Ambulatory arterial stiffness index as a predictor of cardiovascular events.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Ambulatory arterial stiffness index as a predictor of cardiovascular events."

Transcription

1 Ambulatory arterial stiffness index as a predictor of cardiovascular events. A meta-analysis of longitudinal studies. Konstantinos Aznaouridis, Charalambos Vlachopoulos, Christodoulos Stefanadis. 1 st Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece. August 31, 2011 No conflict of interest

2 Arterial stiffness and risk stratification Increased pulse wave velocity is added to the list of factors influencing prognosis as an early index of hypertension-related target organ (large artery) damage

3 Arterial stiffness and risk stratification

4 Ambulatory BP and risk stratification Prospective studies have shown that a higher ambulatory systolic or diastolic BP predicts CV events even after adjustment for office BP. Clement DL et al, N Engl J Med. 2003;348: Fagard RH et al, Hypertension. 2008;51: Recently, a large epidemiological study showed that ambulatory systolic pressure, and especially nighttime pressure, is an important predictor of cardiovascular events and all-cause mortality. Boggia J et al, Hypertension. 2011;57:

5 Ambulatory arterial stiffness index (AASI) AASI: 1 minus the slope of diastolic on systolic pressure during 24- hour ambulatory monitoring Dolan E et al, Hypertension. 2006;47: Li Y et al, Hypertension. 2006;47:

6 Ambulatory arterial stiffness index (AASI) There is a general impression that AASI has a significant predictive role based on the results of individual studies. However, no overall quantitative estimate of this role exists.

7 Purposes of meta-analysis To calculate quantitative estimates of the predictive value of AASI for outcomes (total CV events, stroke, allcause mortality). To investigate whether publication bias could have affected the estimated predictive ability of AASI

8 Outcomes of meta-analysis 1) total CV events 2) stroke 3) total (all-cause) mortality Study eligibility 1) full-length publications in peer-reviewed journals 2) evaluated AASI 3) reported a combined CV outcome or stroke or total mortality

9 Literature search Systematic review of the English literature in the PubMed and Cochrane databases until February The search terms were ambulatory arterial stiffness, ambulatory arterial stiffness index, arterial elasticity, or arterial stiffness and prediction, risk, death, mortality, outcome, or events.

10 Data & Statistics Aggregate data reported in published articles were used for analysis (no data of individual patients). The risk estimates of each study were reported as a hazard ratio, relative risk (RR) or odds ratio. The predictive ability of AASI was evaluated for - high (vs low) AASI - increase of 1 SD Patients were allocated to high or low AASI groups according to cutoffs provided by each study (median, upper tertile or quartile, optimal cutoff derived by ROC curves) When possible, adjusted risk estimates from multivariate models were used to control for possible selection bias in the original studies. According to the observed heterogeneity, a fixed or a random effects model was used to obtain the pooled RR. All analyses were performed with Comprehensive Meta Analysis Version 2 (Biostat, Englewood, New Jersey).

11 Results Qualitative summary Our search identified 58 publications, which were narrowed by preliminary review to 19 potentially relevant original articles. Of those, 12 studies were excluded because of 1) cross-sectional study design (n = 11), or 2) had the whole population or part of the population in common (n=1). Our meta-analysis included 7 original articles following 20,505 subjects for a mean follow-up of 7.8 years All studies were published since 2006

12 Author, year Population- Sample size Followup Events AASI cut-off (high vs. low) Dolan 2006 Hypertension (most) (N=11,291) 5.3 y (median) 566 CV deaths (151 stroke deaths, 358 cardiac deaths) upper boundary of the 95 prediction interval of individual data points in relation to age Hansen 2006 Community based adults (half hypertensives) (N=1,829) 9.4 y (median) 212 CV events 40 strokes 150 CHD events upper boundary of the 95 prediction interval of individual data points in relation to age Kikuya 2007 General population (half hypertensives) (N=1,542) 13.3 y (median) 345 deaths 126 CV deaths 63 stroke deaths upper quartile compared with whole population Ben-Dov 2008 Hypertension (most)(n=2,918) 7.0 y (mean) 215 deaths (all-cause) median Palmas 2009 Elderly with diabetes (N=1,178) 6.6 y (mean) 287 deaths (110 CV deaths) upper vs. lower tertile Bastos 2010 Hypertension (N=1,200) 8.2 y (mean) 62 deaths 152 CV events 79 strokes median Muxfeldt 2010 Resistant hypertension(n=547) 4.8 y (median) 65 deaths 45 CV deaths 101 CV events median

13 Results (high vs low AASI) CV outcome Stroke All-cause mortality Compared to low AASI, the pooled RR of total CV events, stroke and all-cause mortality for high AASI patients was 1.51, 2.01 and 1.25, respectively.

14 Results (total CV events vs stroke) High vs. low AASI The pooled RR was higher for stroke than for total CV events

15 Results (1 SD increase) CV outcome Stroke For an increase in AASI by 1 SD, the pooled RR of total CV events and stroke is 1.15 and 1.30, respectively (the risk increases by 15% and 30%).

