Mean Baseline Systolic Blood Pressure Research Articles

Injectable angiotensinogen inhibition therapy for hypertension: a systematic review and meta-analysis

Abstract Introduction Hypertension is the leading risk factor worldwide for cardiovascular mortality, and the development of kidney disease. Management of hypertension involves multiple approaches that involve daily tablet ingestion, with high rates of non-adherence. There is an unmet need for innovative interventions to improve adherence to treatment. Purpose We aimed to perform a systematic review and meta-analysis to investigate the role of injectable angiotensinogen (AGT) inhibitors, such as Zilebesiran and IONIS-AGT-LRx, in the treatment of hypertension. Methods PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled clinical trials (RCTs) comparing injectable AGT inhibitors versus placebo. Efficacy was assessed through mean changes in angiotensinogen, systolic blood pressure (SBP), and diastolic blood pressure (DBP). We also examined safety endpoints. We computed pooled mean differences (MD) or risk ratios (RR) for continuous and binary outcomes, respectively, under a random-effects model with a 95% confidence interval (CI). Results Four studies were included for a total of 512 patients, of whom 279 (54.5%) were male, with a mean age of 57 years old; 349 (68.2%) were white. The mean baseline SBP was 142 ± 19.9 mmHg. In a pooled analysis, mean change of AGT decreased significantly with injectable AGT inhibitor compared with placebo (MD -77.86 %; 95% CI -107.49 to -48.23; p<0.01). Similarly, mean change in SBP (MD -14.15 mmHg; 95% CI -19.53 to -8.78; p=0.30) and DBP (MD -8.49 mmHg; 95% CI -9.98 to -7.00; p=0.78) were also significantly lower in the injectable AGT inhibitor group compared with placebo. AGT inhibitors were well tolerated, without associations with serious adverse events, adverse events related to discontinuation, death, hyperkalaemia, or hypotension. However, there was an increase in injection site reaction with these agents compared with placebo (RR 5.86; 95% CI 1.14 to 30.17; p=0.83). Conclusions In this meta-analysis of RCTs, injectable AGT inhibitors were associated with a significant decrease in mean AGT, SBP, and DBP as compared with placebo. There were no significant differences between groups in serious adverse events, although injection site reaction was more common in patients treated with injectable AGT inhibitors.Forest plot of mean change in SBP

Systolic plood pressure response to ASi BI 690517 with and without empagliflozin in CKD

Abstract Background and Aims: BI 690517 is a highly selective aldosterone synthase inhibitor (ASi) in clinical development for CKD treatment. Coadministration of BI 690517 with a sodium-glucose cotransporter-2 inhibitor may provide additive efficacy and also mitigate risk of hyperkalaemia. This multinational, randomised, dose-finding, Phase II trial (NCT05182840) investigated the efficacy and safety of BI 690517, given alone or in combination with empagliflozin (EMPA), for albuminuria reduction in people with CKD and with or without type 2 diabetes.1 Here, we present a secondary analysis for effects on systolic blood pressure (SBP). Method Adults with CKD receiving a maximally tolerated dose of a renin-angiotensin system inhibitor were randomised (R1) 1:1 to receive background EMPA 10 mg or placebo (PBO-EMPA) during an 8-week run-in. They were then re-randomised (R2) 1:1:1:1 to receive BI 690517 (3 mg, 10 mg, or 20 mg) or PBO-ASI for 14 weeks, in addition to their assigned EMPA or PBO-EMPA therapy. Participants had mean baseline SBP ≥110 and ≤160 mmHg. Elevated blood pressure (BP) was defined as SBP ≥140 mmHg or DBP ≥90 mmHg and receiving ≥2 classes of anti-HTN medication. Changes in SBP from R2 baseline to Week 14 were analysed to assess BI 690517 effects with and without EMPA use. Results Of 714 people randomised at R1, 586 were randomised at R2, and the treated set consisted of 583 people. Demographics and clinical characteristics were similar between dose groups.1 At R2 baseline, 169 (29.0%) people had elevated BP. Mean SBP was 142.7 mmHg in the elevated BP group versus 129.2 mmHg in the non-elevated BP group. Treatment with BI 690517 consistently reduced SBP with reductions that were comparable in people with and without elevated BP (p-value for interaction not significant) (Table). Conclusions In people with CKD, BI 690517 reduced SBP in people with and without elevated BP.(Table)

Abstract 15307: Sex-Specific Cognitive Effects of Intensive Systolic Blood Pressure Lowering in Patients With and Without Diabetes Mellitus

