528 results found
Beaney T, Schutte AE, Tomaszewski M, et al., 2018, May Measurement Month 2017: an analysis of blood pressure screening results worldwide., Lancet Glob Health, Vol: 6, Pages: e736-e743
BACKGROUND: Increased blood pressure is the biggest contributor to the global burden of disease and mortality. Data suggest that less than half of the population with hypertension is aware of it. May Measurement Month was initiated to raise awareness of the importance of blood pressure and as a pragmatic interim solution to the shortfall in screening programmes. METHODS: This cross-sectional survey included volunteer adults (≥18 years) who ideally had not had their blood pressures measured in the past year. Each participant had their blood pressure measured three times and received a a questionnaire about demographic, lifestyle, and environmental factors. The primary objective was to raise awareness of blood pressure, measured by number of countries involved, number of people screened, and number of people who have untreated or inadequately treated hypertension (defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or both, or on the basis of receiving antihypertensive medication). Multiple imputation was used to estimate the mean of the second and third blood pressure readings if these were not recorded. Measures of association were analysed using linear mixed models. FINDINGS: Data were collected from 1 201 570 individuals in 80 countries. After imputation, of the 1 128 635 individuals for whom a mean of the second and third readings was available, 393 924 (34·9%) individuals had hypertension. 153 905 (17·3%) of 888 616 individuals who were not receiving antihypertensive treatment were hypertensive, and 105 456 (46·3%) of the 227 721 individuals receiving treatment did not have controlled blood pressure. Significant differences in adjusted blood pressures and hypertension prevalence were apparent between regions. Adjusted blood pressure was higher in association with antihypertensive medication, diabetes, cerebrovascular disease, smoking, and alcohol consumption. Blood pressure was higher when measured o
Bethel MA, Patel RA, Merrill P, et al., 2018, Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-analysis, LANCET DIABETES & ENDOCRINOLOGY, Vol: 6, Pages: 105-113, ISSN: 2213-8587
Crossan C, Dehbi H-M, Williams H, et al., 2018, A protocol for an economic evaluation of a polypill in patients with established or at high risk of cardiovascular disease in a UK NHS setting: RUPEE (NHS) study, BMJ OPEN, Vol: 8, ISSN: 2044-6055
Dzudie A, Rayner B, Ojji D, et al., 2018, Roadmap to Achieve 25% Hypertension Control in Africa by 2025., Glob Heart, Vol: 13, Pages: 45-59
BACKGROUND: The Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority action to reduce heart disease and stroke on the continent. OBJECTIVES: The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa (SSA) by the year 2025. METHODS: Development of this roadmap started with the creation of a consortium of experts with leadership skills in hypertension. In 2014, experts in different fields, including physicians and nonphysicians, were invited to join. Via face-to-face meetings and teleconferences, the consortium made a situation analysis, set a goal, identified roadblocks and solutions to the management of hypertension and customized the World Heart Federation roadmap to Africa. RESULTS: Hypertension is a major crisis on the continent but very few randomized controlled trials have been conducted on its management. Also, only 25.8% of the countries have developed or adopted guidelines for management of hypertension. Other major roadblocks are either government and health-system related or health care professional or patient related. The PASCAR hypertension task force identified a 10-point action plan to be implemented by African ministries of health to achieve 25% control of hypertension in Africa by 2025. CONCLUSIONS: Hypertension affects millions of people in SSA and if left untreated, is a major cause of heart disease and stroke. Very few SSA countries have a clear hypertension policy. This PASCAR roadmap identifies practical and effective solutions that would improve detection, treatment and control of hypertension on the continent and could be implemented as is or adapted to specific national settings.
