Hypertension Medication Use Research Articles

Socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes management services in Indonesia.

SummaryObjectivesTo describe socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes (T2D) management services in the Indonesian population and to determine whether education level and geographical location contribute to inequalities.MethodsCross‐sectional study using data from the 2014 Indonesia Family Life Survey (N = 30 762 for hypertension; N = 6758 for T2D). Socioeconomic status was measured by household consumption. The prevalence of hypertension and T2D was determined using internationally standardised clinical measurement, while disease management was defined by participation in screening and current use of medication. The relative index of inequality (RII) was used to estimate inequalities, adjusted to education level and geographical location.ResultsFor all household consumption quintiles, we observed low rates of screening participation for T2D and low medication use in both hypertension and T2D. We found socioeconomic inequalities in screening participation for hypertension (RII 2.68, 95% CI 2.42–2.96) and T2D (RII 7.30, 95% CI 5.48–9.72) and also for medication use in hypertension (RII 3.09, 95% CI 2.28–4.18) and T2D (RII 2.81, 95% CI 1.09–7.27). Education level contributed to socioeconomic inequalities in screening utilisation for both hypertension and T2D. Geographical location contributed to inequalities in screening utilisation and medication use for T2D. Socioeconomic inequalities in medication use for hypertension and T2D were larger among men than women.ConclusionsLarge socioeconomic inequalities were found in the utilisation of hypertension and T2D management services in Indonesia. Improving affordability, availability and approachability of services is crucial to reduce such inequalities.

The Association Between Obstructive Sleep Apnea Characterized by a Minimum 3 Percent Oxygen Desaturation or Arousal Hypopnea Definition and Hypertension.

The association between obstructive sleep apnea (OSA) and hypertension in prior studies has been determined using a definition of hypopnea requiring a 4% O₂ desaturation. However, the American Academy of Sleep Medicine (AASM) recommends using a 3% O₂ desaturation or an arousal. This analysis assesses the relationship between OSA and hypertension utilizing the AASM recommended definition and the 2018 American College of Cardiology/American Heart Association hypertension guidelines. Data from 6113 participants from the Sleep Heart Health Study were analyzed. The AASM recommended apnea-hypopnea index (AHI) was classified into 4 categories of OSA severity: < 5, 5 to < 15, 15 to < 30 and ≥ 30 events/h. Three definitions of hypertension were used: elevated (> 120/< 80 or use of hypertension medications [meds]), stage 1/stage 2 (> 130/80 or meds), stage 2 (> 140/90 or meds). Data were analyzed using logistic regression controlling for demographics, smoking and body mass index. Multiple linear regression analysis assessed the relationship between natural log AHI, and systolic and diastolic blood pressure controlling for the same covariates. For all definitions of blood pressure elevation, increasing OSA severity was associated with greater likelihood of an elevated or hypertensive status in fully adjusted models (odds ratio [95% confidence interval]): elevated 1.30 (1.09-1.54), 1.39 (1.13-1.70) 1.69 (1.29-2.13); stage 1/2: 1.25 (1.06-1.47), 1.32 (1.10-1.59), 1.53 (1.23-1.91); stage 2: 1.07 (0.91-1.25), 1.21 (1.01-1.44), 1.37 (1.11-1.69) for AHI 5 to < 15, 15 to < 30 and > 30 events/h (< 5 events/h reference). Linear regression found that AHI was associated with both systolic and diastolic blood pressure in fully adjusted models. Use of the AASM recommended definition of hypopnea as a component of the AHI is associated with the presence of hypertension. Budhiraja R, Javaheri S, Parthasarathy S, Berry RB, Quan SF. The association between obstructive sleep apnea characterized by a minimum 3 percent oxygen desaturation or arousal hypopnea definition and hypertension. J Clin Sleep Med. 2019;15(9):1261-1270.

