Ajay Kr Gupta

Queen Mary, University of London | QMUL · William Harvey Research Institute, Dept of Clinical Pharmacology

Background and Objective Hypertensive disorders of pregnancy (HDP) are a leading cause of adverse maternal and perinatal outcomes internationally. This review aims to critically analyse international guidelines pertaining specifically to the management of HDP in cases of gestational hypertension and pre-eclampsia. By highlighting best practices and...

Healthcare professionals (HCPs) experienced prolonged stressful conditions during the coronavirus disease 2019 pandemic, and the global situation (particularly in the United Kingdom) meant that they continue to sustain mental stress related to the subsequent cost-of-living and healthcare budgeting crises. The psychological toll on HCPs may lead to...

Background Previous meta-analyses of summary data from randomised controlled trials have shown that statin therapy increases the risk of diabetes, but less is known about the size or timing of this effect, or who is at greatest risk. We aimed to address these gaps in knowledge through analysis of individual participant data from large, long-term, r...

Hypertension is a prevalent public health problem, contributing to >10 million deaths annually. Though multiple therapeutics exist, many patients suffer from treatment-resistant hypertension or try several medications before achieving blood pressure control. Genomic advances offer mechanistic understanding of blood pressure variability, therapeutic...

Background and Aims Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood...

BACKGROUND Patients with previous coronary artery bypass grafting often require invasive coronary angiography (ICA). However, for these patients, the procedure is technically more challenging and has a higher risk of complications. Observational studies suggest that computed tomography cardiac angiography (CTCA) may facilitate ICA in this group, bu...

Background: Whether the relative effects of blood pressure (BP)-lowering treatment on cardiovascular outcomes differ by sex, particularly when BP is not substantially elevated, has been uncertain. Methods: We conducted an individual participant-level data meta-analysis of randomized controlled trials of pharmacological BP lowering. We pooled the...

Background There may be differential impact of the COVID-19 pandemic on mental health and burnout rates of healthcare professionals (HCPs) performing different roles. Aims To examine mental health and burnout rates, and possible drivers for any disparities between professional roles. Methods In this cohort study, online surveys were distributed t...

Background: Little is known about the relationship between workplace support and mental health and burnout among health care professionals (HCPs) during the COVID-19 pandemic. In this cohort study, we sought to evaluate the association between perceived level of (and changes to) workplace support and mental health and burnout among HCPs, and to id...

Background One potential modifiable factor to improve the mental health of healthcare professionals (HCPs) during the pandemic is lifestyle. Aims This study aimed to assess whether an improved lifestyle during the pandemic is associated with improved mental health symptoms and mental well-being in HCPs over time. Methods This was a cohort stud...

Given the potential for nosocomial outbreaks, we must understand factors associated with negative vaccine attitudes amongst healthcare professionals (HCPs) before the rollout of a newly developed vaccine in a pandemic setting. The aim of this prospective cohort study was to study the impact of preexisting and prevailing mental health on United King...

We have previously shown that visit to visit systolic blood pressure variability (BPV) was the major predictor of cardiovascular outcomes in ASCOT, a trial in hypertensive participants randomised to amlodipine based or atenolol based treatment. Treatment differences in BPV accounted for the benefits of the amlodipine based regimen over the atenolol...

Background The COVID-19 pandemic may disproportionately affect the mental health of healthcare professionals (HCPs), especially patient-facing HCPs. Aims To longitudinally examine mental health in HCPs versus non-HCPs, and patient-facing HCPs versus non-patient-facing HCPs. Method Online surveys were distributed to a cohort at three phases (basel...

Introduction: Observational studies showed that visit-to-visit blood pressure variability (BPV) is a significant independent risk factor for cardiovascular morbidity and all-cause mortality. However, the relation between BPV with renal outcomes remains controversial. Methods: In the ASCOT-Legacy Study, 7,092 hypertensive patients, aged 40-79 years,...

