Impact of 2021 ESC Guidelines for Cardiovascular Disease Prevention on Hypertensive Patients Risk: Secondary Analysis of Save Your Heart Study

Pinto, Rita Del; Giua, Corrado; Keber, Enrico; Grippa, Eleonora; Tilotta, Marco; Ferri, Claudio

doi:10.1007/s40292-023-00568-3

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…Other authors emphasize a global approach and the strict control of all risk factors in hypertensive patients, who usually have poor control of other factors. 40 The American College of Cardiology/American Heart Association 9 recommends drug treatment in adults in primary prevention with SBP 130 to 139 mm Hg (16.4% in our study) and high-CVR (20.7% of them); according to our data, ≈30% of adults would require drug treatment (27.4% with SBP ≥140 mm Hg and 3.4% with 130-139 mm Hg at high risk). These numbers are slightly lower to those found in other studies (32%-37%), [41][42][43] but these studies included secondary prevention patients.…”

Section: Discussionmentioning

confidence: 51%

“…Other authors emphasize a global approach and the strict control of all risk factors in hypertensive patients, who usually have poor control of other factors. 40…”

Section: Discussionmentioning

confidence: 99%

“…In other studies, 3 measurements were taken and the results were similar as with 2. 40 Information bias was minimized because calibrated BP devices were used and high-quality measurement of all parameters (including a central laboratory for processing all blood samples) was performed. In addition, all the primary care medical records and hospital reports of each participant were comprehensively reviewed.…”

Section: Limitationsmentioning

confidence: 99%

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Prognosis of Systolic Pressure 130 to 139 According to Risk. A Prospective Cohort Study Between 1992 and 2019

Divison-Garrote,

Carbayo-Herencia,

Simarro-Rueda

et al. 2023

Hypertension

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Background: Guidelines recommend pharmacological treatment for systolic blood pressure (SBP) of 130 to 139 mm Hg in secondary prevention. However, uncertainty persists in primary prevention in low cardiovascular risk patients (CVR). Methods: Cohort study representative of the general population of Albacete/Southeast Spain. We examined 1029 participants with untreated BP and free of cardiovascular disease, followed-up during 1992 to 2019. Cox regression modeled the association of SBP with cardiovascular morbidity and mortality (outcome-1) and cardiovascular morbidity and all-cause mortality (outcome-2). Results: Participants’ mean age was 44.8 years (53.8%, women; 77.1% at low-CVR); 20.3% had SBP 120 to 129; 13.0% 130 to 139 at low-CVR and 3.4% at high-CVR; and 27.4% ≥140 mm Hg. After a 25.7-year median follow-up, 218 outcome-1 and 302 outcome-2 cases occurred. Unadjusted hazard ratios (HR) of outcome-1 for these increasing SBP categories (versus <120) were 2.72, 2.27, 11.54, and 7.52, respectively; and 2.69, 2.32, 10.55, and 7.34 for outcome-2 (all P <0.01). After adjustment for other risk factors, hazard ratio (95% CI) of outcome-1 were 1.49 (0.91–2.44), 1.65 (0.94–2.91, P =0.08), 1.36 (0.72–2.57), and 1.82 (1.15–2.88), respectively, and 1.39 (0.91–2.11), 1.69 (1.05–2.73), 1.09 (0.63–1.88), and 1.64 (1.11–2.41) for outcome-2. Compared with 130 to 139 at low-CVR, hazard ratio for 130 to 139 at high-CVR was 4.85 for outcome-1 ( P <0.001) and 4.43 for outcome-2 ( P <0.001). Conclusions: In this primary prevention population of relatively young average age, untreated SBP of 130 to 139 mm Hg at low-CVR had long-term prognostic value and might benefit from stricter SBP targets. High-CVR patients had nonsignificant higher risk (limited sample size) but 4-fold greater risk when compared with low-CVR. Overall, results indicate the importance of risk stratification, supporting risk-based decision-making.

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Section: Discussionmentioning

confidence: 51%

“…Other authors emphasize a global approach and the strict control of all risk factors in hypertensive patients, who usually have poor control of other factors. 40…”

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Prognosis of Systolic Pressure 130 to 139 According to Risk. A Prospective Cohort Study Between 1992 and 2019

Divison-Garrote,

Carbayo-Herencia,

Simarro-Rueda

et al. 2023

Hypertension

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“… 28 Escalation of inhaled therapy according to the current “treat-to-fail” strategy may therefore fall short in comprehensively addressing individual risk as part of a preventative approach. Risk-based management is an established, evidence-based strategy in numerous therapeutic areas including, eg, cardiovascular medicine, 29 diabetes, 30 or osteoporosis 31 treatment. Identifying at-risk COPD patients prior to the occurrence of exacerbations is therefore pivotal to implement preventative interventions earlier in the course of the disease.…”