16 Results (hypertensives vs normotensives) RR of stroke for a 1 SD-increase in AASI The pooled RR of stroke was significantly higher in normotensives

17 Results Publication bias analysis - Funnel plots of precision - Trim-and-fill method (imputes theoretically missing studies and recalculates the pooled RR) Publication bias is not sufficient to influence our findings in a meaningful way

18 Summary of findings In populations with high AASI, the risk of CV events, stroke and all-cause mortality is higher compared with the risk in patients with low AASI. The predictive ability of increased AASI is higher for stroke than for total CV events. The predictive value of increased AASI is higher in normotensive patients.

19 Limitations Use of aggregate summary- data (no data of individual patients). To define high and low AASI, we used the cutoff values used by each study, because there are no established cutoffs for AASI. Although stroke and all-cause mortality were uniformly defined, the definition of total CV events differed among the studies.

20 Conclusions AASI is a strong predictor of future CV events, stroke and all-cause mortality. Future studies should provide data on a wider range of populations and they should elaborate on the ability of AASI to discriminate, calibrate and reclassify the risk of patients.

21 Ambulatory arterial stiffness index as a predictor of cardiovascular events. A meta-analysis of longitudinal studies. Konstantinos Aznaouridis, Charalambos Vlachopoulos, Christodoulos Stefanadis. 1 st Department of Cardiology, Hippokration Hospital, Athens Medical School, Athens, Greece. August 31, 2011 No conflict of interest

Central pressures and prediction of cardiovascular events in erectile dysfunction patients

Central pressures and prediction of cardiovascular events in erectile dysfunction patients Central pressures and prediction of cardiovascular events in erectile dysfunction patients N. Ioakeimidis, K. Rokkas, A. Angelis, Z. Kratiras, M. Abdelrasoul, C. Georgakopoulos, D. Terentes-Printzios,

More information

Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness

Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness Journal of the American College of Cardiology Vol. 55, No. 13, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/10/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2009.10.061

More information

Peripheral Vessels Unit, 1st Department of Cardiology Athens Medical School Hippokration Hospital, Athens, Greece

Peripheral Vessels Unit, 1st Department of Cardiology Athens Medical School Hippokration Hospital, Athens, Greece Peripheral Vessels Unit, 1st Department of Cardiology Athens Medical School Hippokration Hospital, Athens, Greece Dimitrios Terentes-Printzios, Charalambos Vlachopoulos, Nikolaos Ioakeimidis, Mahmoud Abdelrasoul,

More information

Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice

Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice (2005) 19, 801 807 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Prognostic significance of blood pressure measured in the office, at home and

More information

D Terentes-Printzios, C Vlachopoulos, G Vyssoulis, N Ioakeimidis, P Xaplanteris, K Aznaouridis, E Christoforatou, A Samentzas, A Siama, C Stefanadis

D Terentes-Printzios, C Vlachopoulos, G Vyssoulis, N Ioakeimidis, P Xaplanteris, K Aznaouridis, E Christoforatou, A Samentzas, A Siama, C Stefanadis Peripheral Vessels Unit, 1st Department of Cardiology Athens Medical School Hippokration Hospital, Athens, Greece D Terentes-Printzios, C Vlachopoulos, G Vyssoulis, N Ioakeimidis, P Xaplanteris, K Aznaouridis,

More information

Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo?

Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo? Danno d organo bersaglio e rischio CV. Persiste un ruolo prognostico oltre la patologia d organo? Prof. Massimo Salvetti Clinica Medica University of Brescia Percieved risk Actual risk Sehestedt et al,

More information

Food and plant bioactives for reducing cardiometabolic disease: How does the evidence stack up?

Food and plant bioactives for reducing cardiometabolic disease: How does the evidence stack up? Food and plant bioactives for reducing cardiometabolic disease: How does the evidence stack up? Arrigo F.G. Cicero, MD, PhD Medical and Surgical Sciences Dept., University of Bologna, Italy Italian Nutraceutical

More information

Estrogens vs Testosterone for cardiovascular health and longevity

Estrogens vs Testosterone for cardiovascular health and longevity Estrogens vs Testosterone for cardiovascular health and longevity Panagiota Pietri, MD, PhD, FESC Director of Hypertension Unit Athens Medical Center Athens, Greece Women vs Men Is there a difference in

More information

Overview of the outcome trials in older patients with isolated systolic hypertension

Overview of the outcome trials in older patients with isolated systolic hypertension Journal of Human Hypertension (1999) 13, 859 863 1999 Stockton Press. All rights reserved 0950-9240/99 $15.00 http://www.stockton-press.co.uk/jhh Overview of the outcome trials in older patients with isolated

More information

Departments of Cardiology and Vascular Surgery Michaelidion Cardiac Center University of Ioannina, Greece

Departments of Cardiology and Vascular Surgery Michaelidion Cardiac Center University of Ioannina, Greece Departments of Cardiology and Vascular Surgery Michaelidion Cardiac Center University of Ioannina, Greece ARGYRIS Vassilis, PEROULIS Michalis, MATSAGKAS Miltiadis, BECHLIOULIS Aris, MICHALIS Lampros, NAKA

