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- Neisius, Ulf, et al.
(författare)
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Association of central and peripheral pulse pressure with intermediate cardiovascular phenoytpes.
- 2012
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Ingår i: Journal of Hypertension. - 1473-5598. ; 30:1, s. 67-74
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We assessed the relationship between pulse pressure and intermediate cardiovascular phenotypes in a middle-aged cohort with high prevalence of hypertension. BACKGROUND: It has been suggested that central pulse pressure (cPP) is a better predictor of cardiovascular outcome than peripheral pulse pressure (pPP), particularly in the elderly. Yet, it is unclear if cPP provides additional prognostic information to pPP in younger individuals. METHODS: In 535 individuals we assessed cPP and pPP as well as the intermediate cardiovascular phenotypes pulse wave velocity (PWV; SphygmoCor, Complior, PulsePen), carotid intima-media thickness (C-IMT; carotid ultrasound), left-ventricular mass index (LVMI; echocardiography) and urinary albumin : creatinine ratio (ACR). cPP was derived noninvasively from brachial blood pressure by pulse wave analysis (PWA; SphygmoCor) based on radial pulse wave tonometry and a validated transfer function. RESULTS: The cohort contained 331 hypertensive participants of whom 84% were treated. The average age was 46 ± 16 years. When compared to pPP, cPP had stronger associations with PWV (r = 0.471 vs. r = 0.372; P < 0.01), C-IMT (r = 0.426 vs. r = 0.235; P < 0.01) and LVMI (r = 0.385 vs. r = 0.189; P < 0.01), but equal association with ACR (r = 0.236 vs. r = 0.226; P = n.s.). In contrast, after adjustment for age, mean arterial pressure, heart rate and hypertension status there was no significant difference between cPP and pPP for prediction of PWV (adjusted R, 0.399 vs. 0.413; P = 0.066), C-IMT (adjusted R, 0.399 vs. 0.413; P = 0.487) and LVMI (adjusted R, 0.181 vs. 0.170; P = 0.094) in multivariate analysis. CONCLUSION: In our middle-aged cohort with high prevalence of hypertension cPP is more closely correlated with cardiovascular phenotypes than pPP. When adjusted for relevant cofactors, however, cPP does not provide additional information beyond pPP.
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- Nilsson, Peter M, et al.
(författare)
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New Antidiabetic Agents for the Treatment of Heart Failure in Hypertensive Patients
- 2024. - 2
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Ingår i: Hypertension and Heart Failure : Epidemiology, Mechanisms and Treatment - Epidemiology, Mechanisms and Treatment. - 2366-4614 .- 2366-4606. - 9783031393143 - 9783031393150 ; , s. 79-371
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Bokkapitel (refereegranskat)abstract
- The development of newer glucose-lowering drugs for the treatment of type 2 diabetes in recent years, such as the SGLT-2 inhibitors and GLP-1 receptor agonists/analogues with well-documented clinical benefits from large trials, has influenced international guidelines. These drugs are able to reduce both macro- and microvascular events in patients with type 2 diabetes and to prevent worsening of diabetic nephropathy. One important aspect of these new drugs is also the ability to prevent or treat heart failure (HF) through improved cardiac metabolism, but also by lowering of blood pressure and improvement of central hemodynamics. In this review, the evidence for such effects on HF is discussed for each drug class separately and in combination. In the future there may come new opportunities for fixed drug combinations (FDC) to improve cost-effectiveness and compliance of diabetes treatment when antihypertensive, lipid-lowering, and glucose-lowering drugs are combined. As control of hypertension is of great importance for HF prevention in patients with diabetes in general, the combination of traditional antihypertensive drugs (i.e., blockers of the renin-angiotensin system) with newer glucose-lowering drugs that may also lower blood pressure could prove to be a successful and a very useful combination. Thus, further studies are warranted.
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- Scuteri, Angelo, et al.
(författare)
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Arterial stiffness and influences of the metabolic syndrome: A cross-countries study.
- 2014
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 233:2, s. 654-660
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Tidskriftsartikel (refereegranskat)abstract
- Specific clusters of metabolic syndrome (MetS) components impact differentially on arterial stiffness, indexed as pulse wave velocity (PWV). Of note, in several population-based studies participating in the MARE (Metabolic syndrome and Arteries REsearch) Consortium the occurrence of specific clusters of MetS differed markedly across Europe and the US. The aim of the present study was to investigate whether specific clusters of MetS are consistently associated with stiffer arteries in different populations. We studied 20,570 subjects from 9 cohorts representing 8 different European countries and the US participating in the MARE Consortium. MetS was defined in accordance with NCEP ATPIII criteria as the simultaneous alteration in ≥3 of the 5 components: abdominal obesity (W), high triglycerides (T), low HDL cholesterol (H), elevated blood pressure (B), and elevated fasting glucose (G). PWV measured in each cohort was "normalized" to account for different acquisition methods. MetS had an overall prevalence of 24.2% (4985 subjects). MetS accelerated the age-associated increase in PWV levels at any age, and similarly in men and women. MetS clusters TBW, GBW, and GTBW are consistently associated with significantly stiffer arteries to an extent similar or greater than observed in subjects with alteration in all the five MetS components - even after controlling for age, sex, smoking, cholesterol levels, and diabetes mellitus - in all the MARE cohorts. In conclusion, different component clusters of MetS showed varying associations with arterial stiffness (PWV).
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- Zanchetti, Alberto, et al.
(författare)
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Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence.
- 2014
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Ingår i: Journal of Hypertension. - 1473-5598. ; 32:9, s. 1741-1750
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Forskningsöversikt (refereegranskat)abstract
- It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.
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