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Publications (10 of 121) Show all publications
Ragnarsson, O., Carlberg, B. & Olsson, T. (2023). Dietary salt restriction in primary aldosteronism. Journal of Internal Medicine, 294(1), 2-3
Open this publication in new window or tab >>Dietary salt restriction in primary aldosteronism
2023 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 294, no 1, p. 2-3Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Cardiac and Cardiovascular Systems General Practice
Identifiers
urn:nbn:se:umu:diva-206353 (URN)10.1111/joim.13625 (DOI)000957068400001 ()36945840 (PubMedID)2-s2.0-85150904246 (Scopus ID)
Available from: 2023-04-26 Created: 2023-04-26 Last updated: 2023-07-12Bibliographically approved
Brunström, M., Carlberg, B. & Kjeldsen, S. E. (2023). Effect of antihypertensive treatment in isolated systolic hypertension (ISH): systematic review and meta-analysis of randomised controlled trials. Blood Pressure, 32(1), Article ID 2226757.
Open this publication in new window or tab >>Effect of antihypertensive treatment in isolated systolic hypertension (ISH): systematic review and meta-analysis of randomised controlled trials
2023 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 32, no 1, article id 2226757Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Isolated systolic hypertension (ISH) in middle-aged and elderly is associated with high cardiovascular risk, but no randomised controlled trial has assessed the effect of antihypertensive treatment in ISH using today's definition, i.e. systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg.

METHODS: A systematic review and meta-analysis of randomised controlled trials was performed. Studies with ≥1000 patient-years of follow-up, comparing more intensive versus less intensive BP targets, or active drug versus placebo, were included if the mean baseline SBP was ≥140 mmHg and the mean baseline DBP was <90 mmHg. The primary outcome was major adverse cardiovascular events (MACE). Relative risks from each trial were pooled in random-effects meta-analyses, stratified by baseline and attained SBP level.

RESULTS: Twenty-four trials, including 113,105 participants (mean age 67 years; mean blood pressure 149/83 mmHg) were included in the analysis. Overall, treatment reduced the risk of MACE by 9% (relative risk 0.91, 95% confidence interval 0.88-0.93). Treatment was more effective if baseline SBP was ≥160 mmHg (RR 0.77, 95% CIs 0.70-0.86) compared to 140-159 mmHg (RR 0.92, 95% CIs 0.89-0.95; p = 0.002 for interaction), but provided equal additional benefit across all attained SBP levels (RR 0.80, 95% CIs 0.70-0.92 for <130 mmHg, RR 0.92, 95% CIs 0.89-0.96 for 130-139 mmHg, and RR 0.87, 95% CIs 0.82-0.93 for ≥140 mmHg; p = 0.070 for interaction).

CONCLUSIONS: These findings support antihypertensive treatment of isolated systolic hypertension, regardless of baseline SBP, to target SBP <140 mmHg and even <130 mmHg if well tolerated.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2023
Keywords
antihypertensive treatment, blood pressure goal, blood pressure target, elderly, Isolated systolic hypertension
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-212065 (URN)10.1080/08037051.2023.2226757 (DOI)001018684900001 ()37395100 (PubMedID)2-s2.0-85163615143 (Scopus ID)
Available from: 2023-07-18 Created: 2023-07-18 Last updated: 2023-07-18Bibliographically approved
Andersson, T., Nilsson, L., Larsen, F., Carlberg, B. & Söderberg, S. (2023). Long-term sequelae following acute pulmonary embolism: a nationwide follow-up study regarding the incidence of CTEPH, dyspnea, echocardiographic and V/Q scan abnormalities. Pulmonary Circulation, 13(4), Article ID e12306.
Open this publication in new window or tab >>Long-term sequelae following acute pulmonary embolism: a nationwide follow-up study regarding the incidence of CTEPH, dyspnea, echocardiographic and V/Q scan abnormalities
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2023 (English)In: Pulmonary Circulation, ISSN 2045-8932, E-ISSN 2045-8940, Vol. 13, no 4, article id e12306Article in journal (Refereed) Published
Abstract [en]

