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Biomedical subjects

A Siewert-Delle

Publications and source records attributed to A Siewert-Delle.

7 recordsLinked to original sources
PubMed1999

Long-term renal function in primary hypertension. An epidemiological and pathophysiological study.

The purpose of this study was to investigate the influence of birth factors on adult blood pressure and to study the long-term renal function and hemodynamic changes in primary hypertension. The investigations were performed in two population-based samples of men derived from two large screening investigations on blood pressure, a screening investigation of 49-year-old men and the Primary Prevention Study. Birth variables were studied in 430 subjects, born in 1926-27, who had participated in the screening investigation of 49-year-old men in Göteborg. The 14-year follow-up study of renal function and haemodynamics and urinary albumin excretion was performed in a stratified random sample of normotensive (n = 11) and hypertensive (n = 23) 49-year-old men. The effects of intensified blood pressure control (to a diastolic blood pressure, DBP < or = 85 mmHg) on renal function, haemodynamics and urinary albumin excretion, achieved by addition of felodipine or ramipril to ongoing treatment with beta-blockade, were investigated in 28 hypertensives. To determine if treated primary hypertension can lead to end-stage renal disease, the development of serum creatinine levels during 20 years in 686 hypertensive men from the Primary Prevention Study, recruited from a random third of the male population aged 47-55 years at entry, was studied. The findings demonstrate that preterm birth (gestational age less than 38 weeks) seemed to increase the risk of hypertension in adult life. They also showed, that good long-term blood pressure control (DBP < or = 90 mmHg) in primary hypertension can protect the kidneys from abnormal progressive decline in glomerular filtration rate and arrest proteinuria but does not normalise the reduced renal blood flow or the increased renal vascular resistance seen in primary hypertension. On decreasing the DBP to < or = 85 mmHg, achieved by addition of felodipine to ongoing treatment with beta-blockade, renal blood flow increased and renal vascular resistance decreased to levels no longer significantly different from normal. Addition of ramipril to beta-blockade reduced blood pressure less and renal function and haemodynamics did not normalise, but the urinary albumin excretion was lowered. The median value for the urinary albumin excretion remained within the range of the urinary albumin excretion of the normotensives in both the felodipine and the ramipril-treated groups. In the Primary Prevention Study, none of the hypertensives developed a hypertensive end-stage renal disease and only a few patients showed a slight increase in serum creatinine level before the age of 70. Thus, white patients with non-malignant primary hypertension without underlying renal disease and with good blood pressure control do not appear to develop progressive decline in kidney function or hypertensive end-stage renal disease.

Antihypertensive Agents↗
PubMed1998

The impact of birth weight and gestational age on blood pressure in adult life: a population-based study of 49-year-old men.

The impact of birth weight and gestational age on blood pressure in adult life was studied in a population of 49-year-old men born in 1926-27 who took part in a screening investigation of blood pressure performed in 1975-76 in Göteborg, Sweden. Birth records were traced in 430 subjects and compared with screening records. The adult systolic blood pressure (SBP) was not correlated with birth weight but was inversely correlated with gestational age in the whole study group (r = -0.10, P = .04; n = 430). The correlation between adult blood pressure and gestational age was stronger in preterm subjects, ie, those with a gestational age less than 38 weeks (for SBP, r = -0.46, P = .001 and for diastolic blood pressure [DBP], r = -0.44, P = .01; n = 44), and these correlations were independent of birth weight. There was, however, no correlation between adult blood pressure and gestational age in subjects born at term (between 38 and 41 complete weeks of gestation) or postterm (more than 42 weeks of gestation). The inverse correlation between adult SBP and gestational age was stronger in low-birth-weight subjects (< or = 2500 g; r = -0.86, P < .001; n = 14). After adjustment for birth weight, in this group an increase by 1 week of gestation was associated with a decrease in adult SBP of 7.2 mm Hg (95% CI, 10.1-4.2). In the whole study group, a positive correlation was found between adult blood pressure and adult body mass index (BMI) (r = 0.30, P < .001 for SBP and r = 0.33, P < .001 for DBP). In preterm subjects, however, no such correlation was found, but in subjects born at term or postterm, adult blood pressure was significantly correlated with BMI (for SBP at term, r = 0.34, P < .001 and postterm, r = 0.47, P < .001 and for DBP at term, r = 0.36, P < .001 and postterm, r = 0.30, P < .05). This study indicates that adult blood pressure appears to be related to different variables in different ranges of gestation. In preterm subjects, gestational age appears to have a great impact on adult blood pressure. In subjects born at term or later, however, adult blood pressure was not associated with factors related to birth, but only to the adult BMI.

Birth Weight↗
PubMed1998

Does treated primary hypertension lead to end-stage renal disease? A 20-year follow-up of the Primary Prevention Study in Göteborg, Sweden.

