1
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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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2
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Heimark S, Mehlum MH, Mancia G, Søraas CL, Liestøl K, Wachtell K, Larstorp AC, Rostrup M, Mariampillai JE, Kjeldsen SE, Julius S, Weber MA. Middle-Aged and Older Patients With Left Ventricular Hypertrophy: Higher Mortality With Drug Treated Systolic Blood Pressure Below 130 mm Hg. Hypertension 2023. [PMID: 37350267 DOI: 10.1161/hypertensionaha.123.21454] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Approximately 40% of people with hypertension have left ventricular hypertrophy (LVH) detected by ECG or echocardiography. Because patients with LVH have poor myocardial microcirculation, they may be too sensitive to lowering systolic blood pressure (SBP) too much due to a lack of myocardial perfusion pressure. We aimed to investigate whether the average achieved SBP <130 mm Hg may cause harm in patients with LVH in the Valsartan Antihypertensive Long-Term Use Evaluation trial (VALUE). METHODS Of the 15 245 VALUE participants, we identified 13 803 patients without cardiovascular events during the first 6 months after randomization. Of these, 2458 patients had electrocardiographic LVH (ECG-LVH). Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other prespecified end points for patients who achieved average SBP 130 to 139 mm Hg (No-LVH group n=4863; ECG-LVH group n=929) and <130 mm Hg (No-LVH group n=2107; ECG-LVH group n=305). Reference groups were patients who achieved average SBP ≥140 mm Hg following the first excluded 6 months (No-LVH group n=4375; ECG-LVH group n=1224). RESULTS The No-LVH group achieving average SBP <130 mm Hg had a significantly lower incidence of several cardiovascular end points. The ECG-LVH group achieving average SBP <130 mm Hg had higher cardiac mortality (hazard ratio, 1.98 [95% CIs, 1.06-3.70]; P=0.032) and all-cause mortality (hazard ratio, 1.74 [95% CIs, 1.17-2.60]; P=0.007), and SBP <130 mm Hg was not associated with a reduction in any end point. CONCLUSIONS Our findings may be seen as a signal that caution is warranted when treating middle-aged and older patients with electrocardiographic or echocardiographic LVH to SBP <130 mm Hg.
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Affiliation(s)
- Sondre Heimark
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Department of Nephrology, Oslo University Hospital, Ullevaal, Norway. (S.H.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Maria H Mehlum
- Department of Geriatrics, Oslo University Hospital, Ullevaal, Norway. (M.H.M.)
| | | | - Camilla L Søraas
- Department of Environmental and Occupational Medicine, Oslo University Hospital, Ullevaal, Norway. (C.L.S.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Knut Liestøl
- Institute of Informatics, University of Oslo, Norway. (K.L.)
| | - Kristian Wachtell
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (K.W.)
| | - Anne C Larstorp
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Norway. (A.C.L.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Morten Rostrup
- Institute of Basic Medical Sciences University of Oslo, Norway. (M.R.)
- Department of Acute Medicine, Oslo University Hospital, Ullevaal, Norway. (M.R.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | | | - Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway. (S.E.K.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
| | - Michael A Weber
- Department of Cardiovascular Medicine, SUNY Downstate College of Medicine, NY (M.A.W.)
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3
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Aarskog NR, Iuell RS, Dunlop O, Sevre K, Bendz B, Rostrup M. Neuropsychological function is associated with hypocapnia at simulated high altitude. Acta Physiol (Oxf) 2023; 237:e13949. [PMID: 36772955 DOI: 10.1111/apha.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Affiliation(s)
- Nikolai Ravn Aarskog
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Oona Dunlop
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Sevre
- Department of Cardiology, Division of Cardiovascular & Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Bjørn Bendz
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Cardiovascular & Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Morten Rostrup
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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4
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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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5
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Udjus C, Sjaastad I, Hjørnholm U, Tunestveit TK, Hoffmann P, Hinojosa A, Espe EKS, Christensen G, Skjønsberg OH, Larsen KO, Rostrup M. Extreme altitude induces divergent mass reduction of right and left ventricle in mountain climbers. Physiol Rep 2022; 10:e15184. [PMID: 35146955 PMCID: PMC8831961 DOI: 10.14814/phy2.15184] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022] Open
Abstract
Mountain climbing at high altitude implies exposure to low levels of oxygen, low temperature, wind, physical and psychological stress, and nutritional insufficiencies. We examined whether right ventricular (RV) and left ventricular (LV) myocardial masses were reversibly altered by exposure to extreme altitude. Magnetic resonance imaging and echocardiography of the heart, dual x‐ray absorptiometry scan of body composition, and blood samples were obtained from ten mountain climbers before departure to Mount Everest or Dhaulagiri (baseline), 13.5 ± 1.5 days after peaking the mountain (post‐hypoxia), and six weeks and six months after expeditions exceeding 8000 meters above sea level. RV mass was unaltered after extreme altitude, in contrast to a reduction in LV mass by 11.8 ± 3.4 g post‐hypoxia (p = 0.001). The reduction in LV mass correlated with a reduction in skeletal muscle mass. After six weeks, LV myocardial mass was restored to baseline values. Extreme altitude induced a reduction in LV end‐diastolic volume (20.8 ± 7.7 ml, p = 0.011) and reduced E’, indicating diastolic dysfunction, which were restored after six weeks follow‐up. Elevated circulating interleukin‐18 after extreme altitude compared to follow‐up levels, might have contributed to reduced muscle mass and diastolic dysfunction. In conclusion, the mass of the RV, possibly exposed to elevated afterload, was not changed after extreme altitude, whereas LV mass was reduced. The reduction in LV mass correlated with reduced skeletal muscle mass, indicating a common denominator, and elevated circulating interleukin‐18 might be a mechanism for reduced muscle mass after extreme altitude.