Background: The SPRINT trial demonstrated that intensive systolic blood pressure (SBP) lowering (<120 mm Hg) reduced risk of mild cognitive impairment compared to standard SBP control (<140 mm Hg). However, the ACCORD-BP trial did not show the same effect in patients with diabetes. Aims: This study aimed to 1) determine the impact of intensive SBP on cognitive impairment in patients with and without diabetes by analyzing individual patient data of ACCORD-BP and SPRINT, using three cognitive domains and the same follow-up durations, and 2) assess potential sex differences in the effect of intensive SBP lowering on cognitive function in patients with and without diabetes. Methods/Approach: We pooled individual patient data from the SPRINT and ACCORD-BP and standardized cognitive outcomes at baseline, 20-24 months, and 40-48 months post-randomization. Both studies randomized hypertensive patients to intensive SBP control or standard SBP control. Cognitive outcomes included general cognitive function, cognitive processing speed, and memory. Linear mixed models were employed, adjusting for covariates such as age, baseline BMI, SBP, eGFR and LDL. Analyses were repeated separately for patients with and without diabetes and for men and women. Results: The study cohort comprised of 10,800 patients (mean age 67.2 ±9.1 years; mean baseline SBP:139.6 ± 15.6 mmHg, with 14.7% having diabetes and 61.8% being women. Patients without diabetes in the intensive SBP control group had an accelerated decline in processing speed decline compared to the standard control group (P time*treatment interaction=0.02). Patients with diabetes exhibited similar rates of decline in all cognitive outcomes across treatment groups. Stratifying by sex, intensive SBP control was associated with improved memory in female patients (estimated sd=0.07 (0.03), p=0.06), and faster decline in processing speed in male patients. (p=0.03). Conclusions: The effects of intensive SBP control on general cognitive function were comparable between patients with and without diabetes and between men and women. While intensive SBP control was associated with accelerated decline in cognitive processing speed in patients without diabetes, it was linked to improved memory in female patients.

WeChat-Based Intervention for Chinese Immigrants With Hypertension: Development and Evaluation Study.

Despite Chinese immigrants having a higher or comparable proportion of hypertension (HTN) compared to non-Hispanic White and Hispanic individuals, there are no effective technology-based intervention studies that target HTN management in Chinese immigrants in the United States. The aim of this study was to develop and pilot-test the efficacy of a culturally and linguistically sensitive social media-based intervention (WeChat) for Chinese immigrants to improve blood pressure (BP) control, antihypertensive medication adherence, and self-efficacy. The study was conducted in 2020 with a pre- and posttest design (N=20). A WeChat-based intervention was implemented using one 20-minute video presentation plus one 20-minute nurse counseling session via WeChat at the baseline, followed by 4 biweekly 20-minute nurse counseling sessions via WeChat calls. The primary outcome (BP control) and secondary outcomes, including medication adherence and self-efficacy in HTN management, were measured at baseline and at 6 months. The participants' mean age was 68.9 (SD 10.2; range: 51-86) years. The majority of the participants were female (n=13, 65%), had a high school degree or less (n=15, 75%), were married (n=16, 80%), not religious (n=13, 65%), and not employed (n=12, 60%). The results showed that the mean baseline systolic BP was 131.43 (SD 9.61) mmHg, and the mean diastolic BP was 79.79 (SD 9.62) mmHg. The 6-month outcome showed a reduction of systolic BP (-0.74, SD 9.18 mmHg; P=.05) and diastolic BP (-0.96, SD 6.92 mmHg; P=.001). The mean score for medication adherence at baseline was 4.50 (SD 1.70), and it significantly improved to 3.65 (SD 1.18) at 6 months (reversely scored; possible range was 1-5, with 1 being the best score; P=.001). Self-efficacy in HTN management had a trend in reduction from a baseline score of 8.28 (SD 1.25) decreasing to 7.93 (SD 1.48) at 6 months, with a mean difference of 0.34 (SD 2.02), with a score of 0 indicating the lowest self-efficacy and a score of 10 indicating the highest self-efficacy. Our WeChat-based HTN management program showed a significant improvement in diastolic BP and medication adherence as well as a trend of reduction for systolic BP and self-efficacy in managing HTN in Chinese immigrants. Compared to the traditional health care system, the proposed WeChat-based HTN management program has a low cost and is easy to implement. Thus, further investigation is recommended to generate further results. This intervention should be tested across different regions and clinical settings to verify the findings. The long-term goal is to implement the intervention in clinical settings to help Chinese immigrants at large achieve better HTN management.

