95 results on '"Cohen, Jordana"'
Search Results
2. Antihypertensive Medication Use Trajectories After Bariatric Surgery: A Matched Cohort Study.
- Author
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Passman JE, Wall-Wieler E, Liu Y, Zheng F, and Cohen JB
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- Humans, Female, Male, Middle Aged, Adult, Obesity surgery, Obesity epidemiology, Cohort Studies, Body Mass Index, Bariatric Surgery methods, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Hypertension epidemiology
- Abstract
Background: Metabolic and bariatric surgery (MBS) is the most effective and durable treatment for obesity. We aimed to compare the trajectories of antihypertensive medication (AHM) use among obese individuals treated and not treated with MBS., Methods: Adults with a body mass index of ≥35 kg/m
2 were identified in the Merative Database (US employer-based claims database). Individuals treated with versus without MBS were matched 1:1 using baseline demographic and clinical characteristics as well as AHM utilization. Monthly AHM use was examined in the 3 years after the index date using generalized estimating equations. Subanalyses investigated rates of AHM discontinuation, AHM initiation, and apparent treatment-resistant hypertension., Results: The primary cohort included 43 206 adults who underwent MBS matched with 43 206 who did not. Compared with no MBS, those treated with MBS had sustained, markedly lower rates of AHM use (31% versus 15% at 12 months; 32% versus 17% at 36 months). Among patients on AHM at baseline, 42% of patients treated with MBS versus 7% treated medically discontinued AHM use ( P <0.01). The risk of apparent treatment-resistant hypertension was 3.41× higher (95% CI, 2.91-4.01; P <0.01) 2 years after the index date in patients who did not undergo MBS. Among those without hypertension treated with MBS versus no MBS, 7% versus 21% required AHM at 2 years., Conclusions: MBS is associated with lower rates of AHM use, higher rates of AHM discontinuation, and lower rates of AHM initiation among patients not taking AHM. These findings suggest that MBS is both an effective treatment and a preventative measure for hypertension., Competing Interests: E. Wall-Wieler, Y. Liu, and F. Zheng are employed by Intuitive. The other authors report no conflicts.- Published
- 2024
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3. Entering a New Era of Antihypertensive Therapy.
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Cohen JB and Bress AP
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- Humans, Antihypertensive Agents therapeutic use, Hypertension drug therapy
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- 2024
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4. Association Between Self-Reported Medication Adherence and Therapeutic Inertia in Hypertension: A Secondary Analysis of SPRINT (Systolic Blood Pressure Intervention Trial).
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Jacobs JA, Derington CG, Zheutlin AR, King JB, Cohen JB, Bucheit J, Kronish IM, Addo DK, Morisky DE, Greene TH, and Bress AP
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- Adult, Humans, Female, Aged, Male, Blood Pressure, Self Report, Cross-Sectional Studies, Medication Adherence, Antihypertensive Agents therapeutic use, Antihypertensive Agents pharmacology, Hypertension drug therapy, Hypertension epidemiology
- Abstract
Background: Therapeutic inertia (TI), failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains prevalent in hypertension management. The degree to which self-reported antihypertensive adherence is associated with TI with intensive BP goals remains unclear., Methods and Results: Cross-sectional analysis was performed of the 12-month visit of participants in the intensive arm of SPRINT (Systolic Blood Pressure Intervention Trial), which randomized adults to intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic BP goals. TI was defined as no increase in antihypertensive regimen intensity score, which incorporates medication number and dose, when systolic BP is ≥120 mm Hg. Self-reported adherence was assessed using the 8-Item Morisky Medication Adherence Scale (MMAS-8) and categorized as low (MMAS-8 score <6), medium (MMAS-8 score 6 to <8), and high (MMAS-8 score 8). Poisson regressions estimated prevalence ratios (PRs) and 95% CIs for TI associated with MMAS-8. Among 1009 intensive arm participants with systolic BP >120 mm Hg at the 12-month visit (mean age, 69.6 years; 35.2% female, 28.8% non-Hispanic Black), TI occurred in 50.8% of participants. Participants with low adherence (versus high) were younger and more likely to be non-Hispanic Black or smokers. The prevalence of TI among patients with low, medium, and high adherence was 45.0%, 53.5%, and 50.4%, respectively. After adjustment, neither low nor medium adherence (versus high) were associated with TI (PR, 1.11 [95% CI, 0.87-1.42]; PR, 1.08 [95% CI, 0.84-1.38], respectively)., Conclusions: Although clinician uncertainty about adherence is often cited as a reason for why antihypertensive intensification is withheld when above BP goals, we observed no evidence of an association between self-reported adherence and TI.
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- 2024
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5. Orthostatic hypotension, orthostatic hypertension, and ambulatory blood pressure in patients with chronic kidney disease in CRIC.
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Ghazi L, Cohen JB, Townsend RR, Drawz PE, Rahman M, Pradhan N, Cohen DL, Weir MR, Rincon-Choles H, and Juraschek SP
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- Humans, Female, Middle Aged, Aged, Male, Blood Pressure physiology, Blood Pressure Monitoring, Ambulatory, Prospective Studies, Hypotension, Orthostatic, Hypertension complications, Renal Insufficiency, Chronic complications
- Abstract
Background: Orthostatic changes in blood pressure (BP), either orthostatic hypotension or orthostatic hypertension (OHTN), are common among patients with chronic kidney disease. Whether they are associated with unique out-of-office BP phenotypes is unknown., Methods: CRIC is a prospective, multicenter, observational cohort study of participants with CKD. BP measured at 2 min after standing and ambulatory BP monitoring (ABPM) were obtained on 1386 participants. Orthostatic hypotension was defined as a 20 mmHg drop in SBP or 10 mmHg drop in DBP when changing from seated to standing positions. Systolic and diastolic night-to-day ratio was also calculated. OHTN was defined as a 20 or 10 mmHg rise in SBP or DBP when changing from a seated to a standing position. White-coat effect (WCE) was defined as seated minus daytime ambulatory BP., Results: Of the 1386 participants (age: 58 ± 10 years, 44% female, 39% black), 68 had orthostatic hypotension and 153 had OHTN. Postural reduction in SBP or DBP was positively associated with greater systolic and diastolic WCE and systolic and diastolic night-to-day ratio. Orthostatic hypotension was positively associated with diastolic WCE (β = 3 [0.2, 5.9]). Diastolic OHTN was negatively associated with systolic WCE (β = -4 [-7.2, -0.5]) and diastolic WCE (β = -6 [-8.1, -4.2])., Conclusion: Postural change in BP was associated with WCE and night-to-day-ratio. Orthostatic hypotension was positively associated with WCE and OHTN was negatively associated with WCE. These findings strengthen observations that postural changes in BP may associate with distinct BP patterns throughout the day. These observations are informative for subsequent research tailoring orthostatic hypotension and OHTN treatment to specific BP phenotypes., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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6. Effectiveness of Hypertension Management Strategies in SPRINT-Eligible US Adults: A Simulation Study.
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Zhang F, Bryant KB, Moran AE, Zhang Y, Cohen JB, Bress AP, Sheppard JP, King JB, Derington CG, Weintraub WS, Kronish IM, Shea S, and Bellows BK
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- Adult, Humans, United States epidemiology, Antihypertensive Agents therapeutic use, Antihypertensive Agents pharmacology, Risk Factors, Blood Pressure, Cardiovascular Diseases epidemiology, Hypertension diagnosis, Hypertension drug therapy, Hypertension epidemiology
- Abstract
Background: Despite reducing cardiovascular disease (CVD) events and death in SPRINT (Systolic Blood Pressure Intervention Trial), intensive systolic blood pressure goals have not been adopted in the United States. This study aimed to simulate the potential long-term impact of 4 hypertension management strategies in SPRINT-eligible US adults., Methods and Results: The validated Blood Pressure Control-Cardiovascular Disease Policy Model, a discrete event simulation of hypertension care processes (ie, visit frequency, blood pressure [BP] measurement accuracy, medication intensification, and medication adherence) and CVD outcomes, was populated with 25 000 SPRINT-eligible US adults. Four hypertension management strategies were simulated: (1) usual care targeting BP <140/90 mm Hg (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care), (2) intensive care per the SPRINT protocol targeting BP <120/90 mm Hg (SPRINT intensive), (3) usual care targeting guideline-recommended BP <130/80 mm Hg (American College of Cardiology/American Heart Association usual care), and (4) team-based care added to usual care and targeting BP <130/80 mm Hg. Relative to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, among the 18.1 million SPRINT-eligible US adults, an estimated 138 100 total CVD events could be prevented per year with SPRINT intensive, 33 900 with American College of Cardiology/American Heart Association usual care, and 89 100 with team-based care. Compared with the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure usual care, SPRINT intensive care was projected to increase treatment-related serious adverse events by 77 600 per year, American College of Cardiology/American Heart Association usual care by 33 300, and team-based care by 27 200., Conclusions: As BP control has declined in recent years, health systems must prioritize hypertension management and invest in effective strategies. Adding team-based care to usual care may be a pragmatic way to manage risk in this high-CVD-risk population.
