Impact Of Blood Pressure Lowering Research Articles

Estimating the Population Benefits of Blood Pressure Lowering: A Wide-Angled Mendelian Randomization Study in UK Biobank.

BackgroundThe causal relevance of elevated blood pressure for several cardiovascular diseases (CVDs) is uncertain, as is the population impact of blood pressure lowering. This study systematically assesses evidence of causality for various CVDs in a 2‐sample Mendelian randomization framework, and estimates the potential reduction in the prevalence of these diseases attributable to long‐term population shifts in the distribution of systolic blood pressure (SBP).Methods and ResultsWe investigated associations of genetically predicted SBP as predicted by 256 genetic variants with 21 CVDs in UK Biobank, a population‐based cohort of UK residents. The sample consisted of 376 703 participants of European ancestry, aged 40 to 69 years at recruitment. Genetically predicted SBP was positively associated with 14 of the outcomes (P<0.002), including dilated cardiomyopathy, endocarditis, peripheral vascular disease, and rheumatic heart disease. Using genetic variation to estimate the long‐term impact of blood pressure lowering on disease in a middle‐aged to early late‐aged UK‐based population, population reductions in SBP were predicted to result in an overall 16.9% (95% CI, 12.2%–21.3%) decrease in morbidity for a 5–mm Hg decrease from a population mean of 137.7 mm Hg, 30.8% (95% CI, 22.8%–38.0%) decrease for a 10–mm Hg decrease, and 56.2% (95% CI, 43.7%–65.9%) decrease for a 22.7–mm Hg decrease in SBP (22.7 mm Hg represents a shift from the current mean SBP to 115 mm Hg).ConclusionsRisk of many CVDs is influenced by long‐term differences in SBP. The burden of a broad range of CVDs could be substantially reduced by long‐term population‐wide reductions in the distribution of blood pressure.

Impact of blood pressure lowering on ventricular repolarization heterogeneity in patients with newly diagnosed hypertension.

Frontal plane QRS-T (fQRS-T) angle is a marker of ventricular repolarization heterogeneity and increased fQRS-T angle is associated with arrhythmias, adverse events and mortality. However, little is known about the importance and usefulness of fQRS-T angle in hypertensive patients. The present study aimed to investigate the association between blood pressure (BP) levels and fQRS-T angle. The main goal was to demonstrate whether BP lowering has a favorable effect on fQRS-T angle in hypertensive patients. This study included 392 newly diagnosed hypertensive patients who underwent antihypertensive therapy. Responders and nonresponders to antihypertensive therapy were compared regarding baseline and post-treatment fQRS-T angle. fQRS-T angle was calculated as the absolute difference between QRS and T wave axes that were obtained from electrocardiography. Response to treatment was defined as achieving BP levels <140/90 mmHg. At the 1-month follow-up visit, responders had significantly lower fQRS-T angle compared to nonresponders despite the similar baseline fQRS-T angle (baseline: 57° ± 18.2° vs.56.6° ± 16.3°; P = 0.819, at 1 month: 36.9° ± 13.7 vs.53.5° ± 15.6°; P < 0.001). Moreover, after 3 months of antihypertensive treatment, both responders at 1 month and 3 months had significantly lower fQRS-T angle compared to nonresponders (34.8° ± 13.3° vs. 35.4° ± 12.9° vs. 52.3° ± 13.9°; P < 0.001). Furthermore, a significant moderate positive correlation was observed between systolic BP and fQRS-T angle (r:0.797; P < 0.001), and between diastolic BP and fQRS-T angle (r:0.761; P < 0.001). In the present study, a significant decrease in fQRS-T angle was observed following BP lowering throughout the study period. Therefore, fQRS-T angle may be useful in the monitoring of antihypertensive treatment.

Preventing Hypertension After Ischemic Stroke In The Spontaneously Hypertensive Rat

