| 1. |
- Collen, Anna-Clara, 1970, et al.
(författare)
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Cardiac structure and function is related to current blood pressure rather than to previous hypertensive pregnancy
- 2015
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Ingår i: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 29:11, s. 702-704
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Tidskriftsartikel (refereegranskat)abstract
- One-hundred five women were examined with echocardiography and ambulatory blood pressure measurements 40 years post partum to evaluate the effect of former hypertensive pregnancies versus current blood pressure on cardiac structure and function. Hypertensive pregnancies did not have an adverse effect on the heart, but current minor elevation in blood pressure had a negative impact on the myocardium. The increased prevalence of hypertension following hypertensive pregnancies may be a crucial factor regarding the increased risk for cardiovascular disease shown in affected women.
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| 2. |
- Taft, Charles, 1950, et al.
(författare)
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Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To explore relationships between patients’ self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms. Design This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension. Setting Four primary healthcare centres situated in urban and suburban communities in Sweden. Participants 50 patients undergoing treatment for hypertension. Primary and secondary outcome measures Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling. Results Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms—dizziness, headache, restlessness, fatigue or palpitations—were significantly associated with BP. Conclusions Our findings that BP was associated with patients’ BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations. Trial registration number NCT01510301; Pre-results. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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| 3. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study
- 2016
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Ingår i: Bmj-British Medical Journal. - : BMJ. - 1756-1833. ; 354
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease. Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years. 187 106 patients registered in the Swedish national diabetes register who had had type 2 diabetes for at least a year, age 75 or younger, and with no previous cardiovascular or other major disease. Clinical events were obtained from the hospital discharge and death registers with respect to acute myocardial infarction, stroke, a composite of acute myocardial infarction and stroke (cardiovascular disease), coronary heart disease, heart failure, and total mortality. Hazard ratios were estimated for different levels of baseline systolic blood pressure with clinical characteristics and drug prescription data as covariates. The group with the lowest systolic blood pressure (110-119 mm Hg) had a significantly lower risk of non-fatal acute myocardial infarction (adjusted hazard ratio 0.76, 95% confidence interval 0.64 to 0.91; P=0.003), total acute myocardial infarction (0.85, 0.72 to 0.99; P=0.04), non-fatal cardiovascular disease (0.82, 0.72 to 0.93; P=0.002), total cardiovascular disease (0.88, 0.79 to 0.99; P=0.04), and non-fatal coronary heart disease (0.88, 0.78 to 0.99; P=0.03) compared with the reference group (130-139 mm Hg). There was no indication of a J shaped relation between systolic blood pressure and the endpoints, with the exception of heart failure and total mortality. Lower systolic blood pressure than currently recommended is associated with significantly lower risk of cardiovascular events in patients with type 2 diabetes. The association between low blood pressure and increased mortality could be due to concomitant disease rather than antihypertensive treatment.
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| 4. |
- Andersson, Tobias, 1976, et al.
(författare)
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Mortality trends and cause of death in patients with new-onset type 2 diabetes and controls: A 24-year follow-up prospective cohort study.
- 2018
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Ingår i: Diabetes research and clinical practice. - : Elsevier BV. - 1872-8227 .- 0168-8227. ; 138, s. 81-89
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Tidskriftsartikel (refereegranskat)abstract
- Our aim was to assess causes of death and temporal changes in excess mortality among patients with new-onset type 2 diabetes in Skaraborg, Sweden.Patients from the Skaraborg Diabetes Register with prospectively registered new-onset type 2 diabetes 1991-2004 were included. Five individual controls matched for sex, age, geographical area and calendar year of study entry were selected using population records. Causes of deaths until 31 December 2014 were retrieved from the Cause of Death Register. Adjusted excess mortality among patients and temporal changes of excess mortality were calculated using Poisson models. Cumulative incidences of cause-specific mortality were calculated by competing risk regression.During 24years of follow-up 4364 deaths occurred among 7461 patients in 90,529 person-years (48.2/1000 person-years, 95% CI 46.8-49.7), and 18,541 deaths in 479,428 person-years among 37,271 controls (38.7/1000 person-years, 38.1-39.2). The overall adjusted mortality hazard ratio was 1.47 (p<.0001) among patients diagnosed at study start 1991 and decreased by 2% (p<.0001) per increase in calendar year of diagnosis until 2004. Excess mortality was mainly attributed to endocrine and cardiovascular cause of death with crude subdistributional hazard ratios of 5.06 (p<.001) and 1.22 (p<.001).Excess mortality for patients with new-onset type 2 diabetes was mainly attributed to deaths related to diabetes and the cardiovascular system, and decreased with increasing year of diagnosis 1991-2004. Possible explanations could be temporal trends of earlier diagnosis due to lowered diagnostic thresholds and intensified diagnostic activities, as well as improved treatment.
