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Ciccarone Center Research


Blood Pressure

Landmark Articles

Preventive strategies for coronary heart disease.
By: Blaha MJ, Ketlogetswe KS, Ndumele CE, Gluckman TJ, Blumenthal RS.
Comparison of the Framingham Heart Study hypertension model with blood pressure alone in the prediction of risk of hypertension: the Multi-Ethnic Study of Atherosclerosis.
By: Muntner P, Woodward M, Mann DM, Shimbo D, Michos ED, Blumenthal RS, Carson AP, Chen H, Arnett DK.
In this multi-ethnic cohort of U.S. adults, the Framingham Heart Study model was not substantially better than systolic blood pressure (SBP) alone for predicting hypertension.
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Exercise blood pressure and future cardiovascular death in asymptomatic individuals.
By: Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S.
Individuals with exaggerated exercise BP tend to develop future hypertension. It is controversial whether they have higher risk of death from cardiovascular disease (CVD). We found that, in asymptomatic individuals, elevated exercise BP carried higher risk of CVD death but became nonsignificant after accounting for rest BP. However, Bruce stage 2 BP >180/90 mm Hg identified nonhypertensive individuals at higher risk of CVD death.
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Coronary artery calcium in relation to initiation and continuation of cardiovascular preventive medications: The Multi-Ethnic Study of Atherosclerosis (MESA).
By: Nasir K, McClelland RL, Blumenthal RS, Goff DC Jr, Hoffmann U, Psaty BM, Greenland P, Kronmal RA, Budoff MJ.
In this observational study, we examined whether high baseline CACS were associated with the initiation as well continuation of new lipid-lowering medication (LLM), blood pressure-lowering medication (BPLM), and regular aspirin (ASA) use in a multi-ethnic population-based cohort. Findings indicate that CACS >400 was associated with a higher likelihood of initiation and continuation of LLM, BPLM, and ASA. The association was weaker for continuation than for initiation of these preventive therapies.
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Progression of coronary artery calcification: not down-and-out.
By: McEvoy JW, Blaha MJ.

Blood pressure has been consistently shown to be strongly associated with CAC progression, and we believe that the findings of INSIGHT (International Nifedipine Study: Intervention as Goal for Hypertension Therapy) are diluted by inclusion in the heterogeneous review by McCullough et al. Unfortunately, on-treatment blood pressure control was not reported in this trial. We look forward to seeing the results of future blood pressure and CAC progression trials before agreeing with the authors’ conclusion that CAC “may not be a suitable surrogate target for treatment trials in patients with cardiovascular or renal disease.”

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Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging.
By: Giles JT, Malayeri AA, Fernandes V, Post W, Blumenthal RS, Bluemke D, Vogel-Claussen J, Szklo M, Petri M, Gelber AC, Brumback L, Lima J, Bathon JM.
Heart failure is a major contributor to cardiovascular morbidity and mortality in patients with RA, but little is known about myocardial structure and function in this population. This study suggests that the progression to heart failure in RA may occur through reduced myocardial mass rather than hypertrophy. Both modifiable and nonmodifiable factors may contribute to lower levels of left ventricular mass and volume.
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Geographic variation in hypertension prevalence among blacks and whites: the multi-ethnic study of atherosclerosis.
By: Kershaw KN, Diez Roux AV, Carnethon M, Darwin C, Goff DC Jr, Post W, Schreiner PJ, Watson K.
Many studies have examined differences in hypertension across race/ethnic groups but few have evaluated differences within groups. We investigated within-group geographic variations in hypertension prevalence among black and white participants of the MESA study. We conclude that a better understanding of geographic heterogeneity may inform interventions to reduce racial/ethnic disparities.
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Effect of Beta-blocker therapy on rehospitalization rates in women versus men with heart failure and preserved ejection fraction.
By: Farasat SM, Bolger DT, Shetty V, Menachery EP, Gerstenblith G, Kasper EK, Najjar SS.

Beta blockers are empirically used in many patients with heart failure (HF) and preserved ejection fraction (HFpEF) because they allow more time for diastolic filling and because they improve outcomes in patients with systolic HF. However, recent data suggest that impaired chronotropic and vasodilator responses to exercise, which can worsen with beta blockade, may play a key role in the pathophysiology of HFpEF. We prospectively examined the association between beta-blocker therapy after hospitalization for decompensated HF and HF rehospitalization at 6 months in 66 consecutive patients with HFpEF (71 +/- 13 years old, 68% women, 42% Black). Subjects were stratified based on receiving (BB+; 15 men, 28 women) or not receiving (BB-) beta-blockers at hospital discharge. In men, HF rehospitalization occurred less frequently in the BB+ than in the BB- group, albeit nonsignificantly (20% vs 50%, p = 0.29). In women, HF rehospitalization occurred more frequently in the BB+ than in the BB- group (75% vs 18%, p <0.001). In univariate analyses, discharge beta-blocker was associated with HF rehospitalization in women (odds ratio [OR] 14.00, 95% confidence interval [CI] 3.09 to 63.51, p = 0.001), but not in men (OR 0.25, 95% CI 0.03 to 1.92, p = 0.18). In a forward logistic regression model that offered all univariate predictors of HF rehospitalization, discharge beta blocker remained an independent predictor of HF rehospitalization in women (OR 11.06, 95% CI 1.98 to 61.67, p = 0.006). In conclusion, this small observational study suggests that beta-blocker therapy may be associated with a higher risk of HF rehospitalization in women with HFpEF. The risks and benefits of beta-blocker therapy in patients with HFpEF should be evaluated in randomized, controlled trials.

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