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8. The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association.

Author

Bress, Adam P., Anderson, Timothy S., Flack, John M., Ghazi, Lama, Hall, Michael E., Laffer, Cheryl L., Still, Carolyn H., Taler, Sandra J., Zachrison, Kori S., and Chang, Tara I.

Abstract

Over the past 3 decades, a substantial body of high-quality evidence has guided the diagnosis and management of elevated blood pressure (BP) in the outpatient setting. In contrast, there is a lack of comparable evidence for guiding the management of elevated BP in the acute care setting, resulting in significant practice variation. Throughout this scientific statement, we use the terms acute care and inpatient to refer to care received in the emergency department and after admission to the hospital. Elevated inpatient BP is common and can manifest either as asymptomatic or with signs of new or worsening target-organ damage, a condition referred to as hypertensive emergency. Hypertensive emergency involves acute target-organ damage and should be treated swiftly, usually with intravenous antihypertensive medications, in a closely monitored setting. However, the risk-benefit ratio of initiating or intensifying antihypertensive medications for asymptomatic elevated inpatient BP is less clear. Despite this ambiguity, clinicians prescribe oral or intravenous antihypertensive medications in approximately one-third of cases of asymptomatic elevated inpatient BP. Recent observational studies have suggested potential harms associated with treating asymptomatic elevated inpatient BP, which brings current practice into question. Despite the ubiquity of elevated inpatient BPs, few position papers, guidelines, or consensus statements have focused on improving BP management in the acute care setting. Therefore, this scientific statement aims to synthesize the available evidence, provide suggestions for best practice based on the available evidence, identify evidence-based gaps in managing elevated inpatient BP (asymptomatic and hypertensive emergency), and highlight areas requiring further research. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Design and Implementation of an Electronic Health Record‐Integrated Hypertension Management Application

Author

Funes Hernandez, Mario, primary, Babakhanian, Meghedi, additional, Chen, Tania P., additional, Sarraju, Ashish, additional, Seninger, Clark, additional, Ravi, Vishnu, additional, Azizi, Zahra, additional, Tooley, James, additional, Chang, Tara I., additional, Lu, Ying, additional, Downing, N. Lance, additional, Rodriguez, Fatima, additional, Li, Ron C., additional, Sandhu, Alexander T., additional, Turakhia, Mintu, additional, Bhalla, Vivek, additional, and Wang, Paul J., additional

Published
2024
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11. Central and peripheral arterial diseases in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Ademi, Zanfina, Chang, Tara I., Clark, Tim, Cooper, Chris, Criqui, Michael, de Bhailis, Áine, De Carlo, Marco, Döhner, Wolfram, Engelman, Daniel T., Fowkes, Gerry, Green, Darren, Hamdan, Allen, Heiss, Christian, Huppert, Peter, Kadian-Dodov, Daniella, Lip, Gregory Y.H., Małyszko, Jolanta, Mark, Patrick B., Miglinas, Marius, Murray, Patrick, Reid, Chris, Rochon, Paul, Ruturi, Josiah, Saratzis, Athanasios, Sarnak, Mark J., Shanahan, Cathy M., Solá, Laura, Teichgräber, Ulf, Textor, Stephen C., Toyoda, Kazunori, Yee-Moon Wang, Angela, Wong, Chris X., Johansen, Kirsten L., Garimella, Pranav S., Hicks, Caitlin W., Kalra, Philip A., Kelly, Dearbhla M., Martens, Sven, Matsushita, Kunihiro, Sarafidis, Pantelis, Sood, Manish M., Herzog, Charles A., Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C., and Reinecke, Holger

Published
2021
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12. Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial

Author

Cohen, Jordana B, Hanff, Thomas C, William, Preethi, Sweitzer, Nancy, Rosado-Santander, Nelson R, Medina, Carola, Rodriguez-Mori, Juan E, Renna, Nicolás, Chang, Tara I, Corrales-Medina, Vicente, Andrade-Villanueva, Jaime F, Barbagelata, Alejandro, Cristodulo-Cortez, Roberto, Díaz-Cucho, Omar A, Spaak, Jonas, Alfonso, Carlos E, Valdivia-Vega, Renzo, Villavicencio-Carranza, Mirko, Ayala-García, Ricardo J, Castro-Callirgos, Carlos A, González-Hernández, Luz A, Bernales-Salas, Eduardo F, Coacalla-Guerra, Johanna C, Salinas-Herrera, Cynthia D, Nicolosi, Liliana, Basconcel, Mauro, Byrd, James B, Sharkoski, Tiffany, Bendezú-Huasasquiche, Luis E, Chittams, Jesse, Edmonston, Daniel L, Vasquez, Charles R, and Chirinos, Julio A

