Publications by authors named "John Chalmers"
Objective: To compare the vascular effects of pursuing more versus less glucose lowering in patients with younger or older age at diabetes diagnosis, and with shorter or longer diabetes duration.
Research Design And Methods: We studied 11,138 participants from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial, classified into subgroups defined by age at diabetes diagnosis (≤50, >50-60, and >60 years) and diabetes duration (≤5, >5-10, and >10 years).
Results: Intensive glucose lowering significantly lowered the risk of the primary composite outcome of major macrovascular and microvascular events (hazard ratio 0.
Article Synopsis
- * A modified Delphi methodology will be employed to gather opinions from a diverse group of UK experts through a series of anonymous surveys, aiming for consensus on effective pain management techniques.
- * The study seeks to analyze expert agreement using structured feedback and will only continue if a consensus of at least 75% is reached among participants, although ethical approval was deemed unnecessary.
Article Synopsis
- Hemorrhagic transformation is a serious complication of intravenous thrombolysis (IVT) in acute ischemic stroke, and this study aimed to understand its impact on clinical outcomes by evaluating different hemorrhage patterns.
- The research analyzed data from the Enhanced Control of Hypertension and Thrombolysis Stroke Study and defined symptomatic intracerebral hemorrhage (sICH) and asymptomatic intracerebral hemorrhage (aICH) based on established criteria, examining their associations with patient outcomes.
- Results showed that 17.8% of participants experienced intracranial hemorrhage, with sICH significantly linked to worse outcomes, including death and major disability, while aICH also posed risks, though to a lesser extent.
Aim: Whether apolipoproteins (apolipoprotein A1, apolipoprotein B, apolipoprotein B/apolipoprotein A1 [ApoB/ApoA1] ratio) or very-low-density lipoprotein (VLDL) cholesterol are better risk predictors than established lipid risk markers, and whether there are sex differences, is uncertain, both in general populations and in patients with diabetes. The aim of this study was to assess the association between established risk markers, apolipoproteins and the risk of macro- and microvascular disease and death in a large study of women and men with diabetes and to assess the potential sex differences in the associations.
Materials And Methods: Established lipid risk markers were studied in 11 140 individuals with type 2 diabetes from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial, and apolipoproteins (A1, B, ApoB/ApoA1 ratio) and VLDL cholesterol from nuclear magnetic resonance (NMR) lipid analyses in biobanked samples from 3586 individuals included in the ADVANCE case-cohort study (ADVANCE CC).
Article Synopsis
- The ADVANCE trial examined the impact of intensive blood pressure lowering with perindopril-indapamide in patients with type 2 diabetes, revealing significant advantages in reducing cardiovascular and mortality risks.
- Secondary analyses identified important risk markers in diabetes, such as the effects of stopping BP therapy and specific cardiac biomarkers.
- The study also highlighted practical challenges in hypertension management, including limitations of traditional office BP readings and insights on the tolerability of combination therapy.
Objectives: The Action To promote brain HEalth iN Adults study aimed to determine the feasibility and applicability of recruitment using home blood pressure (BP) monitoring, routine blood biochemistry and videoconference measures of cognition, in adults at high risk of dementia.
Design: A decentralised double-blind, placebo-controlled, randomised feasibility trial with a four-stage screening process.
Setting: Conducted with participants online in the state of New South Wales, Australia.
The duration of treatment for which a physician may prescribe a medicine, 'prescription duration', is often dispensed at the pharmacy on multiple occasions of shorter time periods, 'dispensing duration'. These durations vary significantly between and within countries. In Australia, the quantity of medication supplied at each dispensing has recently been extended from 30 to 60 days for a selection of medicines used for chronic health conditions, such as diabetes and hypertension.
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- The study investigates how changes in kidney function relate to cardiovascular events, dementia, and mortality in patients who have had a stroke, utilizing data from the PROGRESS clinical trial.
- It analyzes the relationship between different levels of estimated glomerular filtration rate (eGFR) changes over two years and the occurrence of recurrent strokes, major cardiovascular events, dementia, and all-cause death.
- Results show that greater declines in eGFR are linked to significantly higher risks for these outcomes, suggesting that monitoring kidney function may improve risk assessments in stroke patients.
Background: A combination of four ultra-low-dose blood pressure (BP) medications lowered office BP more effectively than initial monotherapy in the QUARTET trial. The effects on average ambulatory BP changes at 12 weeks have not yet been reported in detail.
Methods: Adults with hypertension who were untreated or on monotherapy were eligible for participation.
Article Synopsis
- Intensive glycemic control was found to reduce coronary artery disease (CAD) events in participants with the haptoglobin (Hp)2-2 phenotype in the ACCORD study, but not in those without this phenotype.
- In the ADVANCE study, researchers evaluated the impact of intensive glycemic control on CAD risk, finding no significant benefits for participants with or without the Hp2-2 phenotype overall, but a notable risk reduction in Hp2-2 participants without prior cardiovascular disease.