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- 2024
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7. Antihypertensive medication nonadherence and target organ damage in children with chronic kidney disease.
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Byfield RL, Xiao R, Shimbo D, Kronish IM, Furth SL, Amaral S, and Cohen JB
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- Humans, Child, Female, Adolescent, Male, Antihypertensive Agents therapeutic use, Antihypertensive Agents pharmacology, Blood Pressure Monitoring, Ambulatory, Blood Pressure, Glomerular Filtration Rate, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic drug therapy, Hypertension
- Abstract
Background: Nonadherence is common in children with chronic kidney disease (CKD). This may contribute to inadequate blood pressure control and adverse outcomes. This study examined associations between antihypertensive medication nonadherence, ambulatory blood pressure monitoring (ABPM) parameters, kidney function, and cardiac structure among children with CKD., Methods: We performed secondary analyses of data from the CKD in Children (CKiD) study, including participants with treated hypertension who underwent ABPM, laboratory testing, and echocardiography biannually. Nonadherence was defined by self-report of any missed antihypertensive medication 7 days prior to the study visit. Linear regression and mixed-effects models were used to assess the association of nonadherence with baseline and time-updated ABPM profiles, estimated glomerular filtration rate (eGFR), urine protein to creatinine ratio (UPCR), and left ventricular mass index (LVMI)., Results: Five-hundred and eight participants met inclusion criteria, followed for a median of 2.9 years; 212 (42%) were female, with median age 13 years (IQR 10-16), median baseline eGFR 49 (33-64) ml/min/1.73 m
2 and median UPCR 0.4 (0.1-1.0) g/g. Nonadherence occurred in 71 (14%) participants. Baseline nonadherence was not significantly associated with baseline 24-h ABPM parameters (for example, mean 24-h SBP [β - 0.1, 95% CI - 2.7, 2.5]), eGFR (β 1.0, 95% CI - 0.9, 1.2), UCPR (β 1.1, 95% CI - 0.8, 1.5), or LVMI (β 0.6, 95% CI - 1.6, 2.9). Similarly, there were no associations between baseline nonadherence and time-updated outcome measures., Conclusions: Self-reported antihypertensive medication nonadherence occurred in 1 in 7 children with CKD. We found no associations between nonadherence and kidney function or cardiac structure over time. A higher resolution version of the Graphical abstract is available as Supplementary information., (© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association.)- Published
- 2024
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8. Development of a risk-prediction model for primary aldosteronism in veterans with hypertension.
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Ginzberg SP, Kalva S, Wirtalla CJ, Passman JE, Cohen DL, Cohen JB, and Wachtel H
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- Humans, Renin, Aldosterone, Hyperaldosteronism complications, Hyperaldosteronism diagnosis, Hyperaldosteronism epidemiology, Veterans, Hypertension complications, Hypertension diagnosis, Hypertension epidemiology, Hypokalemia
- Abstract
Background: Rates of screening for primary aldosteronism in patients who meet the criteria are exceedingly low (1%-3%). To help clinicians prioritize screening in patients most likely to benefit, we developed a risk-prediction model., Methods: Using national Veterans Health Administration data, we identified patients who met the criteria for primary aldosteronism screening between 2000 and 2019. We performed multivariable logistic regression to identify characteristics associated with positive primary aldosteronism testing before generating a risk-scoring system based on the coefficients (0< β < 0.5 = 1 pt, 0.5 ≤ β < 1 = 2 pts, 1 ≤ β < 1.5 = 3 pts) and then tested the system performance using an internal validation cohort., Results: We identified 502,190 patients who met primary aldosteronism screening criteria, of whom 1.6% were screened and 15% tested positive. Based on the regression model, we generated a risk-scoring system based on a total of 9 possible points in which age under 50, absence of smoking history, and resistant hypertension each scored 1 point; elevated serum sodium 2 points; and hypokalemia 3 points. Rates of positive screening increased with risk score, with 5.6% to 6.7% of those scoring 0 points testing positive; 7.9% to 9.0% 1 point; 8.6% to 10% 2 points; 13% to 14% 3 points; 21% 4 points; 22% to 38% 5 points; 27% to 38% 6 points; 42% to 49% 7 points; and 50% to 51% ≥8 points., Conclusion: In hypertensive patients who meet the criteria for primary aldosteronism screening, rates of positive screening range from 5.6% to 51%. Use of our risk-predication model incorporating these factors can identify patients most likely to benefit from testing., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2024
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9. Blood Pressure, Incident Cognitive Impairment, and Severity of CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.
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Babroudi S, Tighiouart H, Schrauben SJ, Cohen JB, Fischer MJ, Rahman M, Hsu CY, Sozio SM, Weir M, Sarnak M, Yaffe K, Tamura MK, and Drew D
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- Adult, Humans, Middle Aged, Aged, Blood Pressure, Longitudinal Studies, Disease Progression, Prospective Studies, Glomerular Filtration Rate, Risk Factors, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic epidemiology, Hypertension epidemiology, Cognitive Dysfunction diagnosis, Cognitive Dysfunction epidemiology, Cognitive Dysfunction etiology, Dementia
- Abstract
Rationale & Objective: Hypertension is a known risk factor for dementia and cognitive impairment. There are limited data on the relation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with incident cognitive impairment in adults with chronic kidney disease. We sought to identify and characterize the relationship among blood pressure, cognitive impairment, and severity of decreased kidney function in adults with chronic kidney disease., Study Design: Longitudinal cohort study., Setting & Participants: 3,768 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study., Exposure: Baseline SBP and DBP were examined as exposure variables, using continuous (linear, per 10-mm Hg higher), categorical (SBP<120 [reference], 120 to 140,>140mm Hg; DBP<70 (reference), 70 to 80, > 80mm Hg) and nonlinear terms (splines)., Outcome: Incident cognitive impairment defined as a decline in Modified Mini-Mental State Examination (3MS) score to greater than 1 standard deviation below the cohort mean., Analytical Approach: Cox proportional hazard models adjusted for demographics as well as kidney disease and cardiovascular disease risk factors., Results: The mean age of participants was 58±11 (SD) years, estimated glomerular filtration rate (eGFR) was 44mL/min/1.73m
2 ± 15 (SD), and the median follow-up time was 11 (IQR, 7-13) years. In 3,048 participants without cognitive impairment at baseline and with at least 1 follow-up 3MS test, a higher baseline SBP was significantly associated with incident cognitive impairment only in the eGFR>45mL/min/1.73m2 subgroup (adjusted hazard ratio [AHR], 1.13 [95% CI, 1.05-1.22] per 10mm Hg higher SBP]. Spline analyses, aimed at exploring nonlinearity, showed that the relationship between baseline SBP and incident cognitive impairment was J-shaped and significant only in the eGFR>45mL/min/1.73m2 subgroup (P=0.02). Baseline DBP was not associated with incident cognitive impairment in any analyses., Limitations: 3MS test as the primary measure of cognitive function., Conclusions: Among patients with chronic kidney disease, higher baseline SBP was associated with higher risk of incident cognitive impairment specifically in those individuals with eGFR>45mL/min/1.73m2 ., Plain-Language Summary: High blood pressure is a strong risk factor for dementia and cognitive impairment in studies of adults without kidney disease. High blood pressure and cognitive impairment are common in adults with chronic kidney disease (CKD). The impact of blood pressure on the development of future cognitive impairment in patients with CKD remains unclear. We identified the relationship between blood pressure and cognitive impairment in 3,076 adults with CKD. Baseline blood pressure was measured, after which serial cognitive testing was performed over 11 years. Fourteen percent of participants developed cognitive impairment. We found that a higher baseline systolic blood pressure was associated with an increased risk of cognitive impairment. We found that this association was stronger in adults with mild-to-moderate CKD compared with those with advanced CKD., (Copyright © 2023 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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10. Association of blood pressure variability with Endothelin-1 by menopause status among Black women: findings from the Jackson Heart Study.
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Rethy L, Polsinelli VB, Muntner P, Bello NA, and Cohen JB
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- Humans, Female, Blood Pressure physiology, Menopause physiology, Longitudinal Studies, Endothelin-1, Hypertension
- Abstract
To the Editor: Postmenopausal women have a higher risk of hypertension compared with premenopausal women possibly related to increased endothelial dysfunction in the setting of lower levels of circulating estrogen. Using data from 660 women in the Jackson Heart Study (JHS), postmenopausal women had higher daytime, nighttime and 24 h systolic blood pressure variability (BPV) compared with premenopausal women, and higher nighttime systolic BPV was associated with higher endothlin-1 (a marker of endothelial dysfunction) in postmenopausal women (ß = 0.27 [0.05, 0.50], p = 0.019), even after adjustment for possible confounders including age. These findings highlight the relevance of menopause status to blood pressure variability and the potential role of blood pressure variability in the development of high endothelin-1 in postmenopausal women., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)
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- 2023
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11. Hypertension in Patients Treated With In-Center Maintenance Hemodialysis: Current Evidence and Future Opportunities: A Scientific Statement From the American Heart Association.
