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  • 1. Bakris, George L
    et al.
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Black, Henry R
    Krum, Henry
    Linas, Stuart
    Linseman, Jennifer V
    Arterburn, Sarah
    Sager, Philip
    Weber, Michael
    Divergent results using clinic and ambulatory blood pressures report of a darusentan-resistant hypertension trial2010In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 56, no 5, p. 824-830Article in journal (Refereed)
    Abstract [en]

    Patients with resistant hypertension are at increased risk for cardiovascular events. The addition of new treatments to existing therapies will help achieve blood pressure (BP) goals in more resistant hypertension patients. In the current trial, 849 patients with resistant hypertension receiving ≥3 antihypertensive drugs, including a diuretic, at optimized doses were randomized to the selective endothelin A receptor antagonist darusentan, placebo, or the central α-2 agonist guanfacine. The coprimary end points of the study were changes from baseline to week 14 in trough, sitting systolic BP, and diastolic BP measured in the clinic. Decreases from baseline to week 14 in systolic BP for darusentan (−15±14 mm Hg) were greater than for guanfacine (−12±13 mm Hg; P<0.05) but not greater than placebo (−14±14 mm Hg). Darusentan, however, reduced mean 24-hour systolic BP (−9±12 mm Hg) more than placebo (−2±12 mm Hg) or guanfacine (−4±12 mm Hg) after 14 weeks of treatment (P<0.001 for each comparison). The most frequent adverse event associated with darusentan was fluid retention/edema at 28% versus 12% in each of the other groups. More patients withdrew because of adverse events on darusentan as compared with placebo or guanfacine. We conclude that darusentan provided greater reduction in systolic BP in resistant hypertension patients as assessed by ambulatory BP monitoring, in spite of not meeting its coprimary end points. The results of this trial highlight the importance of ambulatory BP monitoring in the design of hypertension clinical studies.

  • 2. Bejan-Angoulvant, Theodora
    et al.
    Saadatian-Elahi, Mitra
    Wright, James M
    Schron, Eleanor B
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Fagard, Robert
    Staessen, Jan A
    Gueyffier, François
    Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials.2010In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 28, no 7, p. 1366-1372Article in journal (Refereed)
    Abstract [en]

    Background: Results of randomized controlled trials are consistent in showing reduced rates of stroke, heart failure and cardiovascular events in very old patients treated with antihypertensive drugs. However, inconsistencies exist with regard to the effect of these drugs on total mortality.

    Methods: We performed a meta-analysis of available data on hypertensive patients 80 years and older by selecting total mortality as the main outcome. Secondary outcomes were coronary events, stroke, cardiovascular events, heart failure and cause-specific mortality. The common relative risk (RR) of active treatment versus placebo or no treatment was assessed using a random-effect model. Linear meta-regression was performed to explore the relationship between intensity of antihypertensive therapy and blood pressure (BP) reduction and the log-transformed value of total mortality odds ratios (ORs).

    Results: The overall RR for total mortality was 1.06 (95% confidence interval 0.89–1.25), with significant heterogeneity between hypertension in the very elderly trial (HYVET) and the other trials. This heterogeneity was not explained by differences in the follow-up duration between trials. The meta-regression suggested that a reduction in mortality was achieved in trials with the least BP reductions and the lowest intensity of therapy. Antihypertensive therapy significantly reduced (P < 0.001) the risk of stroke (35%), cardiovascular events (27%) and heart failure (50%). Cause-specific mortality was not different between treated and untreated patients.

    Conclusion: Treating hypertension in very old patients reduces stroke and heart failure with no effect on total mortality. The most reasonable strategy is the one associated with significant mortality reduction; thiazides as first-line drugs with a maximum of two drugs.

