Author
Sverre E. Kjeldsen
Other affiliations: University of Michigan, Cornell University, University Hospital of North Norway ...read more
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.
Papers published on a yearly basis
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Jagiellonian University1, University of Bern2, University of Brescia3, University Hospital of Lausanne4, Northwest University (China)5, University of California, Irvine6, Jichi Medical University7, University of Oslo8, Rutgers University9, French Institute of Health and Medical Research10, University of Ottawa11, University of Bergen12, Gdańsk Medical University13, Georgetown University14, University of Milano-Bicocca15, Imperial College London16, McGill University17, University of Erlangen-Nuremberg18, Drexel University19, University of Missouri20, Shanghai Jiao Tong University21, State University of New York System22, University College London Hospitals NHS Foundation Trust23
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01 Jan 2015TL;DR: This chapter will offer some examples of this relationship mainly based on past work by the authors on organ damages of more common assessment in clinical practice as well as of a more clear prognostic value, i.e. left ventricular hypertrophy, increased urinary protein excretion or reduction of glomerular filtration rate and carotid intima-media thickening or plaques.
Abstract: A large number of studies in experimental animals and man show that angiotensin II, catecholamines and many other substances with cardiovascular and/or metabolic effects can favour alterations of organ function and structure independently on their ability to modify blood pressure (BP). There is, however, also a large body of evidence that these alterations are related to BP levels “per se” both in untreated and treated hypertensive patients. This chapter will offer some examples of this relationship mainly based on past work by the authors. The examples will largely focus on organ damages of more common assessment in clinical practice as well as of a more clear prognostic value, i.e. left ventricular hypertrophy, increased urinary protein excretion or reduction of glomerular filtration rate and carotid intima-media thickening or plaques. However, other types of organ damage will be also mentioned, albeit more briefly.
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TL;DR: Findings challenge the common perceptions that strategies to prevent cardiovascular disease should concern only inhabitants of wealthy countries and urge for a shift in priorities as well as public health strategies also for less-developed regions and nations.
Abstract: Several guidelines for risk assessment and management of arterial hypertension have recently been issued such as the seventh Joint National Committee report on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2003 guidelines issued jointly by the European Society of Hypertension and the European Society of Cardiology (2003 ESH/ESC) [1, 2]. The idea of global cardiovascular risk stratification in order to facilitate and improve patient management decisions, however, is not new [3]. A comprehensive method to risk-stratify patients to assess the absolute risk of major cardiovascular events based on the overall effects of risk factors, target organ damage and associated clinical conditions was introduced in the 1999 World Health Organization–International Society of Hypertension (1999 WHO/ISH) guidelines. Since then, however, additional research data, as well as reassessments of the magnitude of cardiovascular disease risk, have led to the recognition that high blood pressure and high cholesterol concentrations have much greater influence on population health than was previously recognized [4]. In fact, about 65% of stroke and almost half of cases of ischemic heart disease can be attributed to systolic blood pressure greater than 115 mmHg and total cholesterol concentration over 3.8 mmol/l [4]. Furthermore, improved surveys of various geographical areas have also demonstrated that high blood pressure and high cholesterol concentration are major risks to health in all regions of the world and not only in high income countries. In the present issue of Blood Pressure, Cuspidi and coworkers [5] have retrospectively calculated the cardiovascular risk in 425 never-treated hypertensive patients, using both the 1999 WHO/ISH and the 2003 ESH/ESC guidelines. There are several interesting findings in their report. They demonstrate that the method of risk stratification recommended by the 2003 ESH/ESC guidelines has a greater sensitivity in defining cardiovascular risk as compared to the 1999 WHO/ISH guidelines. Thus, more patients were classified as having a medium or highadded risk when the 2003 ESH/ESC guidelines were used. Dyslipidemia was the most frequent risk factor in their study population, observed in more than two-thirds of the subjects [5]. In fact, the use of dyslipidemia as a risk factor instead of only using total cholesterol values more than doubled the prevalence of lipid disorders as a risk factor. In addition, the report demonstrates that the accuracy in detecting target organ damage with cardiac and carotid ultrasound procedures and microalbuminuria determination was approximately 10-fold higher than that given by a routine investigation. Reduction of the cardiovascular risk burden attributable to hypertension, lipid disorders and microalbuminuria can be achieved in differences ways. Commonly, personal health services such as pharmacological and non-pharmacological management of high blood pressure and high cholesterol have been shown to be very effective [1, 2]. In addition, non-personal health-related intervention such as mass media messages to change perceptions of healthy diets and legalization to alter contents of processed food represents different approaches to reduce the risk of cardiovascular disease. Indeed, in a recent study [4] in various geographical areas of the world, highas well as low-income countries, a range of specified personal as well as personal health interventions to lower blood pressure as well as cholesterol concentrations was demonstrated to be very cost effective. Thus, such findings challenge the common perceptions that strategies to prevent cardiovascular disease should concern only inhabitants of wealthy countries. On the contrary, available data strongly urge for a shift in priorities as well as public health strategies also for less-developed regions and nations. Moreover, available research also set priority in development of strategies for the control of cardiovascular disease not only for doctors, but also for health policy makers in general. If we are to develop a sustainable and just global strategy for cardiovascular disease prevention, we should also embark on a discussion how allocation of resources for health promotion should be made in rich as well as poorer countries to reduce the emerging cardiovascular disease burden. In essence, in all such regions, we need to make choices to what extent allocations of fund in general should be made between competing medical therapeutic options and priorities. Regardless of highor low-income areas, increased demand, as well as introduction of newer and more expensive technologies, will influence cardiovascular risk assessment and management. A proper health economic evaluation to form a viable strategy should help us to set priorities, and make rational and morally defendable choices.
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Boston University1, Rush University Medical Center2, University of Tennessee Health Science Center3, University of Michigan4, University at Buffalo5, University of Mississippi6, University of Miami7, University of Alabama at Birmingham8, Case Western Reserve University9, National Institutes of Health10
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
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.
24,988 citations
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TL;DR: In those older than age 50, systolic blood pressure of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP, and hypertension will be controlled only if patients are motivated to stay on their treatment plan.
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.
14,975 citations
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TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
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 …
14,173 citations
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
13,400 citations
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TL;DR: 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.
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
13,333 citations