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1. Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis

Author

Agodoa, L, Algra, A, Asselbergs, F W, Beckett, N, Berge, E, Black, H, Brouwers, F P J, Brown, M, Bulpitt, C J, Byington, B, Cutler, J, Devereaux, R B, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S E, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L H, Lueders, S, MacMahon, S, Mancia, G, Matsuzaki, M, Mehlum, M H, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pfeffer, M, Poulter, N R, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J A, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W H, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z Y, Anderson, C, Baigent, C, Brenner, BM, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Pitt, B, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundström, J, Turnbull, F, Viberti, G, Wang, J, Nazarzadeh, Milad, Bidel, Zeinab, Canoy, Dexter, Copland, Emma, Bennett, Derrick A, Dehghan, Abbas, Davey Smith, George, Holman, Rury R, Woodward, Mark, Gupta, Ajay, Adler, Amanda I, Wamil, Malgorzata, Sattar, Naveed, Cushman, William C, McManus, Richard J, Teo, Koon, Davis, Barry R, Chalmers, John, Pepine, Carl J, and Rahimi, Kazem

Published
2022
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2. Antihypertensive treatment and risk of cancer: an individual participant data meta-analysis

Author

Adler, A, Agodoa, L, Algra, A, Asselbergs, F W, Beckett, N, Berge, E, Black, H, Brouwers, F P J, Brown, M, Bulpitt, C J, Byington, B, Chalmers, J, Cushman, W C, Cutler, J, Davis, B R, Devereaux, R B, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A K, Holman, R R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S E, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L H, Lueders, S, MacMahon, S, Mancia, G, Matsuzaki, M, Mehlum, M H, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pepine, C J, Pfeffer, M, Poulter, N R, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J A, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W H, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z Y, Anderson, C, Baigent, C, Brenner, BM, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Pitt, B, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundström, J, Turnbull, F, Viberti, G, Wang, J, Copland, Emma, Canoy, Dexter, Nazarzadeh, Milad, Bidel, Zeinab, Ramakrishnan, Rema, Woodward, Mark, Chalmers, John, Teo, Koon K, Pepine, Carl J, Davis, Barry R, Kjeldsen, Sverre, Sundström, Johan, and Rahimi, Kazem

Published
2021
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3. Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis

Author

Nazarzadeh, Milad, primary, Bidel, Zeinab, additional, Canoy, Dexter, additional, Copland, Emma, additional, Bennett, Derrick A, additional, Dehghan, Abbas, additional, Davey Smith, George, additional, Holman, Rury R, additional, Woodward, Mark, additional, Gupta, Ajay, additional, Adler, Amanda I, additional, Wamil, Malgorzata, additional, Sattar, Naveed, additional, Cushman, William C, additional, McManus, Richard J, additional, Teo, Koon, additional, Davis, Barry R, additional, Chalmers, John, additional, Pepine, Carl J, additional, Rahimi, Kazem, additional, Agodoa, L, additional, Algra, A, additional, Asselbergs, F W, additional, Beckett, N, additional, Berge, E, additional, Black, H, additional, Brouwers, F P J, additional, Brown, M, additional, Bulpitt, C J, additional, Byington, B, additional, Cutler, J, additional, Devereaux, R B, additional, Dwyer, J, additional, Estacio, R, additional, Fagard, R, additional, Fox, K, additional, Fukui, T, additional, Imai, Y, additional, Ishii, M, additional, Julius, S, additional, Kanno, Y, additional, Kjeldsen, S E, additional, Kostis, J, additional, Kuramoto, K, additional, Lanke, J, additional, Lewis, E, additional, Lewis, J, additional, Lievre, M, additional, Lindholm, L H, additional, Lueders, S, additional, MacMahon, S, additional, Mancia, G, additional, Matsuzaki, M, additional, Mehlum, M H, additional, Nissen, S, additional, Ogawa, H, additional, Ogihara, T, additional, Ohkubo, T, additional, Palmer, C, additional, Patel, A, additional, Pfeffer, M, additional, Poulter, N R, additional, Rakugi, H, additional, Reboldi, G, additional, Reid, C, additional, Remuzzi, G, additional, Ruggenenti, P, additional, Saruta, T, additional, Schrader, J, additional, Schrier, R, additional, Sever, P, additional, Sleight, P, additional, Staessen, J A, additional, Suzuki, H, additional, Thijs, L, additional, Ueshima, K, additional, Umemoto, S, additional, van Gilst, W H, additional, Verdecchia, P, additional, Wachtell, K, additional, Whelton, P, additional, Wing, L, additional, Yui, Y, additional, Yusuf, S, additional, Zanchetti, A, additional, Zhang, Z Y, additional, Anderson, C, additional, Baigent, C, additional, Brenner, BM, additional, Collins, R, additional, de Zeeuw, D, additional, Lubsen, J, additional, Malacco, E, additional, Neal, B, additional, Perkovic, V, additional, Pitt, B, additional, Rodgers, A, additional, Rothwell, P, additional, Salimi-Khorshidi, G, additional, Sundström, J, additional, Turnbull, F, additional, Viberti, G, additional, and Wang, J, additional

Published
2022
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4. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis

Author

Rahimi, K, Bidel, Z, Nazarzadeh, M, Copland, E, Canoy, D, Wamil, M, Majert, J, Mcmanus, R, Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Boersma, E, Brouwers, F, Brown, M, Brugts, J, Bulpitt, C, Byington, R, Cushman, W, Cutler, J, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Chalmers, J, Davis, B, Pepine, C, Teo, K, Rahimi K., Bidel Z., Nazarzadeh M., Copland E., Canoy D., Wamil M., Majert J., McManus R., Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Boersma E., Brouwers F. P. J., Brown M., Brugts J. J., Bulpitt C. J., Byington R. P., Cushman W. C., Cutler J., Devereaux R. B., Dwyer J. P., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Chalmers J., Davis B. R., Pepine C. J., Teo K. K., Rahimi, K, Bidel, Z, Nazarzadeh, M, Copland, E, Canoy, D, Wamil, M, Majert, J, Mcmanus, R, Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Boersma, E, Brouwers, F, Brown, M, Brugts, J, Bulpitt, C, Byington, R, Cushman, W, Cutler, J, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Chalmers, J, Davis, B, Pepine, C, Teo, K, Rahimi K., Bidel Z., Nazarzadeh M., Copland E., Canoy D., Wamil M., Majert J., McManus R., Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Boersma E., Brouwers F. P. J., Brown M., Brugts J. J., Bulpitt C. J., Byington R. P., Cushman W. C., Cutler J., Devereaux R. B., Dwyer J. P., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Chalmers J., Davis B. R., Pepine C. J., and Teo K. K.

