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Biomedical subjects

D E Grobbee

Publications and source records attributed to D E Grobbee.

467 records · Page 26Linked to original sources
PubMed1987

Determinants of rise in blood pressure in normotensive children.

Thirty-nine initially normotensive children (25 girls) with a large increase in systolic blood pressure (SBP) over a period of 7 years were compared with 78 children with a small increase, matched for age and gender. They were selected from a random sample of 596 Dutch children who were examined at an initial examination and 4 weeks later, and at yearly intervals thereafter. Body weight, height and Quetelet index at baseline were similar in children with a large rise in SBP and those with a small rise. Children with a large increase had a larger weight gain during follow-up than those with a small rise. Parental blood pressure (BP) and parental history of diabetes mellitus and cardiovascular diseases did not differ between the study groups. Cardiovascular reactivity as assessed by a cold-pressor test at baseline did not differ between the study groups, nor did urinary sodium excretion during follow-up. Total tobacco consumption was larger in those with a small increase. Children with a large rise in SBP experienced a larger fall in SBP from the initial to the 4-week examination. The individual variability of BP over the whole observation period did not differ between the study groups. These observations suggest that a fall in BP after a short follow-up period may be indicative of high BP in the years to come.

Adolescent↗
PubMed1986

Effect of calcium supplementation on diastolic blood pressure in young people with mild hypertension.

In a double-blind trial 90 mildly hypertensive subjects aged 16-29 years were randomly assigned to 1 g calcium per day or placebo. Calcium supplementation did not affect systolic blood pressure, but at six and twelve weeks diastolic blood pressure had fallen by 3.1 (p = 0.04) and 2.4 (p = 0.11) mm Hg, respectively, more in the calcium group than it had in the placebo group. Subjects with a baseline plasma parathyroid hormone (PTH) higher than the median showed a 6.1 mm Hg (p = 0.01) greater fall in diastolic blood pressure after six weeks and 5.4 mm Hg (p = 0.01) after twelve than in the placebo group. The fall in diastolic blood pressure was greater in the calcium group than in the placebo group in subjects with a lower than median serum total calcium and in those with a large bodyweight. Calcium supplementation may lower blood pressure in young people with mildly raised blood pressure, particularly in those with high plasma PTH and/or low serum total calcium.

Adolescent↗
PubMed1986

Does sodium restriction lower blood pressure?

Data from 13 randomised trials on the effect of sodium restriction on blood pressure were analysed. The hypotensive effect of sodium restriction was found to be small and restricted largely to systolic blood pressure, which fell by an average of 3.6 mm Hg (range 0.5-10.0 mm Hg). The reduction increased with age and in those with higher blood pressure. Sodium restriction therefore seems to be of limited use in those who are most eligible for non-pharmacological treatment of high blood pressure--namely, young patients with mild hypertension.

Adolescent↗
PubMed1986

Intact parathyroid hormone (1-84) in primary hypertension.

Intact parathyroid hormone (1-84) (PTH) concentrations were measured in serum of 83 hypertensive and 83 normotensive subjects, aged 20 to 69 years, matched for age and gender, and selected from the same open population. No significant differences in serum intact-PTH levels were found between the total group nor between groups based on three age strata. However, PTH was negatively associated with body weight and after adjustment for differences in body weight, significantly higher intact-PTH levels were found in hypertensive than in normotensive subjects, aged 20-39 years, but not in those aged 40 to 69 years. Our findings suggest that body weight is a confounding variable when comparing differences in intact-PTH between groups. Intact-PTH levels may be increased in a subgroup of young primary hypertensive subjects.

Adult↗
PubMed1986

Non-pharmacological intervention in primary hypertension in childhood.

In children with blood pressure levels persistently in the upper part of the distribution and without evidence for known causes of hypertension, one may ask which approach should be used to lower blood pressure. In general, non-pharmacological intervention will be preferred over drug treatment as a first choice in children with primary hypertension. No specific non-pharmacological treatment is available for children with high blood pressure. The main objective of this review is to underscore the need for further intervention studies in hypertensive children. Although the scientific evidence is rather scanty, some general recommendations concerning body weight, physical activity and fitness, dietary intake of electrolytes and relaxation procedures can be made. In obese children, weight reduction, combined with increase of physical activity, is the measure of first choice to lower blood pressure. In children with a high sympathetic outflow, as evidenced by high levels of circulating catecholamines, increase of physical activity and use of relaxation procedures may be the first approach to lower blood pressure. In children with evidence for disturbances in electrolyte metabolism, as evidenced by high intralymphocytic sodium, low serum calcium, or high PTH, a dietary approach to high blood pressure may be used. In these children, an increase of potassium intake or calcium intake seems a promising way to lower blood pressure.

Body Weight↗
PubMedDate not supplied

Increased survival with beta-blockers: importance of ancillary properties.

