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J Staessen

Publications and source records attributed to J Staessen.

At least 19 recordsLinked to original sources
PubMed2006

ESH-ESC guidelines for the management of hypertension.

The following is a brief statement of the 2003 European Society of Hypertension (ESH)-European Society of Cardiology (ESC) guidelines for the management of arterial hypertension. The continuous relationship between the level of blood pressure and cardiovascular risk makes the definition of hypertension arbitrary. Since risk factors cluster in hypertensive individuals, risk stratification should be made and decision about the management should not be based on blood pressure alone, but also according to the presence or absence of other risk factors, target organ damage, diabetes, and cardiovascular or renal damage, as well as on other aspects of the patient's personal, medical and social situation. Blood pressure values measured in the doctor's office or the clinic should commonly be used as reference. Ambulatory blood pressure monitoring may have clinical value, when considerable variability of office blood pressure is found over the same or different visits, high office blood pressure is measured in subjects otherwise at low global cardiovascular risk, there is marked discrepancy between blood pressure values measured in the office and at home, resistance to drug treatment is suspected, or research is involved. Secondary hypertension should always be investigated. The primary goal of treatment of patient with high blood pressure is to achieve the maximum reduction in long-term total risk of cardiovascular morbidity and mortality. This requires treatment of all the reversible factors identified, including smoking, dislipidemia, or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se. On the basis of current evidence from trials, it can be recommended that blood pressure, both systolic and diastolic, be intensively lowered at least below 140/90 mmHg and to definitely lower values, if tolerated, in all hypertensive patients, and below 130/80 mmHg in diabetics. Lifestyle measures should be instituted whenever appropriate in all patients, including subjects with high normal blood pressure and patients who require drug treatment. The purpose is to lower blood pressure and to control other risk factors and clinical conditions present. In most, if not all, hypertensive patients, therapy should be started gradually, and target blood pressure achieved progressively through several weeks. To reach target blood pressure, it is likely that a large proportion of patients will require combination therapy with more than one agent. The main benefits of antihypertensive therapy are due to lowering of blood pressure per se. There is also evidence that specific drug classes may differ in some effect or in special groups of patients. The choice of drugs will be influenced by many factors, including previous experience of the patient with antihypertensive agents, cost of drugs, risk profile, presence or absence of target organ damage, clinical cardiovascular or renal disease or diabetes, patient's preference.

Age Factors↗
PubMed2004

Determinants of white-coat hypertension.

BACKGROUND: The prevalence of white-coat hypertension (WCH) is considerable in patients referred with elevated office blood pressure. Failure to recognise this phenomenon can lead to the inappropriate use of antihypertensive medications. We undertook this study to determine the profile of patients with WCH. METHODS: Baseline clinic and daytime ambulatory blood pressures were available from 5716 patients referred over a 22-year period. Individuals were considered to have WCH if they had an elevated clinic blood pressure measurement greater than 140/90 mmHg and normal daytime mean ambulatory blood pressure. Mean age was 53.6 years and 53.2% were female. RESULTS: The overall prevalence of white-coat hypertension was 15.4%. A higher prevalence was seen amongst older adults, females, and non-smokers. CONCLUSION: Multivariate logistic regression analysis confirmed these characteristics as independent predictors of WCH.

Blood Pressure Determination↗
PubMed2001

Task Force I: methodological aspects of blood pressure measurement.

OBJECTIVE: To reach a consensus on important methodological aspects of blood pressure measurement. METHODS: A Task Force on the methodological aspects of blood pressure measurement wrote this review after the Eighth International Consensus Conference on Blood Pressure Monitoring, in Sendai, Japan (28-31 October 2001). This consensus paper is based on the papers presented by Task Force I and on the discussion sessions, and is therefore representative of a broad spectrum of expert opinion. POINTS OF CONSENSUS: Consensus was reached on the following five issues: (1) there is an urgent need for a simplified protocol for the validation of blood pressure measuring devices; (2) there is a need for a means of updating the "state of the market" for validated devices so that users can have easy access to this information; (3) new devices must be validated independently, and existing devices that have not been validated must be reappraised; (4) manufacturers should confirm when new models use algorithms which have been validated previously; (5) the Food and Drug Administration now accepts that when ambulatory blood pressure measurement is used in clinical short-term trials in which side-effects are not being assessed, a placebo arm is not required.

