Sverre E. Kjeldsen

Bio: Sverre E. Kjeldsen is an academic researcher from University of Oslo. The author has contributed to research in topics: Blood pressure & Left ventricular hypertrophy. The author has an hindex of 94, co-authored 735 publications receiving 89059 citations. Previous affiliations of Sverre E. Kjeldsen include University of Michigan & Cornell University.

Long-term pacing in VVI-modes elicit similar sympathetic drive.

Abstract: Ventricular inhibited (VVI] pacing in patients with atrioventricular (AV) hlock may increase sympathetic nervous tone compared to the hemodynamically superior AV synchronous mode even if symptoms of cardiac decompensation are lacking. Thus, short-term VVI pacing induces a higher release of norepinephrine into coronary sinus blood than does atrial pacing.^ However, this difference may subside due to adaptation during long-term pacing. A general increase in the adrenergic drive should be reflected in systemic catecholamine concentrations. We examined seven symptom-free patients, aged 32-74 years, treated with dual chamber pacemakers for high degree AV block: Cordis Sequicor 233 (Cordis Corp., Miami, FL, USA) in four and Intermedics 483-01 (Intermedics, Inc., Freeport, TX, USA) in three patients. Holter monitoring during VVI pacing demonstrated continuous pacing with the atria in stable sinus rhythm in all patients. In random succession the pacemakers were programmed either to VVI 70 ppm or to optimal DDD program. Each period lasted 7-21 days, and the patient was not informed of the pacing mode used. At the end of each period the patient was examined at 8 A.M. after at overnight fast and an abstension from drugs, coffee, tea, and tobacco. A plastic cannula was inserted into a forearm artery under local anaesthesia without epinephrine. After supine rest for 30 minutes in a quiet and dimly lit room, 5 mL of aterial blood was collected for catechoiamine assay. The patient was then exercised on a tricycle ergometer, and blood sampling was repeated at maximal work. The blood samples were immediately placed on ice with a preservative and centrifuged. The plaisma was stored at —70° until analysis. Plasma epinephrine and norepinephrine concentrations were measured by the method of Peuler and Johnson^ as previously reported.^ The resting plasma norepinephrine concentrations in VVI and DDD were 253 ± 28 pg/mL (mean ± SEM) and 226 ± 54 pg/mL, respectively, increasing during exercise to 2,962 ± 768 pg/mL and 2,848 ± 768 pg/mL. The corresponding plasma epinephrine concentrations were 60 ± 10 pg/mL and 58 ±C 10 pg/mL at rest and 353 ± 74 pg/mL and 338 ± 62 pg/mL during exercise.* None of the differences between VVI and DDD was statistically significant. Atrial rates were identical in both pacing modes, and Holter monitoring revealed that during the last 24 hours before blood sampling all patients had close to 100% paced rhythm. Thus, the preset study cannot demonstrate any difference between VVI and DDD long-term pacing with respect to arterial catecholamine concentrations. Arterial catecholamine concentrations reflect the total sympathetic stimulation, whereas, venous samples are influenced by organ secretion or extraction of catecholamines. Thus, during VVI and DDD pacing, any difference in myocardial catecholamine release or uptake, if present, was not large enough to appear in systemic circulation.

The PARAGON-Heart failure trial - another disappointment for heart failure patients with hypertension and preserved ejection fraction.

Abstract: Novel angiotensin receptor antagonist/neprilysin inhibitors (ARNIs) seek to exploit the clinical benefits of combining renin-angiotensin-aldosterone-system (RAAS) antagonism and neutral endopeptida...