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Affiliation(s)
- Camilla Udjus
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway.,Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Ulla Hjørnholm
- Section of Cardiovascular and Renal Research, Medical Division, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Torbjørn K Tunestveit
- Section of Cardiovascular and Renal Research, Medical Division, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Pavel Hoffmann
- Section for Interventional Cardiology, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Alexis Hinojosa
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway.,Interventional Centre (IVS), Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway
| | - Emil K S Espe
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Geir Christensen
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway.,K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ole H Skjønsberg
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karl-Otto Larsen
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Rostrup
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section of Cardiovascular and Renal Research, Medical Division, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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6
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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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7
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Ernst G, Watne LO, Frihagen F, Wyller TB, Dominik A, Rostrup M. Low Heart Rate Variability Predicts Stroke and Other Complications in the First Six Postoperative Months After a Hip Fracture Operation. Front Cardiovasc Med 2021; 8:640970. [PMID: 33829048 PMCID: PMC8019729 DOI: 10.3389/fcvm.2021.640970] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background: One-year mortality after hip fractures is underestimated and is reported as 25%. An improved risk stratifying could contribute to a better follow up of these patients. Heart Rate Variability (HRV) is an easy point-of-care investigation and is been used in cardiology, endocrinology, and perioperative care. This observational study intended to explore relevant associations between HRV parameters and 6-months mortality and morbidity after a hip fracture. Methods: One hundred and sixty-five patients admitted to two hospitals were included, and short-time HRV measurements (5 min, and 10 min at the two hospitals, respectively) were obtained. Mortality data were gathered by means of the Norwegian central address register. Patients, close relatives of patients, and in some cases their general physicians or nursery home physicians were interviewed 6 months postoperatively regarding the incidence of pneumonia, cardiac events, or stroke. Results: One and hundred fifty-seven (95.2%) patients were followed up after 6 months post-surgery. Twenty-one (13%) died during this period. Twenty patients (13%) developed pneumonia, eight (5 %) stroke, and four (2%) myocardial infarction. No HRV parameter was associated with 6-month general mortality. However, patients who developed stroke had significantly lower High Frequency Power (HF, p < 0.001) and lower Very Low Frequency Power (VLF, p = 0.003) at inclusion compared to patients without complications. Patients who developed pneumonia had at the inclusion lower root mean square of successive differences (RMSSD, p = 0.044). Patients with a history of coronary heart disease (n = 41) showed a mortality of 7%. Mortality in this group was associated with standard deviation of beat-to-beat intervals (SDNN, p = 0.006), Total Power (TP, p = 0.009), HF (p = 0.026), and Low Frequency Power (LF, p = 0.012). Beta-blocker intake was associated with lower heart rate, but not with differences in HRV parameters. Conclusion: In this exploratory study, we present for the first-time significant associations between different preoperative HRV parameters and stroke, myocardial infarction, and pneumonia during a 6-month period after hip fracture. HRV might be a simple and effective tool to identify patients at risk that would warrant better follow-up.
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Affiliation(s)
- Gernot Ernst
- Department of Anesthesiology, Kongsberg Hospital, Kongsberg, Norway.,Section of Cardiovascular and Renal Research, University of Oslo, Oslo, Norway
| | - Leiv Otto Watne
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Torgeier Bruun Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andreas Dominik
- Technische Hochschule Mittelhessen (THM) University of Applied Sciences, Kompetenzzentrum für Informationstechnologie (KITE), Giessen, Germany
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research, University of Oslo, Oslo, Norway.,Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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8
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Olsen E, Holzhauer B, Julius S, Kjeldsen SE, Larstorp ACK, Mancia G, Mehlum MH, Mo R, Rostrup M, Søraas CL, Zappe D, Weber MA. Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus compared to all middle-aged and elderly hypertensive study patients with high cardiovascular risk. Blood Press 2021; 30:90-97. [PMID: 33403890 DOI: 10.1080/08037051.2020.1856642] [Citation(s) in RCA: 3] [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: 10/22/2022]
Abstract
PURPOSE Event-based clinical outcome trials have shown limited evidence to support guidelines recommendations to lower blood pressure (BP) to <130/80 mmHg in middle-aged and elderly hypertensive patients with diabetes mellitus or with general high cardiovascular (CV) risk. We addressed this issue by post-hoc analysing the risk of CV events in patients who participated in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial and compared the hypertensive patients with type 2 diabetes mellitus with all high-risk hypertensive patients. MATERIALS AND METHODS Patients were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (<25% to ≥75%) in which BP was reduced to <140/90 or <130/80 mmHg. Patients with diabetes mellitus (n = 5250) were compared with the entire VALUE population with high CV risk (n = 15,245). RESULTS After adjustments for baseline differences between groups, a reduction in the proportion of visits in which BP was reduced to <140/90 mmHg, but not to <130/80 mmHg, was accompanied by a progressive increase in the risk of CV morbidity and mortality as well as stroke, myocardial infarction and heart failure in both diabetes mellitus and in all high-risk patients. Target BP <130/80 mmHg reduced stroke risk in the main population but not in the diabetes mellitus patients. Patients with diabetes mellitus had higher event rates for the primary cardiac endpoint and all-cause mortality driven by a higher rate of heart failure. CONCLUSION In the high-risk hypertensive patients of the VALUE trial achieving more frequently BP <140/90 mmHg, but not <130/80 mmHg, showed principally the same protective effect on overall and cause-specific cardiovascular outcomes in patients with diabetes mellitus and in the general high-risk hypertensive population.
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Affiliation(s)
- Eirik Olsen
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | | | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sverre E Kjeldsen
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,Departments of Cardiology and Nephrology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Maria H Mehlum
- Department of Geriatrics, Oslo University Hospital, Oslo, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | - Morten Rostrup
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Camilla L Søraas
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Unit of Environmental and Occupational Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Michael A Weber
- Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, NY, USA
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9
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Olsen E, Holzhauer B, Julius S, Kjeldsen SE, Larstorp ACK, Mancia G, Mehlum MH, Mo R, Rostrup M, Søraas CL, Zappe D, Weber MA. Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus and hypertension. Blood Press 2021; 30:82-89. [PMID: 33403886 DOI: 10.1080/08037051.2020.1855968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/22/2022]
Abstract
PURPOSE Available data of event-based clinical outcomes trials show that little evidence supports the guidelines recommendations to lower blood pressure (BP) to <130/80 mmHg in middle-aged and elderly people with type 2 diabetes mellitus and hypertension. We addressed this issue by post-hoc analysing the risk of cardiovascular (CV) events in mostly elderly high-risk hypertensive patients with type 2 diabetes mellitus participating in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial. MATERIAL AND METHODS Patients (n = 5250) were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (<25% to ≥ 75%) in which BP was reduced to <140/90 or <130/80 mmHg. RESULTS After adjustment for baseline demographic differences between groups, a reduction in the proportion of visits in which BP achieved <140/90 mmHg accompanied a progressive increase in the risk of CV mortality and morbidity as well as of cause-specific events such as stroke, myocardial infarction and heart failure. A progressive reduction in the proportion of visits in which BP was reduced <130/80 mmHg did not have any effect on CV risks. CONCLUSION In mostly elderly high-risk hypertensive patients with type 2 diabetes mellitus participating in the VALUE trial, achieving more frequently BP <140/90 mmHg showed a marked protective effect on overall and all cause-specific cardiovascular outcomes. This was not the case for a more frequent achievement of the more intensive BP target, i.e. <130/80 mmHg.