Published
2021
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15. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease

Author

Cheung, Alfred K., Chang, Tara I., Cushman, William C., Furth, Susan L., Hou, Fan Fan, Ix, Joachim H., Knoll, Gregory A., Muntner, Paul, Pecoits-Filho, Roberto, Sarnak, Mark J., Tobe, Sheldon W., Tomson, Charles R.V., Lytvyn, Lyubov, Craig, Jonathan C., Tunnicliffe, David J., Howell, Martin, Tonelli, Marcello, Cheung, Michael, Earley, Amy, and Mann, Johannes F.E.

Published
2021
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16. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use and cardiovascular outcomes in patients initiating peritoneal dialysis

Author

Shen, Jenny I, Saxena, Anjali B, Montez-Rath, Maria E, Chang, Tara I, and Winkelmayer, Wolfgang C

Subjects
Kidney Disease, Aging, Cardiovascular, Prevention, Clinical Research, Good Health and Well Being, Adolescent, Adult, Aged, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular Diseases, Cohort Studies, Female, Humans, Kidney Failure, Chronic, Male, Middle Aged, Peritoneal Dialysis, Risk Factors, Treatment Outcome, Young Adult, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, cardiovascular, peritoneal dialysis, renin angiotensin system blockers, Clinical Sciences, Urology & Nephrology
Abstract

BackgroundData on the effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in reducing cardiovascular (CV) risk in patients undergoing peritoneal dialysis (PD) are limited. We investigated the association between ACEI/ARB use and CV outcomes in patients initiating PD.MethodsIn this observational cohort study, we identified from the United States Renal Data System all adult patients who initiated PD from 2007 to 2011 and participated in Medicare Part D, a federal prescription drug benefits program, for the first 90 days of dialysis. Patients who filled a prescription for an ACEI or ARB in those 90 days were considered users. We applied Cox regression to an inverse probability of treatment weighted cohort to estimate the hazard ratios (HRs) for the combined outcome of death, ischemic stroke or myocardial infarction (MI) and each outcome individually.ResultsAmong 4879 patients, 2063 (42%) used an ACEI/ARB. Patients were followed up for a median of 1.2 years. We recorded 1771 events, for a composite rate of 25 events per 100 person-years. ACEI/ARB use (versus nonuse) was associated with a reduced risk of the composite outcome {HR 0.84 [95% confidence interval (CI) 0.76-0.93]}, all-cause mortality [HR 0.83 (95% CI 0.75-0.92)] and CV death [HR 0.74 (95% CI 0.63-0.87)], but not MI [HR 0.88 (95% CI 0.69-1.12)] or ischemic stroke [HR 1.06 (95% CI 0.79-1.43)]. Results were similar in as-treated analyses. In a subgroup analysis, we did not find any effect modification by residual renal function.ConclusionsACEI/ARB use is common in patients initiating PD and is associated with a lower risk of fatal CV outcomes.

Published
2017

17. Comparative effectiveness of angiotensin receptor blockers vs. angiotensin-converting enzyme inhibitors on cardiovascular outcomes in patients initiating peritoneal dialysis

Author

Shen, Jenny I, Saxena, Anjali B, Montez-Rath, Maria E, Leng, Lynn, Chang, Tara I, and Winkelmayer, Wolfgang C

Subjects
Epidemiology, Biomedical and Clinical Sciences, Health Sciences, Clinical Research, Aging, Comparative Effectiveness Research, Kidney Disease, Cardiovascular, Clinical Trials and Supportive Activities, Good Health and Well Being, Aged, Aged, 80 and over, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular Diseases, Databases, Factual, Female, Humans, Kidney Failure, Chronic, Male, Medicare Part D, Peritoneal Dialysis, Proportional Hazards Models, Renin-Angiotensin System, Risk Factors, Time Factors, Treatment Outcome, United States, Peritoneal dialysis, Renin angiotensin system blockers, Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers, Clinical Sciences, Urology & Nephrology, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundThere is evidence that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) may reduce cardiovascular (CV) risk in patients undergoing peritoneal dialysis (PD), but no studies have compared the effectiveness between these drug classes. In this observational cohort study, we compared the association of ARB vs. ACEI use on CV outcomes in patients initiating PD.MethodsWe identified from the US Renal Data System all adult patients who initiated PD from 2007 to 2011 and participated in Medicare Part D, a federal prescription drug benefits program, for the first 90 days of dialysis. Patients who filled a prescription for an ACEI or ARB in those 90 days were considered users. We excluded patients who used both ACEI and ARB. We applied Cox proportional hazards regression to an inverse probability of treatment-weighted cohort to estimate the hazard ratios (HR) for the combined outcome of all-cause death, ischemic stroke, or myocardial infarction; all-cause mortality; and CV death.ResultsAmong 1892 patients using either drug class, 39 % were ARB users. We observed 624 events over 2,898 person-years of follow-up, for a composite event rate of 22 events per 100 person-years. We observed no differences between ARB vs. ACEI users: composite outcome HR 0.94, 95 % confidence interval (CI) 0.79-1.11; all-cause mortality HR 0.92, 95 % CI 0.76-1.10; CV death HR: 1.06, 95 % CI 0.80-1.41.ConclusionWe identified no significant difference in the risks of CV events or death between users of ARBs vs. ACEIs in patients initiating PD, thus supporting their mostly interchangeable use in this population.