Effect of antihypertensive treatment in isolated systolic hypertension (ISH) – systematic review and meta-analysis of randomised controlled trials

Background Isolated systolic hypertension (ISH) in middle-aged and elderly is associated with high cardiovascular risk, but no randomised controlled trial has assessed the effect of antihypertensive treatment in ISH using today’s definition, i.e. systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg. Methods A systematic review and meta-analysis of randomised controlled trials was performed. Studies with ≥1000 patient-years of follow-up, comparing more intensive versus less intensive BP targets, or active drug versus placebo, were included if the mean baseline SBP was ≥140 mmHg and the mean baseline DBP was <90 mmHg. The primary outcome was major adverse cardiovascular events (MACE). Relative risks from each trial were pooled in random-effects meta-analyses, stratified by baseline and attained SBP level. Results Twenty-four trials, including 113,105 participants (mean age 67 years; mean blood pressure 149/83 mmHg) were included in the analysis. Overall, treatment reduced the risk of MACE by 9% (relative risk 0.91, 95% confidence interval 0.88–0.93). Treatment was more effective if baseline SBP was ≥160 mmHg (RR 0.77, 95% CIs 0.70–0.86) compared to 140–159 mmHg (RR 0.92, 95% CIs 0.89–0.95; p = 0.002 for interaction), but provided equal additional benefit across all attained SBP levels (RR 0.80, 95% CIs 0.70–0.92 for <130 mmHg, RR 0.92, 95% CIs 0.89–0.96 for 130–139 mmHg, and RR 0.87, 95% CIs 0.82–0.93 for ≥140 mmHg; p = 0.070 for interaction). Conclusions These findings support antihypertensive treatment of isolated systolic hypertension, regardless of baseline SBP, to target SBP <140 mmHg and even <130 mmHg if well tolerated.

Effects of a Polypill, Aspirin, and the Combination of Both on Cognitive and Functional Outcomes

Vascular risk factors are associated with cognitive decline but studies addressing individual risk factors have not demonstrated an effect of risk factor management on the preservation of cognition. Few trials have examined the effect of vascular risk factor management on function. To determine if a polypill could reduce cognitive and functional decline in people with risk factors but without manifest cardiovascular disease. The International Polycap Study 3 (TIPS-3) was a 2 × 2 × 2 factorial randomized clinical trial. Hospital and community-based centers in 8 countries recruited and followed up participants between July 30, 2012, and September 30, 2020. A total of 5713 individuals were randomly assigned to treatment groups, and 2098 people 65 years or older at intermediate risk of cardiovascular disease completed a cognitive assessment and were included in the analyses. Polypill (antihypertensives and a statin), aspirin, or a combination of both treatments. Cognitive and functional assessments completed at baseline, 2 years, and study end. The primary outcome was the effect of a polypill compared with placebo and a polypill plus aspirin compared with double placebo on the composite outcome of the proportion of participants in each group who experienced a substantive decrease (>1.5 SD change) in cognitive or functional abilities. Of the 2389 study participants older than 65 years, a total of 2098 (88%; mean [SD] age, 70.1 [4.5] years; 1266 female individuals [60%]) completed the baseline and follow-up assessment. A total of 1796 participants (86%) had hypertension, and 680 participants (32%) had impaired fasting plasma glucose levels. Mean (SD) baseline systolic blood pressure was 146.1 (17.7) mm Hg, and mean (SD) low-density lipoprotein cholesterol (LDL-C) level was 124.3 (40.7) mg/dL and decreased by 5.7 mm Hg and 24 mg/dL, respectively, among those assigned to the polypill group. During a 5-year follow-up, there were no significant differences between treatment groups in the number of participants who experienced substantive cognitive decline (356 assigned polypill, 328 assigned placebo) or dementia (2 assigned polypill, 4 assigned placebo). Functional decline was reduced during follow-up for those assigned to polypill compared with placebo (mean [SD] country-standardized adjusted follow-up Standard Assessment of Global Everyday Activities [SAGEA] scores, 0.06 [0.03] vs 0.15 [0.03]; P = .01) and polypill plus aspirin compared with double placebo (mean [SD] country-standardized adjusted follow-up SAGEA scores, 0.01 [0.04] vs 0.14 [0.04]; P = .01). In this randomized clinical trial of patients 65 years or older with vascular risk factors, a polypill, with or without aspirin, was not associated with reduced cognitive outcomes but was associated with reduced functional decline.

PS-P16-8: DIAGNOSIS AND TREATMENT OF HYPERTENSION BY COMMUNITY HEALTH WORKERS IN RURAL NEPAL: MAIN RESULTS OF THE MUTU TRIAL

