| 1. |
- Collen, Anna-Clara, 1970, et al.
(författare)
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Cardiovascular and metabolic characteristics 40 years after hypertensive pregnancies: a long-term follow-up study of mothers.
- 2013
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Ingår i: Journal of hypertension. - 1473-5598. ; 31:4, s. 758-765
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:: Maternal cardiovascular morbidity is increased after hypertensive pregnancies (HTP). The pathways from complicated pregnancies to future cardiovascular disease are complex. The aim of the present study was to test the hypothesis that different cardiovascular mechanisms are changed in women who experienced HTP four decades earlier in comparison to women with normotensive pregnancies. METHODS:: One hundred and five women (50 with hypertensive and 55 with normal pregnancies) were examined with anthropometric measurements; office blood pressure, ambulatory blood pressure and central blood pressure, pulse wave velocity, augmentation index, intimal-media thickness, echocardiography and laboratory measurements. In addition another 204 women were followed-up by a questionnaire regarding their pregnancy 40 years ago, as well as their present health status and medications. RESULTS:: Women with HTP had more often diagnosed hypertension when compared with women with normal pregnancies (50 vs. 31%, respectively; P=0.046), but the groups did not differ in any blood pressure levels. HTP were associated with higher pulse wave velocity (8.8m/s vs. 7.8m/s, P=0.021), and higher levels of P-glucose (5.7mmol/l vs. 5.2mmol/l, P=0.022), P-HbA1c (4.4% vs. 4.2%, P=0.010) and noradrenaline (2.45mmol/l vs. 2.11mmol/l, P=0.040) when compared with normotensive pregnancies. Women followed up with a questionnaire reported deteriorated cardiovascular health compared to women attending the clinical investigations of the study. CONCLUSION:: HTP are associated with impairment in vascular function and metabolic status 40 years postpartum despite well controlled blood pressure levels.
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| 2. |
- Hanse, Eric, 1962, et al.
(författare)
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[The medical education in Gothenburg is being reformed. Professional development, research and internationalization]
- 2011
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Ingår i: Läkartidningen. - 0023-7205. ; 108:12, s. 669-73
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Tidskriftsartikel (refereegranskat)abstract
- The medical education at the Sahlgrenska Academy, University of Gothenburg, is being reformed by an emphasis on professional development, international contacts and research. Students’ professional development consists of five core areas: Communication and self-reflection, Leadership and teamwork, Ethical attitude, Human rights and gender issues, and a Scientific and critical attitude. A learning progression of students’ professional competence is organised by five process leaders, coordinating core learning objectives and examinations within the existing curriculum. By promoting international exchange, more than half of the students in undergraduate medical education have had international contacts. The Sahlgrenska Academy aims to promote medical students’ interest for research and to increase the percentage among medical doctors that have a PhD degree. A program for combining medical education with research and teaching is being launched along with a MD/PhD program for medical basic science and a special PhD/MD program.
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| 3. |
- Janson Fagring, Annika, 1949, et al.
(författare)
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Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987-2006 from the Swedish hospital and death registries
- 2010
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Ingår i: Heart. - : BMJ Publishing Group. - 1355-6037 .- 1468-201X. ; 96:13, s. 1043-1049
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study trends for 20 years in incidence and 1-year mortality in hospitalised patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden. Design and setting Register study of all patients aged 25–84 years identified from the Swedish National Hospital Discharge Register who were hospitalised with a first-time diagnosis of UCP or angina pectoris during 1987 to 2006. Participants A total of 378454 patients, 235855 with UCP and 142599 with angina. Main outcome measures 1-Year mortality and standardised mortality ratios (SMRs). Results From the period 1987–1991 to 2002–2006, the observed 1-year mortality rate in men and women with UCP aged 25–74 years decreased from 2.19% to 1.45% and from 1.85% to 0.91%, respectively. SMRs decreased from 1.67 (95% CI 1.39 to 1.95) and 1.63 (1.27 to 2.00) to 1.09 (0.96 to 1.23) and 0.88 (0.75 to 1.00). Corresponding decreases in 1-year mortality for a discharge diagnosis of angina were from 6.50% to 2.49% in men and from 4.80% to 1.68% in women, with SMRs decreasing from 2.69 (2.33–3.05) and 2.59 (2.06–3.12) to 1.09 (0.93–1.25) and 1.05 (0.81–1.29), respectively. Similar changes occurred in patients aged 75–84 years. Only men with UCP aged 75–84 years still retained a slightly increased mortality (SMR 1.14 (1.01–1.28)). Conclusions The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population.
