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Cardiovascular Disease and Metabolic Syndrome
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Evidence from the Systolic Blood Pressure Intervention Trial (SPRINT) showed that more intensive treatment (BP target of <120 mm Hg) in people with increased risk of CVD (but without diabetes) resulted in a 25% lower relative risk of CVD-related morbidity and mortality and death from any cause (with more adverse events) compared to the group treated to a target of <140 mm Hg.29 Notably, subjects required an average of three medication for intensive control, suggesting that Lifestyle Medicine interventions to target lowered BP may provide substantial benefit, without the same risks of adverse events.
Lifestyle Medicine and Cardiovascular Disease
Published in James M. Rippe, Manual of Lifestyle Medicine, 2021
These more stringent blood pressure criteria were based largely on the results of the Systolic Blood Pressure Intervention Trial (SPRINT), which showed that these lower numbers of blood pressure control significantly reduced both all-cause mortality and mortality from CVD (25). In order to reach these lower levels of blood pressure in the SPRINT Trial, however, it was often necessary to utilize three blood pressure medicines. This highlights the importance of lifestyle modalities which can help lower blood pressure.
Physical Activity and Cardiovascular Disease Risk-Reduction and Treatment
Published in James M. Rippe, Increasing Physical Activity, 2020
The guidelines for blood pressure in the 2017 ACC/AHA recommendations were significantly lower than previous recommendations and were based on the findings of Systolic Blood Pressure Intervention Trial (SPRINT) (26). This trial was conducted in over 9,000 individuals with a mean age of 67.9 and a systolic blood pressure of 130–180 mm/Hg and at increased risk of cardiovascular events. The researchers compared targets of SBP < 120 mmHg to standard targets of SBP<140 mmHg. The SPRINT trial showed a 30% decrease in the composite outcome of MI, acute coronary syndrome, stroke, and HF, or death compared to the standard target group. Unfortunately, in order to achieve these lower levels, three antihypertensive medicines were required in many participants, which may make it impractical in a normal clinical setting.
Safety of ramucirumab treatment in patients with advanced hepatocellular carcinoma and elevated alpha-fetoprotein
Published in Expert Opinion on Drug Safety, 2022
Overall management includes routine blood pressure monitoring, regular urinalysis, risk stratification, fluid restriction, and administration of the appropriate antihypertensive and/or renoprotective agents. Hypertension, proteinuria, and peripheral edema are mechanistically correlated; therefore, the management shares beneficial interactions. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) are recommended therapeutic choices owing to their pleiotropic protective effects on the cardiovascular and renal systems [59]. Dihydropyridine calcium channel blockers are safe alternatives in patients with contraindications to ACEi or ARB. Stricter targets for hypertensive control may be followed to the established evidence such as the Systolic Blood Pressure Intervention Trial [60]. Based on known mechanistic interactions between NO and VEGF inhibition, in addition to discontinuation of ramucirumab, long-acting nitrates or phosphodiesterase inhibitors could be administered in refractory and severe cases [61]. Renal biopsy evaluation is warranted to determine the etiology, guide further interventions and permanent discontinuation of therapy, in patients with nephrotic syndrome or renal function decline [62].
Systolic blood pressure control prevents cognitive decline and slows development of white matter lesions in the brain: the SPRINT MIND study outcomes
Published in Blood Pressure, 2019
Sverre E. Kjeldsen, Krzysztof Narkiewicz, Michel Burnier, Suzanne Oparil
The Systolic Blood Pressure Intervention Trial (SPRINT) tested the hypothesis that intensive systolic blood pressure (BP) control would reduce cardiovascular disease outcomes and mortality to a greater extent than treatment to standard systolic BP target in people with hypertension [1]. The active treatment phase of the trial was stopped after a median follow-up of 3.26 years by the sponsor, the National Heart, Blood and Lung Institute of the US, because of benefit in the intensive treatment arm [2]. Intensive lowering of systolic BP reduced rates of the primary outcome, a composite of acute myocardial infarction (MI), acute coronary syndrome not resulting in MI (non-MI ACS), stroke, acute decompensated heart failure and cardiovascular death, by 25% and the risk of all cause death by 27%. We have discussed the SPRINT findings in previous issues of Blood Pressure [3,4].
Intensive blood pressure lowering prevents mild cognitive impairment and possible dementia and slows development of white matter lesions in brain: the SPRINT Memory and Cognition IN Decreased Hypertension (SPRINT MIND) study
Published in Blood Pressure, 2018
Sverre E. Kjeldsen, Krzysztof Narkiewicz, Michel Burnier, Suzanne Oparil
The Systolic Blood Pressure Intervention Trial (SPRINT) tested the hypothesis that intensive blood pressure (BP) control to a systolic BP target <120 mm Hg would reduce cardiovascular disease outcomes and mortality to a greater extent than treatment to the standard systolic BP target of <140 mm Hg [1]. The active treatment phase of the trial was stopped after a median follow-up of 3.26 years by the sponsor, the National Heart, Blood and Lung Institute of the US, because of benefit in the intensive treatment arm [2]. Intensive lowering of systolic BP to a target of <120 mm Hg reduced rates of the primary outcome, a composite of acute myocardial infarction (MI), acute coronary syndrome not resulting in MI (non-MI ACS), stroke, acute decompensated heart failure and cardiovascular death, by 25% and the risk of death by 27%, compared to the target systolic BP of <140 mm Hg. We have discussed the SPRINT findings extensively in previous issues of Blood Pressure [3–7].