| 1. |
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| 2. |
- Hansen, Tine W., et al.
(författare)
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Diagnostic Thresholds for Ambulatory Blood Pressure Moving Lower : A Review Based on a Meta-Analysis-Clinical Implications
- 2008
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 10:5, s. 377-381
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Forskningsöversikt (refereegranskat)abstract
- Upper limits of normal ambulatory blood pressure (ABP) have been a matter of debate in recent years. Current diagnostic thresholds for ABP rely mainly on statistical parameters derived from reference populations. Recent findings from the International Database of Ambulatory Blood Pressure in Relation to Cardiovascular Outcome (IDACO) provide outcome-driven thresholds for ABP Rounded systolic/diastolic thresholds for optimal ABP were found to be 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. The corresponding rounded thresholds for normal ABP were 125/75 mm Hg, 130/85 mm Hg, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80 mm Hg, 140/85 mm Hg, and 120/70 mm Hg. However, in clinical practice, any diagnostic threshold for blood pressure needs to be assessed in the context of the patient's overall risk profile. The IDACO database is therefore being updated with additional population cohorts to enable the construction of multifactorial risk score charts, which also include ABP.
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| 3. |
- Bengtsson, Ulrika, et al.
(författare)
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Improved Blood Pressure Control Using an Interactive Mobile Phone Support System
- 2016
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 18:2, s. 101-108
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Tidskriftsartikel (refereegranskat)abstract
- This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP 7 mm Hg, diastolic BP 4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.
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| 4. |
- Campbell, Norm R. C., et al.
(författare)
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Using the Global Burden of Disease Study to Assist Development of Nation-Specific Fact Sheets to Promote Prevention and Control of Hypertension and Reduction in Dietary Salt: A Resource From the World Hypertension League
- 2015
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1751-7176 .- 1524-6175. ; 17:3, s. 165-167
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Tidskriftsartikel (refereegranskat)abstract
- Increased blood pressure and high dietary salt are leading risks for death and disability globally. Reducing the burden of both health risks are United Nations' targets for reducing noncommunicable disease. Nongovernmental organizations and individuals can assist by ensuring widespread dissemination of the best available facts and recommended interventions for both health risks. Simple but impactful fact sheets can be useful for informing the public, healthcare professionals, and policy makers. The World Hypertension League has developed fact sheets on dietary salt and hypertension but in many circumstances the greatest impact would be obtained from national-level fact sheets. This manuscript provides instructions and a template for developing fact sheets based on the Global Burden of Disease study and national survey data. (c) 2015 Wiley Periodicals, Inc.
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| 5. |
- Chen, Xiaoping, et al.
(författare)
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Risk factors for the delayed viral clearance in COVID‐19 patients
- 2021
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Ingår i: The Journal of Clinical Hypertension. - : John Wiley & Sons. - 1524-6175 .- 1751-7176. ; 23:8, s. 1483-1489
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Tidskriftsartikel (refereegranskat)abstract
- Comorbidities are important for the disease outcome of COVID-19, however, which underlying diseases that contribute the most to aggravate the conditions of COVID-19 patients are still unclear. Viral clearance is the most important laboratory test for defining the recovery of COVID-19 infections. To better understand which underlying diseases that are risk factors for delaying the viral clearance, we retrospectively analyzed 161 COVID-19 clinical cases in the Zhongnan Hospital of Wuhan University, Wuhan, China between January 5 and March 13, 2020. The demographic, clinical and laboratory data, as well as patient treatment records were collected. Univariable and multivariable analysis were performed to explore the association between delayed viral clearance and other factors by using logistic regression. Survival analyses by Kaplan-Meier and Cox regression modeling were employed to identify factors negatively influencing the viral clearance negatively. We found that hypertension and intravenous immunoglobulin adversely affected the time of viral RNA shedding. Hypertension was the most important risk factor to delay the SARS-CoV-2 virus clearance, however, the use of Angiotensin-Converting Enzyme Inhibitors(ACEI)/Angiotensin Receptor Blockers(ARB) did not shorten the time for virus clearance in these hypertensive patients’ virus clearance. We conclude that patients having hypertension and intravenous immunoglobulin may delay the viral clearance in COVID-19 patients.
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| 6. |
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| 7. |
- Elmståhl, Sölve, et al.
