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  • 51.
    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)
  • 52.
    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)
  • 53. 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.

  • 54.
    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.

  • 55. 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)
  • 56.
    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.

  • 57. Pawlas, Natalia
    et al.
    Strömberg, Ulf
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Cerna, Milena
    Harari, Florencia
    Harari, Raul
    Horvat, Milena
    Hruba, Frantiska
    Koppova, Kvetoslava
    Krskova, Andrea
    Krsnik, Mladen
    Li, Yu-Feng
    Löfmark, Lina
    Lundh, Thomas
    Lundström, Nils-Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Lyoussi, Badiaa
    Markiewicz-Gorka, Iwona
    Mazej, Darja
    Osredkar, Josko
    Pawlas, Krystyna
    Rentschler, Gerda
    Spevackova, Vera
    Spiric, Zdravko
    Sundkvist, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Tratnik, Janja Snoj
    Vadla, Drazenka
    Zizi, Soumia
    Skerfving, Staffan
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Cadmium, mercury and lead in blood of urban women in Croatia, the Czech Republic, Poland, Slovakia, Slovenia, Sweden, China, Ecuador and Morocco2013In: International Journal of Occupational Medicine and Environmental Health, ISSN 1232-1087, E-ISSN 1896-494X, Vol. 26, no 1, p. 58-72Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to make an international comparison of blood levels of cadmium (B-Cd), lead (B-Pb) and mercury (B-Hg) of women in seven European, and three non-European cities, and to identify determinants. About 50 women (age: 46-62) from each city were recruited (totally 480) in 2006-2009. Interview and questionnaire data were obtained. Blood samples were analysed in one laboratory to avoid interlaboratory variation. Between the European cities, the B-Pb and B-Cd results vary little (range of geometric means: 13.5-27.0 mu g/l and 0.25-0.65 mu g/l, respectively); the variation of B-Hg was larger (0.40-1.38 mu g/l). Between the non-European cities the results for B-Pb, B-Cd and B-Hg were 19.2-68.0, 0.39-0.99 and 1.01-2.73 mu g/l, respectively. Smoking was a statistically significant determinant for B-Cd, while fish and shellfish intakes contributed to B-Hg and B-Pb, amalgam fillings also contributed to B-Hg. The present results confirm the previous results from children; the exposure to lead and cadmium varies only little between different European cities suggesting that other factors than the living area are more important. The study also confirms the previous findings of higher cadmium and lead levels in some non-European cities. The geographical variation for mercury is significant.

  • 58.
    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)
  • 59.
    Pennlert, Johanna
    et al.
    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.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wiklund, Per-Gunnar
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Long-Term Risk and Predictors of Recurrent Stroke Beyond the Acute Phase2014In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 45, no 6, p. 1839-1841Article in journal (Refereed)
    Abstract [en]

    Background and Purpose-Previous studies have shown heterogeneous results on predictors and rates of stroke recurrence. This study set out to investigate the long-term risk and predictors of recurrent stroke in Northern Sweden 1995 to 2008.

    Methods-In the population-based Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) stroke incidence registry, stroke survivors of either ischemic stroke or intracerebral hemorrhage were followed for recurrent stroke or death. Cox regression was used to identify predictors of stroke recurrence.

    Results-The study comprised 6700 patients and 26 597 person-years. During follow-up, 928 (13.9%) patients had a recurrent stroke. Comparison between the first time period (1995-1998) and the last (2004-2008) showed declined risk of stroke recurrence (hazard ratio, 0.64 [95% confidence interval, 0.52-0.78]). Previous myocardial infarction was less prevalent in the most recent cohort (P<0.001). Predictors of stroke recurrence were age (hazard ratio, 1.03 [95% confidence interval, 1.02-1.04]) and diabetes mellitus (hazard ratio, 1.34 [95% confidence interval, 1.15-1.57]). After an index intracerebral hemorrhage (n=815), a major part of recurrent events were ischemic (63%), and compared with the ischemic stroke group (n=5885), a tendency toward lower risk of recurrence was observed.

    Conclusions-Despite declining recurrence rates in this relatively young stroke population, almost one third are either dead or have experienced a second stroke in 5 years.