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Affiliation(s)
- Eirik Olsen
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | | | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sverre E Kjeldsen
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.,Departments of Cardiology and Nephrology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | | | - Maria H Mehlum
- Department of Geriatrics, Oslo University Hospital, Oslo, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and University of Trondheim, Trondheim, Norway
| | - Morten Rostrup
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Camilla L Søraas
- Cardiovascular & Renal Research Center, Oslo University Hospital, Oslo, Norway.,Unit of Environmental and Occupational Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Michael A Weber
- Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, NY, USA
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10
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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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11
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Ernst G, Watne LO, Rostrup M, Neerland BE. Delirium in patients with hip fracture is associated with increased heart rate variability. Aging Clin Exp Res 2020; 32:2311-2318. [PMID: 31916197 DOI: 10.1007/s40520-019-01447-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is a method to assess the autonomic nervous system and reflects possibly central brain states. HRV has previously not been examined in patients with hip fracture and delirium. AIMS To explore HRV parameters in hip fracture patients with and without delirium. METHODS Patients admitted to Oslo University Hospital with hip fracture and sinus rhythm in electrocardiogram (ECG) were included. Delirium was diagnosed using the confusion assessment method. HRV was assessed preoperatively after a relaxing period of five minutes, by measuring an ECG signal over 5 min. Parameters in time domain (the standard deviation of the QRS distances-SDNN) and frequency domain (total power (TP), low frequency (LF), high frequency (HF) and LF/HF ratio) were calculated. RESULTS Seventy-five patients were included in the study, and 21 of them had subsyndromal delirium and were excluded from the analysis. Fifty-four patients with a mean age of 83.5 years (SD 8.6, 78% females) were included. Twenty-six patients (48%) had preoperative delirium, 11 (20%) developed delirium postoperatively, whereas 17 (31%) never developed delirium. SDNN, TP and HF values were significantly higher in patients with delirium compared to patients without delirium, and LF and LF/HF were lower. Patients developing postoperative delirium had decreased LF and increased HF before symptom onset. DISCUSSION Increased SDNN, TP and HF and decreased LF values might reflect an abnormal stress response in delirium. CONCLUSION HRV measurements in patients with hip fractures provide additional information beyond heart rate and might be used to identify relevant pathophysiological factors in delirium.
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Affiliation(s)
- Gernot Ernst
- Vestre Viken Hospital Trust, Kongsberg Hospital, Kongsberg, Norway.
- Psychological Institute, University of Oslo, Oslo, Norway.
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Rostrup
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- Department of Behavioral Sciences in Medicine, Institute for Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Bjørn Erik Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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12
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Gundem T, Olasveengen TM, Hovda KE, Gaustad K, Schøndorf C, Rostrup M, Frøyshov S, Undseth Ø, Tonby K, Holten AR, Sunde K. Ventilatory support for hypoxaemic intensive care patients with COVID-19. Tidsskr Nor Laegeforen 2020; 140:20-0445. [PMID: 32815344 DOI: 10.4045/tidsskr.20.0445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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 COVID-19 pneumonia can result in severe hypoxaemic respiratory failure that requires intensive medical care. We wished to describe COVID-19 intensive care patients who were treated with and without invasive ventilatory support. MATERIAL AND METHOD The material was retrieved from the local quality register and comprises data on patients with COVID-19 admitted to the intensive care department at Oslo University Hospital Ullevål from 5 March-28 May 2020. The patients were categorised in three groups on the basis of the treatment they received for respiratory failure (oxygen alone, supplemental non-invasive ventilation (NIV), and intubation/ventilator) and described using descriptive statistics. RESULTS Of 165 hospitalised COVID-19 patients, a total of 26 (16 %) were treated in our intensive care department. Four of them had do-not-resuscitate-orders and were excluded. The 22 patients included in this study had an average age of 56 years (range 25 to 78 years); 17 (77 %) were men. Eleven patients received ventilator treatment, seven oxygen by mask, and four supplemental NIV. In the ventilator group, as of 28 May 2020 two had died, and the remainder had been discharged alive from the intensive care department, with one remaining hospitalised on a ward. All patients treated with oxygen and NIV were alive and had been discharged from hospital. INTERPRETATION For many patients with COVID-19 respiratory failure and need for intensive care, increased oxygen and NIV are sufficient, but the need for intubation must be continuously assessed. More than 90 % of actively treated intensive care patients survived.
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13
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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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14
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Gundem T, Olasveengen TM, Hovda KE, Gaustad K, Schøndorf C, Rostrup M, Frøyshov S, Undseth Ø, Tonby K, Holten AR, Sunde K. T.M. Gundem og medarbeidere svarer. Tidsskriftet 2020; 140:20-0650. [DOI: 10.4045/tidsskr.20.0650] [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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15
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Druce P, Bogatyreva E, Siem FF, Gates S, Kaade H, Sundby J, Rostrup M, Andersen C, Rustad SCA, Tchie A, Mood R, Nygård HM, Urdal H, Winkler AS. Approaches to protect and maintain health care services in armed conflict - meeting SDGs 3 and 16. Confl Health 2019; 13:2. [PMID: 31568540 PMCID: PMC6350312 DOI: 10.1186/s13031-019-0186-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 09/04/2018] [Accepted: 01/16/2019] [Indexed: 11/11/2022] Open
Abstract
The escalation of conflict in the Middle East coincides with an emerging trend of attacks on healthcare. Protection of health personnel, health services and humanitarian workers is no longer respected. This compromises the achievement of the United Nations Sustainable Development Goals 3 – towards health for all, and 16 – towards justice and peace. The Centre for Global Health at the University of Oslo, the Peace Research Institute Oslo and the Norwegian Red Cross co-organised a meeting exploring how conflict impacts health systems and potential solutions to protect and maintain health care services.
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Affiliation(s)
- Philippa Druce
- 1Centre for Global Health, University of Oslo, Oslo, Norway
| | | | | | - Scott Gates
- 3Peace Research Institute Oslo, Oslo, Norway
| | | | - Johanne Sundby
- 1Centre for Global Health, University of Oslo, Oslo, Norway
| | - Morten Rostrup
- Médecins Sans Frontières, Oslo, Norway.,6Department of Acute Medicine, Ullevål University Hospital, Oslo, Norway
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16
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Mehlum MH, Liestøl K, Wyller TB, Hua TA, Rostrup M, Berge E. Blood pressure variability in hypertensive patients with atrial fibrillation in the VALUE trial. Blood Press 2019; 28:77-83. [DOI: 10.1080/08037051.2018.1524707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maria H. Mehlum
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Torgeir B. Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Morten Rostrup
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
| | - Eivind Berge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
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Holen Ø, Rostrup M. Difteriutbrudd i en flyktningleir. Tidsskriftet 2019. [DOI: 10.4045/tidsskr.19.0488] [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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18
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Abstract
SummaryThe present study aimed at testing the hypothesis of a link between mental stress and blood platelet function. Twenty-nine 19-year-old men were recruited from the 98th percentile of mean blood pressure (116 mmHg) at a routine medical screening. They were not informed about their elevated blood pressures at the time of the screening. One year later they were randomized into two groups. Group 1 (n = 16) was exposed to mental stress by a letter informing them about their high blood pressure, while group 2 (n = 13) was sent a neutral letter. At an examination 2 weeks later, heart rate (p <0.05) and plasma adrenaline (p <0.05) responses to a cold pressor test were exaggerated in the informed group. The plasma beta-thromoglobulin (pTG) concentration was elevated in the informed group (p <0.05) as was mean blood pressure (p <0.05). (3TG correlated positively with hematocrit (r = 0.59, p <0.005) and mean blood pressure (r = 0.43, p <0.05), and negatively with plasma HDL (r = −0.61, p = 0.001). The study shows that awareness of hypertension induces a hyperadrenergic state which is associated with the platelet release reaction. Under these circumstances platelet release seems to be correlated to established coronary heart disease risk factors.