Algorithms↗
PubMed2001

Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial.

A number of trials and meta-analyses have demonstrated clear benefits of blood pressure (BP) reduction in patients aged <80 years with regard to the reduction in stroke and cardiovascular events. However, a variety of studies have suggested that the positive relationship between BP and cardiovascular mortality is weakened or indeed reversed in the very elderly. Most intervention trials to date have either excluded or not recruited sufficient patients aged > or =80 years to determine whether there is a significant benefit from treatment in this age group. A meta-analysis of intervention trials that recruited patients aged > or =80 years has suggested a benefit in terms of stroke reduction but has also raised the possibility of an increase in total mortality. The benefit to risk ratio therefore needs to be clearly established before recommendations can be made for treating very elderly patients with hypertension. The Hypertension in the Very Elderly Trial (HYVET) pilot recruited 1283 patients aged > or =80 years and showed the feasibility of performing such a trial in this age group. It was a Prospective Randomised Open Blinded End-Points (PROBE) design but the main trial has additional pharmaceutical sponsorship to run a double-blind trial. Therefore, the main trial is a randomised, double-blind, placebo-controlled trial designed to assess the benefits of treating very elderly patients with hypertension. It compares placebo with a low dose diuretic (indapamide sustained release 1.5mg daily) and additional ACE inhibitor (perindopril) therapy if required. As in the pilot trial, the primary end-point is stroke events (fatal and non-fatal) and the trial is designed to determine whether or not a 35% difference occurs between placebo and active treatment. The main objective will be achieved with 90% power at the 1% level of significance. Secondary outcome measures will include total mortality, cardiovascular mortality, cardiac mortality, stroke mortality and skeletal fracture. 2100 patients aged > or =80 years are to be recruited and followed up for an average of 5 years. Entry BP criteria after 2 months of a single-blind placebo run-in period are a sustained sitting systolic BP (SBP) of 160 to 199mm Hg and a diastolic BP of 90 to 109mm Hg. The standing SBP must be >140mm Hg. The trial will be carried out in accordance with the principles of Good Clinical Practice. We describe in detail the protocol for the main trial and discuss the reasons for the changes from the pilot, the use of the drug regimen, and the BP criteria to be used in the trial.

Age Factors↗
PubMed1999

Out-patient versus in-hospital ambulatory 24-h blood pressure monitoring in heart transplant recipients.

OBJECTIVE: To study the effect of the environment--in-hospital vs. out-patient situation--on blood pressure as measured by ambulatory blood pressure monitoring (ABPM). PATIENTS AND METHODS: Twenty-four hour ABPM was performed sequentially in-hospital and again 9+/-3 days later on an out-patient basis, in 30 consecutive heart transplant recipients (27 men, median age 56 years, median time post-transplant 3 years). The same equipment was used on both occasions, without any interim change in medical treatment. RESULTS: Both systolic and diastolic blood pressure were higher in-hospital than as an out-patient: +7+/-7 and +6+/-5 mm Hg respectively for the 24-h average (P<0.001). Daytime and night-time pressures were affected similarly. Depending on the specific cut-off values used, 37 to 87% of the individual patients were hypertensive in-hospital; 31 to 73% of these had an acceptable blood pressure as an out-patient. The converse was very rare (0 to 3% of the total group). CONCLUSIONS: In heart transplant patients blood pressure as assessed from 24-h ABPM is lower in the home environment than during a hospital stay. The post-transplant attenuation of the circadian variation in blood pressure is not influenced by the environment. Checking an unsatisfactory in-hospital ABPM with an outpatient recording may obviate the need for an (intensified) antihypertensive treatment in a substantial number of patients.

Adolescent↗
PubMed1998

Limitations of the difference between clinic and daytime blood pressure as a surrogate measure of the 'white-coat' effect. Syst-Eur investigators.

