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  • Oxford University Press (OUP)  (40)
  • 1
    Online Resource
    Online Resource
    THE ACCURACY AND PRECISION OF THE ACCUTRACKER AMBULATORY BLOOD PRESSURE MONITOR
    Oxford University Press (OUP) ; 1990
    In:  American Journal of Epidemiology Vol. 132, No. 2 ( 1990-8), p. 343-354
    Details
    In: American Journal of Epidemiology, Oxford University Press (OUP), Vol. 132, No. 2 ( 1990-8), p. 343-354
    Type of Medium: Online Resource
    ISSN: 1476-6256 , 0002-9262
    URL: Article
    DOI: 10.1093/oxfordjournals.aje.a115664
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 1990
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  • 2
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    The Moderate Alcohol and Cardiovascular Health Trial (MACH15): Design and methods for a randomized trial of moderate alcohol consumption and cardiometabolic risk
    Oxford University Press (OUP) ; 2020
    In:  European Journal of Preventive Cardiology Vol. 27, No. 18 ( 2020-12-01), p. 1967-1982
    Details
    In: European Journal of Preventive Cardiology, Oxford University Press (OUP), Vol. 27, No. 18 ( 2020-12-01), p. 1967-1982
    Abstract: Observational studies have documented lower risks of coronary heart disease and diabetes among moderate alcohol consumers relative to abstainers, but only a randomized clinical trial can provide conclusive evidence for or against these associations. Aim The purpose of this study was to describe the rationale and design of the Moderate Alcohol and Cardiovascular Health Trial, aimed to assess the cardiometabolic effects of one alcoholic drink daily over an average of six years among adults 50 years or older. Methods This multicenter, parallel-arm randomized trial was designed to compare the effects of one standard serving (∼11–15 g) daily of a preferred alcoholic beverage to abstention. The trial aimed to enroll 7800 people at high risk of cardiovascular disease. The primary composite endpoint comprised time to the first occurrence of non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalized angina, coronary/carotid revascularization, or total mortality. The trial was designed to provide & gt;80% power to detect a 15% reduction in the risk of the primary outcome. Secondary outcomes included diabetes. Adverse effects of special interest included injuries, congestive heart failure, alcohol use disorders, and cancer. Results We describe the design, governance, masking issues, and data handling. In three months of field center activity until termination by the funder, the trial randomized 32 participants, successfully screened another 70, and identified ∼400 additional interested individuals. Conclusions We describe a feasible design for a long-term randomized trial of moderate alcohol consumption. Such a study will provide the highest level of evidence for the effects of moderate alcohol consumption on cardiovascular disease and diabetes, and will directly inform clinical and public health guidelines.
    Type of Medium: Online Resource
    ISSN: 2047-4881 , 2047-4873
    URL: Article
    DOI: 10.1177/2047487320912376
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2646239-4
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  • 3
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    Evaluation of a Video-Assisted Patient Education Program to Reduce Blood Pressure Delivered Through the Electronic Medical Record: Results of a Quality Improvement Project
    Oxford University Press (OUP) ; 2021
    In:  American Journal of Hypertension Vol. 34, No. 12 ( 2021-12-01), p. 1328-1335
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 34, No. 12 ( 2021-12-01), p. 1328-1335
    Abstract: Low-cost, automated interventions that increase knowledge and skills around diet and lifestyle modifications are recommended for cardiovascular disease risk reduction. METHODS We initiated a quality improvement program to assess the impact of a web-based diet and lifestyle intervention utilizing short animated videos in adults with high blood pressure (BP) at a primary care clinic in Saudi Arabia. We enrolled adults with elevated BP, not on BP medications, who were identified using the electronic medical record. We delivered a web-linked diet and lifestyle intervention using animated videos covering diet and lifestyle topics. Videos and reminders were sent weekly for 5 weeks. Outcomes were proportion who engaged in the program, returned for a repeat BP within 3 months, and change in BP. RESULTS We enrolled 269 adult participants, with a mean (SD) age of 41.6 (12.4) years; 77% were male. At the conclusion of the pilot, we demonstrated a high level of engagement: overall, 69% of materials were viewed and 67% of patients returned for BP. Patients who returned had a mean (SD) baseline systolic BP of 138.0 (7.2) mm Hg and a large mean reduction in systolic BP from baseline, −10.5 mm Hg (12.4; P & lt; 0.001). CONCLUSIONS Overall, the feasibility of a video-assisted, web-based, diet and lifestyle intervention as a support tool for hypertension management demonstrated a high participation rate and a high return rate for reassessment of BP. These findings suggest that this low-cost, automated intervention may have a great potential as a scalable tool for blood pressure management. However, randomized trials to understanding the effectiveness of the support tools are needed.
