Showing papers by "Sverre E. Kjeldsen published in 2010"
University of Glasgow1, Lund University2, Queen Mary University of London3, University of Milano-Bicocca4, Health Science University5, University Medical Center Groningen6, University Hospital of Lausanne7, University of Gothenburg8, University of Oslo9, University of Verona10, University of Dundee11, University of Cambridge12, University of Leicester13, Wellcome Trust Centre for Human Genetics14, Pontifical Catholic University of Chile15, Ludwig Maximilian University of Munich16, University of Tartu17, St George's, University of London18, National Institutes of Health19, University College Dublin20, Royal College of Surgeons in Ireland21, University of Greifswald22, Broad Institute23, Harvard University24, King's College London25, Wellcome Trust Sanger Institute26, University of Washington27, Leiden University Medical Center28, VU University Medical Center29, University of Milan30
TL;DR: The newly discovered UMOD locus for hypertension has the potential to give new insights into the role of uromodulin in BP regulation and to identify novel drugable targets for reducing cardiovascular risk.
Abstract: Hypertension is a heritable and major contributor to the global burden of disease. The sum of rare and common genetic variants robustly identified so far explain only 1%-2% of the population variation in BP and hypertension. This suggests the existence of more undiscovered common variants. We conducted a genome-wide association study in 1,621 hypertensive cases and 1,699 controls and follow-up validation analyses in 19,845 cases and 16,541 controls using an extreme case-control design. We identified a locus on chromosome 16 in the 59 region of Uromodulin (UMOD; rs13333226, combined P value of 3.6x10(-11)). The minor G allele is associated with a lower risk of hypertension (OR [95% CI]: 0.87 [0.84-0.91]), reduced urinary uromodulin excretion, better renal function; and each copy of the G allele is associated with a 7.7% reduction in risk of CVD events after adjusting for age, sex, BMI, and smoking status (H.R. = 0.923, 95% CI 0.860-0.991; p = 0.027). In a subset of 13,446 individuals with estimated glomerular filtration rate (eGFR) measurements, we show that rs13333226 is independently associated with hypertension (unadjusted for eGFR: 0.89 [0.83-0.96], p = 0.004; after eGFR adjustment: 0.89 [0.83-0.96], p = 0.003). In clinical functional studies, we also consistently show the minor G allele is associated with lower urinary uromodulin excretion. The exclusive expression of uromodulin in the thick portion of the ascending limb of Henle suggests a putative role of this variant in hypertension through an effect on sodium homeostasis. The newly discovered UMOD locus for hypertension has the potential to give new insights into the role of uromodulin in BP regulation and to identify novel drugable targets for reducing cardiovascular risk.
378 citations
TL;DR: This analysis supports the concept of RAS inhibition as an emerging treatment for the primary and secondary prevention of AF but acknowledges the fact that some of the primary prevention trials were post-hoc analyses.
371 citations
TL;DR: In patients with Diabetes and hypertension, combining a renin-angiotensin system blocker with amlodipine, compared with hydrochlorothiazide, was superior in reducing cardiovascular events and could influence future management of hypertension in patients with diabetes.
190 citations
TL;DR: The value of serial assessment of HR for improved risk stratification in hypertensive patients with ECG left ventricular hypertrophy is supported, independent of treatment modality, blood pressure lowering, regression of ECG LVH and changing QRS duration.
Abstract: Background Although higher heart rate (HR) at baseline has been associated with an increased risk of cardiovascular (CV) and all-cause mortality, the relationship of in-treatment HR over time to mortality in hypertensive patients with ECG left ventricular hypertrophy (LVH) has not been examined.
Methods and results Heart rate was evaluated over time in 9190 hypertensive patients treated with losartan- or atenolol-based regimens and followed with annual ECGs. During a mean follow-up of 4.8 ± 0.9 years, 814 patients (8.9%) died, 438 (4.8%) from CV causes. In univariate Cox analyses, every 10 bpm higher HR on in-treatment ECGs was associated with a 25% increased risk of CV death [95% confidence interval (CI): 14–32%] and a 27% greater risk of all-cause mortality (95% CI: 21–34%). In an alternative analysis, persistence or development of a HR ≥84 bpm (upper quintile of baseline HR) was associated with an 89% greater risk of CV death (95% CI: 49–141%) and a 97% increased risk of all-cause mortality (95% CI: 65–135%). After adjusting for treatment with losartan vs. atenolol, baseline risk factors for death, baseline HR, baseline and in-treatment systolic and diastolic pressure, incident myocardial infarction, and the known predictive value of baseline and in-treatment QRS duration and ECG LVH, higher in-treatment HR in time-varying multivariable Cox models remained strongly predictive of mortality: every 10 bpm higher HR was associated with a 16% increased adjusted risk of CV mortality (95% CI: 6–27%) and a 25% greater risk of all-cause mortality (95% CI: 17–33%), with persistence or development of a HR ≥84 associated with a 55% greater risk of CV death (95% CI: 16–105%) and a 79% greater adjusted risk of all-cause mortality (95% CI: 46–121%).
