Integrated Blood Pressure Control最新文献

{"title":"Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia.","authors":"Daniel Mengistu Bekele,&nbsp;Dejuma Yadeta Goshu,&nbsp;Alemayehu Worku Yalew,&nbsp;Melinda K Higgins,&nbsp;Rebecca A Gary","doi":"10.2147/IBPC.S370838","DOIUrl":"https://doi.org/10.2147/IBPC.S370838","url":null,"abstract":"<p><strong>Background: </strong>Accurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients' risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).</p><p><strong>Methods: </strong>A cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants' risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.</p><p><strong>Results: </strong>Participants (n=377) had a mean age of 53.61 ± 12.80-years, range (18-82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43-18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36-14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants' CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.</p><p><strong>Conclusion: </strong>Hypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients' CVD risk perception to reduce adverse CVD events.</p>","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9a/27/ibpc-15-81.PMC9363046.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40717418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension and Its Associated Factors Among Long-Distance Truck Drivers in Ethiopia.","authors":"Mohammed Ebrahim Rike,&nbsp;Mengistie Diress,&nbsp;Baye Dagnew,&nbsp;Mihret Getnet,&nbsp;Abbul Hasano Kebalo,&nbsp;Derese Sinamaw,&nbsp;Damtew Solomon,&nbsp;Yonas Akalu","doi":"10.2147/IBPC.S361789","DOIUrl":"https://doi.org/10.2147/IBPC.S361789","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is rising globally and is one of the leading causes of cardiovascular disease. It affects people of different groups; however, owing to a rise in a sedentary lifestyle it is more prevalent among long-distance truck drivers. However, the prevalence of hypertension and its associated factors among truck drivers in Ethiopia is not known. Therefore, this study aimed to determine the prevalence of hypertension and its associated factors among long-distance truck drivers in Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 415 long-distance truck drivers selected by systematic random sampling technique at Modjo dry port from May 15 to 30, 2021. The data were collected and entered into Epi-data 4.6 then it was exported to SPSS version 25 for analysis. Descriptive statistics, bivariable, and multivariable logistic regression analyses were executed. The odds ratio with a 95% confidence interval was computed. In the final model, a variable with a p ≤ 0.05 was declared as a predictor of hypertension.</p><p><strong>Results: </strong>The prevalence of hypertension among long-distance truck drivers in Ethiopia was 34.7%. The odds of hypertension was higher among drivers who were ≥45 years old [Adjusted odds ratio (AOR) = 4.32; 95% Confidence interval (CI): 2.16, 8.62], obese [AOR= 5.12; 95% CI: 1.33, 19.8], alcohol drinkers [AOR=3.05; 95% CI: 1.27, 7.31], and cigarette smokers [AOR= 3.74; 95% CI: 1.64, 8.51]. Drivers who had regular physical exercise were less likely [AOR=0.33; 95% CI: 0.17, 0.63] to have hypertension than drivers with no physical activity.</p><p><strong>Conclusion: </strong>More than a third of the participants in Ethiopia had hypertension. Higher age, obesity, absence of rest between driving, short sleep duration, smoking, alcohol drinking, and physical inactivity were significantly associated with hypertension. Therefore, health education on lifestyle modifications, sleep habits, and the importance of rest breaks between driving should be considered to prevent hypertension and further complications.</p>","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/cb/ibpc-15-67.PMC9233485.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40402805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Habitual Sleep Duration and Blood Pressure Control in United States (US) Adults with Hypertension","authors":"Everlyne G Ogugu, S. Catz, J. Bell, C. Drake, J. Bidwell, James E. Gangwisch","doi":"10.2147/IBPC.S359444","DOIUrl":"https://doi.org/10.2147/IBPC.S359444","url":null,"abstract":"Purpose This study examined the relationship between habitual sleep duration and blood pressure (BP) control in adults with hypertension. Methods This cross-sectional study used data of 5163 adults with hypertension obtained from the 2015–2018 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression was used to analyze the association between habitual sleep duration and BP control. Habitual sleep duration was self-reported and defined as the amount of sleep usually obtained in a night or main sleep period during weekdays or workdays. It was categorized as <6, 6 - <7, 7–9, and >9 hours. BP control was defined as average systolic BP <130mmHg and diastolic BP <80mmHg. Results Results from the fully adjusted models show that among all adults with hypertension, habitual sleep duration of <6 hours night/main sleep period was associated with reduced odds of BP control (OR = 0.53, 95% CI: 0ss.37–0.76, P = 0.001) when compared to 7–9 hours. In the subpopulation of adults who were on antihypertensive medication, those with a sleep duration of <6 hours had lower odds of BP control than those with a sleep duration of 