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Bansal N, Artinian NT, Bakris G, Chang T, Cohen J, Flythe J, Lea J, Vongpatanasin W, and Chertow GM
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- Humans, United States epidemiology, American Heart Association, Renal Dialysis adverse effects, Blood Pressure, Kidney Failure, Chronic, Hypertension diagnosis, Hypertension drug therapy
- Abstract
Nearly 500 000 individuals are treated with maintenance hemodialysis for kidney failure in the United States, and roughly half will die of cardiovascular causes. Hypertension, an important and modifiable risk factor for cardiovascular disease, is observed in >80% of patients treated with maintenance hemodialysis. The pathophysiology of hypertension in patients treated with maintenance hemodialysis is multifactorial and differs from that seen in other patient populations. Factors that contribute to hypertension in patients treated with hemodialysis include volume overload, arterial stiffness, enhanced activity of the sympathetic nervous and renin-angiotensin-aldosterone systems, endothelial dysfunction, and use of erythropoietin-stimulating agents. This scientific statement reviews the current evidence on defining, diagnosing, and treating hypertension in patients treated with maintenance hemodialysis and highlights opportunities for future investigation, including studies on blood pressure targets and treatment strategies.
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- 2023
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12. Identifying Patients for Intensive Blood Pressure Treatment Based on Cognitive Benefit: A Secondary Analysis of the SPRINT Randomized Clinical Trial.
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Ghazi L, Shen J, Ying J, Derington CG, Cohen JB, Marcum ZA, Herrick JS, King JB, Cheung AK, Williamson JD, Pajewski NM, Bryan N, Supiano M, Sonnen J, Weintraub WS, Greene TH, and Bress AP
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- Male, Humans, Aged, United States, Female, Blood Pressure physiology, Antihypertensive Agents therapeutic use, Antihypertensive Agents pharmacology, Medicare, Cognition, Hypertension drug therapy, Hypertension epidemiology, Hypertension complications, Dementia complications
- Abstract
Importance: Intensive vs standard treatment to lower systolic blood pressure (SBP) reduces risk of mild cognitive impairment (MCI) or dementia; however, the magnitude of cognitive benefit likely varies among patients., Objective: To estimate the magnitude of cognitive benefit of intensive vs standard systolic BP (SBP) treatment., Design, Setting, and Participants: In this ad hoc secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), 9361 randomized clinical trial participants 50 years or older with high cardiovascular risk but without a history of diabetes, stroke, or dementia were followed up. The SPRINT trial was conducted between November 1, 2010, and August 31, 2016, and the present analysis was completed on October 31, 2022., Intervention: Systolic blood pressure treatment to an intensive (<120 mm Hg) vs standard (<140 mm Hg) target., Main Outcomes and Measures: The primary outcome was a composite of adjudicated probable dementia or amnestic MCI., Results: A total of 7918 SPRINT participants were included in the analysis; 3989 were in the intensive treatment group (mean [SD] age, 67.9 [9.2] years; 2570 [64.4%] men; 1212 [30.4%] non-Hispanic Black) and 3929 were in the standard treatment group (mean [SD] age, 67.9 [9.4] years; 2570 [65.4%] men; 1249 [31.8%] non-Hispanic Black). Over a median follow-up of 4.13 (IQR, 3.50-5.88) years, there were 765 and 828 primary outcome events in the intensive treatment group and standard treatment group, respectively. Older age (hazard ratio [HR] per 1 SD, 1.87 [95% CI, 1.78-1.96]), Medicare enrollment (HR per 1 SD, 1.42 [95% CI, 1.35-1.49]), and higher baseline serum creatinine level (HR per 1 SD, 1.24 [95% CI, 1.19-1.29]) were associated with higher risk of the primary outcome, while better baseline cognitive functioning (HR per 1 SD, 0.43 [95% CI, 0.41-0.44]) and active employment status (HR per 1 SD, 0.44 [95% CI, 0.42-0.46]) were associated with lower risk of the primary outcome. Risk of the primary outcome by treatment goal was estimated accurately based on similar projected and observed absolute risk differences (C statistic = 0.79). Higher baseline risk for the primary outcome was associated with greater benefit (ie, larger absolute reduction of probable dementia or amnestic MCI) of intensive vs standard treatment across the full range of estimated baseline risk., Conclusions and Relevance: In this secondary analysis of the SPRINT trial, participants with higher baseline projected risk of probable dementia or amnestic MCI gained greater absolute cognitive benefit from intensive vs standard SBP treatment in a monotonic fashion., Trial Registration: ClinicalTrials.gov Identifier: NCT01206062.
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- 2023
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13. Cancer Therapy-Related Hypertension: A Scientific Statement From the American Heart Association.
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Cohen JB, Brown NJ, Brown SA, Dent S, van Dorst DCH, Herrmann SM, Lang NN, Oudit GY, and Touyz RM
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- Male, Humans, Vascular Endothelial Growth Factor A, American Heart Association, Angiogenesis Inhibitors adverse effects, Hypertension chemically induced, Hypertension drug therapy, Antineoplastic Agents adverse effects, Neoplasms drug therapy
- Abstract
Contemporary anticancer drugs have significantly improved cancer survival at the expense of cardiovascular toxicities, including heart disease, thromboembolic disease, and hypertension. One of the most common side effects of these drugs is hypertension, especially in patients treated with vascular endothelial growth factor inhibitors, as well as tyrosine kinase inhibitors and proteasome inhibitors. Adjunctive therapy, including corticosteroids, calcineurin inhibitors, and nonsteroidal anti-inflammatories, as well as anti-androgen hormone therapy for prostate cancer, may further increase blood pressure in these patients. Cancer therapy-induced hypertension is often dose limiting, increases cardiovascular mortality in cancer survivors, and is usually reversible after interruption or discontinuation of treatment. The exact molecular mechanisms underlying hypertension are unclear, but recent discoveries indicate an important role for reduced nitric oxide generation, oxidative stress, endothelin-1, prostaglandins, endothelial dysfunction, increased sympathetic outflow, and microvascular rarefaction. In addition, genetic polymorphisms in vascular endothelial growth factor receptors are implicated in vascular endothelial growth factor inhibitor-induced hypertension. Diagnosis, management, and follow-up of cancer therapy-induced hypertension follow national hypertension guidelines because evidence-based clinical trials specifically addressing patients who develop hypertension as a result of cancer therapy are currently lacking. Rigorous baseline assessment of patients before therapy is started requires particular emphasis on assessing and treating cardiovascular risk factors. Hypertension management follows guidelines for the general population, although special attention should be given to rebound hypotension after termination of cancer therapy. Management of these complex patients requires collaborative care involving oncologists, cardiologists, hypertension specialists, primary care professionals, and pharmacists to ensure the optimal therapeutic effect from cancer treatment while minimizing competing cardiovascular toxicities.
- Published
- 2023
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14. Systolic Blood Pressure Time in Target Range and Major Adverse Kidney and Cardiovascular Events.
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Buckley LF, Baker WL, Van Tassell BW, Cohen JB, Alkhezi O, Bress AP, and Dixon DL
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- Adult, Humans, Blood Pressure physiology, Kidney, Blood Pressure Determination, Antihypertensive Agents therapeutic use, Risk Factors, Hypertension complications, Hypertension epidemiology, Hypertension diagnosis, Cardiovascular Diseases etiology, Cardiovascular Diseases chemically induced, Myocardial Infarction drug therapy
- Abstract
Background: Whether time-in-target range (TTR) for systolic blood pressure (SBP) associates with adverse kidney and cardiovascular events remains incompletely understood., Methods: This study included participants in 2 clinical trials that compared intensive (<120 mm Hg) and standard (<140 mm Hg) SBP lowering. SBP-TTR for months 0 to 3 was calculated using therapeutic ranges of 110 to 130 mm Hg and 120 to 140 mm Hg for the intensive and standard arms, respectively. Adverse kidney events included the composite of dialysis, kidney transplant, serum creatinine >3.3 mg/dL, sustained eGFR <15 mL/(min·1.73 m
2 ), or sustained eGFR decline >40%. Adverse cardiovascular events included myocardial infarction, stroke, heart failure, and cardiovascular death. Adjusted Cox proportional hazards regression models were used to estimate the association between SBP-TTR and kidney and cardiovascular events., Results: Participants with higher TTR were younger and less likely to have preexisting cardiovascular disease. Compared with participants with TTR of 0%, the risk of adverse kidney events was lower for participants with TTR of >0% to 43% (hazard ratio [95% CI], 0.57 [0.42-0.76]; P <0.001), 43% to <70% (0.57 [0.42-0.78]; P =0.001), 70% to <100% (0.53 [0.38-0.74]; P <0.001), and 100% (0.33 [0.20-0.57]; P <0.001) in fully adjusted models. The risk of major adverse cardiovascular events was lower for participants with TTR of >0% to 43% (0.66 [0.52-0.83]; P =0.001), 43% to <70% (0.70 [0.55-0.90]; P =0.005), 70% to <100% (0.65 [0.50-0.84]; P =0.001), or 100% (0.56 [0.39-0.80]; P =0.001) compared with those with TTR of 0%., Conclusions: Higher SBP-TTR associates with lower risks of adverse kidney and cardiovascular events in adults with hypertension. SBP-TTR may be a potential therapeutic target and quality metric.- Published
- 2023
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15. How to find and use validated blood pressure measuring devices.
