| 1. |
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| 2. |
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| 3. |
- Alhadad, Alaa, et al.
(author)
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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis
- 2005
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 19:10, s. 761-767
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Journal article (peer-reviewed)abstract
- Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.0 +/- 4.7 years of 69 consecutive patients ( age 44 +/- 13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge ( from 174 +/- 33/ 100 +/- 13 to 138 +/- 19/80 +/- 15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0 +/- 4.7 years (140 +/- 25/83 +/- 12 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year ( from 84 +/- 28 to 75 +/- 13 mu mol/ l; P = 0.0030) and last follow-up (75 +/- 16 mu mol/ l; P = 0.0017). The number of antihypertensive drugs decreased ( from 2.3 +/- 1.2 before PTRA to 1.4 +/- 1.3 at discharge and at 1 month; P<0.0001, and 1.6 +/- 1.5 at last follow-up; P = 0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43 +/- 29 vs 20 +/- 41 mmHg; P = 0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9 +/- 7.7 vs 1.8 +/- 4.1 years; P = 0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.
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| 4. |
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| 5. |
- Andersson, Ulrika, et al.
(author)
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Variability in home blood pressure and its association with renal function and pulse pressure in patients with treated hypertension in primary care
- 2023
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In: Journal of Human Hypertension. - : SPRINGERNATURE. - 0950-9240 .- 1476-5527.
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Journal article (peer-reviewed)abstract
- Blood pressure variability (BPV) represents a cardiovascular risk factor, regardless of mean level of blood pressure (BP). In this post-hoc analysis from the PERson-centredness in Hypertension management using Information Technology (PERHIT) study, we aimed to explore BPV in daily home measurements in hypertensive patients from primary care, to identify factors associated with high BPV and to investigate whether estimated glomerular filtration rate (eGFR) and pulse pressure, as markers of target organ damage (TOD), are associated with BPV. For eight consecutive weeks, 454 participants reported their daily BP and heart rate in their mobile phone, along with reports of lifestyle and hypertension-related factors. Systolic BP (SBP) values were used to calculate BPV with coefficient of variation (CV) as primary estimate. Background characteristics and self-reports were tested between fifths of CV in a linear regression model, adjusted for age and sex. Associations between BPV and eGFR and pulse pressure were tested with linear and logistic regression models. Higher home BPV was associated with higher age, BP, heart rate, and smoking. BPV was lower for participants with low alcohol consumption and treatment with calcium channel blockers. There was a significant association between BPV and pulse pressure (P = 0.015), and between BPV and eGFR (P = 0.049). Participants with high BPV reported more dizziness and palpitations. In conclusion, pulse pressure and eGFR were significantly associated with home BPV. Older age, high BP, heart rate, and smoking were associated with high BPV, but treatment with calcium channel blockers and low alcohol consumption was associated with low BPV. Trial registration: The study was registered with ClinicalTrials.gov [NCT03554382].
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| 6. |
- Botto, Fernando, et al.
(author)
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Frequency of early vascular aging and associated risk factors among an adult population in Latin America : the OPTIMO study
- 2018
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 32:3, s. 219-227
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Journal article (peer-reviewed)abstract
- The main objective was to estimate the frequency of early vascular aging (EVA) in a sample of subjects from Latin America, with emphasis in young adults. We included 1416 subjects from 12 countries in Latin America who provided information about lifestyle, cardiovascular risk factors (CVRF), and anthropometrics. We measured pulse wave velocity (PWV) as a marker of arterial stiffness, and blood pressure (BP) using an oscillometric device (Mobil-O-Graph). To determine the frequency of EVA, we used multiple linear regression to estimate each subject’s PWV expected for his/her age and systolic BP, and compared with observed values to obtain standardized residuals (z-scores). We defined EVA when z-score was ≥1.96. Finally, a multivariable logistic regression analysis was performed to determine baseline characteristics associated with EVA. Mean age was 49.9 ± 15.5 years, male gender was 50.3%. Mean PWV was 7.52 m/s (SD 1.97), mean systolic BP was 125.3 mmHg (SD 16.7) and mean diastolic BP was 78.9 mmHg (SD 12.2). The frequency of EVA was 5.7% in the total population, 9.8% in adults of 40 years or less and 18.7% in those 30 years or less. In these young adults, multiple logistic regression analyses demonstrated that dyslipidemia and hypertension showed an independent association with EVA, and smoking a borderline association (p = 0.07). In conclusion, the frequency of EVA in a sample from Latin America was around 6%, with higher rates in young adults. These results would support the search of CVRF and EVA during early adulthood.
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| 7. |
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| 8. |
- Cauwenberghs, Nicholas, et al.
(author)
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Impact of age, sex and heart rate variability on the acute cardiovascular response to isometric handgrip exercise
- 2021
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In: Journal of Human Hypertension. - : Nature Publishing Group. - 0950-9240 .- 1476-5527. ; 5:1, s. 55-64
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Journal article (peer-reviewed)abstract
- Isometric handgrip exercise (IHG) triggers acute increases in cardiac output to meet the metabolic demands of the active skeletal muscle. An abnormal cardiovascular response to IHG might reflect early stages of cardiovascular disease. In a large community-based cohort, we comprehensively assessed the clinical correlates of acute cardiovascular changes during IHG. In total, 333 randomly recruited subjects (mean age, 53 +/- 13 years, 45% women) underwent simultaneous echocardiography and finger applanation tonometry at rest and during 3 min of IHG at 40% maximal handgrip force. We calculated time-domain measures of short-term heart rate variability (HRV) from finger pulse intervals. We assessed the adjusted associations of changes in blood pressure (BP) and echocardiographic indexes with clinical characteristics and HRV measures. During IHG, men presented a stronger absolute increase in heart rate, diastolic BP, left ventricular (LV) volumes and cardiac output than women, even after adjustment for covariables. In adjusted continuous and categorical analyses, age correlated positively with the increase in systolic BP and pulse pressure, but negatively with the increase in LV stroke volume and cardiac output during exercise. After full adjustment, a greater increase in systolic and diastolic BP during exercise was associated with lower absolute real variability (P amp;lt;= 0.026) and root mean square of successive differences (P amp;lt;= 0.032) in pulse intervals at rest. In a general population sample, women presented a weaker cardiovascular response to IHG than men. Older age was associated with greater rise in BP pulsatility and diminished cardiac reserve. Low HRV at rest predicted a higher BP increase during isometric exercise.
