Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years

Sousa, Andréa Cristina de; Jardim, Thiago Veiga; Costa, Thiago Oliveira; Magalhães, Fabrício Galdino; Montelo, Marcos Paulo Marinho; Souza, Weimar Kunz Barroso De; Jardim, Paulo César Brandão Veiga; Sousa, Ana Luíza Lima

doi:10.1186/s13098-017-0296-z

Cited by 8 publications

(6 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 4 , 5 , 31 Hypertension-mediated organ damage represents the result of the direct and indirect effect of chronic pressure overload, intensified by the harmful impact of additional cardiovascular risk factors possibly coexisting, with a negative impact on cardiovascular prognosis. 32 Hypertension-mediated organ damage often clusters together, reflecting the extension of the hypertensive burden. 12 …”

Section: Discussionmentioning

confidence: 99%

Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events

Lembo,

Pacella,

Manzi

et al. 2023

European Heart Journal Open

View full text Add to dashboard Cite

Background Chronic pressure overload determines functional and structural alterations, leading to hypertension-mediated organ damage (HMOD), affecting multiple districts. We aim at evaluating the prognostic impact of absence vs presence of HMOD in one or more sites and of blood pressure (BP) and metabolic control in hypertensive patients. Methods The study included 7,237 hypertensive patients from the Campania Salute Network Registry, followed-up for 5.3 ± 4.5years. As HMOD we analysed the presence of left ventricular hypertrophy, carotid plaques and chronic kidney disease (CKD-EPI ≥ 3 stage) and evaluated the impact of 0vs1 vs2 vs3 sites of HMOD on occurrence of major adverse cardiovascular events (MACE). BP control and METS-IR (Metabolic-Score-for-Insulin-Resistance) were also considered. Results Optimal BP control was achieved in 57.3% of patients. MACE occurred in 351 (4.8%) patients. MACE rate in patients without HMOD was 2.7%, whereas it was 4.7%, 7.9% and 9.8% in patients with 1, 2 and 3 sites with HMOD, respectively. By Cox multivariate models, adjusted for age, BP control, mean heart rate, mean METS-IR, number of HMOD sites and drugs, MACE resulted significantly associated with aging, mean METS-IR, antiplatelet therapy, and multiple sites with HMOD, whereas a negative association was found with renin-angiotensin-system inhibitor drugs. Conclusions In hypertensive patients, the risk of MACE increases with the incremental number of districts involved by HMOD, independently of BP control and despite the significant impact of metabolic dysregulation. HMOD involving multiple sites is the deleterious consequence of hypertension and dysmetabolism but, when established, it represents an independent cardiovascular risk factor for MACE occurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events

Lembo,

Pacella,

Manzi

et al. 2023

European Heart Journal Open

View full text Add to dashboard Cite

show abstract

“…Given the positive results of the present study and previous studies involving patients from the same HTN treatment center, 14,16,17,33,34 the format adopted in our service can be a model for other centers handling patients diagnosed with HTN and aiming to implement a team-based strategy.…”

Section: Discussionmentioning

confidence: 73%

Controle da Pressão Arterial e Fatores Associados em um Serviço Multidisciplinar de Tratamento da Hipertensão

Jardim¹,

Souza²,

Barroso³

et al. 2020

Arquivos Brasileiros De Cardiologia

Self Cite

View full text Add to dashboard Cite

Background: Although team-based care is recommended for patients with hypertension, results of this intervention in a real-world setting are missing in the literature. Objective: To report the results of a real-world long-term team-based care for hypertensive patients we conducted this study. Methods: Data of hypertensive patients attending a multidisciplinary treatment center located in the Midwest region of Brazil in June 2017 with at least two follow-up visits were retrospectively assessed. Anthropometric, blood pressure (BP), follow-up time, pharmacological treatment, diabetes and lifestyle data were collected from the last visit to the service. BP values < 140 x 90 mmHg in non-diabetics and < 130 x 80 mmHg in diabetics were considered controlled. A logistic regression model was built to identify variables independently associated to BP control. Significance level adopted p < 0.05. Results: A total of 1,548 patients were included, with a mean follow-up time of 7.6 ± 7.1 years. Most patients were female (73.6%; n=1,139) with a mean age of 61.8 ±12.8 years. BP control rates in all the sample, and in non-diabetics and diabetics were 68%, 79%, and 37.9%, respectively. Diabetes was inversely associated with BP control (OR 0.16; 95%CI 0.12-0.20; p<0.001) while age ≥ 60 years (OR 1.48; 95%CI 1.15-1.91; p=0.003) and female sex (OR 1.38; 95%CI 1.05-1.82; p=0.020) were directly associated. Conclusions: A BP control rate around 70% was found in patients attending a multidisciplinary team care center for hypertension. Focus on patients with diabetes, younger than 60 years and males should be given to further improve these results.