Abstract

Background: The effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified by age and blood pressure at baseline. Methods: We did a meta-analysis using individual participant-level data from randomised controlled trials of pharmacological blood-pressure-lowering versus placebo or other classes of blood-pressure-lowering medications, or between more versus less intensive treatment strategies, which had at least 1000 persons-years of follow-up in each treatment group. Participants with previous history of heart failure were excluded. Data were obtained from the Blood Pressure Lowering Treatment Triallists' Collaboration. We pooled the data and categorised participants into baseline age groups (<55 years, 55–64 years, 65–74 years, 75–84 years, and ≥85 years) and blood pressure categories (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg systolic blood pressure and from <70 mm Hg to ≥110 mm Hg diastolic). We used a fixed effects one-stage approach and applied Cox proportional hazard models, stratified by trial, to analyse the data. The primary outcome was defined as either a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring hospital admission. Findings: We included data from 358 707 participants from 51 randomised clinical trials. The age of participants at randomisation ranged from 21 years to 105 years (median 65 years [IQR 59–75]), with 42 960 (12·0%) participants younger than 55 years, 128 437 (35·8%) aged 55–64 years, 128 506 (35·8%) 65–74 years, 54 016 (15·1%) 75–84 years, and 4788 (1·3%) 85 years and older. The hazard ratios for the risk of major cardiovascular events per 5 mm Hg

Published
2021

5. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis

Author

Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Brouwers, F, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Cushman, W, Cutler, J, Davis, B, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pepine, C, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Brouwers F. P. J., Brown M., Bulpitt C. J., Byington R. P., Chalmers J., Cushman W. C., Cutler J., Davis B. R., Devereaux R. B., Dwyer J., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pepine C. J., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., Wang J., Adler, A, Agodoa, L, Algra, A, Asselbergs, F, Beckett, N, Berge, E, Black, H, Brouwers, F, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Cushman, W, Cutler, J, Davis, B, Devereaux, R, Dwyer, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Gupta, A, Holman, R, Imai, Y, Ishii, M, Julius, S, Kanno, Y, Kjeldsen, S, Kostis, J, Kuramoto, K, Lanke, J, Lewis, E, Lewis, J, Lievre, M, Lindholm, L, Lueders, S, Macmahon, S, Mancia, G, Matsuzaki, M, Mehlum, M, Nissen, S, Ogawa, H, Ogihara, T, Ohkubo, T, Palmer, C, Patel, A, Pepine, C, Pfeffer, M, Pitt, B, Poulter, N, Rakugi, H, Reboldi, G, Reid, C, Remuzzi, G, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Thijs, L, Ueshima, K, Umemoto, S, van Gilst, W, Verdecchia, P, Wachtell, K, Whelton, P, Wing, L, Woodward, M, Yui, Y, Yusuf, S, Zanchetti, A, Zhang, Z, Anderson, C, Baigent, C, Brenner, B, Collins, R, de Zeeuw, D, Lubsen, J, Malacco, E, Neal, B, Perkovic, V, Rodgers, A, Rothwell, P, Salimi-Khorshidi, G, Sundstrom, J, Turnbull, F, Viberti, G, Wang, J, Adler A., Agodoa L., Algra A., Asselbergs F. W., Beckett N. S., Berge E., Black H., Brouwers F. P. J., Brown M., Bulpitt C. J., Byington R. P., Chalmers J., Cushman W. C., Cutler J., Davis B. R., Devereaux R. B., Dwyer J., Estacio R., Fagard R., Fox K., Fukui T., Gupta A. K., Holman R. R., Imai Y., Ishii M., Julius S., Kanno Y., Kjeldsen S. E., Kostis J., Kuramoto K., Lanke J., Lewis E., Lewis J. B., Lievre M., Lindholm L. H., Lueders S., MacMahon S., Mancia G., Matsuzaki M., Mehlum M. H., Nissen S., Ogawa H., Ogihara T., Ohkubo T., Palmer C. R., Patel A., Pepine C. J., Pfeffer M. A., Pitt B., Poulter N. R., Rakugi H., Reboldi G., Reid C., Remuzzi G., Ruggenenti P., Saruta T., Schrader J., Schrier R., Sever P., Sleight P., Staessen J. A., Suzuki H., Thijs L., Ueshima K., Umemoto S., van Gilst W. H., Verdecchia P., Wachtell K., Whelton P., Wing L., Woodward M., Yui Y., Yusuf S., Zanchetti A., Zhang Z. -Y., Anderson C., Baigent C., Brenner B. M., Collins R., de Zeeuw D., Lubsen J., Malacco E., Neal B., Perkovic V., Rodgers A., Rothwell P., Salimi-Khorshidi G., Sundstrom J., Turnbull F., Viberti G., and Wang J.

Abstract

Background: The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiovascular events by baseline levels of systolic blood pressure. Methods: We did a meta-analysis of individual participant-level data from 48 randomised trials of pharmacological blood pressure lowering medications versus placebo or other classes of blood pressure-lowering medications, or between more versus less intensive treatment regimens, which had at least 1000 persons-years of follow-up in each group. Trials exclusively done with participants with heart failure or short-term interventions in participants with acute myocardial infarction or other acute settings were excluded. Data from 51 studies published between 1972 and 2013 were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We pooled the data to investigate the stratified effects of blood pressure-lowering treatment in participants with and without prevalent cardiovascular disease (ie, any reports of stroke, myocardial infarction, or ischaemic heart disease before randomisation), overall and across seven systolic blood pressure categories (ranging from <120 to ≥170 mm Hg). The primary outcome was a major cardiovascular event (defined as a composite of fatal and non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring admission to hospital), analysed as per intention to treat. Findings: Data for 344 716 participants from 48 randomised clinical trials were available for this analysis. Pre-randomisation mean systolic/diastolic blood pressures were 146/84 mm Hg in participants with previous cardiovascular disease (n=157 728) and 157/8

