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  • 1.
    Abrahams-Gessel, Shafika
    et al.
    Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, United States.
    Gómez-Olivé, F. Xavier
    Harvard Center for Population and Development Studies, Harvard University, MA, Cambridge, United States; Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Tollman, Stephen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Wade, Alisha N.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Du Toit, Jacques D.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa.
    Ferro, Enrico G.
    Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, MA, Boston, United States; Harvard Medical School, MA, Boston, United States.
    Kabudula, Chodziwadziwa W.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Gaziano, Thomas A.
    Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, United States; Harvard Center for Population and Development Studies, Harvard University, MA, Cambridge, United States; Cardiovascular Medicine Division, Brigham & Women's Hospital, MA, Boston, United States.
    Improvements in Hypertension Control in the Rural Longitudinal HAALSI Cohort of South African Adults Aged 40 and Older, From 2014 to 20192023Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 36, nr 6, s. 324-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Over half of the South African adults aged 45 years and older have hypertension but its effective management along the treatment cascade (awareness, treatment, and control) remains poorly understood.

    METHODS: We compared the prevalence of all stages of the hypertension treatment cascade in the rural HAALSI cohort of older adults at baseline and after four years of follow-up using household surveys and blood pressure data. Hypertension was a mean systolic blood pressure >140 mm Hg or diastolic pressure >90 mm Hg, or current use of anti-hypertension medication. Control was a mean blood pressure <140/90 mm Hg. The effects of sex and age on the treatment cascade at follow-up were assessed. Multivariate Poisson regression models were used to estimate prevalence ratios along the treatment cascade at follow-up.

    RESULTS: Prevalence along the treatment cascade increased from baseline (B) to follow-up (F): awareness (64.4% vs. 83.6%), treatment (49.7% vs. 73.9%), and control (22.8% vs. 41.3%). At both time points, women had higher levels of awareness (B: 70.5% vs. 56.3%; F: 88.1% vs. 76.7%), treatment (B: 55.9% vs. 41.55; F: 79.9% vs. 64.7%), and control (B: 26.5% vs. 17.9%; F: 44.8% vs. 35.7%). Prevalence along the cascade increased linearly with age for everyone. Predictors of awareness included being female, elderly, or visiting a primary health clinic three times in the previous 3 months, and the latter two also predicted hypertension control.

    CONCLUSIONS: There were significant improvements in awareness, treatment, and control of hypertension from baseline to follow-up and women fared better at all stages, at both time points.

  • 2. De Marco, Marina
    et al.
    Gerdts, Eva
    Casalnuovo, Giuseppina
    Migliore, Teresa
    Wachtell, Kristian
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Department of Medicine, Skellefteå Hospital, Skellefteå, Sweden.
    Dahlöf, Björn
    Olsen, Michael H
    Kizer, Jorge R
    Devereux, Richard B
    de Simone, Giovanni
    Mitral annular calcification and incident ischemic stroke in treated hypertensive patients: the LIFE study2013Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 26, nr 4, s. 567-573Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND Fibro-calcification of the mitral annulus (MAC) has been associated with increased risk of ischemic stroke in general populations. This study was performed to assess whether MAC predicts incidence of ischemic stroke in treated hypertensive patients with left ventricular hypertrophy (LVH).

    METHODS Baseline and follow-up clinical and echocardiographic parameters were assessed in 939 hypertensive patients with electrocardiogram (ECG) LVH participating in the Losartan Intervention for Endpoint reduction in hypertension (LIFE) echocardiography substudy (66 +/- 7 years; 42% women; 11% with diabetes) who did not have aortic or mitral valve stenosis or prosthesis.

    RESULTS MAC was found in 458 patients (49%). Patients with MAC were older (68 +/- 7 vs. 65 +/- 7 years); were more often women (47% vs. 37%); had higher baseline systolic blood pressure (BP) (175 +/- 14 vs. 172 +/- 15 mm Hg), left atrial diameter (4.0 +/- 0.5 vs. 3.8 +/- 0.6 cm), and left ventricular mass index (58 +/- 13 vs. 55 +/- 12 g/m(2.7)) and included more patients with proteinuria (30% vs. 21%; all P < 0.01). During a mean follow-up of 4.8 years, 58 participants had an ischemic stroke. Risk of incident ischemic stroke was significantly related to presence of MAC (log rank = 9; P < 0.01). In multivariable Cox regression analysis models, MAC was associated with increased risk of ischemic stroke (hazard ratio = 1.78-2.35), independent of age, baseline or time-varying systolic BR prevalence or incidence of atrial fibrillation, history of previous cerebrovascular disease, and other well-recognized confounders, such as sex, time-varying left ventricular mass, left atrial diameter, and urinary albumin/creatinine ratio (all P < 0.05).

