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Brobak KM, Halvorsen LV, Aass HCD, Søraas CL, Aune A, Olsen E, Bergland OU, Rognstad S, Blom KB, Birkeland JAK, Høieggen A, Larstorp ACK, Solbu MD. Novel biomarkers in patients with uncontrolled hypertension with and without kidney damage. Blood Press 2024; 33:2323980. [PMID: 38606688 DOI: 10.1080/08037051.2024.2323980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/20/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR) are insensitive biomarkers for early detection of hypertension-mediated organ damage (HMOD). In this nationwide cross-sectional study, we assessed potential biomarkers for early HMOD in healthy persons and patients with hypertension. We hypothesised that plasma levels of biomarkers: (1) are different between healthy controls and patients with hypertension, (2): can classify patients with hypertension according to the degree of hypertension severity. DESIGN AND METHODS Patients with hypertension prescribed ≥2 antihypertensive agents were selected from a multicentre study. Healthy controls were selected from an ongoing study of living kidney donor candidates. Uncontrolled hypertension was defined as systolic daytime ambulatory blood pressure ≥135 mmHg. Kidney HMOD was defined by ACR > 3.0 mg/mmol or eGFR < 60 mL/min/1.73 m2. Patients with hypertension were categorised into three groups: (1) controlled hypertension; (2) uncontrolled hypertension without kidney HMOD; (3) uncontrolled hypertension with kidney HMOD. Fifteen biomarkers were analysed using a Luminex bead-based immunoassay, and nine fell within the specified analytical range. RESULTS Plasma levels of Interleukin 1 receptor antagonist (IL-1RA), neutrophil gelatinase-associated lipocalin (NGAL) and uromodulin were significantly different between healthy controls (n = 39) and patients with hypertension (n = 176). In regression models, with controlled hypertension (n = 55) as the reference category, none of the biomarkers were associated with uncontrolled hypertension without (n = 59) and with (n = 62) kidney HMOD. In models adjusted for cardiovascular risk factors and eGFR, osteopontin (OPN) was associated with uncontrolled hypertension without kidney HMOD (odds ratio (OR) 1.77 (1.05-2.98), p = 0.03), and regulated upon activation normal T-cell expressed and secreted (RANTES) with uncontrolled hypertension with kidney HMOD (OR 0.57 (0.34-0.95), p = 0.03). CONCLUSIONS None of the biomarkers could differentiate our hypertension groups when established risk factors were considered. Plasma OPN may identify patients with uncontrolled hypertension at risk for kidney HMOD.
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Affiliation(s)
- Karl Marius Brobak
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Artic University of Norway, Tromsø, Norway
| | - Lene V Halvorsen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Camilla L Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Section for Environmental and Occupational Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Arleen Aune
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eirik Olsen
- Clinic of Emergency Medicine and Prehospital Care, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, University of Trondheim, Trondheim, Norway
| | - Ola Undrum Bergland
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Stine Rognstad
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Pharmacology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjersti B Blom
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Experimental Medical Research, and KG Jebsen Center for Cardiac Research, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway
| | | | - Aud Høieggen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | - Marit D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Artic University of Norway, Tromsø, Norway
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Halvorsen LV, Søraas CL, Larstorp ACK, Hjørnholm U, Kjær VN, Liestøl K, Aune A, Olsen E, Brobak KM, Bergland OU, Rognstad S, Aarskog NR, Heimark S, Fadl Elmula FEM, Gerdts E, Mo R, Solbu MD, Opdal MS, Kjeldsen SE, Rostrup M, Høieggen A. Effect of Drug Monitoring on Adherence and Blood Pressure: A Multicenter Randomized Clinical Trial. Am J Hypertens 2024:hpae059. [PMID: 38713475 DOI: 10.1093/ajh/hpae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Drug concentration in blood or urine is an acknowledged method to detect non-adherence. Observational studies suggest that informing patients about low or absent serum drug levels improves blood pressure (BP). We performed a multicenter randomized clinical trial to test the hypothesis that therapeutic drug monitoring (TDM) could improve drug adherence and BP in patients with uncontrolled hypertension and reduced adherence to antihypertensive drugs. METHODS Patients were ≥18 years on stable treatment with at least two antihypertensive agents. We planned to randomize 80 non-adherent patients with a systolic daytime ambulatory BP (ABPM) ≥135 mmHg to TDM-intervention or not. The control group and the study-personnel who measured BP remained uninformed about serum drug measurements throughout. All patients and physicians were blinded for BPs. Lifestyle advice and detailed information on disease process and importance of BP treatment were given to both groups. RESULTS From 2017 to 2022, we randomized 46 diagnosed non-adherent from a total of 606 patients with uncontrolled hypertension. The TDM-group had a 6.7 (±14.5) mmHg reduction from 147.9 (±10.3) to 141.1 (±14.1) mmHg, and the control group experienced a 7.3 (±13.2) mmHg reduction from 147.1 (±9.2) to 139.1 (±17.4) mmHg, p=0.9 between groups. Adherence improved in both groups, 73% in the TDM group and 59% in the control group became adherent at three months, p=0.51. CONCLUSIONS In our prospective multicenter clinical trial of uncontrolled and non-adherent hypertensive patients, we found no additional effect of therapeutic drug monitoring (TDM) on blood pressure and drug adherence compared with standard care.
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Affiliation(s)
- Lene V Halvorsen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla L Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Section for Environmental and Occupational Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | - Ulla Hjørnholm
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Vibeke N Kjær
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Arleen Aune
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eirik Olsen
- Norwegian University of Science and Technology, Trondheim, Norway
- Department of Emergency Medicine, St. Olav`s University Hospital; Trondheim, Norway
| | - Karl Marius Brobak
- Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
| | - Ola U Bergland
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Stine Rognstad
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pharmacology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Nikolai R Aarskog
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sondre Heimark
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Mo
- Department of Emergency Medicine, St. Olav`s University Hospital; Trondheim, Norway
- Department of Cardiology, Trondheim University Hospital, Norway
| | - Marit D Solbu
- Metabolic and Renal Research Group, UiT, The Arctic University of Norway, Tromsø, Norway
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
| | - Mimi S Opdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pharmacology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Sverre E Kjeldsen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Rostrup
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Behavioral Sciences, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aud Høieggen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Brobak KM, Melsom T, Eriksen BO, Høieggen A, Norvik JV, Solbu MD. The Association between Urinary Sodium-Potassium Ratio, Kidney Function, and Blood Pressure in a Cohort from the General Population. Kidney Blood Press Res 2024; 49:184-195. [PMID: 38382490 DOI: 10.1159/000535977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/07/2023] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Subclinical kidney dysfunction may contribute to salt-sensitive hypertension. We assessed the association between the urinary sodium-potassium ratio (Na/K ratio) and blood pressure (BP) in a general population cohort without diabetes, chronic kidney disease, cardiovascular disease, or treated hypertension. We investigated whether any such association was mediated by the kidney function markers measured glomerular filtration rate (mGFR), urinary albumin-creatinine ratio (ACR), and urinary epidermal growth factor-creatinine ratio (EGF-Cr). METHODS The Tromsø Study is a population-based study of inhabitants of the municipality of Tromsø, Northern Norway. Participants aged 50-62 years, without diabetes, chronic kidney disease, or cardiovascular disease, were invited to the substudy Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6; 2007-09). For the present study, we excluded participants reporting the use of 1 or more antihypertensive agents, leaving 1,311 RENIS-T6 participants for a cross-sectional analysis. We measured office BP, 24-h ambulatory blood pressure (ABP), and mGFR using iohexol clearance. Na/K ratio, ACR, and EGF-Cr were measured in morning urine samples. RESULTS Urinary Na/K ratio was significantly associated with systolic office BP and ABP independently of cardiovascular risk factors and kidney function markers. A one-standard deviation unit increase in the Na/K ratio was associated with increased systolic ABP by 1.0 (0.3-1.6) mm Hg. Urinary Na/K ratio showed a stronger association with office BP than ABP. EGF-Cr, ACR, and mGFR did not mediate the relationship between urinary Na/K ratio and systolic BP. CONCLUSIONS In a representative sample of the middle-aged North-European population without diabetes, chronic kidney disease, cardiovascular disease, or treated hypertension, there was a consistent association between urinary Na/K ratio and BP. The association with BP was not mediated through kidney function measures, suggesting a relationship between a diet with high sodium and low potassium and higher BP regardless of kidney function.
