Showing papers by "Jackson T. Wright published in 2017"
Veterans Health Administration1, Case Western Reserve University2, Wake Forest University3, University of Utah4, National Institutes of Health5, University of Tennessee Health Science Center6, University of Alabama at Birmingham7, Tulane University8, Medical University of South Carolina9, Ohio State University10, Stanford University11, Anschutz Medical Campus12, Mayo Clinic13, University of California, San Diego14, University of Minnesota15, University of Illinois at Chicago16, New York University17, United States Department of Veterans Affairs18, Henry Ford Health System19
TL;DR: Among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.
Abstract: The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; n=1330) or <140 mm Hg (standard group; n=1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD (P values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (-0.47 versus -0.32 ml/min per 1.73 m2 per year; P<0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.
297 citations
TL;DR: CAC improves risk prediction for cardiovascular disease, myocardial infarction, and heart failure over use of established and novel cardiovascular disease risk factors among patients with CKD; however, the changes in the C statistic are small.
Abstract: Importance Coronary artery calcification (CAC) is highly prevalent in dialysis-naive patients with chronic kidney disease (CKD). However, there are sparse data on the association of CAC with subsequent risk of cardiovascular disease and all-cause mortality in this population. Objective To study the prospective association of CAC with risk of cardiovascular disease and all-cause mortality among dialysis-naive patients with CKD. Design, Setting, and Participants The prospective Chronic Renal Insufficiency Cohort study recruited adults with an estimated glomerular filtration rate of 20 to 70 mL/min/1.73 m 2 from 7 clinical centers in the United States. There were 1541 participants without cardiovascular disease at baseline who had CAC scores. Exposures Coronary artery calcification was assessed using electron-beam or multidetector computed tomography. Main Outcomes and Measures Incidence of cardiovascular disease (including myocardial infarction, heart failure, and stroke) and all-cause mortality were reported every 6 months and confirmed by medical record adjudication. Results During an average follow-up of 5.9 years in 1541 participants aged 21 to 74 years, there were 188 cardiovascular disease events (60 cases of myocardial infarction, 120 heart failures, and 27 strokes; patients may have had >1 event) and 137 all-cause deaths. In Cox proportional hazards models adjusted for age, sex, race, clinical site, education level, physical activity, total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, use of antihypertensive treatment, current cigarette smoking, diabetes status, body mass index, C-reactive protein level, hemoglobin A 1c level, phosphorus level, troponin T level, log N-terminal pro–B-type natriuretic peptide level, fibroblast growth factor 23 level, estimated glomerular filtration rate, and proteinuria, the hazard ratios associated with per 1 SD log of CAC were 1.40 (95% CI, 1.16-1.69; P P = .04) for myocardial infarction, 1.39 (95% CI, 1.10-1.76; P = .006) for heart failure, and 1.19 (95% CI, 0.94-1.51; P = .15) for all-cause mortality. In addition, inclusion of CAC score led to an increase in the C statistic of 0.02 (95% CI, 0-0.09; P Conclusions and Relevance Coronary artery calcification is independently and significantly related to the risks of cardiovascular disease, myocardial infarction, and heart failure in patients with CKD. In addition, CAC improves risk prediction for cardiovascular disease, myocardial infarction, and heart failure over use of established and novel cardiovascular disease risk factors among patients with CKD; however, the changes in the C statistic are small.
235 citations
University of Minnesota1, Wake Forest University2, Baylor College of Medicine3, Columbia University4, Veterans Health Administration5, Vanderbilt University6, National Institutes of Health7, Colorado School of Public Health8, Mayo Clinic9, Tulane University10, Carolinas Healthcare System11, University of California, San Diego12, University of Pennsylvania13, University of Tennessee Health Science Center14, Case Western Reserve University15
TL;DR: Targeting a systolic BP of <120 mm Hg, when compared with <140 mm’g, resulted in lower nighttime, daytime, and 24-hour systolics BP, but did not change the night/day syStolic BP ratio.
Abstract: The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary...
137 citations
University of Utah1, Kaiser Permanente2, Christiana Care Health System3, Veterans Health Administration4, Boston University5, National Institutes of Health6, University of Alabama at Birmingham7, University of California, Los Angeles8, East Carolina University9, University of Miami10, Medical College of Wisconsin11, Case Western Reserve University12, Columbia University13
TL;DR: In this simulation study, intensive systolic blood‐pressure control prevented cardiovascular disease events and prolonged life and did so at levels below common willingness‐to‐pay thresholds per QALY, regardless of whether benefits were reduced after 5 years or persisted for the patient's remaining lifetime.
Abstract: BackgroundIn the Systolic Blood Pressure Intervention Trial (SPRINT), adults at high risk for cardiovascular disease who received intensive systolic blood-pressure control (target, <120 mm Hg) had significantly lower rates of death and cardiovascular disease events than did those who received standard control (target, <140 mm Hg). On the basis of these data, we wanted to determine the lifetime health benefits and health care costs associated with intensive control versus standard control. MethodsWe used a microsimulation model to apply SPRINT treatment effects and health care costs from national sources to a hypothetical cohort of SPRINT-eligible adults. The model projected lifetime costs of treatment and monitoring in patients with hypertension, cardiovascular disease events and subsequent treatment costs, treatment-related risks of serious adverse events and subsequent costs, and quality-adjusted life-years (QALYs) for intensive control versus standard control of systolic blood pressure. ResultsWe deter...