    CONCLUSIONS MAC is common in treated hypertensive patients with ECG LVH and is an independent predictor of incident ischemic stroke.

  • 3.
    Gerdts, Eva
    et al.
    Institute of Medicine, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Okin, Peter M.
    Division of Cardiology, Weill Cornell Medical College, New York, NY, United States.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Wachtell, Kristian
    Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
    Nieminen, Markku S.
    Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
    Dahlöf, Björn
    Department of Medicine, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden.
    Devereux, Richard B.
    Division of Cardiology, Weill Cornell Medical College, New York, NY, United States.
    Association of heart failure hospitalizations with combined electrocardiography and echocardiography criteria for left ventricular hypertrophy2012Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 25, nr 6, s. 678-683Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The value of performing echocardiography in hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) is uncertain.

    Methods: Baseline echo-and electrocardiographic data and cardiovascular events over 4.8 years study treatment were assessed in 922 hypertensive patients in the Losartan Intervention For Endpoint reduction in hypertension echocardiography substudy. Patients were grouped according to presence of LVH on both electrocardiogram (ECG) and echocardiogram (n = 515), only on ECG (n = 172), only on echocardiogram (n = 135), or on none tests (n = 100). LVH was diagnosed by Sokolow Lyon and Cornell product criteria by electrocardiography and as LV mass index 116 g/m 2 in men and 104 g/m 2 in women by echocardiography.

    Results: Patients with LVH on both tests were older, had higher systolic blood pressure and LV mass, lower LV systolic function, and included more patients with aortic regurgitation, albuminuria, and history of ischemic heart disease (all P<0.05). Incidence of combined myocardial infarction, stroke, or cardiovascular death did not differ between groups. Incidence of hospitalization for heart failure was 5.3 and 2.6 times higher in patients with LVH on both tests compared to patients with LVH on ECG or echocardiogram only (P<0.01). In Cox regression, LVH on both tests predicted hospitalization for heart failure (hazard ratio 4.29 (95% confidence interval 1.26-14.65), P = 0.020) independent of other covariates including study treatment allocation and history of ischemic heart disease.

    Conclusions: Our results suggest that combining LVH assessment on a single ECG and echocardiogram provides a simple tool for additional heart failure risk stratification in asymptomatic high-risk hypertensive patients.

  • 4. Greve, Anders M.
    et al.
    Olsen, Michael H.
    Bella, Jonathan N.
    Lonnebakken, Mai T.
    Gerdts, Eva
    Okin, Peter M.
    Palmieri, Vittorio
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nieminen, Markku S.
    Omvik, Per
    Dahlof, Bjorn
    Devereux, Richard B.
    Wachtell, Kristian
    Contrasting Hemodynamic Mechanisms of Losartan- vs. Atenolol-Based Antihypertensive Treatment: A LIFE Study2012Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 25, nr 9, s. 1017-1023Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND Pharmaceutical differences in central hemodynamics might influence cardiac response to antihypertensive treatment despite similar lowering of brachial blood pressure (BP). METHODS Data from all patients with at least two echocardiographic examinations in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) echocardiographic substudy (n = 801); high-risk patients on losartan- vs. atenolol-based antihypertensive therapy. Echocardiography was performed annually for 4 years to measure stroke index (SI), heart rate, cardiac index (CI), conduit artery stiffness assessed as pulse pressure/stroke index (PP/SI) and total peripheral resistance index (TPRI). RESULTS Atenolol- and losartan-based therapy reduced BP similarly (cumulative difference in mean brachial blood pressure 0.3 mm Hg, P = 0.65). After 4 years the cumulative means of SI and heart rate were 1.8 ml/m(2) higher and 5.7 beats/min lower on atenolol-based treatment, respectively (both P < 0.001). This kept CI below baseline in atenolol-treated patients, whereas in the losartan group CI was unchanged from baseline throughout the study. TPRI was decreased more and remained lower in the losartan group (cumulative difference in mean TPRI 287 dynes/sec(-5)/cm/m(2), P < 0.001). These findings partly explained univariate differences in systolic- and diastolic function indices between the two treatments; fully adjusted losartan was only associated with a smaller left atrial diameter (cumulative mean difference 0.07 cm; 95% confidence intervals, -0.13 to -0.01, P = 0.03). CONCLUSIONS Contrasting hemodynamics impacted cardiac response to similar reductions in brachial BP on losartan- vs. atenolol-based therapy. The similar reduction of PP/SI suggests that the antihypertensive regimens used in the LIFE study had comparable effects on arterial stiffness (LIFE study; NCT00338260)