We aimed to follow a nationwide cohort of patients with pulmonary embolism (PE) without any exclusions to generate information regarding long-term symptoms, investigational findings and to determine the prevalence of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that this approach would yield generalizable estimates of CTEPH prevalence and incidence. All individuals diagnosed with acute PE in Sweden in 2005 were identified using the National Patient Register. In 2007, survivors were asked to complete a questionnaire regarding current symptoms. Those with dyspnea were referred for further examinations with laboratory tests, electrocardiogram (ECG), and a ventilation/perfusion scan (V/Q scan). If CTEPH was suspected, a referral to the nearest pulmonary arterial hypertension-center was recommended. Of 5793 unique individuals with PE diagnosis in 2005, 3510 were alive at the beginning of 2007. Altogether 53% reported dyspnea at some degree whereof a large proportion had V/Q scans indicating mismatched defects. Further investigation revealed 6 cases of CTEPH and in parallel 18 cases were diagnosed outside this study. The overall prevalence of CTEPH was 0.4% (95% confidence interval [CI]: 0.2%–0.6%) and 0.7% (95% CI: 0.4%–1.0%) among the survivors. The cumulative incidence of CTEPH in the group of patients who underwent a V/Q scan was 1.1% (95% CI: 0.2%–2.0%). There was a high mortality following an acute PE, a high proportion of persistent dyspnea among survivors, whereof several had pathological findings on V/Q scans and echocardiography. Only a minority developed CTEPH, indicating that CTEPH is the tip of the iceberg of post-PE disturbances.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
chronic thromboembolic pulmonary hypertension, dyspnea, pulmonary embolism, V/Q scan
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-216784 (URN)10.1002/pul2.12306 (DOI)37927611 (PubMedID)2-s2.0-85175874021 (Scopus ID)
Funder
Swedish Heart Lung FoundationRegion VästerbottenUmeå University
Available from: 2023-11-21 Created: 2023-11-21 Last updated: 2023-11-21Bibliographically approved
Shayesteh, A., Boman, A., Hawas, E. & Carlberg, B. (2023). Reconstituted and frozen botulinum toxin A is as effective and safe as fresh for treating axillary hyperhidrosis: a retrospective study. PLOS ONE, 18(12), Article ID e0295393.
Open this publication in new window or tab >>Reconstituted and frozen botulinum toxin A is as effective and safe as fresh for treating axillary hyperhidrosis: a retrospective study
2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 12, article id e0295393Article in journal (Refereed) Published
Abstract [en]

The use of reconstituted and frozen left-over botulinum toxin A, for treatment of patients with axillary hyperhidrosis seems to be common practice in healthcare. Thus, the objective of this study was to investigate the efficacy and safety of frozen and thawed versus fresh reconstituted abobotulinum toxin (Dysport®) and onabotulinum toxin (Botox®) in the treatment of axillary hyperhidrosis. A retrospective study was conducted analysing efficacy and data from pre- and 24 weeks post-treatment questionnaires together with medical records of individuals with moderate to severe axillary hyperhidrosis. The patients had received fresh prepared botulinum toxin A in their right axilla while frozen and thawed botulinum toxin A had been administered in their left axilla. Treatment was conducted at our Hyperhidrosis Clinic, Umeå University Hospital, Sweden 2019-2021. Pre- and post-treatment questionnaires from 106 patients were analysed. The patients were 18 to 55 years old, with a mean age of 30.7 ± 9.9 years. No significant differences in patient-reported variables, Hyperhidrosis Disease Severity Scale and VAS 10-point scale, were found between the different preparations (frozen compared to fresh) for abobotulinum toxin and onabotulinum toxin, before treatment and at 6 months follow-up. Multivariable regression analysis resulted in no significant difference regarding side-effects between the preparations or brands of botulinum toxin. The findings of this study support our clinical experience that both abobotulinum toxin and onabotulinum toxin, reconstituted, frozen and thawed, seem to be as effective and safe as fresh prepared botulinum toxin when treating axillary hyperhidrosis. Our findings indicate that left-over preparations of abo- and onabotulinum toxins, stored and frozen for up to 6 months, is a cost-and time-effective way of handling botulinum toxin for treatment of axillary hyperhidrosis.

Keywords
Hyperhidros, botulinumtoxin, retrospektiv studie, klinisk effect
National Category
Dermatology and Venereal Diseases
Research subject
Dermatology and Venerology; drug formulation and drug delivery
Identifiers
urn:nbn:se:umu:diva-217954 (URN)10.1371/journal.pone.0295393 (DOI)38048338 (PubMedID)2-s2.0-85178569557 (Scopus ID)
Available from: 2023-12-13 Created: 2023-12-13 Last updated: 2023-12-13Bibliographically approved
Eklund, S. A., Israelsson, H., Carlberg, B. & Malm, J. (2023). Vascular risk profiles for predicting outcome and long-term mortality in patients with idiopathic normal pressure hydrocephalus: comparison of clinical decision support tools. Journal of Neurosurgery, 138(2), 476-482
Open this publication in new window or tab >>Vascular risk profiles for predicting outcome and long-term mortality in patients with idiopathic normal pressure hydrocephalus: comparison of clinical decision support tools
2023 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 138, no 2, p. 476-482Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Vascular risk factors (VRFs) may act synergistically, and clinical decision support tools (CDSTs) have been developed that present vascular risk as a summarized score. Because VRFs are a major issue in patients with idiopathic normal pressure hydrocephalus (INPH), a CDST may be useful in the diagnostic workup. The objective was to compare 4 CDSTs to determine which one most accurately predicts short-term outcome and 10-year mortality after CSF shunt surgery in INPH patients.