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| 5. |
- Bager, Johan-Emil, et al.
(författare)
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Acute blood pressure levels and long-term outcome in ischemic stroke.
- 2018
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Ingår i: Brain and behavior. - : Wiley. - 2162-3279. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- Elevated blood pressure (BP) is common in acute ischemic stroke, but its effect on outcome is not fully understood. We aimed to investigate the association of baseline BP and BP change within the first day after stroke with stroke severity, functional outcome, and mortality.Patients admitted to hospital with acute ischemic stroke (IS) from 15 February 2005 through 31 May 2009 were consecutively included. Acute stroke severity and functional outcome at three and twelve months were investigated using multivariate regression analysis; the association between BP and all-cause mortality at one, three, and twelve was investigated by Cox proportional hazard regression and Kaplan-Meier survival curves.A total of 799 patients (mean age 78.4±8.0, 48% men) were included. Higher decreases in systolic and mean arterial blood pressure (ΔSBP and ΔMAP) were associated with decreased 1-month mortality (ΔSBP: hazard ratio, HR: 0.981; 95% CI: 0.968 - 0.994; p=.005), 3-month mortality (ΔSBP: HR 0.989; 95% CI 0.981 - 0.998; p-value .014), and twelve-month mortality (ΔSBP: HR 0.989; 95% CI 0.982 - 0.996; p-value .003). Stroke severity was associated with ΔMAP (B coefficient -.46, p-value .011). Higher SBP and MAP on admission were associated with better functional outcome at three (SBP: OR 0.987; 95% CI 0.978 - 0.997; p-value .008 - MAP: OR 0.985; 95% CI 0.971 - 1; p-value .046) and twelve (SBP: OR 0.988; 95% CI 0.979 - 0.998; p-value .015 - MAP: OR 0.983; 95% CI 0.968 - 0.997; p-value .02) months.In this elderly population, higher BP on arrival to the emergency room (ER) and decrease in BP after the patients' arrival to the ward were associated with improved functional outcome and reduced mortality, respectively. These results may reflect a regulatory situation in which elevated initial blood pressure indicates adequate response to cerebral tissue ischemia while subsequent blood pressure decrease instead may be a consequence of partial, successful reperfusion.
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| 6. |
- Bager, Johan-Emil, et al.
(författare)
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Treatment of hypertension in old patients without previous cardiovascular disease.
- 2019
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Ingår i: Journal of hypertension. - 1473-5598. ; 37:11, s. 2269-2279
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare the risk of cardiovascular disease (CVD) - nonfatal acute myocardial infarction (AMI) or stroke - at blood pressure levels that meet current recommendations with risk at lower levels, particularly in older patients.We identified patients with hypertension aged 40-90 years from a primary care register. Patients with a history of cancer, diabetes mellitus or CVD were excluded. Patients were divided into age groups (40-75 and 76-90), and four groups of SBP 110-129, 130-139 (reference), 140-149 and ≥150mmHg. We used the Kaplan-Meier estimator to study incidence of AMI, stroke and a composite of the two. Cox proportional-hazards regression was used to estimate hazard ratios for outcomes.We included 31704 patients: 26663 were 40-75 years old and 5041 were 76-90 years old. Mean follow-up was 2 years. Although no significant differences in risk of any outcome were found in the younger group, low blood pressure was associated with the lowest risk in the older group. Older patients in the 110-129mmHg group had a lower incidence of CVD (15.9/1000 vs. 25.3/1000 person-years) than the reference group. After adjustment for covariates, the hazard ratio of CVD in older patients in the 110-129mmHg group compared with the reference group was 0.60 (95% confidence interval 0.40-0.92).Blood pressure levels lower than those currently recommended are not harmful among older patients. The association between lower SBP and lesser risk of CVD may instead suggest a beneficial effect of lower SBP.