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| 9. |
- Chan, R, et al.
(author)
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Serum 25-hydroxyvitamin D and parathyroid hormone levels in relation to blood pressure in a cross-sectional study in older Chinese men.
- 2012
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In: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 26:1, s. 20-27
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Journal article (peer-reviewed)abstract
- Vitamin D status, parathyroid hormone (PTH) level and their associations with blood pressure in Chinese population are unknown. This study examined these associations in older Chinese men. Blood pressure, serum 25-hydroxyvitamin D (25OHD) and PTH was measured in 939 community-dwelling Chinese men aged 65 years and older. Linear regression analyses were performed with adjustments for age, body mass index, education, season of measurement, medication use, self-reported history of stroke and Parkinson's disease, and other lifestyle factors. In either crude or adjusted models, serum 25OHD was not associated with blood pressure, whereas increasing PTH levels was associated with higher blood pressure. Men in the highest quartile of serum PTH level had a mean difference of 3.4mmHg and 2.8mmHg higher in as systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively, than men in the lowest quartile of serum PTH level (P(trend)=0.019 for SBP and <0.001 for DBP). In conclusion, the findings support an association between serum PTH and blood pressure, but not for serum 25OHD in older Chinese men whose vitamin D status is optimal. The lack of association between serum 25OHD and blood pressure may possibly because of the relatively high serum 25OHD levels of the study sample.
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| 10. |
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| 11. |
- Collen, Anna-Clara, 1970, et al.
(author)
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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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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 29:11, s. 702-704
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Journal article (peer-reviewed)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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| 12. |
- de Simone, G., et al.
(author)
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Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study
- 2007
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In: J Hum Hypertens. - : Springer Science and Business Media LLC. - 0950-9240. ; 21:8, s. 625-32
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Journal article (peer-reviewed)abstract
- The relation of metabolic syndrome (MetS) with cardiovascular outcome may be less evident when preclinical cardiovascular disease is present. We explored, in a post hoc analysis, whether MetS predicts cardiovascular events in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. MetS was defined by >or=2 risk factors plus hypertension: body mass index >or=30 kg/m(2), high-density lipoprotein (HDL)-cholesterol <1.0/1.3 mmol/l (<40/50 mg/dl) (men/women), glucose >or=6.1 mmol/l (>or=110 mg/dl) fasting or >or=7.8 mmol/l (>or=140 mg/dl) nonfasting or diabetes. Cardiovascular death and the primary composite end point (CEP) of cardiovascular death, stroke and myocardial infarction were examined. In MetS (1,591 (19.3%) of 8,243 eligible patients), low HDL-cholesterol (72%), obesity (77%) and impaired glucose (73%) were similarly prevalent, with higher blood pressure, serum creatinine and Cornell product, but lower Sokolow-Lyon voltage (all P<0.001). After adjusting for baseline covariates, hazard ratios for CEPs and cardiovascular death (4.8+/-1.1 years follow-up) were 1.47 (95% confidence interval (CI), 1.27-1.71)- and 1.73 (95% CI, 1.38-2.17)-fold higher with MetS (both P<0.0001), and were only marginally reduced when further adjusted for diabetes, obesity, low HDL-cholesterol, non-HDL-cholesterol, pulse pressure and in-treatment systolic blood pressure and heart rate. Thus, MetS is associated with increased cardiovascular events in hypertensive patients with ECG-LVH, independently of single cardiovascular risk factors.
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| 13. |
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| 14. |
- Engström, Gunnar, et al.
(author)
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Fatality of acute coronary events in relation to hypertension and low-grade inflammation: a population-based cohort study.
- 2006
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 20:2006 May 4, s. 581-586
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Journal article (peer-reviewed)abstract
- Hypertension has been associated with increased case-fatality rates among individuals who subsequently suffer from acute coronary events. It is unknown whether inflammation modifies this relationship. This population-based study explored the effects of inflammation and hypertension on incidence of coronary event, and on the fatality of the future events. Blood pressure (BP) and five inflammation-sensitive plasma proteins (ISPs, fibrinogen, orosomucoid, alpha 1-antitrypsin, haptoglobin and ceruloplasmin) were determined in 6071 healthy men. During the mean follow-up of 19 years, 679 men had a first coronary event (non-fatal myocardial infarction or death from coronary heart disease). Of them, 197 (29%) were fatal cases (death during the first day). As expected, hypertension was associated with increased incidence of coronary events and increased proportion of fatal cases. At all levels of BP, high ISPs (>= 2 ISPs in top quartile) significantly added to the incidence of events. Men with high ISPs had the highest case-fatality rates. The difference in case-fatality rate between men with and without high ISPs was, however, significant only in men with normal BP (<130/85 mm Hg) (33 vs 19%, P<0.05), and not in men with moderate or severe hypertension (>= 160/100 mm Hg) (40 vs 35%, P=0.32). High ISPs add to the incidence of coronary events at all levels of BP. Hypertension and inflammation are both independently associated with increased case-fatality in subjects who later have an acute coronary event. The influence of ISPs on the case-fatality rate seems to be most important in men with normal BP.
