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- Fedorowski, Artur, et al.
(författare)
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Orthostatic hypotension in genetically related hypertensive and normotensive individuals.
- 2009
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Ingår i: Journal of Hypertension. - 1473-5598. ; 27:5, s. 976-982
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Prevalence and determinants of orthostatic hypotension remain largely unexplored in younger individuals without significant burden of chronic diseases. METHODS: We investigated frequency and main associations of impaired orthostatic response in a cohort of 469 middle-aged hypertensive patients and 453 of their normotensive first-degree relatives. RESULTS: 13.4% of hypertensive and 5.5% of normotensive study participants were found to have orthostatic hypotension. In a backward logistic regression the following determinants of orthostatic hypotension were identified: sex [female, odds ratio (OR) 2.45, 95% confidence interval (CI) 1.14-5.25, P=0.022], reduced glomerular filtration rate [OR (per ml/min/1.73 m2) 0.97, 95% CI 0.94-0.99, P=0.002], systolic [OR (per mmHg) 1.02, 95% CI 1.00-1.05, P=0.047] and diastolic blood pressure [OR (per mmHg) 1.04, 95% CI 1.00-1.09, P=0.033], and antihypertensive treatment (OR 0.41, 95% CI 0.18-0.93, P=0.034). In hypertensive patients use of angiotensin-converting enzyme inhibitors was related to lower orthostatic hypotension frequency. Percentage of orthostatic hypotension-positive patients in the highest blood pressure stratum (> or = 160 mmHg) decreased from 20.2 to 7.6, when diagnostic criteria of orthostatic hypotension were adjusted for mean systolic orthostatic reaction (2 SD value: 30 mmHg) . During follow-up (t=6.6 years) individuals with impaired orthostatic response showed a trend towards increased total mortality (OR 2.16, 95% CI 0.97-4.80, P=0.06) in a crude model. CONCLUSION: Prevalence of orthostatic hypotension in hypertensive patients is higher than in their normotensive first-degree relatives. Independently of age, sex, and elevated blood pressure, orthostatic hypotension may be additionally determined by impaired renal function. Antihypertensive treatment seems to protect from orthostatic hypotension, in particular, use of angiotensin-converting enzyme inhibitors in hypertensive patients. The diagnostic criteria of orthostatic hypotension may need adjustment for initial supine systolic blood pressure to increase clinical accuracy. The prognostic value of impaired orthostatic response regarding risk of cardiovascular disease and mortality remains uncertain and requires further studies.
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| 2. |
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| 3. |
- Fedorowski, Artur, et al.
(författare)
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The metabolic syndrome and risk of myocardial infarction in familial hypertension (Hypertension Heredity in Malmö Evaluation study).
- 2009
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Ingår i: Journal of Hypertension. - 1473-5598. ; 27:1, s. 109-117
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to examine whether three main definitions of the metabolic syndrome (MetS) - WHO, National Cholesterol Education Program-Adult Treatment Panel III and International Diabetes Federation - identify the same individuals and are able to predict incident myocardial infarction (MI) in families with essential hypertension. METHODS: The tested definitions were prospectively related to data on MI in a cohort of approximately 1700 individuals with overt essential hypertension and their normotensive first-degree relatives. RESULTS: At baseline, 616 participants had MetS, yet only 209 of them (33.9%) were identified by all definitions, and compatibility rate for each pair of definitions was approximately 50%. During follow-up (Tmean approximately 6.6 years) 53 participants developed MI and they were generally older and more dysmetabolic than the rest of the cohort. There were also more men, smokers and diabetic individuals in this group. After adjustment for all conventional cardiovascular risk factors, including hypertension and diabetes, only the National Cholesterol Education Program definition could predict the increased risk of MI [odds ratio (OR) = 2.2, confidence interval (CI) = 1.2-4.0, P = 0.01]. Among individual MetS components, incident MI was independently associated with three of them: low high-density lipoprotein-cholesterol (OR = 2.03, CI = 1.09-3.78, P = 0.025) insulin resistance (OR = 2.02, CI = 1.08-3.78, P = 0.028) and increased albumin excretion rate (OR = 1.24, CI = 0.99-1.55, P = 0.060). CONCLUSION: The presence of MetS in hypertensive and genetically hypertension prone individuals may signal the increased risk of future MI. However, only the National Cholesterol Education Program criteria appear to have a sufficient predictive accuracy.
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