Over 80% of patients show a transient increase in blood pressure (BP) after ischemic stroke, regardless of their previous blood pressure level. However, whether this increased pressure is necessary to enhance or maintain oxygenation of penumbra tissues remains uncertain. We aimed to determine the impact of treating post‐stroke hypertension in the spontaneously hypertensive (SH) rat model of ischemic stroke.Male SH rats (374±9 g) were instrumented to allow the long‐term recording of BP, intracranial pressure (ICP) and brain tissue oxygen in the penumbra (pO2) via telemetry. After recording a 3‐day baseline on Day 0 an ischemic stroke was induced via a two‐hour occlusion of the middle cerebral artery (MCAo). BP was either Untreated (n= 6) or Treated (n=6) and controlled to baseline levels with the clinically‐indicated adrenergic antagonist, labetalol (0.25 mg/kg/hr sc via osmotic pump). Behavioural testing and neurological scoring (SHIRPA score) were performed on Days 1, 3, 7 and 10 to evaluate the functional recovery from stroke over time, and postmortem stroke infarct size assessed by histology on Day 10.Following a stroke, BP increased rapidly in Untreated SH rats, reaching a peak of 35±3 mmHg above baseline within 24 hours. Treatment with labetalol significantly reduced BP on D0 and D1 (p&lt;0.05), which in combination with a small increase in ICP (3±0.8 mmHg in Untreated; 0.4±0.3 mmHg in Treated; p=0.047) on D0 resulted in a lower cerebral perfusion pressure (CPP=MAP‐ICP) in Treated animals. Penumbra tissue oxygen levels were not reduced with labetalol treatment, with a small but significant elevation in pO2 seen in the treated animals in the 24 hours after stroke. Treated and Untreated rats showed a similar impairment after stroke in terms of neurological score, functional outcome and infarct volume (274±26 mm3 vs Untreated 256±11 mm3).Treating post‐stroke hypertension does not appear to have a major impact on the functional recovery from stroke in rats with pre‐existing hypertension. Future studies will examine the impact of blood pressure lowering in rats already receiving treatment for pre‐existing hypertension, and of treatment to normotensive BP levels in SH rats to mimic the clinical situation of ‘undiagnosed pre‐existing hypertension’.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Late-Breaking Clinical Trial and Clinical Science Special Reports Abstracts From the American Heart Association's Scientific Sessions 2016; Late-Breaking Abstracts in Resuscitation Science From the Resuscitation Science Symposium 2016.

Late-Breaking Clinical Trial and Clinical Science Special Reports Abstracts From the American Heart Association's Scientific Sessions 2016; Late-Breaking Abstracts in Resuscitation Science From the Resuscitation Science Symposium 2016.

Abstract TP377: Predictors of Diffusion-weighted Imaging Lesions and One-year Case-fatality in Intracerebral Hemorrhage

Introduction: Diffusion-weighted imaging (DWI) lesions in intracerebral hemorrhage (ICH) have been associated with vasculopathy, blood pressure (BP) lowering, and poor functional outcomes. We sought to identify predictors of DWI lesion formation and one-year case-fatality in ICH. Methods: In this retrospective study of primary ICH at our institution from 2009-2011, cases were identified by ICD-9 code and verified by physician review. Only subjects undergoing brain MRI within 72 hours of presentation were included. In addition to standard chart review, we abstracted all BPs available prior to MRI. Vasculopathy severity was assessed by white matter disease score and microbleed burden. Univariate analysis was stratified by DWI lesion presence; logistic regression analyses assessed predictors of DWI lesions and all-cause one-year case-fatality. Results: Of 500 subjects in the overall ICH cohort 98 met inclusion criteria for this analysis, of which 20 (20.4%) had DWI lesions. Selected univariate analysis is shown in the Table. In the best clinical model fit, intraventricular extension (OR 5.63 (1.60, 19.85), p=0.007), microbleeds (OR 3.43 (0.95, 12.34), p=0.06), and delta systolic BP lowering (((max systolic BP-min systolic BP)/max systolic BP)*100) (OR 0.97 (0.95, 0.99), p=0.0005) were associated with DWI lesion presence. Overall one-year case-fatality was 16.3%; age (OR 1.04 (1.00, 1.07), p=0.05), GCS (OR 1.30 (1.09, 1.56), p=0.004), and DWI lesions (OR 3.80 (1.14, 12.61), p=0.03) were independently associated. Conclusions: Predictors of DWI lesions in ICH include underlying vasculopathy but the impact of BP lowering on DWI lesion formation remains unclear. Further investigation of BP effects on DWI lesion formation is warranted with larger cohorts given the association with DWI lesions and one-year case-fatality. Future trials of BP control in ICH should consider stratifying by imaging biomarkers for underlying vasculopathy.

Hypertension: Impact of blood pressure lowering in type 2 diabetes.

Strategies for the management of hypertension in patients with type 2 diabetes mellitus are controversial. New data from a landmark meta-analysis support the use of antihypertensive therapy in these patients but the impact of blood pressure-lowering on albuminuria and progression of chronic kidney disease remains unclear.