  • 3. Black, HR
    et al.
    Bakris, GL
    Weber, MA
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Darusentan for resistant hypertension2006In: Journal of Hypertension, Vol. 24, p. 95-96Article in journal (Other academic)
  • 4.
    Brunström, Mattias
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dahlström, John
    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.
    Lönnberg, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hallström, Sara
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Persson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Weinehall, Lars
    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.
    From efficacy in trials to effectiveness in clinical practice: The Swedish Stroke Prevention Study2016In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 25, no 4, p. 206-211Article in journal (Refereed)
    Abstract [en]

    Blood pressure treatment has shown great efficacy in reducing cardiovascular events in randomized controlled trials. If this is effective in reducing cardiovascular disease in the general population, is less studied. Between 2001 and 2009 we performed an intervention to improve blood pressure control in the county of Vasterbotten, using Sodermanland County as a control. The intervention was directed towards primary care physicians and included lectures on blood pressure treatment, a computerized decision support system with treatment recommendations, and yearly feed back on hypertension control. Each county had approximately 255000 inhabitants. Differences in age and incidence of cardiovascular disease were small. During follow-up, more than 400000 patients had their blood pressure recorded. The mean number of measurements was eight per patient, yielding a total of 3.4 million blood pressure recordings. The effect of the intervention will be estimated combining the blood pressure data collected from the electronic medical records, with data on stroke, myocardial infarction and mortality from Swedish health registers. Additional variables, from health registers and Statistics Sweden, will be collected to address for confounders. The blood pressure data collected within this study will be an important asset for future epidemiological studies within the field of hypertension.

  • 5.
    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)
  • 6.
    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)
  • 7.
    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)
  • 8. Carr, Albert A
    et al.
    Kowey, Peter R
    Devereux, Richard B
    Brenner, Barry M
    Dahlöf, Björn
    Ibsen, Hans
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Lyle, Paulette A
    Snapinn, Steven M
    Zhang, Zhongxin
    Edelman, Jonathan M
    Shahinfar, Shahnaz
    Hospitalizations for new heart failure among subjects with diabetes mellitus in the RENAAL and LIFE studies.2005In: Am J Cardiol, ISSN 0002-9149, Vol. 96, no 11, p. 1530-6Article in journal (Refereed)
  • 9. Cicala, Silvana
    et al.
    de Simone, Giovanni
    Gerdts, Eva
    Dahlöf, Björn
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kjeldsen, Sverre E
    Devereux, Richard B
    Are coronary revascularization and myocardial infarction a homogeneous combined endpoint in hypertension trials? The Losartan intervention for endpoint reduction in hypertension study2010In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 28, no 6, p. 1134-1140Article in journal (Refereed)
    Abstract [en]

    Objective: Construction of prognostically relevant endpoints for clinical trials in hypertension has increasingly included coronary revascularization with myocardial infarction (MI) as manifestations of coronary artery disease. However, whether coronary revascularization and MI predict other cardiovascular events similarly is unknown.

     

    Methods: We examined risks of cardiovascular death, all-cause death, and stroke following MI or coronary revascularization in hypertensive patients with left ventricular hypertrophy (LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE). We studied 9113 patients after excluding those who died within 7 days after MI or underwent coronary revascularization within 24 h after MI.

     

    Results: In multivariate Cox regression adjusting for participating countries, time-varying systolic blood pressure, and Framingham risk score, hazard ratios for cardiovascular death, all-cause death, and stroke were, respectively, 4.5 (P < 0.0001), 2.9 (P < 0.0001), and 1.9 (P = 0.003) in 321 patients with MI as first event. In similar models, coronary revascularization as first event (n = 202) was not associated with increased risks of cardiovascular death, all-cause death, and stroke (P = 0.06–0.86).

     

    Conclusion: During follow-up of hypertensive patients with LVH, occurrence of MI but not coronary revascularization as first cardiovascular event significantly increased risk of subsequent cardiovascular death, all-cause death, and stroke. In view of differences in prognostic implications, when the goal is to have a prognostically relevant composite endpoint for trials in hypertensive patients, caution should be used in combining coronary revascularization with MI.

