and hypertension; and Group 4: Lp(a) ≥ 50 mg/dL and hypertension. Kaplan Meier curves and multivariable Cox proportional hazard models were used to assess the relationship between Lp(a) and hypertension with time to CVD events. Results: The mean follow up time was 13.9 years and there were a total of 809 CVD events. A statistically significant interaction was found between LogLp(a) and hypertension status (p = 0.086). Compared to the reference group (Lp(a) &lt; 50 mg/dL and no hypertension), those with Lp(a) ≥ 50 mg/dL and no hypertension (Group 2) had no increase in risk for CVD events (HR: 1.07; 95% CI: 0.78, 1.46) (Table). However, those with Lp(a) &lt; 50 mg/dL and hypertension (Group 3) or Lp(a) ≥ 50 mg/dL and hypertension (Group 4) demonstrated a statistically significant increase in CVD risk compared to the reference group (HR: 1.66; 95% CI: 1.40, 1.98) and (HR: 2.04; 95% CI: 1.62, 2.59), respectively (Table). Among those with hypertension (Groups 3 and 4), Lp(a) was associated with a significant increase in CVD risk (HR: 1.23; 95% CI: 1.00, 1.51). Conclusion: The present study found a significant interaction between Lp(a) and hypertension. More research is needed to understand the mechanistic link between Lp(a), hypertension, and CVD.

An Evaluation of Aspirin Treatment Preferences ORIGINAL INVESTIGATION of Physicians in Hypertensive Patients in Terms of Current Guidelines: A Subgroup Analysis of the ASSOS Trial in Turkey.

BackgroundThe Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial has been the largest study ever conducted among patients in Turkey regarding aspirin treatment. In the subgroup analysis of the hypertensive group of the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial, we aimed to evaluate the physicians’ adherence to current guidelines regarding their aspirin treatment preferences. MethodsThe Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial is a cross-sectional and multicenter study conducted among 5007 consecutive patients aged ≥18 years. The study population consisted of outpatients on aspirin treatment (80-300 mg). The patient data were obtained from 30 different cardiology clinics of 14 cities from all over Turkey. In this subgroup analysis, patients were divided into 2 groups: the hypertensive group (n = 3467, 69.3%) and the group without hypertension (n = 1540, 30.7%) according to the 2018 European Society of Cardiology/European Society of Hypertension Guidelines for the Management of Arterial Hypertension. ResultsAspirin use for primary prevention was higher in patients with hypertension compared to patients without hypertension [328 (21.3%); 1046 (30.2%); P < .001]. Treatment with a dose of 150 mg aspirin (n = 172, 5%) was mostly preferred by internists for hypertensive patients (n =226, 6.5%); however, a daily dose of 80-100 mg aspirin therapy (n = 1457, 94.6%) was mostly prescribed by cardiologists (n = 1347, 87.5%) for patients without hypertension.ConclusionAspirin was found to be used commonly among patients with hypertension for primary prevention despite the current European Society of Cardiology Arterial Hypertension Guideline not recommending aspirin for primary prevention in patients with hypertension.

Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension.

1. Relationship Between Hypertension and CAD e437 2. Prevention of Cardiovascular Events in Patients With Hypertension and CAD e443 3. BP Goals e445 4. Management of Hypertension in Patients With CAD and Stable Angina e449 5. Management of Hypertension in Patients With ACS e451

Health inequalities associated with neighbourhood deprivation in the Quebec population with hypertension in primary prevention of cardiovascular disease

Although a number of studies look at prevalence, incidence, treatment, mortality and morbidity in relation to hypertension, few have taken into account the effect of residential neighbourhood on these health indicators in the population diagnosed with hypertension. The objective of this study was to measure and compare prevalence, mortality, morbidity, use of medical resources and treatments in relation to the level of material and social deprivation of the area of residence, in a population with a diagnosis of hypertension in primary prevention for cardiovascular disease (CVD) in Quebec in 2006-2007. This study is based on a secondary analysis of the medical administrative data of the Quebec health insurance board, the Régie de l'assurance maladie du Québec, for a cohort of 276 793 patients aged 30 years or older who had been diagnosed with hypertension in 2006 or 2007, but who did not have a known diagnosis of CVD. The health indicators adjusted for age and sex are prevalence, death, a cardiovascular event, physician visits, emergency department visits and use of antihypertensives. Twenty-five types of areas of residence were obtained by crossing the material and social deprivation quintiles. Compared with patients living in materially and socially advantaged areas, those living in deprived areas were at 46% higher risk of a cardiovascular event, 47% higher risk of being frequent emergency department visitors and 31% higher risk of being frequent users of a general practitioner's services, but 25% lower risk of being frequent users of medical specialists' services. Little or no variation was observed in the use of antihypertensives. This study reveals the existence, in a CVD primary prevention context, of large variations in a number of health indicators among hypertensive patients owing to the material and social deprivation of residential neighbourhood. It is therefore important to take the socioeconomic context into account when planning interventions to prevent CVDs and their consequences.

