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1. Chronic kidney disease, atherosclerotic plaque characteristics on carotid magnetic resonance imaging, and cardiovascular outcomes

Author

Srinivasan Beddhu, Robert E. Boucher, Jie Sun, Niranjan Balu, Michel Chonchol, Sankar Navaneethan, Glenn M. Chertow, Raymond Townsend, William Haley, Alfred K. Cheung, Molly B. Conroy, Dominic S. Raj, Dongxiang Xu, Thomas George, Reem Yunis, Guo Wei, Gador Canton, Jeffrey Bates, Jing Chen, Vasilios Papademetriou, Henry Punzi, Alan Wiggers, Jackson T. Wright, Tom Greene, and Chun Yuan

Subjects
Chronic kidney disease, Atherosclerosis, Carotid plaque, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Abstract Background It is unclear whether faster progression of atherosclerosis explains the higher risk of cardiovascular events in CKD. The objectives of this study were to 1. Characterize the associations of CKD with presence and morphology of atherosclerotic plaques on carotid magnetic resonance imaging (MRI) and 2. Examine the associations of baseline CKD and carotid atherosclerotic plaques with subsequent cardiovascular events. Methods In a subgroup (N = 465) of Systolic Blood Pressure Intervention Trial. (SPRINT) participants, we measured carotid plaque presence and morphology at baseline and after 30-months with MRI. We examined the associations of CKD (baseline eGFR

Published
2021
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2. Incidence and Outcomes of Acute Heart Failure With Preserved Versus Reduced Ejection Fraction in SPRINT

Author

Karen C. Johnson, Dominic S. Raj, Michael V. Rocco, Suzanne Oparil, James J Willard, Anjay Rastogi, Jeffrey T. Bates, Laura C. Lovato, Alan Wiggers, William C. Cushman, Natalie A. Bello, Leonardo Tamariz, Carlos J. Rodriguez, Dalane W. Kitzman, Bharathi Upadhya, Cora E. Lewis, and Gerard P. Aurigemma

Subjects
Male, medicine.medical_specialty, Time Factors, Acute decompensated heart failure, Patient Readmission, Ventricular Function, Left, Article, Ventricular Dysfunction, Left, Risk Factors, Internal medicine, medicine, Humans, Intervention trial, Myocardial infarction, Aged, Aged, 80 and over, Heart Failure, Ejection fraction, business.industry, Incidence, Incidence (epidemiology), Stroke Volume, Middle Aged, medicine.disease, Hospitalization, Treatment Outcome, Blood pressure, Sprint, Heart failure, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background: In the SPRINT (Systolic Blood Pressure Intervention Trial), intensive BP treatment reduced acute decompensated heart failure (ADHF) events. Here, we report the effect on HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF) and their subsequent outcomes. Methods: Incident ADHF was defined as hospitalization or emergency department visit, confirmed, and formally adjudicated by a blinded events committee using standardized protocols. HFpEF was defined as EF ≥45%, and HFrEF was EF Results: Among the 133 participants with incident ADHF who had EF assessment, 69 (52%) had HFpEF and 64 (48%) had HFrEF ( P value: 0.73). During average 3.3 years follow-up in those who developed incident ADHF, rates of subsequent all-cause and HF hospital readmission and mortality were high, but there were no significant differences between those who developed HFpEF versus HFrEF. Randomization to the intensive arm had no effect on subsequent mortality or readmissions after the initial ADHF event, irrespective of EF subtype. During follow-up among participants who developed HFpEF, although relatively modest number of events limited statistical power, age was an independent predictor of all-cause mortality, and Black race independently predicted all-cause and HF hospital readmission. Conclusions: In SPRINT, intensive BP reduction decreased both acute decompensated HFpEF and HFrEF events. After initial incident ADHF, rates of subsequent hospital admission and mortality were high and were similar for those who developed HFpEF or HFrEF. Randomization to the intensive arm did not alter the risks for subsequent all-cause, or HF events in either HFpEF or HFrEF. Among those who developed HFpEF, age and Black race were independent predictors of clinical outcomes. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01206062.

Published
2021
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3. Kidney Disease, Hypertension Treatment, and Cerebral Perfusion and Structure