  • 10. de Simone, G
    et al.
    Wachtell, K
    Palmieri, V
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Body build and risk of cardiovascular events in hypertension: The LIFE study2005In: Circulation, Vol. 110, no suppl, p. 771-Article in journal (Other academic)
  • 11. de Simone, Giovanni
    et al.
    Wachtell, Kristian
    Palmieri, Vittorio
    Hille, Darcy A
    Beevers, Gareth
    Dahlöf, Björn
    de Faire, Ulf
    Fyhrquist, Frej
    Ibsen, Hans
    Julius, Stevo
    Kjeldsen, Sverre E
    Lederballe-Pedersen, Ole
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Omvik, Per
    Oparil, Suzanne
    Devereux, Richard B
    Body build and risk of cardiovascular events in hypertension and left ventricular hypertrophy: the LIFE (Losartan Intervention For Endpoint reduction in hypertension) study.2005In: Circulation, ISSN 1524-4539, Vol. 111, no 15, p. 1924-31Article in journal (Refereed)
  • 12. Devereux, Richard B
    et al.
    de Faire, Ulf
    Fyhrquist, Frej
    Harris, Katherine E
    Ibsen, Hans
    Kjeldsen, Sverre E
    Lederballe-Pedersen, Ole
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Omvik, Per
    Oparil, Suzanne
    Wedel, Hans
    Hille, Darcy A
    Dahlöf, Björn
    Blood pressure reduction and antihypertensive medication use in the losartan intervention for endpoint reduction in hypertension (LIFE) study in patients with hypertension and left ventricular hypertrophy.2007In: Curr Med Res Opin, ISSN 1473-4877, Vol. 23, no 2, p. 259-70Article in journal (Refereed)
  • 13. Eijkelkamp, Wouter B A
    et al.
    Zhang, Zhongxin
    Brenner, Barry M
    Cooper, Mark E
    Devereux, Richard B
    Dahlöf, Björn
    Ibsen, Hans
    Keane, William F
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Olsen, Michael H
    Parving, Hans-Henrik
    Remuzzi, Giuseppe
    Shahinfar, Shahnaz
    Snapinn, Steven M
    Wachtell, Kristian
    de Zeeuw, Dick
    Renal function and risk for cardiovascular events in type 2 diabetic patients with hypertension: the RENAAL and LIFE studies.2007In: Journal of Hypertension, ISSN 0263-6352, Vol. 25, no 4, p. 871-6Article in journal (Refereed)
  • 14. Fagard, R H
    et al.
    Grassi, G
    Hall, J
    Harrap, S
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Schiffrin, E
    Heagerty, T
    International Society of Hypertension Low and Middle Income Countries Committee Review of the Goals of the Committee and of 5 years of ISH activities in Low and Middle Income Countries2010In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 28, no 3, p. 635-636Article in journal (Refereed)
  • 15. Fossum, Eigil
    et al.
    Moan, Andreas
    Kjeldsen, Sverre E
    Devereux, Richard B
    Julius, Stevo
    Snapinn, Steven M
    Edelman, Jonathan M
    de Faire, Ulf
    Fyhrquist, Frej
    Ibsen, Hans
    Kristianson, Krister
    Lederballe-Pedersen, Ole
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Omvik, Per
    Oparil, Suzanne
    Wedel, Hans
    Dahlöf, Björn
    The effect of losartan versus atenolol on cardiovascular morbidity and mortality in patients with hypertension taking aspirin: the Losartan Intervention for Endpoint Reduction in hypertension (LIFE) study.2005In: J Am Coll Cardiol, ISSN 0735-1097, Vol. 46, no 5, p. 770-5Article in journal (Refereed)
  • 16. Fyhrquist, Frej
    et al.
    Dahlöf, Björn
    Devereux, Richard B
    Kjeldsen, Sverre E
    Julius, Stevo
    Beevers, Gareth
    de Faire, Ulf
    Ibsen, Hans
    Kristianson, Krister
    Lederballe-Pedersen, Ole
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Omvik, Per
    Oparil, Suzanne
    Hille, Darcy A
    Lyle, Paulette A
    Edelman, Jonathan M
    Snapinn, Steven M
    Wedel, Hans
    Pulse pressure and effects of losartan or atenolol in patients with hypertension and left ventricular hypertrophy.2005In: Hypertension, ISSN 1524-4563, Vol. 45, no 4, p. 580-5Article in journal (Refereed)
  • 17. Halldin, Mats
    et al.
    Hjemdahl, Paul
    de Faire, Ulf
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Samuelsson, Ola
    [Reply from the SBU about salt and high blood pressure: More controlled long-term trials are required]2004In: Lakartidningen, ISSN 0023-7205, Vol. 101, no 51-52, p. 4257-Article in journal (Other academic)
  • 18.
    Hedblad, B
    et al.
    Lund Univ, Malmö, Sweden .
    Melander, H
    Med Prod Agcy, Uppsala, Sweden .
    de Faire, U
    Karolinska Inst, Stockholm, Sweden .
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kahan, T
    Karolinska Inst, Stockholm, Sweden .