Objective: To evaluate the effectiveness and safety of a community health worker intervention for diagnosing and managing hypertension (HTN) in rural Nepal. Design &amp; Methods: We conducted a quasi-experimental study in two rural municipalities in Nepal, assigning one as an active site (7 communities) and the other as a comparison site (8 communities, which received enhanced usual care). The intervention in the active site involved three home visits for blood pressure (BP) monitoring and counseling by trained community-based community health workers (Female Community Health Volunteers) and treatment of HTN by trained community health workers based in government Health Posts under physician supervision using a simplified protocol with amlodipine. The comparison site received one home visit by Female Community Health Volunteers. A total of 1428 adults with untreated HTN (systolic BP of 140–179 and/or diastolic BP of 90–119 mm Hg) were enrolled. The primary outcome was a reduction in systolic BP at 12 months (measured in 94% of enrolled participants), and the secondary outcome was HTN control rate defined as BP &lt; 140/90 mm Hg. Results: The mean baseline systolic BP was 145.4 mm Hg in the active site (n = 576, 46% women) and 146.9 mm Hg in the comparison site (n = 760, 46% women). At 12 months, while BP was lower in both sites, mean SBP fell more in the active site [net mean difference of -11.0 mm Hg, (95% CI: -12.5 to -9.6; P &lt; 0.001)] (Table). The corresponding net difference in DBP was -6.0 mm Hg (95% CI: -6.8 to -5.1; P &lt; 0.001). HTN control and medication treatment were both higher in the active site compared to the comparison site (Table). There were four deaths unrelated to the intervention (2 in the comparison site and 2 in the active site). Conclusion: In rural communities of Nepal, a health system intervention with trained community health workers diagnosing and treating hypertension, supervised by a physician, substantially lowered BP and achieved higher control rates compared to usual care. The success of this intervention provides strong support of enhanced roles for community health workers to diagnose and treat HTN. Scaling up such interventions could potentially address the major workforce gaps that lead to low HTN control rates, particularly in rural communities of low and middle-income countries.

Chlorthalidone vs. Hydrochlorothiazide for Hypertension–Cardiovascular Events

BackgroundWhether chlorthalidone is superior to hydrochlorothiazide for preventing major adverse cardiovascular events in patients with hypertension is unclear.MethodsIn a pragmatic trial, we randomly assigned adults 65 years of age or older who were patients in the Department of Veterans Affairs health system and had been receiving hydrochlorothiazide at a daily dose of 25 or 50 mg to continue therapy with hydrochlorothiazide or to switch to chlorthalidone at a daily dose of 12.5 or 25 mg. The primary outcome was a composite of nonfatal myocardial infarction, stroke, heart failure resulting in hospitalization, urgent coronary revascularization for unstable angina, and non–cancer-related death. Safety was also assessed.ResultsA total of 13,523 patients underwent randomization. The mean age was 72 years. At baseline, hydrochlorothiazide at a dose of 25 mg per day had been prescribed in 12,781 patients (94.5%). The mean baseline systolic blood pressure in each group was 139 mm Hg. At a median follow-up of 2.4 years, there was little difference in the occurrence of primary-outcome events between the chlorthalidone group (702 patients [10.4%]) and the hydrochlorothiazide group (675 patients [10.0%]) (hazard ratio, 1.04; 95% confidence interval, 0.94 to 1.16; P=0.45). There were no between-group differences in the occurrence of any of the components of the primary outcome. The incidence of hypokalemia was higher in the chlorthalidone group than in the hydrochlorothiazide group (6.0% vs. 4.4%, P<0.001).ConclusionsIn this large pragmatic trial of thiazide diuretics at doses commonly used in clinical practice, patients who received chlorthalidone did not have a lower occurrence of major cardiovascular outcome events or non–cancer-related deaths than patients who received hydrochlorothiazide. (Funded by the Veterans Affairs Cooperative Studies Program; ClinicalTrials.gov number, NCT02185417.)

Real-World Incidence and Management of Ibrutinib-Induced Hypertension in Patients with Chronic Lymphocytic Leukemia

Background: Clinical trials demonstrated that ibrutinib improves progression-free and overall survival in patients with chronic lymphocytic leukemia (CLL). After widespread use of ibrutinib in clinical practice, the incidence of ibrutinib-induced hypertension (HTN) has been more frequent than reported in the clinical trials, with an incidence between 35% and 72%. No guidelines exist for the management of ibrutinib-induced HTN. Methods: A single-center, retrospective cohort study was conducted in patients with CLL initiated on ibrutinib from April 2014 to May 2020. We identified patients at least 18 years old, prescribed ibrutinib for CLL at UNC Medical Center and affiliated centers, alive and not transitioned to hospice or discontinued from ibrutinib within two months of initiation. Patients were excluded if they had blood pressure (BP) measurements documented at less than 3 visits within 24 weeks of initiating ibrutinib. Co-primary study outcomes were overall incidence and severity of HTN within 24 weeks of ibrutinib initiation. Secondary study outcomes include change in systolic BP (SBP) and diastolic BP (DBP), and the probability of increasing the antihypertensive intensity (e.g., new agent or increased dose) adjusted for mean SBP. Incidence of HTN, including new onset (defined by ACC/AHA 2017 Guideline for High Blood Pressure in Adults) or worsening HTN (defined by change in version 5 of Common Terminology Criteria for Adverse Events [CTCAE v5.0] grade), was assessed by descriptive statistics. A linear mixed effects regression model, with random intercepts for patients, estimated mean SBP and DBP measurements at weeks 0, 4, 8, 12, 16, 20, and 24. A logistic mixed effects model was used to estimate the probability of antihypertensive therapy intensification, adjusting for SBP. Results: Among 37 patients (mean age 67.3 ± 10.6 years, 87% Caucasian, 65% male), mean baseline SBP and DBP were 134.0 ± 17.9 mmHg and 70.5 ± 9.87 mmHg, respectively, and 73% were on at least one antihypertensive agent prior to ibrutinib initiation. The prevalence of HTN at baseline was 54% (Stage 2, 38%). Over 24 weeks, the incidence of new onset HTN was 69% (Stage 2, 33%) and worsening HTN was 68% (Stage 2, 92%). At 24 weeks, 29% of BPs were defined as Grade 3 per CTCAE v5.0. Over 24 weeks, mean SBP increased 9.7 mmHg (95% CI 2.20, 16.50) and mean DBP increased 5.9-mmHg (95% CI 1.03, 9.13). On average, patients who had a SBP measurement less than 165 mmHg had a less than 5% chance of antihypertensive intensification. The chance of intensification for patients with a SBP measurement of 165-210 mmHg increased up to 15%. Conclusions: Following initiation of ibrutinib in CLL patients, the incidence of new onset and worsening HTN was higher than previously described. Over 24 weeks, a clinically meaningful increase in BP occurred. Regardless of BP severity, antihypertensive intensification was minimal.