show abstract

“…Although our multidisciplinary service has always focused on the overall patient management it is primarily specialized in hypertension treatment, which can explain this finding. Previous studies conducted in the same setting also showed good results in blood pressure management [ 11 , 21 ] which must be simultaneously seen as extremely positive and as a call for action to improve management of other co-morbidities.…”

Section: Discussionmentioning

confidence: 91%

Multidisciplinary treatment of patients with diabetes and hypertension: experience of a Brazilian center

Jardim

Inuzuka

Galvão

et al. 2018

Diabetol Metab Syndr

Self Cite

View full text Add to dashboard Cite

BackgroundAlthough multidisciplinary treatment is recommended for type 2 diabetes mellitus and hypertension (HTN), there is a lack of scientific literature supporting the hypothesis of extending this treatment strategy to patients with both diabetes and HTN. Aiming to report results of long-term multidisciplinary treatment for these patients and identify strategies to improve their management, we conducted this study.MethodsData of patients with diabetes and HTN with regular follow-up visits in a multidisciplinary HTN treatment center from Brazil’s Midwest were retrospectively assessed. Patients ≥ 18 years enrolled in the service by June 2017 with a minimum of three visits were included. Anthropometric, blood pressure (BP), laboratory, pharmacological treatment, lifestyle, and cardiovascular events data were collected from first (V1), intermediate (V2) and most recent (V3) visits to the service. BP < 130 × 80 mmHg, LDL-cholesterol (LDL-C) < 70 mg/dL and HbA1C < 7.0% were defined as treatment targets. Wilcoxon signed-rank test was used to compare variables along study visits. A linear regression model was built to identify variables associated with better overall patient control.ResultsA total of 162 patients were included (mean age of 56.5 ± 10.8 years). Median follow-up time was 60 (IQR 40–109) months, 80.2% of the sample was female and 83.3% had no cardiovascular event history. BP, total cholesterol, LDL-C, triglycerides and HbA1C values showed a significant trend to improve along the study visits (p < 0.001). Growing trend in aspirin (p = 0.045) and statins (p < 0.001) use was found, in addition to treatment compliance increase (p < 0.001). Significant improvement trends in BP (p < 0.001), LDL-C (p = 0.004) and HbA1C (p = 0.002) control were also found across visits. Control rates of BP, LDL-C and HbA1C in combination were low in V1, V2 and V3 (1.2, 1.9 and 6.8%, respectively), but showed significant improvement trend (p < 0.001). Treatment compliance (β-coefficient = 1.20; 95% CI 1.07–1.34; p < 0.001) was positively associated with better overall patients control.ConclusionsMultidisciplinary treatment of patients with diabetes and HTN significantly improved clinical and laboratory parameters, despite ageing of population evaluated. Although combined control of HbA1C, BP and LDL-cholesterol increased along follow-up, management of all these three conditions needs to improve, and focus on treatment compliance should be given to attain this goal.

show abstract

Hypertensive diabetic patients: incidence of cardiovascular and renal outcomes in a historical cohort over 11 years

Cited by 8 publications

References 39 publications

Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events

Hypertension-mediated organ damage involving multiple sites is an independent risk factor for cardiovascular events

Controle da Pressão Arterial e Fatores Associados em um Serviço Multidisciplinar de Tratamento da Hipertensão

Multidisciplinary treatment of patients with diabetes and hypertension: experience of a Brazilian center

Contact Info

Product

Resources

About