Published
2021

8. Antihypertensive treatment and risk of cancer: an individual participant data meta-analysis

Author

Copland, Emma, primary, Canoy, Dexter, additional, Nazarzadeh, Milad, additional, Bidel, Zeinab, additional, Ramakrishnan, Rema, additional, Woodward, Mark, additional, Chalmers, John, additional, Teo, Koon K, additional, Pepine, Carl J, additional, Davis, Barry R, additional, Kjeldsen, Sverre, additional, Sundström, Johan, additional, Rahimi, Kazem, additional, Adler, A, additional, Agodoa, L, additional, Algra, A, additional, Asselbergs, F W, additional, Beckett, N, additional, Berge, E, additional, Black, H, additional, Brouwers, F P J, additional, Brown, M, additional, Bulpitt, C J, additional, Byington, B, additional, Chalmers, J, additional, Cushman, W C, additional, Cutler, J, additional, Davis, B R, additional, Devereaux, R B, additional, Dwyer, J, additional, Estacio, R, additional, Fagard, R, additional, Fox, K, additional, Fukui, T, additional, Gupta, A K, additional, Holman, R R, additional, Imai, Y, additional, Ishii, M, additional, Julius, S, additional, Kanno, Y, additional, Kjeldsen, S E, additional, Kostis, J, additional, Kuramoto, K, additional, Lanke, J, additional, Lewis, E, additional, Lewis, J, additional, Lievre, M, additional, Lindholm, L H, additional, Lueders, S, additional, MacMahon, S, additional, Mancia, G, additional, Matsuzaki, M, additional, Mehlum, M H, additional, Nissen, S, additional, Ogawa, H, additional, Ogihara, T, additional, Ohkubo, T, additional, Palmer, C, additional, Patel, A, additional, Pepine, C J, additional, Pfeffer, M, additional, Poulter, N R, additional, Rakugi, H, additional, Reboldi, G, additional, Reid, C, additional, Remuzzi, G, additional, Ruggenenti, P, additional, Saruta, T, additional, Schrader, J, additional, Schrier, R, additional, Sever, P, additional, Sleight, P, additional, Staessen, J A, additional, Suzuki, H, additional, Thijs, L, additional, Ueshima, K, additional, Umemoto, S, additional, van Gilst, W H, additional, Verdecchia, P, additional, Wachtell, K, additional, Whelton, P, additional, Wing, L, additional, Woodward, M, additional, Yui, Y, additional, Yusuf, S, additional, Zanchetti, A, additional, Zhang, Z Y, additional, Anderson, C, additional, Baigent, C, additional, Brenner, BM, additional, Collins, R, additional, de Zeeuw, D, additional, Lubsen, J, additional, Malacco, E, additional, Neal, B, additional, Perkovic, V, additional, Pitt, B, additional, Rodgers, A, additional, Rothwell, P, additional, Salimi-Khorshidi, G, additional, Sundström, J, additional, Turnbull, F, additional, Viberti, G, additional, and Wang, J, additional

Published
2021
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13. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: A meta-analysis of randomised trials

Author

Agodoa, L, Estacio, R, Schrier, R, Lubsen, J, Chalmers, J, Cutler, J, Davis, B, Wing, L, Poulter, N, Sever, P, Remuzzi, G, Ruggenenti, P, Nissen, S, Lindholm, L, Fukui, T, Ogihara, T, Saruta, T, Black, H, Sleight, P, Lievre, M, Suzuki, H, Fox, K, Lisheng, L, Ohkubo, T, Imai, Y, Yusuf, S, Bulpitt, C, Lewis, E, Brown, M, Palmer, C, Wang, J, Pepine, C, Ishii, M, Yui, Y, Kuramoto, K, Pfeff Er, M, Asselbergs, F, Van Gilst, W, Byington, B, Pitt, B, Brenner, B, Remme, W, De Zeeuw, D, Rahman, M, Viberti, G, Teo, K, Zanchetti, A, Malacco, E, Mancia, G, Staessen, J, Fagard, R, Holman, R, Hansson, L, Kostis, J, Kanno, Y, Lueders, S, Matsuzaki, M, Poole-Wilson, P, Schrader, J, Rahimi, K, Anderson, C, Chapman, N, Collins, R, Macmahon, S, Neal, B, Rodgers, A, Whelton, P, Woodward, M, Agodoa L., Estacio R., Schrier R., Lubsen J., Chalmers J., Cutler J., Davis B., Wing L., Poulter N. R., Sever P., Remuzzi G., Ruggenenti P., Nissen S., Lindholm L. H., Fukui T., Ogihara T., Saruta T., Black H., Sleight P., Lievre M., Suzuki H., Fox K., Lisheng L., Ohkubo T., Imai Y., Yusuf S., Bulpitt C. J., Lewis E., Brown M., Palmer C., Wang J., Pepine C., Ishii M., Yui Y., Kuramoto K., Pfeff Er M., Asselbergs F. W., Van Gilst W. H., Byington B., Pitt B., Brenner B., Remme W. J., De Zeeuw D., Rahman M., Viberti G., Teo K., Zanchetti A., Malacco E., Mancia G., Staessen J., Fagard R., Holman R., Hansson L., Kostis J., Kanno Y., Lueders S., Matsuzaki M., Poole-Wilson P., Schrader J., Rahimi K., Anderson C., Chapman N., Collins R., MacMahon S., Neal B., Rodgers A., Whelton P., Woodward M., Agodoa, L, Estacio, R, Schrier, R, Lubsen, J, Chalmers, J, Cutler, J, Davis, B, Wing, L, Poulter, N, Sever, P, Remuzzi, G, Ruggenenti, P, Nissen, S, Lindholm, L, Fukui, T, Ogihara, T, Saruta, T, Black, H, Sleight, P, Lievre, M, Suzuki, H, Fox, K, Lisheng, L, Ohkubo, T, Imai, Y, Yusuf, S, Bulpitt, C, Lewis, E, Brown, M, Palmer, C, Wang, J, Pepine, C, Ishii, M, Yui, Y, Kuramoto, K, Pfeff Er, M, Asselbergs, F, Van Gilst, W, Byington, B, Pitt, B, Brenner, B, Remme, W, De Zeeuw, D, Rahman, M, Viberti, G, Teo, K, Zanchetti, A, Malacco, E, Mancia, G, Staessen, J, Fagard, R, Holman, R, Hansson, L, Kostis, J, Kanno, Y, Lueders, S, Matsuzaki, M, Poole-Wilson, P, Schrader, J, Rahimi, K, Anderson, C, Chapman, N, Collins, R, Macmahon, S, Neal, B, Rodgers, A, Whelton, P, Woodward, M, Agodoa L., Estacio R., Schrier R., Lubsen J., Chalmers J., Cutler J., Davis B., Wing L., Poulter N. R., Sever P., Remuzzi G., Ruggenenti P., Nissen S., Lindholm L. H., Fukui T., Ogihara T., Saruta T., Black H., Sleight P., Lievre M., Suzuki H., Fox K., Lisheng L., Ohkubo T., Imai Y., Yusuf S., Bulpitt C. J., Lewis E., Brown M., Palmer C., Wang J., Pepine C., Ishii M., Yui Y., Kuramoto K., Pfeff Er M., Asselbergs F. W., Van Gilst W. H., Byington B., Pitt B., Brenner B., Remme W. J., De Zeeuw D., Rahman M., Viberti G., Teo K., Zanchetti A., Malacco E., Mancia G., Staessen J., Fagard R., Holman R., Hansson L., Kostis J., Kanno Y., Lueders S., Matsuzaki M., Poole-Wilson P., Schrader J., Rahimi K., Anderson C., Chapman N., Collins R., MacMahon S., Neal B., Rodgers A., Whelton P., and Woodward M.