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpab135
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 4
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    Effects of Antihypertensive Deprescribing Strategies on Blood Pressure, Adverse Events, and Orthostatic Symptoms in Older Adults: Results From TONE
    Oxford University Press (OUP) ; 2022
    In:  American Journal of Hypertension Vol. 35, No. 4 ( 2022-04-02), p. 337-346
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 35, No. 4 ( 2022-04-02), p. 337-346
    Abstract: The Trial of Nonpharmacologic Interventions in the Elderly (TONE) demonstrated the efficacy of weight loss and sodium reduction to reduce hypertension medication use in older adults. However, the longer-term effects of drug withdrawal (DW) on blood pressure (BP), adverse events, and orthostatic symptoms were not reported. Methods TONE enrolled adults, ages 60–80 years, receiving treatment with a single antihypertensive and systolic BP (SBP)/diastolic BP & lt;145/ & lt;85 mm Hg. Participants were randomized to weight loss, sodium reduction, both, or neither (usual care) and followed up to 36 months; ~3 months postrandomization, the antihypertensive was withdrawn and only restored if needed for uncontrolled hypertension. BP and orthostatic symptoms (lightheadedness, feeling faint, imbalance) were assessed at randomization and throughout the study. Two physicians independently adjudicated adverse events, masked to intervention, classifying symptomatic (lightheadedness, dizziness, vertigo), or clinical events (fall, fracture, syncope). Results Among the 975 participants (mean age 66 years, 48% women, 24% black), mean (±SD) BP was 128 ± 9/71 ± 7 mm Hg. Independent of assignment, DW increased SBP by 4.59 mm Hg (95% confidence interval [CI]: 3.89, 5.28) compared with baseline. There were 113 adverse events (84 symptomatic, 29 clinical), primarily during DW. Compared with usual care, combined weight loss and sodium reduction mitigated the effects of DW on BP (β = −4.33 mm Hg; 95% CI: −6.48, −2.17) and reduced orthostatic symptoms long term (odds ratio = 0.62; 95% CI: 0.41, 0.92), without affecting adverse events (hazard ratio = 1.81; 95% CI: 0.90, 3.65). In contrast, sodium reduction alone increased risk of adverse events (hazard ratio = 1.75; 95% CI: 1.04, 2.95), mainly during DW. Conclusions In older adults, antihypertensive DW may increase risk of symptomatic adverse events, highlighting the need for caution in withdrawing their antihypertensive medications. Clinical trials registration Trial Number NCT00000535.
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpab171
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 5
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    Clinical events and patient-reported outcome measures during CKD progression: findings from the Chronic Renal Insufficiency Cohort Study
    Oxford University Press (OUP) ; 2021
    In:  Nephrology Dialysis Transplantation Vol. 36, No. 9 ( 2021-08-27), p. 1685-1693
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 36, No. 9 ( 2021-08-27), p. 1685-1693
    Abstract: Patients with chronic kidney disease (CKD) face risks of not only end-stage kidney disease (ESKD), cardiovascular disease (CVD) and death, but also decline in kidney function, quality of life (QOL) and mental and physical well-being. This study describes the multidimensional trajectories of CKD using clinical events, kidney function and patient-reported outcome measures (PROMs). We hypothesized that more advanced CKD stages would associate with more rapid decline in each outcome. Methods Among 3939 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, we evaluated multidimensional disease trajectories by G- and A-stages of enrollment estimated glomerular filtration rate (eGFR) and albuminuria, respectively. These trajectories included clinical events (ESKD, CVD, heart failure and death), eGFR decline and PROMs [kidney disease QOL (KDQOL) burden, effects and symptoms questionnaires, as well as the 12-item short form mental and physical component summaries]. We also evaluated a group-based multitrajectory model to group participants on the basis of longitudinal PROMs and compared group assignments by enrollment G- and A-stage. Results The mean participant age was 58 years, 45% were women, mean baseline eGFR was 44 mL/min/1.73 m2 and median urine albumin:creatinine ratio was 52 mg/g. The incidence of all clinical events was greater and eGFR decline was faster with more advanced G- and A-stages. While baseline KDQOL and physical component measures were lower with more advanced G- and A-stage of CKD, changes in PROMs were inconsistently related to the baseline CKD stage. Groups formed on PROM trajectories were fairly distinct from existing CKD staging (observed agreement 60.6%) and were associated with the risk of ESKD, CVD, heart failure and death. Conclusions More advanced baseline CKD stage was associated with a higher risk of clinical events and faster eGFR decline, and was only weakly related to changes in patient-reported metrics over time.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfaa364