Background Lifestyle modifications are cornerstone of hypertension prevention and treatment. We aimed to systematically review hypertension guidelines on their recommendations on non-pharmacological factors including lifestyle interventions, to highlight strength of evidence, similarities, and differences. Methods The systematic review was registe...

Background Statin therapy is effective for the prevention of atherosclerotic cardiovascular disease and is widely prescribed, but there are persisting concerns that statin therapy might frequently cause muscle pain or weakness. We aimed to address these through an individual participant data meta-analysis of all recorded adverse muscle events in la...

Background Controversy exists as to whether the threshold for blood pressure-lowering treatment should differ between people with and without type 2 diabetes. We aimed to investigate the effects of blood pressure-lowering treatment on the risk of major cardiovascular events by type 2 diabetes status, as well as by baseline levels of systolic blood...

Background: Rapid and accurate new biomarkers to predict risk of cardiovascular disease (CVD) are essential. The utility of extracellular vesicles in predicting the CVD risk is postulated, yet it remains unknown whether their expression is altered in response to statin therapy. Methods: We performed in-vitro studies with human umbilical vein end...

Aims To examine the relationship between self-reported level of workplace support (WS) and various mental health outcomes in HCPs and non-HCPs at different time-points during the COVID-19 pandemic, and to examine whether improved WS is associated with improved mental health outcomes over time. Lastly, to identify what support healthcare professiona...

Background: More than 80% of individuals in low and middle-income countries (LMICs) are unvaccinated against coronavirus disease 2019 (COVID-19). In contrast, the greatest burden of cardiovascular disease is seen in LMIC populations. Hypertension (HTN), diabetes mellitus (DM), ischaemic heart disease (IHD) and myocardial injury have been variably...

Background: Outcome following ST-segment elevation myocardial infarction (STEMI) is thought to be worse in women than in age-matched men. We assessed whether such differences occur in the UK Pan-London dataset and if age, and particularly menopause, influences upon outcome. Methods: We undertook an observational cohort study of 26,799 STEMI pati...

Background and purpose NO is a vasodilator and independent modulator of cardiac remodelling. Commonly, in cardiac disease (e.g., heart failure), endothelial dysfunction (synonymous with NO deficiency) has been implicated in increased BP, cardiac hypertrophy and fibrosis. Currently, no effective therapies replacing NO have succeeded in the clinic. I...

Background The effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified b...

The coronavirus disease-2019 (COVID-19) pandemic has had an unprecedented impact leading to novel adaptations in post-graduate medical education for cardiovascular and general internal medicine. Whilst the results of initial community COVID-19 vaccination are awaited, continuation of multimodality teaching and training that incorporates telelearnin...

Background The effects of pharmacological blood pressure lowering at normal or high-normal blood pressure ranges in people with or without pre-existing cardiovascular disease remains uncertain. We analysed individual participant data from randomised trials to investigate the effects of blood pressure lowering treatment on the risk of major cardiova...

Background Some studies have suggested a link between antihypertensive medication and cancer, but the evidence is so far inconclusive. Thus, we aimed to investigate this association in a large individual patient data meta-analysis of randomised clinical trials. Methods We searched PubMed, MEDLINE, The Cochrane Central Register of Controlled Trials...

Objective Several ECG criteria are used clinically to define Left Ventricular Hypertrophy (LVH), but there is no consensus on which of these criteria is better at predicting cardiovascular (CV) events in hypertensive patients. In this post-hoc analysis, our objective was to compare the discriminative ability and strength of association of different...

Objective Resistant hypertension (RH) is associated with the increased risk of cardiovascular events (CVEs); that excess risk is often attributed to the legacy of the previous period of uncontrolled blood pressures (BPs). We used the database of the ASCOT trial to evaluate the risk of CVEs (non-fatal myocardial infarction, fatal coronary heart dise...