Author

Manjula Kurella Tamura, Sarah Gaussoin, Nicholas M. Pajewski, Greg Zaharchuk, Barry I. Freedman, Stephen R. Rapp, Alexander P. Auchus, William E. Haley, Suzanne Oparil, Jessica Kendrick, Christianne L. Roumie, Srinivasan Beddhu, Alfred K. Cheung, Jeff D. Williamson, John A. Detre, Sudipto Dolui, R. Nick Bryan, Ilya M. Nasrallah, Paul Whelton, Karen C. Johnson, Joni Snyder, Diane Bild, Denise Bonds, Nakela Cook, Jeffrey Cutler, Lawrence Fine, Peter Kaufmann, Paul Kimmel, Lenore Launer, Claudia Moy, William Riley, Laurie Ryan, Eser Tolunay, Song Yang, David Reboussin, Jeff Williamson, Walter T. Ambrosius, William Applegate, Greg Evans, Capri Foy, Dalane Kitzman, Mary Lyles, Nick Pajewski, Steve Rapp, Scott Rushing, Neel Shah, Kaycee M. Sink, Mara Vitolins, Lynne Wagenknecht, Valerie Wilson, Letitia Perdue, Nancy Woolard, Tim Craven, Katelyn Garcia, Laura Lovato, Jill Newman, James Lovato, Lingyi Lu, Chris McLouth, Greg Russell, Bobby Amoroso, Patty Davis, Jason Griffin, Darrin Harris, Mark King, Kathy Lane, Wes Roberson, Debbie Steinberg, Donna Ashford, Phyllis Babcock, Dana Chamberlain, Vickie Christensen, Loretta Cloud, Christy Collins, Delilah Cook, Katherine Currie, Debbie Felton, Stacy Harpe, Marjorie Howard, Michelle Lewis, Pamela Nance, Nicole Puccinelli-Ortega, Laurie Russell, Jennifer Walker, Brenda Craven, Candace Goode, Margie Troxler, Janet Davis, Sarah Hutchens, Anthony A. Killeen, Anna M. Lukkari, Robert Ringer, Brandi Dillard, Norbert Archibeque, Stuart Warren, Mike Sather, James Pontzer, Zach Taylor, Elsayed Z. Soliman, Zhu-Ming Zhang, Yabing Li, Chuck Campbell, Susan Hensley, Julie Hu, Lisa Keasler, Mary Barr, Tonya Taylor, Christos Davatzikos, Ilya Nasarallah, Lisa Desiderio, Mark Elliott, Ari Borthakur, Harsha Battapady, Guray Erus, Alex Smith, Ze Wang, Jimit Doshi, Jackson T. Wright, Mahboob Rahman, Alan J. Lerner, Carolyn Still, Alan Wiggers, Sara Zamanian, Alberta Bee, Renee Dancie, George Thomas, Martin Schreiber, Sankar Dass Navaneethan, John Hickner, Michael Lioudis, Michelle Lard, Susan Marczewski, Jennifer Maraschky, Martha Colman, Andrea Aaby, Stacey Payne, Melanie Ramos, Carol Horner, Paul Drawz, Pratibha P. Raghavendra, Scott Ober, Ronda Mourad, Muralidhar Pallaki, Peter Russo, Pratibha Raghavendra, Pual Fantauzzo, Lisa Tucker, Bill Schwing, John R. Sedor, Edward J. Horwitz, Jeffrey R. Schellling, John F. O’Toole, Lisa Humbert, Wendy Tutolo, Suzanne White, Alishea Gay, Walter Clark, Robin Hughes, Mirela Dobre, Carolyn H. Still, Monique Williams, Udayan Bhatt, Lee Hebert, Anil Agarwal, Melissa Brown Murphy, Nicole Ford, Cynthia Stratton, Jody Baxter, Alicia A. Lykins, Alison McKinley Neal Leena Hirmath, Osei Kwame, Kyaw Soe, William F. Miser, Colleen Sagrilla, Jan Johnston, Amber Anaya, Ashley Mintos, Angel A. Howell, Kelly Rogers, Sara Taylor, Donald Ebersbacher, Lucy Long, Beth Bednarchik, Adrian Schnall, Jonathan Smith, Lori Peysha, Lisa Leach, Megan Tribout, Carla Harwell, Pinkie Ellington, Mary Ann Banerji, Pranav Ghody, Melissa Vahídeh Rambaud, Raymond Townsend, Debbie Cohen, Yonghong Huan, Mark Duckworth, Virginia Ford, Juliet Leshner, Ann Davison, Sarah Vander Veen, Crystal A. Gadegbeku, Avi Gillespie, Anuradha Paranjape, Sandra Amoroso, Zoe Pfeffer, Sally B. Quinn, Jiang He, Jing Chen, Eva Lustigova, Erin Malone, Marie Krousel-Wood, Richard Deichmann, Patricia Ronney, Susan Muery, Donnalee Trapani, Michael Rocco, David Goff, Carlos Rodriguez, Laura Coker, Amret Hawfield, Joseph Yeboah, Lenore Crago, John Summerson, Anita Hege, Matt Diamond, Laura Mulloy, Marcela Hodges, Michelle Collins, Charlene Weathers, Heather Anderson, Emily Stone, Walida Walker, Andrew McWilliams, Michael Dulin, Lindsay Kuhn, Susan Standridge, Lindsay Lowe, Kelly Everett, Kelry Preston, Susan Norton, Silena Gaines, Ali A. Rizvi, Andrew W. Sides, Diamond Herbert, Matthew M. Hix, Melanie