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Biomedical subjects

D E Grobbee

Publications and source records attributed to D E Grobbee.

At least 19 recordsLinked to original sources
PubMed1992

Predicting hypertension in childhood: value of blood pressure measurement and family history.

An elevated casual blood pressure (BP) in children and a positive family history for hypertension are risk indicators for adult hypertension. The risk of future hypertension is higher when BP levels in children or their parents are higher. Using multiple BP readings in children and their parents, groups of children can be discriminated with contrasting risks as a basis for studying the early phase of primary hypertension. Yet, as a means of detecting groups of children eligible for intervention, family history and BP level lack sensitivity for adequate selection. Before screening for future hypertension may be initiated successfully in prepubertal children, more should be known about the determinants and etiology of future BP rise.

Blood Pressure↗
PubMed1992

A community-based study of dementia: the Rotterdam Elderly Study.

The Rotterdam Elderly Study is designed as a community-based prospective follow-up study. The study population consists of almost 12,000 individuals aged 55 years and over who are living in an urban area in Rotterdam, the Netherlands. The objective of the study is to investigate the prevalence, incidence and determinants of neurogeriatric disorders, cardiovascular diseases, locomotor diseases and ophthalmologic diseases. In this paper we give a general outline of the Rotterdam Elderly Study, and a detailed description of the case finding and diagnostic procedures for the study of dementia. The risk factors for dementia that are assessed in the study are summarized.

Aged↗
PubMed1992

Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study.

The objective of the present study was to assess the prevalence of moderate and severe stenosis of the right carotid artery in the elderly and its associations with smoking, blood pressure, serum lipid levels, and hemostatic factors. The Rotterdam Elderly Study is a recently started single-center prospective follow-up study of a cohort of 11,854 elderly people aged 55 years or more. In 1990, 954 participants of the Rotterdam Elderly Study underwent ultrasonic duplex examination of the right internal carotid artery. A reduction of the lumen diameter of 16-49% was found in 29 people (3.0%). Severe stenosis (50% or more) was observed in 13 people (1.4%). With differences in age, sex, and body mass index taken into account, subjects with moderate-to-severe carotid artery disease had, compared with participants without stenosis, lower mean high density lipoprotein cholesterol levels (mean difference, 0.10 mmol/l; 95% confidence interval, 0, 0.20) and higher mean fibrinogen levels (difference, 0.24 g/l; 0.04, 0.45). Among them were more people with hypertension (mean difference, 16%) and more current smokers (mean difference, 13%). Factor VIIc and factor VIIIc activity was higher in subjects with carotid artery disease, without, however, reaching statistical significance (mean difference, 0.06 IU/ml [-0.01, 0.12] and 0.21 IU/ml [-0.05, 0.47], respectively). Our data suggest that hypertension, smoking, and reduced serum high density lipoprotein cholesterol levels, combined with unfavorable increases in hemostatic factors, may be related to carotid artery disease in the elderly.

Aged↗
PubMed1992

The risk of spina bifida aperta after first-trimester exposure to valproate in a prenatal cohort.

Use of antiepileptic drugs (AEDs) during pregnancy is associated with an increased risk of congenital malformations. Spina bifida aperta has been linked specifically to valproic acid (VPA) (estimated risk, 1 to 2%). The actual risk, the exclusive association of VPA with spina bifida and not anencephaly, and the precise causative relation remain matters of discussion. A prospective cohort study of pregnant women with epilepsy receiving AEDs and referred for prenatal diagnosis before week 22 of gestation was conducted, with follow-up to 3 months after birth. Pregnancies (291 singleton and 6 twin) in 261 women were evaluated. The prevalence of anomalies after exposure to any AED was 6.9%. For fetuses exposed to VPA, the prevalence was 9.4%, including six cases of spina bifida, two of which were in monozygotic twins (giving a prevalence rate of 6.3%, or 5.4%, if twins counted as one). Spina bifida was associated with a significantly higher average daily dose of VPA as compared with pregnancies with normal outcome (1.640 +/- 136 mg/d vs 941 +/- 48 mg/d, p = 0.0001). No relation was observed between the occurrence of spina bifida and type of maternal seizure or epilepsy, family history of epilepsy or neural-tube defects, or medical history. From these results we suggest that when the use of VPA during pregnancy cannot be avoided, the teratogenic risk might be diminished by reduction of the daily dose.

