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Biomedical subjects

J Staessen

Publications and source records attributed to J Staessen.

At least 37 records · Page 2Linked to original sources
PubMed1996

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

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 < 150 mmHg and by > or = 20 mmHg. Matching placebos were used in the control group. 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 < 0.001 for all comparisons). 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.

Aged↗
PubMed1996

Long-term blood pressure control in older Chinese patients with isolated systolic hypertension: a progress report on the Syst-China trial.

This report on the ongoing double-blind placebo-controlled Syst-China trial investigated whether antihypertensive drug treatment based mainly on a calcium entry blocker and a converting enzyme inhibitor, would be suitable for maintaining long-term blood pressure (BP) control in older Chinese patients (average age: 67 years) with isolated systolic hypertension (systolic pressure 160-219 mm Hg and diastolic pressure < 95 mm Hg). Active treatment consisted of nitrendipine (10- 40 mg/day) with the possible addition of captopril (12.5- 50 mg/day) and hydrochlorothiazide (12.5-50 mg/day), as necessary to reduce systolic pressure to a level of 150 mm Hg or lower and by at least 20 mm Hg. Matching placebos were used in the control group. This progress analysis was restricted to BP control up to 3 years of follow-up. The placebo (n = 1134) and active treatment n = 1245) groups had similar characteristics at enrolment. The sitting BP averaged 170/86 mm Hg. Systolic pressure fell (P < 0.001) on average 8 mm Hg more on active treatment than on placebo and diastolic pressure 3 mm Hg more. Fewer patients remained on monotherapy in the placebo than in the active treatment group (P < 0.001); on placebo the second and third line medications were started more frequently (P < 0.001). This progress report showed that significant BP reduction can be achieved and maintained in older Chinese patients treated with a calcium antagonist, associated with a converting-enzyme inhibitor and a thiazide, as necessary. Whether this BP reduction would result in a clinically meaningful decrease of cardiovascular complications is still under investigation.

Aged↗
PubMed1995

Relation of left ventricular mass and filling to exercise blood pressure and rest blood pressure.

Ninety-two young men with normal blood pressure (BP) or borderline elevated BP underwent echocardiography and maximal exercise testing to study whether left ventricular (LV) mass and the mitral inflow velocity pattern are more closely related to BP measured during dynamic exercise than to pressure measured at rest. LV mass was significantly related (p < 0.05) to systolic BP measured at rest and at various workloads; however, the variance of LV mass that could be explained by exercise pressures, in addition to preexercise pressure, age, body size, resting heart rate, and peak oxygen uptake, was not significant. The ratio of the late to early mitral inflow velocity was significantly related to systolic BP at rest but not to the pressures during exercise, and there was no independent contribution of exercise BP to its variance. Thus, systolic BP at various levels of dynamic exercise does not contribute independently to the interindividual variance of LV mass and mitral inflow pattern in young men with normal or borderline elevated BP.

Adolescent↗
PubMed1995

The ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database.

OBJECTIVE: To delineate more precisely an operational threshold for making clinical decisions based on ambulatory blood pressure (ABP) measurement by studying the ABP in subjects who were diagnosed as either normotensive or hypertensive by conventional blood pressure (CBP) measurement. SUBJECTS: Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (systolic CBP < or = 140 mmHg and diastolic CBP < or = 90 mmHg) and 1773 were hypertensive (systolic CBP > or = 160 mmHg and/or diastolic CBP > or = 90 mmHg). Of the latter, 1324 had systolic and 1310 had diastolic hypertension. RESULTS: Ninety-five percent of the normotensive subjects had a 24-h ABP below (systolic and diastolic, respectively) 133 and 82 mmHg. Of the patients with systolic hypertension, 24% had a 24-h systolic ABP of < 133 mmHg. Similarly, 30% of those with diastolic hypertension had a 24-h diastolic ABP of < 82 mmHg. The probability that hypertensive patients had a 24-h ABP below these thresholds was higher in women than in men, increased with age and was 2- to 4-fold greater if the CBP of the patient had been measured at only one visit and if fewer than 3 CBP measurements had been averaged to establish the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for the 24-h systolic ABP and by 25% for the 24-h diastolic ABP, and for each 5 mmHg increment in diastolic CBP it increased by 6 and 9%, respectively. CONCLUSION: The ABP distributions of the normotensive subjects included in the present international database were not materially different from those in previous reports in the literature. One-fifth to more than one-third of the hypertensive patients had an ABP which was below the 95th centile of the ABP in normotensive subjects, but this proportion decreased if the hypertensive patients had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined.

