Intervention Trial

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Juanita Crook - One of the best experts on this subject based on the ideXlab platform.

Neil Fleshner - One of the best experts on this subject based on the ideXlab platform.

William C Cushman - One of the best experts on this subject based on the ideXlab platform.

  • Estimated GFR Variability and Risk of Cardiovascular Events and Mortality in SPRINT (Systolic Blood Pressure Intervention Trial).
    American journal of kidney diseases : the official journal of the National Kidney Foundation, 2020
    Co-Authors: Rakesh Malhotra, Anthony A Killeen, William C Cushman, Dalane W Kitzman, Ronit Katz, Vasantha Jotwani, Adhish Agarwal, Debbie L Cohen, Areef Ishani, Suzanne Oparil
    Abstract:

    While low estimated glomerular filtration rate (eGFR) is associated with cardiovascular disease (CVD) events and mortality, the clinical significance of variability in eGFR over time is uncertain. We aimed to evaluate the association between variability in eGFR and the risk of CVD events and all-cause mortality. Longitudinal analysis of clinical Trial participants. 7,520 Systolic Blood Pressure Intervention Trial (SPRINT) participants aged ≥ 50 year with 1 or more CVD risk factors. eGFR variability, estimated by the coefficients of variation of eGFR measurements at the 6, 12, and 18-month study visits. SPRINT primary CVD composite outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or CVD death) and all-cause mortality from month 18 to end of follow-up. Cox models evaluated associations between eGFR variability and CVD outcomes and all-cause mortality. Models were adjusted for demographics, randomization arm, CVD risk factors, albuminuria and month 18 eGFR. Mean age was 68±9 years, 65% were men, and 58% were white. The mean eGFR was 73±21 ml/min/1.73m2 at 6 months. There were 370 CVD events and 154 deaths during a median follow-up of 2.4 years. Greater eGFR variability was associated with higher risk for all-cause mortality (hazard ratio (HR) per standard deviation (SD) greater variability, 1.29; 95% confidence interval (CI) 1.14 to 1.45) but not CVD events (HR 1.05; 95% CI 0.95 to 1.16) after adjusting for albuminuria at baseline, eGFR at month 18, and other CVD risk factors. Associations were similar when stratified by treatment arm and baseline CKD status, when accounting for concurrent systolic BP changes, use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and diuretic medications during follow-up. Persons with diabetes and proteinuria > 1 g/day were excluded. In Trial participants at high risk for CVD with hypertension, greater eGFR variability was independently associated with all-cause mortality but not CVD events. Copyright © 2020. Published by Elsevier Inc.

  • blood pressure measurement in sprint systolic blood pressure Intervention Trial
    Hypertension, 2018
    Co-Authors: Karen C Johnson, Walter T Ambrosius, Alfred K Cheung, William C Cushman, Joni K. Snyder, Gregory W Evans, Paul K Whelton, J A Cutler, Srinivasan Beddhu, Lawrence J Fine
    Abstract:

    Recent publications have stated that the blood pressure (BP) measurement technique used in SPRINT (Systolic Blood Pressure Intervention Trial) was unattended. However, the SPRINT protocol does not address the issue of attendance. A survey was conducted immediately after SPRINT closeout visits were completed to inquire whether BP measurements were usually attended or unattended by staff. There were 4082 participants at 38 sites that measured BP after leaving the participant alone the entire time (always alone), 2247 at 25 sites that had personnel in the room the entire time (never alone), 1746 at 19 sites that left the participant alone only during the rest period (alone for rest), and 570 at 6 sites that left the participant alone only during the BP readings (alone for BP measurement). Similar systolic and diastolic BPs within randomized groups were noted during follow-up at the majority of visits in all 4 measurement categories. In the always alone and never alone categories, the intensive group had a similarly reduced risk for the primary outcome compared with the standard group (hazard ratio, 0.62; 95% confidence interval, 0.51–0.76 and hazard ratio, 0.64; 95% confidence interval, 0.46–0.91, respectively; pairwise interaction P value, 0.88); risk was not significantly reduced for the intensive group in the smaller alone-for-rest and the alone-for-BP-measurement categories. Similar BP levels and cardiovascular disease risk reduction were observed in the intensive group in SPRINT participants whether the measurement technique used was primarily attended or unattended. Clinical Trial Registration— URL: http://www.clinicalTrials.gov. Unique identifier: NCT01206062.

  • Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).
    Circulation, 2017
    Co-Authors: Elsayed Z. Soliman, Jeffrey T. Bates, Walter T Ambrosius, William C Cushman, Zhu-ming Zhang, Javier A. Neyra, Thaddeus Y. Carson, Leonardo Tamariz, Ghazi, Monique E. Cho
    Abstract:

    BACKGROUND It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of left ventricular hypertrophy (LVH) in patients with hypertension and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS This analysis included 8164 participants (mean age, 67.9 years; 35.3% women; 31.2% blacks) with hypertension but no diabetes mellitus from the SPRINT Trial (Systolic Blood Pressure Intervention Trial): 4086 randomly assigned to intensive BP lowering (target SBP

  • visit to visit office blood pressure variability and cardiovascular outcomes in sprint systolic blood pressure Intervention Trial
    Hypertension, 2017
    Co-Authors: Tara I Chang, Alfred K Cheung, William C Cushman, William J. Kostis, David M Reboussin, Dominic S Raj, Glenn M Chertow, Gianfranco Parati, Erik Riessen, Brian P Shapiro
    Abstract:

    Studies of visit-to-visit office blood pressure (BP) variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive ( P =0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective Trials. Clinical Trial Registration URL: http://www.clinicalTrials.gov. Unique identifier: NCT01206062

  • patterns and correlates of baseline thiazide type diuretic prescription in the systolic blood pressure Intervention Trial
    Hypertension, 2016
    Co-Authors: Tara I Chang, Alfred K Cheung, William C Cushman, John B. Kostis, Gregory W Evans, Matthew Diamond, Jamie P Dwyer, Yonghong Huan, Dalane W Kitzman, Suzanne Oparil
    Abstract:

    Thiazides and thiazide-type diuretics are recommended as first-line agents for the treatment of hypertension, but contemporary information on their use in clinical practice is lacking. We examined patterns and correlates of thiazide prescription in a cross-sectional analysis of baseline data from participants enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT). We examined baseline prescription of thiazides in 7582 participants receiving at least 1 antihypertensive medication by subgroup, and used log-binomial regression to calculate adjusted prevalence ratios for thiazide prescription (versus no thiazide). Forty-three percent of all participants were prescribed a thiazide at baseline, but among participants prescribed a single agent, the proportion was only 16%. The prevalence of thiazide prescription differed significantly by demographic factors, with younger participants, women, and blacks all having higher adjusted prevalence of thiazide prescription than other corresponding subgroups. Participants in the lowest category of kidney function (estimated glomerular filtration rate <30 mL/min per 1.73 m2) were half as likely to be prescribed a thiazide as participants with preserved kidney function. In conclusion, among persons with hypertension and heightened cardiovascular risk, we found that thiazide prescription varied significantly by demographics and kidney disease status, despite limited evidence about relative differences in effectiveness.

Walter T Ambrosius - One of the best experts on this subject based on the ideXlab platform.

  • pulse wave velocity and central aortic pressure in systolic blood pressure Intervention Trial participants
    PLOS ONE, 2018
    Co-Authors: Mark A Supiano, Jeffrey T. Bates, Walter T Ambrosius, Laura C. Lovato, Jamie P Dwyer, Dalane W Kitzman, Srinivasan Beddhu, Paul E Drawz, Naomi M Hamburg, James P Lash
    Abstract:

    : Arterial stiffness, typically assessed as the aortic pulse wave velocity (PWV), and central blood pressure levels may be indicators of cardiovascular disease (CVD) risk. This ancillary study to the Systolic Blood Pressure Intervention Trial (SPRINT) obtained baseline assessments (at randomization) of PWV and central systolic blood pressure (C-SBP) to: 1) characterize these vascular measurements in the SPRINT cohort, and 2) test the hypotheses that PWV and C-SBP are associated with glucose homeostasis and markers of chronic kidney disease (CKD). The SphygmoCor® CPV device was used to assess carotid-femoral PWV and its pulse wave analysis study protocol was used to obtain C-SBP. Valid results were obtained from 652 participants. Mean (±SD) PWV and C-SBP for the SPRINT cohort were 10.7 ± 2.7 m/s and 132.0 ± 17.9 mm Hg respectively. Linear regression analyses for PWV and C-SBP results adjusted for age, sex, and race/ethnicity in relation to several markers of glucose homeostasis and CKD did not identify any significant associations with the exception of a marginally statistically significant and modest association between PWV and urine albumin-to-creatinine ratio (linear regression estimate ± SE, 0.001 ± 0.0006; P-value 0.046). In a subset of SPRINT participants, PWV was significantly higher than in prior studies of normotensive persons, as expected. For older age groups in the SPRINT cohort (age > 60 years), PWV was compared with a reference population of hypertensive individuals. There were no compelling associations noted between PWV or C-SBP and markers of glucose homeostasis or CKD. CLINICAL Trial REGISTRATION: NCT01206062.