  • 5. Grøntved, Anders
    et al.
    Andersen, Lars B
    Franks, Paul W
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Verhage, Bas
    Wareham, Nicholas J
    Ekelund, Ulf
    Loos, Ruth J F
    Brage, Søren
    NOS3 variants, physical activity, and blood pressure in the European Youth Heart Study2011Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 24, nr 4, s. 444-450Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The NOS3 Glu298Asp variant may associate with resting BP in adolescence but not in childhood, an effect that could be modified by PA.

  • 6. Kurbasic, Azra
    et al.
    Fraser, Abigail
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Franks, Paul W.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Department of Clinical Sciences Malmö, Genetic and Molecular Epidemiology Unit, Lund University Diabetes Centre, Clinical Sciences Malmö, Lund University, Malmö, Sweden. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA..
    Rich-Edwards, Janet W.
    Timpka, Simon
    Maternal Hypertensive Disorders of Pregnancy and Offspring Risk of Hypertension: A Population-Based Cohort and Sibling Study2019Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 32, nr 4, s. 331-334Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Women with a history of hypertensive disorders of pregnancy (HDP) are at increased risk of hypertension, cardiovascular disease, and type 2 diabetes. Offspring from pregnancies complicated by HDP also have worse cardiometabolic status in childhood and young adulthood, but the offspring risk of clinical hypertension in adulthood is largely unknown.

    METHODS: We studied 13,893 first-born adult offspring (49.4% female) who attended a structured population-based primary care visit (The Västerbotten Health Survey) at age 40 years in Sweden between 1994 and 2013. Data on maternal HDP were collected from a population-based birth register. We investigated the association between maternal HDP and the risk of adult offspring hypertension and worse cardiometabolic risk factor status utilizing multivariable poisson and linear regression models. We also conducted a sibling comparison, which inherently accounted for familial factors shared by siblings (N = 135).

    RESULTS: Offspring participants of women with HDP (N = 383, 2.8%) had increased relative risk of hypertension (1.67, 95% confidence interval: 1.38, 2.01) and also higher mean body mass index, systolic blood pressure, diastolic blood pressure, and worse 2-hour 75 g oral glucose tolerance test result at age 40 years. No difference was observed for serum cholesterol. Point estimates for the cardiometabolic risk factors were attenuated in the sibling analyses.

    CONCLUSION: Offspring born to mothers with a history of HDP are on an adverse cardiometabolic trajectory and should be considered as concomitant targets for primordial prevention of hypertension in the maternal post-pregnancy period.

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  • 7.
    Macmahon, Stephen
    et al.
    George Institute for International Health, University of Sydney, Sydney, New South Wales, Australia.
    Alderman, Michael H.
    Albert Einstein College of Medicine, Yeshiva University, New York, New York, USA.
    Lindholm, Lars Hjalmar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lisheng, Liu
    Chinese Academy of Medical Sciences, Fu Wai Hospital, Beijing, China.
    Sanchez, Ramiro A.
    Instituto de Cardiologia y Cirugia Cardiovascular, Universidad "Dr René G Favaloro," Buenos Aires, Argentina.
    Seedat, Yackoob K.
    Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
    Blood-pressure-related disease is a global health priority2008Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 21, nr 8, s. 843-844Artikel i tidskrift (Refereegranskat)
  • 8. Okin, Peter M
    et al.
    Hille, Darcy A
    Kjeldsen, Sverre E
    Lindholm, Lars H
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Edelman, Jonathan M
    Dahlöf, Björn
    Devereux, Richard B
    Greater regression of electrocardiographic left ventricular hypertrophy during hydrochlorothiazide therapy in hypertensive patients2010Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 23, nr 7, s. 786-793Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background 

    Treatment of hypertensive patients with a losartan-based regimen was associated with greater regression of electrocardiographic (ECG) left ventricular hypertrophy (LVH) than atenolol-based therapy in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, independent of blood pressure (BP) changes. However, whether concomitant hydrochlorothiazide (HCTZ) therapy in >70% of LIFE patients was associated with greater regression of LVH independent of BP changes and whether this effect differed between treatment arms has not been examined.