Published
2017

18. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Adragão, Teresa, Anumudu, Samaya J., Chan, Christopher T., Cheung, Alfred K., Costanzo, Maria Rosa, Dasgupta, Indranil, Davenport, Andrew, Davies, Simon J., Dekker, Marijke J.E., Dember, Laura M., Gallego, Daniel, Gómez, Rafael, Hawley, Carmel M., Hecking, Manfred, Iseki, Kunitoshi, Jha, Vivekanand, Kooman, Jeroen P., Kovesdy, Csaba P., Lacson, Eduardo, Jr., Liew, Adrian, Lok, Charmaine E., McIntyre, Christopher W., Mehrotra, Rajnish, Miskulin, Dana C., Movilli, Ezio, Paglialonga, Fabio, Pecoits-Filho, Roberto, Perl, Jeff, Pollock, Carol A., Riella, Miguel C., Rossignol, Patrick, Shroff, Rukshana, Solá, Laura, Søndergaard, Henning, Tang, Sydney C.W., Tong, Allison, Tsukamoto, Yusuke, Watnick, Suzanne, Weir, Matthew R., Wetmore, James B., Wilkie, Caroline, Wilkie, Martin, Flythe, Jennifer E., Chang, Tara I., Gallagher, Martin P., Lindley, Elizabeth, Madero, Magdalena, Sarafidis, Pantelis A., Unruh, Mark L., Wang, Angela Yee-Moon, Weiner, Daniel E., Cheung, Michael, Jadoul, Michel, Winkelmayer, Wolfgang C., and Polkinghorne, Kevan R.

Published
2020
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20. Balancing the Evidence: How to Reconcile the Results of Observational Studies vs. Randomized Clinical Trials in Dialysis.

Author

Shen, Jenny I, Lum, Erik L, and Chang, Tara I

Subjects
Humans, Renal Dialysis, Evidence-Based Medicine, Research Design, Randomized Controlled Trials as Topic, Observational Studies as Topic, Comparative Effectiveness Research, Clinical Trials and Supportive Activities, Clinical Research, Health and social care services research, 8.4 Research design and methodologies (health services), Clinical Sciences, Urology & Nephrology
Abstract

Because large randomized clinical trials (RCTs) in dialysis have been relatively scarce, evidence-based dialysis care has depended heavily on the results of observational studies. However, when results from RCTs appear to contradict the findings of observational studies, nephrologists are left to wonder which type of study they should believe. In this editorial, we explore the key differences between observational studies and RCTs in the context of such seemingly conflicting studies in dialysis. Confounding is the major limitation of observational studies, whereas low statistical power and problems with external validity are more likely to limit the findings of RCTs. Differences in the specification of the population, exposure, and outcomes can also contribute to different results among RCTs and observational studies. Rigorous methods are required regardless of what type of study is conducted, and readers should not automatically assume that one type of study design is superior to the other. Ultimately, dialysis care requires both well-designed, well-conducted observational studies and RCTs to move the field forward.