BACKGROUND: The difference between clinic and ambulatory average daytime blood pressures is frequently taken as a surrogate measure of the 'white-coat effect' (i.e. the pressor reaction triggered in the patient by the physician's visit). OBJECTIVE: To assess the reproducibility of this difference and its relationship with clinic and average ambulatory daytime blood pressure levels. DESIGN AND METHODS: These issues were addressed with two large groups of subjects in whom both clinic and ambulatory blood pressures were measured, namely 783 outpatients with systolic and diastolic essential hypertension [Group 1, aged 50.8+/-9.4 years (mean +/- SD)], participating in standardized Italian trials of antihypertensive drugs, and 506 elderly patients (group 2, age 71+/-7 years) with isolated systolic hypertension, participating in the European Syst-Eur trial. RESULTS: The clinic-daytime blood pressure difference for the essential systolic and diastolic hypertensive patients (group 1) was 13.6+/-14.3 mmHg for systolic and 9.1+/-8.6 mmHg for diastolic blood pressure (P always < 0.01). This difference for the elderly patients with isolated systolic hypertension (group 2) was 21.2+/-16.0 mmHg for systolic and only 1.3+/-10.2 mmHg for diastolic blood pressure (P < 0.01 and P < 0.05, respectively). In both studies little or no systematic clinic-daytime difference could be observed for heart rate. The reproducibility of the clinic-daytime blood pressure difference, tested for 108 essential systolic and diastolic hypertensive patients from group 1 and 128 isolated systolic hypertensives from group 2, was invariably lower than that both of daytime and of clinic blood pressure values. Finally, the clinic-daytime blood pressure difference was progressively higher for increasing levels of clinic blood pressure and progressively lower for higher levels of ambulatory daytime blood pressure. CONCLUSIONS: Thus, the clinic-daytime blood pressure difference has a limited reproducibility; depends not only on clinic but also on daytime average blood pressure, which means that its size is a function of the blood pressure criteria employed for selection of the patients in a trial; and is never associated with a systematic clinic-daytime difference in heart rate, which further questions its use as a reliable surrogate measure of the true pressor response induced in the patient by the doctor's visit.

Adolescent↗
PubMed1998

Quality of life of elderly patients with isolated systolic hypertension: baseline data from the Syst-Eur trial. Syst-Eur Trial Investigators.

OBJECTIVE: To describe measures of quality of life of elderly patients with isolated systolic hypertension at entry to a placebo-controlled randomized trial of antihypertensive treatment and to investigate factors associated with these. DESIGN: Cross-sectional analyses at entry to a randomized controlled trial. SETTING: Patients attending hypertension clinics or general practitioners' surgeries at 30 centres in 10 European countries. PATIENTS: Six hundred and thirty-one patients aged 60 years or more, with a sitting systolic blood pressure during the run-in phase of 160-219 mmHg, a sitting diastolic blood pressure below 95 mmHg and a standing systolic blood pressure of 140 mmHg or more. MAIN OUTCOME MEASURES: Cognitive function tests (Reitan Trail Making A and B), Brief Assessment Index (a measure of depressed mood) and four subscales from the Sickness Impact Profile (Ambulation, Social Interaction, Sleep and Rest and Housework). RESULTS: Poor quality of life was generally associated with increasing age, previous treatment with antihypertensive drugs, presence of cardiovascular complications and, among women, high diastolic blood pressure, higher consumption of alcohol and high body mass index. CONCLUSIONS: At entry to the trial there was considerable heterogeneity of patients in terms of measures of quality of life and cognitive performance. It remains to be determined whether these influence subsequent quality of life during randomized treatment.

Age Factors↗
PubMed1998

Characterisation of hypertensive patients according to 24 H peripheral resistance.

To clarify whether a circadian rhythm of peripheral resistance exists in humans and whether hypertensive patients represent a homogeneous category in this respect, 15 normotensives aged 31 +/- 4 years and 30 hypertensives aged 41 +/- 13 years were confined to bed for 22 h and forearm flow recorded automatically. Night-time BP values were higher in hypertensive patients (Group B) whose night/day ratios of mean BP were below the 95% C.I. of the normal regression of the normotensives, than in those falling within the 95% C.I. (Group A). Forearm resistance was lower during sleep than during waking in Group A and in the normotensive controls, paralleling the nocturnal blood pressure fall. On the contrary, in the Group B hypertensives, despite a comparable night-time BP decrease, forearm resistance was higher during sleep than during waking.

Adult↗
PubMed1997

Optimizing the assessment of the elderly patient with borderline hypertension: the Hypertension and Ambulatory Recording in the OLD (HAROLD) study.