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| 4. |
- Manhem, Karin, 1954, et al.
(författare)
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Influence of chronic hormone replacement therapy on left ventricular mass and serum-ACE activity.
- 2010
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Ingår i: Blood pressure. - : Informa UK Limited. - 1651-1999 .- 0803-7051. ; 19:5, s. 295-300
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: The aim of this investigation was to study the effects of hormone replacement therapy (HRT) on left ventricular mass (LVM) and serum-angiotensin-converting enzyme (ACE) activity (S-ACE) in well controlled hypertensive postmenopausal women. METHODS: In this prospective, randomized, crossover, double-blind trial we studied 20 well controlled hypertensive postmenopausal women who received 6 months of HRT and 6 months of placebo on top of antihypertensive treatment. Two-dimensional M-mode, office blood pressure, 24-h ambulatory blood pressure (ABPM), S-estradiol and S-ACE activity were investigated at baseline, after 6 and 12 months. RESULTS: LVM was significantly influenced by HRT (analysis of variance, ANOVA, p<0.01). However, the order in randomization of HRT and placebo had an impact on the analysis of LVM reduction (baseline - HRT - placebo: ns; baseline - placebo - HRT: p<0.01 ANOVA). Only the women lacking blockade of the renin-angiotensin-aldosterone system (RAAS) as antihypertensive treatment (n=10) experienced a reduction in LVM and a tendency of decreased S-ACE activity in response to HRT compared with baseline (p< 0.05 and p= 0.06 respectively). CONCLUSIONS: Six months of HRT resulted in significant reduction of LVM without any change in ABPM. HRT may reduce LVM through interaction with the RAAS, since hypertensive women without RAAS blockade exhibited an effect of HRT on LVM and S-ACE activity, which was not seen in women on RAAS blockade.
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| 5. |
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| 6. |
- Brandin, Lisa, 1974, et al.
(författare)
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Effects of estrogen plus progesterone on hemodynamic and vascular reactivity in hypertensive postmenopausal women.
- 2010
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Ingår i: Blood pressure. - : Informa UK Limited. - 1651-1999 .- 0803-7051. ; 19:3, s. 156-63
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To investigate the medium-term effects of estrogen plus progesterone therapy (EPT) on vascular reactivity, endothelial function and hemodynamic responses in 20 hypertensive postmenopausal women. METHODS: This randomized, double-blind, cross-over, placebo-controlled study investigates the effect of 6 months of EPT (conjugated equine estrogen plus medroxyprogesterone). Blood pressure (office and ambulatory), heart rate and heart rate variability (HRV) were measured at baseline and following EPT/placebo treatment. In eight women, we used a wire-myograph to assess endothelial function and contractile response of subcutaneous arteries to transmural nerve stimulation (TNS) and exogenous noradrenaline. RESULTS: EPT decreased vascular reactivity to cumulative TNS compared with baseline (p<0.01) and placebo (p<0.05). Moreover, EPT diminished sensitivity to exogenous noradrenaline (p<0.05). Although EPT reinforced response to acetylcholine, we observed no difference in maximal relaxation induced by substance P or acetylcholine. EPT did not affect ambulatory blood pressure, heart rate or HRV. CONCLUSIONS: Oral combined medium-term EPT reduces adrenergic reactivity in subcutaneous arteries from treated hypertensive postmenopausal women. EPT might act postjunctionally at the adrenergic vascular receptor level. In the present study, EPT neither reduces sympathetic activity nor increases vagal tone, and thus does not support an effect on the central hemodynamic system.
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| 7. |
- Collen, Anna-Clara, 1970, et al.