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Picone DS, Padwal R, Stergiou GS, Cohen JB, McManus RJ, Eckert S, Asayama K, Atkins N, Rakotz M, Lombardi C, Brady TM, and Sharman JE
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- Humans, Blood Pressure, Reproducibility of Results, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Sphygmomanometers, Hypertension diagnosis
- Abstract
Clinically validated, automated arm-cuff blood pressure measuring devices (BPMDs) are recommended for BP measurement. However, most BPMDs available for purchase by consumers globally are not properly validated. This is a problem because non-validated BPMDs are less accurate and precise than validated ones, and therefore if used clinically could lead to misdiagnosis and mismanagement of BP. In response to this problem, several validated device lists have been developed, which can be used by clinicians and consumers to identify devices that have passed clinical validation testing. The purpose of this review is to describe the resources that are available for finding validated BPMDs in different world regions, to identify the differences between validated device lists, and describe current gaps and challenges. How to use validated BPMDs properly is also summarised., (© 2022. The Author(s).)
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- 2023
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16. Primary Aldosteronism and the Role of Mineralocorticoid Receptor Antagonists for the Heart and Kidneys.
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Cohen JB, Bancos I, Brown JM, Sarathy H, Turcu AF, and Cohen DL
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- Humans, Mineralocorticoid Receptor Antagonists therapeutic use, Kidney, Blood Pressure, Hyperaldosteronism drug therapy, Hyperaldosteronism surgery, Hypertension drug therapy
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Primary aldosteronism (PA) is the most common cause of secondary hypertension but is frequently underrecognized and undertreated. Patients with PA are at a markedly increased risk for target organ damage to the heart and kidneys. While patients with unilateral PA can be treated surgically, many patients with PA are not eligible or willing to undergo surgery. Steroidal mineralocorticoid receptor antagonists (MRAs) are highly effective for treating PA and reducing the risk of target organ damage. However, steroidal MRAs are often underprescribed and can be poorly tolerated by some patients due to side effects. Nonsteroidal MRAs reduce adverse renal and cardiovascular outcomes among patients with diabetic kidney disease and are bettertolerated than steroidal MRAs. While their blood pressure-lowering effects remain unclear, these agents may have a potential role in reducing target organ damage in patients with PA.
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- 2023
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17. Resistant Hypertension in Chronic Kidney Disease: A Burden unto Itself.
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Shulman R and Cohen JB
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- Humans, Hypertension complications, Hypertension drug therapy, Renal Insufficiency, Chronic complications
- Published
- 2022
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18. Renin-Angiotensin System Inhibitors in Patients With COVID-19: A Meta-Analysis of Randomized Controlled Trials Led by the International Society of Hypertension.
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Gnanenthiran SR, Borghi C, Burger D, Caramelli B, Charchar F, Chirinos JA, Cohen JB, Cremer A, Di Tanna GL, Duvignaud A, Freilich D, Gommans DHF, Gracia-Ramos AE, Murray TA, Pelorosso F, Poulter NR, Puskarich MA, Rizas KD, Rothlin R, Schlaich MP, Schreinlecher M, Steckelings UM, Sharma A, Stergiou GS, Tignanelli CJ, Tomaszewski M, Unger T, van Kimmenade RRJ, Wainford RD, Williams B, Rodgers A, and Schutte AE
- Subjects
- Adult, Angiotensin Receptor Antagonists pharmacology, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors adverse effects, Antihypertensive Agents therapeutic use, Female, Humans, Male, Randomized Controlled Trials as Topic, Renin-Angiotensin System, Acute Kidney Injury chemically induced, COVID-19, Hypertension, Myocardial Infarction drug therapy
- Abstract
Background Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin-angiotensin system inhibitors (RASi) in adults with COVID-19. We therefore performed a meta-analysis to assess the safety and efficacy of RASi in adults with COVID-19. Methods and Results MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID-19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all-cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow-up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all-cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69-1.30]) either overall or in subgroups defined by COVID-19 severity or trial type. Network meta-analysis identified no difference between angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33-1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05-3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. Conclusions This meta-analysis of randomized controlled trials evaluating angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID-19 found no difference in all-cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID-19.
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- 2022
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19. Factors associated with antihypertensive monotherapy among US adults with treated hypertension and uncontrolled blood pressure overall and by race/ethnicity, National Health and Nutrition Examination Survey 2013-2018.
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Zheutlin AR, Derington CG, King JB, Berchie RO, Herrick JS, Dixon DL, Cohen JB, Shimbo D, Kronish IM, Saseen JJ, Muntner P, Moran AE, and Bress AP
- Subjects
- Adult, Blood Pressure physiology, Cross-Sectional Studies, Ethnicity, Humans, Nutrition Surveys, United States epidemiology, Young Adult, Antihypertensive Agents therapeutic use, Hypertension complications, Hypertension drug therapy, Hypertension epidemiology
- Abstract
Background: Treating hypertension with antihypertensive medications combinations, rather than one medication (ie, monotherapy), is underused in the United States, particularly in certain race/ethnic groups. Identifying factors associated with monotherapy use despite uncontrolled blood pressure (BP) overall and within race/ethnic groups may elucidate intervention targets in under-treated populations., Methods: Cross-sectional analysis of National Health and Nutrition Examination Surveys (NHANES; 2013-2014 through 2017-2018). We included participants age ≥20 years with hypertension, taking at least one antihypertensive medication, and uncontrolled BP (systolic BP [SBP] ≥ 140 mmHg or diastolic BP [DBP] ≥ 90 mmHg). Demographic, clinical, and healthcare-access factors associated with antihypertensive monotherapy were determined using multivariable-adjusted Poisson regression., Results: Among 1,597 participants with hypertension and uncontrolled BP, age- and sex- adjusted prevalence of monotherapy was 42.6% overall, 45.4% among non-Hispanic White, 31.9% among non-Hispanic Black, 39.6% among Hispanic, and 50.9% among non-Hispanic Asian adults. Overall, higher SBP was associated with higher monotherapy use, while older age, having a healthcare visit in the previous year, higher body mass index, and having heart failure were associated with lower monotherapy use., Conclusion: Clinical and healthcare-access factors, including a healthcare visit within the previous year and co-morbid conditions were associated with a higher likelihood of combination antihypertensive therapy., Competing Interests: Disclosure None, (Copyright © 2021. Published by Elsevier Inc.)
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- 2022
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20. Updates in hypertension: new trials, targets and ways of measuring blood pressure.
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Abu Salman L and Cohen JB
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- Aged, Antihypertensive Agents adverse effects, Antihypertensive Agents therapeutic use, Blood Pressure, Blood Pressure Determination, Female, Humans, Male, Hypertension diagnosis, Hypertension drug therapy, Hypertension epidemiology, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic drug therapy, Renal Insufficiency, Chronic epidemiology
- Abstract
Purpose of Review: Several recent trials and observational studies have identified critical areas that can help to improve the management and measurement of blood pressure in patients with hypertension., Recent Findings: High-quality trial evidence supports intensive SBP lowering to 110-130 mmHg in older patients, potassium- based salt substitution in patients without chronic kidney disease, and chlorthalidone for the management of hypertension in patients with chronic kidney disease. In addition, population-based studies indicate enormous underdiagnosis of primary aldosteronism as well as greater sustained intensification of antihypertensive therapy in older patients by maximizing medication dosage rather than adding new agents. The prevalence of hypertension is stable worldwide, though is generally improving in high-income countries and worsening in low-income countries. Furthermore, although cuffless blood pressure devices have the potential to improve access to blood pressure measurement, they have not yet demonstrated sufficient accuracy for clinical use., Summary: Growing evidence supports intensive blood pressure lowering, sodium reduction, targeted antihypertensive treatment and appropriate screening for secondary hypertension to optimize blood pressure control and reduce the risk of target organ damage from hypertension. Future studies are needed to identify ways to improve our ability to implement these findings in routine clinical practice., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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21. Evaluation and Management of Secondary Hypertension.