More information

A NOVEL CARDIOVASCULAR RISK BIOMETRIC - AORTIC PULSE WAVE VELOCITY

A NOVEL CARDIOVASCULAR RISK BIOMETRIC - AORTIC PULSE WAVE VELOCITY A NOVEL CARDIOVASCULAR RISK BIOMETRIC - AORTIC PULSE WAVE VELOCITY Calvin Cole, ACII Head of Underwriting, Europe RGA International London, United Kingdom ccole@rgare.com John R. Cockcroft, FRCP Visiting

More information

Central hemodynamics and prediction of cardiovascular events in patients with erectile dysfunction

Central hemodynamics and prediction of cardiovascular events in patients with erectile dysfunction Central hemodynamics and prediction of cardiovascular events in patients with erectile dysfunction N.Skliros, N.Ioakeimidis, D.Terentes-Printzios, C.Vlachopoulos Cardiovascular Diseases and Sexual Health

More information

Low fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease

Low fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease (2002) 16, 837 841 & 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Low fractional diastolic pressure in the ascending aorta increased the risk

More information

The Effect of Heart Rate on Wave Reflections May Be Determined by the Level of Aortic Stiffness: Clinical and Technical Implications

The Effect of Heart Rate on Wave Reflections May Be Determined by the Level of Aortic Stiffness: Clinical and Technical Implications nature publishing group The Effect of Heart Rate on Wave Reflections May Be Determined by the Level of Aortic Stiffness: Clinical and Technical Implications Theodore G. Papaioannou 1, Charalambos V. Vlachopoulos

More information

TODAY S TOPIC Blood Pressure & Pulse Wave Measurement Combined in One Procedure Re-classification of Risk Patients

TODAY S TOPIC Blood Pressure & Pulse Wave Measurement Combined in One Procedure Re-classification of Risk Patients CARDIOVASCULAR TECHNOLOGY AND INDICATION SERVICE TODAY S TOPIC Blood Pressure & Pulse Wave Measurement Combined in One Procedure Re-classification of Risk Patients SERIES Hypertension Management in the

More information

MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY BLOOD PRESSURE MONITORING

MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY BLOOD PRESSURE MONITORING MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY 02/19/09 PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

Summary HTA. HTA-Report Summary

Summary HTA. HTA-Report Summary Summary HTA HTA-Report Summary Prognostic value, clinical effectiveness and cost-effectiveness of high sensitivity C-reactive protein as a marker in primary prevention of major cardiac events Schnell-Inderst

More information

Low grade inflammation and cardiovascular disease

Low grade inflammation and cardiovascular disease Low grade inflammation and cardiovascular disease Konstantinos Aznaouridis, MD PhD 1 st Department of Cardiology Hippokration Hospital Athens Medical School Atherosclerosis Start from very young To Old

More information

AGING, BLOOD PRESSURE & CARDIOVASCULAR DISEASE EVENT RISK. Michael Smolensky, Ph.D. The University of Texas Austin & Houston

AGING, BLOOD PRESSURE & CARDIOVASCULAR DISEASE EVENT RISK. Michael Smolensky, Ph.D. The University of Texas Austin & Houston AGING, BLOOD PRESSURE & CARDIOVASCULAR DISEASE EVENT RISK Michael Smolensky, Ph.D. The University of Texas Austin & Houston Disclosures Partner: Circadian Ambulatory Diagnostics Consultant: Spot On Sciences

More information

Ambulatory Blood Pressure Monitoring Clinical Practice Recommendations

Ambulatory Blood Pressure Monitoring Clinical Practice Recommendations Acta Medica Marisiensis 2016;62(3):350-355 DOI: 10.1515/amma-2016-0038 UPDATE Ambulatory Blood Pressure Monitoring Clinical Practice Recommendations Mako Katalin *, Ureche Corina, Jeremias Zsuzsanna University

More information

Hypertension: What s new since JNC 7. Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF

Hypertension: What s new since JNC 7. Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Hypertension: What s new since JNC 7 Harold M. Szerlip, MD, FACP, FCCP, FASN, FNKF Disclosures Spectral Diagnostics Site investigator Eli Lilly Site investigator ACP IM ITE writing committee NBME Step

More information

Hypertension Management Controversies in the Elderly Patient

Hypertension Management Controversies in the Elderly Patient Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No

More information

Meta-analysis: Advanced methods using the STATA software

Meta-analysis: Advanced methods using the STATA software Page 1 sur 5 Wednesday 20 September 2017 - Introduction to meta-analysis Introduction I. Why do a meta-analysis? II. How does a meta-analysis work? Some concepts III. Definition of an «effect size» 1.