This article describes the objectives and protocol of the HAROLD study, a trial designed to assess whether home blood pressure (BP), 24-hour ambulatory BP, left ventricular structure and function, and albumin excretion rate are more accurate predictors of outcome than traditional sphygmomanometric BP in elderly subjects with borderline hypertension. Development of sustained hypertension (BP > or = 160/95 mmHg) and incidence of morbid events over a 5-year follow-up are considered soft and hard endpoints, respectively. Patients with blood pressure values between 140/90 and 159/94 mmHg after three months of observation and who have never been treated, are eligible for the study; these subjects must be 60 to 79 years old, and free from other important risk factors for atherosclerosis. Baseline exams, which include plasma renin and insulin, 24-hour urine collection for detection of microalbuminuria, and echo-doppler cardiac examination are repeated after three and five years follow-up, or when subjects develop sustained hypertension. To recruit a large enough number of subjects to allow a sufficient number of endpoints (over 1000 subjects), the study is conducted as a multicenter trial. Ninety Italian Hospital Centers have agreed to participate in the study.

Aged↗
PubMed1997

Relationship of tachycardia with high blood pressure and metabolic abnormalities: a study with mixture analysis in three populations.

Faster resting heart rate has been shown to be associated with a higher risk of developing hypertension and a greater incidence of cardiovascular morbidity and mortality. The aim of this study was to investigate the distribution of heart rate and its relationship with blood pressure and other cardiovascular risk factors in three populations. One European general population (Belgian study), one North American general population (Tecumseh study), and one European hypertensive population (HARVEST trial) were studied. Within each population, mixture analysis was used to investigate whether a mixture of two normal distributions explained the variance in heart rate better than a single distribution. In the men of all populations, mixture analysis identified a larger subpopulation of subjects with normal heart rate and a smaller one with fast heart rate. The subgroups with tachycardia had higher blood pressure and lipid levels than those with normal heart rate. In the populations in which they were measured, fasting insulin and postload glucose were also higher in the men with faster heart rate. A subgroup with tachycardia could also be singled out among the women from Tecumseh, but no relation between heart rate and blood pressure could be found. These findings show that in Western societies, high heart rate pertains to a distinct subgroup of subjects, who are more frequently men and exhibit the characteristic features of the insulin resistance syndrome. Sympathetic overactivity is likely to be the mechanism underlying this clinical condition.

Adolescent↗
PubMed1996

Effect of strength training on blood pressure measured in various conditions in sedentary men.

To examine the effect of long term strength training on heart rate and blood pressure, measured in different conditions, and on their variability, thirty healthy, previously sedentary men were randomized into a training and a control group. The strength training program consisted of 48 training sessions on a multigym apparatus at a frequency of 3 sessions each week, involving leg press, bench press, leg curl, shoulder press, leg extension and sit ups. The control group was asked not to change their sedentary lifestyle. In the subjects of the training group the load could be increased significantly for all exercises (p < 0.01). Heart rate and blood pressure were measured at rest in the supine and sitting position, during 24 hours with a non-invasive ambulatory device and during an exercise test on a cycloergometer. Repeated measures analysis of variance did not show an effect of strength training on heart rate or on blood pressure. In addition, power spectral analysis of the RR interval (ECG) and of the beat-to-beat blood pressure in the supine subject revealed similar total, low frequency and high frequency power before and after training, indicating that the neural control of both heart rate and blood pressure was not affected by a 16-week program of strength training.

Blood Pressure↗
PubMed1996

Prediction of the actual awake and asleep blood pressures by various methods of 24 h pressure analysis.