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Affiliation(s)
- Morten Rostrup
- The Department of Internal Medicine, Ullevål Hospital, University of Oslo Medical School, Norway
| | - Håvard Holth Mundal
- The Department of Internal Medicine, Ullevål Hospital, University of Oslo Medical School, Norway
| | - Sverre Erik Kjeldsen
- The Department of Internal Medicine, Ullevål Hospital, University of Oslo Medical School, Norway
| | - Knut Gjesdal
- The Department of Internal Medicine, Ullevål Hospital, University of Oslo Medical School, Norway
| | - Ivar Eide
- The Department of Internal Medicine, Ullevål Hospital, University of Oslo Medical School, Norway
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Ernst G, Watne LO, Frihagen F, Wyller TB, Dominik A, Rostrup M. Decreases in heart rate variability are associated with postoperative complications in hip fracture patients. PLoS One 2017; 12:e0180423. [PMID: 28742855 PMCID: PMC5526500 DOI: 10.1371/journal.pone.0180423] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/15/2017] [Indexed: 11/18/2022] Open
Abstract
Background To explore relevant associations between deviations in linear and nonlinear heart rate variability (HRV) scores, and short-term morbidity and mortality in patients undergoing hip-surgery after a fracture. Methods 165 patients with hip fractures being admitted for surgery at two hospitals were included in a prospective cohort study. A short-term ECG was recorded within 24 hours of arrival. 15 patients had to be excluded due to insufficient quality of the ECG recordings. 150 patients were included in the final analysis. Linear parameters were calculated in time domain: standard deviation of NN intervals (SDNN), root mean square of successive differences (rMSSD); and frequency domain: Total Power (TP), High Frequency Power (HF), Low Frequency Power (LF), Very Low Frequency Power (VLF), and the ratio of LF/HF. Postoperative outcome was evaluated at the time of discharge. This included occurrence of pneumonia, overall infection rate, stroke, myocardial infarction, and all-cause mortality. Results Patients experiencing complications had significantly lower rMSSD (p = 0.04), and TP (p = 0.03) preoperatively. Postoperative infections were predicted by decreased VLF preoperatively (p = 0.04). There was a significant association between pneumonia and LF/HF<1 (p = 0.03). The likelihood ratio to develop pneumonia when LF/HF < 1 was 6,1. Conclusion HRV seems to reflect the general frailty of the patient with hip fracture and might be used to identify patients in need of increased surveillance or prophylactic treatment.
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Affiliation(s)
- Gernot Ernst
- Department of Anaesthesiology, Kongsberg hospital, Kongsberg, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Leiv Otto Watne
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Morten Rostrup
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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20
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Abou-Arab MH, Rostrup M, Heier T. Dose requirements of alfentanil to eliminate autonomic responses during rapid-sequence induction with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. J Clin Anesth 2016; 35:465-474. [PMID: 27871575 DOI: 10.1016/j.jclinane.2016.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/09/2015] [Accepted: 09/13/2016] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Opioids are integral part of anesthesia induction, but information on optimal dosing is limited. We aimed to determine doses of alfentanil needed to eliminate increases in 5 autonomic response variables (plasma concentrations of epinephrine, norepinephrine and vasopressin, arterial blood pressure [ABP], and heart rate) during rapid-sequence induction of anesthesia with thiopental 4 mg/kg and rocuronium 0.6 mg/kg. DESIGN Prospective, randomized, observer-blinded, interventional clinical study. SETTING Large academic institution. PATIENTS Eighty-four healthy patients, aged 18 to 55 years, received 1 of 7 assessor-blinded doses of alfentanil (0, 10, 20, 30, 40, 50, and 60 μg/kg) together with thiopental 4 mg/kg and rocuronium 0.6 mg/kg, administered in rapid succession (15 seconds). Laryngoscopy was initiated 40 seconds after rocuronium, and tracheal intubation was concluded within 15 seconds thereafter. MEASUREMENTS An indwelling radial artery catheter was used for hemodynamic monitoring and blood sampling. Relationships between alfentanil dose and response variables were tested with linear regression, and the influence of covariates (sex, body weight, and age) was determined. Alfentanil dose needed to prevent increases in ABP >10% above baseline with 95% probability was estimated with logistic regression. MAIN RESULTS Significant relationships were determined between alfentanil dose and response variables. Clinically interesting influence of covariates was not found. Alfentanil 55 μg/kg was needed to prevent increases in ABP postintubation >10% above baseline with 95% probability. One individual needed a bolus of vasopressor postintubation. CONCLUSIONS Optimal control of autonomic responses during rapid-sequence induction was achieved with clinically relevant doses of alfentanil in healthy patients anesthetized with thiopental 4 mg/kg and rocuronium 0.6 mg/kg.
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Affiliation(s)
- Mohammad H Abou-Arab
- Department of Anesthesia, Division of Emergencies and Critical Care Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Rostrup
- Department of Acute Medicine, and Section of Cardiovascular and Renal Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Tom Heier
- Department of Anesthesia, Division of Emergencies and Critical Care Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway.
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Rostrup M, Edwards JK, Abukalish M, Ezzabi M, Some D, Ritter H, Menge T, Abdelrahman A, Rootwelt R, Janssens B, Lind K, Paasma R, Hovda KE. Correction: The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014. PLoS One 2016; 11:e0157256. [PMID: 27257672 PMCID: PMC4892636 DOI: 10.1371/journal.pone.0157256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Skårn SN, Eggesbø HB, Flaa A, Kjeldsen SE, Rostrup M, Brunborg C, Reims HM, Aksnes TA. Predictors of abdominal adipose tissue compartments: 18-year follow-up of young men with and without family history of diabetes. Eur J Intern Med 2016; 29:26-31. [PMID: 26712453 DOI: 10.1016/j.ejim.2015.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Received: 10/06/2015] [Revised: 11/24/2015] [Accepted: 11/29/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Abdominal adipose tissue (AAT) consists of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), which can be further divided into superficial and deep SAT. Despite being a key factor in the development of metabolic and cardiovascular diseases, what predicts future amount of AAT is largely unknown. OBJECTIVE To determine long-term predictors of amount of AAT. METHODS This was a mean 18-year follow-up study of a cohort of 94 healthy young Caucasian men, with and without a family history of diabetes (FHD). Cardiovascular risk markers were examined both at baseline and at follow-up. At follow-up, computed tomography (CT) of AAT was conducted to assess amount of superficial and deep SAT, and VAT. RESULTS In multiple regression analyses, baseline body mass index (BMI) remained a positive predictor of future amount of superficial and deep SAT, while high-density lipoprotein (HDL) cholesterol was a negative predictor of all three sub-compartments. Baseline risk markers were generally stronger predictors among men with FHD, than among men without. In addition, FHD had greater impact on amount of deep SAT and VAT, than on amount of superficial SAT. CONCLUSION Our data suggest that the traditional cardiovascular risk markers BMI, HDL cholesterol and family history of diabetes are long-term predictors of the different abdominal adipose tissue compartments from young towards middle age in healthy men. In men with family history of diabetes, cardiovascular risk markers at a young age seem to be of greater importance to future amount of abdominal adipose tissue, than among men without.