    Beta blockers reduce left ventricular mass less than other antihypertensive drugs: a systematic review and meta analysis2009In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 27, no Suppl. 4, p. s319-s319Article in journal (Refereed)
  • 19. Ibsen, Hans
    et al.
    Wachtell, Kristian
    Olsen, Michael H
    Borch-Johnsen, Knut
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Mogensen, Carl Erik
    Dahlöf, Björn
    Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE Study.2004In: Kidney Int Suppl, ISSN 0098-6577, no 92, p. S56-8Article in journal (Refereed)
  • 20. Ibsen, Hans
    et al.
    Wachtell, Kristian
    Olsen, Michael H
    Borch-Johnsen, Knut
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Mogensen, Carl Erik
    Dahlöf, Björn
    Devereux, Richard B
    de Faire, Ulf
    Fyhrquist, Frej
    Julius, Stevo
    Kjeldsen, Sverre E
    Lederballe-Pedersen, Ole
    Nieminen, Markku S
    Omvik, Per
    Oparil, Suzanne
    Wan, Ying
    Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy? A LIFE substudy.2004In: J Hypertens, ISSN 0263-6352, Vol. 22, no 9, p. 1805-11Article in journal (Refereed)
  • 21. Jönsson, Bengt
    et al.
    Carides, George W
    Burke, Thomas A
    Dasbach, Erik J
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Dahlöf, Björn
    Cost effectiveness of losartan in patients with hypertension and LVH: an economic evaluation for Sweden of the LIFE trial.2005In: J Hypertens, ISSN 0263-6352, Vol. 23, no 7, p. 1425-31Article in journal (Refereed)
  • 22. Kizer, Jorge R
    et al.
    Dahlöf, Björn
    Kjeldsen, Sverre E
    Julius, Stevo
    Beevers, Gareth
    de Faire, Ulf
    Fyhrquist, Frej
    Ibsen, Hans
    Kristianson, Krister
    Lederballe-Pedersen, Ole
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Omvik, Per
    Oparil, Suzanne
    Wedel, Hans
    Wachtell, Kristian
    Edelman, Jonathan M
    Snapinn, Steven M
    Harris, Katherine E
    Devereux, Richard B
    Stroke reduction in hypertensive adults with cardiac hypertrophy randomized to losartan versus atenolol: the Losartan Intervention For Endpoint reduction in hypertension study.2005In: Hypertension, ISSN 1524-4563, Vol. 45, no 1, p. 46-52Article in journal (Refereed)
  • 23. Kizer, JR
    et al.
    Hoieggen, A
    Alderman, MH
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Serum uric acid and ischemic stroke risk among hypertensive patients with left ventricular hypertrophy: the losartan intervention for endpoint reduction in hypertension.2004In: Journal of the American College of Cardiology: Suppl, Vol. 43, p. 475A-Article in journal (Other academic)
  • 24. Kjeldsen, SE
    et al.
    Dahlöf, B
    Devereaux, RB
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Benefits of losartan on preventing stroke in patients with isolated systolic hypertension:: A LIFE substudy2004In: Journal of the Americal College of Cardiology, Vol. 43, p. 482 A-Article in journal (Other academic)
  • 25.
    Kjeldsen, Sverre E
    et al.
    University of Oslo, Ullevaal Hospital, Oslo, Norway.
    Devereux, Richard B
    Weill Cornell Medical College, New York, NY, USA.
    Hille, Darcy A
    Merck Research Laboratories, North Wales, PA, USA.
    Lyle, Paulette A
    Merck Research Laboratories, North Wales, PA, USA.
    Dahlöf, Björn
    Sahlgrenska University Hospital/Östra, Göteborg, Sweden.
    Julius, Stevo
    University of Michigan Medical Center, Ann Arbor, MI, USA.
    Edelman, Jonathan M
    Merck Research Laboratories, North Wales, PA, USA.
    Snapinn, Steven M
    Merck Research Laboratories, North Wales, PA, USA.
    de Faire, Ulf
    Karolinska University Hospital, Stockholm, Sweden.
    Fyhrquist, Frej
    Helsinki University Central Hospital, Helsinki, Finland.
    Ibsen, Hans
    Holbaek Hospital, Holbaek, Denmark.
    Lederballe-Pedersen, Ole
    Viborg Hospital, Viborg, Denmark.
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Helsinki University Central Hospital, Helsinki, Finland.
    Omvik, Per
    Haukeland University Hospital, Bergen, Norway.
    Oparil, Suzanne
    University of Alabama Medical Center, Birmingham, AL, USA.
    Wedel, Hans
    Nordic School of Public Health, Göteborg, Sweden.
    Predictors of cardiovascular events in patients with hypertension and left ventricular hypertrophy: the losartan inventervention for endpoint reduction in hypertension study2009In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 18, no 6, p. 348-361Article in journal (Refereed)
    Abstract [en]