Feitosa MF, Kraja AT, Chasman DI, et al., 2018, Novel genetic associations for blood pressure identified via gene-alcohol interaction in up to 570K individuals across multiple ancestries, PLOS ONE, Vol: 13, ISSN: 1932-6203
Feldman RD, Fitchett D, Hegele RA, et al., 2018, Type 2 Diabetes and the Reduction of Cardiovascular Risk: Sorting Out the Actors and the Roles., Can J Cardiol, Vol: 34, Pages: 532-535
Jun M, Ohkuma T, Zoungas S, et al., 2018, Changes in Albuminuria and the Risk of Major Clinical Outcomes in Diabetes: Results From ADVANCE-ON., Diabetes Care, Vol: 41, Pages: 163-170
OBJECTIVE: To assess the association between 2-year changes in urine albumin-to-creatinine ratio (UACR) and the risk of clinical outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS: We analyzed data from 8,766 participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Post-Trial Observational Study (ADVANCE-ON). Change in UACR was calculated from UACR measurements 2 years apart, classified into three groups: decrease in UACR of ≥30%, minor change, and increase in UACR of ≥30%. By analyzing changes from baseline UACR groups, categorized into thirds, we repeated these analyses accounting for regression to the mean (RtM). The primary outcome was the composite of major macrovascular events, renal events, and all-cause mortality; secondary outcomes were these components. Cox regression models were used to estimate hazard ratios (HRs). RESULTS: Over a median follow-up of 7.7 years, 2,191 primary outcomes were observed. Increases in UACR over 2 years independently predicted a greater risk of the primary outcome (HR for ≥30% UACR increase vs. minor change: 1.26; 95% CI 1.13-1.41), whereas a decrease in UACR was not significantly associated with lower risk (HR 0.93; 95% CI 0.83-1.04). However, after allowing for RtM, the effect of "real" decrease in UACR on the primary outcome was found to be significant (HR 0.84; 95% CI 0.75-0.94), whereas the estimated effect on an increase was unchanged. CONCLUSIONS: Changes in UACR predicted changes in the risk of major clinical outcomes and mortality in type 2 diabetes, supporting the prognostic utility of monitoring albuminuria change over time.
Laurent S, Mancia G, Poulter N, 2018, Perindopril 3.5 mg/amlodipine 2.5 mg versus renin-angiotensin system inhibitor monotherapy as first-line treatment in hypertension: a combined analysis., J Hypertens
BACKGROUND: Many patients are diagnosed with hypertension each year, making rapid and effective control of blood pressure (BP) crucial. Appropriate first-line treatment is important, and special attention should be paid to the positive effects of lowering BP early. Perindopril 3.5 mg/amlodipine 2.5 mg (P3.5/A2.5) is a single-pill combination suitable for first-line use. The doses of each component of the single-pill combination were selected for a first-line setting. OBJECTIVE: To investigate the effectiveness of the P3.5/A2.5 combination at lowering BP compared with renin-angiotensin system (RAS)-inhibitor monotherapies, after 1 month of treatment. METHODS: Individual patient data from three randomized controlled trials were used to evaluate the efficacy of P3.5/A2.5 versus RAS-inhibitor monotherapies after 1 month in 5496 patients with hypertension, in a combined analysis. RESULTS: P3.5/A2.5 was well tolerated and significantly more effective at reducing BP after 1 month than RAS-inhibitor monotherapies (perindopril 5 mg, irbesartan 150 mg or valsartan 80 mg). P3.5/A2.5 was associated with a significantly lower SBP (P = 0.002) and DBP (P = 0.005) after 1 month of treatment compared with RAS-inhibitor monotherapies. CONCLUSION: In a large patient population, early administration of P3.5/A2.5 resulted in a significantly greater BP-lowering effect than perindopril, irbesartan or valsartan monotherapies after 1 month. Reducing BP levels within a month of treatment may reasonably be expected to lead to a reduced risk of cardiovascular events.