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Affiliation(s)
- Sigrid Nordang Skårn
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway; Department of Acute Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Heidi B Eggesbø
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Arnljot Flaa
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, 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
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Henrik M Reims
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Tonje Amb Aksnes
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway; Section for Interventional Cardiology, Department of Cardiology, Heart-, Lung-, and Vascular-Disease Clinic, Oslo University Hospital, Oslo, Norway
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Rostrup M, Edwards JK, Abukalish M, Ezzabi M, Some D, Ritter H, Menge T, Abdelrahman A, Rootwelt R, Janssens B, Lind K, Paasma R, Hovda KE. The Methanol Poisoning Outbreaks in Libya 2013 and Kenya 2014. PLoS One 2016; 11:e0152676. [PMID: 27030969 PMCID: PMC4816302 DOI: 10.1371/journal.pone.0152676] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/17/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Outbreaks of methanol poisoning occur frequently on a global basis, affecting poor and vulnerable populations. Knowledge regarding methanol is limited, likely many cases and even outbreaks go unnoticed, with patients dying unnecessarily. We describe findings from the first three large outbreaks of methanol poisoning where Médecins Sans Frontières (MSF) responded, and evaluate the benefits of a possible future collaboration between local health authorities, a Non-Governmental Organisation and international expertise. METHODS Retrospective study of three major methanol outbreaks in Libya (2013) and Kenya (May and July 2014). Data were collected from MSF field personnel, local health personnel, hospital files, and media reports. FINDINGS In Tripoli, Libya, over 1,000 patients were poisoned with a reported case fatality rate of 10% (101/1,066). In Kenya, two outbreaks resulted in approximately 341 and 126 patients, with case fatality rates of 29% (100/341) and 21% (26/126), respectively. MSF launched an emergency team with international experts, medications and equipment, however, the outbreaks were resolving by the time of arrival. INTERPRETATION Recognition of an outbreak of methanol poisoning and diagnosis seem to be the most challenging tasks, with significant delay from time of first presentations to public health warnings being issued. In spite of the rapid response from an emergency team, the outbreaks were nearly concluded by the time of arrival. A major impact on the outcome was not seen, but large educational trainings were conducted to increase awareness and knowledge about methanol poisoning. Based on this training, MSF was able to send a local emergency team during the second outbreak, supporting that such an approach could improve outcomes. Basic training, simplified treatment protocols, point-of-care diagnostic tools, and early support when needed, are likely the most important components to impact the consequences of methanol poisoning outbreaks in these challenging contexts.
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Affiliation(s)
- Morten Rostrup
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Médecins Sans Frontières International, Geneva, Switzerland
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jeffrey K. Edwards
- Médecins Sans Frontières, Nairobi, Kenya
- Department of International Health, School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohamed Abukalish
- Libyan Emergency Medicine Association, Tripoli Medical Center, Tripoli, Libya
| | - Masoud Ezzabi
- Medical Department, Tripoli Central Hospital, Tripoli, Libya
| | - David Some
- Médecins Sans Frontières, Nairobi, Kenya
| | | | - Tom Menge
- Department of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | | | - Rebecca Rootwelt
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Bart Janssens
- Médecins Sans Frontières Operational Centre, Brussels, Belgium
| | | | - Raido Paasma
- Department of Anesthesiology and ICU, Pärnu County Hospital, Pärnu, Estonia
| | - Knut Erik Hovda
- Médecins Sans Frontières, Oslo, Norway
- The Norwegian CBRNe Centre of Medicine, Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- * E-mail:
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Aksnes TA, Kjeldsen SE, Rostrup M, Holzhauer B, Hua TA, Julius S. Predictors of cardiac morbidity in diabetic, new-onset diabetic and non-diabetic high-risk hypertensive patients: The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial. Blood Press 2016; 25:235-40. [PMID: 26808585 DOI: 10.3109/08037051.2015.1134071] [Citation(s) in RCA: 2] [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: 11/13/2022]
Abstract
Diabetic and new-onset diabetic patients with hypertension have higher cardiac morbidity than patients without diabetes. We aimed to investigate whether baseline predictors of cardiac morbidity, the major constituent of the primary endpoint in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial, were different in patients with diabetes and new-onset diabetes compared to patients without diabetes. In total, 15,245 high-risk hypertensive patients in the VALUE trial were followed for an average of 4.2 years. At baseline, 5250 patients were diabetic by the 1999 World Health Organization criteria, 1298 patients developed new-onset diabetes and 8697 patients stayed non-diabetic during follow-up. Cardiac morbidity was defined as a composite of myocardial infarction and heart failure requiring hospitalization, and baseline predictors were identified by univariate and multivariate stepwise Cox regression analyses. History of coronary heart disease (CHD) and age were the most important predictors of cardiac morbidity in both diabetic and non-diabetic patients. History of CHD, history of stroke and age were the only significant predictors of cardiac morbidity in patients with new-onset diabetes. Predictors of cardiac morbidity, in particular history of CHD and age, were essentially the same in high-risk hypertensive patients with diabetes, new-onset diabetes and without diabetes who participated in the VALUE trial.
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Affiliation(s)
- Tonje A Aksnes
- a Department of Cardiology , Oslo University Hospital , Ullevål , Oslo , Norway
| | - Sverre E Kjeldsen
- a Department of Cardiology , Oslo University Hospital , Ullevål , Oslo , Norway
| | - Morten Rostrup
- b Department of Acute Medicine , Oslo University Hospital , Ullevål , Oslo , Norway
| | | | | | - Stevo Julius
- e Division of Cardiovascular Medicine , University of Michigan , Ann Arbor , MI , USA
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Eide I, Ekeberg Ø, Jacobsen D, Kjeldsen SE, Os I, Rostrup M, Stendal M. MINNEORD. Tidsskriftet 2016. [DOI: 10.4045/tidsskr.16.0601] [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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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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Tvinnereim AB, Opdahl H, Rostrup M, Sunde K. [A young man with respiratory infection and intense pain]. Tidsskr Nor Laegeforen 2015; 135:658-61. [PMID: 25899371 DOI: 10.4045/tidsskr.14.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
| | | | - Morten Rostrup
- Akuttmedisinsk avdeling Generell intensiv Oslo universitetssykehus, Ullevål
| | - Kjetil Sunde
- Avdeling for anestesiologi Generell intensiv Oslo universitetssykehus, Ullevål
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Rostrup M. Nyttig om utfordringer i psykososialt hjelpearbeid. Tidsskriftet 2015. [DOI: 10.4045/tidsskr.15.0330] [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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29
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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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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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Hoffmann P, Mykjåland G, Wangberg H, Tønnessen T, Sjaastad I, Nordsletten L, Hjørnholm U, Løset A, Rostrup M. 938Myocardial mass and function in extreme hypobaric
hypoxia. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070cf] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hassellund SS, Flaa A, Kjeldsen SE, Seljeflot I, Karlsen A, Erlund I, Rostrup M. Effects of anthocyanins on cardiovascular risk factors and inflammation in pre-hypertensive men: a double-blind randomized placebo-controlled crossover study. J Hum Hypertens 2012; 27:100-6. [PMID: 22336903 DOI: 10.1038/jhh.2012.4] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
High intake of fruits and vegetables is associated with reduced cardiovascular risk. A number of fruits and vegetables are rich in anthocyanins, which constitute a subgroup of the flavonoids. Anthocyanins have demonstrated anti-inflammatory and anti-oxidative properties, and anthocyanin-rich interventions have indicated beneficial effects on blood pressure and other cardiovascular risk factors. We assessed whether a purified anthocyanin supplement improves cardiovascular metabolic risk factors and markers of inflammation and oxidative stress in prehypertensive participants, and whether plasma polyphenols are increased 1-3 h following intake. In all, 31 men between 35-51 years with screening blood pressure >140/90 mm Hg without anti-hypertensive or lipid-lowering medication, were randomized in a double-blinded crossover study to placebo versus 640 mg anthocyanins daily. Treatment durations were 4 weeks with a 4-week washout. High-density lipoprotein (HDL)-cholesterol and blood glucose were significantly higher after anthocyanin versus placebo treatment (P=0.043 and P=0.024, respectively). No effects were observed on inflammation or oxidative stress in vivo, except for von Willebrand factor, which was higher in the anthocyanin period (P=0.007). Several plasma polyphenols increased significantly 1-3 h following anthocyanin intake. The present study strengthens the evidence that anthocyanins may increase HDL-cholesterol levels, and this is demonstrated for the first time in prehypertensive and non-dyslipidemic men. However, no other beneficial effects in the short term were found on pathophysiological markers of cardiovascular disease.