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Affiliation(s)
- Karl Marius Brobak
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Toralf Melsom
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Odvar Eriksen
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aud Høieggen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Viljar Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit Dahl Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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Mariampillai JE, Halvorsen LV, Larstorp AC, Heimark S, Waldum-Grevbo B, Kjeldsen SE, Nordby G, Stenehjem AE, Berg JP, Høieggen A. Diabetes og kronisk nyresykdom. Tidsskr Nor Laegeforen 2023; 143:22-0822. [PMID: 37668137 DOI: 10.4045/tidsskr.22.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Chronic kidney disease is one of the most serious complications of diabetes. One of the challenges in the follow-up of patients with diabetes is to discover signs of kidney disease. Recent research shows that several drugs have renal protective effects. In this clinical review article we present markers used in the follow-up of patients with diabetes and chronic kidney disease, and new treatment options.
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Affiliation(s)
| | - Lene Vernås Halvorsen
- Nyremedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Anne Cecilie Larstorp
- Avdeling for medisinsk biokjemi, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Sondre Heimark
- Nyremedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | | - Sverre Erik Kjeldsen
- Hjertemedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | | | | - Jens Petter Berg
- Institutt for klinisk medisin, Universitetet i Oslo, og, Avdeling for medisinsk biokjemi, Oslo universitetssykehus
| | - Aud Høieggen
- Nyremedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
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Kjeldsen SE, Mariampillai JE, Høieggen A. Uric acid and left ventricular mass in prediction of cardiovascular risk-New insight from the URRAH study. Eur J Intern Med 2023; 114:45-46. [PMID: 37179137 DOI: 10.1016/j.ejim.2023.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Sverre E Kjeldsen
- University of Oslo, Medical Faculty, Institute for Clinical Medicine, Oslo, Norway; Oslo University Hospital Ullevaal, Departments of Cardiology and Nephrology, Oslo, Norway.
| | | | - Aud Høieggen
- University of Oslo, Medical Faculty, Institute for Clinical Medicine, Oslo, Norway; Oslo University Hospital Ullevaal, Departments of Cardiology and Nephrology, Oslo, Norway
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Brobak KM, Andreassen RM, Melsom T, Høieggen A, Norvik JV, Solbu MD. Associations of urinary orosomucoid, N-acetyl-β-D-glucosaminidase, and albumin with blood pressure and hypertension after 7 years. The Tromsø Study. Blood Press 2022; 31:270-283. [PMID: 36193001 DOI: 10.1080/08037051.2022.2128043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Purpose: Subclinical chronic kidney disease is known to exacerbate hypertension and progression of kidney damage. In order to initiate timely interventions, early biomarkers for this vicious circle are needed. Our aim was to describe the cross-sectional associations of urinary orosomucoid and urinary N-acetyl-β-D-glucosaminidase (NAG) with blood pressure and the longitudinal associations of urinary orosomucoid and NAG to hypertension after 7 years, and to compare the strength of these associations to the urinary albumin excretion (UAE).Material and methods: The Tromsø Study is a population-based, prospective study of inhabitants of the municipality of Tromsø, Northern Norway. Morning spot urine samples were collected on three consecutive days in the Tromsø 6 survey (2007-2008). We assessed the cross-sectional associations of urinary orosomucoid, NAG and UAE with blood pressure in Tromsø 6. In a cohort of participants attending Tromsø 6 and Tromsø 7 (2015-2016), we studied whether urinary biomarkers were longitudinally associated with hypertension.Results: A total of 7197 participants with a mean age of 63.5 years (SD 9.2), and a mean blood pressure of 141/78 mmHg (SD 23.0/10.6), were included in the study. Orosomucoid and UAE, but not NAG, was significantly associated with systolic and diastolic blood pressure in all the crude and multivariable cross-sectional analyses. Orosomucoid had consistently, although marginally, stronger associations with blood pressure. Incident hypertension at follow-up (Tromsø 7) was consistently significantly associated with urinary orosomucoid, but not urinary NAG or UAE. However, the standardized regression coefficients for orosomucoid were only marginally stronger than the standardized regression coefficients for ACR.Conclusion: In a cohort from the general population urine orosomucoid had a stronger cross-sectional association with blood pressure than UAE. After 7 years, urine orosomucoid showed the strongest association with incident hypertension. There were varying and weak associations between U-NAG, blood pressure and hypertension.
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Affiliation(s)
- Karl M Brobak
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Runa M Andreassen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.,Helgeland Hospital Trust, Sandnessjøen, Norway
| | - Toralf Melsom
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aud Høieggen
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon V Norvik
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marit D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
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Halvorsen LV, Bergland OU, Søraas CL, Larstorp ACK, Hjørnholm U, Kjær VN, Kringen MK, Clasen PE, Haldsrud R, Kjeldsen SE, Rostrup M, Fadl Elmula FEM, Opdal MS, Høieggen A. Nonadherence by Serum Drug Analyses in Resistant Hypertension: 7-Year Follow-Up of Patients Considered Adherent by Directly Observed Therapy. J Am Heart Assoc 2022; 11:e025879. [PMID: 36073648 DOI: 10.1161/jaha.121.025879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Measurement of serum concentrations of drugs is a novelty found useful in detecting poor drug adherence in patients taking ≥2 antihypertensive agents. Regarding patients with treatment-resistant hypertension, we previously based our assessment on directly observed therapy. The present study aimed to investigate whether serum drug measurements in patients with resistant hypertension offer additional information regarding drug adherence, beyond that of initial assessment with directly observed therapy. Methods and Results Nineteen patients assumed to have true treatment-resistant hypertension and adherence to antihypertensive drugs based on directly observed therapy were investigated repeatedly through 7 years. Serum concentrations of antihypertensive drugs were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry from blood samples taken at baseline, 6-month, 3-year, and 7-year visits. Cytochrome P450 polymorphisms, self-reported adherence and beliefs about medicine were performed as supplement investigations. Seven patients (37%) were redefined as nonadherent based on their serum concentrations during follow-up. All patients reported high adherence to medications. Nonadherent patients expressed lower necessity and higher concerns regarding intake of antihypertensive medication (P=0.003). Cytochrome P450 polymorphisms affecting metabolism of antihypertensive drugs were found in 16 patients (84%), 21% were poor metabolizers, and none were ultra-rapid metabolizers. Six of 7 patients redefined as nonadherent had cytochrome P450 polymorphisms, however, not explaining the low serum drug concentrations measured in these patients. Conclusions Our data suggest that repeated measurements of serum concentrations of antihypertensive drugs revealed nonadherence in one-third of patients previously evaluated as adherent and treatment resistant by directly observed therapy, thereby improving the accuracy of adherence evaluation. Registration URL: https://www.clinicaltrials.gov; unique identifier: NCT01673516.
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Affiliation(s)
- Lene V Halvorsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ola U Bergland
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Camilla L Søraas
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Section for Environmental and Occupational Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Anne Cecilie K Larstorp
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Medical Biochemistry Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Ulla Hjørnholm
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | - Vibeke N Kjær
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
| | | | - Per-Erik Clasen
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Renate Haldsrud
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
| | - Sverre E Kjeldsen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Cardiology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Basic Medical Sciences University of Oslo Norway
| | - Fadl Elmula M Fadl Elmula
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Acute Medicine Oslo University Hospital, Ullevaal Oslo Norway
| | - Mimi S Opdal
- Department of Pharmacology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
| | - Aud Høieggen
- Section of Cardiovascular and Renal Research Oslo University Hospital, Ullevaal Oslo Norway
- Department of Nephrology Oslo University Hospital, Ullevaal Oslo Norway
- Institute of Clinical Medicine University of Oslo Norway
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Zacks ES, Stokke IM, Wachtell K, Hille DA, Høieggen A, Kjeldsen SE, Julius S, Gerdts E, Okin PM, Devereux RB. Time-varying serum uric acid predicts new-onset atrial fibrillation in treated hypertensive patients. The LIFE Study. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: The Losartan Intervention For Endpoint reduction in hypertension (LIFE) Study showed less new-onset atrial fibrillation (AF) in hypertensive patients receiving losartan- vs. atenolol-based treatment. Because losartan reduces serum uric acid (SUA) levels, the aim of the present study was to investigate relations of SUA with new-onset AF in the study.
Methods: Hypertensive patients with electrocardiographic (ECG) left ventricular hypertrophy (LVH) and no prior AF (n = 8,243) were treated for 5.0 ± 0.4 years with losartan- or atenolol-based therapy. Associations of SUA with new-onset AF documented by Minnesota coding were assessed by Cox models using SUA and systolic blood pressure as time-varying covariates to take into account changes of SUA related to losartan or diuretic treatment, changes in renal function, and aging.
