1. Relevance of age and hypertension for blood pressure targets in comatose survivors of cardiac arrest: a BOX-trial sub-study.
- Author
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Byrne C, Kjærgaard J, Møller JE, Biering-Sørensen T, Borregaard B, Schmidt H, and Hassager C
- Subjects
- Humans, Male, Female, Middle Aged, Age Factors, Aged, Blood Pressure physiology, Cardiopulmonary Resuscitation methods, Survival Rate trends, Hypertension physiopathology, Hypertension complications, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest mortality, Out-of-Hospital Cardiac Arrest complications, Coma therapy, Coma etiology, Coma physiopathology
- Abstract
Aims: To assess whether the optimal mean arterial blood pressure (MAP) target after out-of-hospital cardiac arrest (OHCA) is influenced by age and a history of arterial hypertension., Methods and Results: A post hoc analysis of data from the Blood Pressure and Oxygenation Targets in Post Resuscitation Care trial. The trial included 789 comatose patients randomized to a MAP target of 63 or 77 mmHg. The primary outcome of this sub-study was 1-year all-cause mortality. Cox proportional hazards regression and restricted cubic splines were used to examine whether prevalent hypertension and age modified the effect of low vs. high MAP target on all-cause mortality. Of the 789 patients randomized, 393 were assigned to a high MAP target, and 396 to a low MAP target. Groups were well-balanced for mean age (high MAP target 63 ± 13 years vs. low 62 ± 14 years) and hypertension (45 vs. 47%, respectively). At 1 year, the primary outcome occurred in 143 patients (36%) with a high MAP target and 138 (35%) with a low MAP target. The risk of the primary outcome increased linearly with increasing age (P < 0.001). The effect of a high vs. low MAP target on the primary outcome was modified by age when tested continuously, potentially favouring a low MAP target in younger patients (P for interaction = 0.03). Prevalent hypertension did not modify the effect of a high vs. low MAP target on the primary outcome (P for interaction = 0.67)., Conclusion: Among patients resuscitated after OHCA, older patients and those with a history of hypertension did not benefit from a high MAP target., Competing Interests: Conflict of interest: C.B.: speaker’s fee: Bayer. J.K.: received funding for the BOX trial (NNF17OC0028706) and DANOHCA trial (NNF22OC0079649) from the Novo Nordisk Foundation. J.E.M.: institutional research grant outside submitted work: Abiomed and the Novo Nordic Foundation; lecture fee: Abbott, Boehringer Ingelheim, and Orion. T.B.-S.: steering committee member of the Amgen-financed GALACTIC-HF trial, Boehringer Ingelheim–financed EASi-KIDNEY trial, LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System trial; chief investigator of the Sanofi Pasteur–financed NUDGE-FLU, DANFLU-1, and DANFLU-2 trials; advisory board: Sanofi Pasteur, Amgen, CSL Seqirus, and GSK; speaker honorarium: Bayer, Novartis, Sanofi Pasteur, GE Healthcare, and GSK; research grants: GE Healthcare, AstraZeneca, Novo Nordisk, and Sanofi Pasteur; consultant appointments: Novo Nordisk, IQVIA, and Parexel. B.B. and H.S.: nothing to declare. C.H.: research grant from the Novo Nordisk Foundation, the Lundbeck Foundation, and The Danish Heart Foundation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
- Published
- 2024
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