  • blood pressure measurement in sprint systolic blood pressure Intervention Trial
    Hypertension, 2018
    Co-Authors: Karen C Johnson, Walter T Ambrosius, Alfred K Cheung, William C Cushman, Joni K. Snyder, Gregory W Evans, Paul K Whelton, J A Cutler, Srinivasan Beddhu, Lawrence J Fine
    Abstract:

    Recent publications have stated that the blood pressure (BP) measurement technique used in SPRINT (Systolic Blood Pressure Intervention Trial) was unattended. However, the SPRINT protocol does not address the issue of attendance. A survey was conducted immediately after SPRINT closeout visits were completed to inquire whether BP measurements were usually attended or unattended by staff. There were 4082 participants at 38 sites that measured BP after leaving the participant alone the entire time (always alone), 2247 at 25 sites that had personnel in the room the entire time (never alone), 1746 at 19 sites that left the participant alone only during the rest period (alone for rest), and 570 at 6 sites that left the participant alone only during the BP readings (alone for BP measurement). Similar systolic and diastolic BPs within randomized groups were noted during follow-up at the majority of visits in all 4 measurement categories. In the always alone and never alone categories, the intensive group had a similarly reduced risk for the primary outcome compared with the standard group (hazard ratio, 0.62; 95% confidence interval, 0.51–0.76 and hazard ratio, 0.64; 95% confidence interval, 0.46–0.91, respectively; pairwise interaction P value, 0.88); risk was not significantly reduced for the intensive group in the smaller alone-for-rest and the alone-for-BP-measurement categories. Similar BP levels and cardiovascular disease risk reduction were observed in the intensive group in SPRINT participants whether the measurement technique used was primarily attended or unattended. Clinical Trial Registration— URL: http://www.clinicalTrials.gov. Unique identifier: NCT01206062.

  • Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).
    Circulation, 2017
    Co-Authors: Elsayed Z. Soliman, Jeffrey T. Bates, Walter T Ambrosius, William C Cushman, Zhu-ming Zhang, Javier A. Neyra, Thaddeus Y. Carson, Leonardo Tamariz, Ghazi, Monique E. Cho
    Abstract:

    BACKGROUND It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of left ventricular hypertrophy (LVH) in patients with hypertension and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS This analysis included 8164 participants (mean age, 67.9 years; 35.3% women; 31.2% blacks) with hypertension but no diabetes mellitus from the SPRINT Trial (Systolic Blood Pressure Intervention Trial): 4086 randomly assigned to intensive BP lowering (target SBP

  • the design and rationale of a multicenter clinical Trial comparing two strategies for control of systolic blood pressure the systolic blood pressure Intervention Trial sprint
    Clinical Trials, 2014
    Co-Authors: Walter T Ambrosius, Anthony A Killeen, Kaycee M Sink, Dan R Berlowitz, Alfred K Cheung, William C Cushman, Lawrence J Fine, David C Goff, Karen C Johnson, Cora E Lewis
    Abstract:

    Background:High blood pressure is an important public health concern because it is highly prevalent and a risk factor for adverse health outcomes, including coronary heart disease, stroke, decompensated heart failure, chronic kidney disease, and decline in cognitive function. Observational studies show a progressive increase in risk associated with blood pressure above 115/75 mm Hg. Prior research has shown that reducing elevated systolic blood pressure lowers the risk of subsequent clinical complications from cardiovascular disease. However, the optimal systolic blood pressure to reduce blood pressure–related adverse outcomes is unclear, and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical Trial.Purpose:To describe the design considerations of the Systolic Blood Pressure Intervention Trial (SPRINT) and the baseline characteristics of Trial participants.Methods:The Systolic Blood Pressure Intervention Trial is a multicen...

Kris Wallace - One of the best experts on this subject based on the ideXlab platform.

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