Section: Discussionmentioning

confidence: 99%

Real-World Effectiveness of Fluticasone Furoate/Umeclidinium/Vilanterol Once-Daily Single-Inhaler Triple Therapy for Symptomatic COPD: The ELLITHE Non-Interventional Trial

Beeh,

Scheithe,

Schmutzler

et al. 2024

COPD

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Purpose Real-life effectiveness data on once-daily single-inhaler triple therapy (odSITT) with the inhaled corticosteroid fluticasone furoate (FF), the long-acting muscarinic antagonist umeclidinium (UMEC), and the long-acting β 2 -agonist vilanterol (VI) in patients with chronic obstructive pulmonary disease (COPD) are important to complement evidence from well-controlled randomized clinical trials. Effectiveness of odSITT was quantified by assessing health status and symptoms in usual care. Patients and Methods ELLITHE was a single-country (Germany), multicenter, open-label, non-interventional effectiveness study between 2020 and 2022, evaluating the effect of treatment initiation with FF/UMEC/VI 100/62.5/25 µg once-daily via the ELLIPTA inhaler on improvements in clinical outcomes versus baseline in COPD patients. The primary endpoint was the change in the total COPD Assessment Test (CAT) score between baseline and month 12. Key secondary endpoints included change in CAT score over time, occurrence of exacerbations until month 12, changes in forced expiratory volume in one second (FEV 1 ), inhaler adherence, and safety. Results Nine hundred and six patients were included (age 66.6 years, 55.6% male, mean FEV 1 52.6% of predicted, mean CAT 21.5 units, 1.4 exacerbations/year pre-study). About 63.9% of patients were escalated from dual therapies, and 18% were switched from multiple-inhaler triple therapies. Reductions in CAT score at month 12 were statistically significant and above the threshold of clinical importance (−2.6 units; p < 0.0001). CAT score also improved at interim visits. CAT improvements were more pronounced in patients with high baseline scores and better inhaler adherence. Exacerbations during follow-up were rare (0.2 events/year) compared to pre-study (1.4 events/year). FEV 1 was improved by 93 mL (p < 0.0001). No new safety effects were observed. Conclusion In usual care, treatment with odSITT resulted in significant and clinically relevant improvements of CAT score and FEV 1 in COPD patients, regardless of the occurrence of exacerbations. These findings challenge the current guideline recommendations for SITT only in patients experiencing exacerbations.

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“…— no implementation of latest available pharmacological options and instead continuation of therapy with older, less effective drugs [ 24 ];…”

Section: Struggle Formentioning

confidence: 99%

STRUGGLE FOR. Italian-Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023 for better control of classical modifiable risk factors in clinical practice

Filipiak,

Barrios,

Ferri

et al. 2023

Cardiol J.

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The progress in pharmacotherapy that has been made in recent years, including the introduction of very effective and safe lipid-lowering and antihypertensive drugs, has not yet translated into the expected universal control of blood pressure, lipid disorders and diabetes. In the STRUGGLE FOR Italian-Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023, experts from five countries recounted several points about the paradigms of cardiological and cardiometabolic care for better control of classical modifiable risk factors in the year 2023. It is believed herein, that the need to intensify treatment, actively search for patients with cardiovascular risk factors, especially with arterial hypertension, hypercholesterolemia and diabetes, should go hand in hand with the implementation of the latest therapy, based on single pill combinations including proven, effective antihypertensive, lipid-lowering and antidiabetic molecules, many of which are listed in the present document. There is a need to use both new technological concepts, completely new drugs, as well as novel treatment concepts such as metabolic treatment in coronary artery disease, try to intensify the fight against smoking in every way, including the available range of drugs and procedures reducing the harm. This approach will provide substantially better control of the underlying cardiovascular risk factors in countries as varied as Italy, Poland, Spain, Uzbekistan and Vietnam.

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Impact of 2021 ESC Guidelines for Cardiovascular Disease Prevention on Hypertensive Patients Risk: Secondary Analysis of Save Your Heart Study

Cited by 9 publications

References 20 publications

Prognosis of Systolic Pressure 130 to 139 According to Risk. A Prospective Cohort Study Between 1992 and 2019

Prognosis of Systolic Pressure 130 to 139 According to Risk. A Prospective Cohort Study Between 1992 and 2019

Real-World Effectiveness of Fluticasone Furoate/Umeclidinium/Vilanterol Once-Daily Single-Inhaler Triple Therapy for Symptomatic COPD: The ELLITHE Non-Interventional Trial

STRUGGLE FOR. Italian-Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023 for better control of classical modifiable risk factors in clinical practice

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