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  • 1.
    Andersson, T.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Larsen, F.
    Soderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Searching for CTEPH: a Swedish National Follow-Up after en Episode of Acute Pulmonary Embolism2016In: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, E-ISSN 1557-3117, Vol. 35, no 4, p. S149-S149Article in journal (Other academic)
  • 2.
    Brunström, Mattias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses2016In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 352, article id i717Article, review/survey (Refereed)
    Abstract [en]

    Objective: To assess the effect of antihypertensive treatment on mortality and cardiovascular morbidity in people with diabetes mellitus, at different blood pressure levels.

    Design: Systematic review and meta-analyses of randomised controlled trials.

    Data sources: CENTRAL, Medline, Embase, and BIOSIS were searched using highly sensitive search strategies. When data required according to the protocol were missing but trials were potentially eligible, we contacted researchers, pharmaceutical companies, and authorities.

    Eligibility criteria: Randomised controlled trials including 100 or more people with diabetes mellitus, treated for 12 months or more, comparing any antihypertensive agent against placebo, two agents against one, or different blood pressure targets.

    Results: 49 trials, including 73 738 participants, were included in the meta-analyses. Most of the participants had type 2 diabetes. If baseline systolic blood pressure was greater than 150 mm Hg, antihypertensive treatment reduced the risk of all cause mortality (relative risk 0.89, 95% confidence interval 0.80 to 0.99), cardiovascular mortality (0.75, 0.57 to 0.99), myocardial infarction (0.74, 0.63 to 0.87), stroke (0.77, 0.65 to 0.91), and end stage renal disease (0.82, 0.71 to 0.94). If baseline systolic blood pressure was 140-150 mm Hg, additional treatment reduced the risk of all cause mortality (0.87, 0.78 to 0.98), myocardial infarction (0.84, 0.76 to 0.93), and heart failure (0.80, 0.66 to 0.97). If baseline systolic blood pressure was less than 140 mm Hg, however, further treatment increased the risk of cardiovascular mortality (1.15, 1.00 to 1.32), with a tendency towards an increased risk of all cause mortality (1.05, 0.95 to 1.16). Metaregression analyses showed a worse treatment effect with lower baseline systolic blood pressures for cardiovascular mortality (1.15, 1.03 to 1.29 for each 10 mm Hg lower systolic blood pressure) and myocardial infarction (1.12, 1.03 to 1.22 for each 10 mm Hg lower systolic blood pressure). Patterns were similar for attained systolic blood pressure.

    Conclusions: Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg. If systolic blood pressure is less than 140 mm Hg, however, further treatment is associated with an increased risk of cardiovascular death, with no observed benefit.

  • 3.
    Brunström, Mattias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Thrombolysis in acute stroke2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, no 9976, p. 1394-1395Article in journal (Refereed)
  • 4.
    Burger, Dylan
    et al.
    University of Ottawa, Ottawa, Ontario, Canada.
    Veerabhadrappa, Praveen
    Temple University, Philadelphia, Pennsylvania, USA.
    Charchar, Fadi
    University of Ballarat, Ballarat, Victoria, Australia.
    Tomaszewski, Maciej
    University of Leicester, Leicester, UK.
    Harrap, Stephen
    University of Melbourne, Melbourne, Victoria, Australia.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Touyz, Rhian M.
    University of Ottawa, Ottawa, Ontario, Canada.
    Report of the first International Society of Hypertension (ISH) Trainee/New Investigator Symposium: A Global Hypertension Initiative2012In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 30, no 3, p. 631-632Article in journal (Refereed)
  • 5.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Beta-blockers for hypertension.2007In: CMAJ, ISSN 1488-2329, Vol. 176, no 7, p. 971; author reply 971-2Article in journal (Refereed)
  • 6.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Måttligt förhöjt blodtryck, en systematisk litteraturöversikt.2004Report (Other (popular science, discussion, etc.))
  • 7.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Proteinuria early in the development of hypertension2014In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 32, no 12, p. 2351-2352Article in journal (Other academic)
  • 8.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Time to lower treatment BP targets for hypertension?2009In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 374, no 9689, p. 503-504Article in journal (Other academic)
  • 9.
    Carlberg, Bo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindholm, Lars Hjalmar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Comment: Stroke and blood-pressure variation: new permutations on an old theme.2010In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 375, no 9718, p. 867-869Article in journal (Refereed)
  • 10.
    Carlberg, Bo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Nilsson, Peter M
    Hypertension in the elderly: what is the goal blood pressure target and how can this be attained?2010In: Current Hypertension Reports, ISSN 1522-6417, E-ISSN 1534-3111, Vol. 12, no 5, p. 331-334Article in journal (Refereed)
    Abstract [en]

    For the aging populations of Europe, many emerging health problems in addition to myocardial infarction and stroke are associated with hypertension. Recently, the role of hypertension in the risk of vascular cognitive impairment and dementia has been highlighted, and there are studies to show that control of hypertension may slow this process. Furthermore, as many elderly individuals will also develop type 2 diabetes or impaired renal function, the risk of hypertension in these patients is more pronounced. New guidelines have tried to provide evidence-based treatment algorithms in which control of hypertension is just one aspect of general risk factor control, with the aim of decreasing the total risk.

