George Bakris

Aim The cardiovascular benefits provided by glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) extend beyond weight reduction and glycaemic control. One possible mechanism may relate to blood pressure (BP) reduction. We aim to quantify the BP‐lowering effects of GLP1‐RAs. Methods A comprehensive database search for placebo‐controlled randomized controlled trials on GLP‐1RA treatment was conducted until December 2023. Data extraction and quality assessment were carried out, employing a robust statistical analysis using a random effects model to determine outcomes with a mean difference (MD) in mmHg and 95% confidence intervals (CIs). The primary endpoint was the mean difference in systolic BP (SBP) and diastolic BP. Subgroup analyses and meta‐regressions were done to account for covariates. Results Compared with placebo, GLP‐1RAs modestly reduced SBP [semaglutide: MD …

This is an updated review of meta-analyses of blood pressure goals derived from the most recent guidelines. These analyses focus on outcomes based on goals recommended by various guidelines and deal with specific areas of interest such as those over age 70 and various magnitudes of high risk. The update confirms what was noted in the earlier edition. Those with high cardiovascular risk (ie,> 15% in 10 years clearly benefit from blood pressure [BP] levels< 130/80 mm Hg if they can tolerate that level). People with lower risk garner no greater benefit from being less than 130/80 mm Hg compared to less than 140/90 mm Hg. There is no evidence to support levels of less than 120/80 mm Hg in any group including those with advanced kidney disease who have diabetes.

BACKGROUND Sodium glucose cotransporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1 RA), and the nonsteroidal mineralocorticoid receptor antagonist (ns-MRA) finerenone all individually reduce cardiovascular, kidney, and mortality outcomes in patients with type 2 diabetes and albuminuria. However, the lifetime benefits of combination therapy with these medicines are not known. METHODS We used data from 2 SGLT2i trials (CANVAS [Canagliflozin Cardiovascular Assessment] and CREDENCE [Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation]), 2 ns-MRA trials (FIDELIO-DKD [Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease] and FIGARO-DKD [Efficacy and Safety of Finerenone in Subjects With Type 2 Diabetes Mellitus and the Clinical Diagnosis of Diabetic Kidney Disease]), and 8 GLP …

Methods: Patients with type 1 (T1D) and type 2 (T2D) diabetes registered in the nationwide Swedish National Diabetes Register (NDR) 2002-2018 were included. The patients were categorized into non-FH or probable FH according to a truncated version of the Dutch Lipid Clinic Network criteria based on LDL levels and premature ASCVD. Patients with≥ 6 points were considered as having probable FH. The risk of fatal outcomes and and cardiovascular events was assessed in patients with and without probable FH using Cox proportional hazards models adjusting for age and sex.Results: A total of 42,429 T1D and 593,333 T2D patients were followed for a median of 11.4 and 6.8 years respectively, and of these, 137 and 5,473 were categorized as having probable FH. Compared to patients without probable FH, those with probable FH had an increased risk of all-cause mortality (hazard ratio 3.9; 95% confidence …

BACKGROUND Chronic kidney disease (CKD) is a common comorbidity in patients with apparent treatment-resistant hypertension (aTRH). We assessed clinical outcomes, healthcare resource utilization events, and costs in patients with aTRH or difficult-to-control hypertension and stage 3-4 CKD with uncontrolled versus controlled blood pressure (BP). METHODS This retrospective cohort study used linked IQVIA Ambulatory EMR–US and IQVIA PharMetrics® Plus claims databases. Adult patients had claims for≥ 3 antihypertensive medication classes within 30 days between 01/01/2015 and 06/30/2021, 2 office BP measures recorded 1-90 days apart,≥ 1 claim with ICD-9/10-CM diagnosis codes for CKD 3/4, and≥ 1 year of continuous enrollment. Baseline BP was defined as uncontrolled (≥ 130/80 mmHg) or controlled (< 130/80 mmHg) BP. Outcomes included risk of major adverse cardiovascular events plus …

Kidney disease is most commonly due to diabetes and poorly controlled hypertension. These account for over 60% of people on dialysis. The data are very clear that: if blood pressure goals of less than 130/80 mm Hg, glucose control of HbA1c less than 7%, and cholesterol are managed, kidney disease progression is slowed. Moreover, agents to maximally slow kidney disease progression that must be used as pillars of therapy include (1) blockers of the renin angiotensin system in maximally tolerated doses (2) a sodium-glucose cotransporter-2 (SGLT2) inhibitor, and finally finerenone, a nonsteroidal mineralocorticoid receptor antagonist in those with diabetes. As kidney function declines below an estimated glomerular filtration rate (eGFR) of 45 mL/min/1.73 m2, the risk of hyperkalemia is present and may preclude kidney-saving therapy. Newer potassium binders that are well tolerated and can be used daily are …

The traditional view of diabetic kidney disease (DKD) involves the development of albuminuria, followed by a steady decline in the glomerular filtration rate (GFR). End-stage kidney disease and ranges in GFR decline from> 40% to 57%(doubling of serum creatinine) are often used in clinical trials as validated clinical end points to demonstrate differences between novel and established therapies. The caveat, however, is that substantial time is needed to confirm these differences. Therefore, developing outcome trials to evaluate new agents for kidney disease progression is very challenging and expensive. It is worth noting that the median follow-up of appropriately powered clinical trials focused on primary renal outcomes was 35 months. 1 The slope of GFR decline has been used in clinical trials as an alternative indicator of kidney disease progression, with the common assumption that the GFR decline follows a …

ObjectivesThis study aimed to evaluate the efficacy and safety of finerenone, a selective, non-steroidal mineralocorticoid receptor antagonist, on cardiovascular and kidney outcomes by age and/or sex.DesignFIDELITY post hoc analysis; median follow-up of 3 years.SettingFIDELITY: a prespecified analysis of the FIDELIO-DKD and FIGARO-DKD trials.ParticipantsAdults with type 2 diabetes and chronic kidney disease receiving optimised renin–angiotensin system inhibitors (N=13 026).InterventionsRandomised 1:1; finerenone or placebo.Primary and secondary outcome measuresCardiovascular (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalisation for heart failure (HHF)) and kidney (kidney failure, sustained ≥57% estimated glomerular filtration rate (eGFR) decline or renal death) composite outcomes.ResultsMean age was 64.8 years; 45.2%, 40.1% and 14.7% were aged <65, 65 …