Adolescent↗
PubMed1995

Multiple standardized clinic blood pressures may predict left ventricular mass as well as ambulatory monitoring. A metaanalysis of comparative studies.

It is generally recognized that the relation between left ventricular mass (index) and blood pressure measured in the clinic is weak. Several investigators have studied whether ambulatory blood pressure outside the hospital environment can explain more of the variance of left ventricular mass than does clinic pressure. In a metaanalysis of such comparative studies, the weighted correlation coefficient averaged 0.35 (95% confidence limits: 0.30 to 0.40) for systolic clinic pressure and was significantly (P < .001) higher for the 24-h pressure (r = 0.50; range 0.45 to 0.54). In several studies, however, the methodology and conditions of the clinic pressure measurements were poorly described or standardized, whereas multiple meticulously obtained measurements were present in other reports. The ambulatory pressure monitoring was usually performed with great care and reported in detail. In some studies in which clinic blood pressure consisted of multiple readings in well-standardized conditions in the resting subject, clinic pressure seemed to predict left ventricular mass as well as ambulatory monitoring. We suggest that the strength of the relationship of left ventricular mass with ambulatory pressure may not differ from that with clinic pressure when an adequate number of blood pressures are measured in well-standardized conditions in the clinic.

Adult↗
PubMed1995

Double-blind comparison of antihypertensive treatment with ramipril and piretanide, given alone or in combination.

In a double-blind, randomized, multicenter trial, we compared the efficacy and safety of the fixed combination of 5 mg ramipril and 6 mg piretanide and the respective component monotherapies in hypertensive patients [supine diastolic blood pressure (DBP) 100-114 mm Hg]. After a single-blind run-in period on placebo, 611 patients were randomized to ramipril (n = 209), piretanide (n = 201), or the combination therapy (n = 201). At randomization, the three groups had the same characteristics (51% men, age 55 +/- 10 years, BP 165 +/- 18/104 +/- 6 mm Hg). At 4 weeks, BP decreased more with combined therapy than with monotherapy. As compared with piretanide monotherapy, the gain in the antihypertensive effect in the supine position averaged 2.1 mm Hg [90% confidence interval (CI) -0.8-5.0 mm Hg; p = 0.07] systolic BP (SBP) and 1.9 mm Hg (CI 0.3-3.5 mm Hg, p = 0.02) DBP and, as compared with ramipril monotherapy, these differences were 4.2 mm Hg (CI 1.3-7.0 mm Hg, p = 0.008) and 2.0 mm Hg (CI 0.5-3.6 mm Hg, p = 0.009). The incidence of adverse events (AE) and the changes in biochemical measurements were similar in the three treatment groups with the exception of spontaneously reported polyuria and serum uric acid concentration. Polyuria was reported more frequently (p < 0.001) with piretanide therapy (n = 23) and combined therapy (n = 19) than with ramipril therapy (n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

State of the market. A review of ambulatory blood pressure monitoring devices.

The introduction of 24-hour ambulatory blood pressure measurement into clinical practice created a large market for ambulatory blood pressure measurement devices. Forty-three such devices from 31 manufacturers or suppliers are now available to satisfy a market demand that is likely to increase. The aim of this article is to identify the devices available and then to examine critically any validation studies assessing accuracy and performance. Of the 43 devices available 18 have been validated according to the protocols of the Association for the Advancement of Medical Instrumentation (AAMI) or the British Hypertension Society (BHS) in 25 reported studies. In 9 of these studies the protocol was not adhered to, and the results, which are therefore questionable, are noted but not considered further. Fourteen devices were evaluated according to the accuracy criteria of both protocols, and of these 9 fulfilled the requirements. From this review of 43 devices on the market it may be concluded that, at the time of writing, there is published evidence for only 9 devices meeting the generally accepted AAMI and BHS criteria for accuracy and performance; these are the A&D TM-2420 models 6 and 7 and TM-2421, CH-Druck, Nissei ABPM DS-240, Profilomat, QuietTrak, and SpaceLabs SL-90202 and SL-90207.

