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- Almgren, Torbjörn, 1959, et al.
(författare)
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Diabetes in treated hypertension is common and carries a high cardiovascular risk: results from a 28-year follow-up.
- 2007
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Ingår i: Journal of hypertension. - 0263-6352. ; 25:6, s. 1311-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this study was to analyse predictive factors for development of type 2 diabetes during life-long therapy for hypertension and the alleged additional cardiovascular risk this constitutes. METHODS: The study group (n = 754) comprised the hypertensive subgroup of a randomized population sample of 7500 men, aged 47-54 years, screened for cardiovascular risk factors and followed for 25-28 years. The patients were treated with thiazide diuretics and beta-adrenergic blocking drugs with the addition of hydralazin during the first decade. Calcium antagonists were substituted for hydralazin and, if needed, angiotensin-converting enzyme inhibitors were added when these drugs became available. RESULTS: A total of 148 (20.4%) treated hypertensive patients developed diabetes during 25 years, and in multivariate Cox regression analysis body mass index, serum triglycerides and treatment with beta-blockers were positively related with this complication. New-onset diabetes implied a significantly increased risk for stroke [hazard ratio (HR): 1.67; 95% confidence interval (95% CI): 1.1-2.6; P < 0.05], myocardial infarction (OR: 1.66; 95% CI: 1.1-2.5; P < 0.05) and mortality (OR: 1.42; 95% CI: 1.1-1.9; P < 0.05). The greatest risk for stroke was new-onset diabetes, followed by smoking (OR: 1.46; 95% CI: 1-2.2; P = 0.07) and the greatest risk for myocardial infarction was new-onset diabetes, followed by smoking (HR: 1.64; 95% CI: 1.1-2.4; P < 0.01). The greatest risk for mortality was smoking (HR: 1.73; 95% CI: 1.3-2.2; P < 0.005). Achieved systolic and diastolic blood pressure were not predictive of cardiovascular complications or death. The mean observation time from onset of diabetes mellitus to a first stroke was 9.1 years and to a first myocardial infarction 9.3 years. CONCLUSION: Diabetes in treated hypertensive patients is alarmingly common and carries a high risk for cardiovascular complications and mortality.
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| 2. |
- Almgren, Torbjörn, 1959
(författare)
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Outcomes in treated hypertensive men - a follow-up during three decades
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To analyse survival, cause specific mortality and cardiovascular morbidity in relation to cardiovascular risk factors, to investigate the prevalence of type 2 diabetes and the cardiovascular risk this constitutes and to study systolic blood pressure over time in treated hypertensive men during three decades of follow-up. Subjects and methods: 754 hypertensive men were identified at a screening in Göteborg of a randomly selected group of 10000 men, 47-54 years old, and were treated and followed with annual check-ups at an outpatient clinic during three decades. Results: During 22-23 years 37 % of the hypertensive men died compared to 29 % of the non-hypertensive men. The impaired survival in hypertensive men escalated with time and was mainly due to a doubled incidence of death in ischemic heart disease; 20 % compared to 10 %. Smoking, S-cholesterol and target organ damage at entry and S-cholesterol during follow-up was related to a fatal or non-fatal myocardial infarction in the hypertensive men. During 25-28 years 22 % of the hypertensive men had a fatal or nonfatal stroke compared to 13 % of the non-hypertensive men. Diabetes at entry and smoking at entry and during the study was significantly related to a first, fatal or non-fatal stroke in treated hypertensive men. The most prevalent cardiovascular complication was myocardial infarction that occurred in 33 % of the hypertensive men and in 22 % of the non-hypertensive subjects. In the 725 hypertensive men with no diabetes at entry, 20.4 % (n=148) developed type 2 diabetes during 25 years. Body mass index, serum triglycerides and treatment with betablockers at entry were significantly related to new-onset diabetes. New-onset diabetes implied a significant increased risk for stroke (HR: 1.67; CI: 1.1-2.6), myocardial infarction (HR: 1.66; CI: 1.1-2.5) and mortality (HR: 1.42; CI: 1.1-1.9). Systolic blood pressure increased 22.5 mmHg after 30 years from achieved blood pressure at the third annual check-up, in a 33 % randomly selected subgroup of treated hypertensive men free from cardiovascular disease. Systolic blood pressure increased 7.6 mmHg 30 years after screening in the randomly selected 3 % subgroup of the non-hypertensive men without current anti- hypertensive medication and free from cardiovascular disease. The difference in systolic blood pressure increment between treated hypertensive men and normotensive men was 15.0 mmHg (95 % CI: 7.7-22.2 mmHg). Conclusions: Hypertensive men had an impaired survival and an access of cardiovascular complications in spite of long-term treatment. They had an increased prevalence of diabetes and new-onset diabetes implied an increased risk of cardiovascular complications. In spite of treatment systolic blood pressure increased three times more than in non-hypertensive men.
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| 3. |
- Almgren, Torbjörn, 1959, et al.
(författare)
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Reninom – en ovanlig men botbar orsak till sekundär hypertoni
- 2023
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Ingår i: Lakartidningen. - 1652-7518. ; 120
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Tidskriftsartikel (refereegranskat)abstract
- Reninoma - rare juxtaglomerular tumor associated with hypertension We present a case study of two female patients, aged 20-30 years, who were diagnosed with reninoma, a rare juxtaglomerular tumor associated with hypertension, high plasma renin and hypokalemia. Both patients were referred to the Department of Internal Medicine at Sahlgrenska University Hospital, but their cases were ten years apart. In both instances, the renin-secreting tumor was surgically removed, resulting in the normalization of blood pressure without the need for antihypertensive medication. Based on our findings, we recommend physicians interested in hypertension to analyze plasma renin levels before starting antihypertensive treatment in young patients. Additionally, we suggest performing an MRI of the kidneys followed by renal vein catheterization, which can confirm but not exclude the presence of a reninoma. It is important to note that treatment with RAAS (renin-angiotensin-aldosterone system) blockers may mask the effects of reninoma on blood pressure and potassium levels. Since RAAS blockers are contraindicated during pregnancy, it is of particular importance to diagnose reninoma in young women of childbearing age.
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