7–9 hours (OR = 0.53, 95% CI: 0.36–0.77, P = 0.002). No significant differences were noted in all adults with hypertension and in the subpopulation of those on antihypertensive medication in BP control between the reference sleep duration group (7–9 hours) and the 6 - <7 or >9 hours groups. There were no significant differences across age groups or gender in the relationship between habitual sleep duration and BP control. Conclusion Sleep duration of <6 hours is associated with reduced odds of hypertension control. These significant findings indicate that interventions to support adequate habitual sleep duration may be a promising addition to the current hypertension management guidelines.","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47148500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Hypertension in Pregnancy: Challenges and Solutions","authors":"H. Afify, A. Kong, Jopher Bernal, I. Elgendy","doi":"10.2147/IBPC.S242242","DOIUrl":"https://doi.org/10.2147/IBPC.S242242","url":null,"abstract":"Abstract Pulmonary hypertension (PH) is a heterogeneous disease characterized by an elevated mean pulmonary artery pressure of 20 mm Hg or above. PH is a prevalent condition among women of reproductive age and is linked with poor prognosis during pregnancy. Pregnancy is a stressful event and complicates the management and prognosis in patients with PH. In this review, we discuss the pathogenesis, clinical presentation as well as therapeutic options for PH during pregnancy. We also highlight knowledge gaps to guide future research.","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46428192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Levels of NT-Pro BNP in Patients with Preeclampsia","authors":"Thanh Xuan Nguyen, Van Tri Nguyen, Hong Ngoc Nguyen-Phan, Bui Bao Hoang","doi":"10.2147/IBPC.S360584","DOIUrl":"https://doi.org/10.2147/IBPC.S360584","url":null,"abstract":"Objective This study aims to determine the serum levels of NT-proBNP in women with preeclampsia with and without severe signs and to evaluate the cardiovascular risks in these two groups of participants. Methods A descriptive cross-sectional study was conducted on 52 women with preeclampsia in the Department of Gynecology and Obstetrics – Hue Central Hospital, from August 2019 to September 2020. Results In preeclampsia women, the rate of hypertension in stage 3, stage 2, and stage 1 were 46.1%, 32.7%, and 21.2%, respectively. The average Sokolow-Lyon index in the preeclampsia group with and without severe signs was 22.25 ± 7.38mm, 20.16 ± 5.54mm, respectively. The average left ventricular mass index in the group of preeclampsia patients without and with severe signs was 92.27 ± 14.56g/m2 and 120.68 ± 16.47g/m2, respectively. The average ejection fraction in the group of preeclampsia patients without severe signs and with severe signs was 65.11 ± 3.45%, 56.21 ± 7.12%, correspondingly. In contrast, the difference between the two groups was statistically significant with p < 0.05. The plasma NT-proBNP level in the preeclampsia group without severe signs was 349.12 ± 93.51pg/mL, whereas the concentration in the preeclampsia group with severe signs was 725.32 ± 290.46pg/mL (p < 0.05). Conclusion The NT-proBNP level was statistically significantly increased in the patients with preeclampsia. Analyzing and comparing the figures and changes found in two groups of PE patients, with and without severe signs, we suggest that women diagnosed with PE with severe signs have a higher risk of developing cardiovascular problems forthwith and henceforth.","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42859037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Hypertension Etiologies in Patients Undergoing Noncardiac Surgery in University Health Network Hospitals–Canada from 2015–2020","authors":"S. Mohseni, Sahar Behnam-Roudsari, Mohammad Tarbiat, Pouyan Shaker, Seyedmohammadshahab Shivaie, Mohammad Ali Shafiee","doi":"10.2147/IBPC.S347395","DOIUrl":"https://doi.org/10.2147/IBPC.S347395","url":null,"abstract":"Introduction Perioperative hypertension, defined as increased blood pressure around the surgery, is a known risk factor for perioperative complications, including cardiovascular events. Identifying reasons associated with hypertension in each period is of great help in preventing and better managing perioperative hypertension. Objective The aim of the study was to explore common etiologies of hypertension during the perioperative period (pre, intra, and post-operation) in patients who underwent noncardiac surgeries in University Health Network (UHN) hospitals, Canada, from 2015 to 2020. Patients and Methods We retrospectively analyzed the medical records of 174 patients undergoing noncardiac surgeries who experienced perioperative hypertension. We assessed the prevalence of 10 reasons for perioperative hypertension as a whole and also each period separately according to the physicians’ notes in patients’ medical records. Two-way measurements ANOVA was used to determine the change of mean hypertension among patients for specific etiology. Results The common etiologies of perioperative hypertension were poorly controlled hypertension (21.8%), excessive fluid therapy (19.5%), excessive vasopressor (18.4%), and medication withdrawal (13.7%). Regarding each period separately, the most common reasons were poorly