Results: Time-varying SUA was associated with new AF defined by Minnesota code [hazard ratio (HR) = 1.19 per 16.8 μmol/L (1 mg/dL), (95% confidence intervals (CIs), 1.12–1.26), P < 0.0001], independent of losartan treatment [HR = 0.75 (95% CIs, 0.61–0.93), P = 0.007], older age [HR = 1.95 per 7.0 years (95% CIs, 1.73–2.20), P < 0.0001], male sex [HR = 1.46 (95% CIs, 1.09–1.94), P = 0.010] and higher Cornell voltage-duration product [HR = 1.10 per 1,023 ms·mm (95% CIs, 1.01–1.21), P = 0.034]. Similar results were obtained in Cox models with SUA levels partitioned according to baseline quartiles and in which AF was defined by physician reports or by both Minnesota coding and physician reports.
Conclusions: In-treatment SUA is a strong predictor for new-onset AF in hypertensive patients, independent of effects of antihypertensive treatment, age, sex, and ECG-LVH. Further research is needed to clarify how uric acid may provoke AF (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Eran S. Zacks
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ildri M. Stokke
- 2Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, N-0407 Oslo, Norway
| | - Kristian Wachtell
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Darcy A. Hille
- 3Merck Research Laboratories, North Wales, PA 19454, USA
| | - Aud Høieggen
- 2Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, N-0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- 2Departments of Cardiology and Nephrology, Ullevaal Hospital, University of Oslo, N-0407 Oslo, Norway 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Eva Gerdts
- 5Department of Clinical Science, University of Bergen, N-5020 Bergen, Norway
| | - Peter M. Okin
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Richard B. Devereux
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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9
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Høieggen A, Sverre JM, Kittelsen P, Sørensen T, Svendsen T. Berit Holten. Tidsskriftet 2022. [DOI: 10.4045/tidsskr.22.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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10
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Bergland OU, Halvorsen LV, Søraas CL, Hjørnholm U, Kjær VN, Rognstad S, Brobak KM, Aune A, Olsen E, Fauchald YM, Heimark S, Thorstensen CW, Liestøl K, Solbu MD, Gerdts E, Mo R, Rostrup M, Kjeldsen SE, Høieggen A, Opdal MS, Larstorp ACK, Fadl Elmula FEM. Detection of Nonadherence to Antihypertensive Treatment by Measurements of Serum Drug Concentrations. Hypertension 2021; 78:617-628. [PMID: 34275336 DOI: 10.1161/hypertensionaha.121.17514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ola Undrum Bergland
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Lene V Halvorsen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Camilla L Søraas
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Section for Environmental and Occupational Medicine (C.L.S.)
| | - Ulla Hjørnholm
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Vibeke N Kjær
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Stine Rognstad
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Pharmacology (S.R., C.W.T., M.S.O.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Karl Marius Brobak
- Metabolic and Renal Research Group (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø.,UiT The Arctic University of Norway, and Section of Nephrology (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø
| | - Arleen Aune
- Department of Clinical Science, University of Bergen (A.A., E.G.).,Department of Heart Disease, Haukeland University Hospital, Bergen (A.A., E.G.)
| | - Eirik Olsen
- Department of Cardiology, Trondheim University Hospital, University of Trondheim (E.O., R.M.)
| | - Ylva M Fauchald
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Sondre Heimark
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | | | - Knut Liestøl
- Department of Informatics (K.L.), University of Oslo
| | - Marit D Solbu
- Metabolic and Renal Research Group (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø.,UiT The Arctic University of Norway, and Section of Nephrology (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen (A.A., E.G.).,Department of Heart Disease, Haukeland University Hospital, Bergen (A.A., E.G.)
| | - Rune Mo
- Department of Cardiology, Trondheim University Hospital, University of Trondheim (E.O., R.M.)
| | - Morten Rostrup
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Acute Medicine (M.R., F.E.M.F.E.).,Department of Behavioral Sciences, Institute of Basic Medical Sciences (M.R.), University of Oslo
| | - Sverre E Kjeldsen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Cardiology (S.E.K.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Aud Høieggen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Mimi S Opdal
- Department of Pharmacology (S.R., C.W.T., M.S.O.)
| | - Anne Cecilie K Larstorp
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Medical Biochemistry (A.C.K.L.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Fadl Elmula M Fadl Elmula
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Acute Medicine (M.R., F.E.M.F.E.)
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11
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Rognstad S, Søraas CL, Bergland OU, Høieggen A, Strømmen M, Helland A, Opdal MS. Establishing Serum Reference Ranges for Antihypertensive Drugs. Ther Drug Monit 2021; 43:116-125. [PMID: 32881780 DOI: 10.1097/ftd.0000000000000806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) involves the measurement of serum drug concentrations to optimize pharmacotherapy. Traditionally, blood pressure measurements alone, and not TDM, have been used to evaluate the antihypertensive drug response. However, approximately 50% of hypertensive patients treated with lifestyle changes and antihypertensive drugs fail to achieve blood pressure control. Serum drug concentration measurements could be useful to select the optimal drugs in adjusted doses and to identify nonadherence. Implementation of TDM in clinical routine for antihypertensive drugs depends on established serum reference ranges. METHODS Commonly used antihypertensive drugs were identified based on prescription data. The authors performed a review of authoritative literature on reported serum drug concentrations and calculated expected concentrations from previously reported pharmacokinetic parameters with commonly prescribed daily doses. Finally, serum drug concentrations in samples from patients undergoing antihypertensive treatment were measured. RESULTS Serum reference ranges for 24 frequently used antihypertensive drugs were established based on results from 3 approaches. CONCLUSIONS Serum drug concentration measurements, interpreted in light of the established reference ranges, together with blood pressure measurements and other clinical data, may help identify nonadherent patients and tailor individual antihypertensive treatment when deviant drug responses appear in line with the concept of personalized medicine.
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Affiliation(s)
- Stine Rognstad
- Department of Pharmacology, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo
- Section of Cardiovascular and Renal Research, Oslo University Hospital
| | - Camilla L Søraas
- Section of Cardiovascular and Renal Research, Oslo University Hospital
- Unit of Environmental and Occupational Medicine, Oslo University Hospital
| | - Ola U Bergland
- Institute of Clinical Medicine, University of Oslo
- Section of Cardiovascular and Renal Research, Oslo University Hospital
| | - Aud Høieggen
- Institute of Clinical Medicine, University of Oslo
- Section of Cardiovascular and Renal Research, Oslo University Hospital
- Department of Nephrology, Oslo University Hospital, Ullevål
| | - Magnus Strømmen
- Department of Surgery, Center for Obesity Research, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology
| | - Arne Helland
- Department of Clinical Pharmacology, St. Olavs University Hospital; and
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mimi S Opdal
- Department of Pharmacology, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo
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12
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Undrum Bergland O, Larstorp ACK, Lund Søraas C, Høieggen A, Rostrup M, Norheim Kjaer V, Godang K, Sevre K, Fadl Elmula FEM. Changes in sympathetic nervous system activity after renal denervation: results from the randomised Oslo RDN study. Blood Press 2021; 30:154-164. [PMID: 33399016 DOI: 10.1080/08037051.2020.1868286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Sympathetic nervous system (SNS) over-activity is associated with essential hypertension. Renal sympathetic denervation (RDN) possibly lowers office- and ambulatory blood pressure (BP) in patients with treatment-resistant hypertension (TRH). We aimed to assess the effect of RDN compared to drug adjustment on SNS activity among patients with TRH by measuring plasma catecholamines and heart rate variability (HRV) during stress tests. MATERIALS AND METHODS Patients with TRH were randomised to RDN (n = 9) or Drug Adjustment (DA) (n = 10). We measured continuous HRV and beat-to-beat-BP using FinaPres® and obtained plasma catecholamines during standardised orthostatic- and cold-pressor stress tests (CPT) before- and six months after randomisation. RESULTS CPT revealed no differences between groups at baseline in peak adrenaline concentration (69.3 pg/mL in the DA group vs. 70.0 pg/mL in the RDN group, p = 0.38) or adrenaline reactivity (Δ23.1 pg/mL in the DA group vs. Δ29.3 pg/mL in the RDN group, p = 0.40). After six months, adrenaline concentrations were statistically different between groups after one minute (66.9 pg/mL in the DA group vs. 55.3 pg/mL in the RDN group, p = 0.03), and six minutes (62.4 pg/mL in the DA group vs. 50.1 pg/mL in the RDN group, p = 0.03). There was a tendency of reduction in adrenaline reactivity after six months in the RDN group (Δ26.3 pg/mL at baseline vs. Δ12.8 pg/ml after six months, p = 0.08), while it increased in the DA group (Δ13.6 pg/mL at baseline vs. Δ19.9 pg/mL after six months, p = 0.53). We also found a difference in the Low Frequency band at baseline following the CPT (667µs2 in the DA group vs. 1628µs2 in the RDN group, p = 0.03) with a clear tendency of reduction in the RDN group to 743µs2 after six months (p = 0.07), compared to no change in the DA group (1052µs2, p = 0.39). CONCLUSION Our data suggest that RDN reduces SNS activity after six months. This finding warrants investigation in a larger study. Clinical Trial Number registered at www.clinicaltrials.gov: NCT01673516.