Mohammedi K, Chalmers J, Herrington W, et al., 2018, Associations between body mass index and the risk of renal events in patients with type 2 diabetes., Nutr Diabetes, Vol: 8
BACKGROUND/OBJECTIVES: We aimed to evaluate the relationship between BMI and the risk of renal disease in patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) study. SUBJECTS/METHODS: Participants were divided into six baseline BMI categories: <18.5 (underweight, n = 58); ≥18.5 to <25 (normal, n = 2894); ≥25 to <30 (overweight, n = 4340); ≥30 to <35 (obesity grade 1, n = 2265); ≥35 to <40 (obesity grade 2, n = 744); and ≥40 kg/m2 (obesity grade 3, n = 294); those underweight were excluded. The composite outcome "major renal event" was defined as development of new macroalbuminuria, doubling of creatinine, end stage renal disease, or renal death. These outcomes and development of new microalbuminuria were considered individually as secondary endpoints. RESULTS: During 5-years of follow-up, major renal events occurred in 487 (4.6%) patients. The risk increased with higher BMI. Multivariable-adjusted HRs (95% CIs), compared to normal weight, were: 0.91 (0.72-1.15) for overweight; 1.03 (0.77-1.37) for obesity grade 1; 1.42 (0.98-2.07) for grade 2; and 2.16 (1.34-3.48) for grade 3 (p for trend = 0.006). These findings were similar across subgroups by randomised interventions (intensive versus standard glucose control and perindopril-indapamide versus placebo). Every additional unit of BMI over 25 kg/m2 increased the risk of major renal events by 4 (1-6)%. Comparable results were observed with the risk of secondary endpoints. CONCLUSIONS: Higher BMI is an independent predictor of major renal events in patients with type 2 diabetes. Our findings encourage weight loss to improve nephroprotection in these patients.
Ojji DB, Poulter N, Damasceno A, et al., 2018, Rationale and design of the comparison of 3 combination therapies in lowering blood pressure in black Africans (CREOLE study): 2 × 3 factorial randomized single-blind multicenter trial., Am Heart J, Vol: 202, Pages: 5-12
BACKGROUND: Current hypertension guidelines recommend the use of combination therapy as first-line treatment or early in the management of hypertensive patients. Although there are many possible combinations of blood pressure(BP)-lowering therapies, the best combination for the black population is still a subject of debate because no large randomized controlled trials have been conducted in this group to compare the efficacy of different combination therapies to address this issue. METHODS: The comparison of 3 combination therapies in lowering BP in the black Africans (CREOLE) study is a randomized single-blind trial that will compare the efficacy of amlodipine plus hydrochlorothiazide versus amlodipine plus perindopril and versus perindopril plus hydrochlorothiazide in blacks residing in sub-Saharan Africa (SSA). Seven hundred two patients aged 30-79 years with a sitting systolic BP of 140 mm Hg and above, and less than 160 mm Hg on antihypertensive monotherapy, or sitting systolic BP of 150 mm Hg and above, and less than 180 mm Hg on no treatment, will be centrally randomized into any of the 3 arms (234 into each arm). The CREOLE study is taking place in 10 sites in SSA, and the primary outcome measure is change in ambulatory systolic BP from baseline to 6 months. The first patient was randomized in June 2017, and the trial will be concluded by 2019. CONCLUSIONS: The CREOLE trial will provide unique information as to the most efficacious 2-drug combination in blacks residing in SSA and thereby inform the development of clinical guidelines for the treatment of hypertension in this subregion.
Pieber TR, Marso SP, McGuire DK, et al., 2018, DEVOTE 3: temporal relationships between severe hypoglycaemia, cardiovascular outcomes and mortality, DIABETOLOGIA, Vol: 61, Pages: 58-65, ISSN: 0012-186X
Poulter NR, Castillo R, Charchar FJ, et al., 2018, Are the American Heart Association/American College of Cardiology High Blood Pressure Guidelines Fit for Global Purpose?: Thoughts From the International Society of Hypertension., Hypertension, Vol: 72, Pages: 260-262
Rådholm K, Chalmers J, Ohkuma T, et al., 2018, Use of the waist-to-height ratio to predict cardiovascular risk in patients with diabetes: Results from the ADVANCE-ON study., Diabetes Obes Metab, Vol: 20, Pages: 1903-1910
AIMS: Patients with type 2 diabetes have a high risk of cardiovascular disease (CVD). Central obesity has been particularly associated with this risk relationship. We aimed to evaluate waist to height ratio (WHtR) as a predictor of risk in such patients. METHODS: WHtR was evaluated as a predictor of the risk of CVD and mortality amongst 11 125 participants with type 2 diabetes in the ADVANCE and ADVANCE-ON studies, and was compared with body mass index (BMI), waist circumference and waist hip ratio (WHR). Primary outcome was a composite of death from CVD, non-fatal myocardial infarction or non-fatal stroke. Secondary outcomes were myocardial infarction, stroke, cardiovascular death and death from any cause. Cox models were used, with bootstrapping to compare associations between anthropometric measures for the primary outcome. RESULTS: Median follow-up time was 9.0 years. There was a positive association between WHtR and adverse outcomes. The hazard ratio (HR) (confidence interval), per SD higher WHtR, was 1.16 (1.11-1.22) for the primary endpoint, with no heterogeneity by sex or region, but a stronger effect in individuals aged 66 years or older. The other 3 anthropometric measurements showed similar associations, although there was evidence that WHtR marginally outperformed BMI and WHR. Based on commonly used BMI cut-points, the equivalent WHtR cut-points were estimated to be 0.55 and 0.6, with no evidence of a difference across subgroups. CONCLUSIONS: In patients with diabetes, WHtR is a useful indicator of future adverse risk, with similar effects in different population subgroups.