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| 15. |
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| 16. |
- Engström, Gunnar, et al.
(author)
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Plasma levels of complement C3 is associated with development of hypertension: a longitudinal cohort study.
- 2007
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 21, s. 276-282
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Journal article (peer-reviewed)abstract
- Hypertension has been associated with raised plasma levels of complement factor 3 and 4 (C3 and C4). The nature of this association is unclear. This population-based longitudinal study explored whether C3 or C4 is associated with development of hypertension. Blood pressure and plasma levels of C3 and C4 were determined in 2178 healthy men, aged 35-50 years, initially without treatment for hypertension. Incidence of hypertension and blood pressure increase over 15.7 (+/- 2.2) years follow-up was studied in relation to C3 and C4 at baseline. Among men with initially normal blood pressure (<160/95 mm Hg), incidence of hypertension (>= 160/95 mm Hg or treatment) was 32, 42, 37 and 47%, respectively, for men with C3 in the first, second, third and fourth quartile (trend: P = 0.001). This relationship remained significant after adjustment for confounding factors. Among men without blood pressure treatment, systolic BP increase (mean + standard error, adjusted for age, initial blood pressure and follow-up time) was 17.5 + 0.8, 19.6 + 0.9, 19.8 + 0.8 and 20.8 + 0.8 mm Hg, respectively, in the C3 quartiles (trend: P = 0.004). C3 was not associated diastolic blood pressure at follow-up. Although C4 was associated with blood pressure at the baseline examination, there was no relationship between C4 and development of hypertension or future blood pressure increase. It is concluded that C3 in plasma is associated with future blood pressure increase and development of hypertension.
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| 17. |
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| 18. |
- Franks, Paul
(author)
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Identifying genes for primary hypertension : methodological limitations and gene-environment interactions
- 2009
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 23:4, s. 227-237
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Journal article (peer-reviewed)abstract
- Hypertension segregates within families, indicating that genetic factors explain some of the variance in the risk of developing the disease; however, even with major advances in genotyping technologies facilitating the discovery of multiple genetic risk markers for cardiovascular and metabolic diseases, little progress has been made in defining the genetic defects that cause elevations in blood pressure. Several plausible explanations exist for this apparent paradox, one of which is that the risk conveyed by genes involved in the development of hypertension is context dependent. This notion is supported by a growing number of published animal and human studies, although none has yet provided unequivocal evidence that genetic and environmental factors interact to influence the risk of primary hypertension in humans. In this review, an assumption is made that common genetic variation contributes meaningfully to the development of primary hypertension. The review focuses on (i) several methodological limitations of genetic association studies and (ii) the roles that gene-environment interactions might play in the development of primary hypertension. The proceeding sections of the review examine the design features necessary for future studies to adequately test the hypothesis that genes for primary hypertension act in a context-dependent manner. Finally, an outline of how knowledge of gene-environment interactions might be used to optimize the prevention or treatment of primary hypertension is provided.Journal of Human Hypertension advance online publication, 13 November 2008; doi:10.1038/jhh.2008.134.
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| 19. |
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| 20. |
- Goharian, T S, et al.
(author)
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Examining the causal association of fasting glucose with blood pressure in healthy children and adolescents: a Mendelian randomization study employing common genetic variants of fasting glucose.
- 2015
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 29:3, s. 179-184
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Journal article (peer-reviewed)abstract
- The aim of the study was to determine whether genetically raised fasting glucose (FG) levels are associated with blood pressure (BP) in healthy children and adolescents. We used 11 common genetic variants of FG discovered in genome-wide association studies (GWAS), including the rs560887 single-nucleotide polymorphism (SNP) located in the G6PC2 locus found to be robustly associated with FG in children and adolescents, as an instrument to associate FG with resting BP in 1506 children and adolescents from the European Youth Heart Study (EYHS). Rs560887 was associated with increased FG levels corresponding to an increase of 0.08 mmol l(-1) (P=2.4 × 10(-8)). FG was associated with BP, independent of other important determinants of BP in conventional multivariable analysis (systolic BP z-score: 0.32 s.d. per increase in mmol l(-1) (95% confidence interval (CI) 0.20-0.44, P=1.9 × 10(-7)), diastolic BP z-score: 0.13 s.d. per increase in mmol l(-1) (95% CI 0.04-0.21, P=3.2 × 10(-3)). This association was not supported by the Mendelian randomization approach, neither from instrumenting FG from all 11 variants nor from the rs560887, where non-significant associations of glucose with BP were observed. The results of this study could not support a causal association between FG and BP in healthy children and adolescents; however, it is possible that rs560887 has pleiotropic effects on unknown factors with a BP lowering effect or that these results were due to a lack of statistical power.Journal of Human Hypertension advance online publication, 31 July 2014; doi:10.1038/jhh.2014.63.
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| 21. |
- Gottsäter, Mikael, et al.
(author)
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Predictive markers of abdominal aortic stiffness measured by echo-tracking in subjects with varying insulin sensitivity
- 2014
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In: Journal of Human Hypertension. - : Nature Publishing Group. - 0950-9240 .- 1476-5527. ; 28:7, s. 456-460
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Journal article (peer-reviewed)abstract
- Arterial stiffness is influenced by advancing age and vascular disease and is an independent risk factor for cardiovascular events and death. Using ultrasound measurements, arterial stiffness in a specific arterial segment can be assessed. The aim of this observational study was to explore the prospective and cross- sectional associations between arterial stiffness measured by ultrasound locally in the abdominal aorta and cardiovascular risk factors/markers including insulin resistance measured by the homeostatic model assessment- insulin resistance (HOMA- IR), lipids and abdominal obesity. This study includes 335 subjects from Malmo ", Sweden, examined in 1991- 1994 and again at follow- up in 1998- 2000 (mean age 64 years, 42% men). Ultrasound measurement of the abdominal aorta was performed at follow- up investigation. In the female subgroup, there was a positive association between HOMA-IR at baseline and abdominal aortic stiffness at follow-up (beta = 0.18, P 0.03) and a negative association between high-density lipoprotein and aortic stiffness (beta = 0.23, P 0.005), independently of classical cardiovascular risk factors. These associations were not found among men. The results suggest a greater or different role of impaired glucose metabolism in the pathophysiology of arterial stiffness in women than in men.