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Affiliation(s)
- Ola Undrum Bergland
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | - Camilla Lund Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Section for Environmental and Occupational Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Aud Høieggen
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Rostrup
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Vibeke Norheim Kjaer
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Knut Sevre
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Fadl Elmula M Fadl Elmula
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway
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13
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Bergland OU, Søraas CL, Larstorp ACK, Halvorsen LV, Hjørnholm U, Hoffman P, Høieggen A, Fadl Elmula FEM. The randomised Oslo study of renal denervation vs. Antihypertensive drug adjustments: efficacy and safety through 7 years of follow-up. Blood Press 2020; 30:41-50. [PMID: 33030064 DOI: 10.1080/08037051.2020.1828818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE The blood pressure (BP) lowering effect of renal sympathetic denervation (RDN) in treatment-resistant hypertension shows variation amongst the existing randomised studies. The long-term efficacy and safety of RDN require further investigation. For the first time, we report BP changes and safety up to 7 years after RDN, compared to drug adjustment in the randomised Oslo RDN study. MATERIALS AND METHODS Patients with treatment-resistant hypertension, defined as daytime systolic ambulatory BP ≥135 mmHg after witnessed intake of ≥3 antihypertensive drugs including a diuretic, were randomised to either RDN (n = 9) or drug adjustment (n = 10). The initial primary endpoint was the change in office BP after 6 months. The RDN group had their drugs adjusted after 1 year using the same principles as the Drug Adjustment group. Both groups returned for long-term follow-up after 3 and 7 years. RESULTS The decrease in office BP and ambulatory BP (ABPM) after 6 months did not persist, but gradually increased in both groups. From 6 months to 7 years follow-up, mean daytime systolic ABPM increased from 142 ± 10 to 145 ± 15 mmHg in the RDN group, and from 133 ± 11 to 137 ± 13 mmHg in the Drug Adjustment group, with the difference between them decreasing. In a mixed factor model, a significantly different variance was found between the groups in daytime systolic ABPM (p = .04) and diastolic ABPM (p = .01) as well as office diastolic BP (p<.01), but not in office systolic BP (p = .18). At long-term follow-up we unveiled no anatomical- or functional renal impairment in either group. CONCLUSIONS BP changes up to 7 years show a tendency towards a smaller difference in BPs between the RDN and drug adjustment patients. Our data support RDN as a safe procedure, but it remains non-superior to intensive drug adjustment 7 years after the intervention.
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Affiliation(s)
- Ola Undrum Bergland
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla Lund Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Section for Environmental and Occupational Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | - Lene V Halvorsen
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Ulla Hjørnholm
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
| | - Pavel Hoffman
- Department of Cardiology, Section for Interventional Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Aud Høieggen
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Fadl Elmula M Fadl Elmula
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital Ullevål, Oslo, Norway
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Bergo KK, Larstorp AC, Hoffmann P, Hjørnholm U, Cataliotti A, Høieggen A, Rostrup M, Fadl Elmula FEM. Renal sympathetic denervation lowers systemic vascular resistance in true treatment-resistant hypertension. Blood Press 2020; 30:31-40. [PMID: 32633141 DOI: 10.1080/08037051.2020.1789446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Renal sympathetic denervation (RDN) is again gaining interest as recent well-designed trials have demonstrated reduced ambulatory blood pressure (BP) after RDN. However, the hemodynamic mechanisms have not been elucidated. We aimed for the first time to investigate the effect of RDN on the "Hallmark of Hypertension" namely increased systemic vascular resistance index (SVRI). MATERIALS AND METHODS We investigated SVRI change in patients with true treatment-resistant hypertension randomised to RDN (n = 9) or drug adjusted control (n = 9). Treatment-resistant hypertension was defined as office systolic BP ≥ 140 mmHg despite ≥ 3 antihypertensive drugs including a diuretic. True treatment-resistant hypertension was confirmed prior to inclusion with ambulatory daytime systolic BP ≥ 135 mmHg immediately after witnessed intake of antihypertensive drugs. Hemodynamic variables were recorded with thoracic impedance cardiography at baseline and at three and six months follow-up after RDN. This non-invasive method also guided further tailoring of drug treatment in the control group aiming to normalise hemodynamic variables and BP. RESULTS From three to six months follow-up after RDN, SVRI decreased with a median of -611 dyn*s*m2/cm5 [IQR -949 to -267] (p < 0.01), while supine mean BP decreased with a median of -11 mmHg [IQR -21 to -3] (p = 0.02). In the same period, SVRI in the control group was reduced with -674 dyn*s*m2/cm5 [IQR -1,309 to -340] (p < 0.01), while supine mean BP decreased with -15 mmHg [IQR -29 to -6] (p = 0.01). Thus, hemodynamic variables and BP in the two groups normalised in parallel. CONCLUSION Our data suggest that in patients with true treatment-resistant hypertension, renal sympathetic denervation lowers BP by reducing systemic vascular resistance of similar size as in the control group with careful individual selection of antihypertensive drugs and dose titration.
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Affiliation(s)
- Kaja K Bergo
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Anne C Larstorp
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
| | - Pavel Hoffmann
- Section for Interventional Cardiology, Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Ulla Hjørnholm
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
| | - Alessandro Cataliotti
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Aud Høieggen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway.,Department of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Fadl Elmula M Fadl Elmula
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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Hjørnholm U, Larstorp ACK, Andersen MH, Høieggen A. Directly observed therapy prior to ambulatory blood pressure measurement (DOT-HTN) in uncontrolled hypertensive patients - Effect on blood pressure, safety and patient perception. Blood Press 2019; 28:327-335. [DOI: 10.1080/08037051.2019.1633907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Ulla Hjørnholm
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Cecilie K. Larstorp
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Helen Andersen
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Aud Høieggen
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
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16
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Abstract
Fibromuscular dysplasia affects the muscles of small and medium-sized arteries. The aetiology of the condition is unknown; it is most frequently seen in middle-aged women, but can affect both sexes at any age. Hypertension is the most common clinical manifestation when the renal arteries are affected. The diagnosis is made based on clinical suspicion and specific angiographic findings. The treatment is aimed at normalisation of blood pressure with the aid of drugs or through revacularisation.
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Drangsholt SH, Cappelen UW, von der Lippe N, Høieggen A, Os I, Brekke FB. Beliefs about medicines in dialysis patients and after renal transplantation. Hemodial Int 2019; 23:117-125. [DOI: 10.1111/hdi.12717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Nanna von der Lippe
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - Aud Høieggen
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - Ingrid Os
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - Fredrik B. Brekke
- Sanitary Battalion; Brigade North, Norwegian Armed Forces; Setermoen Norway
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18
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Stubnova V, Os I, Høieggen A, Solbu MD, Grundtvig M, Westheim AS, Atar D, Waldum-Grevbo B. Gender differences in association between uric acid and all-cause mortality in patients with chronic heart failure. BMC Cardiovasc Disord 2019; 19:4. [PMID: 30611196 PMCID: PMC6321661 DOI: 10.1186/s12872-018-0989-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 12/21/2018] [Indexed: 12/24/2022] Open
Abstract
Background Elevated serum uric acid (SUA) is associated with poor prognosis in patients with cardiovascular disease, yet it is still not decided whether the role of SUA is causal or only reflects an underlying disease. The purpose of the study was to investigate if SUA was an independent predictor of 5-year all-cause mortality in a propensity score matched cohort of chronic heart failure (HF) outpatients. Furthermore, to assess whether gender or renal function modified the effect of SUA. Methods Patients (n = 4684) from the Norwegian Heart Failure Registry with baseline SUA were included in the study. Individuals in the highest gender-specific SUA quartile were propensity score matched 1:1 with patients in the lowest three SUA quartiles. The propensity score matching procedure created 928 pairs of patients (73.4% males, mean age 71.4 ± 11.5 years) with comparable baseline characteristics. Kaplan Meier and Cox regression analyses were used to investigate the independent effect of SUA on all-cause mortality. Results SUA in the highest quartile was an independent predictor of all-cause mortality in HF outpatients (hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.03–1.37, p-value 0.021). Gender was found to interact the relationship between SUA and all-cause mortality (p-value for interaction 0.007). High SUA was an independent predictor of all-cause mortality in women (HR 1.65, 95% CI 1.24–2.20, p-value 0.001), but not in men (HR 1.06, 95% CI 0.89–1.25, p-value 0.527). Renal function did not influence the relationship between SUA and all-cause mortality (p-value for interaction 0.539). Conclusions High SUA was independently associated with inferior 5-year survival in Norwegian HF outpatients. The finding was modified by gender and high SUA was only an independent predictor of 5-year all-cause mortality in women, not in men.