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Sarathy H, Salman LA, Lee C, and Cohen JB
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- Antihypertensive Agents therapeutic use, Blood Pressure, Humans, Hypertension diagnosis, Hypertension drug therapy, Hypertension etiology, Sleep Apnea, Obstructive complications, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive therapy
- Abstract
Hypertension is a major cause of cardiovascular morbidity and mortality globally. Many patients with hypertension have secondary causes of hypertension that merit further evaluation. For example, secondary hypertension can result in target organ damage to the heart, kidneys, and brain independent of the effects of blood pressure. Several causes benefit from targeted therapies to supplement first-line antihypertensive agents. However, secondary hypertension is often underrecognized. The goal of this review is to highlight optimal approaches to the diagnosis and management of common causes of secondary hypertension, including primary aldosteronism, renovascular hypertension, obstructive sleep apnea, and drug-induced hypertension., Competing Interests: Disclosure All authors report no relevant disclosures. Dr J.B. Cohen is supported by the National Institutes of HealthNational Heart, Lung, and Blood InstituteK23-HL133843 and R01-HL153646, National Center for Advancing Translational SciencesU01-TR003734, National Institute of Diabetes and Digestive and Kidney DiseasesR01-DK123104and U24-DK060990 and American Heart Association Bugher Award., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2022
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22. Using web-based training to improve accuracy of blood pressure measurement among health care professionals: A randomized trial.
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Hayer R, Kirley K, Cohen JB, Tsipas S, Sutherland SE, Oparil S, Shay CM, Cohen DL, Kabir C, and Wozniak G
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- Blood Pressure, Blood Pressure Determination, Health Personnel, Humans, Internet, Hypertension diagnosis
- Abstract
Accurate blood pressure measurement is crucial for proper screening, diagnosis, and monitoring of high blood pressure. However, providers are not aware of proper blood pressure measurement skills, do not master all the appropriate skills, or miss key steps in the process, leading to inconsistent or inaccurate readings. Training in blood pressure measurement for most providers is usually limited to a one-time brief demonstration during professional education coursework. The American Medical Association and the American Heart Association developed a 30-minute e-Learning module designed to refresh and improve existing blood pressure measurement knowledge and clinical skills among practicing providers. One hundred seventy-seven practicing providers, which included medical assistants, nurses, advanced practice providers, and physicians, participated in a multi-site randomized educational study designed to assess the effect of this e-Learning module on blood pressure measurement knowledge and skills. Participants were randomized 1:1 to either the intervention or control group. The intervention group followed a pre-post assessment approach, and the control group followed a test-retest approach. The initial assessment showed that participants in both the intervention and control groups correctly performed less than half of the 14 skills considered necessary to obtain an accurate blood pressure measurement (mean scores 5.5 and 5.9, respectively). Following the e-Learning module, the intervention group performed on average of 3.4 more skills correctly vs 1.4 in the control group (P < .01). Our findings reinforce existing evidence that errors in provider blood pressure measurements are highly prevalent and provide novel evidence that refresher training improves measurement accuracy., (© 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)
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- 2022
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23. Analysis of Therapeutic Inertia and Race and Ethnicity in the Systolic Blood Pressure Intervention Trial: A Secondary Analysis of a Randomized Clinical Trial.
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Zheutlin AR, Mondesir FL, Derington CG, King JB, Zhang C, Cohen JB, Berlowitz DR, Anstey DE, Cushman WC, Greene TH, Ogedegbe O, and Bress AP
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- Aged, Blood Pressure, Cross-Sectional Studies, Female, Follow-Up Studies, Health Status Disparities, Healthcare Disparities, Humans, Hypertension drug therapy, Male, Middle Aged, Antihypertensive Agents administration & dosage, Black People statistics & numerical data, Hispanic or Latino statistics & numerical data, Hypertension ethnology, White People statistics & numerical data
- Abstract
Importance: Therapeutic inertia may contribute to racial and ethnic differences in blood pressure (BP) control., Objective: To determine the association between race and ethnicity and therapeutic inertia in the Systolic Blood Pressure Intervention Trial (SPRINT)., Design, Setting, and Participants: This cross-sectional study was a secondary analysis of data from SPRINT, a randomized clinical trial comparing intensive (<120 mm Hg) vs standard (<140 mm Hg) systolic BP treatment goals. Participants were enrolled between November 8, 2010, and March 15, 2013, with a median follow-up 3.26 years. Participants included adults aged 50 years or older at high risk for cardiovascular disease but without diabetes, previous stroke, or heart failure. The present analysis was restricted to participant visits with measured BP above the target goal. Analyses for the present study were performed in from October 2020 through March 2021., Exposures: Self-reported race and ethnicity, mutually exclusively categorized into groups of Hispanic, non-Hispanic Black, or non-Hispanic White participants., Main Outcomes and Measures: Therapeutic inertia, defined as no antihypertensive medication intensification at each study visit where the BP was above target goal. The association between self-reported race and ethnicity and therapeutic inertia was estimated using generalized estimating equations and stratified by treatment group. Antihypertensive medication use was assessed with pill bottle inventories at each visit. Blood pressure was measured using an automated device., Results: A total of 8556 participants, including 4141 in the standard group (22 844 participant-visits; median age, 67.0 years [IQR, 61.0-76.0 years]; 1467 women [35.4%]) and 4415 in the intensive group (35 453 participant-visits; median age, 67.0 years [IQR, 61.0-76.0 years]; 1584 women [35.9%]) with at least 1 eligible study visit were included in the present analysis. Among non-Hispanic White, non-Hispanic Black, and Hispanic participants, the overall prevalence of therapeutic inertia in the standard vs intensive groups was 59.8% (95% CI, 58.9%-60.7%) vs 56.0% (95% CI, 55.2%-56.7%), 56.8% (95% CI, 54.4%-59.2%) vs 54.5% (95% CI, 52.4%-56.6%), and 59.7% (95% CI, 56.5%-63.0%) vs 51.0% (95% CI, 47.4%-54.5%), respectively. The adjusted odds ratios in the standard and intensive groups for therapeutic inertia associated with non-Hispanic Black vs non-Hispanic White participants were 0.85 (95% CI, 0.79-0.92) and 0.94 (95% CI, 0.88-1.01), respectively. The adjusted odds ratios for therapeutic inertia comparing Hispanic vs non-Hispanic White participants were 1.00 (95% CI, 0.90-1.13) and 0.89 (95% CI, 0.79-1.00) in the standard and intensive groups, respectively., Conclusions and Relevance: Among SPRINT participants above BP target goal, this cross-sectional study found that therapeutic inertia prevalence was similar or lower for non-Hispanic Black and Hispanic participants compared with non-Hispanic White participants. These findings suggest that a standardized approach to BP management, as used in SPRINT, may help ensure equitable care and could reduce the contribution of therapeutic inertia to disparities in hypertension., Trial Registration: ClinicalTrials.gov identifier: NCT01206062.
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- 2022
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24. Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association.
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Hall ME, Cohen JB, Ard JD, Egan BM, Hall JE, Lavie CJ, Ma J, Ndumele CE, Schauer PR, and Shimbo D
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- American Heart Association, Anti-Obesity Agents therapeutic use, Appetite Depressants therapeutic use, Humans, Hypertension therapy, Obesity prevention & control, Orlistat therapeutic use, Phentermine therapeutic use, United States, Weight Loss drug effects, Bariatric Surgery methods, Exercise physiology, Hypertension physiopathology, Obesity physiopathology, Weight Loss physiology
- Abstract
Hypertension is a major risk factor for cardiovascular and renal diseases in the United States and worldwide. Obesity accounts for much of the risk for primary hypertension through several mechanisms, including neurohormonal activation, inflammation, and kidney dysfunction. As the prevalence of obesity continues to increase, hypertension and associated cardiorenal diseases will also increase unless more effective strategies to prevent and treat obesity are developed. Lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited. Effective pharmacotherapeutic and procedural strategies, including metabolic surgeries, are additional options to treat obesity and prevent or attenuate obesity hypertension, target organ damage, and subsequent disease. Medications can be useful for short- and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity. Unanswered questions remain related to the mechanisms of obesity-related diseases, long-term efficacy of different treatment and prevention strategies, and timing of these interventions to prevent obesity and hypertension-mediated target organ damage. Further investigation, including randomized controlled trials, is essential to addressing these questions, and emphasis should be placed on the prevention of obesity to reduce the burden of hypertensive cardiovascular and kidney diseases and subsequent mortality.
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- 2021
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25. Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.
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Turgeon RD, Althouse AD, Cohen JB, Enache B, Hogenesch JB, Johansen ME, Mehta R, Meyerowitz-Katz G, Ziaeian B, and Hiremath S
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- Blood Pressure physiology, Blood Pressure Monitoring, Ambulatory, Circadian Rhythm physiology, Humans, Hypertension physiopathology, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension drug therapy
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- 2021
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26. Renal Denervation for the Treatment of Hypertension: Unnerving or Underappreciated?
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Sarathy H and Cohen JB
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- Humans, Denervation, Hypertension surgery, Kidney innervation, Kidney surgery
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- 2021
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27. Response to Lowering Nighttime Blood Pressure with Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Pro Side of the Argument.