  • 11.
    Carlberg, Bo
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Samuelsson, Ola
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Atenolol in hypertension: is it a wise choice?2004In: Lancet, ISSN 1474-547X, Vol. 364, no 9446, p. 1684-9Article in journal (Refereed)
  • 12.
    Carlberg, Bo
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Samuelsson, Ola
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Finns möjligen hela bilden om atenolol hos Kent Forsén?2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 3, p. 151-152Article in journal (Other academic)
  • 13.
    Ekblom, Kim
    et al.
    Umeå University, Faculty of Medicine, Medical Biosciences, Clinical chemistry.
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Medical Biosciences, Clinical chemistry.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Strand, Tage
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine.
    Anticoagulant treatment at a specialized outpatient anticoagulant therapy unit, a descriptive study.2005In: Thromb J, ISSN 1477-9560, Vol. 3, p. 20-Article in journal (Refereed)
  • 14.
    Eriksson, Marie
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    The disparity in long-term survival after a first stroke in patients with and without diabetes persists: the Northern Sweden MONICA Study2012In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 34, no 2, p. 153-160Article in journal (Refereed)
    Abstract [en]

    Background: Diabetes is an established risk factor for stroke. Compared to nondiabetic patients, diabetic patients also have an increased risk of new vascular events and death after stroke. We analyzed how differences in long-term survival between diabetic and nondiabetic stroke patients have changed over time, and if differences varied with respect to sex and age.

    Methods: This population-based study included 12,375 first-ever stroke patients, 25-74 years old, who were registered in the Northern Sweden MONICA Stroke Registry 1985-2005. Uniform diagnostic criteria for stroke case ascertainment were used throughout the study period. The diagnosis of diabetes was based on medical records or diabetes diagnosed during the acute stroke event. Patients were separated into four cohorts according to year of stroke and followed for survival until August 30, 2008.

    Results: The diabetes prevalence at stroke onset was 21%, similar in men and women, and remained stable throughout the study period. The diabetic patients were an average of 2 years older, more often nonsmokers and more likely to have antihypertensive treatment, antithrombotics, atrial fibrillation, and a history of myocardial infarction or transient ischemic attack than the nondiabetic patients. The total follow-up time was 86,086 patient-years during which a total of 1,930 (75.7%) of the diabetic patients and 5,744 (58.5%) of the nondiabetic patients died (p < 0.001). Median survival was 60 months (95% CI: 57-64) in diabetic patients and 117 months (113-120) in the nondiabetic patients. Survival improved significantly in both groups (p < 0.001). A Cox regression, adjusting for possible confounders (age, sex, antihypertensive medication, antithrombotics or other thrombolytic agents, history of myocardial infarction, type of stroke, diabetes, cohort and the diabetes-by-sex, diabetes-by-age and diabetes-by-cohort interactions), showed a hazard ratio of 1.67 (1.58-1.76) comparing survival in diabetic versus nondiabetic patients. The reduced survival in diabetic stroke patients was more pronounced in women (p = 0.02) and younger patients (p < 0.001). There was a tendency that the difference in survival decreased between the earlier cohorts and the 2000-2005 cohort, but the test for interaction did not reach statistical significance (p = 0.08).

    Conclusion: Long-term survival after a first stroke has improved in both diabetic and nondiabetic patients. Survival is markedly lower in diabetics, especially in women and younger patients, and the disparity persisted over 24 years. Decreasing the disparity in stroke survival is a challenge for stroke and diabetes care. New treatment methods in combination with intense secondary prevention in diabetic patients, especially in younger women, are needed.

  • 15.
    Eriksson, Marie
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Comparison of blood pressure measurements between an automated oscillometric device and a Hawksley random-zero sphygmomanometer in the northern Sweden MONICA study.2012In: Blood Pressure Monitoring, ISSN 1359-5237, E-ISSN 1473-5725, Vol. 17, no 4, p. 164-170Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Hawksley random-zero sphygmomanometer (random-zero) has been used widely in epidemiological observation studies. This study compares blood pressure measurements using the random-zero with measurements using an automated oscillometric device and suggests a correction of the automated oscillometric measurements to enable comparisons of blood pressure levels over time.