Abstract

Summary Background The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI). Methods We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m2, 25 to <30 kg/m2, and ≥30 kg/m2) or a continuous variable. Findings Analyses were based on 135 715 individuals from 22 trials who had 14 353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m2 higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics. Interpretation We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean. Funding None.

Published
2015

25. Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials

Author

Agodoa, L, Anderson, C, Asselbergs, FW, Baigent, C, Black, H, Brenner, B, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Collins, R, Cutler, J, Dahlof, B, Davis, B, de Zeeuw, D, Dens, J, Estacio, R, Fagard, R, Fox, K, Fukui, T, Hansson, L, Holman, R, Hunsicker, L, Imai, Y, Ishii, M, Kanno, Y, Kostis, J, Kuramoto, K, Lewis, E, Lievre, M, Lindholm, LH, Liu, L, Lubsen, J, Lueders, S, MacMahon, S, Malacco, E, Mancia, G, Matsuzaki, M, Neal, B, Nissen, S, Ohkubo, T, Ogihara, T, Pepine, C, Pfeffer, M, Pitt, B, Poole-Wilson, P, Poulter, N, Rahman, M, Remme, W, Remuzzi, G, Rodgers, A, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, J, Suzuki, H, Teo, K, van Gilst, WH, Viberti, G, Wang, J, Whelton, P, Wing, L, Yui, Y, Yusuf, S, Zanchetti, A, Barzi, F, Heritier, S, Li, N, Ninomiya, T, Perkovic, V, Turnbull, F, Woodward, M, Wilson, K, Kearney, ACP, Gallagher, M, Cass, A, Groningen Kidney Center (GKC), Cardiovascular Centre (CVC), Cardiology, Clinical Research Unit, Pathology, Graduate School, ACS - Heart failure & arrhythmias, and Amsterdam Reproduction & Development (AR&D)

Subjects
medicine.medical_specialty, Hemodynamics, Renal function, CONVERTING ENZYME-INHIBITOR, PLACEBO-CONTROLLED TRIAL, CALCIUM-ANTAGONIST, DOUBLE-BLIND, HYPERTENSIVE PATIENTS, RISK-FACTOR, Internal medicine, medicine, Myocardial infarction, Intensive care medicine, PUBLICATION BIAS, biology, business.industry, Research, Angiotensin-converting enzyme, General Medicine, medicine.disease, RENAL OUTCOMES, Blood pressure, ATHEROSCLEROSIS, Heart failure, Cardiology, Aortic pressure, biology.protein, CORONARY-ARTERY-DISEASE, business, Kidney disease
Abstract

Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease.Design Collaborative prospective meta-analysis of randomised trials.Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or each other or that compare different blood pressure targets, with at least 1000 patient years of follow-up per arm.Main outcome measures Major cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death) in composite and individually and all cause death.Participants 26 trials (152 290 participants), including 30 295 individuals with reduced estimated glomerular filtration rate (eGFR), which was defined as eGFRData extraction Individual participant data were available for 23 trials, with summary data from another three. Meta-analysis according to baseline kidney function was performed. Pooled hazard ratios per 5 mm Hg lower blood pressure were estimated with a random effects model.Results Compared with placebo, blood pressure lowering regimens reduced the risk of major cardiovascular events by about a sixth per 5 mm Hg reduction in systolic blood pressure in individuals with (hazard ratio 0.83, 95% confidence interval 0.76 to 0.90) and without reduced eGFR (0.83, 0.79 to 0.88), with no evidence for any difference in effect (P=1.00 for homogeneity). The results were similar irrespective of whether blood pressure was reduced by regimens based on angiotensin converting enzyme inhibitors, calcium antagonists, or diuretics/beta blockers. There was no evidence that the effects of different drug classes on major cardiovascular events varied between patients with different eGFR (all P>0.60 for homogeneity).Conclusions Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease.

Published
2016

26. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index : A meta-analysis of randomised trials

Author

Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., Woodward, M., Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Epidemiology and Data Science, Graduate School, APH - Methodology, and APH - Personalized Medicine

Subjects
medicine.medical_specialty, DISEASE, Body Mass Index, EVENTS, Internal medicine, medicine, Humans, Obesity, Stroke, Antihypertensive Agents, METABOLIC SYNDROME, Randomized Controlled Trials as Topic, Medicine(all), business.industry, MORTALITY, Hazard ratio, General Medicine, medicine.disease, PREVENTION, EUROPEAN-SOCIETY, PROSPECTIVELY-DESIGNED OVERVIEWS, REDUCTION, Blood pressure, Cardiovascular Diseases, Heart failure, Meta-analysis, Hypertension, Physical therapy, Metabolic syndrome, business, Body mass index, Risk Reduction Behavior
Abstract

Summary Background The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI). Methods We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m2 higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics. Interpretation We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean. Funding None.

Published
2015

28. Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: A meta-analysis of randomised trials

Author

Cardiologie, Circulatory Health, Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., Woodward, M., Cardiologie, Circulatory Health, Agodoa, L., Estacio, R., Schrier, R., Lubsen, J., Chalmers, J., Cutler, J., Davis, B., Wing, L., Poulter, N. R., Sever, P., Remuzzi, G., Ruggenenti, P., Nissen, S., Lindholm, L. H., Fukui, T., Ogihara, T., Saruta, T., Black, H., Sleight, P., Lievre, M., Suzuki, H., Fox, K., Lisheng, L., Ohkubo, T., Imai, Y., Yusuf, S., Bulpitt, C. J., Lewis, E., Brown, M., Palmer, C., Wang, J., Pepine, C., Ishii, M., Yui, Y., Kuramoto, K., Pfeff Er, M., Asselbergs, F. W., Van Gilst, W. H., Byington, B., Pitt, B., Brenner, B., Remme, W. J., De Zeeuw, D., Rahman, M., Viberti, G., Teo, K., Zanchetti, A., Malacco, E., Mancia, G., Staessen, J., Fagard, R., Holman, R., Hansson, L., Kostis, J., Kanno, Y., Lueders, S., Matsuzaki, M., Poole-Wilson, P., Schrader, J., Rahimi, K., Anderson, C., Chapman, N., Collins, R., MacMahon, S., Neal, B., Rodgers, A., Whelton, P., and Woodward, M.