Blood Pressure Monitoring, Ambulatory↗
PubMed1995

Heritability of conventional and ambulatory blood pressures. A study in twins.

Conventional and 24-hour ambulatory blood pressures were measured in 26 pairs of monozygotic twins and 27 pairs of dizygotic twins, all male, ages 18 to 38 years, to determine the heritability of blood pressure measured under various conditions. Conventional pressure was the average of three well-standardized measurements in the supine position, and ambulatory pressure was recorded during the subjects' normal activities by use of the SpaceLabs 90202 device. Heritability was assessed by classic methods and by model fitting and path analysis. In the latter approach, the percent genetic variance was 70% for mean 24-hour systolic pressure and 73% for diastolic pressure, which was similar to the results for the conventional pressures (64% and 73%, respectively). During the night, these estimates were 72% and 51% for systolic and diastolic pressures, respectively, and also the average pressures of the total awake daytime period were under partial genetic control (63% and 55%, respectively). The remaining variances could be attributed primarily to unique environmental influences. However, shared and nonshared environmental factors were predominant for the pressures during a fixed 6-hour afternoon period. We conclude that the heritability of blood pressure is relatively high in young adult healthy men, for standardized conventional pressure and the average 24-hour pressure. Genetic variance is somewhat higher for the asleep pressure than for the awake systolic pressure.

Adolescent↗
PubMed1995

Diurnal blood pressure profile in older patients with isolated systolic hypertension. The SYST-EUR Investigators.

This study describes the diurnal blood pressure (BP) profile and identifies its correlates in older patients with isolated systolic hypertension (ISH). The ambulatory BP readings of 408 patients, aged > or = 60 years, with ISH on clinic measurement, enrolled in the placebo run-in phase of the Syst-Eur Trial were examined. The time-weighted 24 h BP, daytime and night-time BP and the cusum-derived crest and trough BP were computed to express the BP level. The daily alteration between the high and low BP span was estimated from the day-night BP difference, the cusum derived circadian alteration magnitude and plot height, as well as the amplitude of the Fourier curve. The 24 h SBP and DBP tended to be higher in men (150 +/- 15/82 +/- 9 mm Hg) than in women (147 +/- 17/79 +/- 10 mm Hg), but the sex difference was only significant for DBP. In multiple regression analysis, the 24 h SBP increased (P < 0.05) by 3 mm Hg for each 10 year increment in age and was also 10 mm Hg higher (P < 0.001) in smokers than in non-smokers; the 24 h DBP was 2 mm Hg higher (P < 0.05) in men than in women and decreased (P < 0.05) by 1.5 mm Hg for each 10 year increment in age. The day-night difference in SBP increased with 2 mm Hg for each 10 mm Hg increase in the conventional pressure, decreased with 5 mm Hg for each 10 year increment in age and was 6 mm Hg higher in smokers than in non-smokers; the day-night difference in diastolic pressure was 2 mm Hg greater in women than in men. We conclude that the main determinants of the diurnal BP variation in older patients with isolated systolic hypertension were sex, age, smoking habits and the level of pressure on conventional measurement.

Age Distribution↗
PubMed1995

Low-level lead exposure, renal function and blood pressure.

