Good afternoon!
I am going to speak to you today
about sub-study or sub-analysis that we did,
in the core could blood pressure study.
Asking the question
if you have someone who have hypertensive and diabetes,
and he or she is centrally obese
which is what we’ve seen most diabetes and hypertension.
Does it agree of overweigh or central obesity，
in any way modify,
the core blood pressure study outcome
is reviewed that in moment .
Just like you know I have no conflicts of interest.
Now we know
this is pretty obvious to everyone that obesity is increasing in the United States,
and the rate is going up****** .
Along with obesity
we know the blood pressure goes up,
and there is almost a strick line in my say .
And if we look at majority and larger
randomized clinical studies in hypertension
that I’ve been done in the last several years or in the last decade.
We can see that
the just about all the studies have a mean BMI about 29-30 suggesting
that the most the blood pressure that
we are seeing now there is at least trying to understand how to treat best.
Isn’t people who are either overweight or on the border of obesity.
Now we know that as blood pressure goes up
there are more cardiovascular outcomes
We know that however
if you catagorize overweight and obesity
by BMI
you have a much
less acute rise
in the main side effect
of hypertension IE myocardial infarction .
And if you catagorize the obesity by central obesity.
This is from Silin U***s work in the heart study
my right said.
And you can see that there is much stronger
relationship between cardiovascular outcomes this case
myocardial infarction
with central obesity or hip-to-waist ratio is post BMI.
And these pictures sort reflect
a lot of the hypertension that we are seeing today.
Those of us who are clinical practice see this every day.
And why are people
who are centrally obese,
why do they have hypertension?
Could they be a lot sicker?
And therefore benefit
from more aggressive blood pressure lowering
than people who have hypertension,
but are not that centrally obese.
And when you are centrally obese,
you have a lot of cytokines and imflammation proteins and so f** ,
your extra cellular volume increases,there is increase sympathetic tone.
The obesity itself impress on the kidneys can cause kidney disfunction.
There is pressure on the blood vessels,
and many of these people have obstructive sleep apnea,
which even worthens
their blood pressure.
So perhaps
if one is truly overweight and it is a central obesity,
f you are more aggressive,
maybe you will get
more band**for your back
in preventing cardiovascular outcomes
than someone who is not that obese or centrally obese.
Now just to remind you what was your ACCORD study,
it finished several years ago
but this was the study that took about 10000 people
and randomized them into intensive
glucose and non-intensive glucose arm.
There were two sub-studies of the overall study
in. One was the lipid study looking at
weather rasing HDL and lowering triglyceride
had any impact on CVD outcomes
as a post to leaving those factors alone in both groups the LDL was under 100.
And that study shows really no difference between the two groups.
The other sub-study of the ACCORD
was a blood pressure study in which about 4700 people
were randomized and half of them
were randomized to a systolic blood pressure under 120
and the other have to a systolic between 130 and 135 .
And I just briefly all the patients have to have an A1c 7.5% to 11% .
They had to be a high risk of cardiovascular disease.
The majority of them were over 55,
although those who were over 40 and already had CVD
could be included.
And there were verious critiria for weather
of not you qualifty for the blood pressure arm of the study .
We tried as much as possible to avoid microproteinuria and moderate renal disfunction.
And here just about everybody was on multiple medications,
most people started with thiazide and ACE,
blood *****inhibitor.
And then it depending on the group in which they were in
they were either given more medications or less medication,
so that they achieve the goals of the group they were randomized.
These are the results you can see that consistantly this is for systolic blood pressure.
Systolic blood pressure in the standard treatment group was about 133, 134;
in the intensive about 119,118.
You can see on the top of the graph there were
also differences in the total number of medications
that each group was being assigned to.
They ++ outcome blood pressure study
there was no difference between standard
and intensive blood pressure
for the primary outcome which was nonfatal MI
and nonfatal stroke or CVD death
the two treatments was centrally equivalent
Only in stroke that we see
a significantly difference
those who were intensively treated did better than those who received standard therapy.
So the
study’s conclusion where that intensive BP treatment
was *** for preventing stroke
and in need to treat 89 peoples to prevent one stroke
you have to treat them intensively
89 people in order to avoid one stroke over 5 years.
Now, are these outcomes the same somebody looks like the person here
which maybe a very large proportion of your diabetic patients
And here is the answer.
if we go through,
we can see that took the primary outcome which again
is non fatal MI , stroke and CVD death.
The key interaction between the four quartile
does not reach statistical significance.
In other words,
the benefit you achieve from intensive verses non intensive
was not different between quartiles of obesity.
Four of the people who are very centrally obese,
no difference,
like what, if you go down stroke,
the benefit of intensive verses non intensive
was not different by quartiles of central obesity.
I forgot to mention the measure of central obesity
here was waist to height ratio
which is very similar and maybe even better than waist to hip ratio.
Anyway,
similar results were also found for CVD mortality
and from non fatal MI
in no case was the degree of central obesity.
Did it have anyway to affect the overall ACCORD blood pressure study outcome?
If we look the outcomes and
adjust the degree of the obesity,
once again,
the overall findings of the ACCORD blood pressure remain the same.
IF you are treading
blood pressure intensively, you will prevent stroke,
but not for the other outcomes.
Last,
we did an analysis
what is the association of central obesity
with any of these outcomes.
And it turns out there is not strong association
between the primary outcome stroke,
or non fatal MI with the degree of central obesity,
but cardiovascular mortality is related to central obesity.
The heavier you are, the greater your risk of CVD death.
So in conclusion,
the central obesity does not modify overall
ACCORD blood pressure study findings,
and intensively lowering blood pressure in centrally obese
individuals does not asked at
to CVD protection other than for stroke.
And being centrally obese
increases your risk for CVD mortality,
but interestingly not for CAD,
or for stroke.
Thank you.
The question is what the actual quartile waist to height
I don’t’ remember that,
it would be in the paper.
I’d a question regarding the ****, you use waist to height,
did the same *** waist to hip, why was …
We did not believe it or not ACCORD did not do hip circumference,
we had to use waist to height
So to make this more clinically relevant…
About when we use just waist,
we got the same results. So
waist and waist to height Right,
where identical outcome.
Any other questions?
Applauds