    METHODS: The northern Sweden MONICA population survey 2009 included 1729 participants, 853 men and 876 women, 25-74 years old. Blood pressure was measured using both random-zero and an automated oscillometric device in all participants. The Omron M7 digital blood pressure monitor was used for automated oscillometric measurements. A linear mixed model was used to derive a formula to adjust the automated oscillometric readings.

    RESULTS: Automated oscillometric measurements of systolic blood pressure were generally lower than random-zero measurements in women [oscillometric mean 122.1 mmHg (95% confidence interval: 121.0-123.2) versus random-zero mean 124.4 mmHg (123.5-125.5)], whereas automated oscillometric measurements of systolic blood pressure were generally higher than random-zero measurements in men [oscillometric 131.1 mmHg (130.0-132.2) versus random-zero 129.0 mmHg (127.9-130.1)]. For diastolic blood pressure, automated oscillometric measurements were higher in both women [oscillometric 79.9 mmHg (79.2-80.5) versus random-zero 76.7 mmHg (76.0-77.4)] and men [oscillometric 83.1 mmHg (82.4-83.8) vs. random-zero 81.2 mmHg (80.6-81.9)]. The difference also varied with age and order of measurement. Adjustment of the automated oscillometric measurements using mixed model regression coefficients produced estimates of blood pressure that were close to the random-zero measurements.

    CONCLUSION: Blood pressure measurements using an automated oscillometric device differ from those with random-zero, but the oscillometric measurements can be adjusted, on the basis of sex, age and measurement order, to be similar to the random-zero measurements.

  • 16. Gueyffier, Francois
    et al.
    Marchant, Ivanny
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Modeling the impact of cardiovascular prevention strategies: toward better information for public health decisions2012In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 30, no 1, p. 51-52Article in journal (Refereed)
  • 17.
    Hannuksela, Matias
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Lundqvist, Stefan
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Thoracic aorta: dilated or not?2006In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 40, no 3, p. 175-178Article in journal (Refereed)
    Abstract [en]

    Objectives: Knowledge of normal aortic diameters is important in the assessment of aortic disease. The aim of this study was to determine normal thoracic aortic diameters.

    Design: 77 patients undergoing computed tomography of the thorax were studied. The diameter of the thoracic aorta was measured at three levels in the ascending aorta and at three levels in the descending aorta. The diameter was studied in relation to age, sex, weight and height.

    Results: We found that aortic diameter is increasing with increasing age. Even sex and BMI influence the aortic diameter but to a lesser extent than age. The upper normal limit for ascending aorta can be calculated with the formula D(mm) = 31 + 0.16*age and for descending aorta with the formula D(mm) = 21 + 0.16*age. Thus a 20-year-old person has an upper normal limit for ascending aorta of 34 mm and an 80-year-old person has a limit of 44 m.

    Conclusions: The thoracic aortic diameter varies with age, sex and body weight and height. The strongest correlation can be seen with age. Age should therefore be taken into consideration when determining whether the thoracic aorta is dilated or not.

  • 18.
    Israelsson, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience. Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wikkelsö, Carsten
    Laurell, Katarina
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Kahlon, Babar
    Leijon, Göran
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Vascular risk factors contribute to idiopathic normal pressure hydrocephalus: the INPH-CRasH StudyManuscript (preprint) (Other academic)
    Abstract [en]

    Objective

    The objective was to determine the complete modern vascular risk factor (VRF) profile of idiopathic normal pressure hydrocephalus (INPH) using a large sample of representative INPH-patients and population-based controls, in order to confirm the impact of vascular disease on INPH pathophysiology.

     

    Methods

    All shunted INPH-patients in Sweden 2008-2010 were compared to age- and gender-matched population-based controls. Inclusion criteria: 60-85 years and mini mental state estimation ³23. The ten most important modern VRFs as well as cerebrovascular and peripheral vascular disease were prospectively assessed through blood samples, by-protocol clinical examinations and standardized questionnaires. Investigated VRFs: hypertension, hyperlipidemia, diabetes, obesity, psychosocial factors, smoking, diet, alcohol intake, cardiac disease and, physical activity.

     

    Results

    After exclusion, 176 INPH-patients and 368 controls participated. Using multivariable logistic regression, hyperlipidemia (OR: 2.380, 95%CI: 1.434-3.950), diabetes (OR: 2.169, 95%CI: 1.195-3.938), obesity (OR: 5.428, 95%CI: 2.502-11.772) and, psychosocial factors (OR: 5.343, 95%CI: 3.219-8.868) were independently associated with INPH. Hypertension, physical inactivity, cerebrovascular and peripheral vascular disease were overrepresented in INPH, although not independently. The protective factors: moderate alcohol intake and physical activity were overrepresented among the controls. The population attributable risk percentage was 24%.

