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Sökning: WFRF:(Kahan Thomas)

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  • [1]234567...8Nästa
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  • Gordin, D., et al. (författare)
  • The effects of baroreflex activation therapy on blood pressure and sympathetic function in patients with refractory hypertension: the rationale and design of the Nordic BAT study
  • 2017
  • Ingår i: Blood Pressure. - : Taylor & Francis. - 0803-7051 .- 1651-1999. ; 26:5, s. 294-302
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To explore the effects of baroreflex activation therapy (BAT) on hypertension in patients with treatment resistant or refractory hypertension.Methods: This investigator-initiated randomized, double-blind, 1:1 parallel-design clinical trial will include 100 patients with refractory hypertension from 6 tertiary referral hypertension centers in the Nordic countries. A Barostim Neo System will be implanted and after 1 month patients will be randomized to either BAT for 16 months or continuous pharmacotherapy (BAT off) for 8 months followed by BAT for 8 months. A second randomization will take place after 16 months to BAT or BAT off for 3 months. Eligible patients have a daytime systolic ambulatory blood pressure (ABPM) of 145mm Hg, and/or a daytime diastolic ABPM of 95mm Hg after witnessed drug intake (including 3 antihypertensive drugs, preferably including a diuretic).Results: The primary end point is the reduction in 24-hour systolic ABPM by BAT at 8 months, as compared to pharmacotherapy. Secondary and tertiary endpoints are effects of BAT on home and office blood pressures, measures of indices of cardiac and vascular structure and function during follow-up, and safety.Conclusions: This academic initiative will increase the understanding of mechanisms and role of BAT in the refractory hypertension.
  • Kahan, Thomas, et al. (författare)
  • Risk prediction in stable angina pectoris
  • 2013
  • Ingår i: European Journal of Clinical Investigation. - 0014-2972 .- 1365-2362. ; 43:2, s. 141-151
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND:Although stable angina pectoris often carries a favourable prognosis, it remains important to identify patients with an increased risk of cardiovascular (CV) complications. Many new markers of disease activity and prognosis have been described. We evaluated whether common and easily accessible markers in everyday care provide sufficient prognostic information.MATERIALS AND METHODS:The Angina Pectoris Prognosis Study in Stockholm treated 809 patients (248 women) with stable angina pectoris with metoprolol or verapamil double blind during a median follow-up of 3·4 years, with a registry-based extended follow-up after 9·1 years. Clinical and mechanistic variables, including lipids and glucose, renal function, ambulatory and exercise-induced ischaemia, heart rate variability, cardiac and vascular ultrasonography, and psychosocial variables were included in an integrated analysis. Main outcome measures were nonfatal myocardial infarction (MI) and CV death combined.RESULTS: In all, 139 patients (18 women) suffered a main outcome. Independent predictive variables were (odds ratio [95% confidence intervals]), age (1·04 per year [1·00;1·08], P = 0·041), female sex (0·33 [0·16;0·69], P = 0·001), fasting blood glucose (1.29 per mM [1.14; 1.46], P < 0·001), serum creatinine (1·02 per μM [1·00;1·03], P < 0·001) and leucocyte counts (1·21 per 106 cells/L [1·06;1·40], P = 0·008). Smoking habits, lipids and hypertension or a previous MI provided limited additional information. Impaired fasting glucose was as predictive as manifest diabetes and interacted adversely with serum creatinine. Sexual problems were predictive among men.CONCLUSIONS:Easily accessible clinical and demographic variables provide a good risk prediction in stable angina pectoris. Impaired glucose tolerance and an elevated serum creatinine are particularly important.