Conclusion Higher in-treatment HR on serial ECGs predicts greater likelihood of subsequent CV or all-cause mortality, independent of treatment modality, blood pressure lowering, regression of ECG LVH and changing QRS duration in hypertensive patients with ECG LVH. These findings support the value of serial assessment of HR for improved risk stratification in hypertensive patients.
Clinical trials registration: [http://clinicaltrials.gov/ct/show/[NCT00338260][2]?order=1cp][2].
[]: http://clinicaltrials.gov/ct/show/NCT00338260?order=1cp
88 citations
TL;DR: The study suggests that CV and sympathoadrenal reactivity, specifically to mental stress, are relatively stable individual characteristics, which support one of the necessary preconditions to consider hyperreactivity involved in the development of hypertension and CV disease.
Abstract: Cardiovascular (CV) hyperreactivity to stress must be reasonably stable if it is considered to be important in the development of hypertension and CV disease. The aim of the present study was to assess long-term stability of blood pressure, heart rate, epinephrine, and norepinephrine responses to a cold pressor test and a mental arithmetic stress test. Eighty-one subjects selected from the first (n=30), 50th (n=30), and 95th to 99th (n=39) percentiles of the mean blood pressure distribution at a military draft procedure were tested on 2 occasions 18 years apart. Stress responses were measured during a cold pressor test (hand immersed in ice water for 1 minute) and during a mental stress test (subtraction for 5 minutes). Intra-arterial blood pressure measurements and arterial catecholamine samples were taken at the initial examination. At follow-up, noninvasive Finapres beat-to-beat blood pressure measurements and venous plasma catecholamine samples were used. The 18-year correlations of the CV and epinephrine absolute responses during mental stress ranged from 0.6 to 0.8. The entry/follow-up correlation of systolic blood pressure during the mental stress test (95% CI: 0.69 to 0.86) was significantly higher than during the cold pressor test (95% CI: 0.30 to 0.65), and responses to mental stress overall appeared to be more stable than responses to the cold pressor test. Our study suggests that CV and sympathoadrenal reactivity, specifically to mental stress, are relatively stable individual characteristics. These results support one of the necessary preconditions to consider hyperreactivity involved in the development of hypertension and CV disease.
83 citations
TL;DR: There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.
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.
59 citations
TL;DR: The data suggest that all four imaging modalities measured EF closely similar after STEMI as demonstrated by a very small bias, and EDV measured by MRI was consistently higher when compared with the other methods which may be caused by different tracing-methods and imaging principles.
Abstract: Aims Magnetic resonance imaging (MRI) is often considered to be the gold standard in measuring left ventricular function and volumes. The aim of this study was to assess the agreements between standard echocardiography (standard echo), contrast echocardiography (contrast echo), single-photon emission computed tomography (SPECT), and MRI in the determination of left ventricular ejection fraction (EF) and end-diastolic volumes (EDV) in patients treated for acute ST-elevation myocardial infarction (STEMI).
Methods and results Standard echo, contrast echo, SPECT and MRI were performed on the same day, 3 months after STEMI in 150 patients participating in the NORwegian Study on District Treatment of ST-Elevation Myocardial Infarction (NORDISTEMI). Bland–Altman analysis of EF measured by all four imaging modalities showed generally low mean differences but wide limits of agreement. The mean EDV difference, however, was consistently higher when MRI was compared with standard echo (54.9 mL), contrast echo (41.7 mL) and SPECT (54.6 mL), and the limits of agreement were wider. The mean EDV differences between contrast echo vs. standard echo, SPECT vs. standard echo and contrast echo vs. SPECT were small.