     

    Conclusions

    Our findings confirm that INPH-patients have a more dangerous VRF-profile and lack the protective factors present in the population. Almost one quarter of INPH could be explained by VRF, suggesting that INPH possibly may be a subgroup of vascular dementia. Targeted interventions against modifiable VRF are likely to have beneficial effects in INPH.

  • 19.
    Lindholm, Lars H
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Blood-pressure drugs and cancer: much ado about nothing?2011In: The Lancet Oncology, ISSN 1470-2045, E-ISSN 1474-5488, Vol. 12, no 1, p. 6-8Article in journal (Refereed)
  • 20.
    Lindholm, Lars H
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Samuelsson, Ola
    Beta blockers in primary hypertension: Do age and type of beta-blocker matter?2006In: J Hypertens, ISSN 0263-6352, Vol. 24, no 11, p. 2143-5Article in journal (Refereed)
  • 21.
    Lindholm, Lars H
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Samuelsson, Ola
    Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis.2005In: Lancet, ISSN 1474-547X, Vol. 366, no 9496, p. 1545-53Article in journal (Refereed)
  • 22.
    Lindholm, Lars H
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Kartman, Bernt
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Persson, Mats
    Svensson, Anders
    Samuelsson, Ola
    Cost implications of development of diabetes in the ALPINE study.2006In: J Hypertens Suppl, ISSN 0952-1178, Vol. 24, no 1, p. S65-72Article in journal (Refereed)
  • 23.
    Lindholm, Lars H
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Samuelsson, O
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Beta-blockers in primary hypertension. No more confusion.: Cardiology at the Limits VII.2006In: Cardiology at the Limits VII, Cape Town: University of Cape Town Press , 2006Chapter in book (Other academic)
  • 24. Mullan, Rebecca J
    et al.
    Flynn, David N
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Tleyjeh, Imad M
    Kamath, Celia C
    LaBella, Matthew L
    Erwin, Patricia J
    Guyatt, Gordon H
    Montori, Victor M
    Systematic reviewers commonly contact study authors but do so with limited rigor.2009In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 62, no 2, p. 138-142Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Author contact can enhance the quality of systematic reviews. We conducted a systematic review of the practice of author contact in recently published systematic reviews to characterize its prevalence, quality, and results. STUDY DESIGN AND SETTING: Eligible studies were systematic reviews of efficacy published in 2005-2006 in the 25 journals with the highest impact factor publishing systematic reviews in clinical medicine and the Cochrane Library, identified by searching MEDLINE, EMBASE, and the Cochrane Library. Two researchers determined whether and why reviewers contacted authors. To assess the accuracy of the abstracted data, we surveyed reviewers by e-mail. RESULTS: Forty-six (50%) of the 93 eligible systematic reviews published in top journals and 46 (85%) of the 54 eligible Cochrane reviews reported contacting authors of eligible studies. Requests were made most commonly for missing information: 40 (76%) clinical medicine reviews and 45 (98%) Cochrane reviews. One hundred and nine of 147 (74%) reviewers responded to the survey, and reported a higher rate of author contact than apparent from the published record. CONCLUSION: Although common, author contact is not a universal feature of systematic reviews published in top journals and the Cochrane Library. The conduct and reporting of author contact purpose, procedures, and results require improvement.

  • 25.
    Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Trends of blood pressure levels and management in Västerbotten County, Sweden, during 1990-20102012In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 5, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Background: Availability of longitudinal data on hypertension and blood pressure levels are important to assess changes over time at the population level. Moreover, detailed information in different population sub-groups is important to understand inequity and social determinants of blood pressure distribution in the population.

    Objectives: The objectives of this study are to: (1) describe the trends of population blood pressure levels in men and women between different educational levels and geographic areas in Sweden during 1990-2010; (2) identify prevalences of hypertension, awareness, treatment, and control in the population; and (3) assess the 10-year risk of developing hypertension among individuals with normal and high normal blood pressures.

    Methods: This study is based on data from the Vasterbotten Intervention Program (VIP) in Vasterbotten County, Sweden. The cross-sectional analysis includes 133,082 VIP health examinations among individuals aged 30, 40, 50, and 60 years from 1990 to 2010. The panel analysis includes 34,868 individuals who were re-examined 10 years after the baseline examination. Individuals completed a self-administered health questionnaire that covers demographic and socio-economic information, self-reported health, and lifestyle behaviours. Blood pressure measurement was obtained prior to the questionnaire. In the cross-sectional analysis, trends of blood pressure by sex, and between educational groups and geographic areas are presented. In the panel analysis, the 10-year risk of developing hypertension is estimated using the predicted probability from logistic regression analysis for each sex, controlling for age and educational level.