(författare)
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Association between cerebral microbleeds and hypertension in the Swedish general population “Good Aging in Skåne” study
- 2019
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 21:8, s. 1099-1107
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Tidskriftsartikel (refereegranskat)abstract
- Cerebral microbleeds (CMB) on MRI are frequent in healthy aging individuals but precede ischemic and hemorrhagic stroke and dementia. Different etiologies have been suggested for nonlobar CMB, which have a stronger connection to hypertension (HT) than do lobar CMB. This study aimed to investigate the prevalence of CMB and the association between nonlobar/lobar CMB and different blood pressure (BP) and HT treatment conditions in a longitudinal, population-based cohort of the Good Aging in Skåne (GÅS) study. White matter hyperintensities (WMH), CMB, atrophies, and infarctions were identified with brain 3T MRI, and BP parameters were examined in 344 randomly selected subjects between 70 and 87 years old. CMB were observed in 26% of the whole cohort, increasing from 19% of subjects in their 70s to 30% of those over 80 years of age. Of these subjects, 38% had multiple CMB, and 59% had a lobar localization. CMB were associated with severe confluent WMH (odds ratio = 7.02; 2.16-18.84). Increasing age, being male, and having HT, impaired cognition, or a history of angina pectoris were associated with CMB. Both lobar and nonlobar CMB were associated with HT. Nonlobar CMB were particularly associated with increased BP, pulse pressure, controlled HT, and uncontrolled HT. After controlling for sex and HT, age was no longer a risk factor for CMB In conclusion, sex and HT are the major risk factors for CMB, especially nonlobar CMB, which suggests stricter implementation of recommended guidelines for HT treatment in the elderly.
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| 8. |
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| 9. |
- Hussain, Tasfia, et al.
(författare)
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Quality assessment of consumer-facing websites on sodium reduction
- 2022
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Ingår i: The Journal of Clinical Hypertension. - : Wiley-Blackwell. - 1524-6175 .- 1751-7176. ; 24:10, s. 1285-1292
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to evaluate the quality of information and guidance on dietary sodium reduction available on consumer-facing websites. Google Trends was used to identify the five most-used search terms related to dietary sodium reduction. For each term, websites on the first two pages were collected (n = 18-20). Of 93 websites collected, 24 were excluded due to defective links, duplicate websites, or not being consumer-focused. The remaining 69 websites were evaluated using a novel instrument, JHU-SALT, that includes 14 questions on topics related to salt reduction. The questions are grouped into three domains ("information," "guidance," and "accuracy"). For each question, websites were scored using a 3-step ordinal scale ("topic not addressed," "topic somewhat addressed," or "topic addressed adequately"). Only three of 14 JHU-SALT questions were addressed adequately by a majority of websites. Many websites provided information on the adverse health effects of a high sodium diet (74%, n = 51) or mentioned intake recommendations (64%, n = 44). Information on fundamental concepts was largely missing. The majority of websites (80%, n = 55) provided information on lifestyle strategies to reduce blood pressure, but most did not provide guidance to help implement those strategies. While missing information was common, misinformation was uncommon. The DISCERN questionnaire was utilized as well. Consumers seeking information and guidance on dietary sodium reduction will find that most available websites provide accurate but limited information, and insufficient guidance on how to lower sodium intake. Websites that provide both relevant information and guidance are needed to help consumers effectively reduce dietary sodium.
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| 10. |
- Kolyviras, A., et al.
(författare)
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Differential associations of systolic and diastolic time rate of blood pressure variation with carotid atherosclerosis and plaque echogenicity
- 2017
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1751-7176 .- 1524-6175. ; 19:11, s. 1070-1077
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Tidskriftsartikel (refereegranskat)abstract
- In the current study, the authors sought to assess whether the time rate of systolic and diastolic blood pressure variation is associated with advanced subclinical stages of carotid atherosclerosis and plaque echogenicity assessed by gray scale median. The authors recruited 237 consecutive patients with normotension and hypertension who underwent 24-hour ambulatory blood pressure monitoring and carotid artery ultrasonography. There was an independent association between low 24-hour systolic time rate and increased echogenicity of carotid plaques (adjusted odds ratio for highest vs lower tertiles of gray scale median, 0.470; 95% confidence interval, 0.245-0.902 [P = .023]). Moreover, increased nighttime diastolic time rate independently correlated with the presence (adjusted odds ratio, 1.328; P = .015) and number of carotid plaques (adjusted odds ratio, 1.410; P = .003). These results indicate differential associations of the systolic and diastolic components of time rate of blood pressure variation with the presence, extent, and composition of carotid plaques and suggest that when blood pressure variation is assessed, both components should be considered.