More information

The role of physical activity in the prevention and management of hypertension and obesity

The role of physical activity in the prevention and management of hypertension and obesity The 1 st World Congress on Controversies in Obesity, Diabetes and Hypertension (CODHy) Berlin, October 26-29 2005 The role of physical activity in the prevention and management of hypertension and obesity

More information

Pharmacological modulation of vascular structure and function. L. Van Bortel. Heymans Institute of Pharmacology, Ghent University

Pharmacological modulation of vascular structure and function. L. Van Bortel. Heymans Institute of Pharmacology, Ghent University Pharmacological modulation of vascular structure and function L. Van Bortel Heymans Institute of Pharmacology, Ghent University BHC 2015 Pharmacological modulation of Endothelial function CIMT Pulse wave

More information

Evidence Synthesis Number 88

Evidence Synthesis Number 88 Evidence Synthesis Number 88 Screening Asymptomatic Adults for Coronary Heart Disease With Resting or Exercise Electrocardiography: Systematic Review to Update the 2004 U.S. Preventive Services Task Force

More information

Correspondence should be addressed to Stefano Omboni;

Correspondence should be addressed to Stefano Omboni; International Journal of Hypertension Volume 2015, Article ID 601812, 10 pages http://dx.doi.org/10.1155/2015/601812 Research Article Evaluation of 24-Hour Arterial Stiffness Indices and Central Hemodynamics

More information

Ivana Nedeljkovic, M Ostojic, V Giga, V Stojanov, J Stepanovic, A Djordjevic Dikic, B Beleslin, M Nikolic, M Petrovic, D Popovic

Ivana Nedeljkovic, M Ostojic, V Giga, V Stojanov, J Stepanovic, A Djordjevic Dikic, B Beleslin, M Nikolic, M Petrovic, D Popovic Combined cardiopulmonary exercise stress echocardiography test: New test for assessment of diastolic dysfunction in patients with hypertension Ivana Nedeljkovic, M Ostojic, V Giga, V Stojanov, J Stepanovic,

More information

Cardiac Cycle MCQ. Professor of Cardiovascular Physiology. Cairo University 2007

Cardiac Cycle MCQ. Professor of Cardiovascular Physiology. Cairo University 2007 Cardiac Cycle MCQ Abdel Moniem Ibrahim Ahmed, MD Professor of Cardiovascular Physiology Cairo University 2007 1- Regarding the length of systole and diastole: a- At heart rate 75 b/min, the duration of

More information

INTERNATIONAL REGISTRY FOR AMBULATORY BLOOD PRESSURE AND ARTERIAL STIFFNESS TELEMONITORING

INTERNATIONAL REGISTRY FOR AMBULATORY BLOOD PRESSURE AND ARTERIAL STIFFNESS TELEMONITORING INTERNATIONAL REGISTRY FOR AMBULATORY BLOOD PRESSURE AND ARTERIAL STIFFNESS TELEMONITORING VASOTENS Registry Vascular health ASsessment Of The hypertensive patients Project Coordinator: Dr. Stefano Omboni

More information

Evidence Based Medicine

Evidence Based Medicine Course Goals Goals 1. Understand basic concepts of evidence based medicine (EBM) and how EBM facilitates optimal patient care. 2. Develop a basic understanding of how clinical research studies are designed

More information

Cardiovascular Diseases in CKD

Cardiovascular Diseases in CKD 1 Cardiovascular Diseases in CKD Hung-Chun Chen, MD, PhD. Kaohsiung Medical University Taiwan Society of Nephrology 1 2 High Prevalence of CVD in CKD & ESRD Foley RN et al, AJKD 1998; 32(suppl 3):S112-9

More information

RESEARCH. Dagfinn Aune, 1,2 Abhijit Sen, 1 Manya Prasad, 3 Teresa Norat, 2 Imre Janszky, 1 Serena Tonstad, 3 Pål Romundstad, 1 Lars J Vatten 1

RESEARCH. Dagfinn Aune, 1,2 Abhijit Sen, 1 Manya Prasad, 3 Teresa Norat, 2 Imre Janszky, 1 Serena Tonstad, 3 Pål Romundstad, 1 Lars J Vatten 1 open access BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants Dagfinn Aune, 1,2 Abhijit

More information

Study of Serum Uric Acid Level in Hypertension

Study of Serum Uric Acid Level in Hypertension IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 4 Ver. VI (April. 2017), PP 69-73 www.iosrjournals.org Study of Serum Uric Acid Level in Hypertension

More information

Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study

Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study DOI 10.1007/s00394-017-1408-0 ORIGINAL CONTRIBUTION Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study Elly Mertens 1,2

More information

Does TEVAR affect the heart?

Does TEVAR affect the heart? Does TEVAR affect the heart? Christos D. Liapis, MD, FACS, FRCS, FEBVS Professor (Em) of Vascular Surgery National & Kapodistrian University of Athens Director Vascular & Endovascular Clinic Athens Medical

More information

The Meta on Meta-Analysis. Presented by Endia J. Lindo, Ph.D. University of North Texas

The Meta on Meta-Analysis. Presented by Endia J. Lindo, Ph.D. University of North Texas The Meta on Meta-Analysis Presented by Endia J. Lindo, Ph.D. University of North Texas Meta-Analysis What is it? Why use it? How to do it? Challenges and benefits? Current trends? What is meta-analysis?