Abstract 15672: Cost-Effectiveness of Team-Based Care for Hypertension

Introduction: Team-based care (TBC), typically involving a physician and non-physician working in collaboration, is more effective than usual physician-only care in reducing blood pressure (BP). This analysis estimated the cost-effectiveness of TBC strategies vs. usual care over 10 years. Methods: We used the Cardiovascular Disease (CVD) Policy Model to project long-term BP, CVD events, and survival in a nationally representative cohort of 10,000 US adults (aged ≥20 years) with uncontrolled BP (≥140/90 mmHg) from the National Health and Nutrition Examination Survey. We compared (1) usual care, (2) TBC with a registered nurse providing hypertension counseling, and (3) TBC with a pharmacist providing counseling and titrating medications. BP reductions with TBC were derived from meta-analysis; other inputs were derived from published literature and publicly available data. TBC interventions were simulated to last six months, after which individuals were assumed to return to usual care. The outcomes were mean per-patient direct healthcare costs (2021 USD), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) from a US healthcare sector perspective. Sensitivity analyses assessed the impact of TBC program design and hypertension care process parameters on the cost-effectiveness of TBC. Results: The mean (SD) age was 59.8 (16.6) years, 50.0% were female, and mean baseline systolic BP was 150.9 (14.2) mmHg. At 10 years, TBC with nurse counseling and with pharmacist titration were projected to result in mean (95% uncertainty interval) 0.6-mmHg (0.4, 0.8) and 2.8-mmHg (2.2, 3.4) greater reductions in systolic BP. Both TBC strategies were estimated to dominate (i.e., cost less and more effective) usual care, with nurse counseling projected to cost -$617 (-$1539, $364) and with pharmacist titration -$416 (-$1400, $470) less than usual care. Compared with TBC with nurse counseling, TBC with pharmacist titration had an ICER of $13,000/QALY gained (88.0% probability ICER &lt;$50,000/QALY gained). The ICER was most sensitive to the probability of pharmacist medication intensification. Conclusions: TBC with pharmacist titration is a cost-effective strategy to reduce CVD events in US adults with uncontrolled hypertension.

Effect of the Mediterranean diet on blood pressure in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials

Abstract Background It is unclear whether the Mediterranean diet (MedDiet) has a favorable effect on blood pressure (BP) levels because among randomized controlled trials (RCTs) investigating the MedDiet-mediated BP reduction there are significant methodological and clinical differences. Purpose The purpose of this study was to comprehensively assess the MedDiet BP-effect compared to the usual diet or another dietary intervention (e.g. low-fat diet) in adults with and without hypertension, accounting for different confounders. Methods We systematically searched Medline and the Cochrane Collaboration Library databases and identified 35 RCTs (13,943 participants). Random-effects model was used to calculate the mean attained systolic BP (SBP) and diastolic BP (DBP) differences during follow-up. Subgroup and meta-regression analyses were also conducted. Results Compared to the usual diet and all other active intervention diets the MedDiet reduced SBP and DBP (difference in means: −1.5 mm Hg; 95% CI: −2.8, −0.1; P=0.035, and −0.9 mm Hg; 95% CI: −1.5, −0.3; P=0.002, respectively). Compared only to the usual diet the MedDiet reduced SBP and DBP, while compared to all other active intervention diets or only to the low-fat diet the MedDiet did not reduce SBP and DBP. The MedDiet reduced DBP levels to a higher extent in trials with a mean baseline SBP ≥130 mm Hg, while both SBP and DBP were reduced more in trials with a mean follow-up period ≥16 weeks. The quality of evidence was rated as moderate for both outcomes according to the grading of recommendations, assessment, development and evaluation (GRADE) approach. Conclusions The adoption of the MedDiet was accompanied by a relatively small, but yet significant BP reduction, while higher baseline SBP levels and longer follow-up duration enhanced the BP-lowering effect of the intervention Funding Acknowledgement Type of funding sources: None.