BACKGROUND: Hypertension is reported to be one of the most common causes of end-stage renal disease (ESRD) in Europe and in the United States. However, the frequency with which treated primary hypertension leads to renal failure is not known. The majority of patients with ESRD have hypertension. Whether this is the cause or the consequence of the impaired renal function is often not possible to establish. METHODS: To determine if treated primary hypertension can lead to ESRD, we studied the development of serum creatinine levels in 686 white hypertensive men, recruited from a random third of the male population aged 47-55 years living in Göteborg, Sweden (n=9998; 7495 participants). At entry and during 20 years follow-up, all signs of kidney disease, secondary hypertension, or increase in blood pressure were investigated. Records of patients with a serum creatinine value > or = 130 micromol/l at any time during the observation period were thoroughly studied to ascertain the cause of the impaired renal function. RESULTS: A serum creatinine level above 130 micromol was seen in 8.9% (61/686) of the treated hypertensives during the 20 years of follow-up. An underlying renal disorder was found in 7.2% (49/686) of the patients; renoparenchymal disease (2.2%), renovascular disease (1.5%), diabetic nephropathy (1.2%) or a urological disease (1.6%). Only 1.7% (12/686) of the hypertensives showed a moderate progressive increase in serum creatinine of unknown cause. The serum creatinine in this group was 133+/-8 micromol/l (mean+/-SD; range 124-144) after 15 years and 139+/-7 micromol/l (range 132-151) after 20 years. Thus, none of these patients aged 66-71 years had developed ESRD or a clinically important reduction in renal function. CONCLUSION: The main finding in this population-based study of white middle-aged men with primary nonmalignant hypertension was that long-term antihypertensive treatment was not associated with development of end-stage renal disease or even an abnormal progressive decline in kidney function.

Antihypertensive Agents↗
PubMed1996

Effect of 14 years of antihypertensive treatment on renal function and urinary albumin excretion in primary hypertension.

The effects on blood pressure (BP), renal function, and urinary albumin excretion (UAE) of 14 years of antihypertensive treatment were studied and compared to the changes seen with normal aging. The studied groups included randomly selected men with newly diagnosed primary hypertension at baseline (n = 23) and normotensive (NT) men of the same age (n = 11). The hypertensives (HT) were treated with beta-blockers either as monotherapy or combined with diuretics or hydralazine. Glomerular filtration rate (GFR; inulin clearance), renal blood flow (RBF, para-aminohippurate clearance), renal vascular resistance (RVR), and 24-h UAE were determined. The two groups were investigated at baseline (before treatment) and after 7 and 14 years. At baseline, BP and RVR were significantly increased and RBF was significantly decreased in the HT over that in the NT. The BP in the HT was significantly reduced after 7 years of treatment and a further but nonsignificant reduction to 139 +/- 14/88 +/- 6 mm Hg (mean +/- SD) was seen after 14 years. GFR in the HT was significantly reduced from 103 +/- 15 mL/min to 84 +/- 19 mL/min (mean +/- SD) after 7 years, but no further reduction was seen after 14 years. During the 14 years RBF decreased and RVR increased in the HT but these changes were of the same magnitude as in the NT. The UAE did not change significantly during the study. In conclusion, good blood pressure control with conventional antihypertensive treatment in mild to moderate primary hypertension seems to protect the kidney from progressive decline in GFR and increase in UAE. The increase in RVR and the decrease in RBF seen during 14 years of antihypertensive treatment was of the same magnitude as that seen with normal aging.

Adrenergic beta-Antagonists↗
PubMed1995

Effects of intensified blood-pressure reduction on renal function and albumin excretion in primary hypertension. Addition of felodipine or ramipril to long-term treatment with beta-blockade.

The effect of intensified blood pressure (BP) control with a reduction of the diastolic BP to < or = 85 mm Hg on renal function and urinary albumin excretion (UAE) was studied in 28 men with primary hypertension (aged 62 to 72 years) treated for 13 +/- 5 years with beta-blockade, diuretics, or hydralazine. They were compared with 25 normotensive (NT) men of similar age. At baseline (BL), glomerular filtration rate (GFR), renal plasma flow (RPF) (clearance of inulin and para-aminohippurate), and the UAE were studied. Thereafter, all antihypertensive drugs except beta-blockers were withdrawn and either felodipine (5 to 20 mg; n = 13) or ramipril (2.5 to 10 mg; n = 15) was added in a double blind, randomized fashion. Hydrochlorothiazide was added if necessary. The investigations were repeated after 6 weeks and 1 year of double-blind treatment. At BL, the BP and the renal vascular resistance (RVR) were significantly higher and GFR and RPF were significantly lower in both hypertensive groups than in NT. After 1 year, the BP treatment goal was reached by all patients in the felodipine group but only by two-thirds in the ramipril group in spite of addition of diuretics to 60% of the latter group. In the felodipine group, the BP, GFR, and RVR after 1 year no longer differed significantly from normal. The UAE and the fractional albumin clearance increased significantly after 1 year's treatment in the felodipine group but did not change in the ramipril group. The fractional albumin clearance, however, did not differ significantly from normal either at BL or after 1 year's treatment in any of the hypertensive groups. It is therefore possible to reduce BP and improve renal function in primary hypertension to levels not significantly different from normal after treatment with felodipine in combination with beta-blockade. Although this regimen increased the low UAE slightly, the fractional albumin clearance changed less and did not differ significantly from normal. The ramipril/beta-blocker combination reduced BP less and did not change the slightly reduced renal function or the UAE.

Adrenergic beta-Antagonists↗