    Objective. We assessed readily available patient characteristics, including albuminuria (not included in traditional cardiovascular risk scores), as predictors of cardiovascular events in hypertension with left ventricular hypertrophy (LVH) and developed risk algorithms/scores for outcomes.

    Methods. The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study compared effects of losartan-based versus atenolol-based therapy on cardiovascular events in 9193 patients with hypertension and LVH. Univariate and multivariate analyses identified baseline variables with significant impact on development of the primary composite endpoint (cardiovascular death, stroke and myocardial infarction) and its components. Multivariate analysis used a Cox regression model with stepwise selection process. Risk scores were developed from coefficients of risk factors from the multivariate analysis, validated internally using naïve and jack-knife procedures, checked for discrimination and calibration, and compared with Framingham coronary heart disease and other risk scores.

    Results. LIFE risk scores showed increasing endpoint rates with increasing quintile (first to fifth quintile, composite endpoint 2.8–26.7%, cardiovascular death 0.5–14.4%, stroke 1.2–11.3%, myocardial infarction 1.4–8.1%) and were confirmed with a jack-knife approach that adjusts for potentially optimistic bias. The Framingham coronary heart disease and other risk scores overestimated risk in lower risk patients and underestimated risk in higher risk patients, except for myocardial infarction.

    Conclusion. A number of patient characteristics predicted cardiovascular events in patients with hypertension and LVH. Risk scores developed from these patient characteristics, including albuminuria, strongly predicted outcomes and may improve risk assessment of patients with hypertension and LVH and planning of clinical trials.

  • 26. Kjeldsen, Sverre E
    et al.
    Lyle, Paulette A
    Kizer, Jorge R
    Dahlöf, Björn
    Devereux, Richard B
    Julius, Stevo
    Beevers, Gareth
    de Faire, Ulf
    Fyhrquist, Frej
    Ibsen, Hans
    Kristianson, Krister
    Lederballe-Pedersen, Ole
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Omvik, Per
    Oparil, Suzanne
    Snapinn, Steven M
    Harris, Katherine E
    Wedel, Hans
    The effects of losartan compared to atenolol on stroke in patients with isolated systolic hypertension and left ventricular hypertrophy. The LIFE study.2005In: J Clin Hypertens (Greenwich), ISSN 1524-6175, Vol. 7, no 3, p. 152-8Article in journal (Refereed)
  • 27. Kjeldsen, Sverre E
    et al.
    Lyle, Paulette A
    Tershakovec, Andrew M
    Devereux, Richard B
    Oparil, Suzanne
    Dahlöf, Björn
    de Faire, Ulf
    Fyhrquist, Frej
    Ibsen, Hans
    Kristianson, Krister
    Lederballe-Pedersen, Ole
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Nieminen, Markku S
    Omvik, Per
    Wedel, Hans
    Targeting the renin-angiotensin system for the reduction of cardiovascular outcomes in hypertension: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.2005In: Expert Opin Emerg Drugs, ISSN 1744-7623, Vol. 10, no 4, p. 729-45Article in journal (Refereed)
  • 28. Kohler, Stefan
    et al.
    Annerstedt, Kristi Sidney
    Diwan, Vishal
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Randive, Bharat
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Department of Public Health and Environment, R. D. Gardi Medical College, Ujjain, India..
    Vora, Kranti
    De Costa, Ayesha
    Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 427Article in journal (Refereed)
    Abstract [en]

    Background: There has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women.

    Methods: A convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics.

    Results: Forty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0-3 days postpartum: 0.28 vs. 0.57, 3-7 days postpartum: 0.59 vs. 0.81; P<0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, painordiscomfort; P0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21-30 days postpartum: 0.85 vs. 0.93; P<0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted (P=0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P<0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3.

    Conclusions: Vaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is asuitable instrumentto assess postpartum QOL in Indian women.

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