Association between acute kidney injury and atrial fibrillation in patients undergoing cardiac surgery

Introduction Atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery, affecting up to 50% of patients in the immediate postoperative period. Postoperative AF is associated with increased morbidity, mortality and prolonged ITU stay. Recent guidelines (1) have identified age >75, history of AF, renal failure, mitral valve surgery/pathology, heart failure and chronic obstructive pulmonary disease as preoperative risk factors for developing new postoperative AF, with the intention of providing these patients with pre-emptive treatment to reduce the risk of AF in the postoperative period. We hypothesised that acute kidney injury (AKI) in the postoperative period could be an additional risk factor for the development of AF. Methods We performed an analysis on routinely collected data from patients who underwent elective cardiac surgery at our institution between 1st July 2013 and 31st December 2018. Patients who had pre-existing cardiac arrhythmias and patients who had undergone previous cardiac surgery were excluded. Multivariable logistic regression was used to explore the associations that postoperative AKI (defined as an increase in baseline creatinine by a minimum of 26.4 µmol/L or by 50% of the baseline measurement, during the first 48 hours after surgery) and preoperative risk factors had with postoperative AF. Results A total of 5588 patients were included in the study. The incidence of postoperative AF was 1384 (24.8%), postoperative AKI occurred in 686 patients (12.3%). Postoperative AKI was significantly associated with postoperative AF after adjustment for preoperative variables (adjusted odds ratio = 1.572; confidence interval = 1.295 to 1.908; p = III, previous congestive heart failure, recent MI, routine use of hypertension medication, CABG + valve surgery and aortic surgery (see Table 1). Discussion This analysis of a large, contemporary cohort of patients identifies postoperative AKI as an associated risk factor for postoperative AF, along with other preoperative variables. Early identification of this patient cohort would allow targeted preventative treatment to reduce the incidence of postoperative AF. This analysis provides impetus for clinical trials that further explore the association between AF and AKI.

Association Between Self-Reported Hypertension and Antihypertensive Medication Use and Cardiovascular Disease–Related Events and Expenditures Among Patients Diagnosed With Hypertension

Research suggests that persons who are aware of the risk factors for cardiovascular disease (CVD) are more likely to engage in healthy behaviors than persons who are not aware of the risk factors. We examined whether patients whose insurance claims included an International Classification of Diseases, Ninth Revision (ICD-9) code associated with hypertension who self-reported high blood pressure were more likely to fill antihypertensive medication prescriptions and less likely to have CVD-related emergency department visits and hospitalizations (hereinafter, CVD-related events) and related medical expenditures than patients with these codes who did not self-report high blood pressure. We used a large convenience sample from the MarketScan Commercial Database linked with the MarketScan Health Risk Assessment (HRA) Database to identify patients aged 18-64 in the United States whose insurance claims included an ICD-9 code associated with hypertension and who completed an HRA from 2008 through 2012 (n = 111 655). We used multivariate logistic regression analysis to examine the association between self-reported high blood pressure and (1) filling prescriptions for antihypertensive medications and (2) CVD-related events. Because most patients with hypertension will not have a CVD-related event, we used a 2-part model to analyze medical expenditures. The first part estimated the likelihood of a CVD-related event, and the second part estimated expenditures. Patients with an ICD-9 code of hypertension who self-reported high blood pressure had a significantly higher predicted probability of filling antihypertensive medication prescriptions (26.5%; 95% confidence interval, 25.7-27.3; P < .001), had a significantly lower predicted probability of a CVD-related event (0.6%, P < .001), and on average spent significantly less on CVD-related events ($251, P = .01) than patients who did not self-report high blood pressure. This study affirms that self-knowledge of high blood pressure, even among patients who are diagnosed and treated for hypertension, can be improved. Interventions that improve patients' awareness of their hypertension may improve antihypertensive medication use and reduce adverse CVD-related events.

Responses to Pirfenidone Treatment in Patients with Idiopathic Pulmonary Fibrosis is Not Associated with Changes in Echocardiographic Parameters of Left Ventricular Structure and Function

Background Pirfenidone, an FDA-approved novel anti-fibrotic agent used in the treatment of idiopathic pulmonary fibrosis (IPF), has been implicated in mitigating myocardial fibrosis, systolic and diastolic dysfunction in animal models (Kuwahara et al, Circulation 2002). However to date, the effect of Pirfenidone on left ventricular (LV) structure and function in humans with IPF has not been studied. Hypothesis We hypothesize that changes in echocardiographic parameters of LV structure and function would be more favorable in responders compared to non-responders of pirfenidone in patients with IPF. Methods We performed a retrospective review of 27 consecutive patients with IPF on pirfenidone between 2014-2018 with serial baseline and follow up echocardiograms and pulmonary function testing. Treatment failure (non-response) was defined as an absolute decline in forced vital capacity (FVC) of more than 10% whilst being on the medication. Comprehensive echocardiographic data extraction and analysis was performed in all patients. Changes in parameters of LV structure (LV mass, interventricular septal and posterior wall thickness, indexed end systolic and diastolic volumes), systolic function (LVEF), diastolic function (Indexed left atrial volume, trans-mitral Doppler flow patterns, tissue Doppler indices) and global LV longitudinal strain were compared between responders and non-responders. Results In our study cohort, 18 responders and 9 non-responders were identified. Responders were significantly older than non-responders, yet sex, history of CAD, hypertension, diabetes, atrial fibrillation, CKD and cardiac medication use were not significantly different. Baseline echocardiographic parameters were comparable, except for septal e/e’, which was higher in responders (11.68 vs 10.1; p Conclusion In contrary to our hypothesis, we observed that response to pirfenidone therapy in patients with IPF did not associate with echocardiographic changes of left ventricle structure and function.