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| 7. |
- Bokrantz, Tove, et al.
(författare)
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7b.10: Thiazide Diuretics and Fracture-Risk among Hypertensive Patients. Results from the Swedish Primary Care Cardiovascular Database (Spccd)
- 2015
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Ingår i: Journal of hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 0263-6352 .- 1473-5598. ; 33 Suppl 1
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: To investigate whether treatment with thiazide diuretics reduces the risk of osteoporotic fractures in hypertensive patients in primary health care. Further we aimed to examine the impact of duration of thiazide use, the consequences of discontinuation of use and effect-modifications by gender. DESIGN AND METHOD: This retrospective cohort study includes 60 893 individuals, diagnosed with hypertension during 2001-2008 included in the Swedish Primary Care Cardiovascular Database. All patients were followed from a fixed baseline (1 Jan 2006, or the date the patient received their first diagnosis of hypertension if that date came later) until they had an incident osteoporotic fracture, died, or reached the end of the study at 31 Dec 2012, whichever came first. Patients exposed to thiazide diuretics (dispensed drugs recorded through the Prescribed Drug Register) were compared with hypertensive patients never exposed to thiazides. RESULTS: During follow up 2421 osteoporotic fractures occurred. Current use of thiazide diuretics was found to be associated with significantly reduced risk of osteoporotic fractures (adjusted hazard ratios 0.88; 95% CI 0.81-0.97) independent of blood pressure level. In addition, risk appeared to decline with longer duration of use. In contrast, discontinuation of dispensed prescriptions of thiazides was associated with increased risk of osteoporotic fractures (HR 1.17; 95% CI 1.04-1.31).However, a trend towards attenuation of the increased risk with longer duration past treatment period was seen. When analyzing men and women separately similar results were seen, for both genders, although only statistically significant for men. CONCLUSIONS: In this large retrospective cohort study of hypertensive men and women from Sweden, we could identity a protective effect on osteoporotic fractures among current users of thiazide diuretic drugs independent of blood pressure level. However, the risk of fracture was found to be increased in patients shortly after discontinuation of treatment compared to patients never prescribed thiazide diuretic drugs. The reason for an augmented outcome on osteoporotic fractures among patients with former thiazide diuretic therapy needs to be further elucidated.
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| 8. |
- Bokrantz, Tove, et al.
(författare)
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Reply.
- 2017
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Ingår i: Journal of hypertension. - 1473-5598. ; 35:3, s. 646-647
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 9. |
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| 10. |
- Collen, Anna-Clara, 1970, et al.
(författare)
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Cardiovascular response to stress and perceived stress is not altered 40 years after hypertensive pregnancies
- 2015
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Ingår i: Hypertension in Pregnancy. - : Informa UK Limited. - 1064-1955 .- 1525-6065. ; 34:1, s. 116-124
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Women experiencing hypertensive pregnancies have an increased risk for cardiovascular disease. Whether stress increase the risk is unknown. The objective was to test if cardiovascular response to stress and/or perceived stress differed in relation to blood pressure status during pregnancy 40 years earlier. Methods: Cardiovascular response was examined with mental stress test, and perceived stress was evaluated with a questionnaire in 105 women. Results: Resting heart rate was higher, and pulse reactivity was lower in women with previous hypertensive pregnancies. Neither blood pressure nor perceived stress differed. Conclusion: Response to physical or psychological stress is not affected many years after pregnancy.
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