  • 60.
    Pennlert, Johanna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Overholser, Rosanna
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium.
    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.
    Van Rompaye, Bart
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Belgium.
    Wiklund, Per-Gunnar
    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.
    Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation2017In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 2, p. 314-320Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: This study aims to provide observational data on the relationship between the timing of antithrombotic treatment and the competing risks of severe thrombotic and hemorrhagic events in a cohort of Swedish patients with atrial fibrillation and intracerebral hemorrhage (ICH).

    METHODS: Patients with atrial fibrillation and a first-ever ICH were identified in the Swedish Stroke Register, Riksstroke, 2005 to 2012. Riksstroke was linked with other national registers to find information on treatment, comorbidity, and outcome. The optimal timing of treatment in patients with low and high thromboembolic risk was described through cumulative incidence functions separately for thrombotic and hemorrhagic events and for the combined end point vascular death or nonfatal stroke.

    RESULTS: The study included 2619 ICH survivors with atrial fibrillation with 5759 person-years of follow-up. Anticoagulant treatment was associated with a reduced risk of vascular death and nonfatal stroke in high-risk patients with no significantly increased risk of severe hemorrhage. The benefit seemed to be greatest when treatment was started 7 to 8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within 3 years was 17.0% when anticoagulant treatment was initiated 8 weeks after ICH and 28.6% without any antithrombotic treatment (95% confidence interval for difference, 1.4%-21.8%). For high-risk men, the corresponding risks were 14.3% versus 23.6% (95% confidence interval for difference, 0.4%-18.2%).

    CONCLUSIONS: This nationwide observational study suggests that anticoagulant treatment may be initiated 7 to 8 weeks after ICH in patients with atrial fibrillation to optimize the benefit from treatment and minimize risk.

  • 61.
    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.

  • 62.
    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.

  • 63.
    Persson, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Mjörndal, Tom
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Pharmacology.
    Carlberg, Bo
    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.
    Evaluation of a computer-based decision support system for treatment of hypertension with drugs: retrospective, nonintervention testing of cost and guideline adherence2000In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 247, no 1, p. 87-93Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate a computerized decision support system (DSS) for drug treatment of hypertension, regarding quality, safety, and cost compared to actual antihypertensive drug treatment.

    Design. The medical profiles of 338 hypertensive patients treated with drugs against hypertension were processed by the DSS. The drug treatment proposed by the system was then compared to actual treatment given by their physician.

    Setting. Four health centres in the county of Västerbotten, in Sweden.

    Subjects. A list of hypertensive patients was extracted from the computerized medical records of each health centre and every fifth patient’s medical profile was assessed by the system.

    Interventions. None.

    Main outcome measures. Drug used, drug used in relation to certain major diseases such as diabetes mellitus, asthma, ischaemic heart disease (IHD), and previous myocardial infarction. Adherence to hypertension guidelines, safety, and cost.

    Results. The DSS suggested significantly more thiazides and significantly fewer calcium antagonists than the physicians had prescribed, with a total cost reduction of 33–40%, depending on doses chosen. The DSS drug profile was more adherent to guidelines in patients with major complicating diseases, suggesting an improvement in treatment quality for these patients by the DSS.

    Conclusion. The DSS which fully implements current guidelines may improve the quality of antihypertensive treatment, concurrently leading to a considerable reduction in drug costs.

  • 64.
    Persson, Sven-Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Wanhainen, Anders
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Arnerlöv, Conny
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Decreasing prevalence of abdominal aortic aneurysm and changes in cardiovascular risk factors2017In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 65, no 3, p. 651-658Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A significant reduction in the incidence of cardiovascular disease, including abdominal aortic aneurysm (AAA), has been observed in the past decades. In this study, a small but geographically well defined and carefully characterized population, previously screened for AAA and risk factors, was re-examined 11 years later. The aim was to study the reduction of AAA prevalence and associated factors.