The state of hypertension care in 44 low-income and middle-income countries: a cross-sectional study of nationally representative individual-level data from 1·1 million adults

Evidence from nationally representative studies in low-income and middle-income countries (LMICs) on where in the hypertension care continuum patients are lost to care is sparse. This information, however, is essential for effective targeting of interventions by health services and monitoring progress in improving hypertension care. We aimed to determine the cascade of hypertension care in 44 LMICs-and its variation between countries and population groups-by dividing the progression in the care process, from need of care to successful treatment, into discrete stages and measuring the losses at each stage. In this cross-sectional study, we pooled individual-level population-based data from 44 LMICs. We first searched for nationally representative datasets from the WHO Stepwise Approach to Surveillance (STEPS) from 2005 or later. If a STEPS dataset was not available for a LMIC (or we could not gain access to it), we conducted a systematic search for survey datasets; the inclusion criteria in these searches were that the survey was done in 2005 or later, was nationally representative for at least three 10-year age groups older than 15 years, included measured blood pressure data, and contained data on at least two hypertension care cascade steps. Hypertension was defined as a systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, or reported use of medication for hypertension. Among those with hypertension, we calculated the proportion of individuals who had ever had their blood pressure measured; had been diagnosed with hypertension; had been treated for hypertension; and had achieved control of their hypertension. We weighted countries proportionally to their population size when determining this hypertension care cascade at the global and regional level. We disaggregated the hypertension care cascade by age, sex, education, household wealth quintile, body-mass index, smoking status, country, and region. We used linear regression to predict, separately for each cascade step, a country's performance based on gross domestic product (GDP) per capita, allowing us to identify countries whose performance fell outside of the 95% prediction interval. Our pooled dataset included 1 100 507 participants, of whom 192 441 (17·5%) had hypertension. Among those with hypertension, 73·6% of participants (95% CI 72·9-74·3) had ever had their blood pressure measured, 39·2% of participants (38·2-40·3) had been diagnosed with hypertension, 29·9% of participants (28·6-31·3) received treatment, and 10·3% of participants (9·6-11·0) achieved control of their hypertension. Countries in Latin America and the Caribbean generally achieved the best performance relative to their predicted performance based on GDP per capita, whereas countries in sub-Saharan Africa performed worst. Bangladesh, Brazil, Costa Rica, Ecuador, Kyrgyzstan, and Peru performed significantly better on all care cascade steps than predicted based on GDP per capita. Being a woman, older, more educated, wealthier, and not being a current smoker were all positively associated with attaining each of the four steps of the care cascade. Our study provides important evidence for the design and targeting of health policies and service interventions for hypertension in LMICs. We show at what steps and for whom there are gaps in the hypertension care process in each of the 44 countries in our study. We also identified countries in each world region that perform better than expected from their economic development, which can direct policy makers to important policy lessons. Given the high disease burden caused by hypertension in LMICs, nationally representative hypertension care cascades, as constructed in this study, are an important measure of progress towards achieving universal health coverage. Harvard McLennan Family Fund, Alexander von Humboldt Foundation.

Psychological distress and C-reactive protein in a South African national survey.

