Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis
Pulse pressure (PP), a marker of arterial system properties, has been linked to cardiovascular (CV) complications. We examined (a) association between unit changes of PP and (i) composite CV outcomes and (ii) development of left-ventricular hypertrophy (LVH) and (b) effect of mean arterial pressure...
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| Format: | Article |
| Language: | English |
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Wiley
2013-01-01
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| Series: | International Journal of Nephrology |
| Online Access: | http://dx.doi.org/10.1155/2013/120167 |
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| author | Otelio Randall John Kwagyan Tamrat Retta Kenneth Jamerson Velvie Pogue Keith Norris Muluemebet Ketete Shichen Xu Tom Greene Xuelei Wang Lawrence Agodoa |
| author_facet | Otelio Randall John Kwagyan Tamrat Retta Kenneth Jamerson Velvie Pogue Keith Norris Muluemebet Ketete Shichen Xu Tom Greene Xuelei Wang Lawrence Agodoa |
| author_sort | Otelio Randall |
| collection | DOAJ |
| description | Pulse pressure (PP), a marker of arterial system properties, has been linked to cardiovascular (CV) complications. We examined (a) association between unit changes of PP and (i) composite CV outcomes and (ii) development of left-ventricular hypertrophy (LVH) and (b) effect of mean arterial pressure (MAP) control on rate of change in PP. We studied 1094 nondiabetics with nephrosclerosis in the African American Study of Kidney Disease and Hypertension. Subjects were randomly assigned to usual MAP goal (102–107 mmHg) or a lower MAP goal (≤92 mmHg) and randomized to beta-blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker. After covariate adjustment, a higher PP was associated with increased risk of CV outcome (RR = 1.28, CI = 1.11–1.47, P<0.01) and new LVH (RR = 1.26, CI = 1.04–1.54, P=0.02). PP increased at a greater rate in the usual than in lower MAP groups (slope ± SE: 1.08 ± 0.15 versus 0.42 ± 0.15 mmHg/year, P=0.002), but not by the antihypertensive treatment assignment. Observations indicate that control to a lower MAP slows the progression of PP, a correlate of cardiovascular remodeling and complications, and may be beneficial to CV health. |
| format | Article |
| id | doaj-art-222a2b56676647238a2009a031617a2a |
| institution | Kabale University |
| issn | 2090-214X 2090-2158 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Nephrology |
| spelling | doaj-art-222a2b56676647238a2009a031617a2a2025-02-03T01:24:35ZengWileyInternational Journal of Nephrology2090-214X2090-21582013-01-01201310.1155/2013/120167120167Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with NephrosclerosisOtelio Randall0John Kwagyan1Tamrat Retta2Kenneth Jamerson3Velvie Pogue4Keith Norris5Muluemebet Ketete6Shichen Xu7Tom Greene8Xuelei Wang9Lawrence Agodoa10Howard University, College of Medicine, Washington, DC 20060, USAHoward University, College of Medicine, Washington, DC 20060, USAHoward University, College of Medicine, Washington, DC 20060, USAUniversity of Michigan, Ann Arbor, MI 48109, USAHarlem Hospital Center, New York, NY 10037, USAMartin Luther King/Charles R. Drew University of Medicine, Los Angeles, CA 90059, USAHoward University, College of Medicine, Washington, DC 20060, USAHoward University, College of Medicine, Washington, DC 20060, USAUniversity of Utah, Salt Lake City, UT 84112, USAThe Cleveland Clinic Foundation, Cleveland, OH 44195, USANational Institute of Health, Bethesda, MD 66420, USAPulse pressure (PP), a marker of arterial system properties, has been linked to cardiovascular (CV) complications. We examined (a) association between unit changes of PP and (i) composite CV outcomes and (ii) development of left-ventricular hypertrophy (LVH) and (b) effect of mean arterial pressure (MAP) control on rate of change in PP. We studied 1094 nondiabetics with nephrosclerosis in the African American Study of Kidney Disease and Hypertension. Subjects were randomly assigned to usual MAP goal (102–107 mmHg) or a lower MAP goal (≤92 mmHg) and randomized to beta-blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker. After covariate adjustment, a higher PP was associated with increased risk of CV outcome (RR = 1.28, CI = 1.11–1.47, P<0.01) and new LVH (RR = 1.26, CI = 1.04–1.54, P=0.02). PP increased at a greater rate in the usual than in lower MAP groups (slope ± SE: 1.08 ± 0.15 versus 0.42 ± 0.15 mmHg/year, P=0.002), but not by the antihypertensive treatment assignment. Observations indicate that control to a lower MAP slows the progression of PP, a correlate of cardiovascular remodeling and complications, and may be beneficial to CV health.http://dx.doi.org/10.1155/2013/120167 |
| spellingShingle | Otelio Randall John Kwagyan Tamrat Retta Kenneth Jamerson Velvie Pogue Keith Norris Muluemebet Ketete Shichen Xu Tom Greene Xuelei Wang Lawrence Agodoa Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis International Journal of Nephrology |
| title | Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis |
| title_full | Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis |
| title_fullStr | Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis |
| title_full_unstemmed | Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis |
| title_short | Effect of Intensive Blood Pressure Control on Cardiovascular Remodeling in Hypertensive Patients with Nephrosclerosis |
| title_sort | effect of intensive blood pressure control on cardiovascular remodeling in hypertensive patients with nephrosclerosis |
| url | http://dx.doi.org/10.1155/2013/120167 |
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