Clinical Implications

HomeHypertensionVol. 61, No. 4Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Apr 2013https://doi.org/10.1161/HYP.0b013e31828e0de3Hypertension. 2013;61:745Aldosterone Physiology and Cardiometabolic Risk (page 886)Normal aldosterone regulation is dynamic and responsive. Therefore, single cross-sectional aldosterone measurements capture only a limited range of aldosterone physiology. Quantifying the dynamic nature of aldosterone physiology may improve the understanding of the relationship between aldosterone and cardiometabolic diseases. In this issue of Hypertension, Vaidya et al hypothesized that progressive cardiometabolic abnormalities would predict a blunted dynamic range of aldosterone. Novel indices of aldosterone responses to dietary sodium manipulation were developed, the Sodium-modulated Aldosterone Suppression-Stimulation Index (for serum and SAUSSI for urine), and tested with risk factors in 539 human participants. These indices were calculated as the ratio of aldosterone on a high dietary sodium balance (maximally suppressed aldosterone) to aldosterone on restricted dietary sodium balance (stimulated aldosterone), thereby reflecting the full dynamic range of aldosterone to dietary sodium modulation. Individual cardiometabolic risk factors and components of the metabolic syndrome strongly predicted higher Sodium-modulated Aldosterone Suppression-Stimulation Index and SAUSSI and captured more predictive power than cross-sectional aldosterone measurements alone. These results suggest that abnormal aldosterone physiology, an impaired ability to appropriately stimulate and suppress aldosterone, may contribute to, and result from, progressive cardiometabolic abnormalities.Download figureDownload PowerPointAntihypertensive Therapy and Insulin Action (page 800)Meta-analysis of studies in hypertensive patients using β-blockers and thiazide diuretics indicates that although lowering blood pressure is associated with significantly fewer coronary heart disease events, the benefit is less than that expected from prospective observational data. One explanation is that these older drugs adversely affect cardiovascular risk factors through deleterious effects on insulin action, thereby reducing the impact of blood pressure lowering. This has led to increasing use of newer antihypertensive agents such as angiotensin-converting enzyme inhibitors and calcium channel blockers known to have neutral metabolic effects. Despite this, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest antihypertensive study to date, has shown diuretics to be superior to these newer agents in lowering some cardiovascular outcomes. In this issue of Hypertension, McHenry et al report results from a small study of carefully selected nondiabetic hypertensive patients. In a randomized double-blind crossover protocol, the authors find that sensitive measures of insulin action assessed by the euglycemic hyperinsulinemic clamp technique are no different after treatment with an angiotensin-converting enzyme inhibitor combined with low-dose thiazide compared with an angiotensin-converting enzyme inhibitor alone. These results contrast with the authors’ previous studies in diabetic hypertensive patients, where even low doses of thiazides had a negative impact on glucose metabolism. Overall, the current study is reassuring and should encourage physicians to include low-dose thiazide diuretics in treatment regimens for essential hypertension.Left Ventricular Global Function Index: Predictive Value (page 770)Current indices of left ventricular (LV) function are adequate at reflecting the heart’s actual functional state with respect to the vascular system and the body’s needs. However, they do not take into account how much structural remodeling has occurred and the lifetime evolution of the cardiovascular (CV) system for 1 specific individual. Our intent with proposing this novel approach was to integrate information on ventricular remodeling into the functional capacity of the heart for a given vascular system of an individual.By assessing stroke volume with respect to size of LV cavity and myocardium, the LV global function index combines LV mass, volume, and stroke volume into 1 index. In a multiethnic population free of symptomatic CV disease at baseline, the LV global function index was strongly and consistently associated with adverse CV events during follow-up, whereas LV ejection fraction was not associated with hard CV events beyond heart failure. LV global function index’s predictive power was better and more consistent than LV mass-to-volume ratio and LV ejection fraction and was comparable with indexed LV mass.By conventional indices, the impact of long-standing increased workload, such as hypertension, is manifested on LV structure before LV function. It is, therefore, essential to have a reliable and reproducible assessment of both LV structure as well as LV function in the risk stratification of cardiac patients. Therefore, LV global function index may provide unique information in the CV risk assessment and therapeutic follow-up of hypertensive patients.Download figureDownload PowerPoint Previous Back to top Next FiguresReferencesRelatedDetails April 2013Vol 61, Issue 4 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/HYP.0b013e31828e0de3 Originally publishedApril 1, 2013 PDF download Advertisement

Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals

There is considerable uncertainty regarding the efficacy of blood pressure–lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure–lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE: 0.5/0.3 mm Hg), with no difference by body mass index quarters (&lt;23.1, 23.1 to 25.3, 25.4 to 27.8, and ≥27.9 kg/m 2 ). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs): 0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity ≥0.07) or with the standard definitions of overweight and obesity (&lt;25, 25 to 29, and ≥30 kg/m 2 ; all P for heterogeneity ≥0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure–lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.

Does Early Intensive Lowering of Blood Pressure Reduce Hematoma Volume and Improve Clinical Outcome After Acute Cerebral Hemorrhage?

Background: Intracerebral hemorrhage (ICH) is a poorly understood condition with devastating results. Despite the personal and social impact of ICH, modern medicine can offer little hope. Surgery is the longest-standing therapy, but with no demonstrated evidence of positive effect. Reduction of the early hypertension seen with ICH is believed to limit hematoma growth and improve clinical outcome. The effectiveness and safety of an early, aggressive blood-pressure-lowering strategy for ICH patients has only recently been examined in randomized controlled trials. Clinical Question: Does early, intensive lowering of blood pressure reduce hematoma volume and improve clinical outcome after acute cerebral hemorrhage? Evidence Review: Two trials assessing the clinical impact of blood pressure lowering in intracerebral hemorrhage were acquired and appraised. Results: The two randomized trials incorporated similar parallel designs and both trials measured clinical outcomes and short-term change in hematoma size. The smaller trial was only partially blinded and showed no difference in any of the outcomes; the large trial demonstrated marginal reduction in proportional hematoma growth, but no significant difference in clinical outcome. Conclusions: There is currently insufficient evidence to support the routine practice of lowering blood pressure of patients suffering an acute intracerebral hemorrhage.