To examine the association of psychological distress with serum C-reactive protein (CRP) in a South African cohort. Data were analysed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) of 2012. Psychological distress was evaluated using the Kessler Psychological Distress Scale. Linear regression models assessed the association of psychological distress with serum CRP, adjusting for possible confounding factors. The analytic sample comprised n = 3944 individuals (mean age = 40 and sex = 36% males). Psychological distress was significantly associated with increased serum CRP levels (B = 0.31 and p = 0.001). This association was no longer significant after adjusting for demographic variables, lifestyle factors, cardiac disease, diabetes, hypertension, trauma and anti-inflammatory medication use (B = 0.15 and p = 0.062). Psychological distress was associated with elevated levels of CRP among South African adults. However, the association was confounded by a range of factors, with demographic variables (age, sex and population group) having the largest confounding effect. These findings indicate that CRP is not a useful biomarker of psychological distress, and that additional work is needed on the underlying psychobiology of psychological distress.

Association of exposure to Chinese famine in early life with the incidence of hypertension in adulthood: A 22-year cohort study

Background and aimsUndernutrition in early life may have a lifelong effect on adult health. The conclusions on the association of exposure to famine with the risk of hypertension were inconsistent. The aim of this study was to examine the association of exposure to the Chinese famine with incident hypertension. Methods and resultsData were obtained from the China Health and Nutrition Survey. All included participants were divided into five birth cohorts: no exposure, born in or after 1962 (N = 2 088); fetal exposure, between 1959 and 1961 (N = 880); early childhood exposure, between 1956 and 1958 (N = 1 214); mid-childhood exposure, between 1953 and 1955 (N = 1 287); and late childhood exposure, between 1949 and 1952 (N = 1 445). Hypertension was defined as SBP/DBP ≥140/90 mmHg, use of hypertensive medications, or a self-reported diagnosis. A total of 6 914 participants were included. The exposure to famine decreased the incidence of hypertension (P = 0.0018, 0.0001, <0.0001, and <0.0001; HR: 0.715, 0.686, 0.622, and 0.527, respectively) in males. Similarly, the exposure to famine might also decrease incident hypertension in the rural areas (P = 0.0013, <0.0001, <0.0001, and <0.0001; HR: 0.735, 0.706, 0.679, and 0.539, respectively). There were interaction effects between famine severity and exposure to famine in early (P = 0.024) and late childhood (P = 0.009). ConclusionExposure to the Chinese famine decreased the incidence of hypertension, especially in males and in the rural areas. Furthermore, the exposure postponed the age at the onset of hypertension.

Change in Perceived Stress Moderates the Association Between Weight Change and HbA1c Change in Puerto Rican Women (P21-035-19)

ObjectivesTo assess the association between weight change and change in HbA1c in Puerto Rican men and women, and to evaluate the moderating role of perceived stress in this association MethodsBaseline and 2-year data from the Boston Puerto Rican Health Study were used. Individuals on diabetes medications were excluded. The sample included 218 men and 549 women with complete measures at baseline and 2-year follow up. Stress was assessed with the Perceived Stress Scale-14 and HbA1c from fasting blood samples. Changes in weight, perceived stress, and HbA1c from baseline to year 2 were calculated (i.e., year 2 – baseline). Analyses included linear regression models stratified by sex and adjusted for baseline age, education, smoking status, diet quality, physical activity, body mass index (BMI), baseline HbA1c, diabetes status, menopause status and use of medications for hypertension, hyperlipidemia, depression and thyroid disease. Likelihood ratio (LR) tests were used to evaluate the interaction between weight change and change in perceived stress. ResultsMean baseline to year 2 change in weight was −0.3 kg + 6.1 for women and 0.3 kg + 4.7 for men. Mean change in HbA1c was 0.03% + 0.87 for women and −0.07% + 1.16 for men. Weight change was associated with HbA1c change in women (= 0.037; P < 0.001) but not in men. In women, there was an interaction between weight change and change in perceived stress (p value LR test = 0.005) on change in HbA1c. The coefficient for the interaction was positive and statistically significant (= 0.002; p value = 0.006), indicating that the positive association between weight change on HbA1c change was greater with increasing changes in perceived stress. ConclusionsIn this sample of Puerto Rican men and women, weight change was positively associated with change in HbA1c in women but not in men. Change in perceived stress increased HbA1c sensitivity to weight change. Future studies are needed to replicate our findings and examine pathways that explain this interaction. Funding SourcesResearch was supported by NIH P50 HL105185, P01 AG023394, R01 AG055948, and the University of Massachusetts CCTS (TL1, UL1TR001453). Supporting Tables, Images and/or Graphs▪