Health inequalities in a canadian population with hypertension in primary prevention

Health inequalities in a canadian population with hypertension in primary prevention

Effects of Antihypertensive Drugs on Central Blood Pressure in Humans: A Preliminary Observation

Central blood pressure (BP) is considered a better predictor of cardiovascular events than brachial BP. Modifications of central, beyond brachial BP, can be assessed by pressure amplification, a potential new cardiovascular risk factor. Comparison between drugs' effect on central hemodynamics has been poorly studied. Our aim was to assess the hemodynamic effect of a 12-week treatment with amlodipine 5mg, or candesartan 8mg, or indapamide sustained-release 1.5mg, in comparison with placebo. We analyzed 145 out-patients with essential hypertension in primary prevention enrolled in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) study, a multicenter, randomized, double-blinded, placebo-controlled trial. Arterial stiffness, central BP, pressure amplification, and wave reflection were measured by applanation tonometry. Baseline characteristics of patients were homogeneous between groups. After treatment, we found that active drugs produced similar reduction of both central and peripheral BPs, with no significant interdrug differences (all P < 0.05; excluded peripheral pulse pressure, compared with placebo). Second, amlodipine (1.9% ± 15.3%), candesartan (3.0% ± 14.6%) and indapamide (4.1% ± 14.4%) all increased pulse pressure amplification, but only indapamide was statistically different from placebo (P = 0.02). Finally, no significant changes were observed on pulse wave velocity, heart rate, and augmentation index. The 3 antihypertensive drugs similarly reduced peripheral and central BP, as compared with placebo, but a significant increase in pulse pressure amplification was obtained only with indapamide, independently of arterial stiffness modifications. 3283161 by BIOPHARMA.

Preventing cardiovascular disease among Canadians: Is the treatment of hypertension or dyslipidemia cost-effective?

The direct health care costs associated with treating hypertension and dyslipidemia continue to grow in most western countries, including Canada. Despite the proven effectiveness of hypertension and lipid therapies to prevent cardiovascular disease, the cost-effectiveness of long-term primary prevention, as currently advocated by Canadian treatment guidelines, remains to be determined. Therapeutic efficiency, defined as person-years of treatment per year of life saved (YOLS) and the cost-effectiveness of treatment were estimated for groups of Canadian adults, 40 to 74 years of age. The clinical indications for treatment were based on the Canadian national guidelines in 2005. Analyses focused on those without cardiovascular disease or diabetes using risk factor data from the Canadian heart health surveys and drug data from a national study, the MyHealthCheckUp survey. The expected impact of therapy was based on published results: statins would result in a 40% drop in low-density lipoprotein cholesterol and a 6% increase in high-density lipoprotein cholesterol, while hypertension therapy would result in a 6.4% drop in systolic and a 5.6% drop in diastolic blood pressure. The estimated daily cost of statins was $1.98 versus $1.72 for antihypertensives. Overall, 2.33 million patients would be treated with lipid therapy and 2.34 million with antihypertensives. The average cost-effectiveness of lipid therapy would be approximately $16,700 per YOLS while hypertension therapy would be approximately $37,100 per YOLS. Lifelong lipid and hypertension therapy would be associated with 1.1 million and 472,000 life years saved at a national cost of $18.3 billion and $17.5 billion, respectively. However, hypertension treatment for some groups of Canadians appeared relatively expensive (more than $50,000 per YOLS) including men or women younger than 50 years of age. Despite attractive cost-effectiveness ratios, treatment appeared relatively inefficient (person-years of treatment per YOLS more than 100 years) for statin therapy among women younger than 50 years of age, and hypertension treatment for women younger than 60 years of age and men younger than 50 years of age. Given Canadian guidelines, the treatment of dyslipidemia or hypertension in primary prevention appears economically attractive overall. However, for some groups of individuals, the forecasted future benefits appear to be relatively small given the many years of treatment that are required.

Control of Blood Pressure After Stroke

Acornerstone of primary stroke prevention is built on treating “hypertension” in asymptomatic subjects who are usually at low or medium vascular risk, dogma based on the results of numerous randomized, controlled trials and meta-analyses of them. Similarly, several trials have shown that blood pressure (BP) should be lowered in patients who have had a recent stroke.1–3 Note here the distinction between treating hypertension in primary prevention and lowering BP in secondary prevention. Three randomized trials were of sufficient size to help determine clinical practice in patients with cerebrovascular disease. The Post-stroke Antihypertensive Treatment Study (PATS) found that treatment with the thiazide-like diuretic, indapamide, reduced BP (by 5/2 mm Hg) and stroke recurrence by 29% in 5665 Chinese patients.1 In contrast, the Heart Outcomes Prevention Evaluation (HOPE) Study was a trial of ramipril (angiotensin converting enzyme inhibitor [ACE-I]) in 9297 patients with high vascular risk in which 1013 patients had a history of previous stroke. Within this subgroup, ramipril was effective at reducing BP (by 11/4 mm Hg) whereas the composite outcome of stroke, myocardial infarction (MI), and vascular death was reduced by 30%. The largest trial to date was the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS), which assessed a treatment regime based on another ACE-I, perindopril, given with or without indapamide (at the investigators choice) in …