  • Kurland, Lisa, et al. (författare)
  • Aldosterone synthase (CYP11B2) -344 C/T polymorphism is related to antihypertensive response : result from the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) trial
  • 2002
  • Ingår i: American Journal of Hypertension. - : Elsevier. - 0895-7061 .- 1941-7225. ; 15:5, s. 389-93
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Our aim was to determine whether the aldosterone synthase (CYP11B2) -344 C/T polymorphism was associated with the blood pressure (BP)-lowering response to antihypertensive treatment. METHODS: Patients with mild-to-moderate primary hypertension and left ventricular hypertrophy were randomized in a double-blind study to receive treatment with either the angiotensin II type 1 (AT1) receptor antagonist irbesartan (n = 43), or the beta1-adrenergic receptor blocker atenolol (n = 43). The aldosterone synthase (CYP11B2) -344 C/T polymorphism was analyzed using solid-phase minisequencing and related to BP reduction after 3 months treatment. Serum aldosterone levels were measured. RESULTS: After 3 months treatment the mean reductions in BP were similar for both treatment groups. When assessing the systolic BP reduction in the irbesartan group, patients with the TT variant had a more pronounced reduction (-21 +/- 19 SD mm Hg, n = 17) than both the TC (-14 +/- 18 mm Hg, n= 18) and CC (0 +/- 17 mm Hg, n = 8) genotypes (P = .04). There was no association between this polymorphism and the diastolic BP response. The -344 C/T polymorphism was not associated with the BP response to atenolol. Nor was it related to the baseline serum aldosterone level. CONCLUSIONS: The aldosterone synthase -344 C/T polymorphism was related to the BP-lowering response in hypertensive patients treated with the AT1-receptor antagonist irbesartan.
  • Kurland, Lisa, et al. (författare)
  • Angiotensin converting enzyme gene polymorphism predicts blood pressure response to angiotensin II receptor type 1 antagonist treatment in hypertensive patients
  • 2001
  • Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 19:10, s. 1783-1787
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To determine whether polymorphisms in the renin-angiotensin system can predict blood pressure-lowering response to antihypertensive treatment; more specifically, in response to treatment with irbesartan or atenolol. DESIGN AND METHODS: Eighty-six patients with hypertension were randomized to double-blind treatment with either the angiotensin II type 1 receptor antagonist irbesartan or the beta1 adrenergic receptor blocker atenolol and followed for 3 months. We analysed angiotensinogen T174M and M235T, angiotensin converting enzyme (ACE) I/D and angiotensin II type 1 receptor A1166C polymorphisms and related them to blood pressure reduction. RESULTS: The mean reductions in blood pressure were similar for both treatments. In the irbesartan group, individuals homozygous for the ACE gene I allele showed a greater reduction in diastolic blood pressure, exceeding those with the D allele (-18 +/- 11 SD versus -7 +/- 10 mmHg, P = 0.0096). This was not the case during treatment with atenolol, and the interaction term between type of treatment and ACE II genotype was significant (P = 0.0176). The angiotensinogen and angiotensin II type 1 receptor polymorhisms were not related to the response to treatment. CONCLUSIONS: ACE genotyping predicted the blood pressure-lowering response to antihypertensive treatment with irbesartan but not atenolol. Thus, specific genotypes might predict the response to specific antihypertensive treatment.
  • Malmqvist, Karin, et al. (författare)
  • Regression of left ventricular hypertrophy in human hypertension with irbesartan
  • 2001
  • Ingår i: Journal of Hypertension. - 0263-6352 .- 1473-5598. ; 19:6, s. 1167-1176
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The Swedish irbesartan left ventricular hypertrophy investigation versus atenolol (SILVHIA). OBJECTIVE: Angiotensin II induces myocardial hypertrophy. We hypothesized that blockade of angiotensin II subtype 1 (AT1) receptors by the AT1-receptor antagonist irbesartan would reduce left ventricular mass (as measured by echocardiography) more than conventional treatment with a beta blocker. DESIGN AND METHODS: This double-blind study randomized 115 hypertensive men and women with left ventricular hypertrophy to receive either irbesartan 150 mg q.d. or atenolol 50 mg q.d. for 48 weeks. If diastolic blood pressure remained above 90 mmHg, doses were doubled, and additional medications (hydrochlorothiazide and felodipine) were prescribed as needed. Echocardiography was performed at weeks 0, 12, 24 and 48. RESULTS: Baseline mean blood pressure was 162/ 104 mmHg, and mean left ventricular mass index was 157 g/m2 for men and 133 g/m2 for women. Systolic and diastolic blood pressure reductions were similar in both treatment groups. Both irbesartan (P < 0.001) and atenolol (P< 0.001) progressively reduced left ventricular mass index, e.g. by 26 and 14 g/m2 (16 and 9%), respectively, at week 48, with a greater reduction in the irbesartan group (P = 0.024). The proportion of patients who attained a normalized left ventricular mass (i.e. < or = 131 g/m2 for men and < or = 100 g/m2 for women) tended to be greater with irbesartan (47 versus 32%, P = 0.108). CONCLUSIONS: Left ventricular mass was reduced more in the irbesartan group than in the atenolol group. These results suggest that blocking the action of angiotensin II at AT1-receptors may be an important mechanism, beyond that of lowering blood pressure, in the regulation of left ventricular mass and geometry in patients with hypertension.