Conclusion Our data suggest that all four imaging modalities measured EF closely similar after STEMI as demonstrated by a very small bias. The limits of agreement were however wide. EDV measured by MRI was consistently higher when compared with the other methods which may be caused by different tracing-methods and imaging principles. As echocardiography is preferable from a cost-benefit point of view, further analysis would be needed to clarify the nature of such differences.
44 citations
TL;DR: The analysis suggests that SUA is an independent risk marker for NOD in hypertensive patients with LVH.
33 citations
TL;DR: A review of the evidence for a relationship between heart rate and cardiovascular mortality and morbidity and hypertension discusses the measurement of heart rate for risk stratification.
Abstract: Five decades ago, hypertension was a debated risk factor for the development of cardiovascular disease. After further studies and the introduction of antihypertensive medications, few, if any, have doubted the important role hypertension plays as a cardiovascular risk factor. Today, a growing body of evidence emphasizes the relationship between heart rate and hypertension, and heart rate and cardiovascular disease, which makes the measurement of heart rate an important component of the cardiovascular risk assessment. Current European guidelines for managing arterial hypertension recommend the measurement of heart rate for risk stratification, but there still are no recommendations for treatment. This review discusses the evidence for a relationship between heart rate and cardiovascular mortality and morbidity and hypertension.
23 citations
20 citations
TL;DR: The diversity in the development of hypertensive organ damage, with changes in retinal microvasculature preceding other signs of damage, should encourage more liberal use of fundus photography in assessing cardiovascular risk in hypertensive individuals.
Abstract: Screening for hypertensive organ damage is important in assessing cardiovascular risk in hypertensive individuals. In a 20-year follow-up of normotensive and hypertensive men, signs of end-organ damage were examined, focusing on hypertensive retinopathy. In all, 56 of the original 79 men were reexamined for hypertensive organ damage, including by digital fundus photography. The diameters of the central retinal artery equivalent (CRAE) and vein were estimated and the artery-to-vein diameter ratio calculated. Components of metabolic syndrome were assessed. Fifty percent of the normotensive men developed hypertension during follow-up. Significant differences appeared in CRAE between the different blood pressure groups (P=0.025) while no differences were observed for other markers of hypertensive organ damage. There were significant relationships between CRAE and blood pressure at baseline (r=-0.466, P=0.001) and at follow-up (r=-0.508, P<0.001). A linear decrease in CRAE was observed with increasing number of components of the metabolic syndrome (beta=-3.947, R(2)=0.105, P=0.023). Retinal vascular diameters were closely linked to blood pressures and risk factors of the metabolic syndrome. The diversity in the development of hypertensive organ damage, with changes in retinal microvasculature preceding other signs of damage, should encourage more liberal use of fundus photography in assessing cardiovascular risk in hypertensive individuals.
TL;DR: The results of this meta-analysis cannot change the indications for the treatment of ARBs for cardiovascular disease; however, Sipahi and colleagues’ fi ndings need further investigation to clarify the concerns raised.
Abstract: 820 www.thelancet.com/oncology Vol 11 September 2010 years, how could ARBs induce development of a cancer after 2–4 years of treatment? Finally, since ARBs are antagonists of the angiotensin II type-1 receptor—with much greater affi nity for the type-1 receptor (involved in cell-growth promotion) than for the type-2 receptor (antiproliferative eff ect)—how can the higher incidence of cancer in patients treated with ARBs be explained? In Sipahi and co-workers’ study, telmisartan was the study drug in nearly 85% of patients who received ARBs. However, the occurrence of malignancies was similar in ONTARGET for the telmisartan and ramipril groups, and in TRANSCEND there were slightly more malignancies reported in the telmisartan group than in the placebo group, whereas in PRoFESS, there were slightly more malignancies reported in the placebo group than in the telmisartan group. However, angiotensin II type-1 receptor antagonists, particularly telmisartan, have been studied extensively, and no mutagenic or carcinogenic eff ects have been noted in preclinical studies. In conclusion, the results of this meta-analysis cannot change the indications for the treatment of ARBs for cardiovascular disease; however, Sipahi and colleagues’ fi ndings need further investigation to clarify the concerns raised.
TL;DR: HCTZ use was associated with greater regression of ECG LVH and this effect was greater in patients on losartan- than atenolol-based therapy, independent of baseline severity of ECGs and hypertension and changes in BP.
TL;DR: In this group of STEMI patients treated with thrombolysis, no difference in left ventricular function after 3 months was found between patients treating with early versus late invasive strategy.