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Affiliation(s)
- Viera Stubnova
- Finnmark Hospital Trust, Kirkenes, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ingrid Os
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Aud Høieggen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Marit D Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway.,Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Morten Grundtvig
- Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway
| | - Arne S Westheim
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
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19
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Sommer M, von der Lippe N, Kløw NE, Høieggen A. M. Sommer og medarbeidere svarer. Tidsskriftet 2019; 139:19-0273. [DOI: 10.4045/tidsskr.19.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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20
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Mariampillai JE, Eskås PA, Heimark S, Larstorp ACK, Fadl Elmula FEM, Høieggen A, Nortvedt P. Apparent treatment-resistant hypertension – patient–physician relationship and ethical issues. Blood Press 2017; 26:133-138. [DOI: 10.1080/08037051.2016.1277129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Anne Cecilie K. Larstorp
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Fadl Elmula M. Fadl Elmula
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Internal Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Aud Høieggen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Per Nortvedt
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for Medical Ethics, University of Oslo, Oslo, Norway
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21
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Berra E, Azizi M, Capron A, Høieggen A, Rabbia F, Kjeldsen SE, Staessen JA, Wallemacq P, Persu A. Evaluation of Adherence Should Become an Integral Part of Assessment of Patients With Apparently Treatment-Resistant Hypertension. Hypertension 2016; 68:297-306. [DOI: 10.1161/hypertensionaha.116.07464] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Elena Berra
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Michel Azizi
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Arnaud Capron
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Aud Høieggen
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Franco Rabbia
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Sverre E. Kjeldsen
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Jan A. Staessen
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Pierre Wallemacq
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
| | - Alexandre Persu
- From the Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., E.B.); Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy (F.R., E.B.); Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium (A.P.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular
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22
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Eskås PA, Heimark S, Mariampillai JE, Larstorp ACK, Fadl Elmula FEM, Høieggen A. [Medication adherence and monitoring of antihypertensive treatment]. Tidsskr Nor Laegeforen 2016; 136:920-3. [PMID: 27272370 DOI: 10.4045/tidsskr.15.0978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Lack of adherence to medication may be the explanation for unsatisfactory drug efficacy and is often misinterpreted as resistance to treatment. When encountering patients with persistent high blood pressure despite antihypertensive treatment, it is therefore important to discover whether they are actually taking their medication. This article aims to provide an updated overview of methods of revealing and monitoring medication adherence. The article is based on non-systematic literature searches in PubMed and on the senior authors' own clinical experience.
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Affiliation(s)
| | | | | | - Anne Cecilie K Larstorp
- Avdeling for medisinsk biokjemi Klinikk for laboratoriemedisin og Enhet for indremedisinsk forskning Oslo universitetssykehus, Ullevål
| | - Fadl Elmula Mohamed Fadl Elmula
- Avdeling for hjertemedisin og avdeling for generell indremedisin Medisinsk klinikk Oslo universitetssykehus, Ullevål og Institutt for klinisk medisin, Medisinsk fakultet Universitetet i Oslo
| | - Aud Høieggen
- Nyremedisinsk avdeling Medisinsk klinikk Oslo universitetssykehus, Ullevål og Institutt for klinisk medisin Medisinsk fakultet Universitetet i Oslo
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23
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Heimark S, Eskås PA, Mariampillai JE, Larstorp ACK, Høieggen A, Fadl Elmula FEM. Tertiary work-up of apparent treatment-resistant hypertension. Blood Press 2016; 25:312-8. [DOI: 10.3109/08037051.2016.1172865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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24
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Eskås PA, Heimark S, Eek Mariampillai J, Larstorp ACK, Fadl Elmula FEM, Høieggen A. Adherence to medication and drug monitoring in apparent treatment-resistant hypertension. Blood Press 2016; 25:199-205. [PMID: 26729283 DOI: 10.3109/08037051.2015.1121706] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Poor drug adherence is one of the main reasons for the failure to achieve treatment targets in hypertensive patients. In patients who receive pharmacological treatment, assessment of drug adherence is of the utmost importance. The aim of this review is to present an update of the methods available to reveal and monitor non-adherence in patients with apparent treatment-resistant hypertension. Methods for monitoring adherence are divided into indirect and direct methods. The indirect methods are mainly based on self-reported adherence and can easily be manipulated by the patient. Directly observed therapy and therapeutic drug monitoring are examples of direct methods. There are limitations and advantages to all of the methods, and because of the patient's ability to manipulate the outcome of indirect methods, direct methods should be preferred. Therapeutic drug monitoring and directly observed therapy with subsequent ambulatory blood pressure measurement are considered to be reliable methods and should be used more in the routine assessment of patients with apparent treatment-resistant hypertension.
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Affiliation(s)
| | - Sondre Heimark
- a Faculty of Medicine , University of Oslo , Oslo , Norway
| | | | | | - Fadl Elmula M Fadl Elmula
- a Faculty of Medicine , University of Oslo , Oslo , Norway ;,c Section for Cardiovascular and Renal Research ;,d Department of Cardiology ;,e Department of Internal Medicine
| | - Aud Høieggen
- a Faculty of Medicine , University of Oslo , Oslo , Norway ;,c Section for Cardiovascular and Renal Research ;,f Department of Nephrology , Oslo University Hospital , Ullevaal , Oslo , Norway
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25
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Skårn SN, Flaa A, Kjeldsen SE, Rostrup M, Brunborg C, Reims HM, Fossum E, Høieggen A, Aksnes TA. High screening blood pressure at young age predicts future masked hypertension: A 17 year follow-up study. Blood Press 2015; 24:131-8. [DOI: 10.3109/21695717.2015.1030889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Sigrid Nordang Skårn
- Section of Cardiovascular and Renal Research
- Department of Acute Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnljot Flaa
- Section of Cardiovascular and Renal Research
- Department of Cardiology
| | - Sverre E. Kjeldsen
- Section of Cardiovascular and Renal Research
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research
- Department of Acute Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services
| | - Henrik M. Reims
- Section of Cardiovascular and Renal Research
- Department of Pathology
| | - Eigil Fossum
- Section of Cardiovascular and Renal Research
- Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic
| | - Aud Høieggen
- Section of Cardiovascular and Renal Research
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
| | - Tonje Amb Aksnes
- Section of Cardiovascular and Renal Research
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
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26
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Persu A, Jin Y, Fadl Elmula FEM, Renkin J, Høieggen A, Kjeldsen SE, Staessen JA. Renal denervation in treatment-resistant hypertension: a reappraisal. Curr Opin Pharmacol 2015; 21:48-52. [DOI: 10.1016/j.coph.2014.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/11/2014] [Accepted: 12/21/2014] [Indexed: 11/30/2022]
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27
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Mariampillai JE, Fadl Elmula FEM, Hoffmann P, Sørensen H, Høieggen A, Kjeldsen SE. [Questionable efficacy of renal denervation]. Tidsskr Nor Laegeforen 2014; 134:1643-4. [PMID: 25223668 DOI: 10.4045/tidsskr.14.0900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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28
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Kjeldsen SE, Sørensen H, Fadl Elmula FEM, Brekke M, Gjønnæss E, Hjørnholm U, Kjære VN, Rostrup M, Fossum E, Os I, Stenehjem A, Høieggen A, Hoffmann P. [Re: Renal sympathetic denervation in treatment-resistant hypertension]. Tidsskr Nor Laegeforen 2014; 134:1449-50. [PMID: 25138398 DOI: 10.4045/tidsskr.14.0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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29
