Background
The beneficial prognostic impact of statins has been established in patients with ischemic heart disease but not in those with heart failure (HF). In addition, it is still unclear whether ...patients benefit from statins regardless of low‐density lipoprotein cholesterol levels.
Methods and Results
We examined 2444 consecutive stage C or D HF patients with ischemic heart disease registered in CHART‐2 (Chronic Heart Failure Registry and Analysis in the Tohoku District 2), a multicenter, prospective, observational cohort study in Japan. Patients were divided into 3 groups according to the Japanese standard doses of statins and statin‐intensity categories defined by the 2013 American College of Cardiology and American Heart Association guidelines: higher (moderate‐high)‐intensity (n=868), lower (low)‐intensity (n=526), and no statin (n=1050). The median follow‐up period was 6.4 years (13929 person‐years). Analysis with the inverse probability of treatment weighted using a propensity score for multiple treatment revealed that both the higher‐intesity group (hazard ratio HR: 0.68; P<0.001) and the lower‐intensity group (HR: 0.82; P<0.001) had significantly lower incidence of the primary end point—a composite of all‐cause death and HF admission—compared with the no statin group. The higher‐intensity statin group had significantly lower incidence of the primary end point (HR: 0.82; P<0.001), all‐cause death (HR: 0.83; P<0.001), and HF admission (HR: 0.78; P<0.001) than the lower‐intensity statin group. Moreover, the use of statins, either higher‐ or lower‐intensity, was associated with reduced incidence of the primary end point, regardless of low‐density lipoprotein cholesterol levels.
Conclusions
These results suggest that statin use, particularly the use of higher‐intensity statins, has a beneficial prognostic impact in HF patients with ischemic heart disease, regardless of low‐density lipoprotein cholesterol levels.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00418041.
The Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) study was conducted to measure the control of blood pressure (BP) as evaluated by home BP measurement among 3,400 patients ...with essential hypertension (mean age: 66 years; females: 55%) receiving antihypertensive treatment in primary care settings in Japan. The purpose of this first report was to compare characteristics of BP control as measured at home and in the clinic (office) and define their association with BP control as evaluated by physicians. Mean systolic/diastolic BP (SBP/DBP) values were 140/82 mmHg for home BP and 143/81 mmHg for office BP. BP levels were not adequately controlled among approximately 60% of the patients, according to reference values described in the national guidelines (office BP: <140/90 mmHg; home BP: <135/85 mmHg). Even among patients evaluated by physicians as having excellent or fairly good BP control, office and home SBP values were insufficiently controlled in approximately 50%. Although the tendency was more remarkable among older patients, whose recommended target BP levels are higher than those of middle-aged patients in the Japanese Hypertension Society 2000 criteria, office and home BP values were not adequately controlled in approximately 50% of the middle-aged patients whose BP control was evaluated as good. Our findings suggest that an important reason why home and office BP values are not adequately controlled is that physicians approve relatively higher BP levels under treatment, even among middle-aged patients. (Hypertens Res 2004; 27: 755-763)
Although self-measured blood pressure (BP) at home (HBP) has become popular in clinical practice, little information is available regarding the proportion of diabetic patients with properly ...controlled HBP. We evaluated the status of HBP control in diabetic hypertensives. HBP control status was cross-sectionally evaluated among 3400 essential hypertensives taking antihypertensive treatment. Of these, 466 (14%) had diabetes. Physicians evaluated the subjects’ HBP control as “poor”, “fairly good”, or “excellent” using a self-administered questionnaire.
When the HBP threshold in diabetic patients was set tentatively at 130/80
mmHg or 135/85
mmHg, HBP was properly controlled in 18% or 30% of diabetic patients, respectively. The same trend was observed in office BP. The average number of drugs prescribed for diabetic patients was 2.0 drugs. In the majority of diabetic patients with uncontrolled BP, the BP control status in two-thirds of those was evaluated as “excellent” or “fairly good” by their physicians. In Japan, HBP and office BP were not adequately controlled in most diabetic hypertensives. The main reason for this would appear to be a lack of intensive treatment and a lack of recognition by physicians that their patients’ BP was insufficiently controlled.
This study sought to clarify the factors associated with the magnitude of the difference between home and office blood pressures in treated hypertensive patients. Study subjects consisted of 3,308 ...essential hypertensive patients (mean age, 66 years; males, 44%) receiving antihypertensive treatment in primary care settings in Japan. Patients were classified into 3 groups (the home effect group, small difference group, and office effect group) according to tertiles of the magnitude of the office-home systolic blood pressure difference. Compared to the other two groups, the home effect group patients were significantly and independently older, were more often habitual drinkers, had a greater family history of cerebrovascular disease or personal history of ischemic heart disease, and were prescribed a greater number of antihypertensive drugs, non-amlodipine calcium channel blockers, and alpha-blockers as antihypertensive drugs. Compared to the other two groups, the office effect group patients were significantly and independently younger, included more females, less frequently had a family history of cerebrovascular disease or personal history of ischemic heart disease, and were less often prescribed alpha-blockers as antihypertensive drugs. The characteristics of home effect group patients and the factors negatively affecting the blood pressure difference were the same. Among treated hypertensive patients, compared to patients in the other groups, office effect group patients had a lower-risk profile, whereas home effect group patients had a higher-risk profile. These predictive factors might be useful clinically to help identify patients who may have a large difference between home and office blood pressures.
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