To establish whether a difference in SBP between arms is associated with peripheral or cardiovascular (CV) disease, and with an increased risk of CV or.

Slides:

Advertisements

Similar presentations

Aggressive Hyperglycemia Management. Significant hospital hyperglycemia requires close follow-up Previously diagnosed diabetes and elevated A1C Without.

Advertisements

Foos et al, EASD, Lisbon, 13 September 2011 Comparison of ACCORD trial outcomes with outcomes estimated from modelled and meta- analysis studies Volker.

Valsartan Antihypertensive Long-Term Use Evaluation Results

TROPHY TRial Of Preventing HYpertension. High-normal BP increases CV risk Vasan RS et al. N Engl J Med. 2001;345: Incidence of CV events in women.

Cholesterol quintile (mg/dL)

Assessment of Target Organ Damage: Established and Novel Methods Christian Delles BHF Glasgow Cardiovascular Research Centre Institute of Cardiovascular.

Rimoldi SF et al. J Clin Hypertens (Greenwich). 2015;17(3): Efficacy and safety of calcium channel blocker/diuretics combination therapy in hypertensive.

ESH 2004 Paris1 Blood Pressure Control by Home Monitoring A Meta-Analysis of Randomised Trials FP Cappuccio, SM Kerry, L Forbes, A Donald Published in:

Efficacy and safety of angiotensin receptor blockers: a meta-analysis of randomized trials Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.

The concept of Diabetes & CV risk: A lifetime risk challenge

Type 2 diabetes and high blood pressure How explosive is the cocktail?

Long-term predictive value of assessment of coronary atherosclerosis by contrast- enhanced coronary computed tomography angiography: meta- analysis and.

{ R. Diaz-Garcia MD, J. Bernardo MD Stem Cell Therapy for Patients with Critical Limb Ischemia: A Meta-analysis with Critical Limb Ischemia: A Meta-analysis.

Who should have statins 18 th March Nonfatal MI CHD death Any major coronary event CABG PTCA Unspecified Any coronary revascularisation.

Pravastatin in Elderly Individuals at Risk of Vascular Disease Presented at Late Breaking Clinical Trials AHA 2002 PROSPER.

Can pharmacists improve outcomes in hypertensive patients? Sookaneknun P (1), Richards RME (2), Sanguansermsri J(1), Teerasut C (3) : (1)Faculty of Pharmacy,

A systematic meta-analysis of randomized controlled trials for adjuvant chemotherapy for localized resectable soft-tissue sarcoma Nabeel Pervaiz Nigel.

CARU The HY pertension in the V ery E lderly T rial – latest data Stephen Jackson Professor of Clinical Gerontology King’s Health Partners.

Aim To determine the effects of a Coversyl- based blood pressure lowering regimen on the risk of recurrent stroke among patients with a history of stroke.

To assess the prognostic value of variability in home-measured blood pressure (BP) and heart rate (HR) in a general population. Objective: Methods: BP.

Central blood pressure: what do we really know today?

ASCOT and Steno-2: Aggressive risk reduction benefits two different patient populations *Composite of CV death, nonfatal MI or stroke, revascularization,

Background There are 12 different types of medications to lower blood sugar levels in patients with type 2 diabetes. It is widely agreed upon that metformin.

Heart rate in heart failure: Heart rate in heart failure: risk marker or risk factor? A subanalysis of the SHIFT trial on behalf of the Investigators M.

Canagliflozin Cardiovascular Safety. 2 Potential CV protection pathways of SGLT2i Diab Vasc Dis Res Mar;12(2):

Selenium supplementation for the primary prevention of cardiovascular disease: a Cochrane review Clinical

Long-term prognostic value of white coat hypertension: an insight from diagnostic use of both ambulatory and home blood pressure measurements Reference:

Incidence of Abnormal Ankle-Brachial Index in Diabetic Patients Asymptomatic of Arteriosclerotic Vascular disease Brintha Vasagar, MD, MPH, Katee Castleman,

Date of download: 6/18/2016 From: Treatment of Anemia in Patients With Heart Disease: A Systematic Review Ann Intern Med. 2013;159(11): doi: /

Results from ASCOT-BPLA: Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm VBWG.

Over Time Additional Risk Factors Can Progress: Effect of Cholesterol and BP on CHD Risk in MRFIT Trial

Summary of “A randomized trial of standard versus intensive blood-pressure control” The SPRINT Research Group, NEJM, DOI: /NEJMoa Downloaded.

Antonio Coca, MD, PhD, FRCP, FESC

Dr John Cox Diabetes in Primary Care Conference Cork

Hypertension in the Post SPRINT era

A Systematic Review and Meta-analysis

Blood Pressure and Age in Controlling Hypertension

Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies The Emerging.

