Pub Date : 2017-06-01Epub Date: 2017-01-19DOI: 10.1016/j.amjmed.2017.01.004
Sripal Bangalore, Bora Toklu, Eugenia Gianos, Arthur Schwartzbard, Howard Weintraub, Gbenga Ogedegbe, Franz H Messerli
Background: The optimal on-treatment blood pressure (BP) target has been a matter of debate. The recent SPRINT trial showed significant benefits of a BP target of <120 mm Hg, albeit with an increase in serious adverse effects related to low BP.
Methods: PubMed, EMBASE, and CENTRAL were searched for randomized trials comparing treating with different BP targets. Trial arms were grouped into 5 systolic BP target categories: 1) <160 mm Hg, 2) <150 mm Hg, 3) <140 mm Hg, 4) <130 mm Hg, and 5) <120 mm Hg. Efficacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure, and safety outcomes of serious adverse effects were evaluated using a network meta-analysis.
Results: Seventeen trials that enrolled 55,163 patients with 204,103 patient-years of follow-up were included. There was a significant decrease in stroke (rate ratio [RR] 0.54; 95% confidence interval [CI], 0.29-1.00) and myocardial infarction (RR 0.68; 95% CI, 0.47-1.00) with systolic BP <120 mm Hg (vs <160 mm Hg). Sensitivity analysis using achieved systolic BP showed a 72%, 97%, and 227% increase in stroke with systolic BP of <140 mm Hg, <150 mm Hg, and <160 mm, respectively, when compared with systolic BP <120 mm Hg. There was no difference in death, cardiovascular death, or heart failure when comparing any of the BP targets. However, the point estimate favored lower BP targets (<120 mm Hg, <130 mm Hg) when compared with higher BP targets (<140 mm Hg or <150 mm Hg). BP targets of <120 mm Hg and <130 mm Hg ranked #1 and #2, respectively, as the most efficacious target. There was a significant increase in serious adverse effects with systolic BP <120 mm Hg vs <150 mm Hg (RR 1.83; 95% CI, 1.05-3.20) or vs <140 mm Hg (RR 2.12; 95% CI, 1.46-3.08). BP targets of <140 mm Hg and <150 mm Hg ranked #1 and #2, respectively, as the safest target for the outcome of serious adverse effects. Cluster plots for combined efficacy and safety showed that a systolic BP target of <130 mm Hg had optimal balance between efficacy and safety.
Conclusions: In patients with hypertension, a on-treatment systolic BP target of <130 mm Hg achieved optimal balance between efficacy and safety.
{"title":"Optimal Systolic Blood Pressure Target After SPRINT: Insights from a Network Meta-Analysis of Randomized Trials.","authors":"Sripal Bangalore, Bora Toklu, Eugenia Gianos, Arthur Schwartzbard, Howard Weintraub, Gbenga Ogedegbe, Franz H Messerli","doi":"10.1016/j.amjmed.2017.01.004","DOIUrl":"10.1016/j.amjmed.2017.01.004","url":null,"abstract":"<p><strong>Background: </strong>The optimal on-treatment blood pressure (BP) target has been a matter of debate. The recent SPRINT trial showed significant benefits of a BP target of <120 mm Hg, albeit with an increase in serious adverse effects related to low BP.</p><p><strong>Methods: </strong>PubMed, EMBASE, and CENTRAL were searched for randomized trials comparing treating with different BP targets. Trial arms were grouped into 5 systolic BP target categories: 1) <160 mm Hg, 2) <150 mm Hg, 3) <140 mm Hg, 4) <130 mm Hg, and 5) <120 mm Hg. Efficacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure, and safety outcomes of serious adverse effects were evaluated using a network meta-analysis.</p><p><strong>Results: </strong>Seventeen trials that enrolled 55,163 patients with 204,103 patient-years of follow-up were included. There was a significant decrease in stroke (rate ratio [RR] 0.54; 95% confidence interval [CI], 0.29-1.00) and myocardial infarction (RR 0.68; 95% CI, 0.47-1.00) with systolic BP <120 mm Hg (vs <160 mm Hg). Sensitivity analysis using achieved systolic BP showed a 72%, 97%, and 227% increase in stroke with systolic BP of <140 mm Hg, <150 mm Hg, and <160 mm, respectively, when compared with systolic BP <120 mm Hg. There was no difference in death, cardiovascular death, or heart failure when comparing any of the BP targets. However, the point estimate favored lower BP targets (<120 mm Hg, <130 mm Hg) when compared with higher BP targets (<140 mm Hg or <150 mm Hg). BP targets of <120 mm Hg and <130 mm Hg ranked #1 and #2, respectively, as the most efficacious target. There was a significant increase in serious adverse effects with systolic BP <120 mm Hg vs <150 mm Hg (RR 1.83; 95% CI, 1.05-3.20) or vs <140 mm Hg (RR 2.12; 95% CI, 1.46-3.08). BP targets of <140 mm Hg and <150 mm Hg ranked #1 and #2, respectively, as the safest target for the outcome of serious adverse effects. Cluster plots for combined efficacy and safety showed that a systolic BP target of <130 mm Hg had optimal balance between efficacy and safety.</p><p><strong>Conclusions: </strong>In patients with hypertension, a on-treatment systolic BP target of <130 mm Hg achieved optimal balance between efficacy and safety.</p>","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"1 1","pages":"707-719.e8"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83880187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2016.09.003