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 6
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    Prospective associations of health literacy with clinical outcomes in adults with CKD: findings from the CRIC study
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation Vol. 38, No. 4 ( 2023-03-31), p. 904-912
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. 4 ( 2023-03-31), p. 904-912
    Abstract: Limited health literacy is associated with significant morbidity and mortality in the general population but the relation of health literacy with long-term clinical outcomes among adults with chronic kidney disease (CKD) is less clear. Methods Prospective data from the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3715) were used. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults (dichotomized as limited/adequate). Cox proportional hazards models were used to separately examine the relations of health literacy with CKD progression, cardiovascular event (any of the following: myocardial infarction, congestive heart failure, stroke or peripheral artery disease), and all-cause, cardiovascular and non-cardiovascular mortality. Poisson regression was used to assess the health literacy–hospitalization association. Models were sequentially adjusted: Model 1 adjusted for potential confounders (sociodemographic factors), while Model 2 additionally adjusted for potential mediators (clinical and lifestyle factors) of the associations of interest. Results In confounder-adjusted models, participants with limited (vs adequate) health literacy [555 (15%)] had an increased risk of CKD progression [hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.06–1.71] , cardiovascular event (HR 1.67; 95% CI 1.39–2.00), hospitalization (rate ratio 1.33; 95% CI 1.26–1.40), and all-cause (HR 1.54; 95% CI 1.27–1.86), cardiovascular (HR 2.39; 95% CI 1.69–3.38) and non-cardiovascular (HR 1.27; 95% CI 1.01–1.60) mortality. Additional adjustments for potential mediators (Model 2) showed similar results except that the relations of health literacy with CKD progression and non-cardiovascular mortality were no longer statistically significant. Conclusions In the CRIC Study, adults with limited (vs adequate) health literacy had a higher risk for CKD progression, cardiovascular event, hospitalization and mortality—regardless of adjustment for potential confounders.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfac201
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 7
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    Cost of behavioral weight loss programs implemented in clinical practice: The POWER trial at Johns Hopkins
    Oxford University Press (OUP) ; 2020
    In:  Translational Behavioral Medicine Vol. 10, No. 1 ( 2020-02-03), p. 103-113
    Details
    In: Translational Behavioral Medicine, Oxford University Press (OUP), Vol. 10, No. 1 ( 2020-02-03), p. 103-113
    Abstract: Obesity presents an important public health problem that affects more than a third of the U.S. adult population and that is associated with increased morbidity, mortality, and costs. Previously, we documented that two primary care-based weight loss interventions were clinically effective. To encourage the implementation of and reimbursement for these interventions, we evaluated their relative cost-effectiveness. We performed a cost analysis of the Practice-based Opportunities for Weight Reduction (POWER) trial, a three-arm trial that enrolled 415 patients with obesity from six primary care practices. Trial participants were randomized to a control arm, an in-person support intervention, or a remote support intervention; in the two intervention arms, behavioral interventions were delivered over 24 months, in two phases. Weight loss was measured at 6, 12, and 24 months. Using timesheets and empirical data, we evaluated the cost of the in-person and remote support interventions from the perspective of a health care system delivering the interventions. A univariate sensitivity analysis was conducted to evaluate uncertainty around model assumptions. All comparisons were tested using independent t-tests. Cost of the in-person intervention was higher at 6 months ($113 per participant per month and $117 per kg lost) than the remote support intervention ($101 per participant per month and $99 per kg lost; p & lt; .001). Costs were also higher for the in-person support intervention at 24 months ($73 per participant per month and $342 per kg lost) than for the remote support intervention ($53 per participant per month and $275 per kg lost; p & lt; .001). In the sensitivity analyses, cost ranged from $274/kg lost to $456/kg lost for the in-person support intervention and from $218/kg to $367/kg lost for the remote support intervention. A primary care weight loss intervention administered remotely was relatively more cost-effective than an in-person intervention. Expanding the scope of reimbursable programs to include other cost-effective interventions could help ensure that a broader range of patients receive the type of support needed.