Published
2016

24. Chronic Kidney Disease and Coronary Artery Disease: JACC State-of-the-Art Review

Author

Banerjee, Debasish, Briguori, Carlo, Chang, Tara I., Chen, Chien-Liang, deFilippi, Christopher R., Ding, Xiaoqiang, Ferro, Charles J., Gill, Jagbir, Gössl, Mario, Isbel, Nicole M., Ishii, Hideki, Jardine, Meg J., Kalra, Philip A., Laufer, Günther, Lentine, Krista L., Lobdell, Kevin, Lok, Charmaine E., London, Gérard M., Małyszko, Jolanta, Mark, Patrick B., Marwan, Mohamed, Nie, Yuxin, Parfrey, Patrick S., Pecoits-Filho, Roberto, Pilmore, Helen, Qunibi, Wajeh Y., Raggi, Paolo, Rattazzi, Marcello, Rossignol, Patrick, Ruturi, Josiah, Sabanayagam, Charumathi, Shanahan, Catherine M., Shroff, Gautam R., Shroff, Rukshana, Webster, Angela C., Weiner, Daniel E., Winther, Simon, Wiseman, Alexander C., Yip, Anthony, Zarbock, Alexander, Sarnak, Mark J., Amann, Kerstin, Bangalore, Sripal, Cavalcante, João L., Charytan, David M., Craig, Jonathan C., Gill, John S., Hlatky, Mark A., Jardine, Alan G., Landmesser, Ulf, Newby, L. Kristin, Herzog, Charles A., Cheung, Michael, Wheeler, David C., Winkelmayer, Wolfgang C., and Marwick, Thomas H.

Published
2019
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29. Canagliflozin, Blood Pressure Variability, and Risk of Cardiovascular, Kidney, and Mortality Outcomes: Pooled Individual Participant Data From the CANVAS and CREDENCE Trials

Author

Fletcher, Robert A., primary, Arnott, Clare, additional, Rockenschaub, Patrick, additional, Schutte, Aletta E., additional, Carpenter, Lewis, additional, Vaduganathan, Muthiah, additional, Agarwal, Rajiv, additional, Bakris, George, additional, Chang, Tara I., additional, Heerspink, Hiddo J. L., additional, Jardine, Meg J., additional, Mahaffey, Kenneth W., additional, Neal, Bruce, additional, Pollock, Carol, additional, Jun, Min, additional, Rodgers, Anthony, additional, Perkovic, Vlado, additional, and Neuen, Brendon L., additional

Published
2023
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32. Risk factors for ESRD in individuals with preserved estimated GFR with and without albuminuria: results from the Kidney Early Evaluation Program (KEEP).

Author

Chang, Tara I, Li, Suying, Chen, Shu-Cheng, Peralta, Carmen A, Shlipak, Michael G, Fried, Linda F, Whaley-Connell, Adam T, McCullough, Peter A, Kurella Tamura, Manjula, and KEEP Investigators

Subjects
KEEP Investigators, Humans, Kidney Failure, Chronic, Albuminuria, Hypertension, Diabetes Mellitus, Type 2, Disease Progression, Glomerular Filtration Rate, Mass Screening, Renal Dialysis, Kidney Transplantation, Proportional Hazards Models, Risk Assessment, Risk Factors, Cohort Studies, Age Factors, Comorbidity, Sex Factors, Adult, Aged, Middle Aged, Program Development, Female, Male, Ethnicity, Clinical Research, Kidney Disease, Prevention, Renal and urogenital, blood pressure, chronic kidney disease, diabetes, dialysis risk factors, end-stage renal disease, public health., Clinical Sciences, Public Health and Health Services, Urology & Nephrology
Abstract

BackgroundGiven the increasing costs and poor outcomes of end-stage renal disease (ESRD), we sought to identify risk factors for ESRD in people with preserved estimated glomerular filtration rate (eGFR), with or without albuminuria, who were at high risk of ESRD.MethodsThis cohort study included participants in the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) with eGFR ≥ 60 mL/min/1.73 m(2) at baseline stratified by the presence or absence of albuminuria. The Chronic Kidney Disease Epidemiology Collaboration equation was used to calculate eGFR. Urine was tested for albuminuria by semiquantitative dipstick. The outcome was the development of treated chronic kidney failure, defined as initiation of maintenance dialysis therapy or kidney transplantation, determined by linkage to the US Renal Data System. We used a Cox model with the Fine-Gray method to assess risk factors for treated chronic kidney failure while accounting for the competing risk of death.ResultsDuring a median follow-up of 4.8 years, 126 of 13,923 participants with albuminuria (16/10,000 patient-years) and 56 of 109,135 participants without albuminuria (1.1/10,000 patient-years) developed treated chronic kidney failure. Diabetes was a strong risk factor for developing treated chronic kidney failure in participants with and without albuminuria (adjusted HRs of 9.3 [95% CI, 5.7-15.3] and 7.8 [95% CI, 4.1-14.8], respectively). Black race, lower eGFR, and higher systolic blood pressure also were associated with higher adjusted risks of developing treated chronic kidney failure.ConclusionsIn a diverse high-risk cohort of KEEP participants with preserved eGFR, we showed that diabetes, higher systolic blood pressure, lower eGFR, and black race were risk factors for developing treated chronic kidney failure irrespective of albuminuria status, although the absolute risk of kidney failure in participants without albuminuria was very low. Our findings support testing for kidney disease in high-risk populations, which often have otherwise unrecognized kidney disease.