Kim Fasula, C. Evans, L. Boyd, Lori J. Giblin, Benjamin Z. Belavsky, S. Hetzel, P. Mcbride, D. DeMets, C. Hennekens
{"title":"Randomized Trial of Plaque-Identifying Toothpaste: Decreasing Plaque and Inflammation.","authors":"Kim Fasula, C. Evans, L. Boyd, Lori J. Giblin, Benjamin Z. Belavsky, S. Hetzel, P. Mcbride, D. DeMets, C. Hennekens","doi":"10.1016/j.amjmed.2016.09.003","DOIUrl":"https://doi.org/10.1016/j.amjmed.2016.09.003","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"30 1","pages":"746-749"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91543679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2017.01.011
E. McDonald, R. Saleh, T. Lee
{"title":"Mindfulness-Based Laboratory Reduction: Reducing Utilization Through Trainee-Led Daily 'Time Outs'.","authors":"E. McDonald, R. Saleh, T. Lee","doi":"10.1016/j.amjmed.2017.01.011","DOIUrl":"https://doi.org/10.1016/j.amjmed.2017.01.011","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"43 1","pages":"e241-e244"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78730412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2016.12.042
Joseph A. Moore, Siayareh Rambally
{"title":"Fusobacterium nucleatum Bacteremia Presenting with Portal Vein Thrombosis: An Abdominal Lemierre Syndrome?","authors":"Joseph A. Moore, Siayareh Rambally","doi":"10.1016/j.amjmed.2016.12.042","DOIUrl":"https://doi.org/10.1016/j.amjmed.2016.12.042","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"31 1","pages":"e255-e256"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73350349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2017.01.019
S. Rowe, Kristen H Rowe, P. Hill, Pamela T. Johnson
{"title":"Challenges in Quality Improvement: Appropriate Utilization of Computed Tomography Angiograms for Evaluation of Pulmonary Embolism.","authors":"S. Rowe, Kristen H Rowe, P. Hill, Pamela T. Johnson","doi":"10.1016/j.amjmed.2017.01.019","DOIUrl":"https://doi.org/10.1016/j.amjmed.2017.01.019","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"26 1","pages":"652-656"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78116087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2017.02.002
Ethan Craig, R. Sedighi Manesh, J. Cuda, A. Gelber
{"title":"Labial Pain, Swelling and Fever: An Autoinflammatory Disorder.","authors":"Ethan Craig, R. Sedighi Manesh, J. Cuda, A. Gelber","doi":"10.1016/j.amjmed.2017.02.002","DOIUrl":"https://doi.org/10.1016/j.amjmed.2017.02.002","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"1 1","pages":"662-665"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90296894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2016.12.037
V. Serebruany, Seth D Fortmann, Vasily Cherepanov, O. Litvinov, Moo-Hyun Kim, T. Marciniak
{"title":"Excess Ticagrelor Mortality in the Food and Drug Administration Adverse Event Reporting System: Time to Recount PLATO Trial Deaths.","authors":"V. Serebruany, Seth D Fortmann, Vasily Cherepanov, O. Litvinov, Moo-Hyun Kim, T. Marciniak","doi":"10.1016/j.amjmed.2016.12.037","DOIUrl":"https://doi.org/10.1016/j.amjmed.2016.12.037","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"458 1","pages":"e245-e246"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74833433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2017.01.010
G. Dimitriadis, G. Kaltsas, T. Ghobara, B. Sinha, Eftychia E. Drakou, K. Gopalakrishnan, C. Kosmas, S. Keay, D. Grammatopoulos, H. Randeva
{"title":"Hypertestosteronemia and Infertility from a Mediastinal Extragonadal Germ Cell Tumor.","authors":"G. Dimitriadis, G. Kaltsas, T. Ghobara, B. Sinha, Eftychia E. Drakou, K. Gopalakrishnan, C. Kosmas, S. Keay, D. Grammatopoulos, H. Randeva","doi":"10.1016/j.amjmed.2017.01.010","DOIUrl":"https://doi.org/10.1016/j.amjmed.2017.01.010","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"39 1","pages":"e261-e263"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76631535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2017.02.004
T. Walsh, N. Bhanot, M. Murillo, J. Uchin, Zaw Min
{"title":"Creeping Skin Lesions: Primary Cutaneous Cryptococcosis.","authors":"T. Walsh, N. Bhanot, M. Murillo, J. Uchin, Zaw Min","doi":"10.1016/j.amjmed.2017.02.004","DOIUrl":"https://doi.org/10.1016/j.amjmed.2017.02.004","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"22 1","pages":"666-668"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72669466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-06-01DOI: 10.1016/j.amjmed.2017.01.014
Chris Goates, S. Tsuha, Selene Working, J. Carey, E. Spivak
{"title":"Seronegative West Nile Virus Infection in a Patient Treated with Rituximab for Rheumatoid Arthritis.","authors":"Chris Goates, S. Tsuha, Selene Working, J. Carey, E. Spivak","doi":"10.1016/j.amjmed.2017.01.014","DOIUrl":"https://doi.org/10.1016/j.amjmed.2017.01.014","url":null,"abstract":"","PeriodicalId":101216,"journal":{"name":"The American Journal of Medicine Supplements","volume":"385 1","pages":"e257-e258"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84970408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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