Thomas MC, Woodward M, Li Q, et al., 2018, Relationship Between Plasma 8-OH-Deoxyguanosine and Cardiovascular Disease and Survival in Type 2 Diabetes Mellitus: Results From the ADVANCE Trial., J Am Heart Assoc, Vol: 7
BACKGROUND: 8-Oxo-2'-deoxyguanosine (8-oxo-2'-dG) is a biomarker of oxidative DNA damage that is associated with cardiovascular disease and premature mortality in the general population. Although oxidative stress has a proven role in cardiovascular complications in diabetes mellitus, evidence for a relationship between plasma 8-oxo-2'-dG and major cardiovascular outcomes in diabetes mellitus is weak. METHODS AND RESULTS: A case-cohort study was performed in 3766 participants with prevalent diabetes mellitus in the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) trial (ClinicalTrials.gov number NCT00145925). The hazard ratios for mortality and major acute cardiovascular events were derived using Cox regression models. During a median of 5 years of follow-up, 695 (18.4%) participants in this enriched cohort died (including 354 deaths from cardiovascular disease). Individuals with higher levels of 8-oxo-2'-dG were more likely to die. After adjusting for cardiovascular disease risk factors, the hazard ratio for a 1-SD increase in plasma 8-oxo-2'-dG was 1.10 (95% confidence interval, 1.01-1.20; P=0.03). This was driven by an independent association between plasma 8-oxo-2'-dG and cardiovascular death (hazard ratio, 1.23; 95% confidence interval, 1.10-1.37 [P<0.001]). By contrast, no association was seen between 8-oxo-2'-dG and noncardiovascular disease death (of which cancer was the major single cause). 8-Oxo-2'-dG was also not significantly associated with either nonfatal myocardial infarction or nonfatal stroke. CONCLUSIONS: In adults with type 2 diabetes mellitus, increased levels of 8-oxo-2'-dG are independently associated with all-cause mortality and cardiovascular mortality in adults with longstanding type 2 diabetes mellitus who participated in the ADVANCE trial, consistent with the role of oxidative damage in the development and progression of cardiovascular decompensation in diabetes mellitu
Verma S, Bhatt DL, Bain SC, et al., 2018, Effect of Liraglutide on Cardiovascular Events in Patients With Type 2 Diabetes Mellitus and Polyvascular Disease: Results of the LEADER Trial., Circulation, Vol: 137, Pages: 2179-2183
Welsh P, Rankin N, Li Q, et al., 2018, Circulating amino acids and the risk of macrovascular, microvascular and mortality outcomes in individuals with type 2 diabetes: results from the ADVANCE trial., Diabetologia, Vol: 61, Pages: 1581-1591
AIMS/HYPOTHESES: We aimed to quantify the association of individual circulating amino acids with macrovascular disease, microvascular disease and all-cause mortality in individuals with type 2 diabetes. METHODS: We performed a case-cohort study (N = 3587), including 655 macrovascular events, 342 microvascular events (new or worsening nephropathy or retinopathy) and 632 all-cause mortality events during follow-up, in a secondary analysis of the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) study. For this study, phenylalanine, isoleucine, glutamine, leucine, alanine, tyrosine, histidine and valine were measured in stored plasma samples by proton NMR metabolomics. Hazard ratios were modelled per SD increase in each amino acid. RESULTS: In models investigating associations and potential mechanisms, after adjusting for age, sex and randomised treatment, phenylalanine was positively, and histidine inversely, associated