Published
2015

29. Clinical pharmacological meeting

Author

Lubsen, J., Tijssen, J. G. P., Sluiter, H. E., Huysmans, F. Th. H., Thien, Th. A., Koene, R. A. P., Vincent, H. H., Derkx, F. H. M., Veld, A. J. Man in 't, Boomsma, F., Schalekamp, H. A. D. H., Hoefnagels, W. H. L., Lenders, J. W. M., Thien, Th., Smits, P., van 't Laar, A., v. Wijk, L. M., Kingma, J. H., Dunselman, P. H. J. M., v. Gilst, W. H., Lie, K. I., Wesseling, H., Lohman, J. J. H. M., Hooymans, P. M., Koten, M. L. P., Verhey, M. T. J. M., Merkus, F. W. H. M., Koopmans, P., Gribnau, F., Demacker, P., Jonkman, J. H. G., Van der Boon, W. J. V., Schoenmaker, R., Holtkamp, A., Hempenius, J., Edelbroek, P. M., Linssen, A. C. G., Zitman, F. G., Rooymans, H. G. M., de Wolff, F. A., Speth, P. A. J., Linssen, P. L. M., Wessels, J. H. C., Haanen, C., Elferink, F., van der Vijgh, W. J. F., van der Poort, S. E. J. M., Vermorken, J. B., Pinedo, H. M., Sonneveld, P., Nooter, K., van den Engh, G. J., Schurgers, N., de Blaey, C. J., and Crommelin, D. J. A.

Published
1984
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30. Essentials of Bayesian diagnostic reasoning

Author

Lubsen J

Subjects
business.industry, Bayesian probability, Diagnostic reasoning, Diagnostic test, Bayes Theorem, Machine learning, computer.software_genre, Decision Support Techniques, Bayes' theorem, Clinical decision making, Bayes test, Internal Medicine, Humans, Medicine, Artificial intelligence, business, computer, Statistical hypothesis testing
Published
1995

32. A Propensity-Matched Study of Hypertension and Increased Stroke-Related Hospitalization in Chronic Heart Failure

Author

Filippatos, G.S. Adamopoulos, C. Sui, X. Love, T.E. Pullicino, P.M. Lubsen, J. Bakris, G. Anker, S.D. Howard, G. Kremastinos, D.T. Ahmed, A.

Abstract

Hypertension is a risk factor for heart failure and stroke. However, the effect of hypertension on stroke in patients with heart failure has not been well studied. In the Digitalis Investigation Group trial, 3,674 (47%) of the 7,788 patients had a history of hypertension. Probability or propensity scores for a history of hypertension were calculated for each patient through use of a multivariable logistic regression model and were then used to match 2,386 pairs of patients with and without a history of hypertension. Kaplan-Meier and matched Cox regression analyses were used to estimate associations of a history of hypertension hospitalization for stroke during 37 months of median follow-up. After matching, patients without and with a history of hypertension had a mean systolic blood pressure of 127 mm Hg. Hospitalization for stroke occurred in 90 patients (rate, 129/10,000 person-years of follow-up) without a history of hypertension and 121 patients (rate, 178/10,000 person-years of follow-up) with a history of hypertension (hazard ratio when hypertension was compared with no hypertension = 1.52; 95% confidence interval = 1.11 to 2.08; p = 0.010). This association was also observed among patients with baseline systolic blood pressure

Published
2008

33. Blood pressure-dependent and independent effects of agents that inhibit the renin-angiotensin system

Author

Agodoa, L, Anderson, C, Asseibergs, F, Baigent, C, Black, H, Brenner, B, Brown, M, Bulpitt, C, Byington, R, Chalmers, J, Collins, R, Cutler, J, Dahlof, B, Davis, B, de Zeeuw, D, Dens, J, Estacio, R, Fagard, Robert, Fox, K, Fukui, T, Hansson, L, Holman, R, Hunsicker, L, Imai, Y, Ishii, M, Kanno, Y, Kostis, J, Kuramoto, K, Lewis, E, Lievre, M, Lindholm, LH, Liu-Huang, Li-chuan, Lubsen, J, Lueders, S, MacMahon, S, Malacco, E, Mancia, G, Matsuzaki, M, Neal, B, Nissen, S, Ohkubo, T, Ogihara, T, Pepine, C, Pfeffer, M, Pitt, B, Poole-Wilson, P, Rahman, M, Remme, W, Remuzzi, G, Rodgers, A, Ruggenenti, P, Saruta, T, Schrader, J, Schrier, R, Sever, P, Sleight, P, Staessen, Jan A, Teo, K, Viberti, G, Wang, J, Whelton, P, Wing, L, Yui, Y, Yusuf, S, Zanchetti, A, Swedberg, K, Kjekshus, J, Algert, C, Perkovic, V, Turnbull, F, Woodward, M, and Groningen Kidney Center (GKC)

Subjects
coronary-artery-disease, Physiology, CONVERTING-ENZYME-INHIBITORS, converting-enzyme-inhibitors, Placebo-controlled study, heart failure, Angiotensin-Converting Enzyme Inhibitors, high-risk patients, 030204 cardiovascular system & hematology, PLACEBO-CONTROLLED TRIAL, Renin-Angiotensin System, Coronary artery disease, 0302 clinical medicine, placebo-controlled trial, HYPERTENSIVE PATIENTS, 030212 general & internal medicine, prospectively-designed overviews, Stroke, Randomized Controlled Trials as Topic, major cardiovascular events, blood pressure, stroke, CHRONIC HEART-FAILURE, 3. Good health, Cardiovascular Diseases, randomized controlled-trial, Cardiology, ventricular systolic function, Cardiology and Cardiovascular Medicine, meta-regression analyses, RECEPTOR BLOCKERS, medicine.medical_specialty, Placebo, Sensitivity and Specificity, 03 medical and health sciences, VENTRICULAR SYSTOLIC FUNCTION, Internal medicine, Renin–angiotensin system, Internal Medicine, medicine, Humans, CARDIOVASCULAR MORBIDITY, cardiovascular diseases, coronary heart disease, HIGH-RISK PATIENTS, lipid-lowering treatment, business.industry, medicine.disease, RANDOMIZED-TRIAL, chronic heart-failure, Blood pressure, MYOCARDIAL-INFARCTION, meta-analyses, Relative risk, Heart failure, business, Angiotensin II Type 1 Receptor Blockers
Abstract

Objectives To evaluate the blood pressure-dependent and independent effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on major cardiovascular events.Methods Using data from 26 large-scale trials comparing an ACEI or an ARB with placebo or another drug class, meta-regression analyses were conducted in which treatment-specific relative risks for major cause-specific outcomes [stroke, major coronary heart disease (CHD) events and heart failure] were regressed against follow-up blood pressure differences.Results From a total of 146 838 individuals with high blood pressure or an elevated risk of cardiovascular disease, 22 666 major cardiovascular events were documented during follow-up. The analyses showed comparable blood pressure-dependent reductions in risk with ACEI and ARB (P > 0.3 for all three outcomes). The analyses also showed that ACEI produced a blood pressure-independent reduction in the relative risk of CHD of approximately 9% (95% confidence interval 3-14%). No similar effect was detected for ARB, and there was some evidence of a difference between ACEI and ARB in this regard (P =0.002). For both stroke and heart failure there was no evidence of any blood pressure-independent effects of either ACEI or ARB.Conclusion There are similar blood pressure-dependent effects of ACEI and ARB for the risks of stroke, CHD and heart failure. For ACEI, but not ARB, there is evidence of blood pressure-independent effects on the risk of major coronary disease events.