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Turgeon R, Althouse A, Cohen JB, Enache B, Hogenesch JB, Johansen M, Mehta R, Meyerowitz-Katz G, Ziaeian B, and Hiremath S
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- Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Blood Pressure Monitoring, Ambulatory, Humans, Hypertension drug therapy, Hypotension drug therapy
- Published
- 2021
28. Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID-19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID-19 Pandemic.
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Bress AP, Cohen JB, Anstey DE, Conroy MB, Ferdinand KC, Fontil V, Margolis KL, Muntner P, Millar MM, Okuyemi KS, Rakotz MK, Reynolds K, Safford MM, Shimbo D, Stuligross J, Green BB, and Mohanty AF
- Subjects
- Health Status Disparities, Humans, Needs Assessment, SARS-CoV-2, Socioeconomic Factors, United States epidemiology, Blood Pressure Monitoring, Ambulatory methods, Blood Pressure Monitoring, Ambulatory statistics & numerical data, COVID-19 epidemiology, Health Services Accessibility organization & administration, Health Services Accessibility standards, Healthcare Disparities standards, Hypertension ethnology, Hypertension therapy, Racism prevention & control, Social Determinants of Health ethnology
- Abstract
The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.
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- 2021
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29. Antihypertensive Class and Cardiovascular Outcomes in Patients With HIV and Hypertension.
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Rethy LB, Feinstein MJ, Achenbach CJ, Townsend RR, Bress AP, Shah SJ, and Cohen JB
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- Adult, Antihypertensive Agents administration & dosage, Antihypertensive Agents classification, Calcium Channel Blockers administration & dosage, Calcium Channel Blockers classification, Female, Humans, Hypertension complications, Male, Middle Aged, Sodium Chloride Symporter Inhibitors administration & dosage, Sodium Chloride Symporter Inhibitors classification, Treatment Outcome, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Calcium Channel Blockers therapeutic use, HIV Infections complications, Hypertension drug therapy, Sodium Chloride Symporter Inhibitors therapeutic use
- Abstract
[Figure: see text].
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- 2021
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30. Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor use and COVID-19-related outcomes among US Veterans.
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Derington CG, Cohen JB, Mohanty AF, Greene TH, Cook J, Ying J, Wei G, Herrick JS, Stevens VW, Jones BE, Wang L, Zheutlin AR, South AM, Hanff TC, Smith SM, Cooper-DeHoff RM, King JB, Alexander GC, Berlowitz DR, Ahmad FS, Penrod MJ, Hess R, Conroy MB, Fang JC, Rubin MA, Beddhu S, Cheung AK, Xian W, Weintraub WS, and Bress AP
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- Aged, COVID-19 mortality, COVID-19 virology, Female, Hospitalization statistics & numerical data, Humans, Hypertension pathology, Male, Middle Aged, Propensity Score, Proportional Hazards Models, Retrospective Studies, Risk Factors, SARS-CoV-2 isolation & purification, Survival Rate, Veterans, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme Inhibitors therapeutic use, COVID-19 pathology, Hypertension drug therapy
- Abstract
Background: Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) may positively or negatively impact outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the association of ARB or ACEI use with coronavirus disease 2019 (COVID-19)-related outcomes in US Veterans with treated hypertension using an active comparator design, appropriate covariate adjustment, and negative control analyses., Methods and Findings: In this retrospective cohort study of Veterans with treated hypertension in the Veterans Health Administration (01/19/2020-08/28/2020), we compared users of (A) ARB/ACEI vs. non-ARB/ACEI (excluding Veterans with compelling indications to reduce confounding by indication) and (B) ARB vs. ACEI among (1) SARS-CoV-2+ outpatients and (2) COVID-19 hospitalized inpatients. The primary outcome was all-cause hospitalization or mortality (outpatients) and all-cause mortality (inpatients). We estimated hazard ratios (HR) using propensity score-weighted Cox regression. Baseline characteristics were well-balanced between exposure groups after weighting. Among outpatients, there were 5.0 and 6.0 primary outcomes per 100 person-months for ARB/ACEI (n = 2,482) vs. non-ARB/ACEI (n = 2,487) users (HR 0.85, 95% confidence interval [CI] 0.73-0.99, median follow-up 87 days). Among outpatients who were ARB (n = 4,877) vs. ACEI (n = 8,704) users, there were 13.2 and 14.8 primary outcomes per 100 person-months (HR 0.91, 95%CI 0.86-0.97, median follow-up 85 days). Among inpatients who were ARB/ACEI (n = 210) vs. non-ARB/ACEI (n = 275) users, there were 3.4 and 2.0 all-cause deaths per 100 person months (HR 1.25, 95%CI 0.30-5.13, median follow-up 30 days). Among inpatients, ARB (n = 1,164) and ACEI (n = 2,014) users had 21.0 vs. 17.7 all-cause deaths, per 100 person-months (HR 1.13, 95%CI 0.93-1.38, median follow-up 30 days)., Conclusions: This observational analysis supports continued ARB or ACEI use for patients already using these medications before SARS-CoV-2 infection. The novel beneficial association observed among outpatients between users of ARBs vs. ACEIs on hospitalization or mortality should be confirmed with randomized trials., Competing Interests: The authors have read the journal’s policy, and the authors of the study have the following competing interests to declare: APB receives research grant funding to his institution from Amarin and Amgen Inc, unrelated to the current manuscript. GCA is past Chair and current member of FDA’s Peripheral and Central Nervous System Advisory Committee; has served as a paid advisor to IQVIA; is a co-founding Principal and equity holder in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and is a past member of OptumRx’s National P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. JCF serves on Data and Safety Monitoring Boards (DSMBs) for Novartis, Amgen, AstraZeneca and Boehringer-Ingelheim. The views expressed are of the authors and do not necessarily represent the views or opinions of the US Government or the US Department of Veterans Affairs. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.
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- 2021
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31. Reconsidering α-Blockade for the Management of Hypertension in Patients With CKD.
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Ahmad S, Neubauer A, and Cohen JB
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- Cohort Studies, Humans, Kidney, Hypertension drug therapy, Renal Insufficiency, Chronic complications
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- 2021
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32. Adverse Health Outcomes Associated With Refractory and Treatment-Resistant Hypertension in the Chronic Renal Insufficiency Cohort.
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Buhnerkempe MG, Prakash V, Botchway A, Adekola B, Cohen JB, Rahman M, Weir MR, Ricardo AC, and Flack JM
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- Adult, Aged, Cohort Studies, Female, Humans, Hypertension complications, Hypertension epidemiology, Male, Middle Aged, Patient Outcome Assessment, Proportional Hazards Models, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Renal Insufficiency, Chronic complications
- Abstract
Refractory hypertension (RfH) is a severe phenotype of antihypertension treatment failure. Treatment-resistant hypertension (TRH), a less severe form of difficult-to-treat hypertension, has been associated with significantly worse health outcomes. However, no studies currently show how health outcomes may worsen upon progression to RfH. RfH and TRH were studied in 3147 hypertensive participants in the CRIC (Chronic Renal Insufficiency Cohort study). The hypertensive phenotype (ie, no TRH or RfH, TRH, or RfH) was identified at the baseline visit, and health outcomes were monitored at subsequent visits. Outcome risk was compared using Cox proportional hazards models with time-varying covariates. A total of 136 (4.3%) individuals were identified with RfH at baseline. After adjusting for participant characteristics, individuals with RfH had increased risk for the composite renal outcome across all study years (50% decline in estimated glomerular filtration rate or end-stage renal disease; hazard ratio for study years 0-10=1.73 [95% CI, 1.42-2.11]) and the composite cardiovascular disease outcome during later study years (stroke, myocardial infarction, or congestive heart failure; hazard ratio for study years 0-3=1.25 [0.91-1.73], for study years 3-6=1.50 [0.97-2.32]), and for study years 6-10=2.72 [1.47-5.01]) when compared with individuals with TRH. There was no significant difference in all-cause mortality between those with refractory versus TRH. We provide the first evidence that RfH is associated with worse long-term health outcomes compared with TRH.
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- 2021
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33. Masked Hypertension: Fragile in More Ways Than One.
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Cohen JB
- Subjects
- Adult, Blood Pressure Monitoring, Ambulatory, Humans, Reproducibility of Results, Hypertension diagnosis, Hypertension epidemiology, Masked Hypertension diagnosis, Masked Hypertension epidemiology
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- 2020
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34. Coronavirus Disease 2019 and Hypertension: The Role of Angiotensin-Converting Enzyme 2 and the Renin-Angiotensin System.