OBJECTIVE: To assess the relationships of daytime and night-time blood pressures and the day-night pressure differences, obtained by various analytical methods, with the actual awake and asleep pressures and the awake-asleep pressure difference. METHODS: Ambulatory blood pressure was successfully monitored by use of the SpaceLabs 90202 device in 91 healthy young men during a weekend, when they went to bed and awoke at variable and often unusual times. The actual 'awake' and 'asleep' blood pressures were calculated on the basis of these times, noted by the subjects. The 24 h recordings were further analysed by use of two clock time-independent methods (square-wave fitting; cumulative sum analysis) and by one 'wide' (A) and one 'narrow' (B) fixed-time method (daytime: 0700-2200 h or 1000-2000 h; night-time: 2200-0700 h or 0000-0600 h, for methods A and B, respectively). RESULTS: In the total study population, square-wave fitting (+1.1 +/- 1.5 mmHg, mean +/- SD) and cumulative sum analysis (2.4 +/- 1.9 mmHg) overestimated the actual awake systolic blood pressure and underestimated the asleep pressure (-0.7 +/- 1.7 and -1.8 +/- 1.8 mmHg, respectively). The fixed-time techniques underestimated the awake pressure (-2.6 +/- 3.1 and -0.2 +/- 3.2 mmHg for methods A and B, respectively) and overestimated the asleep pressure by +4.9 +/- 5.5 and +2.7 +/- 6.1 mmHg, respectively. The actual awake-asleep pressure difference was overestimated by square-wave fitting (+1.8 +/- 1.9 mmHg) and more so by cumulative sum analysis (+4.2 +/- 2.5 mmHg); the underestimation by the fixed time approach averaged -3.0 +/- 8.4 mmHg with method B and amounted to -7.5 +/- 8.3 mmHg with method A. Overall, the SD of the various differences between the estimated and the actual awake and asleep pressures, and consequently the limits of agreement, were larger for the fixed-time methods than for the clock time-independent techniques. In the 47 subjects who went to bed before 2400 h and awoke between 0600 and 1000 h, the results of the clock time-independent methods were similar to the results in the total study population, whereas the deviations of the fixed time pressures from the actual awake and asleep blood pressures were considerably reduced. The results were similar for diastolic blood pressure. CONCLUSIONS: Clock time-independent methods, particularly square-wave fitting, can predict the actual awake and asleep blood pressures and the awake-asleep pressure differences with reasonable accuracy and the results are independent of the awake-asleep pattern of the subjects. However, fixed-time methods are only reliable when the subjects go to bed and arise within well-defined periods, and yield more accurate results when the morning and evening phases are excluded from the daytime and night-time periods.

Adult↗
PubMed1996

Geographical and temporal differences in the urinary excretion of inorganic arsenic: a Belgian population study.

OBJECTIVE: This Belgian study assessed the geographical and temporal differences in the exposure of the population to inorganic arsenic, a known carcinogen. METHODS: In the CadmiBel study (1985-9) the 24 h urinary arsenic excretion was measured, as an index of recent exposure, in industrialised cities (Liège: n = 664, Charleroi: n = 291), in a rural control area (Hechtel-Eksel: n = 397), and in rural districts in which the population had possibly been exposed through the drinking water or the emissions of nonferrous smelters (Wezel: n = 93, Lommel: n = 111, and Pelt: n = 133). In the PheeCad study, in 1991-5, the rural areas (n = 609) were re-examined together with an urban control area (Leuven: n = 152). RESULTS: The CadmiBel results showed that after adjustment for sex, age, and body mass index, the 24 h arsenic excretion was on average low in Liège (91 nmol), Charleroi (155 nmol), Hechtel-Eksel (144 nmol), and Wezel (158 nmol), whereas the highest excretions were found in Lommel (570 nmol) and Pelt (373 nmol). During the PheeCad study, the mean 24 h arsenic excretion in the rural areas ranged from 81 to 111 nmol. This was lower than six years earlier and similar to the excretion in the control town (108 nmol). Longitudinal studies in 529 people living in the rural areas confirmed that their 24 h arsenic excretion had decreased (P < 0.001) from 222 to 100 nmol. As well as the drinking water, industry was likely to be a source of the increased exposure in Lommel and Pelt in 1985-9, because at that time the urinary arsenic excretion did not follow the regional differences in the arsenic content of the drinking water, because the fall in the arsenic excretion over time coincided with the implementation by industry of stricter environmental regulations, because in individual subjects the urinary arsenic excretion was inversely correlated with the distance to the nearest smelter, and because an increased arsenic excretion was only found downwind from the main smelter. The official network that monitors the arsenic concentration in airborne and fall out dust did not detect the high exposure in Lommel and Pelt between 1985 and 1989. CONCLUSION: This study highlights the necessity to validate environmental monitoring programmes by directly estimating the internal exposure of the population.

Adult↗
PubMed1996

Ambulatory blood pressure during antihypertensive therapy guided by conventional pressure.