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Persu A, Jin Y, Baelen M, Vink E, Verloop WL, Schmidt B, Blicher MK, Severino F, Wuerzner G, Taylor A, Pechère-Bertschi A, Jokhaji F, Fadl Elmula FEM, Rosa J, Czarnecka D, Ehret G, Kahan T, Renkin J, Widimský J, Jacobs L, Spiering W, Burnier M, Mark PB, Menne J, Olsen MH, Blankestijn PJ, Kjeldsen S, Bots ML, Staessen JA, Baelen M, Gerber B, Horman S, Kefer J, Lengelé JP, le Polain de Waroux JB, Renkin J, Scavée C, Severino F, Vanoverschelde JL, Ehret G, Péchère-Bertschi A, Berry C, Brady A, Delles C, Dominiczak A, Freel M, Jardine A, Moss J, Muir S, Mark P, Padmanabhan S, Roditi G, Bauersachs J, Brinkmann J, Haller H, Heusser K, Jordan J, Klein G, Menne J, Schmidt B, Tank J, Czarnecka D, Jastrzębski M, Styczkiewicz K, Burnier M, Wuerzner G, Asayama K, Gu Y, Hashimoto A, Jacobs L, Jin Y, Kuznetsova T, Liu Y, Thijs L, Staessen JA, Blicher M, Beck-Nielse H, Flemming Høilund-Carlsen P, Olsen M, Brekke M, Engeseth K, Fadl Elmula FEM, Fossum E, Gjønnæss E, Hjørnholm U, Hoffmann P, Høieggen A, Kjær V, Kjeldsen SE, Larstorp AC, Meyerdierks O, Os I, Rostrup M, Stenehjem A, Rosa J, Petrak O, Zelinka T, Strauch B, Curila K, Tousek P, Widimský J, Widimský P, Jokhaji F, Lander R, Kahan T, Spaak J, Blankestijn PJ, Bots ML, Doevendans PA, Rookmaaker MB, Spiering W, Verloop WL, Vink EE, Voskuil M, Vonken EJ. Eligibility for Renal Denervation. Hypertension 2014; 63:1319-25. [DOI: 10.1161/hypertensionaha.114.03194] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Alexandre Persu
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Yu Jin
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Marie Baelen
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Eva Vink
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Willemien L. Verloop
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Bernhard Schmidt
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Marie K. Blicher
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Francesca Severino
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Grégoire Wuerzner
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Alison Taylor
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Antoinette Pechère-Bertschi
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Fadi Jokhaji
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Fadl Elmula M. Fadl Elmula
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Jan Rosa
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Danuta Czarnecka
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Georg Ehret
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Thomas Kahan
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Jean Renkin
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Jiří Widimský
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Lotte Jacobs
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Wilko Spiering
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Michel Burnier
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Patrick B. Mark
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Jan Menne
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Michael H. Olsen
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Peter J. Blankestijn
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Sverre Kjeldsen
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Michiel L. Bots
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
| | - Jan A. Staessen
- From the Pole of the Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P., J. Renkin) and Division of Cardiology, Cliniques Universitaires Saint-Luc (A.P., M.B., F.S., J. Renkin), Université Catholique de Louvain, Brussels, Belgium; Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (Y.J., L.J., J.A.S.); Julius Center for Health Sciences and Primary
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Fadl Elmula FEM, Hoffmann P, Larstorp AC, Fossum E, Brekke M, Kjeldsen SE, Gjønnæss E, Hjørnholm U, Kjær VN, Rostrup M, Os I, Stenehjem A, Høieggen A. Adjusted Drug Treatment Is Superior to Renal Sympathetic Denervation in Patients With True Treatment-Resistant Hypertension. Hypertension 2014; 63:991-9. [DOI: 10.1161/hypertensionaha.114.03246] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Fadl Elmula M. Fadl Elmula
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Pavel Hoffmann
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Anne C. Larstorp
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Eigil Fossum
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Magne Brekke
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Sverre E. Kjeldsen
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Eyvind Gjønnæss
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Ulla Hjørnholm
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Vibeke N. Kjær
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Morten Rostrup
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Ingrid Os
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Aud Stenehjem
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
| | - Aud Høieggen
- From Section for Cardiovascular and Renal Research, Department of Cardiology (F.M.F., A.C.L., S.E.K.), Department of Preventive Cardiology (U.H., V.N.K.), Department of Acute Medicine (M.R.), and Department of Nephrology (I.O., A.S., A.H.), Medical Clinic; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic (P.H., E.F., M.B.); and Section for Vascular Intervention, Department of Radiology, Clinic for Laboratory Medicine (E.G.), Oslo University
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Sørensen H, Fadl Elmula FEM, Kjeldsen SE, Brekke M, Gjønnæss E, Hjørnholm U, Kjær VN, Rostrup M, Fossum E, Os I, Stenehjem A, Høieggen A, Hoffmann P. [Renal sympathetic denervation in treatment-resistant hypertension]. Tidsskr Nor Laegeforen 2014; 134:32-6. [PMID: 24429753 DOI: 10.4045/tidsskr.13.0276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Renal denervation (RDN) has been introduced as a potential new treatment for patients with treatment-resistant hypertension, defined as a blood pressure above 140/90 mm Hg despite treatment with at least three antihypertensive drugs. We present an overview of this type of treatment, describe the method and discuss its possible future uses. METHOD The review is based on a discretionary selection of relevant articles from our archive, our own experience and a literature search in PubMed. RESULTS The use of RDN for treatment-resistant hypertension is based on a single randomised study with a total of 104 patients, in which the intervention group experienced a fall in blood pressure of 32/12 mm Hg, while blood pressure in the control group remained unchanged. More than 16,000 patients, particularly in Germany, have been treated on this basis. In the USA, data from a larger randomised study (n = 530) that includes sham surgery are awaited before any decision is made on whether to approve the method for use. INTERPRETATION Before RDN can become recommended treatment in Norway, more evidence is required that the method lowers blood pressure, and that this reduces morbidity and mortality.
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Fadl Elmula FEM, Hoffmann P, Fossum E, Brekke M, Gjønnæss E, Hjørnholm U, Kjær VN, Rostrup M, Kjeldsen SE, Os I, Stenehjem AE, Høieggen A. Renal sympathetic denervation in patients with treatment-resistant hypertension after witnessed intake of medication before qualifying ambulatory blood pressure. Hypertension 2013; 62:526-32. [PMID: 23836798 DOI: 10.1161/hypertensionaha.113.01452] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
It is unknown whether the decline in blood pressure (BP) after renal denervation (RDN) is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate the BP lowering effect of RDN in true treatment-resistant hypertension by excluding patients with poor drug adherence. Patients with resistant hypertension (n=18) were referred for a thorough clinical and laboratory work-up. Treatment-resistant hypertension was defined as office systolic BP>140 mm Hg, despite maximally tolerated doses of ≥ 3 antihypertensive drugs, including a diuretic. In addition, ambulatory daytime systolic BP>135 mm Hg was required after witnessed intake of antihypertensive drugs to qualify. RDN (n=6) was performed with Symplicity Catheter System. The mean office and ambulatory BPs remained unchanged at 1, 3, and 6 months in the 6 patients, whereas there was no known change in antihypertensive medication. Two patients, however, had a fall in both office and ambulatory BPs. Our findings question whether BP falls in response to RDN in patients with true treatment-resistant hypertension. Additional research must aim to verify potential BP lowering effect and identify a priori responders to RDN before this invasive method can routinely be applied to patients with drug-resistant hypertension. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.
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Affiliation(s)
- Fadl Elmula Mohamed Fadl Elmula
- Section for Cardiovascular and Renal Research, Department of Cardiology, Medical Clinic, Oslo University Hospital, Ullevål, Oslo, Norway
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Kjeldsen SE, Schultz M, Vinkenes K, Aksnes TA, Høieggen A. Blodtrykksbehandling – mot enighet om mangt. Tidsskriftet 2013; 133:2226. [DOI: 10.4045/tidsskr.13.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Høieggen A. Dypdykk i glomerulonefritter. Tidsskriftet 2013. [DOI: 10.4045/tidsskr.13.1205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Gudmundsdottir H, Høieggen A, Stenehjem A, Waldum B, Os I. Hypertension in women: latest findings and clinical implications. Ther Adv Chronic Dis 2012; 3:137-46. [PMID: 23251774 DOI: 10.1177/2040622312438935] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular disease claims more women's lives than any other disease. Hypertension is an important risk factor for cardiovascular disease in women but is often underestimated and undiagnosed and there is an ongoing misperception that women are at a lower risk of cardiovascular disease than men. The attainment of clinical blood pressure goals can markedly reduce cardiovascular morbidity and mortality, yet approximately two-thirds of treated hypertensive women have uncontrolled blood pressure. Furthermore, there are special risk factors that are unique for women that needs acknowledgement in order to help prevent the great number of hypertension-related events in women. Guidelines for treatment of hypertension are similar for men and women. More studies on the interaction between gender and response to antihypertensive drugs would be of interest.
