Elsayed Z. Soliman

PUBLISHED in @JAMA_current: our recent ARIC findings suggest atrial myopathy may be a novel risk for dementia @faye_epi @alonso_epi @gottesman_lab @LinYeeChen3 jamanetwork.com/journals/jama/…

@guto_montezano @georgehret @HyperAHA Thank you everyone for your interest and the engaging discussion. #HYPHIP @HyperAHA

@ezsoliman1 thank you so much for being here and talking to us about your work. Congrats again on your #HYPHIP article. Thank you to our SoMe editor @georgehret for hosting the chat! I learned a lot today. @HyperAHA

@guto_montezano @georgehret @HyperAHA Q15: we do not know until we examine it. However, let us not put too much weight on subgroups. They are hypothesis generaring. #HYPHIP @HyperAHA

Q15 @ezsoliman1 @georgehret #HYPHIP How the data on the subgroups, such as the race perspective as an example, can be extrapolated to population outside the US, since SPRINT was only US based (if I am not mistaken)? @HyperAHA

@georgehret @HyperAHA @Hopitaux_unige @AtulPathak31 Q14....also, we should follow the current BP guidelines....Note: our results about preventing AF among HTN not addressing coexisting AF with HTN. . #HYPHIP @HyperAHA

Q14 @ezsoliman1: What is your advice to patients with AF and HYPERTENSION, what target and by what measurement method ?@ezsoliman1 #HYPHIP @HyperAHA @Hopitaux_unige @AtulPathak31

@georgehret @HyperAHA @Hopitaux_unige @AtulPathak31 Q14. Maintaining a heart-healthy lifestyle is always our best option. Understanding and seeking proper management of AF risk factors comes next. #HYPHIP @HyperAHA

@guto_montezano @georgehret @HyperAHA Q13. The strength of association as we found in the REGARDS study could vary as we age. As for intensive vs. standard, we only looked at age cut-off 75 above and below. With the SPRINT age, it is hard to answer your question. #HYPHIP @HyperAHA

Q13 @ezsoliman1 @georgehret #HYPHIP Would the AF/BP relationship be the same in younger population, as hypertension is now affecting younger people? Apologies if I missed this somewhere.@HyperAHA

@hswapnil @asouth_neph @HyperAHA @georgehret @statsepi We are talking about "well-conducted" trials, not any trial. In Sprint we adjusted for the clinical center network for example, but not for baseline characteristics. #HYPHIP @HyperAHA

@ezsoliman1 @asouth_neph @HyperAHA @georgehret Hmmm I think most if not all trial statisticians will disagree with that opinion See statsepi.substack.com/p/out-of-balan… from @statsepi #HYPHIP

Q6. @ezsoliman1, were you able to ascertain baseline participant characteristics that may contribute to #AFib development, such as echos and measure of the #RAAS? @HyperAHA #HYPHIP @georgehret #SPRINTStudy

Hi All- Please repeat your question if I missed it. @HyperAHA #HYPHIP

@georgehret @HyperAHA Q12. In SPRINT, AF was defined by Minnesota ECG Classification which suppresses AF detection on certain occasions. We reviewed these ECGs and added more AF cases, Parcha V et al. did not. #HYPHIP @HyperAHA

Q12 @ezsoliman1: Parcha V et al. (same issue of HYPERTENSION as your paper) did not get to the same conclusions regarding strict BP control and AF, please put into context.@ezsoliman1 #HYPHIP @HyperAHA

@hswapnil @asouth_neph @HyperAHA @georgehret In a well-conducted clinical trial, we do not need adjustment for baseline covariate. #HYPHIP @HyperAHA

@ezsoliman1 @asouth_neph @HyperAHA @georgehret Still, would you consider adjustment for baseline covariates? Was that done? (Perhaps I missed that!) #HYPHIP

@georgehret @HyperAHA @Hopitaux_unige Q10. You already said- it has been widely discussed :) Remember SPRINT is a trial and any misclassification should have impacted both arms equally. So debates on ascertainments or measurements should not impact the conclusion but my impact the generalizability. #HYPHIP @HyperAHA

Q10 @ezsoliman1: Can you please share your view on BP measurement techniques in SPRINT (this has been very very widely discussed) and the generalisability of your findings. #HYPHIP @HyperAHA What’s the best office BP to avoid atrial fibrillation ? @Hopitaux_unige

@hswapnil @georgehret @HyperAHA Agree. This is one of the reasons the results of the subgroups need to be read with caution. #HYPHIP @HyperAHA

@ezsoliman1 @georgehret @HyperAHA And the ‘race’ subgroup event rates are quite small. Very hard to say much, right? #HYPHIP

Q3b: You are at the source of one of the most important studies that is currently available: is there evidence that the inter-group difference persists after the end of the randomization ? #HYPHIP @HyperAHA

@fjorios @HyperAHA Q10. They probably were taking other medications. However, this is a randomized clinical trial that ensures balance between groups. #HYPHIP @HyperAHA

Q10 Dr @ezsoliman1 Can you tell us if the patients enrolled in the study were only in BP control or they were also taking some other medicine, such as statins? #HYPHIP @HyperAHA

@georgehret @HyperAHA Q9b-Missing baseline or follow-up ECG. Presence of prevalent AF at baseline. #HYPHIP @HyperAHA

Q9b: Can we please go back to the ECG and remind ourselves of some details on the ECG ascertainment and exclusion criteria please ? @ezsoliman1 #HYPHIP @HyperAHA

@georgehret @HyperAHA Q6. I'd say within the range of what is expected given the main SPRINT results. #HYPHIP @HyperAHA

Q6: Your principal results table are attached here: Less ATRIAL FIBRILLATION ! Can you please comment on the effect size @ezsoliman1 #HYPHIP @HyperAHA Was this what is expected, more or less?

@fjorios @HyperAHA Q5: SPRINT was designed to look at effect of individual drugs but a strategy. #HYPHIP @HyperAHA

Q5. Dr @ezsoliman1 Are there differences in the number of patients with atrial fibrillation according to the drugs used to treat BP? #HYPHIP @HyperAHA

@guto_montezano @georgehret @HyperAHA Q8. Good question. We have not looked at this. We just used the same SPRINT main results plan. Will do #HYPHIP @HyperAHA

Q8 @ezsoliman1 @georgehret #HYPHIP In another SPRINT related study, the concern of drastically reducing diastolic BP leading to increase in cardio risk was reported. Would DBP also influence AF and if yes, would it be a concern? @HyperAHA

@asouth_neph @HyperAHA @georgehret Q9. Power issue due to ascertainment by ECG only. #HYPHIP @HyperAHA

Q9: @ezsoliman1, what do you think contributed most to the relatively imprecise effect sizes that you observed? @HyperAHA #HYPHIP @georgehret

@georgehret @HyperAHA Q3c. Our interpretation of the subgroups is based on Hommel adjusted p-values which take into account that for the race was 0.24. #HYPHIP @HyperAHA

Q3c: The forest plot from your fabulous article is attached here. Subgroup analyses are always error-prone, your findings on some subgroups were particularly striking ! Comments ?@ezsoliman1 #HYPHIP @HyperAHA