More information

Blood Pressure Monitor PASESA

Blood Pressure Monitor PASESA Blood Pressure Monitor PASESA new oscillometric device with AVI&API PASESA Prevent ArterioSclerosis and Enjoy Successful Aging PASESA, digital blood pressure monitor for medical use Sit still for two minutes

More information

Isolated Systolic Hypertension in the elderly. Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg

Isolated Systolic Hypertension in the elderly. Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg Isolated Systolic Hypertension in the elderly Daniel Hayoz Clinique de Médecine Interne HFR-Hôpital Cantonal Fribourg Case no 1 Man aged 75, from Kosovo, in CH since 1.5 years Former smoker (45 PY) BP:

More information

P.K. Tandon, PhD J. Alexander Cole, DSc. Use of Registries for Clinical Evaluation of Rare Diseases

P.K. Tandon, PhD J. Alexander Cole, DSc. Use of Registries for Clinical Evaluation of Rare Diseases Disclaimer: Presentation slides from the Rare Disease Workshop Series are posted by the Kakkis EveryLife Foundation, for educational purposes only. They are for use by drug development professionals and

More information

A nationwide population-based study. Pai-Feng Hsu M.D. Shao-Yuan Chuang PhD

A nationwide population-based study. Pai-Feng Hsu M.D. Shao-Yuan Chuang PhD The Association of Clinical Symptomatic Hypoglycemia with Cardiovascular Events and Total Death in Type 2 Diabetes Mellitus A nationwide population-based study Pai-Feng Hsu M.D. Shao-Yuan Chuang PhD Taipei

More information

Improving risk prediction focusing on intermediate endpoints. Arterial stiffness. Pr. Stéphane LAURENT, MD, PhD, FESC

Improving risk prediction focusing on intermediate endpoints. Arterial stiffness. Pr. Stéphane LAURENT, MD, PhD, FESC Improving risk prediction focusing on intermediate endpoints Arterial stiffness Pr. Stéphane LAURENT, MD, PhD, FESC Pharmacology Department, Hôpital Européen Georges Pompidou, Paris Cardiovascular Research

More information

Articles. Funding Medical Research Council, National Institute for Health Research, and Wellcome Trust.

Articles. Funding Medical Research Council, National Institute for Health Research, and Wellcome Trust. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1 5 million people Eleni Rapsomaniki, Adam Timmis, Julie George,

More information

Pulse pressure (PP) is the difference between systolic and diastolic blood pressure

Pulse pressure (PP) is the difference between systolic and diastolic blood pressure Clinical Investigation Tansel Yildiran, MD Mevlut Koc, MD Abdi Bozkurt, MD Durmus Yildiray Sahin, MD Ilker Unal, MSC Esmeray Acarturk, MD, FESC Key words: Blood pressure/physiology; cardiovascular diseases/mortality/

More information

Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients: A meta-analysis

Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients: A meta-analysis ORIGINAL ARTICLE Cardiology Journal 2010, Vol. 17, No. X, pp. 1 XX Copyright 2010 Via Medica ISSN 1897 5593 Short-term antihypertensive efficacy of perindopril according to clinical profile of 3,188 patients:

More information

Comparison of 44-Hour and Fixed 24-Hour Ambulatory Blood Pressure Monitoring in Dialysis Patients

Comparison of 44-Hour and Fixed 24-Hour Ambulatory Blood Pressure Monitoring in Dialysis Patients ORIGINAL PAPER Comparison of 44-Hour and Fixed 24-Hour Ambulatory Blood Pressure Monitoring in Dialysis Patients Wenjin Liu, MD; Hong Ye, MD; Bing Tang, MD; Zhiping Sun, MD; Ping Wen, MD; Wenhui Wu, MD;

More information

Randomized experiments vs. Propensity scores matching: a Meta-analysis.

Randomized experiments vs. Propensity scores matching: a Meta-analysis. Randomized experiments vs. Propensity scores matching: a Meta-analysis. Antonio Olmos Priyalatha Govindasamy Research Methods and Statistics University of Denver American Evaluation Association Conference

More information

CARDIOVASCULAR DISEASE RISK TESTS

CARDIOVASCULAR DISEASE RISK TESTS CARDIOVASCULAR DISEASE RISK TESTS UnitedHealthcare Oxford Clinical Policy Policy Number: CARDIOLOGY 023.11 T2 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE

More information

Types of Data. Systematic Reviews: Data Synthesis Professor Jodie Dodd 4/12/2014. Acknowledgements: Emily Bain Australasian Cochrane Centre

Types of Data. Systematic Reviews: Data Synthesis Professor Jodie Dodd 4/12/2014. Acknowledgements: Emily Bain Australasian Cochrane Centre Early Nutrition Workshop, December 2014 Systematic Reviews: Data Synthesis Professor Jodie Dodd 1 Types of Data Acknowledgements: Emily Bain Australasian Cochrane Centre 2 1 What are dichotomous outcomes?

More information

Diagnosis is it really Heart Failure?