Objective The long-term cardiovascular (CV) impact of a period of blood pressure (BP)-control and -variability (BPV) achieved on different BP-lowering treatments is unclear. The findings will inform the debate on BP-control targets, and explore the reason of legacy effects. Design and method In the ASCOT-Legacy Study, 7092 hypertensive patients (a...

Objective Patients with resistant hypertension (RHTN) have increased cardiovascular disease risk. It is believed there may be genetic causes, although robust associations remain to be validated. Over 1,000 genetic loci have been discovered for BP from genome-wide association studies (GWAS), with application of genetic risk scores (GRS) enabling pop...

Objective Previously, we reported 16-year cardiovascular (CV) mortality associated with either atenolol- or amlodipine-based treatment regimen; but without data on non-fatal CV events. We now report longer morbidity and mortality including the impact of BP-treatment on the incidence of atrial fibrillation and heart failure Design and method In the...

Objective In hypertensive patients, the extent to which patient-related characteristics influence seasonal blood pressure (BP) variations is unclear. We used repeated BP-measurements in the ASCOT trial to investigate the influence of age, sex, geographical residence and cardiovascular (CV) event occurrence, on the association between month-of-year...

Introduction: The COVID-19 pandemic has led to unprecedented strain to healthcare systems worldwide and posed unique challenges to the healthcare professionals (HCPs) and the general public. Objectives: The aim of this study is to evaluate the impact of COVID-19 on the mental health, behavioural, and physical wellbeing of HCPs in the early and mid...

Introduction The COVID-19 pandemic has led to unprecedented strain to healthcare systems worldwide and posed unique challenges to the healthcare professionals (HCPs) and the general public. Objectives The aim of this study is to evaluate the impact of COVID-19 on the mental health, behavioral, and physical wellbeing of HCPs in the early and mid-te...

Background: COVID-19 has caused acute changes in healthcare delivery; this may impact mental health and wellbeing needs of healthcare professionals (HCPs). Aims: We aimed to identify the causes of anxiety in HCPs during the COVID-19 pandemic, to assess whether HCPs felt they had adequate mental health and wellbeing support and to identify their...

Background and purpose: Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)-lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels. Methods: Participants...

We, the Editors of the Journal of the American Heart Association, sincerely regret the publication of the article "Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019".1 We are aware that the publication of this flawed and biased article has...

As noted by JAHA Editor-in-Chief Barry London1, the views presented in the recently retracted article "Diversity, Inclusion, and Equity: Evolution of Race and Ethnicity Considerations for the Cardiology Workforce in the United States of America From 1969 to 2019"2,3 do not reflect the views of the JAHA Editorial Board, the Editor-in-Chief, or the A...

Coronavirus Disease 2019 (COVID‐19), caused by the Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2), has infected more than 3.0 million people worldwide and killed more than 200,000 as of April 27, 2020, making it the most lethal pandemic since the Spanish flu of 1918. 1, 2 COVID‐19 may preferentially infect individuals with cardiovascu...

High blood pressure remains the major heritable and modifiable risk factor for cardiovascular disease (CVD). Persistent high blood pressure, or hypertension, is a complex trait with both genetic and environmental interactions. Despite swift advances in genomics, translating new discoveries to further our understanding of the underlying molecular me...

Background Angiotensin-converting enzyme inhibitors and calcium channel blockers in combination are widely recommended in hypertension guidelines. The advantages of single-pill combinations (SPCs) are increasingly recognized, so a dosage-adapted combination of perindopril and amlodipine was developed for the initial management of hypertension. Obj...

Importance: The effectiveness of lipid-lowering, blood pressure-lowering, and aspirin treatment for prevention of cardiovascular disease (CVD) differs between individuals with type 2 diabetes (T2DM). Objectives: To develop and externally validate a Diabetes Lifetime-perspective prediction (DIAL) model, for individualising CVD prevention in people...

Background: In patients with hypertension, the long-term cardiovascular and all-cause mortality effects of different blood pressure-lowering regimens and lipid-lowering treatment are not well documented, particularly in clinical trial settings. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study reports mortality outcomes after 16 y...