Average Systolic Blood Pressure and Clinical Outcomes in Patients with Atrial Fibrillation: Prospective Data from COOL-AF Registry.

PurposeHypertension is associated with incident atrial fibrillation (AF) and AF-related complications. We investigated the associations between average systolic blood pressure (SBP) and outcomes in a nationwide cohort of Asian patients with non-valvular atrial fibrillation (NVAF).Patients and MethodsA multicenter nationwide registry of patients with NVAF in Thailand was conducted during 2014–2017. Clinical data, including blood pressure, were recorded at baseline and then every 6 months. Average SBP was calculated from the average of SBP from every visit. Cox regression models were used to calculate the rate of clinical outcomes of interest, ie ischemic stroke or transient ischemic attack (TIA), intracerebral hemorrhage (ICH), and all-cause death. Average SBP was categorized into three groups: <120, 120–140, and ≥140 mmHg.ResultsA total of 3402 patients were included, and the mean age was 67.4±11.3 years. The mean (±SD) baseline and average SBPs were 128.5±18.5 and 128.0±13.4 mmHg, respectively. The mean follow-up duration was 25.7±10.6 months. The median rate of ischemic stroke/TIA, ICH, and all-cause death was 1.43 (1.17–1.74), 0.70 (0.52–0.92), and 3.77 (3.33–4.24) per 100 person-years, respectively. The rate of ischemic stroke/TIA and ICH was lowest in patients with average SBP <120 mmHg, and highest among those with average SBP ≥140 mmHg. The death rates were consistent with a J-curve effect, being lowest in patients with an average SBP 120–140 mmHg. Sustained SBP control is more important than the SBP from a single visit.ConclusionSustained control of SBP was significantly associated with a reduction in adverse clinical outcomes in patients with NVAF.

Effect of Posting on Social Media on Systolic Blood Pressure and Management of Hypertension: A Randomized Controlled Trial.

BackgroundOnline platforms are used to manage aspects of our lives including health outside clinical settings. Little is known about the effectiveness of using online platforms to manage hypertension. We assessed effects of tweeting/retweeting cardiovascular health content by individuals with poorly controlled hypertension on systolic blood pressure (SBP) and patient activation.Methods and ResultsWe conducted this 2‐arm randomized controlled trial. Eligibility included diagnosis of hypertension; SBP >140 mm Hg; and an existing Twitter account or willingness to create one to follow study Twitter account. Intervention arm was asked to tweet/retweet health content 2×/week using a specific hashtag for study duration (6 months). The main measures include primary outcome change in SBP; secondary outcome point change in Patient Activation Measure (PAM). We remotely recruited and enrolled 611 participants, mean age 52 (SD, 11.7). Mean baseline SBP for the intervention group was 155.8 and for control was 155.6. At 6 months, mean SBP for intervention group was 137.6 and for control was 135.7. Mean change in SBP from baseline to 6 months for the intervention group was −18.5 and for control was −19.8 (P=0.48). Mean PAM at baseline for the intervention group was 70.3 for control was 72.7. At 6 months, mean PAM scores were 71.1 (intervention) and 75.6 (control). Mean change in PAM score for the intervention group was 0.0 and for control was 3.3 (P=0.12).ConclusionsRecruiting and engaging patients and collecting outcome measures remotely are feasible using Twitter. Encouraging patients with poorly controlled hypertension to tweet or retweet health content on Twitter did not improve SBP or PAM score at 6 months.RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT02622256.

Effectiveness of an impedance cardiography guided treatment strategy to improve blood pressure control in a real-world setting: results from a pragmatic clinical trial

ObjectiveTo test the effectiveness of an impedance cardiography (ICG) guided treatment strategy on improving blood pressure (BP) control in real-world clinical practice.DesignA single-centre, pragmatic randomised trial.SettingA hypertension clinic of the...