Adult↗
PubMed1991

Renal hemodynamics and the renin-angiotensin-aldosterone system in normotensive subjects with hypertensive and normotensive parents.

BACKGROUND AND METHODS: The kidney is important in blood-pressure regulation, but its role in the development of essential hypertension is still subject to debate. We compared renal hemodynamics, measured in terms of the clearance of para-aminohippuric acid and inulin, and the characteristics of the renin-angiotensin-aldosterone system in three groups of normotensive subjects at different degrees of risk for hypertension: 41 subjects with two normotensive parents, 52 with one normotensive and one hypertensive parent, and 61 with two hypertensive parents. The subjects ranged in age from 7 to 32 years. RESULTS: The mean renal blood flow was lower in the subjects with two hypertensive parents than in those with two normotensive parents (mean difference [+/- SE], 198 +/- 61 ml per minute per 1.73 m2 of body-surface area; P = 0.002). Moreover, both the filtration fraction and renal vascular resistance were higher in the subjects with two hypertensive parents (filtration fraction: mean difference, 3.0 +/- 1.1 percentage points; P = 0.006; renal vascular resistance: mean difference, 2.7 +/- 0.8 mm Hg per deciliter per minute per 1.73 m2; P = 0.006). The subjects with two hypertensive parents had lower plasma concentrations of renin (mean difference, 3.3 +/- 1.6 mU per liter; P = 0.03) and aldosterone (mean difference, 111 +/- 36 pmol per liter; P = 0.003) than those with two normotensive parents. The differences could not be explained by the small differences in blood pressure between the groups. The values in the subjects with one hypertensive and one normotensive parent fell between those for the other two groups. CONCLUSIONS: Renal vasoconstriction is increased and renin and aldosterone secretion is decreased in young persons at risk for hypertension. These findings support the hypothesis that alterations in renal hemodynamics occur at an early stage in the development of familial hypertension.

Adolescent↗
PubMed1991

Determinants of disease and disability in the elderly: the Rotterdam Elderly Study.

In this paper the Rotterdam Elderly Study is presented. The aim of the study is to investigate determinants of disease occurrence and progression in the elderly. In addition to contributing to our understanding of the etiology of geriatric illnesses, the study is expected to lead to specific recommendations for intervention. The study focuses on causally related determinants of major diseases in the elderly. Fields of interest for the Rotterdam Elderly Study are conditions which interfere the most with the quality of life for the elderly. The aims of the Rotterdam Elderly Study are: (1) To investigate, by means of epidemiologic, clinical and basic research, the determinants of diseases in order to assess their etiologic significance. (2) To investigate potentially modifiable determinants in order to be able to develop preventive strategies by providing specific recommendations for intervention studies. The Rotterdam Elderly Study focuses on four primary areas of research: neurogeriatric diseases, cardiovascular diseases, locomotor diseases and ophthalmologic diseases. It is a prospective follow-up study, in which determinants of disease and determinants of progression of disease will be investigated in the total population of 55 years or over of the district of Ommoord in Rotterdam. It is anticipated that about 10,000 people will participate in the study and they will be examined in the period of 1991 to 1995.

Aged↗
PubMed1991

Determinants of bone mineral content in childhood.

In a sample of 1190 children (574 boys and 616 girls), aged 6.8-10.7 years, bone mineral content was studied using quantitative röntgen microdensitometry (QMD) at the diaphyseal and the metaphyseal site of the left second digit. Percentile curves of bone mineral density was determined by skeletal age for boys and girls separately. Bone mineral content at the diaphyseal site was significantly associated with skeletal age, height and body weight in boys and girls and with chronological age at the metaphyseal site in boys. In girls higher levels of bone mineral content were observed in those with a skeletal age greater than 7.3 years, compared to those with a skeletal age equal to or less than 7.3 years, adjusted for height and body weight. In boys a higher level of bone mineral content was found in those with a height greater than 138 cm, adjusted for skeletal age, compared to those with a height equal or less than 130 cm, at the diaphyseal and metaphyseal site. Girls with a relatively higher body weight had lower levels of bone mineral content at the metaphyseal site.

Age Determination by Skeleton↗
PubMed1991

Caffeine, blood pressure, and serum lipids.