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| 11. |
- Lindblom, Sebastian, et al.
(författare)
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Lifestyle counseling in patients with hypertension in primary health care and its association with antihypertensive pharmacotherapy
- 2024
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Ingår i: The Journal of Clinical Hypertension. - 1524-6175 .- 1751-7176. ; 26:7, s. 816-824
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Tidskriftsartikel (refereegranskat)abstract
- The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.
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| 12. |
- Manhem, Karin, 1954, et al.
(författare)
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Meta-analyses and blood pressure goals
- 2018
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 20:8, s. 1149-1152
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 13. |
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| 14. |
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| 15. |
- Pedersen, Line Reinholdt, et al.
(författare)
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Prognostic implications of left ventricular hypertrophy diagnosed on electrocardiogram vs echocardiography
- 2020
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 22:9, s. 1647-1658
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Tidskriftsartikel (refereegranskat)abstract
- It is unclear whether 12-lead ECG employing standard criteria for left ventricular hypertrophy (LVH) provides similar information with respect to long-term cardiovascular risk as echocardiography. The authors performed a retrospective cohort study of 1376 individuals without cardiovascular disease, who underwent ECG (LVH defined using the Sokolow-Lyon voltage combination (>35 mm) or the Cornell voltage-duration product (>2440 mm × ms)) and echocardiography (LVH defined as LV mass index (LVMI) >95 g/m2 for women and >115 g/m2 for men). The prognostic ability of LVH was assessed in Cox regression models adjusted for age, sex, smoking, systolic blood pressure, total cholesterol, antihypertensive medication, and fasting glucose. The primary end point was the composite of coronary events, heart failure, stroke, or death. The main secondary end point was heart failure or cardiovascular death. Median age was 67 (range 56-79) years, 68% were male. Eleven percent had ECG-defined LVH, 17% had echocardiographic LVH. Over median 8.5 years, 29% experienced a primary event. Event rates were 29%/35% for persons without/with ECG-defined LVH and 27%/39% for those without/with echocardiographic LVH. The Sokolow-Lyon combination, Cornell product, and ECG-defined LVH did not significantly predict the primary end point (P ≥.05), but ECG-defined LVH predicted heart failure or cardiovascular death (adjusted hazard ratio (HR), 1.86, 95% confidence interval (CI), 1.13-3.08); P =.02). Conversely, LVMI was a significant, independent predictor of the primary end point (adjusted HR, 1.87, 95% CI, 1.13-3.10; P =.01), as was echocardiographic LVH (adjusted HR, 1.27, 95% CI, 1.01-1.61; P =.04). Echocardiographic LVH may be a better predictor of long-term cardiovascular risk than ECG-defined LVH in middle-aged and older individuals.
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| 16. |
- Pikilidou, Maria, et al.
(författare)
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Arterial Stiffness and Peripheral and Central Blood Pressure in Patients With Sickle Cell Disease.
- 2015
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1751-7176 .- 1524-6175. ; 17:9, s. 726-731
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Tidskriftsartikel (refereegranskat)abstract
- Blood pressure (BP) in patients with sickle cell disease (SCD) has been reported to be lower than in persons in the general population. Data on arterial stiffness, which is an important risk factor for the progression of BP, are inconclusive for this patient population. Forty-five adult patients with SCD and 40 controls matched for sex, age, and body mass index were studied. Brachial systolic BP (SBP) and diastolic BP (DBP) were significantly lower in the patient group (SBP 115.1±13.8 mm Hg vs 121.9±11.3 mm Hg and DBP 68.5±8.0 mm Hg vs 80.6±9.1 mm Hg, P<.05, respectively). Augmentation index (AIx), however, was significantly higher in SCD patients compared with healthy controls (24.9±9.6 for patients vs 12.4±10.8 for controls, P<.001), while carotid femoral pulse wave velocity was comparable between the two groups. The study shows that mechanisms other than arterial elasticity are involved in the low BP phenotype of patients with SCD.
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| 17. |
- Saeed, Sahrai, et al.