To assess the relative importance of ancillary properties (ie, intrinsic sympathomimetic activity (ISA), beta 1-selectivity, membrane stabilizing activity, and lipophilicity) in the effect of beta-blockers on mortality, a meta-analysis of all available secondary and primary prevention trials was performed. Seventy-one trials evaluating the effect on mortality after myocardial infarction (MI) were identified. The overall relative risk (RR) of mortality during beta-blocker treatment versus placebo was 0.89 (95% confidence interval [CI] 0.84-0.93), with a trend according to time of intervention: very early intervention RR 0.94 (95% CI 0.87-1.01), early intervention RR 0.91 (95% CI 0.81-1.01), and late intervention RR 0.80 (95% CI 0.73-0.88). Results were similar or even more marked for the end points one-week mortality, reinfarction, and sudden death. beta 1-selectivity, lipophilicity, absence of membrane stabilizing property, and absence of ISA were associated with a greater risk reduction compared with beta-blockers with the opposite ancillary property. When the effect of the three most frequently used beta-blocking drugs (atenolol, metoprolol, and propranolol) were compared, the drug with the combination of ancillary properties showing the most pronounced beneficial effects (metoprolol) had the most marked effect on survival. A similar trend was observed when the five published primary prevention trials comparing beta-blockers and diuretics in patients with hypertension were considered, but the number of studies was too low to allow for definite conclusions. We conclude that beta-blockade after MI leads to a substantial reduction in mortality. The so-called 'class-effect' of beta-blockers, however, can be questioned, because ancillary properties appear to play an important role in the efficacy of these drugs.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Regional cerebral blood flow and cerebrovascular risk factors in the elderly population.

Regional cerebral blood flow (rCBF) was studied in 60 elderly persons (aged 65 to 84 years) recruited from a population-based study, with single photon emission computed tomography using technetium 99m-labeled hexamethylpropylene amine oxime. We investigated whether it is only age that affects rCBF or whether other factors can be indentified that explain this relationship. Using multiple linear regression analysis, increasing age was significantly associated with rCBF decrease in parietal, temporo-parietal, and temporal cortex, but not in frontal cortex. Adjustment with several risk factors for cerebrovascular disease, including hypertension, history of myocardial infarction, factor VIIc, factor VIIIc, cholesterol and HDL cholesterol, smoking, and diabetes mellitus had no influence on these relations. Conversely, the association between age and rCBF was no longer statistically significant after adjustment with fibrinogen and indicators of carotid atherosclerosis, including intima-media wall thickness of the carotid artery and plaques in the carotid artery. Correction with local ratings of cortical atrophy did not affect the relations between age and rCBF. The results suggest that in the elderly population rCBF declines with age in posterior cortical areas and that these changes may well be explained by the presence of atherosclerosis. Reduced contractility of the vascular muscle wall with increasing age resulting from atherosclerosis may be the underlying mechanism.

Aged↗
PubMedDate not supplied

Higher prevalence of depressive symptoms in middle-aged men with low serum cholesterol levels.

OBJECTIVE: Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity. We set out to establish whether middle-aged men with chronically low cholesterol levels (< or =4.5 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar comparison was also made for measures of anger, hostility, and impulsivity. METHODS: Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990-1991. These levels were remeasured in 1993-1994. Only those whose cholesterol level remained in the same range were included in the study. Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire. RESULTS: Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score > or =15 or > or =17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases. No differences in anger, hostility, and impulsivity were observed between the two groups. CONCLUSIONS: Men with a lower cholesterol level (< or =4.5 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter. These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death.

Anger↗
PubMedDate not supplied

Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study.

OBJECTIVE: To investigate whether an important football match increases stress to such an extent that it triggers acute myocardial infarction and stroke. DESIGN: Longitudinal study of mortality around 22 June 1996 (the day the Dutch football team was eliminated from the European football championship). Mortality on 22 June was compared with the five days before and after the match and in the same period in 1995 and 1997. SETTING: Netherlands. SUBJECTS: Dutch population aged 45 years or over in June 1996. MAIN OUTCOME MEASURES: All cause mortality and mortality due to coronary heart disease and stroke. RESULTS: Mortality from coronary heart disease and stroke was increased in men on the day of the match (relative risk 1.51, 95% confidence interval 1.08 to 2.09). No clear rise in mortality was observed for women (1.11, 0.80 to 1.56). Among men, about 14 excess cardiovascular deaths occurred on the day of the match. CONCLUSION: Important sporting events may provoke a sufficient level of stress to trigger symptomatic cardiovascular disease. The difference between men and women requires further investigation.

Aged↗
PubMedDate not supplied

Response to activated protein C in subjects with and without dementia. The Dutch Vascular Factors in Dementia Study.

We performed a cross-sectional case-control study among 295 subjects with dementia and 406 control subjects drawn from participants of the Rotterdam Study, a population-based cohort study among subjects aged 55 years or over, and from participants of the Rotterdam Stroke Databank, a hospital-based stroke registry, to evaluate the association of the factor V Leiden mutation and activated protein C (APC) response with dementia and its subtypes. The risk of dementia was 2.11-fold increased among carriers of factor V Leiden mutation relative to subjects lacking factor V Leiden mutation (95% confidence interval, CI, 0.93-4.77). The increased risks of vascular dementia and of Alzheimer's disease were 4.28 (95% CI 1.26-14.5) and 2.15 (95% CI 0.82-5.63), respectively. No association was found for APC response. We showed a nonsignificant twofold increased risk of dementia among subjects with factor V Leiden. The association appeared to be stronger for vascular dementia.