Diagnosis is it really Heart Failure? ESC Congress Munich - 25-29 August 2012 Heart Failure with Preserved Ejection Fraction From Bench to Bedside Diagnosis is it really Heart Failure? Prof. Burkert Pieske Department of Cardiology Med.University

More information

CONTRIBUTING FACTORS FOR STROKE:

CONTRIBUTING FACTORS FOR STROKE: CONTRIBUTING FACTORS FOR STROKE: HYPERTENSION AND HYPERCHOLESTEROLEMIA Melissa R. Stephens, MD, FAAFP Associate Professor of Clinical Sciences William Carey University College of Osteopathic Medicine LEARNING

More information

B-type Natriuretic Peptide in VHD: a Non-imaging Helper for the Cardiologist. Dr. Julien Magne, PhD Sart Tilman Liège, BELGIUM

B-type Natriuretic Peptide in VHD: a Non-imaging Helper for the Cardiologist. Dr. Julien Magne, PhD Sart Tilman Liège, BELGIUM B-type Natriuretic Peptide in VHD: a Non-imaging Helper for the Cardiologist Dr. Julien Magne, PhD Sart Tilman Liège, BELGIUM Conflict of Interest Disclosure None BNP Molecular Forms and Processing Brain

More information

Blood Pressure Variability and Its Management in Hypertensive Patients

Blood Pressure Variability and Its Management in Hypertensive Patients Korean J Fam Med. 2012;33:330-335 http://dx.doi.org/10.4082/kjfm.2012.33.6.330 Blood Pressure Variability and Its Management in Hypertensive Patients Review Hee-Jeong Choi* Department of Family Medicine,

More information

Cedars Sinai Diabetes. Michael A. Weber

Cedars Sinai Diabetes. Michael A. Weber Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor

More information

Causes of Poor BP control Rates

Causes of Poor BP control Rates Goals Of Hypertension Management in Clinical Practice World Hypertension League (WHL) Meeting Adel E. Berbari, MD, FAHA, FACP Professor of Medicine and Physiology Head, Division of Hypertension and Vascular

More information

QUIZ 1. Tuesday, March 2, 2004

QUIZ 1. Tuesday, March 2, 2004 Harvard-MIT Division of Health Sciences and Technology HST.542J: Quantitative Physiology: Organ Transport Systems Instructors: Roger Mark and Jose Venegas MASSACHUSETTS INSTITUTE OF TECHNOLOGY Departments

More information

E.Ritz Heidelberg (Germany)

E.Ritz Heidelberg (Germany) Predictive capacity of renal function in cardiovascular disease E.Ritz Heidelberg (Germany) If a cure is not achieved, the kidneys will pass on the disease to the heart Huang Ti Nei Ching Su Wen The Yellow

More information

Vitamin B 12 Intake and Status and Cognitive Function in Elderly People

Vitamin B 12 Intake and Status and Cognitive Function in Elderly People Epidemiologic Reviews The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

More information

Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA

Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA Hypertension Update 2016 AREEF ISHANI, MD MS CHIEF OF MEDICINE MINNEAPOLIS VA MEDICAL CENTER PROFESSOR OF MEDICINE UNIVERSITY OF MINNESOTA Case 1 What should be your BP goal for an elderly (> 75 yrs of

More information

HIGH BLOOD PRESSURE. How can we do better?

HIGH BLOOD PRESSURE. How can we do better? HIGH BLOOD PRESSURE How can we do better? Review date: February 2018 This publication includes practical guidance from GPs, nurses and pharmacists on how you can improve detection and management of high

More information

Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial [HYVET] R. Peters

Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial [HYVET] R. Peters Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial [HYVET] R. Peters ClinicalTrials.gov: NCT00122811 Backgound The prevalence of dementia rises with increasing

More information

Essential Skills for Evidence-based Practice Understanding and Using Systematic Reviews

Essential Skills for Evidence-based Practice Understanding and Using Systematic Reviews J Nurs Sci Vol.28 No.4 Oct - Dec 2010 Essential Skills for Evidence-based Practice Understanding and Using Systematic Reviews Jeanne Grace Corresponding author: J Grace E-mail: Jeanne_Grace@urmc.rochester.edu

More information

Diagnostic methods 2: receiver operating characteristic (ROC) curves

Diagnostic methods 2: receiver operating characteristic (ROC) curves abc of epidemiology http://www.kidney-international.org & 29 International Society of Nephrology Diagnostic methods 2: receiver operating characteristic (ROC) curves Giovanni Tripepi 1, Kitty J. Jager

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Howard R, McShane R, Lindesay J, et al. Donepezil and memantine

More information

Meta-Analysis David Wilson, Ph.D. Upcoming Seminar: October 20-21, 2017, Philadelphia, Pennsylvania

Meta-Analysis David Wilson, Ph.D. Upcoming Seminar: October 20-21, 2017, Philadelphia, Pennsylvania Meta-Analysis David Wilson, Ph.D. Upcoming Seminar: October 20-21, 2017, Philadelphia, Pennsylvania Meta-Analysis Workshop David B. Wilson, PhD September 16, 2016 George Mason University Department of

More information

Biomechanics of Ergometric Stress Test: regional and local effects on elastic, transitional and muscular human arteries

Biomechanics of Ergometric Stress Test: regional and local effects on elastic, transitional and muscular human arteries Journal of Physics: Conference Series Biomechanics of Ergometric Stress Test: regional and local effects on elastic, transitional and muscular human arteries To cite this article: G Valls et al 2011 J.