The possible influence of low-level lead exposure on public health remains a matter of concern. The purpose of this article was to review the evidence that renal function and blood pressure may be affected at exposure levels encountered in the Belgian population. Moreover a meta-analysis explored whether the available studies in man would support a positive association between low-level lead exposure and hypertension. Renal function and lead exposures were studied in Belgium in a random population sample of 965 men and 1016 women (age range: 20 to 88 years). The mean (+/- standard deviation) creatinine clearance was 99 +/- 30 ml/min in men and 80 +/- 25 ml/min in women. In men the geometric mean blood lead concentration was 0.55 mumol/l with range from 0.11 to 3.5 mumol/l and in women 0.36 mumol/l with range from 0.08 to 2.9 mumol/l; the zinc protoporphyrin values in blood averaged 1.0 and 1.1 microgram/g haemoglobin, respectively. The creatinine clearance was negatively correlated with blood lead as well as zinc protoporphyrin values in men and women both before and after adjustments for age, body mass index and diuretic treatment. A tenfold rise in blood lead concentration was associated with a 10 to 13 ml/min reduction in the creatinine clearance. Serum beta 2-micro-globulin and zinc protopohyrin in both sexes, and serum creatinine and zinc protopohyrin in men were also significantly and positively correlated. Blood pressure was also measured in the Belgian population study. The sample, from which patients on antihypertensive treatment had been excluded, included 827 men and 821 women. Systolic/diastolic pressure averaged 131/77 mm Hg in men, and 124/74 mm Hg in women. After adjustment for significant covariates (age, body mass index, pulse rate, serum creatinine and serum calcium, and in women also contraceptive pill intake and menopause), systolic pressure was negatively correlated with blood lead in man (P < 0.05); the partial correlations with blood lead were not significant for systolic pressure in women, nor for diastolic pressure in both sexes. After excluding men exposed at work, the partial correlations between systolic and diastolic pressure and blood lead were negative (P < 0.05). In neither men nor women, there was a significant relation between blood pressure and the zinc protoporphyrin level in blood. A meta-analysis of 23 human studies included 33141 subjects, recruited from the general population in 13 surveys and from occupational groups in 10 studies. In all but 4 studies the results had been adjusted for age, and most studies also considered additional confounders. The association between blood pressure and blood lead was similar in the 2 sexes. In all 23 studies combined, a twofold increase in the blood lead concentration was associated with a 1.0 mm Hg rise in the systolic pressure (95% confidence interval [CI]: 0.4 to 1.6 mm Hg; P = 0.002) and with a 0.6 mm Hg increase in the diastolic pressure (CI: 0.2 to 1.0 mm Hg; P = 0.02). In conclusion, lead exposure may impair renal function in the population at large. However, the alternative hypothesis that renal impairment may lead to an increase in the blood lead concentration cannot yet be excluded with absolute certainty. On balance, the available evidence suggests that there can only be a weak positive association between blood pressure and lead exposure. The latter relationship, which is barely visible at the horizon of epidemiological observation, may not be causal in nature, and is likely to entail any public health implication in terms of hypertension-related complications.

Adolescent↗
PubMed1995

Factors influencing validation of ambulatory blood pressure measuring devices.

With the introduction of 24 h ambulatory blood pressure monitoring into clinical practice a vast market for ambulatory blood pressure monitoring devices has been created. To satisfy this market manufacturers are producing an array of ambulatory blood pressure monitoring devices. There is no obligation on manufacturers to have such devices validated independently, even though two national protocols, one from the British Hypertension Society (BHS) and the other from the Association for the Advancement of Medical Instrumentation (AAMI), call for independent validation and state the means of doing so. However, many factors can influence the validation procedure. They include compliance to the protocol being employed; the accuracy of the standard; establishing precisely the model being validated; the influences of blood pressure level, age and exercise on device accuracy; the provisions necessary for special populations, such as pregnant women, the elderly and children; the influence of oscillometric versus Korotkoff sound detection and electrocardiographic gating on comparative measurements; the assessment of performance as distinct from accuracy; and the relevance of general factors, such as the algorithm being employed and computer compatibility. Forty-three ambulatory blood pressure monitoring devices have been marketed for ambulatory blood pressure measurement and of those only 18 have been validated according to either the BHS or the AAMI protocol. The influence of the factors listed above on the validation studies of those devices will be considered and the relevance of validation procedures to the clinical use of ambulatory blood pressure monitoring devices will be discussed.

Association↗
PubMed1994

Prognostic significance of peak exercise capacity in patients with coronary artery disease.