Activated Protein C Resistance↗
PubMedDate not supplied

Coagulation and fibrinolysis markers and risk of dementia. The Dutch Vascular Factors in Dementia Study.

We performed a cross-sectional case-control study among 277 subjects with dementia and 298 control subjects drawn from participants of the Rotterdam Study, a population-based cohort study among subjects aged 55 years or over, and from participants of the Rotterdam Stroke Databank, a hospital-based stroke registry, with the objective to evaluate the association of indicators of coagulability, fibrinogen, prothrombin fragments 1+2, thrombin-antithrombin complex (TAT), and indicators of fibrinolysis, plasmin-inhibitor complex, D-dimer and tissue-type plasminogen activator (t-PA) with dementia. Increased levels of TAT, D-dimer and t-PA activity were associated with an increased risk of dementia. Additional stratified analyses indicated that an increased TAT level was the primary factor related to dementia. The present study provides evidence that predominantly increased thrombin generation is associated with dementia.

Aged↗
PubMedDate not supplied

Plasminogen activator inhibitor 4G polymorphism is associated with decreased risk of cerebrovascular mortality in older women.

BACKGROUND: A common 4G allele of a 4G/5G polymorphism in the promoter region of the plasminogen activator inhibitor-1 (PAI-1) gene is associated with increased transcription of the PAI-1 protein, which may lead to decreased fibrinolysis. It has therefore been proposed as a candidate risk factor for myocardial infarction or stroke. METHODS AND RESULTS: We studied the relationship between PAI-1 4G/5G genotype and the risk of cardiovascular mortality in a prospective cohort study among 12 239 women initially aged between 52 and 67 years, with a maximum follow-up time of 18 years (153 732 follow-up years). PAI-1 4G/5G genotype was measured in DNA obtained from urine samples, which were collected at baseline, of 498 women who died of a cardiovascular disease and a random sample of 512 women from the same cohort who did not die of cardiovascular disease. The PAI-1 4G/5G genotype was not associated with risk of myocardial infarction or other cardiovascular mortality. However, PAI-1 4G4G homozygotes had a markedly reduced risk of cerebrovascular mortality compared with PAI-1 5G5G homozygotes: the relative risk was 0.4, with a 95% CI of 0.2 to 0.7, whereas the relative risk of cerebrovascular mortality in PAI-1 4G5G heterozygotes compared with PAI-1 5G5G homozygotes was 0.7, with a 95% CI of 0.4 to 1.1. CONCLUSIONS: These findings are suggestive of an important contribution of PAI-1 in cerebrovascular pathology, probably via pathways other than fibrinolysis. PAI-1 may protect against destabilization of the atherosclerotic plaque, or it may inhibit neurotoxicity of tissue plasminogen activator in the brain.

Age Factors↗
PubMedDate not supplied

Application of treatment thresholds to diagnostic-test evaluation: an alternative to the comparison of areas under receiver operating characteristic curves.

Diagnostic tests are often evaluated by comparison of the areas under receiver operating characteristic (ROC) curves. In this study the authors compared this approach with a more direct method that takes into account consequences of a diagnosis. Data from a prospective study of diagnosis of pulmonary embolism were used for a motivating example. Using multivariable logistic regression analysis, three diagnostic models were built and compared based on their ROC curves. Although model 1 (0.706) and model 2 (0.702) had the same ROC-curve area, they performed differently when risks and benefits of subsequent decisions were considered by applying the treatment probability threshold. Models 1 and 3 (0.611) had substantially different ROC-curve areas but performed similarly taking into account the therapeutic consequences. This demonstrates that comparison of diagnostic tests using the areas under the ROC curves may lead to erroneous conclusions about therapeutic usefulness. To correspond to daily practice, it would be more appropriate to also consider the clinical implications in evaluating diagnostic tests. This is made feasible by explicit definition and application of a treatment threshold.

Decision Support Techniques↗
PubMedDate not supplied

Diuretics and risk of sudden death in hypertension--evidence and potential implications.

Randomized trials have produced solid evidence that non potassium-sparing diuretic therapy in hypertension is beneficial, but the controversy regarding the possibility that these drugs may increase the risk of sudden death in some patients continues. Although few sudden deaths were reported in the trials, findings indicate that an excess risk of sudden death in users of these diuretics exists (pooled risk ratio 1.5; 95% CI 1.1-2.0). Two recent case-control studies provide consistent evidence that non potassium-sparing diuretics are associated with a twofold risk of sudden death compared to potassium-sparing diuretic therapy. It is estimated that among the 400,000 men and 1,000,000 women treated for hypertension in the Netherlands, such as excess risk would lead to respectively 96 and 34 cases of sudden death. We conclude that the available evidence strongly suggests that hypertensive patients on non potassium-sparing diuretic therapy are at an increased risk of sudden death. Concomitant prescription of potassium-sparing diuretic agents should be considered in these patients.

Case-Control Studies↗