Publications by authors named "Bress A"
Identification of drug-repurposing targets with genetic and biological support is an economically and temporally efficient strategy for improving treatment of diseases. We employed a cross-disciplinary approach to identify potential treatments for metabolic dysfunction associated steatotic liver disease (MASLD) using humans as a model organism. We identified 212 putative causal genes associated with MASLD using data from a large multi-ancestry genetic association study, of which 158 (74.
View Article and Find Full Text PDFBackground: Whether the differing mechanistic effects between angiotensin-2 receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) on the renin-angiotensin system translate to differential effects on clinical cognitive outcomes is unclear.
Methods: We employed an active comparator, new-user cohort study to emulate a target trial evaluating the per-protocol effect of initiating and continuously adhering to an ARB vs. ACEI on adjudicated amnestic mild cognitive impairment (MCI) and probable dementia (PD) in the Systolic Blood Pressure Intervention Trial.
Article Synopsis
- Dementia disproportionately impacts Hispanic communities, with lower awareness of its risk factors among residents, regardless of ethnicity.
- Interest in dementia prevention programs is notably high, particularly among Hispanic (83%) and younger individuals (82.2%).
- Increasing accessibility of dementia prevention programs targeting these demographics could help reduce disparities in dementia outcomes.
Article Synopsis
- Fewer than 20% of heart failure patients with reduced ejection fraction receive all recommended treatments, highlighting the need to investigate disparities based on race, sex, and social factors for effective care.
- A study analyzed data from the American Heart Association's registry to evaluate how these disparities affect the optimization of quadruple therapy in heart failure patients between July 2021 and September 2023.
- Results showed that while Black and Hispanic patients had slightly higher therapy scores compared to non-Hispanic Whites, females performed better than males, and those without private insurance faced significantly lower optimization scores.
Article Synopsis
- A study utilizing data from the Veterans Health Administration examined trends in the initial treatment regimens for newly diagnosed hypertension from 2000 to 2019, focusing on the use of monotherapy versus dual therapy.
- Initial monotherapy prescriptions increased across all levels of pretreatment systolic blood pressure, while the use of dual therapy declined over the same period.
- The findings highlight a gap between recommended treatment guidelines and the actual medications prescribed to Veterans with high blood pressure, particularly those with systolic BP levels of 160 mm Hg or higher.
The authors conducted a review of pharmacologic therapy in older adults with hypertension. They reviewed the evidence supporting their use in older adults, understanding the physiologic changes and potential adverse drug effects associated with aging and antihypertensive medication use, exploring guideline recommendations for antihypertensive use in older adults, and evaluating the associated risks and benefits of specific classes of antihypertensive medications.
View Article and Find Full Text PDFBlood pressure (BP) levels are important modifiable risk factors for incident cardiovascular disease (CVD). However, many adults are on anti-hypertensive medication (MEDS) which lowers their BP but is a marker for increased CVD risk. To capture the association of BP and its treatment with risk, it is important to estimate BP levels in the absence of medication, i.
View Article and Find Full Text PDFBackground: Nearly one-half of patients admitted with acute decompensated heart failure (ADHF) are discharged with unresolved congestion, elevating rehospitalization risk. This may be due to suboptimal intravenous (IV) loop diuretic dosing, which may be influenced by home oral diuretic dose.
Objectives: The objective of this study was to determine the association between: 1) home oral loop diuretic dose and optimal initial IV loop diuretic dosing in ADHF; and 2)receiving optimal initial IV loop diuretic dosing and length of stay and 30-day readmission.
Background: Antihypertensive medication use patterns have likely been influenced by changing costs and accessibility over the past 3 decades. This study examines the relationships between patent exclusivity loss, medication costs, and national health policies on antihypertensive medication use.
Methods: Using 1996 to 2021 Medical Expenditure Panel Survey data of US adults with hypertension taking at least 1 antihypertensive medication, we conducted a cross-sectional analysis.
Background: Self-care for adults with hypertension includes adherence to lifestyle behaviors and medication. For unpaid caregivers with hypertension, the burden of family caregiving may adversely impact self-care. We examined the association between caregiver strain and hypertension self-care among caregivers with hypertension.