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| 22. |
- Guo, Qian Hui, et al.
(author)
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Difference in the risk profiles of carotid-femoral pulse wave velocity : results from two community-based studies in China and Sweden
- 2019
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527.
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Journal article (peer-reviewed)abstract
- Carotid-femoral pulse wave velocity (cfPWV) and its risk factors may differ between various populations. Few studies have compared the risk profiles associated with cfPWV in different ethnic populations. The study population included 4321 subjects from Shanghai, China (n = 1272, age 75.0 ± 6.5 years, female 57.3%) and Malmö, Sweden (n = 3049, age 72.5 ± 5.5 years, female 60.4%). cfPWV was measured using the SphygmoCor device in both cohorts, with some difference in the determination of pulse transmission distance. The median cfPWV was 8.9 and 10.1 m/s (P < 0.001) respectively in the Chinese and Swedish subjects. cfPWV was associated (P < 0.05) with age, body mass index (BMI), mean arterial pressure (MAP), heart rate, fasting plasma glucose and serum triglycerides in both populations. The standardized effect size (m/s) associated with age (0.091 vs. 0.048, P < 0.001) and fasting plasma glucose (0.025 vs. 0.012, P = 0.046) was greater in the Swedish than Chinese subjects, whereas those with BMI (0.046 vs. 0.008, P < 0.001), MAP (0.079 vs. 0.067, P = 0.016), and heart rate (0.057 vs. 0.046, P = 0.036) were greater in Chinese. No difference was observed in those associated with serum triglycerides (P = 0.128). cfPWV was additionally associated with sex, serum total cholesterol, and on antihypertensive medication in the Swedish subjects, and with serum uric acid in the Chinese subjects (P ≤ 0.041). In conclusion, Chinese and Swedish subjects shared similar major risk factors of arterial stiffness, but with some differences in the strength of associations.
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| 23. |
- Hallberg, Inger, 1956, et al.
(author)
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Supporting the self-management of hypertension: Patients’ experiences of using a mobile phone-based system
- 2016
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 30, s. 141-146
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Journal article (peer-reviewed)abstract
- Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients’ experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension.
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| 24. |
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| 25. |
- Hansen, T. W., et al.
(author)
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Ambulatory blood pressure monitoring for risk stratification in obese and non-obese subjects from 10 populations
- 2014
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 28:9, s. 535-542
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Journal article (peer-reviewed)abstract
- Overweight clusters with high blood pressure (BP), but the independent contribution of both risk factors remains insufficiently documented. In a prospective population study involving 8467 participants (mean age 54.6 years; 47.0% women) randomly recruited from 10 populations, we studied the contribution of body mass index (BMI) to risk over and beyond BP, taking advantage of the superiority of ambulatory over conventional BP. Over 10.6 years (median), 1271 participants (15.0%) died and 1092 (12.9%), 637 (7.5%) and 443 (5.2%) experienced a fatal or nonfatal cardiovascular, cardiac or cerebrovascular event. Adjusted for sex and age, low BMI (<20.7 kg m(-2)) predicted death (hazard ratio (HR) vs average risk, 1.52; P<0.0001) and high BMI (>= 30.9 kg m(-2)) predicted the cardiovascular end point (HR, 1.27; P = 0.006). With adjustments including 24-h systolic BP, these HRs were 1.50 (P <0.001) and 0.98 (P = 0.91), respectively. Across quartiles of the BMI distribution, 24-h and nighttime systolic BP predicted every end point (1.13 <= standardized HR <= 1.67; 0.046 <= P<0.0001). The interaction between systolic BP and BMI was nonsignificant (P >= 0.22). Excluding smokers removed the contribution of BMI categories to the prediction of mortality. In conclusion, BMI only adds to BP in risk stratification for mortality but not for cardiovascular outcomes. Smoking probably explains the association between increased mortality and low BMI.
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| 26. |
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| 27. |
- Hasvold, L. P., et al.
(author)
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Diabetes and CVD risk during angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment in hypertension : a study of 15 990 patients
- 2014
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 28:11, s. 663-669
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Journal article (peer-reviewed)abstract
- Differences in clinical effectiveness between angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in the primary treatment of hypertension are unknown. The aim of this retrospective cohort study was to assess the prevention of type 2 diabetes and cardiovascular disease (CVD) in patients treated with ARBs or ACEis. Patients initiated on enalapril or candesartan treatment in 71 Swedish primary care centers between 1999 and 2007 were included. Medical records data were extracted and linked with nationwide hospital discharge and cause of death registers. The 11 725 patients initiated on enalapril and 4265 on candesartan had similar baseline characteristics. During a mean follow-up of 1.84 years, 36 482 patient-years, the risk of new diabetes onset was lower in the candesartan group (hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69-0.96, P = 0.01) compared with the enalapril group. No difference between the groups was observed in CVD risk (HR 0.99, 95% CI 0.87-1.13, P = 0.86). More patients discontinued treatment in the enalapril group (38.1%) vs the candesartan group (27.2%). In a clinical setting, patients initiated on candesartan treatment had a lower risk of new-onset type 2 diabetes and lower rates of drug discontinuation compared with patients initiated on enalapril. No differences in CVD risk were observed.