Whitmire, Brittany Arnold, Philip Hutchinson, Joseph Espiritu, Mark Feinglos, Eugene Kovalik, Georgianne Gedon-Lipscomb, Kathryn Evans, Connie Thacker, Ronna Zimmer, Mary Furst, MaryAnn Mason, James Powell, Paul Bolin, Junhong Zhang, Mary Pinion, Gail Davis, Winifred Bryant, Presley Phelps, Connie Garris-Sutton, Beatrice Atkinson, Gabriele Contreras, Maritza Suarez, Ivonne Schulman, Don Koggan, Jackie Vassallo, Gloria Peruyera, Sheri Whittington, Cassandra Bethea, Laura Gilliam, Carolyn Pedley, Geraldine Zurek, Miriam Baird, Charles Herring, Mary Martha Smoak, Julie Williams, Samantha Rogers, Lindsay Gordon, Erin Kennedy, Beverly Belle, Jessica McCorkle-Doomy, Jonathan Adams, Ramon Lopez, Juris Janavs, Frederic Rahbari-Oskoui, Arlene Chapman, Allen Dollar, Olubunmi Williams, Yoosun Han, William Haley, Peter Fitzpatrick, Joseph Blackshear, Brian Shapiro, Anna Harrell, Arta Palaj, Katelyn Henderson, Ashley Johnson, Heath Gonzalez, Jermaine Robinson, Leonardo Tamariz, Jennifer Denizard, Rody Barakat, Dhurga Krishnamoorthy, Frank Greenway, Ron Monce, Timothy Church, Chelsea Hendrick, Aimee Yoches, Leighanne Sones, Markee Baltazar, Priscilla Pemu, Connie Jones, Derrick Akpalu, Gordon Chelune, Jeffrey Childs, Lisa Gren, Anne Randall, Laura Dember, Denise Soares, Jerry Yee, Kausik Umanath, Naima Ogletree, Schawana Thaxton, Karen Campana, Dayna Sheldon, Krista MacArthur, J. Brent Muhlestein, Nathan Allred, Brian Clements, Ritesh Dhar, Kent Meredith, Viet Le, Edward Miner, James Orford, Erik R. Riessen, Becca Ballantyne, Ben Chisum, Kevin Johnson, Dixie Peeler, Glenn Chertow, Manju Tamura, Tara Chang, Kevin Erickson, Jenny Shen, Randall S. Stafford, Gregory Zaharchuk, Margareth Del Cid, Michelle Dentinger, Jennifer Sabino, Rukmani Sahay, Ekaterina Telminova, Daniel E. Weiner, Mark Sarnak, Lily Chan, Amanda Civiletto, Alyson Heath, Amy Kantor, Priyanka Jain, Bethany Kirkpatrick, Andrew Well, Barry Yuen, Michel Chonchol, Beverly Farmer, Heather Farmer, Carol Greenwald, Mikaela Malaczewski, James Lash, Anna Porter, Ana Ricardo, Robert T. Rosman, Janet Cohan, Nieves Lopez Barrera, Daniel Meslar, Patricia Meslar, Margaret Conroy, Mark Unruh, Rachel Hess, Manisha Jhamb, Holly Thomas, Pam Fazio, Elle Klixbull, Melissa Komlos-Weimer, LeeAnne Mandich, Tina Vita, Robert Toto, Peter Van Buren, Julia Inrig, Martha Cruz, Tammy Lightfoot, Nancy Wang, Lori Webster, Kalani Raphael, Barry Stults, Tahir Zaman, Debra Simmons, Tooran Lavasani, Rebecca Filipowicz, Guo Wei, Gracie Mary Miller, Jenice Harerra, Jeff Christensen, Ajay Giri, Xiaorui Chen, Natalie Anderton, Arianna Jensen, Julia Lewis, Anna Burgner, Jamie P. Dwyer, Gerald Schulman, Terri Herrud, Ewanda Leavell, Tiffany McCray, Edwina McNeil-Simaan, Munmun Poudel, Malia Reed, Mohammed Sika, Delia Woods, Janice L. Zirkenbach, Dominic S. Raj, Scott Cohen, Samir Patel, Manuel Velasquez, Roshni S. Bastian, Maria Wing, Akshay Roy-Chaudhury, Thomas Depner, Lorien Dalyrymple, George Kaysen, Susan Anderson, John Nord, Joachim H. Ix, Leonard Goldenstein, Cynthia M. Miracle, Nketi Forbang, Maja Mircic, Brenda Thomas, Tiffany Tran, Anjay Rastogi, Mihae Kim, Mohamad Rashid, Bianca Lizarraga, Amy Hocza, Kristine Sarmosyan, Jason Norris, Tushar Sharma, Amanda Chioy, Eric Bernard, Eleanore Cabrera, Christina Lopez, Susana Nunez, Joseph Riad, Suzanne Schweitzer, Siran Sirop, Sarah Thomas, Lauren Wada, Holly Kramer, Vinod Bansal, Corliss E. Taylor, Mark S. Segal, Karen L. Hall, Amir Kazory, Lesa Gilbert, Linda Owens, Danielle Poulton, Elaine Whidden, Jocelyn Wiggins, Caroline Blaum, Linda Nyquist, Lillian Min, Tanya Gure, Ruth Lewis, Jennifer Mawby, Eileen Robinson, Cora E. Lewis, Virginia Bradley, David Calhoun, Stephen Glasser, Kim Jenkins, Tom Ramsey, Nauman Qureshi, Karen Ferguson, Sumrah Haider, Mandy James, Christy Jones, Kim Renfroe, April Seay, Carrie Weigart, Denyse Thornley-Brown, Dana