Published
2007

35. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial

Author

Poole-Wilson, PA, Lubsen, J (Jacob), Kirwan, B-A, van Dalen, FJ (Frederik), Wagener, G, Danchin, N, Just, H, Fox, KA, Pocock, SJ, Clayton, TC, Motro, M, Parker, JD, Bourassa, MG, Dart, AM, Hildebrandt, P, Hjalmarson, A, Kragten, JA, Molhoek, GP, Otterstad, JE, Seabra- Gomes, R, Soler-Soler, J, Weber, S, Koudstaal, Peter, Epidemiology, Cardiology, and Neurology

Subjects
Male, Nifedipine, Endpoint Determination, Placebo, Angina Pectoris, Angina, Double-Blind Method, Clinical endpoint, Medicine, Humans, Myocardial infarction, Intention-to-treat analysis, business.industry, Hazard ratio, General Medicine, Middle Aged, medicine.disease, Calcium Channel Blockers, Survival Analysis, Cardiovascular Diseases, Heart failure, Anesthesia, Female, business, medicine.drug
Abstract

Summary Background Calcium antagonists are widely prescribed for angina pectoris but their effect on clinical outcome is controversial. We aimed to investigate the effect of the calcium antagonist nifedipine on long-term outcome in patients with stable angina pectoris. Methods We randomly assigned 3825 patients with treated stable symptomatic coronary disease to double-blind addition of nifedipine GITS (gastrointestinal therapeutic system) 60 mg once daily and 3840 to placebo. The primary endpoint was the combination of death, acute myocardial infarction, refractory angina, new overt heart failure, debilitating stroke, and peripheral revascularisation. Mean follow-up was 4·9 years (SD 1·1). Analysis was by intention to treat. Findings 310 patients allocated nifedipine died (1.64 per 100 patient-years) compared with 291 people allocated placebo (1·53 per 100 patient-years; hazard ratio 1·07 [95% CI 0·91–1·25], p=0·41). Primary endpoint rates were 4·60 per 100 patient-years for nifedipine and 4·75 per 100 patient-years for placebo (0·97 [0·88–1·07], p=0·54). With nifedipine, rate of death and any cardiovascular event or procedure was 9·32 per 100 patient-years versus 10·50 per 100 patient-years for placebo (0·89 [0·83–0·95], p=0·0012). The difference was mainly attributable to a reduction in the need for coronary angiography and interventions in patients assigned nifedipine, despite an increase in peripheral revascularisation. Nifedipine had no effect on the rate of myocardial infarction. Interpretation Addition of nifedipine GITS to conventional treatment of angina pectoris has no effect on major cardiovascular event-free survival. Nifedipine GITS is safe and reduces the need for coronary angiography and interventions. Published online August 31, 2004 http://image.thelancet.com/extras/04art6402web.pdf

Published
2004

40. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials

Author

Turnbull, F, Neal, B, Algert, C, Chalmers, J, Woodward, M, MacMahon, S, Baigent, C, Cutler, J, Fagard, Robert, Whelton, P, Yusuf, Satara, Chapman, N, Agodoa, L, Black, H, Boissel, JP, Brenner, B, Brown, M, Bulpitt, C, Byington, R, Collins, R, Dahlof, B, Davis, B, Dens, Joseph, Estacio, R, Fox, K, Hansson, L, Holman, R, Hunsicker, L, Kostis, J, Kuramoto, K, Lewis, E, Lindholm, L, Lubsen, J, Malacco, E, Mancia, G, Pepine, C, Pfeffer, M, Pitt, B, Poole-Wilson, P, Remuzzi, G, Rodgers, A, Ruggenenti, P, Schrier, R, Sever, P, Sleight, P, Staessen, Jan A, Tco, K, Turner, R, Wing, L, Yui, Y, and Zanchetti, A

Subjects
Male, microvascular complications, medicine.medical_specialty, medicine.drug_class, Adrenergic beta-Antagonists, converting-enzyme-inhibitor, Angiotensin-Converting Enzyme Inhibitors, morbidity, Calcium channel blocker, Disease, Pharmacology, outcomes, Risk Assessment, Placebos, Angiotensin Receptor Antagonists, Internal medicine, medicine, Humans, Prospective Studies, Prospective cohort study, Diuretics, Antihypertensive Agents, Aged, Randomized Controlled Trials as Topic, Heart Failure, business.industry, coronary heart-disease, General Medicine, antihypertensive therapies, Middle Aged, medicine.disease, Calcium Channel Blockers, isolated systolic hypertension, mortality, Regimen, Blood pressure, Treatment Outcome, Cardiovascular Diseases, Relative risk, Heart failure, Hypertension, Female, double-blind, Risk assessment, business, calcium-channel blocker
Abstract

BACKGROUND: The benefits of reducing blood pressure on the risks of major cardiovascular disease are well established, but uncertainty remains about the comparative effects of different blood-pressure-lowering regimens. We aimed to estimate effects of strategies based on different drug classes (angiotensin-converting-enzyme [ACE] inhibitors, calcium antagonists, angiotensin-receptor blockers [ARBs], and diuretics or beta blockers) or those targeting different blood pressure goals, on the risks of major cardiovascular events and death. METHODS: We did seven sets of prospectively-designed overviews with data from 29 randomised trials (n=162341). The trial eligibility criteria, primary outcomes, and main hypotheses were specified before the result of any contributing trial was known. FINDINGS: In placebo-controlled trials the relative risks of total major cardiovascular events were reduced by regimens based on ACE inhibitors (22%; 95% CI 17-27) or calcium antagonists (18%; 5-29). Greater risk reductions were produced by regimens that targeted lower blood pressure goals (15%; 5-24). ARB-based regimens reduced the risks of total major cardiovascular events (10%; 4-17) compared with control regimens. There were no significant differences in total major cardiovascular events between regimens based on ACE inhibitors, calcium antagonists, or diuretics or beta blockers, although ACE-inhibitor-based regimens reduced blood pressure less. There was evidence of some differences between active regimens in their effects on cause-specific outcomes. For every outcome other than heart failure, the difference between randomised groups in achieved blood pressure reduction was directly related to the observed difference in risk. INTERPRETATION: Treatment with any commonly-used regimen reduces the risk of total major cardiovascular events, and larger reductions in blood pressure produce larger reductions in risk.

