| 1. |
- Bokrantz, Tove, et al.
(författare)
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7b.10: Thiazide Diuretics and Fracture-Risk among Hypertensive Patients. Results from the Swedish Primary Care Cardiovascular Database (Spccd)
- 2015
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Ingår i: Journal of hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 0263-6352 .- 1473-5598. ; 33 Suppl 1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: To investigate whether treatment with thiazide diuretics reduces the risk of osteoporotic fractures in hypertensive patients in primary health care. Further we aimed to examine the impact of duration of thiazide use, the consequences of discontinuation of use and effect-modifications by gender. DESIGN AND METHOD: This retrospective cohort study includes 60 893 individuals, diagnosed with hypertension during 2001-2008 included in the Swedish Primary Care Cardiovascular Database. All patients were followed from a fixed baseline (1 Jan 2006, or the date the patient received their first diagnosis of hypertension if that date came later) until they had an incident osteoporotic fracture, died, or reached the end of the study at 31 Dec 2012, whichever came first. Patients exposed to thiazide diuretics (dispensed drugs recorded through the Prescribed Drug Register) were compared with hypertensive patients never exposed to thiazides. RESULTS: During follow up 2421 osteoporotic fractures occurred. Current use of thiazide diuretics was found to be associated with significantly reduced risk of osteoporotic fractures (adjusted hazard ratios 0.88; 95% CI 0.81-0.97) independent of blood pressure level. In addition, risk appeared to decline with longer duration of use. In contrast, discontinuation of dispensed prescriptions of thiazides was associated with increased risk of osteoporotic fractures (HR 1.17; 95% CI 1.04-1.31).However, a trend towards attenuation of the increased risk with longer duration past treatment period was seen. When analyzing men and women separately similar results were seen, for both genders, although only statistically significant for men. CONCLUSIONS: In this large retrospective cohort study of hypertensive men and women from Sweden, we could identity a protective effect on osteoporotic fractures among current users of thiazide diuretic drugs independent of blood pressure level. However, the risk of fracture was found to be increased in patients shortly after discontinuation of treatment compared to patients never prescribed thiazide diuretic drugs. The reason for an augmented outcome on osteoporotic fractures among patients with former thiazide diuretic therapy needs to be further elucidated.
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| 2. |
- Journath, Gunilla, et al.
(författare)
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Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare.
- 2008
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Ingår i: Journal of hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 26:10, s. 2050-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the association of physician's sex with blood pressure, lipid control, and cardiovascular risk factors in treated hypertensive men and women, stratified for the sex of their physician. METHODS: In a cross-sectional survey of hypertensive patients, 264 primary care physicians (PCPs), 187 men and 77 women from across Sweden, recruited 6537 treated hypertensive patients (48% men) during 2002-2005, consecutively collected from medical records and registered on a web-based form connected to a central database. Patients were included consecutively in the same order as they visited the healthcare centre. RESULTS: Hypertensive women more often reached target systolic/diastolic blood pressure levels (<140/90 mmHg) when treated by female PCPs than when they were treated by male PCPs (32 vs. 24%, P < 0.001). This difference remained when comparing female and male physicians' nondiabetic female patients. Both male and female patients had better control of total cholesterol and low-density lipoprotein cholesterol levels when treated by female PCPs than when treated by male PCPs (total cholesterol <5 mmol/l: women 30 vs. 24%, P < 0.001; men 42 vs. 34%, P < 0.001; low-density lipoprotein cholesterol <3 mmol/l: women 39 vs. 33%, P < 0.01; men 41 vs. 35%, P < 0.05). Female PCPs had a higher proportion of treated hypertensive patients with diabetes than did male PCPs but male PCPs had a higher prevalence of treated hypertensive men with microalbuminuria compared with female PCPs. CONCLUSION: Female physicians appeared more often to reach the treatment goal for blood pressure in female patients and cholesterol levels in all patients than did male physicians.