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| 28. |
- Henriksson, M., et al.
(author)
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Health-care costs of losartan and candesartan in the primary treatment of hypertension
- 2011
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 25:2, s. 130-136
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Journal article (peer-reviewed)abstract
- A recent study of two widely used angiotensin receptor blockers reported a reduced risk of cardiovascular events (-14.4%) when using candesartan compared with losartan in the primary treatment of hypertension. In addition to clinical benefits, costs associated with treatment strategies must be considered when allocating scarce health-care resources. The aim of this study was to assess resource use and costs of losartan and candesartan in hypertensive patients. Resource use (drugs, outpatient contacts, hospitalizations and laboratory tests) associated with losartan and candesartan treatment was estimated in 14 100 patients in a real-life clinical setting. We electronically extracted patient data from primary care records and mandatory Swedish national registers for death and hospitalization. Patients treated with losartan had more outpatient contacts (+15.6%), laboratory tests (+13.8%) and hospitalizations (+13.8%) compared with the candesartan group. During a maximum observation time of 9 years, the mean total costs per patient were 10 369 Swedish kronor (95% confidence interval: 3109-17 629) higher in the losartan group. In conclusion, prescribing candesartan for the primary treatment of hypertension results in lower long-term health-care costs compared with losartan.
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| 29. |
- Holmqvist, Lina, et al.
(author)
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Exercise blood pressure and the risk of future hypertension
- 2012
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In: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 26, s. 691-695
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Journal article (peer-reviewed)abstract
- The aim of this prospective cohort study was to identify which blood pressure measurement during exercise is the best predictor of future hypertension. Further we aimed to create a risk chart to facilitate the evaluation of blood pressure reaction during exercise testing. A number (n=1047) of exercise tests by bicycle ergometry, performed in 1996 and 1997 were analysed. In 2007-2008, 606 patients without hypertension at the time of the exercise test were sent a questionnaire aimed to identify current hypertension. The response rate was 58% (n=352). During the 10-12 years between exercise test and questionnaire, 23% developed hypertension. The strongest predictors of future hypertension were systolic blood pressure (SBP) before exercise (odds ratios (OR) 1.63 (1.31-2.01) for 10 mm Hg difference) in combination with the increase of SBP over time during exercise testing (OR 1.12 (1.01-1.24) steeper increase for every 1 mm Hg min(-1)). A high SBP before exercise and a steep rise in SBP over time represented a higher risk of developing hypertension. A risk chart based on SBP before exercise, increase of SBP over time and body mass index was created. SBP before exercise, maximal SBP during exercise and SBP at 100 W were significant single predictors of future hypertension and the prediction by maximal SBP was improved by adjusting for time/power at which SBP max was reached during exercise testing. Recovery ratio (maximal SBP/SBP 4 min after exercise) was not predictive of future hypertension.
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| 30. |
- Huang, Liping, et al.
(author)
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The contribution of sodium reduction and potassium increase to the blood pressure lowering observed in the Salt Substitute and Stroke Study
- 2024
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In: Journal of Human Hypertension. - : Springer Nature. - 0950-9240 .- 1476-5527. ; 38:4, s. 298-306
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Journal article (peer-reviewed)abstract
- The Salt Substitute and Stroke Study (SSaSS) demonstrated significant reductions in systolic blood pressure (SBP), and the risk of stroke, major cardiovascular events and total mortality with the use of potassium-enriched salt. The contribution of sodium reduction versus potassium increase to these effects is unknown. We identified four different data sources describing the association between sodium reduction, potassium supplementation and change in SBP. We then fitted a series of models to estimate the SBP reductions expected for the differences in sodium and potassium intake in SSaSS, derived from 24-h urine collections. The proportions of the SBP reduction separately attributable to sodium reduction and potassium supplementation were calculated. The observed SBP reduction in SSaSS was -3.3 mmHg with a corresponding mean 15.2 mmol reduction in 24-h sodium excretion and a mean 20.6 mmol increase in 24-h potassium excretion. Assuming 90% of dietary sodium intake and 70% of dietary potassium intake were excreted through urine, the models projected falls in SBP of between -1.67 (95% confidence interval: -4.06 to +0.73) mmHg and -5.33 (95% confidence interval: -8.58 to -2.08) mmHg. The estimated proportional contribution of sodium reduction to the SBP fall ranged between 12 and 39% for the different models fitted. Sensitivity analyses assuming different proportional urinary excretion of dietary sodium and potassium intake showed similar results. In every model, the majority of the SBP lowering effect in SSaSS was estimated to be attributable to the increase in dietary potassium rather than the fall in dietary sodium.
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| 31. |
- Huang, Liping, et al.
(author)
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The impact of baseline potassium intake on the dose-response relation between sodium reduction and blood pressure change : systematic review and meta-analysis of randomized trials.
- 2021
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In: Journal of Human Hypertension. - : Springer Nature. - 0950-9240 .- 1476-5527. ; 35:11, s. 946-957
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Journal article (peer-reviewed)abstract
- Sodium and potassium appear to interact with each other in their effects on blood pressure with potassium supplementation having a greater blood pressure lowering-effect when sodium intake is high. Whether the effect of sodium reduction on blood pressure varies according to potassium intake levels is unclear. We carried out a systematic review and meta-analysis to examine the impact of baseline potassium intake on blood pressure response to sodium reduction in randomized trials in adult populations, with sodium and potassium intake estimated from 24-h urine samples. We included 68 studies involving 5708 participants and conducted univariable and multivariable meta-regression. The median intake of baseline potassium was 67.7 mmol (Interquartile range: 54.6-76.4 mmol), and the mean reduction in sodium intake was 128 mmol (95% CI: 107-148). Multivariable meta-regression that included baseline 24-h urinary potassium excretion, age, ethnicity, baseline blood pressure, change in 24-h urinary sodium excretion, as well as the interaction between baseline 24-h urinary potassium excretion and change in 24-h urinary sodium excretion did not identify a significant association of baseline potassium intake levels with the blood pressure reduction achieved with a 50 mmol lowering of sodium intake (p > 0.05 for both systolic and diastolic blood pressure). A higher starting level of blood pressure was consistently associated with a greater blood pressure reduction from reduced sodium consumption. However, the nonsignificant findings may subject to the limitations of the data available. Additional studies with more varied potassium intake levels would allow a more confident exclusion of an interaction.
