共查询到20条相似文献,搜索用时 0 毫秒
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Paul K. Whelton Robert M. Carey Wilbert S. Aronow Donald E. Casey Karen J. Collins Cheryl Dennison Himmelfarb Sondra M. DePalma Samuel Gidding Kenneth A. Jamerson Daniel W. Jones Eric J. MacLaughlin Paul Muntner Bruce Ovbiagele Sidney C. Smith Crystal C. Spencer Randall S. Stafford Sandra J. Taler Randal J. Thomas Jackson T. Wright 《Journal of the American College of Cardiology》2018,71(19):2199-2269
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Karen K. Stout Curt J. Daniels Jamil A. Aboulhosn Biykem Bozkurt Craig S. Broberg Jack M. Colman Stephen R. Crumb Joseph A. Dearani Stephanie Fuller Michelle Gurvitz Paul Khairy Michael J. Landzberg Arwa Saidi Anne Marie Valente George F. Van Hare 《Journal of the American College of Cardiology》2019,73(12):1494-1563
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David M. Reboussin Norrina B. Allen Michael E. Griswold Eliseo Guallar Yuling Hong Daniel T. Lackland Edgar R. Miller Tamar Polonsky Angela M. Thompson-Paul Suma Vupputuri 《Journal of the American College of Cardiology》2018,71(19):2176-2198
Objective
To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy?Methods
Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses.Results
Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of <130 mm Hg may reduce the risk of several important outcomes including risk of myocardial infarction, stroke, heart failure, and major cardiovascular events. No class of medications (i.e., angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, calcium channel blockers, or beta blockers) was significantly better than thiazides and thiazide-like diuretics as a first-line therapy for any outcome. 相似文献4.
Scott M. Grundy Neil J. Stone Alison L. Bailey Craig Beam Kim K. Birtcher Roger S. Blumenthal Lynne T. Braun Sarah de Ferranti Joseph Faiella-Tommasino Daniel E. Forman Ronald Goldberg Paul A. Heidenreich Mark A. Hlatky Daniel W. Jones Donald Lloyd-Jones Nuria Lopez-Pajares Chiadi E. Ndumele Carl E. Orringer Joseph Yeboah 《Journal of the American College of Cardiology》2019,73(24):3168-3209
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Glenn N. Levine Patrick T. O’Gara Joshua A. Beckman Sana M. Al-Khatib Kim K. Birtcher Joaquin E. Cigarroa Lisa de las Fuentes Anita Deswal Lee A. Fleisher Federico Gentile Zachary D. Goldberger Mark A. Hlatky José A. Joglar Mariann R. Piano Duminda N. Wijeysundera 《Journal of the American College of Cardiology》2019,73(15):1990-1998
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Elisa Zaragoza-Macias Ali N. Zaidi Nandini Dendukuri Ariane Marelli 《Journal of the American College of Cardiology》2019,73(12):1564-1578
Patients with systemic morphological right ventricles (RVs), including congenitally corrected transposition of the great arteries and dextro-transposition of the great arteries with a Mustard or Senning atrial baffle repair, have a high likelihood of developing systemic ventricular dysfunction. Unfortunately, there are a limited number of clinical studies on the efficacy of medical therapy for systemic RV dysfunction.We performed a systematic review and meta-analysis to assess the effect of angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), beta blockers, and aldosterone antagonists in adults with systemic RVs. The inclusion criteria included age ≥18 years, systemic RVs, and at least 3 months of treatment with ACE inhibitor, ARB, beta blocker, or aldosterone antagonist. The outcomes included RV end-diastolic and end-systolic dimensions, RV ejection fraction, functional class, and exercise capacity. EMBASE, PubMed, and Cochrane databases were