University of Milan1, University of Paris2, University of Brescia3, University of Bologna4, University of Lausanne5, Queen Mary University of London6, Ghent University7, University of Barcelona8, University of Glasgow9, Istanbul University10, Hannover Medical School11, University of Manchester12, Rikshospitalet–Radiumhospitalet13, Joseph Fourier University14, Gdańsk Medical University15, Lund University16, University of Copenhagen17, University of Münster18, University of Valencia19, Complutense University of Madrid20, University of Erlangen-Nuremberg21, Maastricht University22, University of Amsterdam23
TL;DR: In this article, Mancia et al. proposed a new approach to solve the problem of korespondencji in Włochy, which is based on the concept of "deletion".
Abstract: Adresy do korespondencji: Professor Giuseppe Mancia, Clinica Medica, University of Milan-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20052 Monza, Milan, Włochy tel.: +39 039 2333357; faks: +39 039 322274; e-mail: giuseppe.mancia@unimib.it Professor Stéphane Laurent, Department of Pharmacology and INSERM U970, European Hospital Georges Pompidou, Paris Descartes University, 20 rue Leblanc, 75015 Paris, Francja tel.: +33 1 56 09 39 91; faks: +33 1 56 09 39 92; e-mail: stephane.laurent@egp.ap-hop.-paris.fr
TL;DR: Blood pressure reductions with this combination are greater than those achieved with either drug alone, and in comparative studies telmisartan/HCTZ is more effective than other ARB/ HCTZ combinations.
Abstract: Background:Control of elevated blood pressure has been shown to reduce the risk of cardiovascular events. The angiotensin II receptor blocker (ARB), telmisartan, has been shown to provide effective 24-hour blood pressure control. Additional antihypertensive efficacy can be achieved by combining telmisartan with the thiazide diuretic hydrochlorothiazide (HCTZ).Objective:To review the clinical data in combination therapy with telmisartan and HCTZ.Methods:Search of Medline and Embase for published clinical studies using the keywords telmisartan and HCTZ.Findings:The telmisartan/HCTZ combination provides significant reductions in blood pressure, effective 24-hour blood pressure control and is well-tolerated. Blood pressure reductions with this combination are greater than those achieved with either drug alone, and in comparative studies telmisartan/HCTZ is more effective than other ARB/HCTZ combinations. However, it should be noted that some of the combinations assessed used doses of the drugs that we...
TL;DR: Development of urbanized, modern and industrialized societies has generally but not uniformly been associated with increasing blood pressure (BP) and an increased prevalence of hypertension (1–4).
Abstract: Development of urbanized, modern and industrialized societies has generally but not uniformly been associated with increasing blood pressure (BP) and an increased prevalence of hypertension (1–4). ...
TL;DR: During follow-up of hypertensive patients with LVH, occurrence of MI but not coronary revascularization as first cardiovascular event significantly increased risk of subsequent cardiovascular death, all-cause death, and stroke.
Abstract: Objective: Construction of prognostically relevant endpoints for clinical trials in hypertension has increasingly included coronary revascularization with myocardial infarction (MI) as manifestatio ...
TL;DR: Focus on prevention of atrial fibrillation development with optimal antihypertensive treatment with aggressive treatment of hypertension may reduce morbidity, mortality and health care expenditures.
Abstract: Atrial fibrillation is the most common clinically significant cardiac arrhythmia and is associated with markedly increased risks of cardiovascular diseases. Atrial fibrillation and hypertension often coexist and are both responsible for considerable morbidity and mortality. Aggressive treatment of hypertension, especially with a blocker of the reninangiotensin system, may postpone or prevent development of atrial fibrillation and reduce thromboembolic complications. Awareness of the risk of developing atrial fibrillation in hypertensives may be of great importance and focus on prevention of atrial fibrillation development with optimal antihypertensive treatment may reduce morbidity, mortality and health care expenditures.
TL;DR: Agreement within Europe abo ut antihypertensive treatment and education – results from the European Society of Hypertension questionnaire.
Abstract: Agreement within Europe abo ut antihypertensive treatment and education – results from the European Society of Hypertension questionnaire Michael H. Olsen, Jean-Michel Mallion, Karl-Heinz Rahn, Serap Erdine, Margus Viigimaa, Stéphane Laurent, Enrico Agabiti-Rosei, Giuseppe Mancia, Roland E. Schmieder, Renata Cifkova, Anna Dominiczak, Sverre E. Kjeldsen, Josep Redon, Alberto Zanchetti, Peter Nilsson, Krzysztof Narkiewicz, on behalf of the ESH Council
TL;DR: Evidence from randomized controlled trials of antihypertensive treatment and of secondary stroke prevention support the thesis that, independent of mean systolic BP, treatments that effect the greatest reduction in BP variability are associated with the greatest reductions in risk.