660-P: Greater Proportions of Subjects Achieved Composite Endpoints with Once-Weekly Semaglutide vs. Comparators in SUSTAIN Trials

Achieving HbA1c targets, weight loss (WL) and systolic blood pressure (SBP) reductions lowers micro- and macrovascular risk in type 2 diabetes (T2D). In SUSTAIN clinical trials, once-weekly (OW) semaglutide, a glucagon-like peptide-1 analog, significantly reduced HbA1c and body weight (BW) and reduced SBP (except in SUSTAIN 8) vs. comparators. This post hoc analysis evaluated composites of these endpoints with semaglutide vs. comparators in SUSTAIN 1-5 and 7-10.Trials were analyzed individually to determine the proportion of subjects achieving composite endpoints A (HbA1c <7.0%, WL ≥5%, SBP reduction ≥5 mmHg) and B (HbA1c ≤6.5%, WL ≥10%, SBP reduction ≥5 mmHg). On-treatment-without-rescue-medication data were used.Across the trials, mean baseline HbA1c, BW and SBP ranges were 8.0-8.4%, 89.5-96.9 kg and 127.9-136.4 mmHg, respectively. Greater proportions of subjects achieved the composite endpoints with semaglutide vs. comparator (A: 12.4-19.1% [0.5 mg]; 18.9-36.7% [1.0 mg] vs. 0.8-15.7% [comparator]; B: 2.5-8.0% [0.5 mg]; 5.0-14.8% [1.0 mg] vs. 0.2-3.0% [comparator]; p<0.05 for both endpoints; Figure).Significantly greater proportions of subjects achieved clinically relevant composite endpoints with OW semaglutide vs. comparators, including more stringent endpoint of HbA1c ≤6.5% and WL ≥10%. These data may assist clinicians in their decision-making in T2D care.View largeDownload slideView largeDownload slide DisclosureP. Gæde: None. A. Catarig: Employee; Self; Novo Nordisk. K. M. Dungan: Advisory Panel; Self; Eli Lilly and Company, Tolerion, Inc., Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Elsevier, Novo Nordisk, Other Relationship; Self; UpToDate, Research Support; Self; Abbott, Sanofi-Aventis, Viacyte, Inc. C. Hindsberger: Consultant; Self; Novo Nordisk A/S, Stock/Shareholder; Self; Novo Nordisk A/S, Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. J. Øllgaard: Employee; Self; Novo Nordisk A/S. S. C. Bain: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Napp Pharmaceuticals, Novo Nordisk A/S, Sanofi, Consultant; Self; ADOCIA, Speaker’s Bureau; Self; Bayer AG, Medscape, WebMD LLC.FundingNovo Nordisk A/S

Mediterranean diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials

It is unclear whether the Mediterranean diet (MedDiet) has a favorable effect on blood pressure (BP) levels because among randomized controlled trials (RCTs) investigating the MedDiet-mediated BP reduction significant methodological and clinical differences are observed. The purpose of this study was to comprehensively assess the MedDiet BP-effect compared to the usual diet or another dietary intervention (e.g. low-fat diet) in adults with and without hypertension, accounting for methodological and clinical confounders. We systematically searched Medline and the Cochrane Collaboration Library databases and identified 35 RCTs (13,943 participants). Random-effects model was used to calculate the mean attained systolic BP (SBP) and diastolic BP (DBP) differences during follow-up. Subgroup and meta-regression analyses were also conducted. Compared to the usual diet and all other active intervention diets the MedDiet reduced SBP and DBP (difference in means:-1.5mm Hg; 95% CI:-2.8,-0.1; P=0.035, and-0.9mm Hg; 95% CI:-1.5,-0.3; P=0.002, respectively). Compared only to the usual diet the MedDiet reduced SBP and DBP, while compared to all other active intervention diets or only to the low-fat diet the MedDiet did not reduce SBP and DBP. The MedDiet reduced DBP levels to a higher extent in trials with mean baseline SBP ≥130mm Hg, while both SBP and DBP were reduced more in trials with a mean follow-up period ≥16 weeks. The quality of evidence was rated as moderate for both outcomes according to the grading of recommendations, assessment, development and evaluation (GRADE) approach. The adoption of the MedDiet was accompanied by a relatively small, but yet significant BP reduction, while higher baseline SBP levels and longer follow-up duration enhanced the BP-lowering effect of the intervention. This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42020167308. CRD42020167308.

Rationale, Design, and Implementation of Intensive Risk Factor Treatment in the CREST2 Trial

A subanalysis of patients entered in the CREST2 trial (carotid revascularization and medical management for asymptomatic carotid stenosis) from 2014 to March 23, 2020 was performed. Interim risk factor data were gathered for 1618 patients at baseline and follow-up through 24 months analyzing intensive medical management alone compared with intensive medical management plus carotid endarterectomy or transfemoral carotid artery stenting for preventing stroke or death. The mean baseline low-density lipoprotein level was 80 mg/dL, which had significantly improved to 67 mg/dL after intensive medical treatment. The mean baseline systolic blood pressure of 140 mm Hg had significantly improved to 130 mm Hg. A rigorous approach to intensive stroke risk factor management in CREST2 resulted in significant improvements in risk factor control.