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| 3. |
- Ljungman, Charlotta, 1977, et al.
(författare)
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7b.02: The Association between Non-Steroidal Anti-Inflammatory Drugs and Blood Pressure Control in Hypertensive Patients and the Relation to Gender
- 2015
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Ingår i: Journal of hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 0263-6352 .- 1473-5598. ; 33 Suppl 1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: Approximately 25% of hypertensive patients >65 years are treated for arthrosis, which is the most common cause of long term use of non-steroidal anti-inflammatory drugs (NSAID). NSAID inhibits prostaglandin synthesis and interacts with the renin angiotensin system. The objective of this study was to investigate if concomitant use of NSAID in hypertensive patients is associated with a lower possibility to reach target blood pressure <140/90 mm Hg, and to elucidate if there are gender differences regarding this matter.(Figure is included in full-text article.) DESIGN AND METHOD: : This cross-sectional cohort study includes 40825 patients with hypertension from the Swedish primary Care Cardiovascular Database (SPCCD) in 2007-2008. Patient characteristics, antihypertensive drug class, dispensations of NSAIDs, comorbidities and blood pressure measurements were analyzed. The proportion of days covered (PDC) with prescription was calculated in order to analyze the NSAID use and the PDC was grouped <50%, 50-80% and >80% of days covered with prescription during 180 days prior to the last blood pressure measurement. RESULTS: In all 6700 patients had at least one prescription of NSAID. Patients with NSAID were younger (67.9 +/- 11.2 vs 69.4 +/- 11.9 years, p < 0.0001), and more often female (63.2 vs 56.3%, p < 0.0001) with a diagnosis of musculoskeletal disease (20.8 vs 12.8%, p < 0.0001 and with no cardiovascular comorbidity (26.5 vs 32.1%, p < 0.0001). There was no difference in SBP between patients with and without NSAID (142 +/- 16, 142 +/- 17 mmHg respectively, ns). Patients with NSAID had a higher DBP (80 +/- 10, 79 +/- 10 mmHg, respectively p < 0.001). In a logistic regression model adjusted for age, smoking, cardiovascular comorbidity, antihypertensive drug class, education, and country of birth there was no difference in the proportion achieving target blood pressure in patients with and without concomitant use of NSAID irrespective of the PDC for NSAID users (figure 1). The results were similar in both genders. CONCLUSIONS: Concomitant use of NSAID in hypertensive patients does not seem to be associated with a higher blood pressure level. The use of NSAIDs is not associated with a reduced ability of achieving target blood pressure. Thus, hypertensive patients do not a priori need to be discouraged to use NSAID.
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| 4. |
- Andersson, Tobias, 1976, et al.
(författare)
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Country of birth and mortality risk in hypertension with and without diabetes: the Swedish primary care cardiovascular database.
- 2021
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Ingår i: Journal of hypertension. - 1473-5598. ; 39:6, s. 1155-1162
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Tidskriftsartikel (refereegranskat)abstract
- Hypertension and diabetes are common and are both associated with high cardiovascular morbidity and mortality. We aimed to investigate associations between mortality risk and country of birth among hypertensive individuals in primary care with and without concomitant diabetes, which has not been studied previously. In addition, we aimed to study the corresponding risks of myocardial infarction and ischemic stroke.This observational cohort study of 62557 individuals with hypertension diagnosed 2001-2008 in the Swedish Primary Care Cardiovascular Database assessed mortality by the Swedish Cause of Death Register, and myocardial infarction and ischemic stroke by the National Patient Register. Cox regression models were used to estimate study outcome hazard ratios by country of birth and time updated diabetes status, with adjustments for multiple confounders.During follow-up time without diabetes using Swedish-born as reference, adjusted mortality hazard ratios per country of birth category were Finland: 1.26 (95% confidence interval 1.15-1.38), high-income European countries: 0.84 (0.74-0.95), low-income European countries: 0.84 (0.71-1.00) and non-European countries: 0.65 (0.56-0.76). The corresponding adjusted mortality hazard ratios during follow-up time with diabetes were high-income European countries: 0.78 (0.63-0.98), low-income European countries: 0.74 (0.57-0.96) and non-European countries: 0.56 (0.44-0.71). During follow-up without diabetes, the corresponding adjusted hazard ratio of myocardial infarction was increased for Finland: 1.16 (1.01-1.34), whereas the results for ischemic stroke were inconclusive.In Sweden, hypertensive immigrants (with the exception for Finnish-born) with and without diabetes have a mortality advantage, as compared to Swedish-born.
