| 1. |
- 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, T., et al.
(författare)
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Stroke and coronary heart disease in treated hypertension -- a prospective cohort study over three decades
- 2005
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Ingår i: J Intern Med. - 0954-6820. ; 257:6, s. 496-502
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare cardiovascular mortality and morbidity in middle-aged hypertensive men with initially nonhypertensive men derived from the same random population sample, and to study stroke morbidity in these men in relation to cardiovascular risk factors during 25-28 years of follow-up. DESIGN: Prospective, population-based observational study in men where the main intervention effort was directed towards treatment of hypertension in a special outpatient clinic. SUBJECTS AND METHODS: A total of 754 hypertensive men aged 47-55 years at screening were compared with 6740 men with normal blood pressure. The hypertensive men got stepped care treatment with either beta-blockers, thiazide diuretics, or combination treatment including vasodilating agents during the whole observational period. Data on cause-specific mortality and morbidity, and all cause mortality were obtained from patient files and the national registers on mortality and hospital admissions respectively. MAIN OUTCOME MEASURES: Baseline and change of cardiovascular risk factors during the first 15 years of follow-up and all cause mortality, and mortality and morbidity from stroke and coronary heart disease during 25-28 years. RESULTS: Treated hypertensive men had their blood pressure reduced with 21/15 mmHg during the first 5 years of the study and mean blood pressure levels were then rather constant. A minor reduction of serum cholesterol was also observed and a significant reduction in the prevalence of smoking. Treated hypertensive men suffered a substantial increased incidence of cardiovascular complications that escalated during the latter course of the study. Their total incidence of stroke was doubled; they had 50% more myocardial infarctions (MIs); mortality from coronary heart disease was doubled and all cause mortality was increased by a third, compared with nonhypertensive. In multiple regression analysis the incidence of stroke was significantly related to smoking and diabetes at entry and in time-dependent Cox's regression analysis it was significantly related only to smoking. There was no relationship observed between achieved systolic or diastolic blood pressure and the risk of stroke or MI nor was there any relationship between the change in blood pressure and such cardiovascular complications. CONCLUSION: In spite of a substantial reduction of their blood pressure, treated hypertensive middle-aged men had a highly increased risk of stroke, MI and mortality from coronary heart disease compared with nonhypertensive men of similar age. The increased risk of cardiovascular complications escalated during the latter course of the study.
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| 3. |
- Eriksson, Björn, 1981-, et al.
(författare)
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The Dynamic Performance of a Pilot Stage in the Poppet Type Hydraulic Flow Amplifier
- 2008
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Ingår i: The 51st NCFP Technical Conference,2008. - Proceedings of the 51st NCFP Technical Conference : Omnipress. ; , s. 659-
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Konferensbidrag (refereegranskat)abstract
- This paper examines the dynamic properties of the pilot stage in a poppet type two-stage flow control valve of the -Valvistor- type. The particular valve studied is a screw-in Valvistor valve of NG16 size. There are several benefits to this valve type: it has a high closed loop bandwidth and the design allows big flow capacities. An attractive feature of this two-stage valve is that the pilot flow contributes to the total flow giving higher steady state flow efficiency. The dynamic characteristics of the main stage were discussed in an earlier paper. In this paper the aim is to study the influence of the pilot stage of the valve. The bandwidth of this type of valve is often unexpected low. Due to the high bandwidth of the Valvistor element the pilot dynamics is often dominating. In this paper it is shown by measurements the influence of different parts in the pilot valve that limits its bandwidth. Flow forces are used in this valve to compensate the pressure dependency in the flow. It is a common way of design in so called pressure compensated valves. It is discussed in the paper how this flow forces influences the dynamic properties of the pilot valve. The mentioned flow forces interact together with the mechanical spring in the pilot valve. Although the studied valve is just one of many variants of the Valvistor principle, we will investigate it closely due to the interest for this valve among other researchers. One important conclusion is that the inductance of the pilot solenoid is often limiting the bandwidth of the valve as a whole.
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