Background: Renal denervation has no validated marker of procedural success. We hypothesized that successful renal denervation would reduce renal sympathetic nerve signaling demonstrated by attenuation of α-1-adrenoceptor-mediated autotransfusion during the Valsalva maneuver. Methods and results: In this substudy of the Wave IV Study: Phase II R...

Data S1. Supplemental Methods. Table S1. Within‐Group Changes in Resting Cardiac Vagal Tone (CVT) and Baroreflex Sensitivity (BRS) Between Baseline and 6 Months Postprocedure

Although laparoscopic sleeve gastrectomy is an established operation for severe obesity, there is controversy regarding the extent to which the antrum is excised. The objective of this systematic review was to investigate the effect on perioperative complications and medium-term outcomes of antral resecting versus antral preserving sleeve gastrecto...

Background Mobile devices may facilitate depression screening in the waiting area of antenatal clinics. This can present implementation challenges, of which we focused on survey layout and technology deployment. Methods We assessed the feasibility of using tablet computers to administer a socio-demographic survey, the Whooley questions and the Edin...

Background: In blinded randomised controlled trials, statin therapy has been associated with few adverse events (AEs). By contrast, in observational studies, larger increases in many different AEs have been reported than in blinded trials. Methods: In the Lipid-Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial, patients aged 40-79 ye...

Objective To estimate the absolute treatment effect of statin therapy on major adverse cardiovascular events (MACE; myocardial infarction, stroke and vascular death) for the individual patient aged ≥70 years. Methods Prediction models for MACE were derived in patients aged ≥70 years with (n = 2550) and without (n = 3253) vascular disease from the “...

To test the hypothesis that adverse effects of statins are only reported in excess in observational studies and not in blinded randomized trials. We collated all reported AEs in hypertensive patients in the Lipid-Lowering arm of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA) during the randomised, double-blind phase (when atorvastatin wa...

Importance Most patients with cardiovascular disease (CVD) do not take recommended medications long-term. The use of fixed-dose combinations (FDCs) improves adherence in several clinical areas. Previous trials of cardiovascular FDCs have assessed short-term effects compared with placebo or no treatment.Objective To assess whether FDC delivery of...

A number of risk scores already exist to predict cardiovascular (CV) events. However, scores developed with data collected some time ago might not accurately predict the CV risk of contemporary hypertensive patients that benefit from more modern treatments and management. Using data from the randomised clinical trial Anglo-Scandinavian Cardiac Outc...

In the current special issue different aspects of childhood obesity and metabolic syndrome (MetS) are being discussed. Childhood obesity is becoming an emerging health problem at individual and public health level. The problem is no more limited to high-income countries and is rapidly growing in low- and middle-income countries [1, 2]. Its early- a...

To assess the blood pressure and lipid-lowering efficacy and tolerability of 'polypills' used in cardiovascular disease prevention trials. Systematic review and meta-analysis. Search strategy: The Cochrane Central Register of Controlled Trials, Medline, and PubMed databases were searched for eligible trials. Study inclusion criteria: Randomised con...

PRISMA checklist. (DOCX)

Meta-analyses comparing ‘quality effects’ models with ‘random effects’ or Mantel Haenszel fixed effects models undertaken in Excel. (DOCX)

Funnel plots to assess for publication bias. (DOCX)

Literature search terms and results, conducted by CRE. (DOCX)

Literature search terms and results, conducted by AKG. (DOCX)

Risk of bias of included studies, using the Cochrane collaboration criteria. (DOCX)

‘Polypills’ meta-analysis flow diagram of a second literature search. (DOCX)

Aims: Plasma renin activity (PRA) has been shown to predict future cardiovascular (CV) events in observational studies and in clinical trials and to be associated with the prevalence of chronic renal disease in hypertensive subjects. In a nested case-control study, we explored the relationship between CV and renal outcomes and all-cause mortality...