Rizik, Bari Cotton, Meredith Fitz-Gerald, Tiffany Grimes, Carolyn Johnson, Sara Kennedy, Chanel Mason, Lesa Rosato-Burson, Robin Willingham, Eric Judd, Tonya Breaux-Shropshire, Felice Cook, Julia Medina, Lama Ghazi, Hemal Bhatt, James Lewis, Roman Brantley, John Brouilette, Jeffrey Glaze, Stephanie Hall, Nancy Hiott, David Tharpe, Spencer Boddy, Catherine Mack, Catherine Womack, Keiko Asao, Beate Griffin, Carol Hendrix, Karen Johnson, Lisa Jones, Chelsea Towers, Henry Punzi, Kathy Cassidy, Kristin Schumacher, Carmen Irizarry, Ilma Colon, Pedro Colon-Ortiz, Pedro J. Colón-Hernández, Orlando J. Carrasquillo-Navarro, Merari Carrasquillo, Nivea Vazquez, Miguel Sosa-Padilla, Alex Cintron-Pinero, Mayra Ayala, Olga Pacheco, Catalina Rivera, Irma Sotomayor-Gonzalez, Jamie Claudio, Jose Lazaro, Migdalia Arce, Lourdes Heres, Alba Perez, Jose Tavarez-Valle, Ferlinda Arocho, Mercedes Torres, Melvaliz Vazquez, Gerard P. Aurigemma, Rebecca Takis-Smith, Julia Andrieni, Noelle Bodkin, Kiran Chaudhary, Paula Hu, John Kostis, Nora Cosgrove, Denise Bankowski, Monica Boleyn, Laurie Casazza, Victoria Giresi, Tosha Patel, Erin Squindo, Yan Wu, Zeb Henson, Marion Wofford, Jessica Lowery, Deborah Minor, Kimberley Harkins, Alexander Auchus, Michael Flessner, Cathy Adair, Jordan Asher, Debbie Loope, Rita Cobb, Reiner Venegas, Thomas Bigger, Natalie Bello, Shunichi Homma, Daniel Donovan, Carlos Lopez-Jimenez, Amilcar Tirado, Asqual Getaneh, Rocky Tang, Sabrina Durant, Mathew Maurer, Sergio Teruya, Stephen Helmke, Julissa Alvarez, Ruth Campbell, Roberto Pisoni, Rachel Sturdivant, Deborah Brooks, Caroline Counts, Vickie Hunt, Lori Spillers, Donald Brautigam, Timothy Kitchen, Timothy Gorman, Jessica Sayers, Sarah Button, June Chiarot, Rosemary Fischer, Melissa Lyon, Maria Resnick, Nicole Hodges, Jennifer Ferreira, William Cushman, Barry Wall, Linda Nichols, Robert Burns, Jennifer Martindale-Adams, Dan Berlowitz, Elizabeth Clark, Sandy Walsh, Terry Geraci, Carol Huff, Linda Shaw, Karen Servilla, Darlene Vigil, Terry Barrett, Mary Ellen Sweeney, Rebecca Johnson, Susan McConnell, Khadijeh Shahid Salles, Francoise Watson, Cheryl Schenk, Laura Whittington, Maxine Maher, Jonathan Williams, Stephen Swartz, Paul Conlin, George Alexis, Rebecca Lamkin, Patti Underwood, Helen Gomes, Clive Rosendorff, Stephen Atlas, Saadat Khan, Waddy Gonzalez, Samih Barcham, Lawrence Kwon, Matar Matar, Anwar Adhami, Jan Basile, Joseph John, Deborah Ham, Hadi Baig, Mohammed Saklayen, Jason Yap, Helen Neff, Carol Miller, Ling Zheng-Phelan, Saib Gappy, Shiva Rau, Arathi Raman, Vicki Berchou, Elizabeth Jones, Erin Olgren, Cynthia Marbury, Michael Yudd, Sithiporn Sastrasinh, Jennine Michaud, Jessica Fiore, Marianne Kutza, Ronald Shorr, Rattana Mount, Helen Dunn, Susan Stinson, Jessica Hunter, Addison Taylor, Jeffery Bates, Catherine Anderson, Kent Kirchner, Jodi Stubbs, Ardell Hinton, Anita Spencer, Santosh Sharma, Thomas Wiegmann, Smita Mehta, Michelle Krause, Kate Dishongh, Richard Childress, Geeta Gyamlani, Atossa Niakan, Cathy Thompson, Janelle Moody, Carolyn Gresham, Jeffrey Whittle, Gary Barnas, Dawn Wolfgram, Heidi Cortese, Jonette Johnson, Christianne Roumie, Adriana Hung, Jennifer Wharton, Kurt Niesner, Lois Katz, Elizabeth Richardson, George Brock, Joanne Holland, Troy Dixon, Athena Zias, Christine Spiller, Penelope Baker, James Felicetta, Shakaib Rehman, Kelli Bingham, Suzanne Watnick, David Cohen, Jessica Weiss, Tera Johnston, Stephen Giddings, Hala Yamout, Andrew Klein, Caroline Rowe, Kristin Vargo, Kristi Waidmann, Vasilios Papademetriou, Jean Pierre Elkhoury, Barbara Gregory, Susan Amodeo, Mary Bloom, Dalia Goldfarb-Waysman, Richard Treger, Mehran Kashefi, Christina Huang, Karen Knibloe, Areef Ishani, Yelena Slinin, Christine Olney, Jacqueline Rust, Paolo Fanti, Christopher Dyer, Shweta Bansal, Monica Dunnam, Lih-Lan Hu, and Perla Zarate-Abbott