  • Thorén, A., et al. (författare)
  • ECG-monitoring of in-hospital cardiac arrest and factors associated with survival
  • 2020
  • Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 150, s. 130-138
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: ECG-monitoring is a strong predictor for 30-days survival after in-hospital cardiac arrest (IHCA). The aim of the study is to investigate factors influencing the effect of ECG-monitoring on 30-days survival after IHCA and elements of importance in everyday clinical practice regarding whether patients are ECG-monitored prior to IHCA. Methods: In all, 19.225 adult IHCAs registered in the Swedish Registry for Cardiopulmonary Resuscitation (SRCR) were included. Cox-adjusted survival curves were computed to study survival post IHCA. Logistic regression was used to study the association between 15 predictors and 30-days survival. Using logistic regression we calculated propensity scores (PS) for ECG-monitoring; the PS was used as a covariate in a logistical regression estimating the association between ECG-monitoring and 30-days survival. Gradient boosting was used to study the relative importance of all predictors on ECG-monitoring. Results: Overall 30-days survival was 30%. The ECG-monitored group (n = 10.133, 52%) had a 38% lower adjusted mortality (HR 0.62 95% CI 0.60−0.64). We observed tangible variations in ECG-monitoring ratio at different centres. The predictors of most relative influence on ECG-monitoring in IHCA were location in hospital and geographical localization. Conclusion: ECG-monitoring in IHCA was associated to a 38% lower adjusted mortality, despite this finding only every other IHCA patient was monitored. The significant variability in the frequency of ECG-monitoring in IHCA at different centres needs to be evaluated in future research. Guidelines for in-hospital ECG-monitoring could contribute to an improved identification and treatment of patients at risk, and possibly to an improved survival. © 2020 Elsevier B.V.
  • Völz, Sebastian, 1980, et al. (författare)
  • Reply.
  • 2019
  • Ingår i: Journal of hypertension. - 1473-5598. ; 3:6, s. 848-
  • Tidskriftsartikel (refereegranskat)
  • Andersson, Tobias, 1976, et al. (författare)
  • The impact of diabetes, education and income on mortality and cardiovascular events in hypertensive patients: A cohort study from the Swedish Primary Care Cardiovascular Database (SPCCD).
  • 2020
  • Ingår i: PloS one. - : Public Library of Science. - 1932-6203. ; 15:8
  • Tidskriftsartikel (refereegranskat)abstract
    • In this study we aimed to estimate the effect of diabetes, educational level and income on the risk of mortality and cardiovascular events in primary care patients with hypertension.We followed 62,557 individuals with hypertension diagnosed 2001-2008, in the Swedish Primary Care Cardiovascular Database. Study outcomes were death, myocardial infarction, and ischemic stroke, assessed using national registers until 2012. Cox regression models were used to estimate adjusted hazard ratios of outcomes according to diabetes status, educational level, and income.During follow-up, 13,231 individuals died, 9981 were diagnosed with diabetes, 4431 with myocardial infarction, and 4433 with ischemic stroke. Hazard ratios (95% confidence intervals) for diabetes versus no diabetes: mortality 1.57 (1.50-1.65), myocardial infarction 1.24 (1.14-1.34), and ischemic stroke 1.17 (1.07-1.27). Hazard ratios for diabetes and ≤9 years of school versus no diabetes and >12 years of school: mortality 1.56 (1.41-1.73), myocardial infarction 1.36 (1.17-1.59), and ischemic stroke 1.27 (1.08-1.50). Hazard ratios for diabetes and income in the lowest fifth group versus no diabetes and income in the highest fifth group: mortality 3.82 (3.36-4.34), myocardial infarction 2.00 (1.66-2.42), and ischemic stroke 1.91 (1.58-2.31).Diabetes combined with low income was associated with substantial excess risk of mortality, myocardial infarction and ischemic stroke among primary care patients with hypertension.