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| 5. |
- Bager, Johan-Emil, et al.
(författare)
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Blood pressure levels and risk of haemorrhagic stroke in patients with atrial fibrillation and oral anticoagulants: results from The Swedish Primary Care Cardiovascular Database of Skaraborg.
- 2021
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Ingår i: Journal of hypertension. - 1473-5598. ; 39:8, s. 1670-1677
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Tidskriftsartikel (refereegranskat)abstract
- To assess the risk of haemorrhagic stroke at different baseline SBP levels in a primary care population with hypertension, atrial fibrillation and newly initiated oral anticoagulants (OACs).We identified 3972 patients with hypertension, atrial fibrillation and newly initiated OAC in The Swedish Primary Care Cardiovascular Database of Skaraborg. Patients were followed from 1 January 2006 until a first event of haemorrhagic stroke, death, cessation of OAC or 31 December 2016. We analysed the association between continuous SBP and haemorrhagic stroke with a multivariable Cox regression model and plotted the hazard ratio as a function of SBP with a restricted cubic spline with 130mmHg as reference.There were 40 cases of haemorrhagic stroke during follow-up. Baseline SBP in the 145-180mmHg range was associated with a more than doubled risk of haemorrhagic stroke, compared with a SBP of 130mmHg.In this cohort of primary care patients with hypertension and atrial fibrillation, we found that baseline SBP in the 145-180mmHg range, prior to initiation of OAC, was associated with a more than doubled risk of haemorrhagic stroke, as compared with an SBP of 130mmHg. This suggests that lowering SBP to below 145mmHg, prior to initiation of OAC, may decrease the risk of haemorrhagic stroke in patients with hypertension and atrial fibrillation.
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| 6. |
- Bager, Johan-Emil, et al.
(författare)
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Treatment of hypertension in old patients without previous cardiovascular disease.
- 2019
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Ingår i: Journal of hypertension. - 1473-5598. ; 37:11, s. 2269-2279
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare the risk of cardiovascular disease (CVD) - nonfatal acute myocardial infarction (AMI) or stroke - at blood pressure levels that meet current recommendations with risk at lower levels, particularly in older patients.We identified patients with hypertension aged 40-90 years from a primary care register. Patients with a history of cancer, diabetes mellitus or CVD were excluded. Patients were divided into age groups (40-75 and 76-90), and four groups of SBP 110-129, 130-139 (reference), 140-149 and ≥150mmHg. We used the Kaplan-Meier estimator to study incidence of AMI, stroke and a composite of the two. Cox proportional-hazards regression was used to estimate hazard ratios for outcomes.We included 31704 patients: 26663 were 40-75 years old and 5041 were 76-90 years old. Mean follow-up was 2 years. Although no significant differences in risk of any outcome were found in the younger group, low blood pressure was associated with the lowest risk in the older group. Older patients in the 110-129mmHg group had a lower incidence of CVD (15.9/1000 vs. 25.3/1000 person-years) than the reference group. After adjustment for covariates, the hazard ratio of CVD in older patients in the 110-129mmHg group compared with the reference group was 0.60 (95% confidence interval 0.40-0.92).Blood pressure levels lower than those currently recommended are not harmful among older patients. The association between lower SBP and lesser risk of CVD may instead suggest a beneficial effect of lower SBP.