(författare)
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The impact of age and 24-h blood pressure on arterial health in acute ischemic stroke patients : The Norwegian stroke in the young study
- 2021
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 23:10, s. 1922-1929
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Tidskriftsartikel (refereegranskat)abstract
- The impact of age and 24-h ambulatory blood pressure (ABPM) on arterial stiffness and carotid intima-media thickness (cIMT) in ischemic stroke patients younger than 60 years of age is poorly explored. A total of 385 acute ischemic stroke patients (aged 49.6±9.7 years, 68% men) were prospectively included and grouped in younger (15–44 years, n = 93) and middle-aged (45–60 years, n = 292). Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWV), and cIMT by carotid ultrasound. 24-h ABPM was recorded. The middle-aged stroke patients had higher prevalence of smoking, hypertension, diabetes mellitus, metabolic syndrome and hypercholesterolemia, and had higher PWV and cIMT (all p <.05). In multivariable linear regression analyses adjusted for sex, BMI, smoking, diabetes mellitus, total cholesterol, high-density lipoprotein cholesterol, triglycerides, eGFR, systolic BP and concomitant antihypertensive treatment, 1SD (4.4 years) higher age was associated with higher PWV (β = 0.44,R2= 0.46, p <.001) in the younger group, and with higher mean cIMT (β = 0.16, R2= 0.21, p =.01) in the middle-aged group. In the middle-aged group, 24-h pulse pressure had a significant association with PWV (β = 0.18, R2= 0.19, p =.009), while the association with cIMT was attenuated (β = 0.13, R2= 0.16, p =.065). 24-h diastolic BP was associated with higher cIMT in the middle-aged group (β = 0.24, p <.001, R2= 0.23), but not with PWV in either age groups. Among ischemic stroke patients < 60 years, higher age was associated with increased arterial stiffness for patients up to age 44 years, and with cIMT in middle-aged patients. 24-h pulse pressure was associated with arterial stiffness, and 24-h diastolic BP was associated with cIMT only in middle-aged patients.
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| 18. |
- Sandberg, Klas, et al.
(författare)
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Hemodynamic responses to In-Bed Cycle Exercise in the acute phase after moderate to severe stroke : A randomized controlled trial
- 2021
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 23:5, s. 1077-1084
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Tidskriftsartikel (refereegranskat)abstract
- Hemodynamic responses to exercise in the acute phase after moderate to severe stroke have remained poorly investigated. The aim of this randomized controlled study, in which 52 (32 women) patients with moderate to severe stroke were randomized to three weeks of 20 minutes in-bed cycle exercise 5 days per week or to usual care, was to explore the systolic blood pressure (SBP) response to exercise and to evaluate the impact of the intervention on the resting and post-test systolic and diastolic blood pressures and heart rate, and on the systolic blood pressure response to exercise. We found that resting SBP decreased from baseline to post-intervention in both the intervention group (147.7 +/- 18.1 mmHg to 125.3 +/- 17.1 mmHg, P < .001) and in the control group (147.8 +/- 23.7 mmHg to 131.4 +/- 14.8 mmHg, P < .001) without a significant difference between the groups (interaction P = .308). However, there was a significant difference (interaction P = .010) regarding how. SBP (change in SBP from pre-test to post-test) changed from baseline to post-intervention. In the intervention group, Delta SBP increased from -1.0 +/- 15.0 mmHg to 8.5 +/- 9.4 mmHg, P = .009, whereas in the control group, Delta SBP decreased from 7.1 + 10.9 mmHg to 4.5 + 11.8 mmHg, P = .395. We conclude that patients randomized to in-bed cycle exercise seemed to normalize their blood pressure response to exercise to a larger extent than patients in the control group.
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| 19. |
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| 20. |
- Ström, Edvin, et al.
(författare)
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Associations between fruit consumption and home blood pressure in a randomly selected sample of the general Swedish population
- 2022
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 24:6, s. 723-730
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Tidskriftsartikel (refereegranskat)abstract
- Frequent fruit consumption has been associated with lower office blood pressure. Less is known about associations between fruit consumption and home blood pressure. Our aim was to study the correlation between consumption of specific fruits and home blood pressure in a large randomly selected study population. The main outcome was systolic home blood pressure. Home blood pressure measurements were performed with calibrated oscillometric meters during seven consecutive days. Means for all available measurements were used. Validated food frequency questionnaires were used for estimating frequency of fruit consumption. The specified fruits were bananas, apples/pears and oranges/citrus fruit. Complete case analysis regarding fruit consumption, office- and home blood pressure measurements and other relevant variables was performed in 2283 study participants out of 2603 available. Multivariable linear regression analysis was performed. There were statistically significant associations between consumption of all fruit types and lower systolic home blood pressure unadjusted (p for trend; bananas, apples/pears and oranges/citrus fruit p < .001). The numerical differences between most and least frequent consumption of fruit were for bananas -2.7 mm Hg, apples/pears -3.9 mm Hg and for oranges/citrus fruit -3.4 mm Hg. When adjusted for covariates, both consumption of apples/pears and oranges/citrus fruit had an independent statistically significant association with lower blood pressure (p = .048 resp. p = .009). Future controlled interventional studies are needed to evaluate the effect of specific fruit on home blood pressure.