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Strand A, Gudmundsdottir H, Høieggen A, Fossum E, Bjørnerheim R, Os I, Kjeldsen SE. Increased hematocrit before blood pressure in men who develop hypertension over 20 years. ACTA ACUST UNITED AC 2012; 1:400-6. [PMID: 20409872 DOI: 10.1016/j.jash.2007.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 07/02/2007] [Accepted: 07/09/2007] [Indexed: 12/01/2022]
Abstract
We have previously demonstrated that neurohormonal activity can predict left ventricular (LV) mass in men who developed hypertension over 20 years. The aim of the study was to investigate early markers of cardiac and hemorheological changes at baseline in these men, i.e., before a rise in blood pressure. Fifty-six middle-aged men were followed for 20 years; 22 were sustained hypertensives, 17 developed hypertension, and 17 were sustained normotensives. They were compared at baseline (42 years) and follow-up (62 years). We investigated Cornell voltage product and Sokolow-Lyon voltage, hematocrit (Hct), and echocardiographic LV parameters. There was no sign of LV hypertrophy by electrocardiography (ECG) at baseline. Baseline Hct discriminated between the groups (P= .015) and correlated to diastolic blood pressure (DBP) at baseline (r = 0.37, P= .006) and follow-up (r = 0.31, P= .020). Regression analysis identified baseline Hct as an independent correlate of DBP in the cohort at baseline when they were untreated (beta = .33, P= .013, R(2) = 0.25), and of borderline significance at follow-up (beta = .26, P= .060, R(2) = 0.12) despite possible interference by antihypertensive drugs. Hct was elevated at baseline compatible with the hypothesis that pathogenic hemorheological processes could be activated at the outset and prior to cardiac changes in men who later develop hypertension.
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Affiliation(s)
- Arne Strand
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
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Høieggen A, Os I. Alvorlig sykdom - barsk behandling. Tidsskriftet 2012; 132:1624-5. [DOI: 10.4045/tidsskr.12.0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Høieggen A, Os I. Nyreskade forårsaket av legemidler. Tidsskriftet 2012; 132:1462-4. [DOI: 10.4045/tidsskr.11.0773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Affiliation(s)
- Sverre E Kjeldsen
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
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Reims HM, Sevre K, Høieggen A, Fossum E, Eide I, Kjeldsen SE. Blood viscosity: Effects of mental stress and relations to autonomic nervous system function and insulin sensitivity. Blood Press 2009; 14:159-69. [PMID: 16036496 DOI: 10.1080/08037050510034176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We studied effects of mental stress on whole-blood viscosity (WBV) and blood pressure (BP), and relations between WBV and autonomic nervous system activity and insulin sensitivity. We measured WBV (rotational rheometer), plasma noradrenaline (NA), finger BP, heart rate variability (HRV) and baroreflex sensitivity (BRS; transfer technique) during hyperinsulinaemic glucose clamp and mental arithmetic stress test (MST) in 20 men with high ( > or =140/90 mmHg) and 21 men with normal (< or =115/75 mmHg) screening BP, and 10 women regardless of screening BP (all normotensive). WBV and NA increased during the MST, while HRV and BRS decreased. During the MST, WBV (all shear rates) and the response ((delta)WBV) (low shear) were higher in men with high compared to normal screening BP (p<0.05). In men, WBV correlated positively with NA and negatively with HRV, BRS and insulin sensitivity. The diastolic BP response ((delta)DBP) was independently explained by high-shear (delta)WBV (p<0.05) and (delta)NA (p<0.0001), and (delta)WBV independently by (delta)DBP (p<0.05). WBV is related to increased sympathetic activity, impaired vagal cardiac control and low insulin sensitivity in young adults. The haemorheological effect of mental stress is increased in young men with high screening BP and may be mediated by the acute increase in BP.
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Affiliation(s)
- Henrik M Reims
- Department of Cardiology, University of Michigan, Ann Arbor, MI, USA.
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Reims HM, Sevre K, Fossum E, Høieggen A, Eide I, Kjeldsen SE. Plasma catecholamines, blood pressure responses and perceived stress during mental arithmetic stress in young men. Blood Press 2009; 13:287-94. [PMID: 15545152 DOI: 10.1080/08037050410016474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We assessed plasma noradrenaline (NA) and adrenaline (A) at rest during a hyperinsulinaemic glucose clamp and responses to a mental arithmetic stress test (MST) in relation to blood pressure (BP) responses (Finapres) and distress in 20 men with high (> or =140/90 mmHg) and 21 men with normal (< or =115/75 mmHg) screening BP, 21-24 years of age. Perceived stress, effort and overall discomfort were scored 1-10. Catecholamines and BP increased in both groups, change in diastolic BP (DeltaDBP; 9.9 vs. 3.8 mmHg, p < 0.05) and DeltaDBP carryover (recovery period minus baseline) (7.2 vs. 2.2 mmHg, p < 0.01) being greater in men with high screening BP. Independently of BP status, change in systolic BP (DeltaSBP) and DeltaSBP carryover were related to A (both p < 0.001), and DeltaDBP and DeltaDBP carryover to DeltaNA (both p < 0.001). The subjective score sum correlated with maximal NA (rs = 0.40) and A (rs = 0.37) (both p < 0.05). Maximal NA was independently related to stress (p < 0.05) and the subjective score sum (p < 0.01). DeltaA% was greater in the high- (score > or =6) than in the low-stress category, independently of BP status (p < 0.05). High screening BP is associated with impaired BP recovery after mental stress. Plasma catecholamine responses are related to BP responses and carryover effects, and reflect perceived stress in young men.
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Affiliation(s)
- Henrik M Reims
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway.
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Affiliation(s)
- Ingrid Os
- Department of Pharmacotherapeutics, University of Oslo, Oslo, Norway.
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Fossum E, Høieggen A, Reims HM, Moan A, Rostrup M, Eide I, Kjeldsen SE. High screening blood pressure is related to sympathetic nervous system activity and insulin resistance in healthy young men. Blood Press 2009; 13:89-94. [PMID: 15182111 DOI: 10.1080/08037050310031008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The cardiovascular metabolic syndrome is characterized by the presence of several cardiovascular risk factors, including blood pressure (BP) elevation. We aimed to study the relation between mental stress, plasma catecholamines, BP and BP responses to mental stress in healthy young Caucasian men selected from different levels of screening BP. We included 98 men with high and 22 men with normal screening BP. They were examined at baseline in the laboratory, during a hyperinsulinemic, isoglycemic glucose clamp and during mental stress. At baseline in the laboratory, the men with high screening BP were characterized by elevated BP (p < 0.005) and plasma catecholamines (p < 0.05), but unaltered serum lipid levels compared to men with normal screening BP. After 2 h rest the differences almost disappeared, but could be reproduced during a mental arithmetic stress test. The men with elevated screening BP had significantly higher fasting glucose (p = 0.01) and lower insulin sensitivity (p < 0.005). In a multiple regression model, norepinephrine during mental stress (R2 = 0.10, p < 0.05) was the main variable to retrospectively explain allocation to the normal or high screening BP group. In conclusion, young healthy men with elevated screening BP are characterized by increased sympathetic activity and insulin resistance. Norepinephrine during mental stress is the main variable to explain allocation to the normal or elevated screening BP group. We have shown that one single screening BP measurement predicts insulin resistance and elevated fasting glucose in this cohort.
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Affiliation(s)
- Eigil Fossum
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway.
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Gudmundsdottir H, Strand AH, Kjeldsen SE, Høieggen A, Os I. Serum phosphate, blood pressure, and the metabolic syndrome--20-year follow-up of middle-aged men. J Clin Hypertens (Greenwich) 2009; 10:814-21. [PMID: 19128269 DOI: 10.1111/j.1751-7176.2008.00032.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The authors investigated the relationship between serum phosphate (S-phosphate) and the metabolic syndrome in a group of middle-aged hypertensive and normotensive men during 20-year follow-up. Fifty-six men participated. Of the original 34 normotensive men, hypertension developed in 17. In the group as a whole and in those in whom hypertension developed, there was a significant negative relationship between S-phosphate at baseline and mean blood pressure (MBP) at follow-up. A significant relationship was observed between S-phosphate at baseline and components of the metabolic syndrome in the group as a whole, in individuals with hypertension, and in individuals with the lowest S-phosphate levels at follow-up. S-phosphate at baseline predicted MBP 20 years later in a group of hypertensive and normotensive men. When grouped according to the number of components of the metabolic syndrome, individuals with the lowest serum phosphate levels had the highest number of risk factors. These findings may suggest a role of low S-phosphate in the development of hypertension and the metabolic syndrome.