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| 32. |
- Ingelsson, Erik, et al.
(author)
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Endothelium-dependent vasodilation in conduit and resistance vessels in relation to the endothelial nitric oxide synthase gene
- 2008
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 22:8, s. 569-578
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Journal article (peer-reviewed)abstract
- Single nucleotide polymorphisms (SNPs) in the endothelial nitric oxide synthase (NOS3) gene have been related to endothelium-dependent vasodilation in either conduit or resistance arteries with divergent results. In the Prospective Study of the Vasculature in Uppsala Seniors study, 959 participants aged 70 (51% men) were evaluated with brachial artery ultrasound to assess flow-mediated vasodilation (FMD; reflecting conduit arteries) and invasive forearm technique with intrabrachial infusion of acetylcholine (endothelium-dependent vasodilation (EDV); reflecting resistance arteries). The 23 SNPs analysed by minisequencing captured >90% of the common genetic variation in the NOS3 gene, using the HapMap population of European ancestry (CEU) as reference. One SNP (Glu298Asp) was related to FMD (nominal P=0.0018), but not to EDV (nominal P=0.76) after adjustment for sex, systolic blood pressure, diastolic blood pressure, pulse rate, antihypertensive treatment, total cholesterol, high-density cholesterol, lipid-lowering medication, fasting glucose, antidiabetic medication, body mass index, current smoking and prior diagnosis of cardiovascular disease. This relation was significant in both men and women in sex-specific analyses, and remained significant after adjusting for multiple testing (empirical P=0.029 from bootstrap resampling). None of the constructed haplotypes were related to vasodilation. The Glu298Asp SNP in the NOS3 gene was related to endothelium-dependent vasodilation in conduit, but not in resistance arteries. This SNP has previously been related to coronary heart disease, and our findings should stimulate to replication and exploration of the association of NOS3 variation with endothelial function in other settings.
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| 33. |
- Johannesson, Magnus, et al.
(author)
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How to assess the economics of hypertension control programmes
- 1996
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In: Journal of human hypertension. - : Nature Publishing. - 1476-5527 .- 0950-9240. ; 10:1, s. S93-S94
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Journal article (peer-reviewed)abstract
- In this paper we summarise the discussion in the session about how to assess the economics of hypertension control programmes. The paper is structured around the four main themes discussed in the session: the methods of economic evaluation, the estimation of costs in an economic evaluation, the estimation of effects in an economic evaluation, and the relationship between economic evaluation and policy-making.
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| 34. |
- Johannesson, Magnus
(author)
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The cost-effectiveness of hypertension treatment in Sweden: an analysis of the criteria for intervention and the choice of drug treatment
- 1996
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In: Journal of human hypertension. - : Springer Nature. - 1476-5527 .- 0950-9240. ; 10 Suppl 2:2, s. S23-S26
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Journal article (peer-reviewed)abstract
- Results of an analysis of the cost-effectiveness of hypertension treatment in Sweden are presented. The cost per life-year gained decreases with age for both men and women and is relatively low for middle-aged and older men and women even in the blood pressure range 90-94 mmHg. The results indicate that it is in general cost-effective to treat middle-aged and older men and women in Sweden with a diastolic blood pressure > or = 90 mmHg, but that it is questionable whether it is in general cost-effective to treat younger men and women with mild hypertension. It is furthermore shown that ACE-inhibitors and calcium-antagonists may be cost-effective in some patient groups at a high risk of coronary heart disease, if they achieve the epidemiologically expected risk reduction for coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials ACE-inhibitors and calcium-antagonists cannot, however, at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated.
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| 35. |
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| 36. |
- Järhult, Susann J., et al.
(author)
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Brachial artery hyperaemic blood flow velocity and left ventricular geometry
- 2012
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 26:4, s. 242-246
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Journal article (peer-reviewed)abstract
- Cardiovascular risk factors and carotid atherosclerosis relate to blood flow velocity in the brachial artery during induced hyperaemia. This relation proved to be particularly strong when using the hyperaemic systolic to diastolic blood flow velocity (SDFV) ratio. In this study, we further investigated this ratio in relation to the left ventricular (LV) geometry in a cross-sectional analysis. In the Prospective Investigation of the Vasculature in Uppsala Seniors study, 1016 seventy-year-olds participated. Blood flow velocity during hyperaemia of the brachial artery by Doppler was analysed. Echocardiography was performed, allowing analysis of LV geometry, categorised into four different groups: normal, concentric remodelling, concentric and eccentric hypertrophy. The SDFV ratio increased in subjects with concentric LV-remodelling (P 0.006) or LV-hypertrophy (P=0.001), but not in those with eccentric hypertrophy (P=0.12) when compared with the group with normal LV geometry. These associations remained significant after adjustment for gender, blood pressure, blood glucose, body mass index and antihypertensive treatment. The SDFV ratio in the brachial artery was related to concentric geometry of the LV in an elderly population sample, suggesting this new hemodynamic variable as a marker of increased afterload. Future studies have to determine if the SDFV ratio is a powerful predictor of future CV events, in addition to LV geometry.
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| 37. |
- Järhult, Susann J., 1971-, et al.