Epidemiological features of primary glomerular disease in Turkey: a multicenter study by the Turkish Society of Nephrology Glomerular Diseases Working Group

BackgroundThe largest data on the epidemiology of primary glomerular diseases (PGDs) are obtained from the databases of countries or centers. Here, we present the extended results of the Primary Glomerular Diseases Study of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) Working Group.MethodsData of patients who underwent renal biopsy and received the diagnosis of PGD were recorded in the database prepared for the study. A total of 4399 patients from 47 centers were evaluated between May 2009 and May 2019. The data obtained at the time of kidney biopsy were analyzed. After the exclusion of patients without light microscopy and immunofluorescence microscopy findings, a total of 3875 patients were included in the study.ResultsThe mean age was 41.5 ± 14.9 years. 1690 patients were female (43.6%) and 2185 (56.3%) were male. Nephrotic syndrome was the most common biopsy indication (51.7%). This was followed by asymptomatic urinary abnormalities (18.3%) and nephritic syndrome (17.8%). The most common PGD was IgA nephropathy (25.7%) followed by membranous nephropathy (25.6%) and focal segmental glomerulosclerosis (21.9%). The mean total number of glomeruli per biopsy was 17 ± 10. The mean baseline systolic blood pressure was 130 ± 20 mmHg and diastolic blood pressure was 81 ± 12 mmHg. The median proteinuria, serum creatinine, estimated GFR, and mean albumin values were 3300 (IQR: 1467–6307) mg/day, 1.0 (IQR: 0.7–1.6) mg/dL, 82.9 (IQR: 47.0–113.0) mL/min and 3.2 ± 0.9 g/dL, respectively.ConclusionsThe distribution of PGDs in Turkey has become similar to that in other European countries. IgA nephropathy diagnosed via renal biopsy has become more prevalent compared to membranous nephropathy.

Regression to the mean in home blood pressure: Analyses of the BP GUIDE study.

The aim of our study was to estimate the size of regression to the mean with home blood pressure (BP) monitoring and compare with that for office BP. Office and home BP measures were obtained from the BP GUIDE (value of central Blood Pressure for GUIDing managEment for hypertension) study, in which 286 patients had BP measured every 3months for 12months. Patients were categorized by 10mmHg strata of baseline BP, and regression to the mean measures was calculated for home and office BP. High baseline home BP readings tended to be lower on long-term follow-up, and low baseline readings tended to be higher. For example, patients in the group with mean baseline home systolic BP≥150mmHg had a mean baseline systolic BP of 156mmHg, which fell to 143mmHg at 12months; and patients in the group with mean baseline home systolic BP<120mmHg had a mean baseline systolic BP of 113mmHg which rose to 120mmHg at 12months. Similar patterns were seen in intervention and control groups, and for diastolic BP. The regression dilution ratio for home systolic BP and diastolic BP was 0.52 and 0.64, respectively, compared to 0.40 and 0.55 for office systolic BP and diastolic BP, respectively. Home BP is subject to regression to the mean to a similar degree as office BP. These findings have implications for the diagnosis and management of hypertension using home BP.

Intensive Blood Pressure Lowering in Patients with Moderate to Severe Grade Acute Cerebral Hemorrhage: Post Hoc Analysis of Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 Trial

Objective: To study the effect of intensive blood pressure reduction in patients with moderate to severe intracerebral hemorrhage (ICH) within the subjects recruited in Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial. Design: Randomized, multicenter, 2 group, open-label clinical trial. Setting: A total of 110 sites in the USA, Japan, China, Taiwan, South Korea, and Germany. Patients: A total of 1,000 patients underwent randomization from May 2011 till September 2015. Interventions: We analyzed the effect of intensive (goal 110–139 mm Hg) over standard (goal 140–179 mm Hg) systolic blood pressure (SBP) reduction using intravenous nicardipine within 4.5 h of symptom onset in moderate to severe grade subjects with ICH in a non-prespecified analysis. Moderate to severe grade was defined by Glasgow Coma Scale score <13 or baseline National Institutes of Health Stroke Scale score ≥10 or baseline intraparenchymal hemorrhage volume ≥30 mL or presence of intraventricular hemorrhage. The primary outcome was death or disability (score 4–6 on the modified Rankin scale) at 3 months after randomization ascertained by a blinded investigator. Measurements and Main Results: Of a total of 682 subjects who met the definition of moderate to severe grade (mean age 61.9 ± 13.1 years, 62.5% men) with a mean baseline SBP of 174.7 ± 24.8 mm Hg, the frequency of hematoma expansion was significantly lower among subjects randomized to intensive SBP reduction than among subjects randomized to standard SBP reduction (20.4 vs. 27.9%, relative risk [RR]: 0.7; 95% confidence interval [CI]: 0.55–0.96). The primary endpoint of death or disability was observed in 52.5% (170/324) of subjects receiving intensive SBP reduction and 48.9% (163/333) of subjects receiving standard SBP reduction (RR: 1.1; 95% CI: 0.9–1.2). Conclusions: Intensive SBP lowering reduced the frequency of hematoma expansion but did not reduce the rate of death or disability in patients with moderate to severe grade ICH.