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Affiliation(s)
- S S Hassellund
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Oslo, Norway.
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Hassellund SS, Flaa A, Sandvik L, Kjeldsen SE, Rostrup M. Long-term stability of cardiovascular and catecholamine responses to stress tests: an 18-year follow-up study. Hypertension 2009; 55:131-6. [PMID: 19948985 DOI: 10.1161/hypertensionaha.109.143164] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular (CV) hyperreactivity to stress must be reasonably stable if it is considered to be important in the development of hypertension and CV disease. The aim of the present study was to assess long-term stability of blood pressure, heart rate, epinephrine, and norepinephrine responses to a cold pressor test and a mental arithmetic stress test. Eighty-one subjects selected from the first (n=30), 50th (n=30), and 95th to 99th (n=39) percentiles of the mean blood pressure distribution at a military draft procedure were tested on 2 occasions 18 years apart. Stress responses were measured during a cold pressor test (hand immersed in ice water for 1 minute) and during a mental stress test (subtraction for 5 minutes). Intra-arterial blood pressure measurements and arterial catecholamine samples were taken at the initial examination. At follow-up, noninvasive Finapres beat-to-beat blood pressure measurements and venous plasma catecholamine samples were used. The 18-year correlations of the CV and epinephrine absolute responses during mental stress ranged from 0.6 to 0.8. The entry/follow-up correlation of systolic blood pressure during the mental stress test (95% CI: 0.69 to 0.86) was significantly higher than during the cold pressor test (95% CI: 0.30 to 0.65), and responses to mental stress overall appeared to be more stable than responses to the cold pressor test. Our study suggests that CV and sympathoadrenal reactivity, specifically to mental stress, are relatively stable individual characteristics. These results support one of the necessary preconditions to consider hyperreactivity involved in the development of hypertension and CV disease.
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Affiliation(s)
- Skjalg S Hassellund
- Center of Cardiovascular and Renal Research, Department of Acute Medicine, Oslo University Hospital Ullevaal, Kirkeveien 166, N-0407 Oslo, Norway.
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Aksnes TA, Flaa A, Sevre K, Mundal HH, Rostrup M, Kjeldsen SE. Effects on plasma noradrenaline may explain some of the improved insulin sensitivity seen by AT‐1 receptor blockade. Blood Press 2009; 17:156-63. [DOI: 10.1080/08037050802162847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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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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Gilbert M, Stalsberg H, Rostrup M. Snøskredforskning i Norge. Tidsskriftet 2009; 129:1355. [DOI: 10.4045/tidsskr.09.0686] [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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Flaa A, Aksnes TA, Kjeldsen SE, Eide I, Rostrup M. Increased sympathetic reactivity may predict insulin resistance: an 18-year follow-up study. Metabolism 2008; 57:1422-7. [PMID: 18803948 DOI: 10.1016/j.metabol.2008.05.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [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: 11/09/2007] [Accepted: 05/28/2008] [Indexed: 11/29/2022]
Abstract
Insulin resistance and sympathetic activity are related by a positive feedback system. However, which precedes the other still remains unclear. The present study aimed to investigate the predictive role of sympathoadrenal activity in the development of insulin resistance in an 18-year follow-up study. We also examined whether reactivity to 2 different stress tests, a cold pressor test and a mental stress test, would differ in their predictive power. The 2 tests are supposed to represent different reactivity mechanisms: alpha- and beta-adrenergic responses, respectively. At entry, arterial plasma epinephrine and norepinephrine concentrations were measured in 99 healthy men (age, 19.3 +/- 0.4 years, mean +/- SD) during rest, a mental stress test, and a cold pressor test. Fasting plasma glucose concentration was measured at entry and at follow-up. Insulin resistance at follow-up was calculated using the homeostasis model assessment of insulin resistance (HOMA-IR). Eighty subjects (81%) were eligible for follow-up after 18.0 +/- 0.9 years (mean +/- SD). The norepinephrine responses to cold pressor test at entry predicted plasma glucose concentration (r = 0.301, P = .010) and HOMA-IR (r = 0.383, P = .004) at follow-up in univariate analyses. In multiple regression analyses, corrected for fasting glucose at entry, family history of diabetes, blood pressure-lowering medication, body mass index at entry, and level of exercise, norepinephrine response to cold pressor test was found to be a positive predictor of future HOMA-IR (P = .010). This is the first long-term follow-up study in white subjects showing that sympathetic reactivity predicts future insulin resistance 18 years later. These findings may provide further insights into the pathophysiologic mechanisms of insulin resistance.
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Affiliation(s)
- Arnljot Flaa
- Department of Acute Medicine/Cardiovascular and Renal Research Center, Ullevaal University Hospital, N-0407 Oslo, Norway.
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Abstract
In the present study we hypothesized that arterial catecholamine concentrations during rest and 2 laboratory stress tests were independent predictors of blood pressure at an 18-year follow-up. At entry, blood pressure, heart rate, and arterial plasma epinephrine and norepinephrine concentrations were measured in 99 healthy men (age: 19.3+/-0.4 years, mean+/-SD) at rest, during a mental arithmetic test, and during a cold pressor test. After 18.0+/-0.9 years of follow-up, resting blood pressure was measured. The norepinephrine and epinephrine concentrations during the mental arithmetic explained 12.7% of the variation of future systolic blood pressure after adjusting for initial resting blood pressure, family history, body mass index, and systolic blood pressure during the stress test in a multiple regression analysis (adjusted R(2)=0.651; P<0.001). To conclude, the present study shows that sympathetic nervous activity during mental arithmetic predicts future blood pressure, indicating a possible causal factor in the development of essential hypertension independent of the initial blood pressure.
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Affiliation(s)
- Arnljot Flaa
- Department of Acute Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway.