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| 21. |
- Vetrano, Davide L., et al.
(författare)
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Impact of disease duration and cardiovascular dysautonomia on hypertension in Parkinson's disease
- 2017
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 19:4, s. 418-423
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Tidskriftsartikel (refereegranskat)abstract
- The authors evaluated the association of Parkinson's disease (PD) duration with hypertension, assessed by office measurements and 24-hour (ambulatory) monitoring, in 167 patients. Hypertension was evaluated through both office and ambulatory blood pressure (BP) measurements. Among participants (mean age 73.4 +/- 7.6years; 35% women), the prevalence of hypertension was 60% and 69% according to office and ambulatory BP measurements, respectively (Cohen's k=0.61; P<.001). PD duration was inversely associated with hypertension as diagnosed by office measurements (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.86-0.98) but not by ambulatory monitoring (OR, 0.94; 95% CI, 0.81-1.01). Ambulatory BP patterns showed higher nocturnal BP among patients with long-lasting disease. In conclusion, ambulatory BP monitoring improves the detection of hypertension by 15% in PD, compared with office evaluation. The likelihood of having hypertension does not decrease during the PD course; rather, BP pattern shifts towards nocturnal hypertension.
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| 22. |
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Wijkman, Magnus, et al.
(författare)
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Predictors and correlates of systolic blood pressure reduction with liraglutide treatment in patients with type 2 diabetes
- 2019
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1751-7176 .- 1524-6175. ; 21:1, s. 105-115
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Tidskriftsartikel (refereegranskat)abstract
- Liraglutide is associated with blood pressure reduction in patients with type 2 diabetes. However, it is not known whether this blood pressure reduction can be predicted prior to treatment initiation, and to what extent it correlates with weight loss and with improved glycemic control during follow-up. We analyzed data from a double-blind, placebo-controlled trial, in which 124 insulin-treated patients with type 2 diabetes were randomized to liraglutide or placebo. We evaluated various baseline variables as potential predictors of systolic blood pressure (SBP) reduction, and evaluated whether changes in SBP correlated with weight loss and with improved glycemic control. A greater reduction in SBP among liraglutide-treated patients was predicted by higher baseline values of SBP (P < 0.0001) and diastolic blood pressure (P = 0.012), and by lower baseline values of mean glucose measured by continuous glucose monitoring (CGM; P = 0.044), and serum fasting C-peptide (P = 0.015). The regression coefficients differed significantly between the liraglutide group and the placebo group only for diastolic blood pressure (P = 0.037) and mean CGM (P = 0.021). During the trial period, SBP reduction correlated directly with change in body weight and BMI, but not with change in HbA1c. We conclude that patients with lower mean CGM values at baseline responded to liraglutide with a larger reduction in SBP, and that improved HbA1c during follow-up was not associated with reductions of SBP. Our data suggest that some patients with type 2 diabetes may benefit from liraglutide in terms of weight and SBP reduction.
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| 27. |
- Wijkman, Magnus, et al.