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Edmonston DL, South AM, Sparks MA, and Cohen JB
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- Acute Lung Injury epidemiology, Acute Lung Injury immunology, Angiotensin I immunology, Angiotensin I metabolism, Angiotensin II immunology, Angiotensin II metabolism, Angiotensin-Converting Enzyme 2 immunology, COVID-19 epidemiology, COVID-19 immunology, Comorbidity, Humans, Hypertension epidemiology, Hypertension metabolism, JNK Mitogen-Activated Protein Kinases immunology, JNK Mitogen-Activated Protein Kinases metabolism, Lung immunology, Lung metabolism, MAP Kinase Signaling System, Peptide Fragments immunology, Peptide Fragments metabolism, Protective Factors, Receptors, Coronavirus immunology, Receptors, Coronavirus metabolism, Renin-Angiotensin System, Risk Factors, SARS-CoV-2, Up-Regulation, Acute Lung Injury metabolism, Angiotensin Receptor Antagonists therapeutic use, Angiotensin-Converting Enzyme 2 metabolism, Angiotensin-Converting Enzyme Inhibitors therapeutic use, COVID-19 metabolism, Hypertension drug therapy
- Abstract
Hypertension emerged from early reports as a potential risk factor for worse outcomes for persons with coronavirus disease 2019 (COVID-19). Among the putative links between hypertension and COVID-19 is a key counter-regulatory component of the renin-angiotensin system (RAS): angiotensin-converting enzyme 2 (ACE2). ACE2 facilitates entry of severe acute respiratory syndrome coronavirus 2, the virus responsible for COVID-19, into host cells. Because RAS inhibitors have been suggested to increase ACE2 expression, health-care providers and patients have grappled with the decision of whether to discontinue these medications during the COVID-19 pandemic. However, experimental models of analogous viral pneumonias suggest RAS inhibitors may exert protective effects against acute lung injury. We review how RAS and ACE2 biology may affect outcomes in COVID-19 through pulmonary and other systemic effects. In addition, we briefly detail the data for and against continuation of RAS inhibitors in persons with COVID-19 and summarize the current consensus recommendations from select specialty organizations., (Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
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- 2020
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35. Restoring the upward trend in blood pressure control rates in the United States: a focus on fixed-dose combinations.
- Author
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Derington CG, Cohen JB, and Bress AP
- Subjects
- Blood Pressure drug effects, Drug Combinations, Humans, United States, Antihypertensive Agents therapeutic use, Hypertension drug therapy
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- 2020
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36. Reply to Tedeschi et al.
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Hanff TC, Harhay MO, Brown TS, Cohen JB, and Mohareb AM
- Subjects
- Hospital Mortality, Humans, Renin-Angiotensin System, SARS-CoV-2, COVID-19, Hypertension
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- 2020
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37. Response by Cohen et al to Letter Regarding Article, "Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19".
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Cohen JB, Hanff TC, South AM, Sparks MA, Hiremath S, Bress AP, Byrd JB, and Chirinos JA
- Subjects
- Angiotensin Receptor Antagonists, Betacoronavirus, COVID-19, Coronavirus Infections, Humans, Inpatients, Pandemics, Pneumonia, Viral, SARS-CoV-2, Angiotensin-Converting Enzyme Inhibitors, Hypertension
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- 2020
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38. Elevated Renin and Aldosterone Levels in a Young Woman With Hypertension.
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Kfoury B and Cohen JB
- Subjects
- Adult, Antihypertensive Agents pharmacology, Computed Tomography Angiography methods, Contraceptives, Oral, Hormonal administration & dosage, Contraceptives, Oral, Hormonal adverse effects, Diagnosis, Differential, Drug Combinations, Female, Humans, Patient Selection, Aldosterone blood, Androstenes administration & dosage, Androstenes adverse effects, Estradiol administration & dosage, Estradiol adverse effects, Hypertension blood, Hypertension complications, Hypertension diagnosis, Hypertension drug therapy, Polycystic Ovary Syndrome complications, Polycystic Ovary Syndrome drug therapy, Renin blood, Renin-Angiotensin System drug effects, Spironolactone pharmacology
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- 2020
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39. Association of 24-Hour Ambulatory Blood Pressure Patterns with Cognitive Function and Physical Functioning in CKD.
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Ghazi L, Yaffe K, Tamura MK, Rahman M, Hsu CY, Anderson AH, Cohen JB, Fischer MJ, Miller ER 3rd, Navaneethan SD, He J, Weir MR, Townsend RR, Cohen DL, Feldman HI, and Drawz PE
- Subjects
- Adult, Aged, Aged, 80 and over, Cognitive Dysfunction epidemiology, Cognitive Dysfunction psychology, Cross-Sectional Studies, Female, Frailty epidemiology, Frailty physiopathology, Frailty psychology, Functional Status, Humans, Hypertension epidemiology, Hypertension physiopathology, Incidence, Male, Middle Aged, Predictive Value of Tests, Prevalence, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic physiopathology, Risk Assessment, Risk Factors, Time Factors, United States epidemiology, Young Adult, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Circadian Rhythm, Cognition, Cognitive Dysfunction diagnosis, Frailty diagnosis, Hypertension diagnosis, Neuropsychological Tests, Renal Insufficiency, Chronic diagnosis
- Abstract
Background and Objectives: Hypertension is highly prevalent in patients with CKD as is cognitive impairment and frailty, but the link between them is understudied. Our objective was to determine the association between ambulatory BP patterns, cognitive function, physical function, and frailty among patients with nondialysis-dependent CKD., Design, Setting, Participants, & Measurements: Ambulatory BP readings were obtained on 1502 participants of the Chronic Renal Insufficiency Cohort. We evaluated the following exposures: ( 1 ) BP patterns (white coat, masked, sustained versus controlled hypertension) and ( 2 ) dipping patterns (reverse, extreme, nondippers versus normal dippers). Outcomes included the following: ( 1 ) cognitive impairment scores from the Modified Mini Mental Status Examination of <85, <80, and <75 for participants <65, 65-79, and ≥80 years, respectively; ( 2 ) physical function, measured by the short physical performance battery (SPPB), with higher scores (0-12) indicating better functioning; and ( 3 ) frailty, measured by meeting three or more of the following criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss. Cognitive function and frailty were assessed at the time of ambulatory BP (baseline) and annually thereafter. SPPB was assessed at baseline logistic and linear regression and Cox discrete models assessed the cross-sectional and longitudinal relationship between dipping and BP patterns and outcomes., Results: Mean age of participants was 63±10 years, 56% were male, and 39% were black. At baseline, 129 participants had cognitive impairment, and 275 were frail. Median SPPB score was 9 (interquartile range, 7-10). At baseline, participants with masked hypertension had 0.41 (95% CI, -0.78 to -0.05) lower SPPB scores compared with those with controlled hypertension in the fully adjusted model. Over 4 years of follow-up, 529 participants had incident frailty, and 207 had incident cognitive impairment. After multivariable adjustment, there was no association between BP or dipping patterns and incident frailty or cognitive impairment., Conclusions: In patients with CKD, dipping and BP patterns are not associated with incident or prevalent cognitive impairment or prevalent frailty., (Copyright © 2020 by the American Society of Nephrology.)
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- 2020
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40. Obstructive Sleep Apnea, Hypertension, and Cardiovascular Risk: Epidemiology, Pathophysiology, and Management.
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Salman LA, Shulman R, and Cohen JB
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- Blood Pressure, Cardiovascular Diseases epidemiology, Cardiovascular Diseases therapy, Humans, Hypertension epidemiology, Hypertension therapy, Risk Factors, Sleep Apnea, Obstructive epidemiology, Cardiovascular Diseases physiopathology, Continuous Positive Airway Pressure, Hypertension physiopathology, Obesity complications, Sleep Apnea, Obstructive physiopathology, Sleep Apnea, Obstructive therapy
- Abstract
Purpose of Review: Given the rising prevalence of obstructive sleep apnea (OSA), we aimed to review the epidemiologic and pathophysiologic relationship of OSA, hypertension, and cardiovascular disease, and to summarize recent advances in the treatment of OSA., Recent Findings: OSA is associated with an elevated risk of hypertension and cardiovascular disease. Several pathophysiologic factors contribute to the relationship between OSA and vascular risk, including neurohormonal dysregulation, endothelial dysfunction, and inflammation. While CPAP reduces blood pressure, it has not been demonstrated to reduce cardiovascular risk. The combination of CPAP and weight loss has a synergistic effect on blood pressure and several metabolic parameters. Adherence to CPAP is poor across studies, potentially contributing to the attenuation of perceived cardiovascular benefit from CPAP therapy. A greater emphasis on adherence to CPAP and the combination of CPAP and weight loss are central to reducing cardiovascular risk among individuals with OSA.
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- 2020
- Full Text
- View/download PDF
41. Weight Loss Medications in the Treatment of Obesity and Hypertension.
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Cohen JB and Gadde KM
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- Blood Pressure Monitoring, Ambulatory, Humans, Weight Loss, Anti-Obesity Agents, Hypertension complications, Hypertension drug therapy, Obesity complications, Obesity drug therapy
- Abstract
Purpose of Review: Weight loss is strongly associated with improvement in blood pressure; however, the mechanism of weight loss can impact the magnitude and sustainability of blood pressure reduction., Recent Findings: Five drugs-orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion-are currently approved for weight loss therapy in the USA. Naltrexone/bupropion results in an increase in in-office and ambulatory blood pressure compared to placebo. Other therapies are associated with modest lowering of blood pressure, and are generally well-tolerated; nonetheless, evidence is limited regarding their effect on blood pressure, particularly longitudinally, in individuals with hypertension. Although weight loss medications can be an effective adjunct to lifestyle modifications in individuals with obesity, there is limited evidence regarding their benefit with regard to blood pressure. Future studies evaluating the effectiveness of weight loss medications should include careful assessment of their short- and long-term impact on blood pressure in individuals with hypertension.