searched. The selected data were pooled and analyzed with the DerSimonian-Laird random-effects meta-analysis model. Between-study heterogeneity was assessed with Cochran’s Q test. A Bayesian meta-analysis model was also used in the event that heterogeneity was low. Bias assessment was performed with the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool, and statistical risk of bias was assessed with Begg and Mazumdar’s test and Egger’s test.Six studies met the inclusion criteria, contributing a total of 187 patients; treatment with beta blocker was the intervention that could not be analyzed because of the small number of patients and diversity of outcomes reported. After at least 3 months of treatment with ACE inhibitors, ARBs, or aldosterone antagonists, there was no statistically significant change in mean ejection fraction, ventricular dimensions, or peak ventilatory equivalent of oxygen. The methodological quality of the majority of included studies was low, mainly because of a lack of a randomized and controlled design, small sample size, and incomplete follow-up.In conclusion, pooled results across the limited available studies did not provide conclusive evidence with regard to a beneficial effect of medical therapy in adults with systemic RV dysfunction. Randomized controlled trials or comparative-effectiveness studies that are sufficiently powered to demonstrate effect are needed to elucidate the efficacy of ACE inhibitors, ARBs, beta blockers, and aldosterone antagonists in patients with systemic RVs. 相似文献
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Paul Muntner Robert M. Carey Samuel Gidding Daniel W. Jones Sandra J. Taler Jackson T. Wright Paul K. Whelton 《Journal of the American College of Cardiology》2018,71(2):109-118
Background
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults provides recommendations for the definition of hypertension, systolic and diastolic blood pressure (BP) thresholds for initiation of antihypertensive medication, and BP target goals.Objectives
This study sought to determine the prevalence of hypertension, implications of recommendations for antihypertensive medication, and prevalence of BP above the treatment goal among U.S. adults using criteria from the 2017 ACC/AHA guideline and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7).Methods
The authors analyzed data from the 2011 to 2014 National Health and Nutrition Examination Survey (N = 9,623). BP was measured 3 times following a standardized protocol and averaged. Results were weighted to produce U.S. population estimates.Results
According to the 2017 ACC/AHA and JNC7 guidelines, the crude prevalence of hypertension among U.S. adults was 45.6% (95% confidence interval [CI]: 43.6% to 47.6%) and 31.9% (95% CI: 30.1% to 33.7%), respectively, and antihypertensive medication was recommended for 36.2% (95% CI: 34.2% to 38.2%) and 34.3% (95% CI: 32.5% to 36.2%) of U.S. adults, respectively. Nonpharmacological intervention is advised for the 9.4% of U.S. adults with hypertension who are not recommended for antihypertensive medication according to the 2017 ACC/AHA guideline. Among U.S. adults taking antihypertensive medication, 53.4% (95% CI: 49.9% to 56.8%) and 39.0% (95% CI: 36.4% to 41.6%) had BP above the treatment goal according to the 2017 ACC/AHA and JNC7 guidelines, respectively.Conclusions
Compared with the JNC7 guideline, the 2017 ACC/AHA guideline results in a substantial increase in the prevalence of hypertension, a small increase in the percentage of U.S. adults recommended for antihypertensive medication, and more intensive BP lowering for many adults taking antihypertensive medication. 相似文献11.