    Results: The prevalence of hypertension decreased from 1990 to 2010; from 43.8 to 36.0% (p<0.001) among men, and 37.6 to 27.5% among women (p<0.001). Individuals with basic education had a significantly higher prevalence of hypertension compared to those with medium or high education. Although the decreases were observed in all geographic areas, individuals in rural inland areas had a much higher prevalence compared to those who lived in Umea City. The proportion of hypertensive women who were aware of their hypertension (61.7%) was significantly higher than men (51.6%). About 34% of men and 42% of women with hypertension reported taking blood pressure medication. Over time, awareness and control of hypertension improved (from 46.5% in 1990 to 69% in 2010 and from 30 to 65%, respectively). The gaps between educational groups diminished. This study shows a significantly higher risk of developing hypertension for men and women with high normal blood pressure compared to those with normal blood pressure at baseline in all age cohorts and educational groups. The average risks of developing hypertension among men with high normal blood pressure were 21.5, 45.8, and 56.3% in the 30, 40, and 50-year cohorts, respectively. Corresponding numbers for women were 22.6, 47.4, and 57.9%.

    Conclusions: Levels of blood pressure and hypertension decreased significantly among the Vasterbotten population in the last 21 years. Hypertension management has improved and there is increased awareness, treatment, and control of blood pressure. Despite these achievements, the persisting social gaps in blood pressure levels and management demand further investigation and action from policy makers. Future research should attempt to identify and address the root causes of these health inequities to ensure better and equal health for the whole population.

  • 26. Olofsson, Anna
    et al.
    Andersson, Sven-Olof
    Carlberg, Bo
    'If only I manage to get home I'll get better' - interviews with stroke patients after emergency stay in hospital on their experience and needs2005In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 19, no 4, p. 433-440Article in journal (Refereed)
  • 27.
    Olsson, Erik M G
    et al.
    Department of Psychology, Uppsala University, Sweden .
    El Alaoui, Samir
    Department of Psychology, Uppsala University, Sweden .
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Ghaderi, Ata
    Department of Psychology, Uppsala University, Sweden .
    Internet-based biofeedback-assisted relaxation training in the treatment of hypertension: a pilot study2010In: Applied Psychophysiology and Biofeedback, ISSN 1090-0586, E-ISSN 1573-3270, Vol. 35, no 2, p. 163-170Article in journal (Refereed)
    Abstract [en]

    The effectiveness of biofeedback-assisted behavioral treatment with Internet-based client-therapist contact for hypertension was tested in outpatient settings. A pilot study with a randomized controlled design was adopted with two conditions (treatment versus passive controls), lasting for 8 weeks. There were two assessment time points (pre-treatment and post-treatment) measuring clinic systolic and diastolic blood pressure (SBP and DBP) and administration of a questionnaire collecting demographic and subjective data. Participants included 19 Swedish adults diagnosed with hypertension. The treatment group lowered their SBP 5.9 mm Hg and their DBP 7.6 mm Hg while the control group lowered their SBP 0.8 mm Hg and DBP 3.0 mm Hg. The effect of treatment was significant for DBP but not for SBP. There were no other significant effects of treatment. This pilot study shows encouraging results regarding Internet-based biofeedback treatment for hypertensive adults. However, further research using a larger sample is needed.

  • 28.
    Pennlert, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wiklund, P. G.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wisten, A.
    Asberg, S.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Antithrombotic treatment following intracerebral hemorrhage in patients with and without atrial fibrillation. A nationwide study based on Riksstroke2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 294-295Article in journal (Other academic)
  • 29.
    Persson, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Mjörndal, Tom
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bohlin, Jens
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindholm, Lars Hjalmar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    1999 WHO/ISH Guidelines applied to a 1999 MONICA sample from northern Sweden2002In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, p. 29-35Article in journal (Refereed)
    Abstract [en]

