82 research outputs found
Reproducibility of Retinal Microvascular Traits Decoded by the Singapore i Vessel Assessment Software Across the Human Age Range
Retinal microvascular traits predict adverse health outcomes. The Singapore I Vessel Assessment (SIVA) software improved automated postprocessing of retinal photographs. In addition to microvessel caliber, it generates measure
Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure
Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P <= 0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension
Development of Risk Prediction Equations for Incident Chronic Kidney Disease
IMPORTANCE ‐ Early identification of individuals at elevated risk of developing chronic kidney disease
could improve clinical care through enhanced surveillance and better management of underlying health
conditions.
OBJECTIVE – To develop assessment tools to identify individuals at increased risk of chronic kidney
disease, defined by reduced estimated glomerular filtration rate (eGFR).
DESIGN, SETTING, AND PARTICIPANTS – Individual level data analysis of 34 multinational cohorts from
the CKD Prognosis Consortium including 5,222,711 individuals from 28 countries. Data were collected from April, 1970 through January, 2017. A two‐stage analysis was performed, with each study first
analyzed individually and summarized overall using a weighted average. Since clinical variables were often differentially available by diabetes status, models were developed separately within participants
with diabetes and without diabetes. Discrimination and calibration were also tested in 9 external
cohorts (N=2,253,540).
EXPOSURE Demographic and clinical factors.
MAIN OUTCOMES AND MEASURES – Incident eGFR <60 ml/min/1.73 m2.
RESULTS – In 4,441,084 participants without diabetes (mean age, 54 years, 38% female), there were
660,856 incident cases of reduced eGFR during a mean follow‐up of 4.2 years. In 781,627 participants
with diabetes (mean age, 62 years, 13% female), there were 313,646 incident cases during a mean
follow‐up of 3.9 years. Equations for the 5‐year risk of reduced eGFR included age, sex, ethnicity, eGFR,
history of cardiovascular disease, ever smoker, hypertension, BMI, and albuminuria. For participants
with diabetes, the models also included diabetes medications, hemoglobin A1c, and the interaction
between the two. The risk equations had a median C statistic for the 5‐year predicted probability of
0.845 (25th – 75th percentile, 0.789‐0.890) in the cohorts without diabetes and 0.801 (25th – 75th
percentile, 0.750‐0.819) in the cohorts with diabetes. Calibration analysis showed that 9 out of 13 (69%)
study populations had a slope of observed to predicted risk between 0.80 and 1.25. Discrimination was
similar in 18 study populations in 9 external validation cohorts; calibration showed that 16 out of 18
(89%) had a slope of observed to predicted risk between 0.80 and 1.25.
CONCLUSIONS AND RELEVANCE – Equations for predicting risk of incident chronic kidney disease
developed in over 5 million people from 34 multinational cohorts demonstrated high discrimination and
variable calibration in diverse populations
Recent status of self-measured home blood pressure in the Japanese general population: a modern database on self-measured home blood pressure (MDAS)
Observational study and participant-level meta-analysis on antihypertensive drug treatment-related cardiovascular risk
Optimal Number of Days for Home Blood Pressure Measurement
Current guidelines make no outcome-based recommendations on the optimal measurement schedule for home blood pressure (BP).status: publishe
The rationale and design of reduction of uncontrolled hypertension by Remote Monitoring and Telemedicine (REMOTE) study
The effects of increasing calcium channel blocker dose vs. adding a diuretic to treatment regimens for patients with uncontrolled hypertension
- …