(author)
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Brachial artery hyperemic blood flow velocity and left ventricular geometry
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In: Journal of Human Hypertension. - 0950-9240 .- 1476-5527.
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Journal article (other academic/artistic)abstract
- ABSTRACT OBJECTIVE Cardiovascular risk factors and carotid atherosclerosis relates to blood flow velocity in the brachial artery during induced hyperemia. This relation proved to be particularly strong when using the hyperemic systolic to diastolic blood flow velocity (SDFV) ratio. In this study, we further investigated this ratios value as a marker of vascular risk in relation to left ventricular (LV) geometry. MATERIAL AND METHODS In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, 1016 70-year-olds participated. Blood flow velocity during hyperemia of the brachial artery by Doppler was analysed. Echocardiography was performed, allowing analysis of LV geometry, categorised into four different groups: normal, concentric remodeling, concentric- and eccentric- hypertrophy. RESULTS The SDFV ratio was increased in subjects with concentric LV -remodeling (p=0.006) or -hypertrophy (p=0.001), but not in those with eccentric hypertrophy (p=0.12) when compared to the group with normal LV geometry. These associations remained significant after adjustment for gender, blood pressure, blood glucose, body mass index and antihypertensive treatment. CONCLUSION The hyperemic systolic to diastolic blood flow velocity ratio in the brachial artery was related to concentric geometry of the LV in an elderly population sample, suggesting this new hemodynamic variable as a marker of increased afterload.
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| 38. |
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| 39. |
- Kahan, T, et al.
(author)
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The effects of cardiac events on quality of life and indirect costs
- 2001
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In: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 15:1, s. S91-S93
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Journal article (peer-reviewed)abstract
- The ASCOT trial is designed to provide important information for treatment of patients with hypertension and hypercholesterolaemia. The economic consequences of alternative therapies, as studied in ASCOT, may be significant, and information about these consequences is important for development of treatment guidelines and for prescription decisions. Therefore a cost-effectiveness analysis based on data from ASCOT is planned. The rationale for and design of this study is described in another paper in this volume.1 This sub-study provides information for an extension of this cost-effectiveness study to include indirect costs and to adjust life years gained for quality of life (utility). Thus cost-effectiveness can be calculated both with and without indirect costs and both as cost per life year gained and cost per quality-adjusted life year (QALY) gained.2 This makes it possible to compare the results with similar studies of the cost-effectiveness of treatment of hypertension and hypercholesterolaemia.
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| 40. |
- Karlsson, Andreas, 1973-
(author)
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A comparison of blood pressure indices as predictors of all-cause mortality among middle-aged men and women during 701,707 person-years of follow-up
- 2018
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In: Journal of Human Hypertension. - : NATURE PUBLISHING GROUP. - 0950-9240 .- 1476-5527. ; 32:10, s. 660-667
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Journal article (peer-reviewed)abstract
- High systolic blood pressure (SBP) is often used as a measure of hypertension in epidemiological studies. Alternative blood pressure (BP) indices include diastolic blood pressure (DBP), pulse pressure (PP), mid-blood pressure (MBP) and mean arterial pressure (MAP). The present study compares the predictive ability for all-cause mortality (ACM) of these indices and the novel BP index mean proportional arterial pressure (MPAP), defined as the weighted mean of SBP and DBP where the weights are proportional to SBP's and DBP's contributions to the sum of SBP and DBP. Using a Swedish cohort of 32,238 middle-aged men and women, not being on antihypertensive treatment, examined in 1989-2000 and followed-up until March 9, 2017, the predictive abilities for ACM of SBP, DBP, PP, MBP, MAP and MPAP were compared using a likelihood-based R 2 -type measure for adjusted and unadjusted Cox regression models. Of the included participants (mean age 45.4 years, 48.2% men), 2936 (9.1%) died during a mean follow-up time of 21.8 years, equalling 701,707 person-years at risk. Higher BP were for all indices significantly associated with increased ACM. For all models, those including MPAP had the highest predictive ability, followed in turn by models including MBP, SBP, MAP, DBP and PP, respectively. The difference was significant for SBP, DBP and PP in unadjusted models and for PP in fully adjusted models. In conclusion, MPAP and MBP are the best predictors of ACM. Until the clinical usefulness of these indices has been evaluated, they may primarily be useful for epidemiological studies.
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| 41. |
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| 42. |
- Kjeldsen, S. E., et al.
(author)
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Effects of losartan vs candesartan in reducing cardiovascular events in the primary treatment of hypertension
- 2010
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 24:4, s. 263-273
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Journal article (peer-reviewed)abstract
- Although angiotensin receptor blockers have different receptor binding properties no comparative studies with cardiovascular disease (CVD) end points have been performed within this class of drugs. The aim of this study was to test the hypothesis that there are blood pressure independent CVD-risk differences between losartan and candesartan treatment in patients with hypertension without known CVD. Seventy-two primary care centres in Sweden were screened for patients who had been prescribed losartan or candesartan between the years 1999 and 2007. Among the 24 943 eligible patients, 14 100 patients were diagnosed with hypertension and prescribed losartan (n = 6771) or candesartan (n = 7329). Patients were linked to Swedish national hospitalizations and death cause register. There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up. Compared with the losartan group, the candesartan group had a lower adjusted hazard ratio for total CVD (0.86, 95% confidence interval (CI) 0.77-0.96, P = 0.0062), heart failure (0.64, 95% CI 0.50-0.82, P = 0.0004), cardiac arrhythmias (0.80, 95% CI 0.65-0.92, P = 0.0330), and peripheral artery disease (0.61, 95% CI 0.41-0.91, P = 0.0140). No difference in blood pressure reduction was observed suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.
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| 43. |
- Kontos, J., et al.