Obituary – Björn Folkow

Abstract: Bj ö rn Folkow passed away at the age of 91 on 23 July 2012 after a short illness. He was an eminent teacher of physiology and his studies of pathophysiology of hypertension greatly contributed to our understanding of this widespread disease. Importantly, Bj ö rn Folkow taught numerous clinician researchers how to adopt a physiological and pathophysiological understanding into their activities. Bj ö rn Folkow always demonstrated a special analytical approach to physiology, and he researched vital and important areas of cardiovascular physiology, which many other researchers often oversaw. A continuing theme of his research was the vascular reactivity and remodelling as well as the impact of the sympathetic nervous system on circulatory control (Folkow 1987). From an early stage in his career, Bj ö rn Folkow studied functional infl uences of myogenic or/and neurohormonal control mechanisms on transmural and driving pressures in various vascular beds. He also addressed important scientifi c research questions related to the relationship between pressure and structural wall/lumen ration, both in the heart as well as in vascular beds. Importantly, Bj ö rn Folkow contributed in his early studies to much of the knowledge on which we base our current understanding of vascular hypertrophy in hypertension. An additional area of interest to Bj ö rn Folkow was the role of the limbic – hypothalamic system in physiological as well as psychological stress situations. After his retirement, Bj ö rn Folkow took a great interest and actively participated in the scientifi c debate on high salt and hypertension. His point on sodium chloride was that although disturbances and risks appear at both extreme ends of sodium intake, counter-regulatory mechanisms are capable of maintaining mean pressure within the normal range, within a wide (15 – 20-fold) range of salt intake both in healthy man and in rats (Folkow 2003). Although, he recognized the importance and full extent of salt intake/metabolism on circulatory physiology, he remained sceptical about societal and population intervention programmes for reductions of salt intake. Bj ö rn Folkow ’ s point was that the induction of primary (essential) hypertension appears to be far more dependent on present-day psychosocial infl uences by means of central enhancements of neuro-endocrine activities. However, at the same token, he did acknowledge that it is a different matter that “ salt contents in processed foods should be declared, and kept low – fi rst, because ‘ salt sensitivity ’ is not uncommon, and second, salt is then easy to add but impossible to eliminate ” (Folkow 2003). His standing as an international scientifi c authority in the pathophysiology of hypertension and several areas of cardiovascular medicine was undisputed. His support was instrumental in the start-up and rise of the journal Blood Pressure and he served as Senior Scientifi c Councillor and honorary Editor for the journal for over 20 years. Bj ö rn Folkow was born in Halmstad in southern Sweden in 1921 and was appointed Professor of Physiology at the newly established Medical School at the University of Gothenburg in 1961. He served as full professor and as chair of the Department until 1987, when he retired. As a Head of Department, Bj ö rn Folkow showed that it is possible to combine great scientifi c authority with generosity and consideration. Over 62 years of continuous activity in academic research and teaching, Bj ö rn was always present and personally available to students and co-workers until shortly before his death. Bj ö rn Folkow was member of several prestigious societies during his career, such as International and European Society of Hypertension. He was elected member 1178 of the Royal Swedish Academy of Sciences and served as a member of the “ Class of Medical Sciences ” until his death. He was a recipient of the prestigious Anders Jahre award in 1980 and an honorary member of the American Physiological Society. In 1987, the European Society of Hypertension (ESH) in collaboration of AstraZeneca instituted Blood Pressure, 2012; 21: 326–327

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

Abstract: "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, β-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Abstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

The Design and Analysis of Experiments

Abstract: THE DESIGN AND ANALYSIS OF EXPERIMENTS. By Oscar Kempthorne. New York, John Wiley and Sons, Inc., 1952. 631 pp. $8.50. This book by a teacher of statistics (as well as a consultant for \"experimenters\") is a comprehensive study of the philosophical background for the statistical design of experiment. It is necessary to have some facility with algebraic notation and manipulation to be able to use the volume intelligently. The problems are presented from the theoretical point of view, without such practical examples as would be helpful for those not acquainted with mathematics. The mathematical justification for the techniques is given. As a somewhat advanced treatment of the design and analysis of experiments, this volume will be interesting and helpful for many who approach statistics theoretically as well as practically. With emphasis on the \"why,\" and with description given broadly, the author relates the subject matter to the general theory of statistics and to the general problem of experimental inference. MARGARET J. ROBERTSON