Subjects
Male, medicine.medical_specialty, Renal function, Perfusion scanning, Blood Pressure, Article, chemistry.chemical_compound, Internal medicine, medicine, Humans, Cerebral perfusion pressure, Renal Insufficiency, Chronic, Antihypertensive Agents, Aged, Creatinine, business.industry, medicine.disease, Perfusion, Blood pressure, chemistry, Cerebral blood flow, Nephrology, Cerebrovascular Circulation, Hypertension, Albuminuria, Cardiology, Female, medicine.symptom, business, Kidney disease, Glomerular Filtration Rate
Abstract

RATIONALE AND OBJECTIVE: The safety of intensive blood pressure (BP) targets is controversial for persons with chronic kidney disease (CKD). We studied the effects of hypertension treatment on cerebral perfusion and structure in those with and without CKD. STUDY DESIGN: Neuroimaging substudy of a randomized trial. SETTING & PARTICIPANTS: A subset of participants in the Systolic Blood Pressure Intervention Trial who underwent brain MRI studies. Presence of baseline CKD was assessed by estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (UACR). INTERVENTION: Participants were randomly assigned to intensive (systolic BP 30 mg/g (N=151), the effects of intensive versus standard BP treatment on change in global cerebral blood flow, WMLs and total brain volume were 1.91 ml/100g/min (95% CI −3.01, 6.82), 0.003 cm(3) (asinh transformed, 95% CI −0.13, 0.13), and −7.0 cm(3) (95% CI −13.3, −0.3), respectively. The overall treatment effects on cerebral blood flow and total brain volume were not modified by baseline eGFR or UACR; however the effect on WMLs was attenuated in participants with albuminuria (interaction p-value 0.04). LIMITATIONS: Measurement variability due to multi-site design. CONCLUSIONS: Among hypertensive adults with primarily early kidney disease, intensive versus standard blood pressure treatment did not appear to have a detrimental effect on brain perfusion or structure. The findings support the safety of intensive blood pressure treatment targets on brain health in persons with early kidney disease. FUNDING: The Systolic Blood Pressure Intervention Trial was funded by the National Institutes of Health (including the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Institute of Neurological Disorders and Stroke), and this substudy was funded by the National Institutes of Diabetes and Digestive and Kidney Diseases. TRIAL REGISTRATION: SPRINT was registered at ClinicalTrials.gov with the study number NCT01206062.

Published
2021

4. Chronic kidney disease, atherosclerotic plaque characteristics on carotid magnetic resonance imaging, and cardiovascular outcomes

Author

Niranjan Balu, Dominic S. Raj, Chun Yuan, Guo Wei, Raymond R. Townsend, Jing Chen, Jackson T. Wright, Jeffrey T. Bates, Srinivasan Beddhu, Glenn M. Chertow, Sankar D. Navaneethan, Michel Chonchol, Alan Wiggers, Reem Yunis, William E. Haley, Gador Canton, Tom Greene, Thomas George, Vasilios Papademetriou, Jie Sun, Alfred K. Cheung, Robert Boucher, Henry Punzi, Molly B. Conroy, and Dongxiang Xu

Subjects
Carotid Artery Diseases, Male, Nephrology, medicine.medical_specialty, Disease, lcsh:RC870-923, Chronic kidney disease, Internal medicine, medicine, Humans, Renal Insufficiency, Chronic, Aged, Aged, 80 and over, medicine.diagnostic_test, Proportional hazards model, business.industry, Magnetic resonance imaging, Atherosclerosis, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Magnetic Resonance Imaging, Carotid plaque, Plaque, Atherosclerotic, Blood pressure, Cardiovascular Diseases, Cardiology, Female, business, Cardiovascular outcomes, Research Article, Kidney disease, Calcification
Abstract