controlled hypertension for pre (42.9%) and intraoperative period (22.7%) and fluid overload for the postoperative period (20.1%). Poor control of hypertension showed both within-subject statistical significance for systolic and between-subject statistical significance for diastolic blood pressure. Conclusion Poorly controlled hypertension is the most significant etiology of perioperative hypertension in patients undergoing noncardiac surgeries. Apart from poorly controlled hypertension, as a patient-related factor, iatrogenic factors such as excessive vasopressor therapy, aggressive fluid replacement and poor management of antihypertensive medications can also cause perioperative hypertension.","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41449765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Single Pill Combinations Compared to Identical Multi Pill Therapy on Outcomes in Hypertension, Dyslipidemia and Secondary Cardiovascular Prevention: The START-Study","authors":"T. Wilke, B. Weisser, H. Predel, R. Schmieder, S. Wassmann, A. Gillessen, J. Blettenberg, U. Maywald, O. Randerath, S. Mueller, M. Böhm","doi":"10.2147/IBPC.S336324","DOIUrl":"https://doi.org/10.2147/IBPC.S336324","url":null,"abstract":"Aim Current guidelines for the treatment of arterial hypertension (AH) or cardiovascular (CV) prevention recommend combination drug treatments with single pill combinations (SPC) to improve adherence to treatment. We aimed to assess whether the SPC concept is clinically superior to multi pill combination (MPC) with identical drugs. Methods and Results In an explorative study, we analyzed anonymized claims data sets of patients treated with CV drugs for hypertension and/or CV disorders who were insured by the German AOK PLUS statutory health fund covering 01/07/2012-30/06/2018. Patients at age ≥18 years who received either a SPC or MPC with identical drugs were followed for up to one year. A one to one propensity score matching (PSM) was applied within patient groups who started identical drug combinations, and results were reported as incidence rate ratios (IRRs) as well as hazard ratios (HRs). After PSM, data from 59,336 patients were analyzed. In 30 out of 56 IRR analyses, superiority of SPC over MPC was shown. In 5 out of 7 comparisons, the HR for the composite outcome of all-cause death and all-cause hospitalizations was in favor of the SPC regimen (SPC versus MPC): valsartan/amlodipine: HR=0.87 (95% CI: 0.84–0.91, p ≤ 0.001); candesartan/amlodipine: 0.77 (95% CI: 0.65–0.90, p = 0.001); valsartan/amlodipine/hydrochlorothiazide: HR=0.68 (95% CI: 0.61–0.74, p ≤ 0.001); ramipril/amlodipine: HR=0.80 (95% CI: 0.77–0.83, p ≤ 0.001); acetylsalicylic acid (ASA)/atorvastatin/ramipril: HR=0.64 (95% CI: 0.47–0.88, p = 0.005). Conclusion SPC regimens are associated with a lower incidence of CV events and lower all-cause mortality in clinical practice. SPC regimens should generally be preferred to improve patient’s prognosis.","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41526116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertension in Pediatric Acute Lymphoblastic Leukemia Patients: Prevalence, Impact, and Management Strategies.","authors":"Lindsey Murphy,&nbsp;Kelly Maloney,&nbsp;Lia Gore,&nbsp;Eliza Blanchette","doi":"10.2147/IBPC.S242244","DOIUrl":"https://doi.org/10.2147/IBPC.S242244","url":null,"abstract":"<p><p>Acute lymphoblastic leukemia (ALL) is the most common cancer diagnosed in children under the age of 18. While modern diagnostic technologies, risk-stratification, and therapy intensification have led to outstanding outcomes for many children with ALL, the side effects and consequences of therapy are not to be underestimated. Hypertension is a well-known acute and chronic side effect of treatment for childhood ALL, although limited data are available regarding the prevalence of hypertension in children undergoing treatment for ALL. In this review of hypertension in pediatric ALL patients, we examine the existing data on incidence and prevalence during treatment and in pediatric ALL survivors. We describe independent risk factors for development of hypertension along with treatment-related causes. Long-term consequences and the risk to survivors of pediatric ALL are further defined. While many ALL patients require antihypertensive medications during some portion of their treatment, there are no clear guidelines on treating inpatient hypertension given challenges that exist in recognizing and managing hypertension in this setting and in this population. Here, we propose an algorithmic approach to diagnose and treat pediatric ALL patients with HTN, along with monitoring and continuation versus cessation of antihypertensive therapy as an outpatient.</p>","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/79/ibpc-15-1.PMC8784271.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39723846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Outcome and Associated Factors Among Patients Admitted with Hypertensive Crisis in Public Hospitals at Harar Town, Eastern Ethiopia: A Cross-Sectional Study.","authors":"Nahom Samuel,&nbsp;Shambel Nigussie,&nbsp;Abera Jambo,&nbsp;Mesay Dechasa,&nbsp;Fekade Demeke,&nbsp;Abduro Godana,&nbsp;Abdi Birhanu,&nbsp;Tigist Gashaw,&nbsp;Assefa Agegnehu Teshome,&nbsp;Amas Siraj","doi":"10.2147/IBPC.S386461","DOIUrl":"https://doi.org/10.2147/IBPC.S386461","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive crisis is a significant global health issue that raises the costs to healthcare systems and requires specific attention to improve clinical outcome. There is scarce information on hypertensive crisis cases treatment outcome in the study setting.