We investigated the association between blood pressure (BP) and the risk of cardiovascular disease (CVD) in individuals with non-proteinuric chronic kidney disease (CKD) without diabetes. Using a large-scale nationwide administrative claims and health checkup database in Japan, we identified 287,238 non-diabetic adults with an estimated glomerular filtration rate <60 mL/min/1.73 m2 and negative/trace proteinuria. We examined the association between BP and CVD events by modeling BP both as a continuous variable and as a categorical variable according to the 2017 ACC/AHA guideline classification. The primary outcome was a composite of myocardial infarction, stroke, heart failure, and atrial fibrillation. Multivariable Cox regression analyses showed that higher systolic BP (SBP) was associated with increased CVD risk (hazard ratio [HR] 1.05 per 10 mmHg; 95% CI 1.04-1.05). Compared with normal BP, the HRs were 1.03 (95% CI 1.00-1.07) for elevated BP, 1.08 (1.05-1.11) for stage 1 hypertension, and 1.20 (1.17-1.24) for stage 2 hypertension. Restricted cubic spline analysis showed an increase in CVD risk at SBP levels above ~130 mmHg. However, among individuals receiving antihypertensive medication, a U-shaped association was observed, with an increased risk also evident at SBP levels below ~130 mmHg. In individuals with non-proteinuric CKD without diabetes, higher SBP was positively associated with increased cardiovascular risk. However, a U-shaped association observed among individuals receiving antihypertensive treatment suggests that the relationship between BP and cardiovascular risk may be complex in this population, highlighting the potential importance of individualized clinical assessment.
Yuta Suzuki, Masachika Nishikawa, Hidehiro Kaneko et al.· Hypertension Research· 0 citations
BACKGROUND
Diagnosis of heart failure with preserved left ventricular ejection fraction (HFpEF) remains a significant clinical challenge, particularly in patients with atrial fibrillation (AF). Recently, the HFA-PEFF score was introduced to aid in the diagnostic work-up of HFpEF. This study aimed to investigate the distribution of the HFA-PEFF score and its relationship with left atrial (LA) function, pressure, and reverse remodeling in patients with AF.
METHODS
We investigated 155 AF patients who underwent their first catheter ablation (CA). Echocardiography was performed before CA, and the HFA-PEFF score was calculated. Direct LA pressure (LAP) was measured at CA. Echocardiography was repeated 6 months after CA to evaluate LA reverse remodeling.
RESULTS
High (5-6), intermediate (2-4) and low (0-1) HFA-PEFF scores were observed in 19 (12.3%), 99 (63.9%) and 37 (23.9%) patients, respectively. Higher HFA-PEFF scores were associated with worse LA function and LA stiffness (both P<0.05). Elevated LAP was detected in 31.6%, 19.2%, and 5.4% of the high, intermediate, and low HFA-PEFF score groups, respectively. In the intermediate HFA-PEFF score group, LA stiffness was a good predictor of elevated LAP, whereas left ventricular global longitudinal strain was more predictive in the high HFA-PEFF score group. Six months after CA, all groups exhibited LA reverse remodeling, while the high-score group retained larger LA size and worse LA function.
CONCLUSIONS
Higher HFA-PEFF scores were associated with advanced LA functional remodeling and elevated LAP in AF patients. Persistent LA remodeling after CA in the high-score group demonstrates the need for careful follow-up.
Satoshi Konoma, K. Nakanishi, M. Daimon et al.· Journal of the American Soci...· 0 citations
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