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Flaa A, Sandvik L, Kjeldsen SE, Eide IK, Rostrup M. Does sympathoadrenal activity predict changes in body fat? An 18-y follow-up study. Am J Clin Nutr 2008; 87:1596-601. [PMID: 18541545 DOI: 10.1093/ajcn/87.6.1596] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Whether alterations in the sympathoadrenal system contribute to obesity or, rather, are consequences of it, is an unresolved issue. OBJECTIVE We hypothesized that the sympathoadrenal system plays a predictive role in the development of body fat. DESIGN At entry, arterial plasma epinephrine and norepinephrine concentrations were measured in 99 healthy men (x +/- SD age: 19.3 +/- 0.4 y) at rest and during a mental stress test and a cold pressor test. Body mass index (BMI; in kg/m(2)), waist circumference, and triceps skinfold thickness were measured at entry and after 18 y of follow-up. RESULTS Eighty subjects (81%) were available for follow-up analyses after a mean (+/-SD) of 18.0 +/- 0.9 y. The epinephrine responses to the mental stress test (E(MST)) showed a negative relation to changes in BMI (P = 0.01) and waist circumference (P = 0.007). The mean increase in BMI was 6.3 among subjects in the lowest E(MST) quartile and 3.7 in the remaining subjects. In multiple regression analyses corrected for level of exercise, BMI, waist circumference, and triceps skinfold thickness at entry, E(MST) was found to be a consistent negative predictor of future BMI (P = 0.005), waist circumference (P = 0.001), and triceps skinfold thickness (P = 0.05). CONCLUSIONS We present the first long-term follow-up study in whites showing that the epinephrine response to mental stress is a negative predictor of future BMI, waist circumference, and triceps skinfold thickness after 18 y of follow-up. These findings may provide further insights into the pathophysiology of obesity.
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Affiliation(s)
- Arnljot Flaa
- Department of Acute Medicine, Cardiovascular and Renal Research Center, Ullevaal University Hospital, Oslo, Norway.
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Bjornaas MA, Bekken AS, Ojlert A, Haldorsen T, Jacobsen D, Rostrup M, Ekeberg O. A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo. BMC Psychiatry 2008; 8:8. [PMID: 18271956 PMCID: PMC2277385 DOI: 10.1186/1471-244x-8-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 02/13/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To study mortality rate and causes of death among all hospitalized opioid addicts treated for self-poisoning or admitted for voluntary detoxification in Oslo between 1980 and 1981, and to compare their mortality to that of the general population. METHODS A prospective cohort study was conducted on 185 opioid addicts from all medical departments in Oslo who were treated for either self-poisoning (n = 93, 1980), voluntary detoxification (n = 75, 1980/1981) or both (n = 17). Their median age was 24 years; with a range from 16 to 41, and 53% were males. All deaths that had occurred by the end of 2000 were identified from the Central Population Register. Causes of death were obtained from Statistics Norway. Standardized mortality ratios (SMRs) were computed for mortality, in general, and in particular, for different causes of death. RESULTS During a period of 20 years, 70 opioid addicts died (37.8%), with a standardized mortality ratio (SMR) equal to 23.6 (95% CI, 18.7-29.9). The SMR remained high during the whole period, ranging from 32.4 in the first five-year period, to 13.4 in the last five-year period. There were no significant differences in SMR between self-poisonings and those admitted for voluntarily detoxification. The registered causes of death were accidents (11.4%), suicide (7.1%), cancer (4.3%), cardiovascular disease (2.9%), other violent deaths (2.9%), other diseases (71.4%). Among the 50 deaths classified as other diseases, the category "drug dependence" was listed in the vast majority of cases (37 deaths, 52.9% of the total). SMRs increased significantly for all causes of death, with the other diseases group having the highest SMR; 65.8 (95% CI, 49.9-86.9). The SMR was 5.4 (95% CI, 1.3-21.5) for cardiovascular diseases, and 4.3 (95% CI, 1.4-13.5) for cancer. The SMR was 13.2 (95% CI, 6.6-26.4) for accidents, 10.7 (95% CI, 4.5-25.8) for suicides, and 28.6 (95% CI, 7.1-114.4) for other violent deaths. CONCLUSION The risk of death among opioid addicts was significantly higher for all causes of death compared with the general population, implying a poor prognosis over a 20-year period for this young patient group.
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Affiliation(s)
- Mari A Bjornaas
- Department of Acute Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway.
| | - Anette S Bekken
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, N-0317 Oslo, Norway
| | - Aasa Ojlert
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, N-0317 Oslo, Norway
| | - Tor Haldorsen
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, N-0317 Oslo, Norway
| | - Dag Jacobsen
- Department of Acute Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway
| | - Morten Rostrup
- Department of Acute Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway
| | - Oivind Ekeberg
- Department of Acute Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway,Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, N-0317 Oslo, Norway
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Aksnes TA, Kjeldsen SE, Rostrup M, Omvik P, Hua TA, Julius S. Impact of new-onset diabetes mellitus on cardiac outcomes in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial population. Hypertension 2007; 50:467-73. [PMID: 17679652 DOI: 10.1161/hypertensionaha.106.085654] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [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: 11/16/2022]
Abstract
There has been a lot of interest about new-onset diabetes mellitus in recent hypertension trials, but the implications of diabetes development on cardiac outcomes have not been known. In the Valsartan Antihypertensive Long-Term Use Evaluation trial, 15 245 high-risk patients were followed for an average of 4.2 years. At baseline, 5250 patients were diabetic by the 1999 World Health Organization criteria, and among the 9995 nondiabetic patients, 1298 patients developed diabetes during follow-up. We have investigated the influence of diabetes development on outcomes in the Valsartan Antihypertensive Long-Term Use Evaluation trial. The patients with diabetes at baseline and new-onset diabetes were compared with patients who did not develop diabetes by a Cox regression model with adjustment for prespecified covariates (age, diabetes status, left ventricular hypertrophy, baseline coronary heart disease, and randomized study treatment). Patients with diabetes at baseline had the highest cardiac morbidity defined as myocardial infarction and heart failure with a hazard ratio of 2.20 (95% CI: 1.95 to 2.49). The patients with new-onset diabetes had significantly higher cardiac morbidity, especially more congestive heart failure, than those without diabetes, with a hazard ratio of 1.43 (95% CI: 1.16 to 1.77). This indicates that patients who develop diabetes during antihypertensive treatment have cardiac morbidity intermediate between diabetic subjects and those subjects who never had diabetes and that it is of importance to find these patients at risk of diabetes development and optimize lifestyle and medical treatment.
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Affiliation(s)
- Tonje A Aksnes
- Department of Cardiology, Ullevaal University Hospital, N-0407 Oslo, Norway.
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Rostrup M, Fossbakk A, Hauge A, Kleppe R, Gnaiger E, Haavik J. Oxygen dependence of tyrosine hydroxylase. Amino Acids 2007; 34:455-64. [PMID: 17520326 DOI: 10.1007/s00726-007-0547-7] [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] [Received: 01/08/2007] [Accepted: 03/14/2007] [Indexed: 10/23/2022]
Abstract
The effects of dioxygen on tyrosine hydroxylase (TH) activity was studied, measuring the formation of DOPA from tyrosine, (3)H(2)O from 3,5-(3)H-tyrosine, or by direct oxygraphic determination of oxygen consumption. A high enzyme activity was observed during the initial 1-2 min of the reactions, followed by a decline in activity, possibly related to a turnover dependent substoichiometrical oxidation of enzyme bound Fe(II) to the inactive Fe(III) state. During the initial reaction phase, apparent K (m)-values of 29-45 microM for dioxygen were determined for all human TH isoforms, i.e. 2-40 times higher than previously reported for TH isolated from animal tissues. After 8 min incubation, the K (m) (O(2))-values had declined to an average of 20 +/- 4 microM. Thus, TH activity may be severely limited by oxygen availability even at moderate hypoxic conditions, and the enzyme is rapidly and turnover dependent inactivated at the experimental conditions commonly employed to measure in vitro activities.
