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Ciccarone Articles

Ciccarone Center Research


Blood Pressure

Landmark Articles

Blood pressure and chronic kidney disease progression in a multi-racial cohort: the Multi-Ethnic Study of Atherosclerosis.
By: Bloomfield GS, Yi SS, Astor BC, Kramer H, Shea S, Shlipak MG, Post WS.
This study concluded that, with the inclusion of cystatin C in the estimated glomerular filtration rate assessment, hypertension was an important predictor of chronic kidney disease progression in a multi-ethnic cohort with stage 3 of the disease.
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Genome-wide association study of cardiac structure and systolic function in African Americans: the Candidate Gene Association Resource (CARe) study.
By: Fox ER, Musani SK, Barbalic M, Lin H, Yu B, Ogunyankin KO, Smith NL, Kutlar A, Glazer NL, Post WS, et al.
In the largest genome-wide association study of cardiac structure and function to date in African-Americans, researchers identified 4 genetic loci related to left ventricular mass, interventricular septal wall thickness, left ventricular internal diastolic diameter, and ejection fraction, which reached genome-wide significance.
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Impact of coronary artery calcification on all-cause mortality in individuals with and without hypertension.
By: Graham G, Blaha MJ, Budoff MJ, Rivera JJ, Agatston A, Raggi P, Shaw LJ, Berman D, Rana JS, Callister T, Rumberger JA, Min J, Blumenthal RS, Nasir K.
This study found that the addition of CAC scores contributed significantly in predicting mortality, in addition to traditional risk factors alone, among those with and without hypertension.
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Pharmacogenetics of antihypertensive response.
By: Campbell CY, Blumenthal RS.
We review the current status of the use of pharmacogenetic techniques to improve blood pressure control.
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Preventive cardiology: past, present, and future.
By: Blaha MJ, Gluckman TJ, Blumenthal RS.
The majority of improvement in rates of mortality from CVD since 1960 has been the result of prevention strategies and not treatment of acute CVD. Prevention occurs at three levels: primordial, primary, and secondary. National guidelines direct population-based and individual-based preventive care. This chapter offers an easy to remember memory tool that facilitates comprehensive preventive care: The Ciccarone Center ABCDE approach.
Association of left ventricular hypertrophy with incident hypertension: the multi-ethnic study of atherosclerosis.
By: Shimbo D, Muntner P, Mann D, Barr RG, Tang W, Post W, Lima J, Burke G, Bluemke D, Shea S.
Increased LV mass and changes in LV geometry may precede hypertension onset. The authors examined the associations of LV mass and geometry, assessed by cardiac magnetic resonance imaging, with hypertension incidence in 2,567 normotensive participants enrolled in 2000-2002 in MESA. Higher levels of LV concentric geometry, defined by higher LV mass to end-diastolic volume quartiles, were associated with higher risk of incident hypertension in a fully adjusted model. In a final model containing both quartiles of LV mass and LV mass/volume, along with all covariates including baseline blood pressure, higher LV mass quartiles were associated with incident hypertension, whereas higher LV mass/volume quartiles were not. In this multiethnic cohort, alterations in LV mass preceded hypertension onset among normotensive individuals.
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The relationship between inflammation, obesity and risk for hypertension in the Multi-Ethnic Study of Atherosclerosis (MESA).
By: Lakoski SG, Cushman M, Siscovick DS, Blumenthal RS, Palmas W, Burke G, Herrington DM.
It has been suggested that inflammation is important in the etiology of hypertension and that this may be most relevant among obese persons. To study this, we examined the independent relationships between obesity, inflammation-related proteins (interleukin-6 (IL-6), CRP and fibrinogen) and risk for hypertension in the Multi-Ethnic Study of Atherosclerosis. The relationship between inflammation-related proteins and hypertension risk was predominantly explained by other hypertension risk factors. Obesity, independent of inflammation, remained a potent risk factor for future hypertension.
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Cardiovascular imaging for assessing cardiovascular risk in asymptomatic men versus women: the multi-ethnic study of atherosclerosis (MESA).
By: Jain A, McClelland RL, Polak JF, Shea S, Burke GL, Bild DE, Watson KE, Budoff MJ, Liu K, Post WS, Folsom AR, Lima JA, Bluemke DA.
CAC, carotid IMT, and LV mass and geometry offer the potential to characterize incident CVD risk in clinically asymptomatic individuals. The objective of the study was to compare these cardiovascular imaging measures for their overall and sex-specific ability to predict CVD. The study sample consisted of 4,965 MESA participants (48% men; mean age, 62±10 years). There was no evidence that imaging measures differed in association with incident CVD by sex. CAC was most strongly associated with CHD and CVD; LV mass and LV concentric remodeling best predicted stroke; and LV mass best predicted HF.
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Update on newer antihypertensive medicines and interventions.
By: Wu KC, Gerstenblith G.

The incidence and prevalence of systemic hypertension are reaching global epidemic proportions. Despite a diverse pharmacologic armamentarium of agents to treat high blood pressure, suboptimal control remains a significant problem in as many as 43% of patients and this rate has not significantly improved over the past 2 decades. There are a variety of factors contributing to this including patient nonadherence due to complex drug regimens and medication side effects, undertreatment, and treatment resistance. There, thus, remains a need to develop novel agents and approaches to antihypertensive therapy that facilitate attainment of optimal blood pressure levels. This monograph will review a number of new pharmacologic targets and interventions as well as a novel method of drug delivery to patients.

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Associations between genetic variants in the ACE, AGT, AGTR1 and AGTR2 genes and renal function in the multi-ethnic study of atherosclerosis.
By: Campbell CY, Fang BF, Guo X, Peralta CA, Psaty BM, Rich SS, Young JH, Coresh J, Kramer HJ, Rotter JI, Post WS.

These data suggest that genetic polymorphisms in the renin-angiotensin system are associated with renal phenotypes in the general population, but that many associations differ across racial/ethnic groups.

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