- The study concludes that intensive glycemic control may specifically help prevent major CAD events in individuals with the Hp2-2 phenotype who have no history of cardiovascular disease.
Background: Low-dose combinations are a promising intervention for improving blood pressure (BP) control but their effects on therapeutic inertia are uncertain.
Methods: Analysis of 591 patients randomized to an ultra-low-dose quadruple pill or initial monotherapy. The episode of therapeutic inertia was defined as a patient visit with a BP of >140/90 mm Hg without intensification of antihypertensive treatment.
Orthostatic hypotension (OH) is more common in the elderly and associated with increased mortality. However, its implications for 85-year-olds are not known. In the prospective observational cohort study Elderly in Linköping Screening Assessment (ELSA 85), 496 individuals in Linköping, Sweden, were followed from age 85 years with cognitive assessments.
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- The study aimed to evaluate if achieving and maintaining systolic blood pressure (SBP) between 120-140 mm Hg early on improves patient outcomes in acute intracerebral hemorrhage cases.
- Researchers analyzed data from 5,761 patients and found that earlier SBP control was linked to better functional outcomes and reduced risk of hematoma expansion.
- The findings emphasize the importance of quick diagnosis, timely transfer, and immediate treatment for patients experiencing intracerebral hemorrhage, especially those with larger initial hematomas.
Article Synopsis
- A study analyzed the prevalence and staging of chronic kidney disease (CKD) in Australia using data from over 2.7 million adults visiting general practices between 2011 and 2020.
- The findings revealed that CKD prevalence increased during the study period, showing rates of 8.4%, 4.7%, and 3.1% in 2020, depending on the definitions used.
- Most patients with CKD were at moderate to high risk of progression, indicating a need for better early detection and management strategies.
Objective: Diabetes presenting at a younger age has a more aggressive nature. We aimed to explore the association of age at type 2 diabetes mellitus (T2DM) diagnosis with subsequent cancer incidence in a large Chinese population.
Research Design And Methods: The prospective population-based longitudinal cohort included 428,568 newly diagnosed T2DM patients from 2011 to 2018.
Introduction: Renal failure is a major safety concern of intensive systolic blood pressure (SBP) lowering. We aimed to determine the effect of this treatment on early change in renal function in participants of the international Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).
Methods: Post hoc analysis of the ENCHANTED BP-arm in which thrombolyzed patients with acute ischemic stroke (AIS) were randomized to intensive (target 130-140 mm Hg within 1 h) or guideline-recommended (target <180 mm Hg) management within 6 h of symptom onset.
Background: Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce the risk of kidney failure and death in patients with chronic kidney disease (CKD) but are underused. We evaluated the number of patients with CKD in Australia that would be eligible for treatment and estimated the number of cardiorenal and kidney failure events that could be averted with improved uptake of SGLT2 inhibitors.
Methods: This cross-sectional observational study leveraged nationally representative primary care data from 392 Australian general practices (MedicineInsight) between 1 January 2020 and 31 December 2021.
Aims: To evaluate whether dog ownership from the time of type 2 diabetes diagnosis improved glycaemic control, increased achievement of major guideline treatment goals or reduced the risk of all-cause death.
Methods: Patients diagnosed with type 2 diabetes were followed by linkage of four Swedish national registers covering diabetes, dog ownership, socioeconomics, and mortality. Linear regression was used to estimate the mean yearly change in glycated haemoglobin (HbA1c).
Article Synopsis
- This study investigates the optimal cut points for baseline NIHSS and Glasgow Coma Scale scores to predict outcomes in patients with acute intracerebral hemorrhage (ICH) using data from the INTERACT trials.
- The findings show that the NIHSS score is a more reliable predictor of death or major disability than the Glasgow Coma Scale and other scores, with a cut point of 10 providing significant sensitivity and specificity.
- The results indicate that a baseline NIHSS score of 10 can effectively forecast poor functional outcomes across various patient subgroups, confirming its utility in clinical assessments.
Blood pressure variability (BPV) represents a cardiovascular risk factor, regardless of mean level of blood pressure (BP). In this post-hoc analysis from the PERson-centredness in Hypertension management using Information Technology (PERHIT) study, we aimed to explore BPV in daily home measurements in hypertensive patients from primary care, to identify factors associated with high BPV and to investigate whether estimated glomerular filtration rate (eGFR) and pulse pressure, as markers of target organ damage (TOD), are associated with BPV. For eight consecutive weeks, 454 participants reported their daily BP and heart rate in their mobile phone, along with reports of lifestyle and hypertension-related factors.
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- * This study analyzes data from over 27 million individuals to assess the impact of low eGFR and severe albuminuria on health outcomes like kidney failure, mortality, and cardiovascular events.
- * Results indicate differing health risks associated with the methods of estimating kidney function, revealing significant correlations between lower eGFR and adverse health outcomes over time.
Objective: To determine the cost-effectiveness and cost-utility of a quadpill containing irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.
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