    Type of Medium: Online Resource
    ISSN: 1869-6716 , 1613-9860
    URL: Article
    DOI: 10.1093/tbm/iby120
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2586893-7
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  • 8
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    Association of urine and plasma ADMA with atherosclerotic risk in DKD cardiovascular disease risk in diabetic kidney disease: findings from the Chronic Renal Insufficiency Cohort (CRIC) study
    Oxford University Press (OUP) ; 2023
    In:  Nephrology Dialysis Transplantation ( 2023-05-25)
    Details
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), ( 2023-05-25)
    Abstract: Chronic kidney disease (CKD) is associated with atherosclerotic cardiovascular disease (ASCVD) risk, especially among those with diabetes. Altered metabolism of solutes that accumulate in CKD [asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and trimethylamine N-oxide (TMAO)] may reflect pathways linking CKD with ASCVD. Methods This case–cohort study included Chronic Renal Insufficiency Cohort participants with baseline diabetes, estimated glomerular filtration rate & lt;60 mL/min/1.73 m2, and without prior history for each outcome. The primary outcome was incident ASCVD (time to first myocardial infarction, stroke or peripheral artery disease event) and secondary outcome was incident heart failure. The subcohort comprised randomly selected participants meeting entry criteria. Plasma and urine ADMA, SDMA and TMAO concentrations were determined by liquid chromatography–tandem mass spectrometry. Associations of uremic solute plasma concentrations and urinary fractional excretions with outcomes were evaluated by weighted multivariable Cox regression models, adjusted for confounding covariables. Results Higher plasma ADMA concentrations (per standard deviation) were associated with ASCVD risk [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.01–1.68]. Lower fractional excretion of ADMA (per standard deviation) was associated with ASCVD risk (HR 1.42, 95% CI 1.07–1.89). The lowest quartile of ADMA fractional excretion was associated with greater ASCVD risk (HR 2.25, 95% CI 1.08–4.69) compared with the highest quartile. Plasma SDMA and TMAO concentration and fractional excretion were not associated with ASCVD. Neither plasma nor fractional excretion of ADMA, SDMA and TMAO were associated with incident heart failure. Conclusion These data suggest that decreased kidney excretion of ADMA leads to increased plasma concentrations and ASCVD risk.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    URL: Article
    DOI: 10.1093/ndt/gfad103
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 9
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    Coffee Consumption and Serum Lipids: A Meta-Analysis of Randomized Controlled Clinical Trials
    Oxford University Press (OUP) ; 2001
    In:  American Journal of Epidemiology Vol. 153, No. 4 ( 2001-02-15), p. 353-362
    Details
    In: American Journal of Epidemiology, Oxford University Press (OUP), Vol. 153, No. 4 ( 2001-02-15), p. 353-362
    Type of Medium: Online Resource
    ISSN: 1476-6256 , 0002-9262
    URL: Article
    DOI: 10.1093/aje/153.4.353
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2001
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  • 10
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    Dietary Sodium Intake and Sodium Density in the United States: Estimates From NHANES 2005–2006 and 2015–2016
    Oxford University Press (OUP) ; 2020
    In:  American Journal of Hypertension Vol. 33, No. 9 ( 2020-09-10), p. 825-830
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 33, No. 9 ( 2020-09-10), p. 825-830
    Abstract: In the United States, current guidelines recommend a total sodium intake & lt;2,300 mg/day, a guideline which does not consider kilocalorie intake. However, kilocalorie intake varies substantially by age and sex. We hypothesized that compared with sodium density, total sodium intake overestimates adherence to sodium recommendations, especially in adults consuming fewer kilocalories. METHODS In the National Health and Nutrition Examination Survey (NHANES), we estimated the prevalence of adherence to sodium intake recommendations ( & lt;2,300 mg/day) and corresponding sodium density intake ( & lt;1.1 mg/kcal = 2,300 mg at 2,100 kcal) by sex, age, race/ethnicity, and kilocalorie level. Adherence estimates were compared between the 2005–2006 (n = 5,060) and 2015–2016 (n = 5,266) survey periods. RESULTS In 2005–2006, 23.1% (95% confidence interval [CI]: 21.5, 24.9) of the US population consumed & lt;2,300 mg of sodium/day, but only 8.5% (CI: 7.6, 9.4) consumed & lt;1.1 mg/kcal in sodium density. In 2015–2016, these figures were 20.9% (CI: 18.8, 23.2) and 5.1% (CI: 4.4, 6.0), respectively. In 2015–2016, compared with 2005–2006, adherence by sodium density decreased more substantially (odds ratio = 0.59; CI: 0.48, 0.72; P & lt; 0.001) than adherence by total sodium consumption (odds ratio = 0.85; CI: 0.73, 0.98; P = 0.03). The difference in adherence between total sodium and sodium density goals was greater among those with lower kilocalorie intake, namely, older adults, women, and Hispanic adults. CONCLUSIONS Adherence estimated by sodium density is substantially less than adherence estimated by total sodium intake, especially among persons with lower kilocalorie intake. Further efforts to achieve population-wide reduction in sodium density intake are urgently needed.
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpaa104
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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