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| 7. |
- Bokrantz, Tove, et al.
(författare)
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Antihypertensive drug classes and the risk of hip fracture: results from the Swedish primary care cardiovascular database.
- 2020
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Ingår i: Journal of hypertension. - 1473-5598. ; 38:1, s. 167-175
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Tidskriftsartikel (refereegranskat)abstract
- Hypertension and fractures related to osteoporosis are major public health problems that often coexist. This study examined the associations between exposure to different antihypertensive drug classes and the risk of hip fracture in hypertensive patients.We included 59246 individuals, 50 years and older, diagnosed with hypertension during 2001-2008 in the Swedish Primary Care Cardiovascular Database. Patients were followed from 1 January 2006 (or the date of diagnosis of hypertension) until they had their first hip fracture, died, or reached the end of the study on 31 December 2012. Cox proportional hazards models were used to calculate the risk of hip fracture across types of antihypertensive medications, adjusted for age, sex, comorbidity, medications, and socioeconomic factors.In total, 2593 hip fractures occurred. Compared to nonusers, current use of bendroflumethiazide or hydrochlorothiazide was associated with a reduced risk of hip fracture (hazard ratio 0.86; 95% CI 0.75-0.98 and hazard ratio 0.84; 95% CI 0.74-0.96, respectively), as was use of fixed drug combinations containing a thiazide (hazard ratio 0.69; 95% CI 0.57-0.83). Current use of loop diuretics was associated with an increased risk of hip fracture (hazard ratio 1.23; 95% CI 1.11-1.35). No significant associations were found between the risk of hip fracture and current exposure to beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone-receptor blockers or calcium channel blockers.In this large observational study of hypertensive patients, the risk of hip fracture differed across users of different antihypertensive drugs, results that could have practical implications when choosing antihypertensive drug therapy.
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| 8. |
- Bokrantz, Tove, et al.
(författare)
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Reply.
- 2017
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Ingår i: Journal of hypertension. - 1473-5598. ; 35:3, s. 646-647
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
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| 10. |
- Collen, Anna-Clara, 1970, et al.
(författare)
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Cardiovascular and metabolic characteristics 40 years after hypertensive pregnancies: a long-term follow-up study of mothers.
- 2013
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Ingår i: Journal of hypertension. - 1473-5598. ; 31:4, s. 758-765
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:: Maternal cardiovascular morbidity is increased after hypertensive pregnancies (HTP). The pathways from complicated pregnancies to future cardiovascular disease are complex. The aim of the present study was to test the hypothesis that different cardiovascular mechanisms are changed in women who experienced HTP four decades earlier in comparison to women with normotensive pregnancies. METHODS:: One hundred and five women (50 with hypertensive and 55 with normal pregnancies) were examined with anthropometric measurements; office blood pressure, ambulatory blood pressure and central blood pressure, pulse wave velocity, augmentation index, intimal-media thickness, echocardiography and laboratory measurements. In addition another 204 women were followed-up by a questionnaire regarding their pregnancy 40 years ago, as well as their present health status and medications. RESULTS:: Women with HTP had more often diagnosed hypertension when compared with women with normal pregnancies (50 vs. 31%, respectively; P=0.046), but the groups did not differ in any blood pressure levels. HTP were associated with higher pulse wave velocity (8.8m/s vs. 7.8m/s, P=0.021), and higher levels of P-glucose (5.7mmol/l vs. 5.2mmol/l, P=0.022), P-HbA1c (4.4% vs. 4.2%, P=0.010) and noradrenaline (2.45mmol/l vs. 2.11mmol/l, P=0.040) when compared with normotensive pregnancies. Women followed up with a questionnaire reported deteriorated cardiovascular health compared to women attending the clinical investigations of the study. CONCLUSION:: HTP are associated with impairment in vascular function and metabolic status 40 years postpartum despite well controlled blood pressure levels.
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