    METHODS: All men and women aged 65 to 75 years living in the Norsjö municipality in northern Sweden in January 2010 were invited to an ultrasound examination of the abdominal aorta, registration of body parameters and cardiovascular risk factors, and blood sampling. An AAA was defined as an infrarenal aortic diameter ≥30 mm. Results were compared with a corresponding investigation conducted in 1999 in the same region.

    RESULTS: A total of 602 subjects were invited, of whom 540 (90%) accepted. In 2010, the AAA prevalence was 5.7% (95% confidence interval [CI], 2.8%-8.5%) among men compared with 16.9% (95% CI, 12.3%-21.6%) in 1999 (P < .001). The corresponding figure for women was 1.1% (95% CI, 0.0%-2.4%) vs 3.5% (95% CI, 1.2%-5.8%; P = .080). A low prevalence of smoking was observed in 2010 as well as in 1999, with only 13% and 10% current smokers, respectively (P = .16). Treatment for hypertension was significantly more common in 2010 (58% vs 44%; P < .001). Statins increased in the population (34% in 2010 vs 3% in 1999; P < .001), and the lipid profile in women had improved significantly between 1999 and 2010.

    CONCLUSIONS: A highly significant reduction in AAA prevalence was observed during 11 years in Norsjö. Treatment for hypertension and with statins was more frequent, whereas smoking habits remained low. This indicates that smoking is not the only driver behind AAA occurrence and that lifestyle changes and treatment of cardiovascular risk factors may play an equally important role in the observed recent decline in AAA prevalence.

  • 65.
    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.

  • 66. Själander, A.
    et al.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Bergqvist, D.
    Eriksson, H.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Svensson, P.
    Efficacy and safety of anticoagulant prophylaxis to prevent venous thromboembolism in acutely ill medical inpatients: a meta-analysis2008In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 263, no 1, p. 52-60Article in journal (Refereed)
    Abstract [en]

    Objectives. Venous thromboembolism (VTE) is a potentially serious complication of hospitalization and immobilization. The use of anticoagulant prophylaxis in acutely ill medical inpatients is still under debate. New data including a recent meta‐analysis have recently been published. We aim at studying the efficacy and safety of anticoagulant prophylaxis in acutely ill medical inpatients, and demonstrate differences between meta‐analyses due to different data extraction from the heterogeneous studies included.

    Subjects: The Cochrane Library, MEDLINE and EMBASE were searched from 1980 to present. Manual searches were performed regarding abstracts from major meetings. Seven blinded randomized controlled clinical trials assessing the prophylactic effect of heparin in acutely ill medical patients were identified and included in the meta‐analysis.

    Results: Low‐molecular weight heparin (LMWH) prophylaxis prevented 48% of symptomatic pulmonary embolism (PE), 48% of symptomatic deep vein thrombosis (DVT) (not significant) and 51% of asymptomatic DVT. A nonsignificant trend towards higher bleeding risk during LMWH prophylaxis was found. Death was not significantly affected. We compared our data with a recent meta‐analysis with different study selection and data extraction and found similar results.

    Conclusions: As DVT and PE are manifestations of the same illness, VTE, one can argue that anticoagulant prophylaxis prevents approximately half of the expected events. Most medical inpatients have short hospital stays, and a low risk of VTE. The important task for the clinician is to identify patients with a sufficiently high risk of symptomatic VTE to warrant LMWH prophylaxis. Despite differences in study selection and data extraction, our study shows results similar to a recent meta‐analysis.

  • 67.
    Sjölander, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Prescription of lipid-lowering drugs increases following receipt of a pictorial representation of patients´carotid ultrasound examinations2019In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 15, no 12, p. E49-E49Article in journal (Other academic)
    Abstract [en]

    Background and objectives: We evaluated whether a pictorial representation of asymptomatic atherosclerosis based on carotid ultrasound examinations given to the participants and their physicians had an impact on the proportion of participants receiving prescriptions for lipid-lowering drugs during the following 465 days. The overall aim of the study was to optimize cardiovascular disease (CVD) prevention.