METHODS: One-hundred forty INPH patients who underwent CSF shunt surgery were included. For each patient, 4 CDST scores (Systematic Coronary Risk Evaluation–Older Persons [SCORE-OP], Framingham Risk Score [FRS], Revised Framingham Stroke Risk Profile, and Kiefer’s Comorbidity Index [KCI]) were estimated. Short-term outcome (3 months after CSF shunt surgery) was defined on the basis of improvements in gait, Mini-Mental State Examination score, and modified Rankin Scale score. The 10-year mortality rate after surgery was noted. The CDSTs were compared by using Cox regression analysis, receiver operating characteristic curve analysis, and the chi-square test.

RESULTS: For 3 CDSTs, increased score was associated with increased risk of 10-year mortality. A 1-point increase in the FRS indicated a 2% higher risk of death within 10 years (HR 1.02, 95% CI 1.003–1.035, p = 0.021); SCORE-OP, 5% (HR 1.05, 95% CI 1.019–1.087, p = 0.002); and KCI, 12% (HR 1.12, 95% CI 1.03–1.219, p = 0.008). FRS predicted short-term outcome of surgery (p = 0.024). When the cutoff value was set to 32.5%, the positive predictive value was 80% and the negative predictive value was 48% (p = 0.012).

CONCLUSIONS: The authors recommend using FRS to predict short-term outcome and 10-year risk of mortality in INPH patients. The study indicated that extensive treatment of the risk factors of INPH may decrease risk of mortality.

Place, publisher, year, edition, pages
Journal of Neurosurgery Publishing Group (JNSPG), 2023
Keywords
INPH, vascular risk factors, mortality, CSF shunt surgery, clinical decision support tool, Framingham Risk Score, hydrocephalus, outcome
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-202118 (URN)10.3171/2022.4.jns22125 (DOI)000933582800005 ()35901765 (PubMedID)2-s2.0-85147296575 (Scopus ID)
Funder
Region VästerbottenUmeå University
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-05Bibliographically approved
Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Norberg, M., Nyström, L., . . . Carlberg, B. (2022). Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease. Blood Pressure, 31(1), 31-39
Open this publication in new window or tab >>Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
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2022 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 31, no 1, p. 31-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
antihypertensive treatment, continuous medical education, Hypertension, implementation science, primary care
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192773 (URN)10.1080/08037051.2022.2041393 (DOI)000757622100001 ()35179089 (PubMedID)2-s2.0-85124775764 (Scopus ID)
Funder
Swedish Research Council, K2007-70X-20515-01-2Swedish Research Council, K2009-69X-20515-04-2Swedish Research Council, 2017-02246Västerbotten County CouncilSwedish Society for Medical Research (SSMF)
Available from: 2022-03-09 Created: 2022-03-09 Last updated: 2023-05-22Bibliographically approved
Kjeldsen, S. E., Brunström, M., Thomopoulos, C., Carlberg, B., Kreutz, R. & Mancia, G. (2022). Blood pressure reduction and major cardiovascular events in people with and without type 2 diabetes [Letter to the editor]. The Lancet Diabetes and Endocrinology, 10(12), 840-840
Open this publication in new window or tab >>Blood pressure reduction and major cardiovascular events in people with and without type 2 diabetes
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2022 (English)In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 10, no 12, p. 840-840Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2022
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-201412 (URN)10.1016/S2213-8587(22)00312-6 (DOI)2-s2.0-85142436619 (Scopus ID)
Available from: 2022-12-01 Created: 2022-12-01 Last updated: 2023-05-22Bibliographically approved
Kreutz, R., Brunström, M., Thomopoulos, C., Carlberg, B. & Mancia, G. (2022). Do recent meta-analyses truly prove that treatment with blood pressure-lowering drugs is beneficial at any blood pressure value, no matter how low?: A critical review. Journal of Hypertension, 40(5), 839-846
Open this publication in new window or tab >>Do recent meta-analyses truly prove that treatment with blood pressure-lowering drugs is beneficial at any blood pressure value, no matter how low?: A critical review
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2022 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 40, no 5, p. 839-846Article, review/survey (Refereed) Published
Abstract [en]