    Background : Treating hypertension with drugs is so far the most cost-effective way to reduce this important risk factor for cardiovascular disease (CVD). It is, however, important to determine absolute risk, and thereby estimate indication for drug treatment, in order to maintain a cost-effective drug treatment. WHO/ISH Hypertension Guidelines from 1999 propose a risk stratification for estimating absolute risk for CVD based on blood pressure and additional risk factors, target organ damage (TOD) and CVD. Objectives : We studied the consequences of applying the recent WHO/ISH risk stratification scheme to a MONICA sample of 6000 subjects from a geographically defined population in northern Sweden, regarding indications for treatment, target blood pressure and risk distribution. Methods : We have risk-classified each of these patients using a computer program, according to the WHO/ISH scheme. Data on TOD were not available. Results : In all, 917 (15%) had drug-treated hypertension. Three-quarters (n = 737) were inadequately treated, with blood pressure levels at or above 140 or 90 mmHg. 1773 (30% of 5997) untreated subjects had a blood pressure of 140/90 or above; 16% in the low-, 62% in the medium-, 8% in the high-, and 14% in the very-high-risk group. The corresponding risk-group pattern for the inadequately treated hypertensives (n = 737) was 5.5, 48.3, 11.1 and 35.2%, respectively. If we shifted the target blood pressure from below 140/90 to below 130/85 for drug-treated subjects under 60 (n = 278) the number of inadequately treated subjects increased by 34 (12.2% of 278); 14 in the low-risk group, 15 in the medium-risk group, and only five in the high- or very-high-risk groups. Conclusions : Only one-fifth of the drug-treated hypertensives were well controlled. Moreover, the incidence of newly detected blood pressure elevation was high. The majority of younger subjects with high blood pressure had low risk, but in those aged 45-54 this had already risen to a medium risk. Changing the target blood pressure to below 130/85, for subjects aged below 60, as recommended by WHO/ISH, affects predominantly low- and medium-risk groups.

  • 30.
    Persson, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Leif
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Stegmayr, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindholm, Lars Hjalmar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Risk stratification by guidelines compared to tisk assessment by risk equations applied to a MONICA sample2003In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 21, no 6, p. 1089-1095Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization/International Society of Hypertension (WHO/ISH) Hypertension Guidelines from 1999 propose a risk stratification scheme for estimating absolute risk for cardiovascular disease (CVD). Risk equations estimated by statistical methods are another way of predicting cardiovascular risk. Objective: We studied the differences between these two approaches when applied to the same set of individuals with high blood pressure. Design and methods: The two northernmost counties in Sweden (NSW) constitute one of the centres in the WHO MONICA (monitoring trends and determinants in cardiovascular disease) Project. Three population surveys have been carried out in 1986, 1990 and 1994, and were used to estimate a risk equation for predicting the 10-year risk of fatal/non-fatal stroke and myocardial infarction. Another MONICA sample from 1999, a total of 5997 subjects, was classified according to the recent WHO/ISH risk stratification scheme. A risk assessment was also performed, by using the risk equations from the NSW MONICA sample and Framingham risk equations. Results: The agreement between the two methods was good when the values obtained from the risk equation were averaged for each risk group obtained from the risk classification by guidelines. However, if the predicted risk for each individual was considered, the agreement was poor for the medium and high-risk groups. Although the average risk for all individuals is the same, many subjects have a higher risk or a lower risk than predicted by guidelines. Conclusions: Risk classification by the 1999 WHO/ISH Hypertension Guidelines is not accurate and detailed enough for medium- and high-risk patients, which could be of clinical importance in the medium risk group.

  • 31.
    Sahlin, Carin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Sandberg, Olov
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Bucht, Gösta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Franklin, Karl
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up2008In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 168, no 3, p. 297-301Article in journal (Refereed)
    Abstract [en]

     

    Background: Sleep apnea occurs frequently among stroke patients, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality. We aimed to investigate whether obstructive or central sleep apnea was related to a reduced long-term survival among stroke patients.

    Methods: One hundred and thirty-two of 151 patients admitted for in-hospital stroke rehabilitation in the catchment area of Umeå from 1 April 1995 to 1 May 1997 underwent overnight sleep apnea recordings at 23 ± 8 days after onset of stroke. All patients were followed-up prospectively for a mean (SD) of 10.0 ± 0.6 years, with death as the primary outcome and no one was lost to follow-up. Obstructive sleep apnea was defined when the obstructive apnea-hypopnea index was over 15 and central sleep apnea when the central apnea-hypopnea index was over 15. Patients with an obstructive and a central apnea-hypopnea index below 15 served as controls.

    Results: Of 132 enrolled patients, 116 had died at follow-up. The risk of death was higher among the 23 patients with obstructive sleep apnea than controls (adjusted hazard ratio, 1.76; 95% confidence interval 1.05 to 2.95, p=0.03), independent of age, gender, body-mass index, smoking, hypertension, diabetes mellitus, atrial fibrillation, mini-mental state examination and Barthel activity of daily living There was no difference in mortality between the 28 patients with central sleep apnea and controls (adjusted hazard ratio, 1.07; 95 percent confidence interval 0.65 to 1.76, p=0.053).