Subjects with elevated conventional clinic or office blood pressure (CBP) may have normal ambulatory blood pressure (ABP). The purpose of this review is to summarize studies in which ABP was monitored while the initiation or intensification of antihypertensive therapy was guided by CBP. These studies show that ABP does not decrease or decreases only slightly in response to treatment in subjects with elevated CBP and low ABP, whereas the CBP is significantly reduced in such patients.

Journal Article↗
PubMed1996

Diurnal blood pressure curve in children and adolescents.

OBJECTIVE: To investigate the diurnal blood pressure curve in healthy normotensive children. Thirty-one children were re-examined after a median interval of 123 days in order to study the reproducibility of the diurnal profile. SUBJECTS: Twenty-four-hour ambulatory blood pressure monitoring and conventional blood pressure readings were obtained in 228 normotensive children, whose ages ranged from 6 to 16 years and of whom 116 were boys and 112 girls. RESULTS: The conventional blood pressure averaged 99+/-11/57+/-9 mmHg in boys and 98+/-12/56+/-9 mmHg in girls (means+/-SD); the corresponding 24 h pressures were 111+/-7/66+/-5 mmHg and 109+/-7/65+/-5 mmHg, respectively. Of the children, 83% had a significant diurnal blood pressure rhythm for systolic pressure and 89% for diastolic pressure. The nocturnal blood pressure fall was normally distributed, averaging 12.0+/-6.3 mmHg systolic and 14.2+/-5.9 mmHg diastolic. There was no evidence for a bimodal distribution. The amplitude of the diurnal blood pressure curve, determined by the Fourier approach, was positively skewed with a mean of 12.5+/-4.2 mmHg for systolic and 14.0+/-4.1 mmHg for diastolic blood pressure. The daily blood pressure maximum occurred at 1344+/-4 h 46 min for systolic and 1321+/-4 h 22 min for diastolic blood pressure. For systolic blood pressure the cumulative sum (cusum)-derived circadian alteration magnitude was 1.7+/-6.2 mmHg higher in boys than in girls, whereas the cusum plot height was also 7.3+/-27.0 mmHg x h higher in male subjects. The repeatability coefficient (2SD of the difference between paired recordings, expressed as a percentage of nearly maximal variation) was 80% for the conventional systolic pressure and 40% for the conventional diastolic blood pressure. The repeatability coefficients for the ambulatory blood pressure levels varied from 32 to 45% and for the parameters describing the diurnal blood pressure profile from 42 to 78%. CONCLUSION: A significant diurnal blood pressure rhythm is observed in most normotensive children and adolescents. There is no evidence for a bimodal distribution of the nocturnal blood pressure fall. The reproducibility of the parameters of the diurnal blood pressure curve tended to be less than that of the ambulatory blood pressure level. Thus, one 24 h recording is probably insufficient to characterize a child's diurnal blood pressure profile fully.

Adolescent↗
PubMed1996

Antihypertensive therapy in older patients with isolated systolic hypertension: the Syst-Eur experience in general practice

Background and objective. This interim report from the Syst-Eur trial investigated the level of blood pressure control achieved during the double-blind period in patients followed in general practices. Methods. In the Syst-Eur trial elderly patients (60 years or older) with isolated systolic hypertension were randomized to either active or placebo treatment. Active treatment consisted of nitrendipine combined with enalapril and/or hydrochlorothiazide to reduce systolic pressure to Results. This analysis was restricted to patients of general practitioners who had been followed for at least 12 months. The placebo (N = 204) and active treatment (N = 217) groups had similar characteristics at randomization. At one year, the difference in sitting pressure between the two treatment groups was 10 mmHg systolic and 4 mmHg diastolic. Fewer patients remained on monotherapy in the placebo than in the active treatment group and on placebo the second and third line medications were started earlier. Nitrendipine tablets were discontinued in 10 patients on placebo and in 21 patients assigned to active treatment (P Conclusions. A significant blood pressure reduction can be achieved and maintained in older patients with isolated systolic hypertension followed by general practitioners. Whether this blood pressure reduction results in a clinically meaningful decrease of cardiovascular complications is under investigation. Keywords. Antihypertensive treatment, general practice, isolated systolic hypertension, randomized clinical trial.

Journal Article↗