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- 2019
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42. The ACC/AHA 2017 Hypertension Guidelines: Both Too Much and Not Enough of a Good Thing?
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Cohen JB and Townsend RR
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- American Heart Association, Evidence-Based Medicine, Humans, Societies, Medical, United States, Hypertension diagnosis, Hypertension therapy, Practice Guidelines as Topic
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- 2018
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43. Systolic blood pressure as a potential target of sigma-1 receptor agonist therapy.
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Cohen JB, Perlis ML, and Townsend RR
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- Animals, Drugs, Investigational pharmacology, Humans, Hypertension metabolism, Treatment Outcome, Sigma-1 Receptor, Antihypertensive Agents pharmacology, Blood Pressure drug effects, Hypertension drug therapy, Receptors, sigma agonists
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- 2018
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- View/download PDF
44. Hypertension in Obesity and the Impact of Weight Loss.
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Cohen JB
- Subjects
- Bariatric Surgery, Cardiovascular Diseases prevention & control, Humans, Renal Insufficiency, Chronic etiology, Risk Factors, Hypertension etiology, Hypertension therapy, Obesity complications, Obesity therapy, Weight Loss
- Abstract
Purpose of Review: Several interrelated mechanisms promote the development of hypertension in obesity, often contributing to end organ damage including cardiovascular disease and chronic kidney disease., Recent Findings: The treatment of hypertension in obesity is complicated by a high prevalence of resistant hypertension, as well as unpredictable hemodynamic effects of many medications. Weight loss stabilizes neurohormonal activity and causes clinically significant reductions in blood pressure. While lifestyle interventions can improve blood pressure, they fail to consistently yield sustained weight loss and have not demonstrated long-term benefits. Bariatric surgery provides more permanent weight reduction, corresponding with dramatic declines in blood pressure and attenuation of long-term cardiovascular risk. Hypertension is closely linked to the prevalence, pathophysiology, and morbidity of obesity. There are multiple barriers to managing hypertension in obesity. Surgical weight loss offers the most promise in reducing blood pressure and decreasing end organ damage in this patient population.
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- 2017
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45. Antihypertensive Medication in Patients Pre- and Postdialysis: Still Hazy After All These Years.
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Cohen JB and Townsend RR
- Subjects
- Blood Pressure drug effects, Humans, Renal Dialysis, Antihypertensive Agents, Hypertension
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- 2016
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46. To restrict or not to restrict? The enigma of sodium intake and mortality.
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Cohen JB and Townsend RR
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- Humans, Blood Pressure, Diet, Sodium-Restricted mortality, Hypertension diet therapy, Hypertension mortality, Sodium Chloride, Dietary adverse effects
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- 2015
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47. Treating Home Versus Predialysis Blood Pressure Among In-Center Hemodialysis Patients: A Pilot Randomized Trial.
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Bansal, Nisha, Glidden, David V, Mehrotra, Rajnish, Townsend, Raymond R, Cohen, Jordana, Linke, Lori, Palad, Farshad, Larson, Hannah, and Hsu, Chi-Yuan
- Subjects
Humans ,Kidney Failure ,Chronic ,Antihypertensive Agents ,Blood Pressure Determination ,Blood Pressure Monitoring ,Ambulatory ,Prognosis ,Renal Dialysis ,Risk Assessment ,Pilot Projects ,Patient Compliance ,Blood Pressure ,Middle Aged ,Home Care Services ,Female ,Male ,Outcome and Process Assessment ,Health Care ,BP management ,BP target ,Blood pressure ,clinical trial ,dry weight adjustment ,end-stage renal disease ,hemodialysis ,home BP ,hypertension ,masked hypertension ,pilot study ,pragmatic trial ,white coat effect ,Neurosciences ,Clinical Research ,Kidney Disease ,Comparative Effectiveness Research ,Clinical Trials and Supportive Activities ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Cardiovascular ,Good Health and Well Being ,Clinical Sciences ,Public Health and Health Services ,Urology & Nephrology - Abstract
Rationale & objectiveObservational studies have reported a U-shaped association between blood pressure (BP) before a hemodialysis session and death. In contrast, because a linear association between out-of-dialysis-unit BP and death has been reported, home BP may be a better target for treatment. To test the feasibility of this approach, we conducted a pilot trial of treating home versus predialysis BP in hemodialysis patients.Study designA 4-month, parallel, randomized, controlled trial.Settings & participants50 prevalent hemodialysis patients in San Francisco and Seattle. Participants were randomly assigned using 1:1 block randomization, stratified by site.InterventionsTo target home systolic BP (SBP) of 100-200mm Hg; 0.2% vs 0%) or low (defined as
- Published
- 2021
48. Management of Hypertension in Chronic Kidney Disease
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Cohen, Jordana B., Townsend, Raymond R., Singh, Ajay K., editor, and Agarwal, Rajiv, editor
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- 2016
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49. Relationship Between ACE2 and Other Components of the Renin-Angiotensin System
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Cohen, Jordana B., Hanff, Thomas C., Bress, Adam P., and South, Andrew M.
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- 2020
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50. Association of renin–angiotensin system blockers with COVID-19 diagnosis and prognosis in patients with hypertension: a population-based study
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Soler, María José, Ribera, Aida, Marsal, Josep Ramon, Méndez, Ana Belen, Andrés Villareal, Mireia, Azancot, María A, Oristrell, Gerard, Méndez-Boo, Leonardo, Cohen, Jordana, Barrabés, José A, Ferreira-González, Ignacio, Universitat Autònoma de Barcelona, Institut Català de la Salut, [Soler MJ, Azancot MA] Servei de Nefrologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Grup de Recerca en Nefrologia, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Ribera A, Marsal JR] Servei de Cardiologia, Unitat d'Epidemiologia Cardiovascular, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. [Mendez AB, Oristrell G] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Andres M, Barrabés JA] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. [Méndez-Boo L] Departament de Salut, SISAP: Sistema d’Informació dels Serveis d’Atenció Primària, Direcció de Sistemes d’Informació, Institut Català de la Salut, Generalitat de Catalunya, Barcelona, Spain. [Cohen J] Division of Renal-Electrolyte and Hypertension, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA. [Ferreira-González I] Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
Angiotensines ,medicine.medical_specialty ,hypertension ,Renin-angiotensin system blockers ,Coronavirus disease 2019 (COVID-19) ,COVID-19 (Malaltia) - Mortalitat ,Cardiovascular Diseases::Vascular Diseases::Hypertension [DISEASES] ,Internal medicine ,Renin–angiotensin system ,Medicine ,In patient ,cardiovascular diseases ,Mortality ,AcademicSubjects/MED00340 ,angiotensin converting enzyme ,Transplantation ,business.industry ,COVID-19 ,renin-angiotensin system blockers ,Angiotensin receptor blockers ,mortality ,angiotensin receptor blockers ,Population based study ,Nephrology ,Hypertension ,Original Article ,Hipertensió ,business ,enfermedades cardiovasculares::enfermedades vasculares::hipertensión [ENFERMEDADES] ,Angiotensin-converting enzyme - Abstract
Background The effect of renin-angiotensin(RAS) blockade either by angiotensin-converting enzyme inhibitors (ACEi) or angiotensin-receptor blockers (ARBs) on coronavirus disease 2019(COVID-19) susceptibility, mortality and severity is inadequately described. We examined the association between renin-angiotensin system (RAS) blockade and COVID-19 diagnosis and prognosis in a large population-based cohort of patients with hypertension. Methods This is a cohort study using regional health records. We identified all individuals aged 18-95 years from 87 health care reference areas of the main health provider in Catalonia(Spain), with a history of hypertension from primary care records. Data were linked to COVID-19 test results, hospital, pharmacy and mortality records from 1 March 2020 to 14 August 2020. We defined exposure to RAS blockers as the dispensation of ACEi/ARBs during the three months before COVID-19 diagnosis or 1 March 2020. Primary outcomes were: COVID-19 infection, and severe progression in hospitalized patients with COVID-19(the composite of need for invasive respiratory support or death). For both outcomes and for each exposure of interest (RAAS blockade, ACEi or ARB) we estimated associations in age-sex-area-propensity matched samples. Results From a cohort of 1,365,215 inhabitants we identified 305,972 patients with hypertension history. Recent use of ACEi/ARBs in patients with hypertension was associated with a lower 6 month-cumulative incidence of COVID-19 diagnosis (3.78% [95% CI: 3.69% - 3.86%] vs 4.53% [95% CI: 4.40% - 4.65%]; p, Graphical Abstract Graphical Abstract
- Published
- 2021
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