    Conclusions: Stroke patients with obstructive sleep apnea run an increased risk of early death. Central sleep apnea was not related to early death among the present patients.

  • 32. Själander, A
    et al.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Bergqvist, D
    Eriksson, H
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Svensson, P
    Efficacy and safety of anticoagulant prophylaxis to prevent venous thromboembolism in acutely ill medical inpatients: a meta-analysis.2008In: J Intern Med, ISSN 1365-2796, Vol. 263, no 1, p. 52-60Article in journal (Refereed)
  • 33.
    Söderberg, Stefan
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Ekmehag, Björn
    Jansson, Kjell
    Larsen, Flemming
    Lockowandt, Ulf
    Nisell, Magnus
    Selimovic, Nedim
    Ullman, Bengt
    Wall, Kent
    Wikström, Gerhard
    Genmäle om begäran om lungskintigrafi: en akademisk studie som vi tror kan förändra vården av kronisk lungemboli2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 24-25, p. 1316-1317Article in journal (Other academic)
  • 34.
    Törmä, Ellinor
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Long term trends in control of hypertension in the Northern Sweden MONICA study 1986-20092015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 957Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A large proportion of treated hypertensive subjects do not achieve target blood pressure (BP) levels. We investigated trends in treatment and BP levels in the population, and among treated hypertensive subjects in northern Sweden.

    METHODS: The six Northern Sweden MONICA population surveys 1986 to 2009, included 6342 subjects aged 45 to 74 years of age, participation rate 79.3 %. Factors associated with lack of BP control are presented for 1106 participants in 2009. BP control was defined as a systolic BP <140 and a diastolic BP <90 mm Hg among treated hypertensive patients.

    RESULTS: Between 1986 and 2009, the proportion of the population that received antihypertensive treatment increased. The proportion of the whole population having BP <140/90 mm Hg increased for all (p < 0.001 for each subgroup), except for men 45-55 years old. In 2009, 62.4 % of the population had BP <140/90 mm Hg, 67.2 % in women and 58.1 % in men (p = 0.002). In the group of treated hypertensive patients, the proportion having BP control increased (p < 0.001) with no difference between sex or age groups. In 2009 52.1 % of treated hypertensives had BP control. In 2009, adequate BP control among treated hypertensive patients was 63.9 % for those with BMI <25, but only 48.8 % for those with BMI > 25 (p = 0.015). Abdominal obesity was associated with less BP control (48.1 %) than without abdominal obesity (66.2 %, p = 0.007). Women who were physically inactive had better BP control than those who were active (p = 0.03). Men treated with two or more antihypertensive drugs were 50 % more likely to reach target BP than men with monotherapy (60.4 % vs. 40.0 %, p = 0.035). Rural or urban living, level of education, diabetes mellitus or having a high cardiovascular risk were not associated with better BP control.

    CONCLUSION: Antihypertensive treatment and BP control have increased in northern Sweden since 1986, although in 2009 still barely half of the treated patients achieved adequate BP levels. Intensified treatment and weight reduction may help to further improve BP control.

  • 35. Veerabhadrappa, Praveen
    et al.
    Burger, Dylan
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Charchar, Fadi
    Tomaszewski, Maciej
    Harrap, Stephen
    ISH Hypertension Future Leaders Group: a network for new investigators run by new investigator2011In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 29, no 8, p. 1664-1665Article in journal (Refereed)
  • 36. Veerabhadrappa, Praveen
    et al.
    Burger, Dylan
    Charchar, Fadi
    Tomaszewski, Maciej
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Harrap, Stephen
    Touyz, Rhian M
    Council for high blood pressure research/InterAmerican society of hypertension/International society of hypertension: first new investigators symposium at the high blood pressure research 2011 scientific sessions2012In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 59, no 2, p. 382-383Article in journal (Refereed)
    Abstract [en]

    For the very first time, the International Society of Hypertension (ISH) sponsored the ISH New Investigators Symposium on September 21, 2011, in Orlando, FL, entitled, “A Global Hypertension Initiative: Trainee/New Investigator Session” as part of the High Blood Pressure Research 2011 Scientific Sessions. This symposium was cosponsored by ISH, the InterAmerican Society of Hypertension, the American Heart Association's Council for High Blood Pressure Research and the Council on the Kidney in Cardiovascular Disease, and was organized entirely by the newly formed ISH New Investigators Committee (NIC; Figure 1) and young/new investigators (students, postdoctoral fellows, and early career scientists) in hypertension research.1 The symposium consisted of a half-day event with both oral and poster presentations of highly rated abstracts highlighting the most recent advances in hypertension research by young researchers. The scientific program was abstract based with >100 abstracts reviewed by new investigators as assigned by NIC. Top-scoring abstracts received an invitation for either oral or poster presentation based on their scientific merit. The program provided an opportunity for learning, networking, and socializing among budding scientists from around the world. More than 50 new investigators across 5 continents presented their research at the session, making it a truly “global” hypertension initiative, which was targeted toward young researchers.