(författare)
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Sympathetic nerve activity in women 40 years after a hypertensive pregnancy
- 2012
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Ingår i: Journal of hypertension. - 1473-5598. ; 30:6, s. 1203-1210
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: : Epidemiological studies show that women with pregnancies complicated by hypertension have an increased risk of cardiovascular morbidity later in life. The underlying mechanisms to the risk increase remain largely unknown. This study evaluated sympathetic nerve activity in women with hypertensive pregnancies 40 years earlier compared to women with normotensive pregnancies. We hypothesized that sympathetic outflow would be increased in women with previous hypertensive pregnancies and that this partly may explain the increased cardiovascular risk. METHODS: : Sympathetic nerve activity to the muscle vascular bed [muscle sympathetic nerve activity (MSNA)] was recorded in 28 women, 18 with and 10 without a hypertensive manifestation during pregnancy. Women were also examined with ambulatory blood pressure measurements, pulse wave velocity, blood pressure response during Stroop test and laboratory analysis. RESULTS: : Women with previous hypertensive pregnancies did not show an increased sympathetic outflow compared to women with normotensive pregnancies. In eight women with treated hypertension sympathetic outflow was increased compared to normotensive women despite similar ambulatory blood pressure values (P < 0.05). During Stroop test the hypertensive women showed increased systolic blood pressure and also displayed the highest augmentation index compared to normotensive women (P < 0.05). CONCLUSION: : Hypertensive pregnancies per se were not associated with increased sympathetic outflow 40 years later. The increased cardiovascular risk in women with previous hypertensive pregnancies cannot be explained by chronic activation of the sympathetic nervous system.In women with previous hypertensive pregnancies, still hypertensive though well controlled, sympathetic outflow and arterial stiffness were, however, increased compared to normotensive counterparts.
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| 8. |
- Hasselstrom, J., et al.
(författare)
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The Swedish Primary Care Cardiovascular Database (SPCCD): 74 751 hypertensive primary care patients
- 2014
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 23:2, s. 116-125
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To describe the Swedish Primary Care Cardiovascular Database, SPCCD. Design. Longitudinal data from electronic medical records, linked to national registers. Setting. 48 primary healthcare centres in urban (south-western Stockholm) and rural (Skaraborg) regions in Sweden. Subjects. Patients diagnosed with hypertension 2001-2008. Main outcome measures. Blood pressure (BP) and impact of retrieval of data on BP levels, clinical characteristics, co-morbidity and pharmacological treatment. Results. The SPCCD contains 74 751 individuals, 56% women. Completeness of data ranged from >99% for drug prescriptions to 34% for smoking habits. BP was recorded in 98% of patients during 2001-2008 and in 63% in 2008. Mean BP based on the last recorded value in 2008 was 142 +/- 17/80 +/- 13 mmHg. Digit preference in BP measurements differed between the two regions, p < 0.001. Antihypertensive drugs were prescribed in primary healthcare to 88% of the patients in 2008; however, when all prescribers were included 96% purchased their drugs. Cardiovascular co-morbidity and diabetes mellitus were present in 28% and 22%, respectively. Conclusion. This large and representative database shows that there is room for improvement of BP control in Sweden. The SPCCD will provide a rich source for further research of hypertension and its complications.
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| 9. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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Electrocardiographic Abnormalities and Elevated cTNT at Admission for Intracerebral Hemorrhage: Predictors for Survival?
- 2013
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Ingår i: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc. - : Wiley. - 1542-474X. ; 18:5, s. 441-9
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Tidskriftsartikel (refereegranskat)abstract
- Cerebrovascular lesions are often associated with electrocardiographic (ECG) abnormalities. The main purpose of this work was to investigate the prognostic value of ECG abnormalities and/or elevated cardiac troponin (cTNT) on admission in patients with nontraumatic intracerebral hemorrhage (ICH).
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| 10. |
- Hjalmarsson, Clara, 1969, et al.
(författare)
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The effect of statins on acute and long-term outcome after ischemic stroke in the elderly.
- 2012
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Ingår i: The American journal of geriatric pharmacotherapy. - : Elsevier BV. - 1876-7761 .- 1543-5946. ; 10:5, s. 313-22
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Tidskriftsartikel (refereegranskat)abstract
- Although treatment with statins has produced beneficial effects when used as secondary prevention, its primary protective role is still somewhat controversial. Moreover, few studies have evaluated the effect of statins in older patients with stroke.
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