Abstract: of future research. Commentary by Dr. Tony Heagerty critically reviewed the implications and limitations of BP variability assessment for future guidelines and clinical practice and outlined recommendations for future research. Dr. Rothwell drew on his experience in the Stroke Prevention Research Unit at Oxford to emphasize the striking relationship between BP variability and stroke. He showed that within individual visit-to-visit variability in systolic BP (SBP) is increased in cohorts at high risk of stroke, i.e., those with established cerebrovascular disease, or previous transient ischemic attack (TIA) or stroke, is reproducible within individuals over time, and is a powerful predictor of stroke independently of mean SBP (3,10–15). Evidence from randomized controlled trials of antihypertensive treatment and of secondary stroke prevention, including the Anglo-Scandinavian Cardiac Outcomes Trial Blood Pressure Lowering Arm (ASCOT-BPLA) (16), the Medical Research Council (MRC) trial of the treatment of hypertension in older adults (17 ) and the UK-TIA trial (18 ) support the thesis that, independent of mean systolic BP, treatments that effect the greatest reduction in BP variability are associated with the greatest reductions in risk. ASCOT-BPLA reported that a calcium channel blocker (CCB, amlodipine) based regimen was more effective in preventing stroke and coronary events than expected, based on change in mean BP, and more effective compared to a beta blocker (BB, atenolol) based regimen; and that this differential effect was independent of changes in other measured vascular risk factors during follow-up (16,19). Within individual visit-to-visit variability in clinic SBP, diastolic BP (DBP) and pulse pressure (PP) were expressed as the standard deviation (SD) and coeffi cient of variation Blood Pressure. 2010; 19: 209–211
TL;DR: A fundamental shortcoming is pointed out in a recently published metaanalysis of cancer rates in patients treated with angiotensin receptor blockers (ARBs) that made a claim, supported by an uncritical editorial in the same issue of the Journal, of a possible link between ARB use and cancer.
Abstract: As editors of Blood Pressure , a hypertension research journal, we feel strongly obligated to point out a fundamental shortcoming in a recently published metaanalysis of cancer rates in patients treated with angiotensin receptor blockers (ARBs). The online publication of the June 14 issue of Lancet Oncology contains a paper by Sipahi et al. entitled “ Angiotensin receptor blockade (ARB) and risk of cancer; meta-analysis of randomized controlled trials ” (1). A major conclusion of the report is based on Figure 4B, labeled “ Cancer in patients without a background of treatment with angiotensin converting enzyme inhibitors ” , which contains these data on cases of incident cancer as a proportion of total patient numbers: ARB, n 1360/16,497 and control, n 1262/16,527, representing a difference between the two groups of 98 patients with cancer. Relying on this narrow difference, the authors made a claim, supported by an uncritical editorial (2) in the same issue of the Journal, of a possible link between ARB use and cancer. The VALUE Trial (3), which compared outcomes with an ARB and a calcium-channel blocker in hypertensive patients at high cardiovascular risk, is quoted by the report of Sipahi et al. (1), but it is erroneously stated that VALUE did not collect cancer information and therefore was not included in the meta-analysis. In reality, cancer data were collected and included in VALUE ’ s formal database, completed in March 2004. Every case of cancer was described with a specifi c diagnosis. In VALUE, there were a total of 510/7649 cancer cases reported with the ARB valsartan (6.7%) vs 591/7596 cases reported with the calcium-channel blocker amlodipine (7.8%). In that large clinical trial, with 15,245 patients followed for several years, this fi nding obviously argues
TL;DR: Higher Sokolow–Lyon voltage during antihypertensive treatment, but not UACR or the Cornell voltage–duration product, was independently associated with higher incidence of coronary as well as peripheral revascularization.