    Methods: This study was performed within a CVD screening and prevention program in Vasterbotten County, Sweden 2013-2016. 3532 par- € ticipants were randomly assigned 1:1 to receive or not receive a simplified picture of an ultrasound scan by mail plus a phone call including a health dialogue with a trained nurse. The picture indicated vascular age and the presence of plaques, and was also sent to participants’ physicians. The control group received no information about the ultrasound. Data on prescriptions was collected from the County Council database.

    Results: During the first 465 days, prescriptions of lipid-lowering drugs were higher in the intervention group compared with the control group among men (34.2% vs 21.3%, p<0.001) and women (25.8% vs 15.2% p<0.001). Corresponding proportions for first prescriptions were 19.2% vs 6.0% (p<0.001) and 16.6% vs 5.7% (p<0.001), respectively. Similar patterns were observed for participants with and without plaque, but with a higher proportion among those with plaque. Cholesterol level, diabetes, prescription of antihypertensives and previous myocardial infarction were in a multivariable logistic regression model associated with first prescriptions. Although prescriptions increased over the study period, 56% of participants with known plaque were not prescribed any lipid-lowering drug.

    Conclusion: Provision of pictorial information on vascular age and carotid plaque based on ultrasound examination increased physician prescriptions of lipid-lowering drugs within the following 465 days.

  • 68.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Dolling, Ann
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Restorative effects of visits to urban and forest environments in patients with exhaustion disorder2014In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 13, no 2, p. 344-354Article in journal (Refereed)
    Abstract [en]

    This experimental study investigated differences in perceived restorativeness, mood, attention capacity and physiological reactions when visiting city and forest environments. Twenty female patients diagnosed with exhaustion disorder visited three different forest environments and one city environment in randomized order. They performed a standardized 90-min test procedure in each of these environments. Evaluation of the environments and psychological effects in mood were studied with self-administered questionnaires. Attention capacity was studied with Necker Cube Pattern Control task. Physiological responses were measured with regularly scheduled controls of heart rate and blood pressure, and a single test of heart rate recovery. Visits to the forest environments were perceived as significantly more restorative, enhancing mood and attention capacity compared to the city. This also applies to the results of heart rate and to some extent to the results of the diastolic blood pressure. The results from this experimental study support our hypothesis that short visits to forest environments enhance both psychological and physiological recovery and that visits to forest environments are likely to be beneficial when suffering from exhaustion disorder. 

  • 69.
    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)
  • 70.
    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.

  • 71. 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)
  • 72. 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.

  • 73. Veerabhadrappa, Praveen
    et al.
    Charchar, Fadi
    Burger, Dylan
    Tomaszewski, Maciej
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Leading the change: Second International Society of Hypertension New Investigators' Symposium2013In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 31, no 2, p. 429-430Article in journal (Other (popular science, discussion, etc.))
  • 74. Wallace, Stephanie E.
    et al.
    Regalado, Ellen S.
    Gong, Limin
    Janda, Alexandra L.
    Guo, Dong-chuan
    Russo, Claudio F.
    Kulmacz, Richard J.
    Hanna, Nadine
    Jondeau, Guillaume
    Boileau, Catherine
    Arnaud, Pauline
    Lee, Kwanghyuk
    Leal, Suzanne M.
    Hannuksela, Matias
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Johnston, Tami
    Antolik, Christian
    Hostetler, Ellen M.
    Colombo, Roberto
    Milewicz, Dianna M.
    MYLK pathogenic variants aortic disease presentation, pregnancy risk, and characterization of pathogenic missense variants2019In: Genetics in Medicine, ISSN 1098-3600, E-ISSN 1530-0366, Vol. 21, no 1, p. 144-151Article in journal (Refereed)
    Abstract [en]

    Purpose: Heritable thoracic aortic disease can result from null variants in MYLK, which encodes myosin light-chain kinase (MLCK). Data on which MYLKmissense variants are pathogenic and information to guide aortic disease management are limited.

    Methods: Clinical data from 60 cases with MYLK pathogenic variants were analyzed (five null and two missense variants), and the effect of missense variants on kinase activity was assessed.