Published
2013

33. International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action

Author

Cheung, Alfred K., primary, Whelton, Paul K., additional, Muntner, Paul, additional, Schutte, Aletta E., additional, Moran, Andrew E., additional, Williams, Bryan, additional, Sarafidis, Pantelis, additional, Chang, Tara I., additional, Daskalopoulou, Stella S., additional, Flack, John M., additional, Jennings, Garry, additional, Juraschek, Stephen P., additional, Kreutz, Reinhold, additional, Mancia, Giuseppe, additional, Nesbitt, Shawna, additional, Ordunez, Pedro, additional, Padwal, Raj, additional, Persu, Alexandre, additional, Rabi, Doreen, additional, Schlaich, Markus P., additional, Stergiou, George S., additional, Tobe, Sheldon W., additional, Tomaszewski, Maciej, additional, Williams, Kim A., additional, and Mann, Johannes F.E., additional

Published
2023
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36. Antihypertensive Medication Regimens Used in the Systolic Blood Pressure Intervention Trial

Author

Derington, Catherine G., primary, Bress, Adam P., additional, Moran, Andrew E., additional, Weintraub, William S., additional, Herrick, Jennifer S., additional, Cushman, William C., additional, Kronish, Ian M., additional, Stults, Barry, additional, Shimbo, Daichi, additional, Muntner, Paul, additional, Greene, Tom, additional, Bates, Jeffrey T., additional, Chang, Tara I., additional, Katz, Lois Anne, additional, Rehman, Shakaib U., additional, Roumie, Christianne L., additional, Tamariz, Leonardo, additional, and King, Jordan B., additional

Published
2023
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42. Association of Total Medication Burden With Intensive and Standard Blood Pressure Control and Clinical Outcomes: A Secondary Analysis of SPRINT

Author

Derington, Catherine G., Gums, Tyler H., Bress, Adam P., Herrick, Jennifer S., Greene, Tom H., Moran, Andrew E., Weintraub, William S., Kronish, Ian M., Morisky, Donald E., Trinkley, Katy E., Saseen, Joseph J., Reynolds, Kristi, Bates, Jeffrey T., Berlowitz, Dan R., Chang, Tara I., Chonchol, Michel, Cushman, William C., Foy, Capri G., Herring, Charles T., Katz, Lois Anne, Krousel-Wood, Marie, Pajewski, Nicholas M., Tamariz, Leonardo, and King, Jordan B.

Published
2019
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48. Effects of Intensive BP Control in CKD

Author

Cheung, Alfred K., Rahman, Mahboob, Reboussin, David M., Craven, Timothy E., Greene, Tom, Kimmel, Paul L., Cushman, William C., Hawfield, Amret T., Johnson, Karen C., Lewis, Cora E., Oparil, Suzanne, Rocco, Michael V., Sink, Kaycee M., Whelton, Paul K., Wright, Jackson T., Jr., Basile, Jan, Beddhu, Srinivasan, Bhatt, Udayan, Chang, Tara I., Chertow, Glenn M., Chonchol, Michel, Freedman, Barry I., Haley, William, Ix, Joachim H., Katz, Lois A., Killeen, Anthony A., Papademetriou, Vasilios, Ricardo, Ana C., Servilla, Karen, Wall, Barry, Wolfgram, Dawn, Yee, Jerry, Cheung, Alfred K., Rahman, Mahboob, Reboussin, David M., Craven, Timothy E., Greene, Tom, Kimmel, Paul L., Cushman, William C., Hawfield, Amret T., Johnson, Karen C., Lewis, Cora E., Oparil, Suzanne, Rocco, Michael V., Sink, Kaycee M., Whelton, Paul K., Wright, Jackson T., Jr., Basile, Jan, Beddhu, Srinivasan, Bhatt, Udayan, Chang, Tara I., Chertow, Glenn M., Chonchol, Michel, Freedman, Barry I., Haley, William, Ix, Joachim H., Katz, Lois A., Killeen, Anthony A., Papademetriou, Vasilios, Ricardo, Ana C., Servilla, Karen, Wall, Barry, Wolfgram, Dawn, and Yee, Jerry

Published
2017
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