An Association Between Large Optic Nerve Cupping and Cognitive Function

To determine if a larger cup-to-disc ratiois associated with poor cognitive function in postmenopausal women without glaucoma or ocular hypertension. We used data from the Women's Health Initiative (WHI) hormone trial, originally designed to test effects of hormone therapy (HT) on various health outcomes. Large cup-to-disc ratio was defined as greater than 0.6 in either eye based on stereoscopic optic nerve photographs. Global cognitive function was assessed annually by Modified Mini-Mental State Examination (3MSE) in the WHI Memory Study. Exclusions were no information on optic nerve grading; no 3MSE scores at the time of the eye examination, ocular hypertension (intraocular pressure >23mm Hg, Goldmann applanation tonometry), or glaucoma medication use. A generalized linear model for log-transformed 3MSE scores was used for determining the association between large cup-to-disc ratio and 3MSE scores, adjusting for age, race, diabetes, body mass index, cardiovascular disease, smoking, HT randomization, education, and diabetic retinopathy. Analyses included 1636 women (mean age ± standard deviation, 69.57 ± 3.64 years; 90.39% white). Of those, 122 women had large cup-to-disc ratio. The mean 3MSE scores in women with vs without large cup-to-disc ratio were 95.4 ± 6 vs 96.6 ± 5. In the adjusted model, women with large cup-to-disc ratio had statistically significantly lower 3MSE scores, compared with those without large cup-to-disc ratio, yielding the predicted mean difference in 3MSE scores of 0.75 with a standard error of 0.05 units (P= .04). Postmenopausal women who had large cup-to-disc ratio without glaucoma or ocular hypertension exhibited lower global cognitive function. Further investigation is warranted. NOTE: Publication of this article is sponsored bythe American Ophthalmological Society.

Impact of uric acid on incident hypertension: Sex-specific analysis in different age groups

The aim of the present study is to evaluate the association of serum uric acid (UA) levels with the risk of incident hypertension among different age groups in men and women using a single large Japanese general cohort. The present study is based on annual health check-up program in Gunma, Japan. We studied 12,029 participants (mean age, 48 ​± ​9 years old; 31% women) free of prevalent cardiovascular disease and hypertension at baseline (2009). Hypertension was defined by self-report, hypertensive medication use, or measured BP ​> ​140/90 ​mmHg ​at each visit. Discrete proportional hazards regression model was used to evaluate the association of UA level at baseline with incident hypertension through 2012 adjusted for age, gender, baseline blood pressure, and other CVD risk factors among different age decade groups in men and women. During follow-up of 3 years, 12% of the cohort (n ​= ​1457) developed hypertension. UA was strongly associated with incident hypertension in the multivariable model in all participants. In age-stratified analysis, participants below 50 years of age in men had the significant association of UA with incident hypertension, whereas participants above 50 years did not. In women, participants above 40 years had the significant association, whereas participants below 40 years did not. The present data suggest that UA level is an independent predictor for incident hypertension among middle aged men below 50 years old and middle aged and the elderly women above 40 years.

Associations between shift work and use of prescribed medications for the treatment of hypertension, diabetes, and dyslipidemia: a prospective cohort study.

Objective This study examined the associations between shift work and use of antihypertensive, lipid-lowering, and antidiabetic medications. Methods Survey data from two cohorts of Finnish men (N=11 998) and women (N=49 944) working in multiple occupations where shift work was used were linked to national Drug Prescription Register data, with up to 11 years of follow-up. In each cohort, age-stratified Cox proportional hazard regression models were computed to examine any incident use of prescription medication for each of the three medical conditions, separately comparing each of two groups of rotating shift workers (those whose schedules included night shifts, and those whose schedules did not include night shifts) with day workers who worked in a similar range of occupations. Results In the larger cohort, among participants aged 40-49 at baseline, shift work without night shifts was associated with increased use of type-2 diabetes medication after adjustments for sex, occupational status, marital status, alcohol consumption, smoking, and physical activity [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.01-1.62], while shift work with night shifts was associated with increased use of dyslipidemia medication after adjustments (HR 1.33, 95% CI 1.12-1.57). There were no such associations among younger and older shift workers. Also in the larger cohort, among those aged <50 years at baseline, both types of shift work were associated with increased use of hypertension medication after adjustments [up to HR 1.20 (95% CI 1.05-1.37)]. There were no positive associations in the smaller cohort. Conclusions There was mixed evidence regarding the use of medications for cardiovascular risk factors by shift workers. Selection effects may have affected the associations.