    Results: Twenty-three individuals (39%) experienced an aortic event (defined as aneurysm repair or dissection); the majority of these events (87%) were aortic dissections. Aortic diameters were minimally enlarged at the time of dissection in many cases. Time-to-aortic-event curves showed that missense pathogenic variant (PV) carriers have earlier-onset aortic events than null PV carriers. An MYLK missense variant segregated with aortic disease over five generations but decreases MYLK kinase acitivity marginally. Functional Assays fail to identify all pathogenic variants in MYLK.

    Conclusion: These data further define the aortic phenotype associated with MYLKpathogenic variants. Given minimal aortic enlargement before dissection, an alternative approach to guide the timing of aortic repair is proposed based on the probability of a dissection at a given age.

  • 75.
    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.

  • 76.
    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.

  • 77.
    Weidung, Bodil
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Department of Public Health and Caring Sciences, Geriatric Medicine, Uppsala University, Uppsala.
    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, Rehabilitation 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.
    Systolic blood pressure decline in very old individuals is explained by deteriorating health: Longitudinal changes from Umea85+/GERDA2017In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 51, article id e9161Article in journal (Refereed)
    Abstract [en]

    Declining systolic blood pressure (SBP) is common in very old age and is associated with adverse events, such as dementia. Knowledge of factors associated with SBP changes could explain the etiology of this decline in SBP. This study investigated longitudinal changes in socioeconomic factors, medical conditions, drug prescriptions, and assessments and their associations with SBP changes among very old followed individuals.The study was based on data from the Umea85+/Gerontological Regional Database (GERDA) cohort study, which provided cross-sectional and longitudinal data on participants aged 85, 90, and 95 years from 2000 to 2015. Follow-up assessments were conducted after 5 years. The main outcome was a change in SBP. Factors associated with SBP changes were assessed using multivariate linear regression models.In the Umea85+/GERDA study, 454 surviving individuals underwent follow-up assessment after 5 years. Of these, 297 had SBP measured at baseline and follow-up. The mean changestandard deviation in SBP was -12 +/- 25mm Hg. SBP decline was associated independently with later investigation year (P=.009), higher baseline SBP (P<.001), baseline antidepressant prescription (P=.011), incident acute myocardial infarction during follow-up (P=.003), new diuretic prescription during follow-up (P=.044), and a decline in the Barthel Activities of Daily Living index at follow-up (P<.001).In conclusion, SBP declines among very old individuals. This decline seems to be associated with initial SBP level, investigation year, and health-related factors.

  • 78.
    Weidung, Bodil
    et al.
    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.
    Systolic blood pressure decline in very old individuals is explained by deteriorating health: Longitudinal changes from Umeå85+/GERDAManuscript (preprint) (Other academic)
  • 79.
    Zarrinkoob, Laleh
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Ambarki, Khalid
    Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Wåhlin, Anders
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Birgander, Richard
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    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, Clinical Neuroscience.
    Aging alters the dampening of pulsatile blood flow in cerebral arteries2016In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016, Vol. 36, no 9, p. 1519-1527Article in journal (Refereed)
    Abstract [en]

    Excessive pulsatile flow caused by aortic stiffness is thought to be a contributing factor for several cerebrovascular diseases. The main purpose of this study was to describe the dampening of the pulsatile flow from the proximal to the distal cerebral arteries, the effect of aging and sex, and its correlation to aortic stiffness. Forty-five healthy elderly (mean age 71 years) and 49 healthy young (mean age 25 years) were included. Phase-contrast magnetic resonance imaging was used for measuring blood flow pulsatility index and dampening factor (proximal artery pulsatility index/distal artery pulsatility index) in 21 cerebral and extra-cerebral arteries. Aortic stiffness was measured as aortic pulse wave velocity. Cerebral arterial pulsatility index increased due to aging and this was more pronounced in distal segments of cerebral arteries. There was no difference in pulsatility index between women and men. Dampening of pulsatility index was observed in all cerebral arteries in both age groups but was significantly higher in young subjects than in elderly. Pulse wave velocity was not correlated with cerebral arterial pulsatility index. The increased pulsatile flow in elderly together with reduced dampening supports the pulse wave encephalopathy theory, since it implies that a higher pulsatile flow is reaching distal arterial segments in older subjects.

12 51 - 79 of 79
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