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Gudmundsdottir H, Strand AH, Høieggen A, Reims HM, Westheim AS, Eide IK, Kjeldsen SE, Os I. Do screening blood pressure and plasma catecholamines predict development of hypertension? Twenty-year follow-up of middle-aged men. Blood Press 2008; 17:94-103. [PMID: 18568698 DOI: 10.1080/08037050801972923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The sympathetic nervous system is implicated in the development and maintenance of hypertension. However, the predictive impact of arterial plasma catecholamines has never been reported. We investigated arterial catecholamines and blood pressures (BPs) prospectively over 20 years in a group of well-characterized middle-aged men. METHODS Fifty-six of original 79 men were available for the follow-up. Multiple regression analysis was done with mean BP at follow-up as a dependent variable, and arterial plasma catecholamines and BP at baseline as independent variables. RESULTS Half of the originally normotensive men developed hypertension during follow-up. There were significant differences in the screening BP values measured at baseline between the new hypertensives and the sustained normotensives. Multiple regression analysis revealed arterial adrenaline at baseline as an independent predictor of mean BP at follow-up in the new hypertensives (beta = 0.646, R2 = 0.42, p = 0.007). Furthermore, arterial noradrenaline at baseline was a negative independent predictor of mean BP at follow-up in the sustained normotensives (beta = -0.578, R2 = 0.334, p = 0.020). Noradrenaline increased with age in the group as a whole (1318+/-373 vs 1534+/-505 pmol/l, p = 0.010) while adrenaline did not change. CONCLUSION Our data suggest that arterial adrenaline is involved in the development of hypertension over 20 years in middle-aged men. Men with sustained normotension may have an inherent protection against sympathetic overactivity. Furthermore, screening BP at baseline in normotensive men differentiated between those who developed hypertension and those who remained normotensive at follow-up.
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Smebye ML, Iversen EK, Høieggen A, Flaa A, Os I, Kjeldsen SE, Olsen MH, Chattopadhyay A, Hille DA, Lyle PA, Devereux RB, Dahlöf B. Effect of hemoglobin levels on cardiovascular outcomes in patients with isolated systolic hypertension and left ventricular hypertrophy (from the LIFE study). Am J Cardiol 2007; 100:855-9. [PMID: 17719333 DOI: 10.1016/j.amjcard.2007.03.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/29/2007] [Accepted: 03/29/2007] [Indexed: 10/23/2022]
Abstract
The optimal hemoglobin level in patients with hypertension or heart failure is not yet defined. The aim of the present investigation was to examine the relation of hemoglobin with cardiovascular outcomes in high-risk patients with isolated systolic hypertension (ISH) and left ventricular hypertrophy (LVH). In 1,326 patients with ISH in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) study, hemoglobin and cardiovascular outcomes were examined using Cox proportional hazard models. Baseline hemoglobin was negatively related to rate of cardiovascular death (hazard ratio 0.81 per 1 g/dl, 95% confidence interval [CI] 0.67 to 0.98, p = 0.032) after adjusting for baseline Framingham risk score, LVH, treatment, and estimated glomerular filtration rate. Hemoglobin decreased slightly during the study and the decrease was more pronounced in the losartan group (13.9 +/- 1.3 to 13.6 +/- 1.4 g/dl) than in the atenolol group (13.9 +/- 1.2 to 13.8 +/- 1.4 g/dl). Hemoglobin as a time-varying covariate was negatively associated with rate of cardiovascular death (hazard ratio 0.75, 95% CI 0.63 to 0.90, p <0.001) and stroke (hazard ratio 0.84, 95% CI 0.72 to 0.99, p = 0.040) after adjusting for baseline Framingham risk score, LVH, treatment, and estimated glomerular filtration rate. In conclusion, in this high-risk population with ISH and LVH, lower hemoglobin at baseline was associated with higher probability of cardiovascular death, and decrease in hemoglobin over time was associated with higher probability of cardiovascular death or stroke; this effect was attenuated by treatment with losartan.
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Affiliation(s)
- Marianne L Smebye
- Department of Nephrology, University of Oslo Ullevaal Hospital, Oslo, Norway
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Kjeldsen SE, Lyle PA, Kizer JR, Oparil S, Høieggen A, Os I. Fixed combination of losartan and hydrochlorothiazide and reduction of risk of stroke. Vasc Health Risk Manag 2007; 3:299-305. [PMID: 17703637 PMCID: PMC2293966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A fixed-dose combination of losartan/hydrochlorothiazide (HCTZ) therapy may be a logical choice for antihypertensive treatment, including for initial therapy in patients with blood pressure elevation >20/10 mmHg above treatment target. The renin-angiotensin-aldosterone-system-activating effect of hydrochlorothiazide augments the efficacy of blocking the angiotensin II type 1 (AT1) receptor with losartan. Some adverse effects associated with hydrochlorothiazide, including increased risk for new-onset diabetes mellitus, may be offset by losartan. Losartan was frequently administered with hydrochlorothiazide in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, in which there was a 25% risk reduction for stroke in the losartan-based compared with the atenolol-based treatment group. The efficacy, tolerability, and convenience of losartan/HCTZ combination therapy may increase patient compliance and lower risk for stroke, a devastating outcome in patients with hypertension.
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Affiliation(s)
- Sverre E Kjeldsen
- Department of Cardiology, Ullevaal University Hospital, N-0407 Oslo, Norway.
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Abstract
Observational data have suggested that increased water intake decreases the risk of CHD. A postulated mechanism is that increased water ingestion reduces blood viscosity. The aim of the present study was to assess the effect of increased fluid intake on blood viscosity. Men (n 67) and postmenopausal women (n 27) with one or more risk factors for CVD who reported intake of ≤ 0·5 litres water daily were randomised to a control group (n 31), an intervention group (n 32) that increased their daily water intake by 1 litre/d and an intervention group (n 31) that ingested 1 litre blueberry juice/d. All were encouraged to continue their usual diet and lifestyle. Whole-blood viscosity and blood and urine chemistries were measured by standard techniques after 2 and 4 weeks. Urine volume increased (by a median of 872 and 725 ml in the water and blueberry juice groups, respectively, v. 10 ml in the control group; P ≤ 0·002), confirming the subjects' adherence to the protocol. Urine osmolality and urinary levels of Na, K and creatinine decreased in the water and blueberry juice groups v. the controls (P < 0·05). No change was seen in whole-blood viscosity or in levels of fibrinogen, total protein, lipids, glucose, insulin, C-peptide or other chemistry and haematology variables. In conclusion, a postulated protective effect of increased water or fluid intake is not explained by a change in blood viscosity and increased fluid intake does not influence CVD risk factors in the short term.
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Affiliation(s)
- Serena Tonstad
- Department of Preventive Cardiology, Ullevål University Hospital, N-0407 Oslo, Norway.
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Fossum E, Olsen MH, Høieggen A, Wachtell K, Reims HM, Kjeldsen SE, Ibsen H, Wan Y, Julius S. Long‐Term Effects of a Losartan‐Compared With an Atenolol‐Based Treatment Regimen on Carotid Artery Plaque Development in Hypertensive Patients With Left Ventricular Hypertrophy: ICARUS, a LIFE Substudy. J Clin Hypertens (Greenwich) 2007; 8:169-73. [PMID: 16522993 PMCID: PMC8109329 DOI: 10.1111/j.1524-6175.2006.04838.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study, there was a 25% risk reduction for stroke with angiotensin receptor blocker-based therapy (losartan) as compared with beta-blocker-based therapy (atenolol) despite comparable blood pressure reductions. This substudy examines treatment effects on the amount and density of atherosclerotic lesions in the common carotid arteries and the carotid bulb in 81 patients during 3 years of treatment. There were no statistically significant changes in the amount of carotid plaque in patients treated with losartan compared with an atenolol-based treatment program. A statistically nonsignificant increase in plaque density and index (average of plaque amount and density) was seen in the atenolol group compared with those treated with losartan. The small number of patients evaluated may have limited the power to detect a difference in outcome. The difference in carotid plaque index increase between the treatment groups during 3 years of treatment could not be statistically linked to specific treatments in the present substudy.
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Affiliation(s)
- Eigil Fossum
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway.
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