More information

University of Dundee

University of Dundee University of Dundee Cardiovascular Epidemiology Unit Why Scotland is adding Social Deprivation and Family History to cardiovascular risk assessment in the ASSIGN score H. Tunstall-Pedoe University of

More information

Principles of meta-analysis

Principles of meta-analysis Principles of meta-analysis 1 The popularity of meta-analyses Search on 22 October 2015 10000 9000 8156 8875 8000 7000 6554 6000 5000 4852 4000 3000 2000 1000 0 1 1 1 272 334 371 323 386 429 482 596 639

More information

Blood Pressure Lowering in Type 2 Diabetes A Systematic Review and Meta-analysis

Blood Pressure Lowering in Type 2 Diabetes A Systematic Review and Meta-analysis Research Original Investigation A Systematic Review and Meta-analysis Connor A. Emdin, HBSc; Kazem Rahimi, DM, MSc; Bruce Neal, PhD; Thomas Callender, MBChB; Vlado Perkovic, PhD; Anushka Patel, PhD IMPORTANCE

More information

Evidence Based Medicine

Evidence Based Medicine Hamadan University of medical sciences School of Public Health Department of Epidemiology Evidence Based Medicine Amin Doosti-Irani, PhD in Epidemiology 10 March 2017 a_doostiirani@yahoo.com 1 Outlines

More information

Determinants of Accelerated Progression of Arterial Stiffness in Normotensive Subjects and in Treated Hypertensive Subjects Over a 6-Year Period

Determinants of Accelerated Progression of Arterial Stiffness in Normotensive Subjects and in Treated Hypertensive Subjects Over a 6-Year Period Determinants of Accelerated Progression of Arterial Stiffness in Normotensive and in Treated Hypertensive Over a 6-Year Period Athanase Benetos, MD, PhD; Chris Adamopoulos, MD; Jeanne-Marie Bureau, MD;

More information

Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods

Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods Jakobsen et al. BMC Medical Research Methodology 2014, 14:120 CORRESPONDENCE Open Access Thresholds for statistical and clinical significance in systematic reviews with meta-analytic methods Janus Christian

More information

Hospital and 1-year outcome after acute myocardial infarction in patients with diabetes mellitus and hypertension

Hospital and 1-year outcome after acute myocardial infarction in patients with diabetes mellitus and hypertension (2003) 17, 665 670 & 2003 Nature Publishing Group All rights reserved 0950-9240/03 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Hospital and 1-year outcome after acute myocardial infarction in patients with

More information

Atherosclerosis 220 (2012) Contents lists available at ScienceDirect. Atherosclerosis

Atherosclerosis 220 (2012) Contents lists available at ScienceDirect. Atherosclerosis Atherosclerosis 220 (2012) 128 133 Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis Carotid plaque, compared with carotid intima-media

More information

Assessment of performance and decision curve analysis

Assessment of performance and decision curve analysis Assessment of performance and decision curve analysis Ewout Steyerberg, Andrew Vickers Dept of Public Health, Erasmus MC, Rotterdam, the Netherlands Dept of Epidemiology and Biostatistics, Memorial Sloan-Kettering

More information

Is normal ejection fraction equivalent to normal systolic function?

Is normal ejection fraction equivalent to normal systolic function? Is normal ejection fraction equivalent to normal systolic function? D. Vinereanu University of Medicine, Bucharest, Romania EAE course, Bucharest No 2 nd criterion (out of 3) for the diagnosis of HFNEF:

More information

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis

Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Efficacy of beta-blockers in heart failure patients with atrial fibrillation: An individual patient data meta-analysis Dipak Kotecha, MD PhD on behalf of the Selection of slides presented at the European

More information

2/11/2017. Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox. Disclosures. Carl J. Lavie, MD, FACC, FACP, FCCP

2/11/2017. Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox. Disclosures. Carl J. Lavie, MD, FACC, FACP, FCCP Weighing the Heavy Cardiovascular Burden of Obesity and the Obesity Paradox Carl J. Lavie, MD, FACC, FACP, FCCP Professor of Medicine Medical Director, Cardiac Rehabilitation and Preventive Cardiology

More information

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Harvey White Green Lane Cardiovascular Service and Cardiovascular

More information

Which method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호

Which method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호 Which method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호 Arterial stiffness Arterial stiffness is inversely related to arterial

More information

Influence of Hypertension and Diabetes Mellitus on. Family History of Heart Attack in Male Patients

Influence of Hypertension and Diabetes Mellitus on. Family History of Heart Attack in Male Patients Applied Mathematical Sciences, Vol. 6, 01, no. 66, 359-366 Influence of Hypertension and Diabetes Mellitus on Family History of Heart Attack in Male Patients Wan Muhamad Amir W Ahmad 1, Norizan Mohamed,