Current European guidelines for the management of hypertension and on cardiovascular disease prevention place the threshold for pharmacological treatment at a SBP level of 140 mmHg or above, with the exception of patients at very high risk (mainly because of coronary heart disease). This is in agreement with the current definition of hypertension, that is, the level of blood pressure at which the benefits of treatment outweigh the risks of treatment, as documented by clinical trials. This rationale and definition was recently challenged by meta-analyses using individual participant-level data from 48 randomized trials by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC). The authors calculated for a fixed 5 mmHg pharmacological reduction of SBP an overall 10% risk reduction for major cardiovascular events. It was concluded that there was no reliable evidence of heterogeneity of treatment effects by baseline SBP categories; that the effect was independent from the presence of cardiovascular disease; applied also to old and very old individuals up to 84 years or beyond; and that BP-lowering was also beneficial in individuals with normal or high-normal SBP down to a baseline SBP less than 120 mmHg. In this report, we identify and discuss a number of shortcomings of the BPLTTC meta-analyses. In our view, the conclusions by the BPLTTC must be -together with accompanying suggestions to abandon the definition of hypertension - strongly rejected as they are not justified and may be harmful for cardiovascular health in individuals without hypertension.

Place, publisher, year, edition, pages
Wolters Kluwer, 2022
Keywords
blood pressure, cardiovascular, hypertension, meta-analysis, pharmacotherapy, risk
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-195063 (URN)10.1097/HJH.0000000000003056 (DOI)000790168600002 ()35191413 (PubMedID)2-s2.0-85129996592 (Scopus ID)
Funder
AstraZeneca
Available from: 2022-05-23 Created: 2022-05-23 Last updated: 2023-05-22Bibliographically approved
Brunström, M., Thomopoulos, C., Carlberg, B., Kreutz, R. & Mancia, G. (2022). Methodological Aspects of Meta-Analyses Assessing the Effect of Blood Pressure-Lowering Treatment on Clinical Outcomes. Hypertension, 79(3), 491-504
Open this publication in new window or tab >>Methodological Aspects of Meta-Analyses Assessing the Effect of Blood Pressure-Lowering Treatment on Clinical Outcomes
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2022 (English)In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 79, no 3, p. 491-504Article in journal (Refereed) Published
Abstract [en]

Systematic reviews and meta-analyses are often considered the highest level of evidence, with high impact on clinical practice guidelines. The methodological literature on systematic reviews and meta-analyses is extensive and covers most aspects relevant to the design and interpretation of meta-analysis findings in general. Analyzing the effect of blood pressure-lowering on clinical outcomes poses several challenges over and above what is covered in the general literature, including how to combine placebo-controlled trials, target-trials, and comparative studies depending on the research question, how to handle the potential interaction between baseline blood pressure level, common comorbidities, and the estimated treatment effect, and how to consider different magnitudes of blood pressure reduction across trials. This review aims to address the most important methodological considerations, to guide the general reader of systematic reviews and meta-analyses within our field, and to help inform the design of future studies. Furthermore, we highlight issues where published meta-analyses have applied different analytical strategies and discuss pros and cons with different strategies.

Keywords
antihypertensive agents, blood pressure, clinical trial, hypertension, meta-analysis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192639 (URN)10.1161/HYPERTENSIONAHA.121.18413 (DOI)000751942600008 ()34965736 (PubMedID)2-s2.0-85124440553 (Scopus ID)
Available from: 2022-02-22 Created: 2022-02-22 Last updated: 2023-05-22Bibliographically approved
Kreutz, R., Brunström, M., Thomopoulos, C., Carlberg, B. & Mancia, G. (2022). Prescribing blood pressure lowering drugs irrespective of blood pressure? [Letter to the editor]. Journal of Hypertension, 40(5), 1050-1051
Open this publication in new window or tab >>Prescribing blood pressure lowering drugs irrespective of blood pressure?
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2022 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 40, no 5, p. 1050-1051Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2022
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-195062 (URN)10.1097/HJH.0000000000003116 (DOI)000790168600027 ()35506281 (PubMedID)2-s2.0-85129996613 (Scopus ID)
Available from: 2022-05-23 Created: 2022-05-23 Last updated: 2022-05-23Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-9279-2791

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