</p><p><strong>Objective: </strong>This study aimed to assess treatment outcome and associated factors among patients admitted with hypertensive crisis at Public Hospitals in Harar Town, Eastern Ethiopia.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 369 hypertensive crisis patients who had been admitted to the emergency department of Hiwot Fana Comprehensive Specialized Hospital and Jugol General Hospital from May 1, 2017, to May 1, 2022. All hypertensive crisis patients who fulfilled the inclusion criteria were included. The data were extracted from medical records using a data abstraction format. The collected data were analyzed using Statistical Package for Social Sciences version 22. Binary logistics regression model using bivariate and multivariable analysis with 95% confidence intervals and <i>P</i>-values were used to determine the association between variables.</p><p><strong>Results: </strong>The medical records of 369 patients in total were reviewed. Of these, the medical records of 363 patients contained all the necessary information and were used in the study. More than half of the patients (238; 65.6%) were males. Among 363 patients admitted with hypertensive crisis, 98 (27.0%, 95% Confidence Interval (CI):22.5%-31.9%) of them had poor treatment outcome of hypertensive crisis. Being female (Adjusted Odds Ratio (AOR)=3.4; 95% CI=1.7-7.9), residing in rural areas (AOR=2.4; 95% CI=2.7-5.1), taking captopril during admission (AOR=5.6; 95% CI=2.4-7.9), taking antihypertensive treatment before admission (AOR=0.5; 95% CI=0.2-0.9), and being non compliant to treatment (AOR=2.7; 95% CI=1.4-3.5) had statistically significant associations with poor treatment outcome of hypertensive crisis compared to their counterparts.</p><p><strong>Conclusion: </strong>The magnitude of poor treatment outcome of hypertensive crisis was high. Sex, residence, non-compliance, and type of emergency drug administered during admission were substantially related with poor treatment outcome of hypertensive crisis. Health professionals should put great emphasis on emergency drugs administered during admission to achieve the desired outcome.</p>","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/10/43/ibpc-15-113.PMC9758999.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10402047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diastolic Blood Pressure J-Curve in Hypertension Management: Links and Risk for Cardiovascular Disease.","authors":"Brian Gaffney, Alan P Jacobsen, Abhishek W Pallippattu, Niall Leahy, John W McEvoy","doi":"10.2147/IBPC.S286957","DOIUrl":"10.2147/IBPC.S286957","url":null,"abstract":"<p><strong>Purpose of review: </strong>The treatment of hypertension has changed dramatically over the last century, with recent trials informing clinical guidelines that recommend aiming for lower blood pressure (BP) targets than ever before. However, a \"J\"- or \"U-shaped curve\" in the association between diastolic BP and cardiovascular events has been observed in epidemiological studies, suggesting that both high diastolic BPs and diastolic BPs below a certain nadir are associated with higher risk of cardiovascular disease (CVD) events. Despite the potential for confounding and reverse causation, this association may caution against overly intensive BP lowering in some hypertensive adults who also have a low baseline diastolic BP.</p><p><strong>Recent findings: </strong>Recent post-hoc analyses of the landmark Systolic Blood Pressure Intervention Trial (SPRINT) appear to contradict these J-curve concerns, finding that the benefit of more intensive BP treatment did not differ based on baseline blood pressure. Similarly, sensitivity analyses of The Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) randomized controlled trial found that patients experienced similar benefits from an intensive BP goal, regardless of whether their diastolic BP was above or below 60 mm Hg. Finally, several Mendelian randomization analyses, which are less susceptible to confounding and reverse causation, demonstrated a clear linear relationship between diastolic BP and cardiovascular events. These studies indicate that a potential reduction in CVD risk is possible, irrespective of baseline diastolic BP values.</p><p><strong>Summary: </strong>Sufficient recent evidence indicates that low diastolic BP is not causal of worse cardiovascular outcomes but rather represents confounding or reverse causation. Therefore, while low diastolic BP can be considered a marker of CVD risk, this risk is not expected to increase with further BP lowering when necessary to control concomitant elevations of systolic BP. Indeed, BP reduction in this setting appears beneficial.</p>","PeriodicalId":45299,"journal":{"name":"Integrated Blood Pressure Control","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2021-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/ed/ibpc-14-179.PMC8685549.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39748793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}