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Affiliation(s)
- M Rostrup
- Cardiovascular and Renal Research Centre, Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway
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Abstract
BACKGROUND Possible mechanisms behind psychophysiological hyperreactivity may be located at a cognitive-emotional level. Several personality traits have been associated with increased cardiovascular reactivity. Subjects with white coat hypertension, which may constitute a kind of hyperreactivity, are found to suppress their emotions and adapt to the surroundings to a larger extent than controls.We hypothesized in this study that a) stress reactivity is related to personality, and that b) responses to cold pressor test (CPT) and mental stress test (MST) are associated with different personality traits. METHODS 87 men were selected from the 1st, 50th and 99th percentile of a blood pressure screening. Cardiovascular and catecholamine responses to MST and CPT were recorded. Fifteen personality traits were assessed using the Karolinska Scale of Personality. Possible independent explanatory predictors for cardiovascular and catecholamine variables at baseline and during stress were analyzed in multiple linear regression analyses using a stepwise forward procedure. RESULTS Multiple regression analyses showed that muscular tension (beta = 0.298, p = 0.004), irritability (beta = 0.282, p = 0.016), detachment (beta = 0.272, p = 0.017), psychasthenia (beta = 0.234, p = 0.031) and somatic anxiety (beta = 0.225, p = 0.046) were significant explanatory variables of reactivity to CPT. During MST, verbal aggression (beta = -0.252, 0.031) and detachment (beta = 0.253, p = 0.044) were significant predictors of norepinephrine and diastolic blood pressure response, respectively.Based on KSP-trait quartiles, delta (Delta) systolic (p = 0.025) and Delta diastolic blood pressure (p = 0.003) during MST were related to detachment score, with the highest reactivity in the 4th quartile, while Delta norepinephrine was significantly related to muscular tension (p = 0.033). Delta systolic and Delta diastolic blood pressure responses to CPT were dependent on detachment (p = 0.049 and p = 0.011, respectively) and psychasthenia (p = 0.020 and p = 0.015), while high verbal aggression was associated with lower reactivity measured by Delta norepinephrine (p = 0.037). CONCLUSION The present study indicates that stress reactivity is clearly related to different personality traits, without any single trait being dominant over others. Furthermore, personality seems to have as much, or even more, importance of predicting responses to CPT than responses to MST.
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Affiliation(s)
- Arnljot Flaa
- Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway
- Cardiovascular and Renal Research Center, Ullevaal University Hospital, Oslo, Norway
| | - Øivind Ekeberg
- Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway
| | - Sverre Erik Kjeldsen
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
- Cardiovascular and Renal Research Center, Ullevaal University Hospital, Oslo, Norway
| | - Morten Rostrup
- Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway
- Cardiovascular and Renal Research Center, Ullevaal University Hospital, Oslo, Norway
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Sunde K, Dunlop O, Rostrup M, Sandberg M, Sjøholm H, Jacobsen D. Determination of prognosis after cardiac arrest may be more difficult after introduction of therapeutic hypothermia. Resuscitation 2006; 69:29-32. [PMID: 16517042 DOI: 10.1016/j.resuscitation.2005.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [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: 09/16/2005] [Accepted: 12/09/2005] [Indexed: 10/24/2022]
Abstract
A 50-year-old patient had status epilepticus and no adequate reactions nine days after prolonged out-of-hospital cardiac arrest. The cause of the arrest was acute myocardial infarction which was treated successfully with percutaneous cardiac intervention (PCI) and a stent placement. He was treated with therapeutic hypothermia (33 degrees C) for 24h and in intensive care with respiratory support for 42 days. One year later he has fully recovered and is back to normal life and academic work. The previously reported 100% prognosis of a poor neurological outcome in the presence of seizures 72 h post arrest may need to be re-examined after introduction of therapeutic hypothermia.
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Affiliation(s)
- Kjetil Sunde
- Department of Anaesthesiology and Institute for Experimental Medical Research, Surgical Division, Ulleval University Hospital, N-0407 Oslo, Norway.
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Flaa A, Mundal HH, Eide I, Kjeldsen S, Rostrup M. Sympathetic activity and cardiovascular risk factors in young men in the low, normal, and high blood pressure ranges. Hypertension 2006; 47:396-402. [PMID: 16446389 DOI: 10.1161/01.hyp.0000203952.27988.79] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [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: 11/16/2022]
Abstract
We hypothesized that resting blood pressure is related to sympathetic activity in young men who are unaware of their blood pressure status in high, normal, and low ranges and that there is a relationship between sympathetic activity and coronary risk factors. Forty-three healthy, young men from the 1st [group 1, 106/52+/-2/2 mm Hg (+/-SEM), n=15], 50th (group 2, 129/79+/-2/1 mm Hg, n=15), and 98th to 99th percentile (group 3, 166/97+/-3/1 mm Hg, n=13) at a blood pressure screening were studied with intraarterial blood pressure, heart rate, and arterial plasma catecholamine responses to a mental, cold pressor, and orthostatic stress test. At baseline, group 3 had significant higher blood pressure (137/74+/-3/2 mm Hg) than group 2 (126/66+/-3/2 mm Hg; P<0.01) and group 1 (116/62+/-2/1 mm Hg; P<0.001). Group 1 had lower systolic blood pressure than group 2 (P=0.007). Baseline epinephrine and norepinephrine showed a clear positive linear trend (P<0.05), with the lowest values being in group 1 and highest in group 3. High-density lipoprotein was negatively related to epinephrine (r=-0.387; P=0.010). Mental stress was the only test that showed significant differences in cardiovascular and sympathetic responses among the groups, where group 3 had a more pronounced response in systolic and diastolic blood pressure and heart rate compared with group 1 (P<0.001) and group 2 (P<0.01). Furthermore, we found significant positive linear trends for Deltacatecholamines during mental stress across the groups (Deltaepinephrine P=0.001 and Deltanorepinephrine P=0.026, ANOVA). We conclude that resting blood pressure reflects both variation in resting arterial catecholamines and variation in cardiovascular and sympathetic responses specifically to mental stress.
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Affiliation(s)
- Arnljot Flaa
- Cardiovascular and Renal Research Center, Ullevaal University Hospital, Oslo, Norway.
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Rostrup M. [Field letters from a disaster region]. Tidsskr Nor Laegeforen 2005; 125:710. [PMID: 15776057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Rostrup M. After the wave: bringing emergency medical care to Aceh. Br J Gen Pract 2005; 55:236-7. [PMID: 15808050 PMCID: PMC1463110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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