  • 37.
    Weidung, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Boström, Gustaf
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Toots, Annika
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Blood Pressure, Gait Speed, and Mortality in Very Old Individuals: A Population-Based Cohort Study2015In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, no 3, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Objectives: Clinical trials and observational studies have produced contradictory results regarding the association of blood pressure (BP) and mortality in people aged 80 years or older. Gait speed at usual pace has been shown to moderate this association in a population of noninstitutionalized people aged 65 years or older. The aims of this study were to investigate the association of BP with all-cause mortality in a representative sample of people aged 85 years or older and to assess whether gait speed moderates this association.

    Design, Setting, and Participants: A total of 806 participants in the population-based prospective Umeå 85+/GERDA study aged 85, 90, and 95 years or older.

    Measurements: Gait speed at usual pace was measured over 2.4 m. The main outcome was hazard ratios (HRs) for all-cause mortality according to systolic and diastolic BP categories in the total sample and in faster-walking (≥0.5 m/s, n = 312) and slower-walking (<0.5 m/s, n = 433) subcohorts; the latter also included habitually nonwalking participants. Comprehensive adjustments were made for sociodemographic and clinical characteristics associated with death.

    Results: Mean age and baseline systolic and diastolic BP were 89.6 ± 4.6 years, 146.8 ± 23.9 mm Hg, and 74.8 ± 11.1 mm Hg, respectively. Most (n = 561 [69%]) participants were women, 315 (39%) were care facility residents, and 566 (70%) were prescribed BP-lowering drugs. Within 5 years, 490 (61%) participants died. In the total sample and slower-walking subcohort, systolic BP appeared to be inversely associated with mortality, although not independent of adjustments. Among faster-walking participants, mortality risk after adjustment was more than 2 times higher in those with systolic BP of 140 to 149 mm Hg (HR = 2.25, 95% confidence interval [CI] = 1.03–4.94) and 165 mm Hg or higher (HR = 2.13, 95% CI = 1.01–4.49), compared with systolic BP of 126 to 139 mm Hg. Mortality risk was also independently higher in faster-walking participants with diastolic BP higher than 80 mm Hg, compared with diastolic BP of 75 to 80 mm Hg (HR = 1.76, 95% CI = 1.07–2.90).

    Conclusion: The gait speed threshold of 0.5 m/s may be clinically useful for the distinction of very old people with and without increased all-cause mortality risk due to elevated systolic and diastolic BP.

  • 38.
    Weidung, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    The association between SBP and mortality risk differs with level of cognitive function in very old individuals2016In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 34, no 4, p. 745-752Article in journal (Refereed)
    Abstract [en]

    Objective:Cognitive impairment and dementia are highly prevalent in very old populations. Cardiovascular disease is a common cause of death in people with dementia.This study investigated whether the association of blood pressure (BP) with mortality differed with respect to mini-mental state examination (MMSE) score in a representative sample of very old individuals.Methods:The sample consisted of 1115 participants aged 85, 90, and at least 95 years from the Umea85+/GErontological Regional DAtabase cohort study. The main outcome was all-cause mortality within 2 years according to BP and MMSE score, using Cox proportional-hazard regression models adjusted for sociodemographic and clinical characteristics associated with death.Results:Mean age, MMSE score, and SBP and DBP were 89.44.6 years, 21.1 +/- 7.6, 146.1 +/- 23.4mmHg, and 74.1 +/- 11.7mmHg, respectively. Within 2 years, 293 (26%) participants died. BP was not associated independently with mortality risk, except among participants with MMSE scores of 0-10 among whom mortality risk was increased in association with SBP at least 165mmHg and 125mmHg or less, compared with 126-139mmHg (adjusted hazard ratio 4.54, 95% confidence interval=1.52-13.60 and hazard ratio 2.23, 95% confidence interval=1.12-4.45, respectively). In age and sex-adjusted analyses, SBP 125mmHg or less was associated with increased mortality risk in participants with MMSE scores at least 18.Conclusion:In people aged at least 85 years, the association of SBP with mortality appears to differ with respect to MMSE score. Very old individuals with very severe cognitive impairment and low or high BP may have increased mortality risk.

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