Background It is unclear whether faster progression of atherosclerosis explains the higher risk of cardiovascular events in CKD. The objectives of this study were to 1. Characterize the associations of CKD with presence and morphology of atherosclerotic plaques on carotid magnetic resonance imaging (MRI) and 2. Examine the associations of baseline CKD and carotid atherosclerotic plaques with subsequent cardiovascular events. Methods In a subgroup (N = 465) of Systolic Blood Pressure Intervention Trial. (SPRINT) participants, we measured carotid plaque presence and morphology at baseline and after 30-months with MRI. We examined the associations of CKD (baseline eGFR 2) with progression of carotid plaques and the SPRINT cardiovascular endpoint. Results One hundred and ninety six (42%) participants had CKD. Baseline eGFR in the non-CKD and CKD subgroups were 77 ± 14 and 49 ± 8 ml/min/1.73 m2, respectively. Lipid rich necrotic-core plaque was present in 137 (29.5%) participants. In 323 participants with both baseline and follow-up MRI measurements of maximum wall thickness, CKD was not associated with progression of maximum wall thickness (OR 0.62, 95% CI 0.36 to 1.07, p = 0.082). In 96 participants with necrotic core plaque at baseline and with a valid follow-up MRI, CKD was associated with lower odds of progression of necrotic core plaque (OR 0.41, 95% CI 0.17 to 0.95, p = 0.039). There were 28 cardiovascular events over 1764 person-years of follow-up. In separate Cox models, necrotic core plaque (HR 2.59, 95% CI 1.15 to 5.85) but not plaque defined by maximum wall thickness or presence of a plaque component (HR 1.79, 95% CI 0.73 to 4.43) was associated with cardiovascular events. Independent of necrotic core plaque, CKD (HR 3.35, 95% CI 1.40 to 7.99) was associated with cardiovascular events. Conclusions Presence of necrotic core in carotid plaque rather than the presence of plaque per se was associated with increased risk of cardiovascular events. We did not find CKD to be associated with faster progression of necrotic core plaques, although both were independently associated with cardiovascular events. Thus, CKD may contribute to cardiovascular disease principally via mechanisms other than atherosclerosis such as arterial media calcification or stiffening. Trial Registration NCT01475747, registered on November 21, 2011.

Published
2021
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5. Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT

Author

Gregory W. Evans, Jeff Whittle, Carolyn F. Pedley, Imran Moinuddin, Suzanne Oparil, Jackson T. Wright, Rose Anne Kenny, William E. Haley, William C. Cushman, Christianne L. Roumie, Alan Wiggers, Lawrence J. Appel, Addison A. Taylor, Tanya R. Gure, Timothy B Plante, John Nord, Edgar R. Miller, Ciaran Finucane, Raymond R. Townsend, and Stephen P. Juraschek

Subjects
Bradycardia, Adult, Male, Risk, medicine.medical_specialty, Opinion, Diastole, Blood Pressure, Comorbidity, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, Orthostatic vital signs, Hypotension, Orthostatic, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Renal Insufficiency, Chronic, Adverse effect, Antihypertensive Agents, Aged, Proportional Hazards Models, business.industry, Proportional hazards model, Hazard ratio, Racial Groups, Middle Aged, Blood pressure, Cardiovascular Diseases, Asymptomatic Diseases, Hypertension, Cardiology, Female, medicine.symptom, Hypotension, business, Goals, Follow-Up Studies
Abstract

Orthostatic hypotension (OH) is frequently observed with hypertension treatment, but its contribution to adverse outcomes is unknown. The SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized trial of adults, age ≥50 years at high risk for cardiovascular disease with a seated systolic blood pressure (BP) of 130 to 180 mm Hg and a standing systolic BP ≥110 mm Hg. Participants were randomized to a systolic BP treatment goal of either Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01206062.

Published
2020

6. Gender, blood pressure, and cardiovascular and renal outcomes in adults with hypertension from the Systolic Blood Pressure Intervention Trial

Author

Capri G. Foy, William C. Cushman, Ruth C. Campbell, Mark S. Segal, Kwame Osei, Suzanne Oparil, Roberto Pisoni, William J. Kostis, Joseph B. Muhlestein, Stephen P. Glasser, Marie Krousel-Wood, Avrum Gillespie, Karen C. Johnson, Mara Z. Vitolins, Laura C. Lovato, Alan Wiggers, and Jeffrey T. Bates

Subjects
Male, medicine.medical_specialty, Systole, Physiology, Myocardial Infarction, MEDLINE, Blood Pressure, 030204 cardiovascular system & hematology, Patient Care Planning, Article, law.invention, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Randomized controlled trial, law, Sex factors, Internal medicine, Internal Medicine, Humans, Medicine, 030212 general & internal medicine, Intervention trial, Acute Coronary Syndrome, Antihypertensive Agents, Aged, Proportional Hazards Models, Heart Failure, business.industry, Proportional hazards model, Incidence, Incidence (epidemiology), Middle Aged, United States, Stroke, Blood pressure, Cardiovascular Diseases, Hypertension, Cardiology, Female, Kidney Diseases, Cardiology and Cardiovascular Medicine, business
Abstract

To determine if the effects of intensive lowering of systolic blood pressure (goal of less than 120 mmHg) versus standard lowering (goal of less than 140 mmHg) upon cardiovascular, renal, and safety outcomes differed by gender.Nine thousand three hundred and sixty-one men and women aged 50 years or older with systolic blood pressure of 130 mmHg or greater, taking 0-4 antihypertensive medications, and with increased risk of cardiovascular disease, but free of diabetes, were randomly assigned to either a systolic blood pressure target of less than 120 mmHg (intensive treatment) or a target of less than 140 mmHg (standard treatment). The primary composite outcome encompassed incident myocardial infarction, heart failure, other acute coronary syndromes, stroke, or cardiovascular-related death. All-cause mortality, renal outcomes, and serious adverse events were also assessed.Compared with the standard treatment group, the primary composite outcome in the intensive treatment group was reduced by 16% [hazard ratio 0.84 (0.61-1.13)] in women, and by 27% in men [hazard ratio 0.73 (0.59-0.89), P value for interaction between treatment and gender is 0.45]. Similarly, the effect of the intensive treatment on individual components of the primary composite outcome, renal outcomes, and overall serious adverse events was not significantly different according to gender.In adults with hypertension but not with diabetes, treatment to a systolic blood pressure goal of less than 120 mmHg, compared with a goal of less than 140 mmHg, resulted in no heterogeneity of effect between men and women on cardiovascular or renal outcomes, or on rates of serious adverse events.ClinicalTrials.gov number, NCT01206062.