APPLICATION OF THE H2FPEF-SCORE TO A GLOBAL CLINICAL TRIAL OF PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION: THE TOPCAT TRIAL

Diagnostic uncertainties have posed challenges to the conduct of global trials of heart failure with preserved ejection fraction (HFpEF). We applied the H2FPEF-score, a validated diagnostic algorithm for HFpEF, to the TOPCAT trial. The H2FPEF-score (age, BMI, hypertension medication use, atrial

Pseudoexfoliation Syndrome and Antidepressant Drug Use

Objectives:To investigate the relationship between pseudoexfoliation syndrome (PES) and the use of antidepressant medications.Materials and Methods:This population-based, cross-sectional study included 2,017 of 2,356 invited subjects who were randomly selected from the Turkish Statistical Institute database (www.turksat.gov.tr/) as part of an epidemiologic study which specifically aimed to detect the prevalence of PES in the province of Eskişehir. During the examination, a detailed questionnaire was administered to determine physician-diagnosed systemic disease and drug use.Results:Eight of the 2,017 participants in the study were excluded for various reasons (2 with posterior synechiae, 2 with corneal opacity, 1 uncooperative patient, 1 eviscerated patient, 1 with active adenoviral keratoconjunctivitis, and 1 with a history of angle closure). PES was detected in 100 (5%) of the 2,009 patients whose data were analyzed. The percentage of subjects with concurrent antidepressant drug use in the PES and non-PES non-glaucoma groups were 4.1% (n=3) and 1.1% (n=21), respectively. The difference between the two groups was statistically significant (p=0.024). In addition, the use of medications for hypertension (p<0.001) and coronary artery disease (p=0.009) was also higher in the PES group.Conclusion:The higher prevalence of antidepressant drug use in patients with PES may be related to the processes of vascular damage and inflammation common to the pathogenesis of both PES and depression, as well as the high rate of chronic systemic comorbidities in these patients.

Incidence and Progression of Coronary Artery Calcium in South Asians Compared With 4 Race/Ethnic Groups.

BackgroundSouth Asians have a relatively high prevalence of coronary artery calcium (CAC) compared with other race/ethnic groups. We determined CAC incidence and progression among South Asians, and compared them with 4 race/ethnic groups.Methods and ResultsData from the MASALA (Mediators of Atherosclerosis in South Asians Living in America) study were used to calculate CAC incidence and progression rates and any CAC change. Data from the MESA (Multi‐Ethnic Study of Atherosclerosis) were used to compare the CAC incidence and progression rates. A total of 698 South Asians had repeat CAC measurements after 4.8±0.8 years. Among those with no CAC at baseline, the age‐adjusted CAC incidence was 8.8% (95% CI, 6.8–10.8%) in men and 3.6% (2.5–4.8%) in women. The median annual CAC progression was 26 (interquartile range, 11–62) for men and 13 (interquartile range, 4–34) for women. Compared with MESA, age‐adjusted CAC incidence was similar in South Asian men compared with white, black, and Latino men, but significantly higher than Chinese men (11.1% versus 5.7%, P=0.008). After adjusting for age, diabetes mellitus, hypertension, and statin medication use, Chinese, black, and Latino men had significantly less CAC change compared with South Asian men, but there were no differences between South Asian and white men. There was no difference in CAC incidence or progression between South Asian women and women in MESA.ConclusionsSouth Asian men had greater CAC change than Chinese, black, and Latino men but similar change to that of whites after adjusting for traditional risk factors.

Use of antihypertensive and antidiabetic medications in Brazil: an analysis of socioeconomic differences. National Health Survey, 2013.

To analyze the socioeconomic and demographic differences in medication use to control hypertension and diabetes mellitus in Brazil. Data from the National Health Survey (Pesquisa Nacional de Saúde - PNS) performed in Brazil in 2013 with a representative sample of the population aged 18years old or older were analyzed. The use of medications for hypertension and diabetes according to income, education, race, possession of a private health insurance plan and region of household were estimated. Theprevalence ratios adjusted for sex and age were also estimated using Poisson regression. 81.4% of the hypertensive population used medication to control the disease. The use was higher among females, white/Caucasian individuals and those with a private health plan. In the case of diabetes mellitus, 80.2% of the population used medication to control the disease and the use was higher in elderly patients, patients with a higher level of education, patients with a private health plan, and patients in the Southeast region. Inequalities according to income and health plan were small even in the strata of sex, age and geographic region analyzed. We found a high use of medication to control hypertension and diabetes. Socioeconomic inequalities in use were not expressive, probably due to medication policies that promote greater and equitable access to medicines in Brazil.