Abstract: Objective. Regression of left ventricular (LV) hypertrophy and albuminuria in hypertension has previously been shown to reduce clinical cardiovascular events and death. We aimed to investigate the associations of regression of electrocardiographic (ECG) LV hypertrophy and albuminuria with the incidence of revascularization. Methods. In 9193 hypertensive patients included in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, we measured urine albumin/creatinine ratio (UACR), LV hypertrophy by electrocardiography, serum high-density lipoprotein (HDL) cholesterol, and blood pressure after 2 weeks of placebo treatment and yearly during 5 years of anti-hypertensive treatment with either an atenolol- or a losartan-based regimen. The incidence of coronary and peripheral revascularization was recorded. Results. In Cox regression analyses adjusted for treatment allocation and continent, high time-varying Sokolow–Lyon voltage (hazard ratio [HR]=1.01 [1.00–1.02], p=0.01), but not ...
Journal Article•
TL;DR: Adresy do korespondencji: Professor Giuseppe Mancia, Clinica Medica, University of Milan-Bicocca, San Gerardo Hospital, Via Pergolesi 33, 20052 Monza, Milan, Włochy.
TL;DR: Prescribing candesartan for the primary treatment of hypertension results in lower long-term health-care costs compared with losartan, and the mean total costs per patient were 10,435 Swedish kronor (SEK) higher in theLosartan group.
Abstract: A recentstudy of two widely used angiotensin receptor blockers (ARBs) reported a reduced risk of cardiovascular events (−14.4%) when treating patients with candesartan compared to 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, hospitalisations, 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 hospitalisation. Patients treated with losartan had more outpatient contacts (+15.6%), laboratory tests (+13.8%), and hospitalisations (+13.8%) compared with the candesartan group. During a maximum observation time of 9 years the mean total costs per patient were 10,435 Swedish kronor (SEK) (95% CI 3,086 to 17,783) higher in the losartan group.
Prescribing candesartan for the primary treatment of hypertension results in lower long-term health-care costs compared with losartan.
TL;DR: The last echocardiographic exam performed before the HF event showed a significant reduction in relative wall thickness and a mild increase in LV diameter and a significant increase in mitral E/A ratio paired with shortening of the IVRT.
TL;DR: The data suggest that exercise systolic blood pressure at the moderate ergometer load of 100 Watt is an independent predictor of long term cardiovascular mortality in healthy middle aged men and that the strength of this association is of the same magnitude as for resting systolics blood pressure.
Abstract: Objective: Systolic blood pressure (SBP) at rest is strongly associated with cardiovascular (CV) mortality, while data on exercise BP have been conflicting. We have previously found peak systolic BP at a workload of 100 Watt (SBP100) to predict CV mortality after a follow-up of up to 21 years. We now aimed to investigate this association after 35 years. Design and Methods: 2014 apparently healthy men aged 40 to 59 were included after an extensive examination program including a bicycle exercise test in the years 1972 to 1975. 1999 men achieved a workload of more than 100 W. The association between SBP 100, SBP and CV mortality was analyzed among these men, first in separate models and then in the same model using Cox proportional hazard and adjusted for age, smoking and total cholesterol. Results: Kaplan-Meier plots illustrate CV mortality in different quartiles of SBP100. Cox models were performed using 1 standard deviation (SD). An increase of 1 SD (24.2 mmHg) in SBP100 was associated with a 1.29 (CI 1.19–1.40, p < 0.001) fold increased risk of CV mortality; corresponding for SBP was 1.27 (CI 1.17–1.38, p < 0.001) fold increased risk of CV mortality was found per 1 SD (17.9 mmHg). Both SBP and SBP100 were independently associated with CV mortality when tested in the same model. Conclusion: Our data suggest that exercise systolic blood pressure at the moderate ergometer load of 100 Watt is an independent predictor of long term cardiovascular mortality in healthy middle aged men and that the strength of this association is of the same magnitude as for resting systolic blood pressure. Figure 1. No caption available.
TL;DR: It took some 20 years before 24 hour ambulatory BP measurement (ABPM) became an integral part of clinical hypertension diagnosis and management.
Abstract: More than three decades ago, Millar-Craig et al. (1) described the patterns of the circadian variation of blood pressure (BP). They demonstrated by using continuous intra-arterial monitoring, that BP was highest in the early to mid-morning period and lowest at night, rapidly rising again before awakening. Their fi ndings marked the beginning of an era where 24 h assessment of BP was to become increasingly common. However, it took some 20 years before 24 hour ambulatory BP measurement (ABPM) became an integral part of clinical hypertension diagnosis and management. Today, 24 h ambulatory BP assessment is widely used in hypertension clinics, and a search on “24 hour blood pressure control” on Google results in about 4.500.000 hits in 0.32 sec.