Copyright © 2011 American Medical Association. All rights reserved.

Should SPRINT change our practice?

Cholesterol Treatment Trialists’ (CTT) Collaboration Slide deck

Copyright © 2007 American Medical Association. All rights reserved.

United States Preventive Services Task Force: Recommendations for ABPM

Comparison of baseline characteristics in participants who subsequently had an incident cardiovascular event or new-onset diabetes in the Prospective.

Personalized Activity Intelligence (PAI) for Prevention of Cardiovascular Disease and Promotion of Physical Activity Bjarne M. Nes, PhD, Christian R.

Ahead of the Curve by Alun D. Hughes Hypertension Volume 64(5):

Relative mortality risk associated with quartiles of systolic blood pressure compared with systolic

Teaching Tool: Blood Pressure Classification

The Hypertension in the Very Elderly Trial (HYVET)

Management of hypertension in patients with chronic kidney disease

Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies The Emerging.

Insights from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)

End point Net change with soy supplements vs control (95% CI) p

Lowering of SBP by 20 mm Hg Reduces Cardiovascular Risk by Half

Personalized Activity Intelligence (PAI) for Prevention of Cardiovascular Disease and Promotion of Physical Activity Bjarne M. Nes, PhD, Christian R.

Ratio of relative risks of heart disease and stroke associated with higher blood pressure, smoking, type I and II diabetes, and higher cholesterol in women.

Cardiovascular autonomic dysfunction in women with polycystic ovary syndrome: a systematic review and meta-analysis Juan Gui, Rui-hao Wang Reproductive.

Jennifer E. Flythe, Stephen E. Kimmel, Steven M. Brunelli

Volume 377, Issue 9771, Pages (March 2011)

Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies The Emerging.

DENERHTN Trial design: Patients with resistant hypertension were randomized to renal denervation plus standardized stepped-care antihypertensive treatment.

Google Scholar: 8,554 publications Systematic search:

DANAMI 3-DEFER Trial design: Patients presenting with STEMI and in whom the operators could establish TIMI 2-3 flow without stenting or those presenting.

Flow chart of the 1683 study members at age 60–64 years by hypertension (HT) status. Flow chart of the 1683 study members at age 60–64 years by hypertension.

An ACCORD BP sub-analysis HR: 1.06; 95%CI: ; P=0.61

CANVAS programe subanalyses HR (95%CI): 0.65 ( ) ( ) ( ) ( )

An ACCORD BP sub-analysis HR: 1.06; 95%CI: ; P=0.61

End point Valsartan Valsartan+HCTZ p

Relationship between 6-month all-cause mortality and the three types of heart failure adjusted for age ≥75 years, peripheral edema at admission, systolic.

Average change in blood pressure (BP) from recruitment to 6-month postrecruitment in intervention and control patients >50 years included due to having.

Presentation transcript:

To establish whether a difference in SBP between arms is associated with peripheral or cardiovascular (CV) disease, and with an increased risk of CV or all-cause mortality. Objective Methods Bibliographic database search (Medline, Embase, Cochrane, and Medline databases) for studies published before July 2011, showing differences in SBP between arms and outcomes data. A random-effects meta-analysis. Background Differences in systolic blood pressure (SBP) of mm Hg or more between arms have been associated with peripheral vascular disease and attributed to subclavian stenosis. 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet Jan 27, Epub ahead of print DOI: /S (11)61710.

Pooled results of five invasive studies using angiography 20 trials met inclusion criteria. The mean difference in SBP between arms was 37 mm Hg (95% CI, 35.4–38.4) for proven subclavian stenosis (>50% occlusion). A difference of 10 mm Hg or more was strongly associated with subclavian stenosis (risk ratio [RR], 8.8; 95% CI, 3.6–21.2). A difference of 15 mm Hg or more was associated with peripheral vascular disease, pre-existing cerebrovascular disease, and increased cardio vascular mortality (hazard ratio [HR], 1.7; 95% CI, 1.1–2.5) and all-cause mortality (HR, 1.6, CI, 1.1–2.3). A difference of 10 mm Hg or higher was associated with peripheral vascular disease (five studies; RR, 2.4, CI, 1.5–3.9). Pooled results of non- invasive studies 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet Jan 27, Epub ahead of print DOI: /S (11)61710.

A difference in SBP of 10 mm Hg or more or 15 mm Hg or more between arms could identify patients at high risk of asymptomatic peripheral vascular disease and mortality. Findings from our study should be incorporated into future guidelines for hypertension and blood-pressure measurement to justify bilateral brachial measurement in the assessment of individuals, and to promote targeted screening for peripheral vascular disease and aggressive risk factor management in subject with a systolic between-arm difference. 1. Clark EC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet Jan 27, Epub ahead of print DOI: /S (11)61710.