Published
2003

41. Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty

Author

Simoons, M.L., Betriu, A., Col, J., Von Essen, R., Lubsen, J., Michel, P.L., Rutsch, W., Schmidt, W., Thery, C., Vahanian, A., Willems, G.M., Arnold, A.E.R., DeBono, D.P., Lambertz, H., Meier, B., Raynaud, P., Dougherty, F.C., Sanz, G.A., Serruys, P.W., Uebis, R., Van De Werf, F., Wood, D., and Verstraete, M.

Subjects
Heart attack, Angioplasty -- Case studies, Coronary heart disease -- Care and treatment
Published
1988

42. The future of clinical trials in secondary prevention after acute coronary syndromes

Author

Bueno, H., Armstrong, P.W., Buxton, M.J., Danchin, N., Lubsen, J., Roland, E., Verheugt, F.W.A., Zalewski, A., Jackson, N., Komajda, M., Steg, P.G., Bueno, H., Armstrong, P.W., Buxton, M.J., Danchin, N., Lubsen, J., Roland, E., Verheugt, F.W.A., Zalewski, A., Jackson, N., Komajda, M., and Steg, P.G.

Abstract

Contains fulltext : 97431.pdf (publisher's version ) (Closed access)

Published
2011

43. Subgroup effects despite homogeneous heterogeneity test results

Author

Groenwold, R.H.H. (Rolf), Rovers, M.M. (Maroeska), Lubsen, J. (Jacob), Heijden, G.J.M.G. (Geert) van der, Groenwold, R.H.H. (Rolf), Rovers, M.M. (Maroeska), Lubsen, J. (Jacob), and Heijden, G.J.M.G. (Geert) van der

Abstract

Background. Statistical tests of heterogeneity are very popular in meta-analyses, as heterogeneity might indicate subgroup effects. Lack of demonstrable statistical heterogeneity, however, might obscure clinical heterogeneity, meaning clinically relevant subgroup effects. Methods. A qualitative, visual method to explore the potential for subgroup effects was provided by a modification of the forest plot, i.e., adding a vertical axis indicating the proportion of a subgroup variable in the individual trials. Such a plot was used to assess the potential for clinically relevant subgroup effects and was illustrated by a clinical example on the effects of antibiotics in children with acute otitis media. Results. Statistical tests did not indicate heterogeneity in the meta-analysis on the effects of amoxicillin on acute otitis media (Q = 3.29, p = 0.51; I2 = 0%; T2 = 0). Nevertheless, in a modified forest plot, in which the individual trials were ordered by the proportion of children with bilateral otitis, a clear relation between bilaterality and treatment effects was observed (which was also found in an individual patient data meta-analysis of the included trials: p-value for interaction 0.021). Conclusions. A modification of the forest plot, by including an additional (vertical) axis indicating the proportion of a certain subgroup variable, is a qualitative, visual, and easy-to-interpret method to explore potential subgroup effects in studies included in meta-analyses

Published
2010
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45. A Propensity-Matched Study of Hypertension and Increased Stroke-Related Hospitalization in Chronic Heart Failure

Author

Filippatos, G.S. (Gerasimos), Adamopoulos, C. (Chris), Sui, X. (Xuemei), Love, T.E. (Thomas), Pullicino, P.M. (Patrick), Lubsen, J. (Jacob), Bakris, G. (George), Anker, S.D. (Stefan), Howard, G. (George), Kremastinos, D.T. (Dimitrios), Ahmed, A. (Ali), Filippatos, G.S. (Gerasimos), Adamopoulos, C. (Chris), Sui, X. (Xuemei), Love, T.E. (Thomas), Pullicino, P.M. (Patrick), Lubsen, J. (Jacob), Bakris, G. (George), Anker, S.D. (Stefan), Howard, G. (George), Kremastinos, D.T. (Dimitrios), and Ahmed, A. (Ali)

Abstract

Hypertension is a risk factor for heart failure and stroke. However, the effect of hypertension on stroke in patients with heart failure has not been well studied. In the Digitalis Investigation Group trial, 3,674 (47%) of the 7,788 patients had a history of hypertension. Probability or propensity scores for a history of hypertension were calculated for each patient through use of a multivariable logistic regression model and were then used to match 2,386 pairs of patients with and without a history of hypertension. Kaplan-Meier and matched Cox regression analyses were used to estimate associations of a history of hypertension hospitalization for stroke during 37 months of median follow-up. After matching, patients without and with a history of hypertension had a mean systolic blood pressure of 127 mm Hg. Hospitalization for stroke occurred in 90 patients (rate, 129/10,000 person-years of follow-up) without a history of hypertension and 121 patients (rate, 178/10,000 person-years of follow-up) with a history of hypertension (hazard ratio when hypertension was compared with no hypertension = 1.52; 95% confidence interval = 1.11 to 2.08; p = 0.010). This association was also observed among patients with baseline systolic blood pressure <140 mm Hg (hazard ratio = 1.35; 95% confidence interval =1.01 to 1.81; p = 0.044). In conclusion, a history of hypertension was associated with increased risk of hospitalization for stroke among patients with heart failure who were balanced in all measured baseline covariates, including blood pressure.

Published
2008
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46. Predictive value of local and core laboratory echocardiographic assessment of cardiac function in patients with chronic stable angina: The ACTION study

Author

Dart, A.M. (Anthony), Otterstad, J.E. (Jan Erik), Kirwan, B.A. (Bridget Anne), Parker, J.D. (John), Brouwer, S. (Sophie) de, Poole-Wilson, P. (Philip), Lubsen, J. (Jacob), Dart, A.M. (Anthony), Otterstad, J.E. (Jan Erik), Kirwan, B.A. (Bridget Anne), Parker, J.D. (John), Brouwer, S. (Sophie) de, Poole-Wilson, P. (Philip), and Lubsen, J. (Jacob)

Abstract

Aims: To evaluate the relationship between echocardiographic cardiac function and outcome in patients with stable symptomatic angina. Methods: Baseline echo left ventricular ejection fraction and volume data measured in a central laboratory was available for 7016 patients (92% of the total) participating in the ACTION trial (A Coronary disease Trial Investigating Outcome with Nifedipine GITS). Ejection fraction was also measured by investigators. Evaluation of the different echocardiographic variables was based on adjusted hazard ratios comparing the unfavourable limit of the 90% range of the variable concerned to the favourable limit. Results: The centrally measured ejection fraction was the most powerful predictor of all-cause death (adjusted hazard ratio = 2.5), myocardial infarction, any stroke or transient ischaemic attack and overt heart failure (adjusted hazard ratio = 4.5). The addition of either end systolic volume or end diastolic volume to ejection fraction did not materially affect the power of prediction. Compared to the central ejection fraction measurement, the investigator-measured ejection fraction was a less powerful predictor for all outcomes considered. Conclusion: Routine echocardiography carefully analysed by standardised methods provides useful prognostic information in patients with stable angina, including for total mortality.