Pulmonary vasodilator therapies are of no benefit in pulmonary hypertension due to left heart disease: A meta-analysis

BackgroundPulmonary hypertension complicating left heart disease (PH-LHD) is the most common cause of PH. Off-label use of pulmonary arterial hypertension (PAH) medications for PH-LHD is prevalent, despite a lack of clinical data supporting their use. MethodsA systematic review and meta-analysis was performed. Comprehensive search of all available literature to date identified ten randomised, placebo controlled trials comprising 439 treated (Phosphodiesterase 5 inhibitors: n = 206; guanylate cyclase stimulators: n = 132; endothelin receptor antagonists: n = 101) and 338 placebo patients. Random effects model was employed to assess outcomes in the treatment compared to the placebo control arm. ResultsThe risks of all-cause mortality, cardiovascular mortality and worsening heart failure were numerically higher in the treated compared to the control group, although not statistically (all-cause mortality: RR = 1.97, 95% CI: 0.64–6.05, p = 0.24; cardiovascular mortality: RR = 2.01, 95% CI: 0.39–10.34, p = 0.4; worsening heart failure: RR = 1.23, 95% CI: 0.68–2.25, p = 0.49). Conversely, right heart hemodynamics improved numerically in the treated group, also without being significant (mean pulmonary artery pressure: MWD = −5.13 mm Hg, 95% CI: −13.2–2.9, p = 0.21; pulmonary vascular resistance: MWD = −0.87 WU, 95% CI: −1.75–0.1, p = 0.053). ConclusionsThe current meta-analysis demonstrated that there is no current evidence to support the widespread use of PAH therapy in PH-LHD. On the basis of a numerically increased risk of clinical harm, these agents should not be prescribed in this setting, unless further evidence of benefit arises in the future.

Coronary risk assessment using traditional risk factors with CT coronary artery calcium scoring in clinical practice.

As coronary artery calcium (CAC) is atherosclerosis and not just a marker of cardiovascular (CV) disease, measurement of a patient's coronary artery calcium score (CACS) is a strong predictor of risk. Clinically performed in asymptomatic patients, the CACS, along with several CV risk factors, namely age, sex, ethnicity, diabetes, tobacco use, family history, cholesterol level, blood pressure, and use of cholesterol or hypertensive medications, provide a predictive model of 10year risk for CV events. Asmartphone "App" makes this quick to obtain and use. This helps the clinician in making recommendations for both lifestyle changes and statin therapy. Those patients in which the most benefit occur from measurement of a CACS are those at an intermediate CV risk. Measurement of the CACS has become an integral part of the clinician's assessment of a patient's CV risk and for guiding preventative therapies.

Metabolic Parameters, Weight Loss, and Comorbidities 4Years After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

Sleeve gastrectomy (LSG) is now the predominant bariatric surgery performed, yet there is limited long-term data comparing important outcomes between LSG and Roux-en-Y gastric bypass (RYGB). This study compares weight loss and impact on comorbidities of the two procedures. We retrospectively evaluated weight, blood pressure, hemoglobin A1c, cholesterol, and medication use for hypertension, diabetes, and hyperlipidemia at 1-4years post-operatively in 380 patients who underwent RYGB and 334 patients who underwent LSG at the University of Michigan from January 2008 to November 2013. Follow-up rates from 714 patients initially were 657 (92%), 556 (78%), 507 (71%), and 498 (70%) at 1-4years post-operatively. Baseline characteristics were similar except for higher weight and BMI in LSG. There was greater weight loss with RYGB vs. LSG at all points. Hemoglobin A1c and total cholesterol improved more in RYGB vs. LSG at 4years. There was greater remission of hypertension and discontinuation of all medications for hypertension and diabetes with RYGB at 4years. Weight loss, reduction in medications for hypertension and diabetes, improvements in markers of diabetes and hyperlipidemia, and remission rates of hypertension were superior with RYGB vs. LSG 4years post-operatively. Choice of bariatric procedures should be tailored to surgical risk, comorbidities, and weight loss goals.

APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults.

APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.