To study the effects of caffeine on serum lipids and blood pressure, we conducted a double-blind, randomized trial with two parallel groups in 69 young, healthy subjects. After a 3-wk run-in period, subjects were randomly assigned to one of two groups receiving either 4-6 140-mL cups filtered decaffeinated coffee per day and an equal number of pills containing 75 mg caffeine or 4-6 140-mL cups filtered decaffeinated coffee per day and an equal number of placebo pills, for 9 wk. In both groups caffeine intake from other sources was not allowed. The main finding of this study is that abstinence from caffeine for a period of 9 wk has no effect on either serum lipids or blood pressure.

Adult↗
PubMed1991

Blood pressure in childhood: pooled findings of six European studies.

In an attempt to study and prevent the development of hypertension, there is a growing interest in measuring blood pressure in children. The aim of this is to detect and monitor those with a relatively high level of blood pressure. Until now, reference values on blood pressure in children are based on data from North-American youngsters. The present study provides percentile charts based on pooled data from studies on blood pressure conducted in six North-West European countries among 28,043 children. These blood pressure centiles are presented as age-, height- and gender-specific. Brief guidelines for blood pressure measurements in childhood and for detection of children with a relatively high blood pressure are included.

Adolescent↗
PubMed1991

Methodology of sodium sensitivity assessment. The example of age and sex.

This article addresses the methodology of sodium sensitivity assessment. There have been reports to suggest that a high sodium intake is a cause of elevated blood pressure and trials to indicate that a reduction in sodium intake may reduce blood pressure that is already high; the implications of these findings are discussed. Many studies on sodium sensitivity suffer from what could be called the "normal probability fallacy"; without appropriate control conditions, an intervention such as sodium restriction may incorrectly be assigned to a more pronounced response in a subgroup of the study population. As an example, findings are reviewed of age and sex as determinants of a response of blood pressure to variations in sodium intake. The limited data available suggest that subjects that are older and have higher blood pressure levels seem to benefit more from a reduction in sodium intake. In addition, elderly subjects at a high dietary sodium intake may have a higher risk of developing hypertension. Findings in both nonexperimental and experimental studies tend to support this view. Findings on sex differences are less consistent. A systematic approach to the assessment of factors and mechanisms responsible for sodium sensitivity in some subjects is needed to determine who might benefit most. Until more data are available, there is little basis to discriminate sodium-sensitive from sodium-resistant hypertensive subjects.

Aging↗
PubMed1991

Primary prevention in hypertension. Valid conclusions from observational studies.

Relatively few observational (i.e., nonexperimental) studies have been conducted to examine the role of antihypertensive drug therapy in the primary prevention of coronary heart disease. To draw valid conclusions from experimental or observational studies, internal validity should be ensured. In particular, similarity of "extraneous" effects, of information, and of prognosis between the treatment groups compared in a particular study is needed. Because allocation of participants to antihypertensive drug therapy in observational studies is nonrandomized by definition, special efforts should be made to achieve comparability of prognosis, that is, to avoid "confounding by indication." Follow-up and case-control studies, the two main types of observational studies, also offer certain advantages over randomized clinical trials, particularly when different classes of drugs are compared. Although few valid observational studies on the efficacy of drug therapy for hypertension in the primary prevention of first coronary events have been published, the available data suggest that beta-blockers might confer greater protection than other drug regimens. However, more evidence is needed to confirm these findings. It is concluded that observational studies could play an increasing role in the assessment of the role of antihypertensive therapy in the primary prevention of coronary heart disease when the inherent potentials and pitfalls of these studies are appreciated.

Adrenergic beta-Antagonists↗
PubMed1990

Aortic calcified plaques and cardiovascular disease (the Framingham Study).

The relation between the presence of calcified plaques in the thoracic aorta, as detected on chest x-rays, and the development of cardiovascular disease is examined during 12 years of follow-up of the Framingham cohort (n = 5,209). The prevalence of aortic calcified plaques approximately doubled with each decade of age, with only a trivial male predominance. Its presence was associated with a twofold increase in risk of cardiovascular death in men and women younger than age 65, even after other risk factors were taken into account. Similar increases in risk were found for coronary artery disease, stroke and intermittent claudication among middle-aged women. In middle-aged men these risks were less marked. The predictive value of aortic calcified plaques generally diminished with age. Risk of sudden coronary death in men with calcified plaques in the thoracic aorta ranged from a sevenfold increase at age 35 to no excess risk at age 70 years. These results support the view that atherosclerosis is a generalized process. The finding of aortic calcified plaques in a relatively young subject on a routine chest x-ray should be regarded as a sign for potential development of clinically manifest atherosclerotic disease in the cardiac, cerebral and peripheral arterial circulation.

Adult↗