(författare)
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Resistance to antihypertensive treatment and long-term risk: The Atherosclerosis Risk in Communities study
- 2021
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 23:10, s. 1887-1896
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Tidskriftsartikel (refereegranskat)abstract
- More stringent blood pressure (BP) goals have led to greater prevalence of apparent resistant hypertension (ARH), yet the long-term prognostic impact of ARH diagnosed according to these goals in the general population remains unknown. We assessed the prognostic impact of ARH according to contemporary BP goals in 9612 participants of the Atherosclerosis Risk in Communities (ARIC) study without previous cardiovascular disease. ARH, defined as BP above goal (traditional goal <140/90 mmHg, more stringent goal <130/80 mmHg) despite the use of >= 3 antihypertensive drug classes or any BP with >= 4 antihypertensive drug classes (one of which was required to be a diuretic) was compared with controlled hypertension (BP at goal with 1-3 antihypertensive drug classes). Cox regression models were adjusted for age, sex, race, study center, BMI, heart rate, smoking, eGFR, LDL, HDL, triglycerides, and diabetes. Using the traditional BP goal, 133 participants (3.8% of the treated) had ARH. If the more stringent BP goal was instead applied, 785 participants (22.6% of the treated) were reclassified from controlled hypertension to uncontrolled hypertension (n = 725) or to ARH (n = 60). Over a median follow-up time of 19 years, ARH was associated with increased risk for a composite end point (all-cause mortality, hospitalization for myocardial infarction, stroke, or heart failure) regardless of whether traditional (adjusted HR 1.50, 95% CI: 1.23-1.82) or more stringent (adjusted HR 1.43, 95% CI: 1.20-1.70) blood pressure goals were applied. We conclude that in patients free from cardiovascular disease, ARH predicted long-term risk regardless of whether traditional or more stringent BP criteria were applied.
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| 28. |
- Wijkman, Magnus, 1978-, et al.
(författare)
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The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.
- 2018
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Ingår i: The Journal of Clinical Hypertension. - Hoboken, United States : Le Jacq Communications, Inc.. - 1524-6175 .- 1751-7176. ; 20, s. 56-64
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of an exaggerated exercise blood pressure (BP) response is unknown in patients with subacute stroke, and it is not known whether an aerobic exercise program modulates this response. The authors randomized 53 patients (27 women) with subacute stroke to 12 weeks of twice-weekly aerobic exercise (n = 29) or to usual care without scheduled physical exercise (n = 24). At baseline, 66% of the patients exhibited an exaggerated exercise BP response (peak systolic BP ≥210 mm Hg in men and ≥190 mm Hg in women) during a symptom-limited ergometer exercise test. At follow-up, patients who had been randomized to the exercise program achieved higher peak work rate, but peak systolic BP remained unaltered. Among patients with a recent stroke, it was common to have an exaggerated systolic BP response during exercise. This response was not altered by participation in a 12-week program of aerobic exercise.
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| 29. |
- Wändell, Per, et al.
(författare)
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Use of cardiovascular drugs and risk of incident heart failure in patients with atrial fibrillation
- 2020
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 22:8, s. 1396-1405
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Tidskriftsartikel (refereegranskat)abstract
- Congestive heart failure (CHF) is the most important cause of death in patients with atrial fibrillation (AF). We aimed to study the association between cardiovascular drugs in AF patients and incident CHF. The study population included all adults (n = 120 756) aged ≥45 years diagnosed with AF in Sweden diagnosed for the period 1998-2006. Outcome was incident congestive heart failure (follow-up 2007-2015) in AF patients. Associations between treatment with cardiovascular pharmacotherapies and CHF were evaluated using Cox regression to estimate hazard ratios (HRs) with 95% CIs, after adjustment for age, sociodemographic variables, and comorbidities. During a mean 5.3 years (SD 3.0) of follow-up, there were 28 257 (23.4%) incident cases of CHF. Treatment with beta-1-selective and non-selective beta-blockers and statins was associated with lower risks of incident CHF in men, HR, (95% CI); 0.90, (0.87-0.94); 0.90, (0.84-0.97), and 0.94, (0.90-0.99), respectively. Only beta-1-selective beta-blockers were protective in women 0.94 (0.91-0.98). Treatment with loop diuretics, potassium-saving agents, ACE inhibitors, and angiotensin receptor blockers was associated with a higher risk of CHF. For men, treatment with heart-active calcium channel blockers also led to a higher risk of CHF. In conclusion, we found that beta-blockers, in particular, but also statins were associated with lower risk of incident CHF in patients with AF.
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| 30. |
- Zhu, Wenhao, et al.
(författare)
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Prognostic implications of residual mild coarctation gradient after interventional repair
- 2024
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Ingår i: The Journal of Clinical Hypertension. - : John Wiley & Sons. - 1524-6175 .- 1751-7176.
