The Modification of Diet in Renal Disease (MDRD) Study equation underestimates glomerular filtration rate (GFR) in patients with mild kidney disease. Levey and associates therefore developed and va...

/pdf/a-new-equation-to-estimate-glomerular-filtration-rate-5fqjpsnzwg.pdf

A New Equation to Estimate Glomerular Filtration Rate

http://ggdpathway.wustl.edu/files/2014/08/ACMG-Guidelines-2015_Richards-et-al.pdf

Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology.

The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Racial differences in the attainment of cardiovascular risk factor goals among insured adults with diabetes mellitus

https://www.lipidjournal.com/article/S1933-2874(12)00096-7/pdf

Changes in Lipoprotein Particle Number with Ezetimibe/Simvastatin Co-administered with Extended-Release Niacin in Patients with Type II Hyperlipidemia†

The original use of risk prediction models was generally confined to single data sets. Several variables were employed, and a logistic regression or Cox proportional hazards model was used to predict an outcome for persons who participated in a study with a cross-sectional or longitudinal study design. The area under the curve for the (sensitivity versus (1-specificity) plot was used as a key metric for the performance of the model and the discrimination between a case and a non-case in cohort studies [1]. Subsequent research led to transporting prediction models to other settings where similar data for the predictor variables and outcomes were available. This adaptation of prediction functions led to assessments of model reliability in other settings and the need for calibration of the initial model to improve prediction in secondary data sets. Discrimination and calibration have become well-accepted metrics that are used by clinical researchers and biostatisticians. This science has provided a proving ground for the comparison of multiple studies that have used similar predictor variables and outcomes. A case in point is the 2001 NHLBI workshop that evaluated prediction of coronary heart disease events in a large number of US cohort studies [2]. Clinical researchers continue to work on improving risk prediction. A key starting point is to ensure that reliable input measurements and outcomes are used, outcomes are adjudicated, and the number of subjects lost to follow up is minimized in cohort studies. It is important to accurately and precisely measure the key variables used in the analyses. For example, a cardiovascular prediction model might be based on the predictor variables age (continuous), sex (male/female), hypertension (yes/no), elevated cholesterol (yes/no), diabetes mellitus (yes/no), and current smoking (yes/no). The outcome might be myocardial infarction as determined by the electrocardiogram. A more sophisticated model that would be more likely to have better predictive capability and probably greater usefulness would have the predictor variables age (continuous), sex (male/female), systolic pressure (continuous), LDL cholesterol level (continuous), HDL cholesterol level (continuous), diabetes mellitus (yes/no), and current smoking (yes/no). The utilization of continuous measures in this setting more accurately characterizes the persons at risk. Additionally, the outcome myocardial infarction would be more accurately described in the modern era if it included electrocardiographic changes, blood test changes diagnostic of acute myocardial infarction, and possible inclusion of sudden cardiac death. This line of reasoning is more likely to provide reliable and reproducible risk protection models that might be used in one locale and then reliably translated to another site. The first Pencina article in this issue presents to assess the impact of calibration on the newer metrics of model performance. The authors evaluate four performance metrics, including Area under the Curve (AUC), discrimination slope, R-model, and R-residuals. The authors highlight the fact that poor calibration can lead to misleading results. They note that simple calibration using the criteria slope = 1 and intercept = 0 is not sufficient [3]. It is likely that future manuscripts assessing calibration will use an extended metrics approach to help readers assess how and why calibration is undertaken when transporting prediction models from one study to the next.

Risk assessment with newer statistical metrics: Risk Assessment with Newer Statistical Metrics

901-81 Association of a Molecular Variant of the Angiotensinogen Gene and Hypertension

In 2013, the American College of Cardiology/American Heart Association published guidelines for atherosclerotic cardiovascular disease (ASCVD) risk assessment.1 They recommended that clinicians calculate ASCVD risk for adult patients and based cholesterol treatment recommendations on these estimates. Persons with severe hypercholesterolemia or those known to have ASCVD were considered to be at high risk for clinical ASCVD, and they fell outside the purview of risk assessment. The remainder, which included most middle-age and older Americans with and without diabetes mellitus, were candidates for ASCVD risk assessment. A reasonable interval has elapsed to evaluate the strategy put forward and to contemplate changes that might improve prevention. Critical issues include how well does the current ASCVD algorithm identify persons who subsequently develop ASCVD events, and can they be improved? Should segments of the US population receive more attention? How can the ASCVD risk estimates be augmented?

The 2013 guidelines provided new functions to estimate ASCVD risk in a 10-year time frame, applicable to millions of American adults 40 to 79 years of age, and the committee also suggested considering 30-year and lifetime risk.1 Several American longitudinal population studies served as data sources …

Peter W.F. Wilson

Papers

Racial differences in the attainment of cardiovascular risk factor goals among insured adults with diabetes mellitus

Changes in Lipoprotein Particle Number with Ezetimibe/Simvastatin Co-administered with Extended-Release Niacin in Patients with Type II Hyperlipidemia†

Risk assessment with newer statistical metrics: Risk Assessment with Newer Statistical Metrics

901-81 Association of a Molecular Variant of the Angiotensinogen Gene and Hypertension

Estimation of Risk for Initial Atherosclerotic Cardiovascular Disease Events: Taking Stock and Moving Forward.