Published
2018
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7. Influence of metabolic syndrome and race on the relationship between intensive blood pressure control and cardiovascular outcomes in the SPRINT cohort

Author

Jan Basile, Kwame Osei, Leonardo Tamariz, Jeff Whittle, Timothy E. Craven, Kyaw Soe, William E. Haley, Nancy R. Kressin, Kathleen Dungan, Alan Wiggers, Jackson T. Wright, and Uzma Rani

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Endocrinology, Diabetes and Metabolism, Myocardial Infarction, Blood Pressure, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Stroke, Antihypertensive Agents, Aged, Heart Failure, Metabolic Syndrome, business.industry, Racial Groups, Hazard ratio, medicine.disease, United States, Race Factors, Blood pressure, Heart failure, Early Termination of Clinical Trials, Hypertension, Cohort, Physical therapy, Female, Metabolic syndrome, business
Abstract

Aims To determine whether baseline metabolic syndrome (MetS) modifies the effect of intensive blood pressure control on cardiovascular (CV) outcomes, and whether effects varied by race/ethnicity. Materials and Methods We performed post-hoc analyses among Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic participants with and without MetS in the Systolic Blood Pressure Intervention Trial (SPRINT) randomized to a systolic blood pressure (SBP) target of less than 120 mm Hg (intensive group, N = 4544) or one less than 140 mm Hg (standard group, N = 4553). Median follow-up was 3.26 years. The primary outcome was the composite of the first occurrence of myocardial infarction (MI), stroke, heart failure, non-MI acute coronary syndrome, or (CV) death. Results Overall, 3521/9097 (38.7%) of subjects met criteria for MetS at baseline. Baseline characteristics were similar between SBP groups within each MetS subgroup except BMI was slightly higher in the Standard arm of the MetS subgroup (33.3+/−5.6 vs. 33.0+/−5.3, p

Published
2017
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8. Effect of Intensive Versus Standard Blood Pressure Treatment According to Baseline Prediabetes Status: A Post Hoc Analysis of a Randomized Trial

Author

Adam P. Bress, Christianne L. Roumie, Addison A. Taylor, Vasilios Papademetriou, Mark N. Feinglos, Michael Doumas, Anjay Rastogi, John Nord, Srinivasan Beddhu, Alfred K. Cheung, Jonathan S. Williams, William C. Cushman, Greg Evans, Charles A. Herring, Athena Zias, Alan Wiggers, James R. Powell, Michael V. Rocco, Mary Ellen Sweeney, David M. Reboussin, Jordan B. King, William J. Kostis, Yingying Zhang, Debra L. Simmons, Reem Yunis, Tom Greene, and Kathryn Evans Kreider

Subjects
Advanced and Specialized Nursing, medicine.medical_specialty, Cardiovascular and Metabolic Risk, business.industry, Endocrinology, Diabetes and Metabolism, Hazard ratio, 030204 cardiovascular system & hematology, medicine.disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Blood pressure, Endocrinology, Randomized controlled trial, Sprint, law, Diabetes mellitus, Internal medicine, Post-hoc analysis, Internal Medicine, medicine, 030212 general & internal medicine, Prediabetes, Adverse effect, business
Abstract

OBJECTIVE To determine whether the effects of intensive ( RESEARCH DESIGN AND METHODS This was a post hoc analysis of SPRINT. SPRINT participants were categorized by prediabetes status, defined as baseline fasting serum glucose ≥100 mg/dL versus those with normoglycemia (fasting serum glucose RESULTS Among 9,361 participants randomized (age 67.9 ± 9.4 years; 35.5% female), 3,898 and 5,425 had baseline prediabetes and normoglycemia, respectively. After a median follow-up of 3.26 years, the hazard ratio for the primary outcome was 0.69 (95% CI 0.53, 0.89) and 0.83 (95% CI 0.66, 1.03) among those with prediabetes and normoglycemia, respectively (P value for interaction 0.30). For all-cause mortality, the hazard ratio with intensive SBP treatment was 0.77 (95% CI 0.55, 1.06) for prediabetes and 0.71 (95% CI 0.54, 0.94) for normoglycemia (P value for interaction 0.74). Effects of intensive versus standard SBP treatment on prespecified renal outcomes and serious adverse events were similar for prediabetes and normoglycemia (all interaction P > 0.05). CONCLUSIONS In SPRINT, the beneficial effects of intensive SBP treatment were similar among those with prediabetes and fasting normoglycemia.