with macrovascular disease risk. These associations were attenuated to the null on further adjustment for extended classical risk factors (including eGFR and urinary albumin/creatinine ratio). After adjustment for extended classical risk factors, higher tyrosine and alanine levels were associated with decreased risk of microvascular disease (HR 0.78; 95% CI 0.67, 0.91 and HR 0.86; 95% CI 0.76, 0.98, respectively). Higher leucine (HR 0.79; 95% CI 0.69, 0.90), histidine (HR 0.89; 95% CI 0.81, 0.99) and valine (HR 0.79; 95% CI 0.70, 0.88) levels were associated with lower risk of mortality. Investigating the predictive ability of amino acids, addition of all amino acids to a risk score modestly improved classification of participants for macrovascular (continuous net reclassification index [NRI] +35.5%, p < 0.001) and microvascular events (continuous NRI +14.4%, p = 0.012). CONCLUSIONS/INTERPRETATION: We report distinct associations between circulat
Zinman B, Marso SP, Poulter NR, et al., 2018, Day-to-day fasting glycaemic variability in DEVOTE: associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2), DIABETOLOGIA, Vol: 61, Pages: 48-57, ISSN: 0012-186X
Atkins ER, Hirakawa Y, Salam A, et al., 2017, Side effects and tolerability of combination blood pressure lowering according to blood pressure levels: an analysis of the PROGRESS and ADVANCE trials, JOURNAL OF HYPERTENSION, Vol: 35, Pages: 1318-1325, ISSN: 0263-6352
Blomster JI, Zoungas S, Woodward M, et al., 2017, The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study, DIABETES RESEARCH AND CLINICAL PRACTICE, Vol: 127, Pages: 212-217, ISSN: 0168-8227
Bunker J, Chang C-L, Chapman N, et al., 2017, True Resistant Hypertension Following Observed Drug Ingestion: A Systematic Evaluation, JOURNAL OF CLINICAL HYPERTENSION, Vol: 19, Pages: 250-255, ISSN: 1524-6175
Crossan C, Dehbi H-M, Williams H, et al., 2017, Economic evaluation of a polypill for the treatment of patients with established or at high risk of cardiovascular disease (CVD): a UK-National Health Service study, Publisher: NATURE PUBLISHING GROUP, Pages: 664-664, ISSN: 0950-9240
Crossan CJ, Dehbi H, Thom S, et al., 2017, COST-EFFECTIVENESS OF A POLYPILL FOR PATIENTS WITH OR AT HIGH RISK OF CARDIOVASCULAR DISEASE IN AN NHS SETTING, Publisher: ELSEVIER SCIENCE INC, Pages: A620-A620, ISSN: 1098-3015
Glaysher MA, Mohanaruban A, Prechtl CG, et al., 2017, A randomised controlled trial of a duodenal-jejunal bypass sleeve device (EndoBarrier) compared with standard medical therapy for the management of obese subjects with type 2 diabetes mellitus, BMJ OPEN, Vol: 7, ISSN: 2044-6055
Gupta A, Thompson D, Whitehouse A, et al., 2017, Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase, LANCET, Vol: 389, Pages: 2473-2481, ISSN: 0140-6736
Holman RR, Bethel MA, Mentz RJ, et al., 2017, Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes., N Engl J Med, Vol: 377, Pages: 1228-1239
BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those
Kraja AT, Cook JP, Warren HR, et al., 2017, New Blood Pressure-Associated Loci Identified in Meta-Analyses of 475000 Individuals, CIRCULATION-CARDIOVASCULAR GENETICS, Vol: 10, ISSN: 1942-325X
Liu DJ, Peloso GM, Yu H, et al., 2017, Exome-wide association study of plasma lipids in > 300,000 individuals, NATURE GENETICS, Vol: 49, Pages: 1758-+, ISSN: 1061-4036
Marso SP, McGuire DK, Zinman B, et al., 2017, Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 377, Pages: 723-732, ISSN: 0028-4793
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