Published
2007
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47. Safety of nifedipine GITS in stable angina: The ACTION trial

Author

Poole-Wilson, P. (Philip), Kirwan, B.A. (Bridget Anne), Vokó, Z. (Zoltán), Brouwer, S. (Sophie) de, Dalen, F.J. (Frederik) van, Lubsen, J. (Jacob), Poole-Wilson, P. (Philip), Kirwan, B.A. (Bridget Anne), Vokó, Z. (Zoltán), Brouwer, S. (Sophie) de, Dalen, F.J. (Frederik) van, and Lubsen, J. (Jacob)

Abstract

Aim: We describe the safety profile of nifedipine GITS as assessed from adverse events reported in the ACTION trial in which 7,665 patients with stable, symptomatic coronary artery disease were randomly assigned nifedipine GITS or placebo and followed for a mean of 4.9 years. Methods: All adverse events were coded using the COSTART coding dictionary. The incidence rate for each event was calculated as the number of patients with the event concerned divided by the total time 'at risk'. Hazard ratios comparing nifedipine with placebo and their 95% confidence intervals were obtained by Cox proportional-hazards analysis. Results: As reported previously, nifedipine significantly reduced the incidence of cardiovascular events and procedures [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.83-0.95]. Apart from the known side effects of nifedipine, which include peripheral oedema, vasodilatation, hypotension, asthenia, constipation, leg cramps, non-specific respiratory complaints, impotence and polyuria, and which were reported more frequently in patients assigned nifedipine, the incidence rates of most other adverse events were similar. There were no differences in the occurrence of gastrointestinal haemorrhage, myocardial infarction and suicide. The rate of occurrence of death or new cancer excluding non-melanoma skin cancer for patients with no history of cancer at baseline was 2.53/100 patient years for patients assigned nifedipine and 2.37/100 patient years for patients assigned placebo (HR 1.06, 95% CI 0.93-1.22). Conclusion: Overall nifedipine GITS was well tolerated by patients with stable symptomatic angina.

Published
2006
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49. A COMPARISON OF INTERNAL MAMMARY ARTERY AND SAPHENOUS-VEIN GRAFTS AFTER CORONARY-ARTERY BYPASS-SURGERY - NO DIFFERENCE IN 1-YEAR OCCLUSION RATES AND CLINICAL OUTCOME

Author

VANDERMEER, J, HILLEGE, HL, VANGILST, WH, DELARIVIERE, AB, DUNSELMAN, PHJM, FIDLER, [No Value], KOOTSTRA, GJ, MULDER, BJM, PFISTERER, M, LIE, KI, MEIJLER, FL, ASCOOP, CAPL, DUNNING, AJ, MICHELS, HR, DEMEDINA, EOR, WELLENS, HJJ, ARNTZENIUS, AC, LUBSEN, J, SCHUILENBERG, RM, SKOTNICKI, SH, DEFEYTER, PJ, HOORNTJE, JCA, VISSER, FC, VANDIJK, RB, DENHEYER, P, JANSSEN, J, VANOMMEN, GVA, BAR, FWHM, HAUER, RNW, VIERSMA, JW, FANGGIDAEJ, D, LIEM, AL, TEUBEN, JHM, VANDERVEEN, HF, TIJSSEN, JGP, VUIJK, M, DEJONGSTE, MJL, EIJGELAAR, A, VANDERDOEF, R, PIEK, J, MEYNE, NG, GIN, RMTY, VERMEULEN, FE, BUSER, P, BURKART, F, GRADEL, E, BONNIER, JJRM, BAVINCK, JH, NUSE, J, SEGGEWISS, K, POSIVAL, H, GLEICHMANN, U, KORFER, R, TERRES, W, BLEIFELD, W, KALMAR, P, PENN, OEK, HITCHCOCK, JF, Wever, E., Life Course Epidemiology (LCE), Cardiovascular Centre (CVC), and Groningen Kidney Center (GKC)

Subjects
surgical procedures, operative, BYPASS, ARTERIES, PATENCY, DIPYRIDAMOLE, LOW-DOSE ASPIRIN, SURVIVAL, TRIAL, VEINS, CHOICE, CLINICAL TRIALS, ORAL ANTICOAGULANTS
Abstract

Background Superior patency rates for internal mammary artery (IMA) grafts compared with vein coronary bypass grafts have been demonstrated by retrospective studies. This difference may have been affected by selection bias of patients and coronary arteries for IMA grafting. Methods and Results To estimate the difference between IMA and vein grafts, we analyzed graft patency data of 912 patients who entered a randomized clinical drug trial. In this trial, 494 patients received both IMA and vein grafts (group 1) and 418 only vein grafts (group 2). Occlusion rates of IMA grafts and IMA plus vein grafts in group 1 were compared with those of vein grafts in group 2. Multivariate analysis was used to compare occlusion rates of IMA and vein grafts while other variables related to graft patency were controlled for. In addition, 1-year clinical outcome was assessed by the incidence of myocardial infarction, thrombosis, major bleeding, and death. Occlusion rates of distal anastomoses in group 1 versus group 2 were 5.4% (IMA grafts) versus 12.7% (vein grafts) (P Conclusions The observed difference in 1-year occlusion rates between IMA and vein grafts can be explained by a maldistribution of graft characteristics by selection of coronary arteries for IMA grafting rather than being ascribed to graft material. One-year clinical outcome is not improved by IMA grafting.

Published
1994

50. Heart rate variability from 24-hour electrocardiography and the 2-year risk for sudden death

Author

Algra, A., Tijssen, J. G., Roelandt, J. R., Pool, J., Lubsen, J., and Other departments

Abstract

BACKGROUND: Low heart rate variability has been implicated as a risk factor for sudden death. However, no large epidemiological studies using sudden death as an outcome event have been reported. METHODS AND RESULTS: A total of 6,693 consecutive patients who underwent 24-hour ambulatory ECG were followed up for 2 years; of these, 245 patients died suddenly. Clinical data at the time of 24-hour ambulatory ECG were collected for all patients who died suddenly and for a random sample of 268 patients from the study cohort. In all patients in sinus rhythm with or without occasional supraventricular arrhythmias at the 24-hour ECG (193 patients who died suddenly and 230 patients from the sample), heart rate variability parameters were derived. Patients with low short-term RR interval variability (mean during 24 hours of per-minute standard deviations [SD] of RR intervals or = 40 msec); after adjustment for age, evidence of cardiac dysfunction, and history of myocardial infarction, the relative risk was 2.6 (95% CI, 1.4, 5.1). The crude relative risk of long-term RR interval variability (SD during 24 hours of per-minute means of RR intervals or = 65 beats per minute had a double risk of sudden death compared with those with a minimum heart rate

Published
1993

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