(author)
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Impact of valvular regurgitation on left ventricular geometry and function in hypertensive patients with left ventricular hypertrophy: the LIFE study
- 2004
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In: J Hum Hypertens. - : Springer Science and Business Media LLC. - 0950-9240. ; 18:6, s. 431-6
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Journal article (peer-reviewed)abstract
- Mild-to-moderate aortic and mitral regurgitation are frequently detected by echocardiogram in asymptomatic hypertensive patients. Our goal was to assess the prevalence and impact of mild-to-moderate mitral and/or aortic regurgitation on left ventricular (LV) structure and function in patients with hypertension and LV hypertrophy (LVH). Hypertensive patients with ECG LVH enrolled in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiography substudy were evaluated. Among 939 patients with needed LV measurements and Doppler data, 242 had mild (1+) valvular regurgitation, and 51 patients had moderate (2+ or 3+) regurgitation of one or both valves. In analyses adjusting for gender, patients with mild mitral and/or aortic regurgitation had larger LV internal dimensions (5.25 vs 5.33 cm, P<0.05), higher LV mass indexed for body surface area (122 vs 125 g/m(2), P<0.05) or height(2.7) (55.4 vs 57.3, P<0.05), and larger left atrial diameter. Patients with moderate regurgitation of one or both valves had larger LV chambers (5.25 vs 5.9 cm, P<0.001), greater mean LV mass (232 vs 248 g, P<0.001) and LV mass indexed for body surface area or height(2.7), and higher Doppler stroke volume. Patients with moderate valvular regurgitation also had a higher prevalence of LVH due to an increased prevalence of eccentric LVH. There were no differences among groups defined by the presence and severity of valvular regurgitation in cardiac output, total peripheral resistance, or pulse pressure/stroke volume, indicating that the observed inter-group differences in LV geometry were not due to differences in the haemodynamic severity of hypertension. Hypertensive patients with mild-to-moderate mitral or aortic valvular insufficiency have additional LV structural and functional changes that may affect prognosis.
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| 44. |
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| 45. |
- Kozakova, Michaela, et al.
(author)
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Gamma-glutamyltransferase, arterial remodeling and prehypertension in a healthy population at low cardiometabolic risk
- 2020
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In: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240.
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Journal article (peer-reviewed)abstract
- Plasma gamma-glutamyltransferase (GGT) was suggested to reflect the level of systemic oxidative stress. Oxidative stress induces changes in arterial structure and function and contributes to the development of hypertension. Therefore, GGT may be associated with arterial remodeling and blood pressure (BP) increment, even in absence of disease. To test this hypothesis, we evaluated, in 825 healthy subjects at low cardiometabolic risk, the associations of plasma GGT with carotid artery intima-media thickness (IMT), luminal diameter and prehypertension; in 154 subjects was evaluated also the association with aortic stiffness (cfPWV). Associations were controlled for insulin sensitivity, C-reactive protein, and life-style habits. In the main population, BP was remeasured after 3 years. Carotid diameter and cfPWV, but not IMT, were directly and independently related to plasma GGT. Subjects with prehypertension (N = 330) had higher GGT as compared with subjects with normal BP (22 [14] vs 17 [11] IU/L; adjusted P = 0.001), and within prehypertensive subjects, those who developed hypertension during 3 years had higher GGT than those without incident hypertension (27 [16] vs 21 [14] IU/L; adjusted P < 0.05). Within subjects with arterial stiffness measurement, those with prehypertension (N = 79) had higher both GGT and arterial stiffness (25 [14] vs 16 [20] IU/L and 9.11 ± 1.24 vs 7.90 ± 0.94 m/s; adjusted P < 0.01 and <0.05). In the view of previous evidence linking plasma GGT concentration to the level of systemic oxidative stress, our findings suggest a role of oxidative stress in subclinical arterial damage and in prehypertension, even in healthy subjects free of cardiometabolic risk. Arterial organ damage may represent the link between GGT and hypertension.
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| 46. |
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| 47. |
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| 48. |
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| 49. |
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| 50. |
- Lind, Lars, et al.
(author)
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Is insulin resistance a predictor of the blood pressure response to anti-hypertensive treatment?
- 1995
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In: Journal of Human Hypertension. - 0950-9240 .- 1476-5527. ; 9:9, s. 759-763
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Journal article (peer-reviewed)abstract
- It is a general impression that the blood pressure (BP) response during monotherapy in hypertensive subjects is highly variable. As decreased insulin sensitivity is a frequent finding in hypertensive patients, the following study was performed to evaluate if the degree of insulin sensitivity could predict the BP response to different types of anti-hypertensive treatments. Insulin sensitivity was evaluated by the hyperinsulinaemic euglycaemic clamp technique before initiation of treatment with beta-adrenergic blockers (n = 181), thiazide diuretics (n = 60), ACE inhibitors (n = 73), non-dihydropyridine calcium antagonists (n = 38), dihydropyridine calcium antagonists (n = 26) or alpha-1 antagonists (n = 39) over periods of 3-6 months in hypertensive patients. The proportion of poor responders, defined as a reduction in the diastolic blood pressure (DBP) of < 3 mm Hg ranged between 8% and 30% in the different groups despite similar pretreatment DBPs (100-102 mm Hg). A decreased pretreatment insulin sensitivity was related to a poor DBP treatment response in the thiazide-treated group only (r = -0.33, P < 0.05). In this group also obesity, as evaluated by body mass index (BMI), was associated with a poor BP response (r = 0.28, P < 0.05), while obesity was a predictor of a favourable reduction in DBP in the group treated with non-dihydropyridine calcium antagonists (r = -0.34, P < 0.05). These associations were still significant when pretreatment DBP was taken into account in multiple regression analysis. Neither age nor sex were found to be significant predictors of BP response in any of the treatment groups.(
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