More information

HYPERTENSION IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014

HYPERTENSION IN THE ELDERLY A BALANCED APPROACH. Barry Goldlist October 31, 2014 HYPERTENSION IN THE ELDERLY A BALANCED APPROACH Barry Goldlist October 31, 2014 DISCLOSURE I have not accepted any money for myself from any pharmaceutical company in the 21 st century I have accepted

More information

Μαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ

Μαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ Μαρία Μαρκέτου Επιμ. Α Καρδιολογική Κλινική ΠαΓΝΗ Ischemic Heart Disease Mortality Rate in Each Decade of Age IHD mortality (floating absolute risk and 95% CI) 256 128 64 32 16 8 4 2 SBP 256 128 64 32

More information

Arterial Stiffness: pathophysiology and clinical impact. Gérard M. LONDON Manhès Hospital Fleury-Mérogis/Paris, France

Arterial Stiffness: pathophysiology and clinical impact. Gérard M. LONDON Manhès Hospital Fleury-Mérogis/Paris, France Arterial Stiffness: pathophysiology and clinical impact Gérard M. LONDON Manhès Hospital Fleury-Mérogis/Paris, France Determinants of vascular overload (afterload) on the heart Peripheral Resistance Arterial

More information

Improved control for confounding using propensity scores and instrumental variables?

Improved control for confounding using propensity scores and instrumental variables? Improved control for confounding using propensity scores and instrumental variables? Dr. Olaf H.Klungel Dept. of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences

More information

SECONDARY HYPERTENSION

SECONDARY HYPERTENSION HYPERTENSION Hypertension is the clinical term used to describe a high blood pressure of 140/90 mmhg or higher (National Institute of Health 1997). It is such a health risk the World Health Organisation

More information

Association of Heart Rate With Blood Pressure Variability: Implications for Blood Pressure Measurement

Association of Heart Rate With Blood Pressure Variability: Implications for Blood Pressure Measurement nature publishing group original contributions Association of Heart Rate With Blood Pressure Variability: Implications for Blood Pressure Measurement Amos Cahan 1, Iddo Z. Ben-Dov 2 and Michael Bursztyn

More information

Blood pressure variability (BPV) Original Research

Blood pressure variability (BPV) Original Research Original Research Hellenic J Cardiol 2015; 56: 208-216 Visit-to-Visit Blood Pressure Variability and Arterial Stiffness Independently Predict Cardiovascular Risk Category in a General Population: Results

More information

Risk Stratification for CAD for the Primary Care Provider

Risk Stratification for CAD for the Primary Care Provider Risk Stratification for CAD for the Primary Care Provider Shimoli Shah MD Assistant Professor of Medicine Directory, Ambulatory Cardiology Clinic Knight Cardiovascular Institute Oregon Health & Sciences

More information

Rikshospitalet, University of Oslo

Rikshospitalet, University of Oslo Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia 29.08.2010 Objectives The trends in cardiovascular

More information

The role of cytoreductive. nephrectomy in elderly patients. with metastatic renal cell. carcinoma in an era of targeted. therapy

The role of cytoreductive. nephrectomy in elderly patients. with metastatic renal cell. carcinoma in an era of targeted. therapy The role of cytoreductive nephrectomy in elderly patients with metastatic renal cell carcinoma in an era of targeted therapy Dipesh Uprety, MD Amir Bista, MD Yazhini Vallatharasu, MD Angela Smith, MA David

More information

Managing HTN in the Elderly: How Low to Go

Managing HTN in the Elderly: How Low to Go Managing HTN in the Elderly: How Low to Go Laxmi S. Mehta, MD, FACC The Ohio State University Medical Center Assistant Professor of Clinical Internal Medicine Clinical Director of the Women s Cardiovascular

More information

MASSACHUSETTS INSTITUTE OF TECHNOLOGY

MASSACHUSETTS INSTITUTE OF TECHNOLOGY Harvard-MIT Division of Health Sciences and Technology HST.542J: Quantitative Physiology: Organ Transport Systems Instructors: Roger Mark and Jose Venegas MASSACHUSETTS INSTITUTE OF TECHNOLOGY Departments

More information

Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis

Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis Gastroenterology Report, 5(3), 2017, 232 236 doi: 10.1093/gastro/gow010 Advance Access Publication Date: 1 May 2016 Original article ORIGINAL ARTICLE Ammonia level at admission predicts in-hospital mortality

More information

Schöttker et al. BMC Medicine (2016) 14:26 DOI /s

Schöttker et al. BMC Medicine (2016) 14:26 DOI /s Schöttker et al. BMC Medicine (2016) 14:26 DOI 10.1186/s12916-016-0570-1 RESEARCH ARTICLE HbA 1c levels in non-diabetic older adults No J-shaped associations with primary cardiovascular events, cardiovascular

More information

A clinical appraisal of left atrial function

A clinical appraisal of left atrial function European Heart Journal (2001) 22, 22 36 doi:10.1053/euhj.1999.1768, available online at http://www.idealibrary.com on Review Article A clinical appraisal of left atrial function C. Stefanadis, J. Dernellis

More information