126 citations
Stanford University1, Wake Forest University2, University of Utah3, Rutgers University4, University of Milan5, George Washington University6, Primary Children's Hospital7, Mayo Clinic8, National and Kapodistrian University of Athens9, University of Pennsylvania10, Tulane University11, University Hospitals of Cleveland12, Case Western Reserve University13, Georgetown University14
TL;DR: It is found that OBPV had no significant associations with the composite end point of fatal and nonfatal cardiovascular events nor with heart failure or stroke, and clinicians should continue to focus on office BP control rather than on O BPV unless definitive benefits of reducing OBPv are shown in prospective trials.
Abstract: Studies of visit-to-visit office blood pressure (BP) variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive ( P =0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective trials. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062
77 citations
University of California, San Francisco1, Cleveland Clinic2, Johns Hopkins University3, University of Southern California4, Tufts Medical Center5, University of Chicago6, University of Alabama at Birmingham7, Ohio State University8, University of California, San Diego9, Emory University10, Georgetown University11, University of California, Los Angeles12, Medical University of South Carolina13, Vanderbilt University Medical Center14, University of Florida15, University of Texas Southwestern Medical Center16, Case Western Reserve University17, Icahn School of Medicine at Mount Sinai18
TL;DR: It is suggested that, during long-term follow-up of the AASK trial, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.
Abstract: We recently showed an association between strict BP control and lower mortality risk during two decades of follow-up of prior participants in the Modification of Diet in Renal Disease (MDRD) trial. Here, we determined the risk of ESRD and mortality during extended follow-up of the African American Study of Kidney Disease and Hypertension (AASK) trial. We linked 1067 former AASK participants with CKD previously randomized to strict or usual BP control (mean arterial pressure ≤92 mmHg or 102-107 mmHg, respectively) to the US Renal Data System and Social Security Death Index; 397 patients had ESRD and 475 deaths occurred during a median follow-up of 14.4 years from 1995 to 2012. Compared with the usual BP arm, the strict BP arm had unadjusted and adjusted relative risks of ESRD of 0.92 (95% confidence interval [95% CI], 0.75 to 1.12) and 0.95 (95% CI, 0.78 to 1.16; P=0.64), respectively, and unadjusted and adjusted relative risks of death of 0.92 (95% CI, 0.77 to 1.10) and 0.81 (95% CI, 0.68 to 0.98; P=0.03), respectively. In meta-analyses of individual-level data from the MDRD and the AASK trials, unadjusted relative risk of ESRD was 0.88 (95% CI, 0.78 to 1.00) and unadjusted relative risk of death was 0.87 (95% CI, 0.76 to 0.99) for strict versus usual BP arms. Our findings suggest that, during long-term follow-up, strict BP control does not delay the onset of ESRD but may reduce the relative risk of death in CKD.
59 citations
TL;DR: In this article, a linear association between higher systolic blood pressure (SBP) and risk of mortality in hemodialysis patients when SBP is measured outside of the dialysis unit (out-of-dialysis-unit-SBP), despite there being a U-shaped association between SBP measured at the kidney unit (dialysis unit) with risk of death.
Abstract: We recently reported a linear association between higher systolic blood pressure (SBP) and risk of mortality in hemodialysis patients when SBP is measured outside of the dialysis unit (out-of-dialysis-unit-SBP), despite there being a U-shaped association between SBP measured at the dialysis unit (dialysis-unit-SBP) with risk of mortality. Here, we explored the relationship between SBP with cardiovascular events, which has important treatment implications but has not been well elucidated. Among 383 hemodialysis participants enrolled in the prospective CRIC study (Chronic Renal Insufficiency Cohort), multivariable splines and Cox models were used to study the association between SBP and adjudicated cardiovascular events (heart failure, myocardial infarction, ischemic stroke, and peripheral artery disease), controlling for differences in demographics, cardiovascular disease risk factors, and dialysis parameters. Dialysis-unit-SBP and out-of-dialysis-unit-SBP were modestly correlated ( r =0.34; P 2-fold increased risk of cardiovascular events compared with those with out-of-dialysis-unit-SBP ≤112 mm Hg (3rd SBP quartile: adjusted hazard ratio, 2.08 [95% confidence interval, 1.12–3.87] and fourth SBP quartile: adjusted hazard ratio, 2.76 [95% confidence interval, 1.42–5.33]). In conclusion, among hemodialysis patients, although there is a U-shaped (paradoxical) association of dialysis-unit-SBP and risk of cardiovascular disease, there is a linear association of out-of-dialysis-unit-SBP with risk of cardiovascular disease. Out-of-dialysis-unit blood pressure provides key information and may be an important therapeutic target.
41 citations
Northwestern University1, University of Pennsylvania2, University of Illinois at Chicago3, George Washington University4, Tulane University5, University of California, Los Angeles6, University of Michigan7, Case Western Reserve University8, Stanford University9, University of California, San Francisco10, Kaiser Permanente11, National Institutes of Health12, Duke University13, Temple University14
TL;DR: In a large, diverse cohort with CKD, significant differences in left ventricular mass and hypertrophic morphology between non-Hispanic Blacks and Whites are found.
12 citations
TL;DR: Baseline TQoL was the only factor that predicted poststroke change in T QoL, and Multivariate regression analysis revealed that baseline TQl was the strongest predictor of poststroke TQOL with similar results for the untransformed QOL.
Abstract: Background and Purpose— The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. Methods— QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan–Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0–1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. Results— After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89–0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00–1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups ( P ≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. Conclusions— The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
4 citations