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Tidskriftsartikel (refereegranskat)abstract
- There is limited data on the prognostic implications of residual mild coarctation (RMC) in patients with repaired native coarctation of the aorta (CoA). To explore the association of RMC with mid-term comorbidities in post-interventional patients, and the predictive value of the residual pressure gradient. The authors retrospectively analyzed 79 native CoA patients who received successful intervention at our hospital between October 2010 and June 2023. The outcomes of the study were late arterial hypertension (either raised blood pressure or commencement of hypotensive medications) only in normotensive patients at early follow-up and the composite mid-term comorbidities including new-onset aortic injury, re-stenosis, and re-intervention. At a median follow-up of 60 months, late hypertension and mid-term comorbidities occurred in 16 (28.1%) and nine (11.4%) patients, respectively. Multivariate Cox proportional hazard regression analysis identified invasive peak systolic CoA pressure gradient (PSPG) as the best independent predictor of both outcomes. The maximally selected rank statistics indicated 10 mm Hg as the best PSPG cut-off value for predicting late hypertension. Compared to patients with PSPG < 11 mm Hg, the cumulative event rates of both outcomes were higher in those with PSPG ≥ 11 mm Hg (log-rank test, p <.001 for both endpoints). PSPG ≥ 11 mm Hg was proved to be the independent predictor of late hypertension with a significantly increased risk. In patients with non-surgical CoA repair, the post-interventional RMC and PSPG ≥11 mm Hg are important predictors of clinical comorbidities at mid-term follow-up.
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- Kjeldsen, S. E., et al.
(författare)
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The effects of losartan compared to atenolol on stroke in patients with isolated systolic hypertension and left ventricular hypertrophy. The LIFE study
- 2005
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Ingår i: J Clin Hypertens (Greenwich). - 1524-6175. ; 7:3, s. 152-8
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Tidskriftsartikel (refereegranskat)abstract
- The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study reported that a losartan-based antihypertensive regimen reduced cardiovascular morbidity and mortality (composite of cardiovascular death, stroke, and myocardial infarction) more than therapy based on atenolol in patients with left ventricular hypertrophy and isolated systolic hypertension (ISH). Patients aged 55-80 years with blood pressures 160-200/<90 mm Hg were followed for a mean of 4.7 years. Blood pressure was similarly reduced in the losartan (n=660) and atenolol (n=666) ISH groups. There were 88 (6.6%) patients who experienced a stroke, 18 of which were fatal. Of patients experiencing strokes, 72.7% had an ischemic stroke. ISH patients in LIFE compared to the non-ISH group had a higher incidence of any stroke and embolic stroke, and similar incidences of fatal, atherosclerotic, and hemorrhagic/other strokes. The incidence of any stroke (40% risk reduction [RR], p=0.02), fatal stroke (70% RR, p=0.035), and atherothrombotic stroke (45% RR, p=0.022) was significantly lower in losartan-treated compared to the atenolol-treated patients. The 36% RR for embolic strokes in the losartan group was not statistically significantly (p=0.33) different from the atenolol group. These data suggest that losartan-based treatment is more effective than an atenolol-based treatment for patients with ISH and a high risk for stroke.
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- Russell, David, et al.
(författare)
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Cardiovascular Events in Subgroups of Patients During Primary Treatment of Hypertension With Candesartan or Losartan
- 2011
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1524-6175. ; 13:3, s. 189-197
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Tidskriftsartikel (refereegranskat)abstract
- Merging data from existing electronic patient records, and electronic hospital discharge and cause of death registers, is a fast and relatively inexpensive method for comparing different treatments with regard to clinical outcome. This study compared the effects of antihypertensive treatment with candesartan or losartan on cardiovascular disease (CVD) using Swedish registers. Patients without previous CVD who were prescribed candesartan (n=7329) or losartan (n=6771) for hypertension during 1999-2007 at 72 Swedish primary care centers were followed for up to 9 years. Both medications were given according to current recommendations, and there was no difference observed in achieved blood pressures. The authors have previously shown that candesartan lowered the risk of all CVD (primary composite end point) more so than losartan (adjusted hazard ratio, 0.86; 95% confidence interval, 0.77-0.96). Candesartan also had a significantly better effect with regards to reducing the development of heart failure, cardiac arrhythmias, and peripheral arterial disease. In the present analysis, the authors found that candesartan, compared with losartan, reduced the risk of all CVD, irrespective of sex, age, previous antihypertensive treatment, baseline blood pressure, and presence of diabetes. These clinical findings may reflect differences between candesartan and losartan in their binding characteristics to the angiotensin type 1 receptor.
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