Impact of Blood Pressure Lowering on Cardiovascular Outcomes in Normal Weight, Overweight, and Obese Individuals The Perindopril Protection Against Recurrent Stroke Study Trial
George Institute for International Health, University of Sydney, Sydney, Australia.Hypertension (Impact Factor: 6.48). 03/2010; 55(5):1193-8. DOI: 10.1161/HYPERTENSIONAHA.109.140624
There is considerable uncertainty regarding the efficacy of blood pressure-lowering therapy in reducing cardiovascular risk in obese people. In this report we examine the effects of blood pressure lowering according to baseline body mass index (kilograms per meter squared) in the Perindopril Protection Against Recurrent Stroke Study. A total of 6105 participants with cerebrovascular disease were randomized to perindopril-based blood pressure-lowering therapy or placebo. The overall mean difference in systolic/diastolic blood pressure between participants assigned active therapy or placebo was 9/4 mm Hg (SE: 0.5/0.3 mm Hg), with no difference by body mass index quarters (<23.1, 23.1 to 25.3, 25.4 to 27.8, and > or = 27.9 kg/m(2)). A consistent treatment benefit was demonstrated for protection against major vascular events across quarters with the following hazard ratios (95% CIs): 0.80 (0.62 to 1.02), 0.78 (0.61 to 1.01), 0.67 (0.53 to 0.86), 0.69 (0.54 to 0.88), and 0.74 (0.66 to 0.84; P for heterogeneity=0.16). Similar results were apparent for stroke and stroke subtypes (all P for heterogeneity > or = 0.07) or with the standard definitions of overweight and obesity (<25, 25 to 29, and > or = 30 kg/m(2); all P for heterogeneity > or = 0.28). The absolute effects of treatment were, however, more than twice that in the highest compared with the lowest body mass index quartile. Across increasing quarters of body mass index over 5 years, active therapy prevented 1 major vascular event among every 28, 23, 13, and 13 patients treated. In conclusion, blood pressure-lowering therapy produced comparable risk reductions in vascular disease across the whole range of body mass indices in participants with a history of stroke. However, the greater baseline level of cardiovascular risk in those with higher body mass index meant that these patients obtained the greatest benefit.
Conference Paper: An upper bound on the slope of convolutional codes[Show abstract] [Hide abstract]
ABSTRACT: The slope is an important distance parameter of a convolutional code. It essentially determines the error-correcting capability. Here we derive an upper bound on the slope.Information Theory, 2002. Proceedings. 2002 IEEE International Symposium on; 02/2002
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ABSTRACT: The prevalence of obesity, including childhood obesity, is increasing worldwide. Weight gain is associated with increases in arterial pressure, and it has been estimated that 60-70% of hypertension in adults is attributable to adiposity. Centrally located body fat, associated with insulin resistance and dyslipidemia, is a more potent determinant of blood pressure elevation than peripheral body fat. Obesity-related hypertension may be a distinct hypertensive phenotype with distinct genetic determinants. Mechanisms of obesity-related hypertension include insulin resistance, sodium retention, increased sympathetic nervous system activity, activation of renin-angiotensin-aldosterone, and altered vascular function. In overweight individuals, weight loss results in a reduction of blood pressure, however, this effect may be attenuated in the long term. An increasing number of community-based programs (including school programs and worksite programs) are being developed for the prevention and treatment of obesity. Assessment and treatment of the obese hypertensive patient should address overall cardiovascular disease (CVD) risk. There are no compelling clinical trial data to indicate that any one class of antihypertensive agents is superior to others, and in general the principles of pharmacotherapy for obese hypertensive patients are not different from nonobese patients. Future research directions might include: (i) development of effective, culturally sensitive strategies for the prevention and treatment of obesity; (ii) clinical trials to identify the most effective drug therapies for reducing CVD in obese, hypertensive patients; (iii) continued search for the genetic determinants of the obese, hypertensive phenotype.American Journal of Hypertension 11/2010; 23(11):1170-8. DOI:10.1038/ajh.2010.172 · 2.85 Impact Factor
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ABSTRACT: Trials of weight-loss drugs indicate some benefits on lipids, blood glucose, or blood pressure levels. Since obesity is associated with increased cardiovascular (CV) medication use and pharmaceutical costs, weight-loss drug use could beneficially impact CV medication use. We examined the temporal associations between CV drugs use 3 years before and after the initiation of orlistat, a weight-loss drug. An historical cohort study in the PHARMO pharmacy registry among new users of orlistat, who were in the database at least 3 years before and after such drug initiation. We assessed the prevalence of use of antihypertensive, antidiabetic, and lipid-lowering drugs within a 6-month period before and after orlistat initiation. Slopes and changes in slopes between these two periods were calculated using logistic generalized estimating equations and odds ratios (OR) with 95% confidence intervals (CI) are presented. A total of 6139 subjects had a prescription of orlistat between January 1992 and May 2009. Mean ± SD age was 46.5 ± 12.5 years, with a majority of female (88.7%). Use of antihypertensive, antidiabetic, and lipid-lowering drugs increased over time, but after start of orlistat the slopes levelled-off. Initiation of orlistat resulted in a significant change in slope for antihypertensive (OR 0.79; 95% CI 0.77-0.81), antidiabetic (0.86; 0.83-0.90), and lipid-lowering drugs (0.84; 0.81-0.88). Our data suggest a potential cost-effectiveness of orlistat, with a reduction in any cardiovascular comedication use over time. By potentially reducing costs of other medications use, orlistat remains as a unique option for tackling the obesity epidemic.04/2011; 19(3):484-9. DOI:10.1177/1741826711406058
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