  • Aspberg, Sara, et al. (författare)
  • Confirmed association between neonatal phototherapy or neonatal icterus and risk of childhood asthma
  • 2010
  • Ingår i: Pediatric Allergy and Immunology. - : Wiley-Blackwell. - 0905-6157 .- 1399-3038. ; 21:4, s. 733-739
  • Tidskriftsartikel (refereegranskat)abstract
    • We have previously demonstrated an association between neonatal phototherapy and/or neonatal icterus and risk of hospitalization for childhood asthma. This study included children who were prescribed anti-asthmatic medication on a population basis to study exposures during the foetal and neonatal period and risk of childhood asthma. The Swedish Medical Birth Register was linked to the Swedish Prescribed Drug Register. Perinatal data for singleton children who were prescribed anti-asthmatic medication (n = 61 256) were compared with corresponding data for all singleton children born in Sweden from 1 January 1990 to 30 June 2003 and surviving to 1 July 2005 (n = 1 338 319). Mantel-Haenszel's odds ratios were calculated after adjustment for various known confounders. Being the first-born child, maternal age above 44 yr, involuntary childlessness for more than 1 yr, maternal smoking during pregnancy, maternal diabetes mellitus of any kind, pre-eclampsia, caesarean section, and instrumental vaginal delivery were all associated with an increased prescription of anti-asthmatic medication during childhood. Preterm birth, low birth weight, being small for gestational age, respiratory problems, mechanical ventilation, and sepsis and/or pneumonia were also associated with increased drug prescriptions. Neonatal phototherapy and/or icterus were risk determinants for children who developed asthma before the age of 12. After controlling for confounders, the odds ratio for phototherapy and/or icterus remained at 1.30 (95% confidence interval 1.16-1.47). In conclusion, this large population-based study confirms an association between some maternal and perinatal factors and childhood asthma, including neonatal phototherapy and/or icterus.
  • Aspberg, Sara, et al. (författare)
  • Fetal and perinatal risk factors for inflammatory bowel disease
  • 2006
  • Ingår i: Acta Pædiatrica. - : Wiley-Blackwell Publishing Ltd. - 1651-2227 .- 0803-5253. ; 95:8, s. 1001-1004
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To study the influence of specific factors and events during pregnancy and the perinatal period on the risk of children developing inflammatory bowel disease. Methods: Population-based national register study. Linkage between the Swedish Medical Birth Register and the Swedish Hospital Discharge Register during the period 1987 to 2000 identified 455 singleton infants who later developed inflammatory bowel disease. Data for these children were compared with data for all children born in Sweden during the same period. Results: Smoking during early pregnancy reduced the risk of inflammatory bowel disease ( odds ratio ( OR) 0.71, 95% CI 0.55-0.91). For ulcerative colitis the odds ratio was 0.70 ( 95% CI 0.56-0.86), and for Crohn's disease 0.73 ( 95% CI 0.58 - 0.94). Infections during the neonatal period seemed to increase the risk of inflammatory bowel disease ( OR 17.6, 95% CI 3.6 - 51.6), but the number of observed events was small. The other factors examined did not influence the risk of inflammatory bowel disease. Conclusion: Maternal smoking during early pregnancy reduces the risk for the child to be hospitalized with a diagnosis of inflammatory bowel disease. Severe neonatal infections may increase the risk. Thus, some exposures during the fetal and neonatal period seem to affect the risk of inflammatory bowel disease later in life.
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