Published
2017

9. Syncope, Hypotension, and Falls in the Treatment of Hypertension: Results from the SPRINT Randomized Clinical Trial

Author

Kaycee M, Sink, Gregory W, Evans, Ronald I, Shorr, Jeffrey T, Bates, Dan, Berlowitz, Molly B, Conroy, Deborah M, Felton, Tanya, Gure, Karen C, Johnson, Dalane, Kitzman, Mary F, Lyles, Karen, Servilla, Mark A, Supiano, Jeff, Whittle, Alan, Wiggers, and Lawrence J, Fine

Subjects
Adult, Aged, 80 and over, Male, Time Factors, Blood Pressure, Comorbidity, Middle Aged, Syncope, Article, Cardiovascular Diseases, Risk Factors, Hypertension, Humans, Accidental Falls, Female, Hypotension, Antihypertensive Agents, Aged
Abstract

BACKGROUND: SPRINT found that treatment of systolic hypertension to a goal of

Published
2018

10. Effect of Intensive Blood Pressure Treatment on Heart Failure Events in the Systolic Blood Pressure Reduction Intervention Trial

Author

Lawrence J. Fine, Jeffrey T. Bates, Karen C. Johnson, Bharathi Upadhya, Gerard P. Aurigemma, Michael V. Rocco, Laura C. Lovato, Suzanne Oparil, Dalane W. Kitzman, Dominic S. Raj, Anjay Rastogi, Natalie A. Bello, Cora E. Lewis, William C. Cushman, Alan Wiggers, Leonardo Tamariz, and Carlos J. Rodriguez

Subjects
Male, medicine.medical_specialty, Time Factors, Blood Pressure, Comorbidity, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Humans, 030212 general & internal medicine, Intervention trial, Antihypertensive Agents, Aged, Proportional Hazards Models, Aged, 80 and over, Heart Failure, Chi-Square Distribution, business.industry, Middle Aged, medicine.disease, Surgery, Clinical trial, Hospitalization, Blood pressure, Treatment Outcome, Sprint, Heart failure, Hypertension, Multivariate Analysis, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background— Acute decompensated heart failure (ADHF) was a frequent common outcome in SPRINT (Systolic Blood Pressure Intervention Trial). We examined whether there was differential reduction in ADHF events from intensive blood pressure [BP] treatment among the 6 key, prespecified subgroups in SPRINT: age ≥75 years, prior cardiovascular disease, chronic kidney disease, women, black race, and 3 levels of baseline systolic BP (≤132 versus >132 to Methods and Results— ADHF was defined as hospitalization for ADHF, confirmed and formally adjudicated by a blinded events committee using standardized protocols. At 3.29 years follow-up, there were 103 ADHF events (2.2%) among 4683 standard arm participants and 65 ADHF events (1.4%) among 4678 intensive arm participants (Cox proportional hazards ratio, 0.63; 95% confidence interval, 0.46–0.85; P value =0.003). In multivariable analyses, including treatment arm, baseline covariates that were significant predictors for ADHF included chronic kidney disease, cardiovascular disease, age≥75 years, body mass index, and higher systolic BP. The beneficial effect of the intervention on incident ADHF was consistent across all prespecified subgroups. Participants who had incident ADHF had markedly increased risk of subsequent cardiovascular events, including a 27-fold increase ( P Conclusions— Targeting a systolic BP Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01206062

Published
2017

11. The association between Self-Reported Medication Adherence scores and systolic blood pressure control: a SPRINT baseline data study

Author

Donald E. Morisky, Christianne L. Roumie, Molly B. Conroy, Ian M. Kronish, Leonardo Tamariz, David C. Goff, Alan Wiggers, Nancy R. Kressin, Paul Muntner, William E. Haley, Jeff Whittle, Jill C. Newman, Olivia N. Gilbert, Robert F. Riley, and Eugene C. Kovalik

Subjects
Male, medicine.medical_specialty, Systole, Cross-sectional study, Medication adherence, Blood Pressure, 030204 cardiovascular system & hematology, Article, Medication Adherence, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Internal Medicine, Humans, Medicine, 030212 general & internal medicine, Antihypertensive Agents, Aged, business.industry, Age Factors, Odds ratio, Confidence interval, Clinical trial, Cross-Sectional Studies, Blood pressure, Sprint, Hypertension, Physical therapy, Female, Self Report, Cardiology and Cardiovascular Medicine, business
Abstract

We examined baseline data from the Systolic Blood Pressure Intervention Trial (SPRINT) to investigate whether medication adherence, measured by the 8-item Morisky Medication Adherence Scale (MMAS-8), was associated with systolic blood pressure (SBP) and whether MMAS-8 score and number of antihypertensive medications interacted in influencing SBP. A total of 8435 SPRINT participants were included: 21.2% had low adherence (MMAS-8:6); 40.0% had medium adherence (6 to8); and 38.8% had high adherence (8). SBP was140 mm Hg in 54.6%; 140-160 mm Hg in 36.6%; and160 mm Hg in 8.8%. In multivariable regression, medium vs. low adherence weakly associated with lower SBP (odds ratio: 1.17; confidence interval: 1.04, 1.31). SPRINT eligibility criteria should be considered when interpreting results. Efforts to understand and enhance adherence are crucial to improve population health, and using self-report instruments might be considered for predicting treatment adherence and response in future efficacy trials and for identifying patients for adherence support in clinical practice.

Published
2016
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