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- In the Systolic Blood Pressure Intervention Trial (SPRINT), long-term kidney failure rates were low, primarily linked to patients' initial kidney function.
- Intensive blood pressure treatment resulted in higher but not statistically significant rates of dialysis or transplantation compared to standard treatment.
- The study analyzed 9,279 participants over roughly 8.6 years, finding that most kidney failure cases occurred in patients with poor baseline kidney function, and intensive treatment did not notably raise the overall risk of kidney failure.
Over the past 3 decades, a substantial body of high-quality evidence has guided the diagnosis and management of elevated blood pressure (BP) in the outpatient setting. In contrast, there is a lack of comparable evidence for guiding the management of elevated BP in the acute care setting, resulting in significant practice variation. Throughout this scientific statement, we use the terms acute care and inpatient to refer to care received in the emergency department and after admission to the hospital.
View Article and Find Full Text PDFBackground: Poor neighborhood-level access to health care, including community pharmacies, contributes to cardiovascular disparities in the United States. The authors quantified the association between pharmacy proximity, antihypertensive and statin use, and blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) among a large, diverse US cohort.
Methods And Results: A cross-sectional analysis of Black and White participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study during 2013 to 2016 was conducted.
Background: Cardiovascular disease (CVD) is among the costliest conditions in the United States, and cost-effectiveness analyses can be used to assess economic impact and prioritize CVD treatments. We aimed to develop standardized, nationally representative CVD events and selected possible CVD treatment-related complication hospitalization costs for use in cost-effectiveness analyses.
Methods: Nationally representative costs were derived using publicly available inpatient hospital discharge data from the 2012-2018 National Inpatient Sample.
Background: Therapeutic inertia (TI), failure to intensify antihypertensive medication when blood pressure (BP) is above goal, remains prevalent in hypertension management. The degree to which self-reported antihypertensive adherence is associated with TI with intensive BP goals remains unclear.
Methods And Results: Cross-sectional analysis was performed of the 12-month visit of participants in the intensive arm of SPRINT (Systolic Blood Pressure Intervention Trial), which randomized adults to intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic BP goals.
Background: Considering that mail-order pharmacy use remains low in the United States, geographic accessibility of community pharmacies (pharmacy access) can have an outsized impact on a community's access to services and care, especially among rural residents. However, previous measurements of pharmacy access rely on methods that do not capture all aspects of geographic access.
Objectives: This study aimed to measure pharmacy access across the contiguous United States and by rural, suburban, and urban areas using drive-time analysis and an improved methodological approach.
Article Synopsis
- * The strategies simulated include usual care, intensive care targeting lower blood pressure, and team-based care, indicating varying levels of effectiveness in reducing CVD events.
- * While intensive care could prevent up to 138,100 cardiovascular events annually, it is also associated with a significant increase in serious treatment-related adverse events, raising concerns about safety.
Article Synopsis
- The REDUCE-IT USA trial found that icosapent ethyl (IPE) significantly reduced cardiovascular events by 31% and 36% over approximately 4.9 years.
- An analysis of the cost-effectiveness of IPE compared to standard care (SC) showed that IPE was less expensive and provided better health outcomes, particularly at a daily cost of $4.59.
- Overall, IPE is recommended for U.S. patients similar to those in the trial, as it remains cost-effective even at a higher daily cost of $11.48.
Article Synopsis
- Glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2Is) are effective new treatments for high-risk diabetes patients, but their adoption rates in the U.S. from 2015 to 2020 are still unclear.
- A study analyzing data from the National Health and Nutrition Examination Surveys (NHANES) revealed that only 9.0% of adults with diabetes were using either GLP1-RAs or SGLT2Is, with no significant difference in usage between those with high cardiovascular and kidney risk (CKR) and those without.
- The findings showed that patients with a history of
Background: Patterns and disparities in guideline-directed medical therapy (GDMT) uptake for heart failure with reduced ejection fraction (HFrEF) across rural vs urban regions are not well described.
Objectives: This study aims to evaluate patterns, prognostic implications, and rural-urban differences in GDMT use among Medicare beneficiaries following new-onset HFrEF.
Methods: Patients with a diagnosis of new-onset HFrEF in a 5% Medicare sample with available data for Part D medication use were identified from January 2015 through December 2020.