    Methods 

    Changes in Cornell product and Sokolow–Lyon voltage LVH were assessed in 9,193 hypertensive patients randomly assigned to treatment with losartan or atenolol, with additional HCTZ therapy added as necessary to achieve target BP goal per study protocol.

    Results 

    After controlling for baseline and change in systolic and diastolic pressure, age, sex, race, prior antihypertensive treatment, baseline and year-4 body mass index and baseline LVH by either Cornell product or Sokolow–Lyon voltage, at year-4 follow-up HCTZ therapy was associated with greater regression of Cornell product LVH (−244 ± 788 vs. −172 ± 771 mm·msec, P < 0.05) and Sokolow–Lyon voltage (−4.2 ± 6.7 vs. −3.0 ± 7.0 mm, P < 0.001) and this effect was significantly greater in patients on losartan (−341 ± 743 vs. −189 ± 775 mm·msec and −5.2 ± 6.6 vs. −3.3 ± 6.6 mm) than in patients on atenolol (−142 ± 822 vs. −158 ± 765 mm·msec and −3.1 ± 6.6 vs. −2.7 ± 7.4 mm; both P < 0.001 for interaction of HCTZ with losartan vs. atenolol therapy).

    Conclusions 

    HCTZ use was associated with greater regression of ECG LVH and this effect was greater in patients on losartan- than atenolol-based therapy, independent of baseline severity of ECG LVH and hypertension and changes in BP.

  • 9. Vimaleswaran, Karani S.
    et al.
    Franks, Paul W.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Medical Research Council Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK.
    Barroso, Inês
    Brage, Soren
    Ekelund, Ulf
    Wareham, Nicholas J.
    Loos, Ruth J. F.
    Habitual Energy Expenditure Modifies the Association Between NOS3 Gene Polymorphisms and Blood Pressure2008Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 21, nr 3, s. 297-302Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The endothelial nitric-oxide synthase (NOS3) gene encodes the enzyme (eNOS) that synthesizes the molecule nitric oxide, which facilitates endothelium-dependent vasodilation in response to physical activity. Thus, energy expenditure may modify the association between the genetic variation at NOS3and blood pressure.

    Methods: To test this hypothesis, we genotyped 11 NOS3 polymorphisms, capturing all common variations, in 726 men and women from the Medical Research Council (MRC) Ely Study (age (mean ± s.d.): 55 ± 10 years, body mass index: 26.4 ± 4.1 kg/m2). Habitual/non-resting energy expenditure (NREE) was assessed via individually calibrated heart rate monitoring over 4 days.

    Results: The intronic variant, IVS25+15 [G→A], was significantly associated with blood pressure; GG homozygotes had significantly lower levels of diastolic blood pressure (DBP) (−2.8 mm Hg; P = 0.016) and systolic blood pressure (SBP) (−1.9 mm Hg; P = 0.018) than A-allele carriers. The interaction between NREE and IVS25+15 was also significant for both DBP (P = 0.006) and SBP (P = 0.026), in such a way that the effect of the GG-genotype on blood pressure was stronger in individuals with higher NREE (DBP: −4.9 mm Hg, P = 0.02. SBP: −3.8 mm Hg, P= 0.03 for the third tertile). Similar results were observed when the outcome was dichotomously defined as hypertension.

    Conclusions: In summary, the NOS3 IVS25+15 is directly associated with blood pressure and hypertension in white Europeans. However, the associations are most evident in the individuals with the highest NREE. These results need further replication and have to be ideally tested in a trial before being informative for targeted disease prevention. Eventually, the selection of individuals for lifestyle intervention programs could be guided by knowledge of genotype.

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