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Are the American College of Cardiology/American Heart Association guidelines for exercise testing for suspected coronary artery disease correct? 总被引:1,自引:0,他引:1
BACKGROUND: Recently published American College of Cardiology (ACC)/American Heart Association (AHA) guidelines state that patients with suspected coronary disease and an intermediate pretest probability are appropriate candidates for exercise ECG, while those with low or high pretest probability are not. METHODS: From 5,103 consecutive patients with symptoms of suspected coronary disease, we evaluated 872 patients who underwent coronary angiography following exercise ECG. Differences in test performance were determined using receiver operating characteristic curve area analysis. A score using age, gender, symptoms, and risk factors was used to classify patients into low, intermediate, and high pretest probability groups. RESULTS: When patients with inadequate exercise tests were excluded, overall sensitivity and specificity were 70% and 66%, respectively. Only the intermediate pretest probability group demonstrated significant incremental value: pretest vs posttest intermediate, 70 +/- 3 vs 79 +/- 3 (p < 0.0001); low, 71 +/- 6 vs 76 +/- 7 (p = 0.39); and high, 69 +/- 8 vs 75 +/- 7 (p = 0.12). From the low- to the high-probability groups, there was a progressive increase in positive predictive value (21%, 62%, and 92%) and decrease in negative predictive value (94%, 72%, and 28%), respectively. The frequencies of abnormal exercise ECGs were lower in the unselected groups compared with the angiography groups (low, 13% vs 36%; intermediate, 22% vs 53%; high, 36% vs 63%). CONCLUSIONS: Based on the information added by exercise testing to clinical data, these results confirm the ACC/AHA guideline assignments for test selection. However, despite these guidelines, patients with a low pretest probability can be selected for exercise testing with the knowledge that a positive result is infrequent and a negative result carries a very high negative predictive value. Intermediate-probability patients on average carry a significant false-negative rate, suggesting that exercise ECG alone may not be a sufficient screening test in all intermediate-probability patients. Because of poor negative predictive value and a large percentage of negative tests, high-probability patients should undergo coronary angiography as the initial strategy, unless the goal of exercise testing is to assess prognosis. 相似文献
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Steven R. Bailey Joshua A. Beckman Timothy D. Dao Sanjay Misra Piotr S. Sobieszczyk Christopher J. White L. Samuel Wann Steven R. Bailey Timothy Dao Herbert D. Aronow Reza Fazel Heather L. Gornik Bruce H. Gray Jonathan L. Halperin Alan T. Hirsch Michael R. Jaff Venkataramu Krishnamurthy Sahil A. Parikh E. Kent Yucel 《Journal of the American College of Cardiology》2019,73(2):214-237
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PURPOSE: To determine if the ACC/ECC guidelines (1991) properly stratify patients according to risk of arrhythmia, defined as a single event on cardiac monitoring, and benefit, defined as a subsequent management change from a recorded telemetry event. SUBJECTS AND METHODS: In 2003, a prospective study of 217 consecutive patients admitted to a 24-bed telemetry unit was conducted for 25 days at a major academic hospital. Patients were categorized per ACC/ECC guidelines as appropriate (class I & II) or inappropriate (class III) based on a non-cardiologist admission diagnosis. A cardiologist-led group then reclassified patients at the time of admission using a brief interview. Continuous telemetry-recorded arrhythmias and resultant management changes were reviewed and recorded daily. Subgroup analysis of patients admitted with a chief complaint of chest pain was also performed. In 2004, after this trial was performed, the American Heart Association released a scientific statement updating practice standards for ECG monitor; however, this paper is based upon the original 1991 ACC/ECC guidelines. RESULTS: Reclassification significantly decreased the percentage of all class I & II patients from 91% to 71% (P<0.001) and the percentage of class I & II patients with chest pain from 100% to 58% (P<0.001) without increasing the percentage of arrhythmias occurring in class III patients. Class II patients had a statistically significant higher percentage of arrhythmias than class I and III patients before and after reclassification (P<0.001 and P<0.001, respectively). Management changes occurring as a direct result of telemetry events were higher in class II than class I or III patients before and after reclassification (P = 0.01 and P = 0.03). Life-threatening arrhythmias (sustained ventricular tachycardia or ventricular fibrillation) occurred in 1% of the 216 patients enrolled in this study. CONCLUSIONS: (1) Cardiology input using ACC/ECC guidelines and a brief interview at admission safely reduced total admissions primarily by identifying low risk chest pain admissions inappropriate for inpatient telemetry monitoring. (2) Life threatening arrhythmias occurring in patients admitted to telemetry are rare. 相似文献
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John W. Hirshfeld Victor A. Ferrari Frank M. Bengel Lisa Bergersen Charles E. Chambers Andrew J. Einstein Mark J. Eisenberg Mark A. Fogel Thomas C. Gerber David E. Haines Warren K. Laskey Marian C. Limacher Kenneth J. Nichols Daniel A. Pryma Gilbert L. Raff Geoffrey D. Rubin Donnette Smith Arthur E. Stillman L. Samuel Wann 《Journal of the American College of Cardiology》2018,71(24):e283-e351