OBJECTIVES: The aim of this study was to investigate the prognostic significance of peak oxygen uptake in patients with coronary artery disease who had an exercise test that could be sustained to exhaustion without limiting symptoms. BACKGROUND: Many studies have reported an inverse association between the level of exercise reached during a stress test and mortality or cardiovascular morbidity. These studies have used submaximal or symptom-limited exercise testing in patients with a recent myocardial infarction. METHODS: Peak oxygen uptake was measured in male patients > or = 4 weeks after myocardial infarction (312 patients) or coronary artery surgery (215 patients) by use of a graded uninterrupted exercise test performed to exhaustion. Apart from peak oxygen uptake, several risk factors for cardiovascular disease, patient and exercise characteristics and drug treatment were considered in the Cox proportional hazards model. RESULTS: During the total follow-up period of 3,213 patient-years, 53 patients died. Of these 53 patients, 33 died of cardiovascular causes. All-cause and cardiovascular mortality decreased with increasing peak oxygen uptake, even after adjustment for significant covariates. The relative hazard rates of 0.43 and 0.29 indicate that a hypothetic increase in peak oxygen uptake by 1 liter/min could be associated with decreases in all-cause and cardiovascular mortality of 57% and 71%, respectively. CONCLUSIONS: Exercise capacity is an independent predictor for subsequent all-cause and cardiovascular mortality in patients able to perform an exercise test until exhaustion.

Coronary Artery Bypass↗
PubMed1994

Effect of age on the hemodynamic response to posture in nonelderly hypertensive patients.

The objective of this study was to assess the effects of age on the hemodynamic response to a change in posture in essential hypertension. Invasive hemodynamic measurements were performed in the supine and sitting position in 110 men, aged 16 to 64 years, in whom cardiovascular complications were virtually excluded. The change of systolic and diastolic intraarterial pressure, from 153/83 mm Hg after 30 min of supine rest to 156 (P < .05)/92 (P < .001) mm Hg after sitting for 10 min, was not significantly (P > .10) related to age. Heart rate (+9 beats/min) and systemic vascular resistance (+4.6 mm Hg/L/min) increased (P < .001) on sitting; cardiac output (-1.7 L/min), stroke volume (-31 mL), and pulmonary capillary wedge pressure (-2.1 mm Hg) fell (P < .001). Whereas the postural changes of heart rate (P < .01), cardiac output (P < .001), stroke volume (P < .001), and wedge pressure (P = .06) were less pronounced in older than in younger patients, the increase of systemic vascular resistance was not related to age (P > .10). The slopes of the postural changes of heart rate and of systemic vascular resistance differed significantly (P = .01). The results were not confounded by the level of blood pressure or weight. In conclusion, the smaller postural falls of cardiac output, stroke volume, and wedge pressure in older patients suggest less thoracic blood volume displacement to the lower parts of the body, possibly resulting from a lesser peripheral venous distensibility. The increase of heart rate in response to the upright posture is less pronounced at older age, whereas the reflex control of the peripheral vasculature is preserved and blood pressure maintained.

Adolescent↗
PubMed1994

Why is antihypertensive drug therapy needed in elderly patients with systolodiastolic hypertension?

OBJECTIVE: This paper presents a meta-analysis of eight outcome trials of antihypertensive drug treatment in elderly hypertensive patients, and uses the results of these trials to discuss day-to-day issues in the treatment of elderly hypertensive patients. META-ANALYSIS: In an intention-to-treat analysis, cardiovascular mortality was decreased on average by 22% (95% confidence interval -32% to -10%). This decrease was a result of reductions in both coronary and cerebrovascular mortality, by 26% (-40% to -9%) and 33% (-50% to -9%), respectively. So far, the effectiveness of antihypertensive therapy in reducing cardiovascular mortality has not been established with confidence in trials where the diastolic blood pressure at random allocation to treatment groups was below 95 mmHg or in patients above 75 years of age. IMPLICATIONS FOR DAY-TO-DAY PRACTICE: No blood pressure treatment goal has been definitively established but a reduction in systolic blood pressure to about 150 mmHg may be optimal. Extrapolation of trial results to the elderly population with systolodiastolic hypertension at large seems acceptable for a Western population, but may be premature for elderly Asians and Africans. beta-Blockers and especially diuretics are recommended as first-line drugs in elderly patients with symptomless, uncomplicated hypertension, since the effectiveness of other drugs in reducing morbidity and mortality has not yet been established. Recommendations for the treatment of symptomless patients with isolated systolic hypertension may be premature. Ongoing trials on systolic hypertension in Europe (Syst-Eur) and China (Syst-China) may provide further information.

Aged↗
PubMed1994

Efficacy and safety of pravastatin in hypertensive hypercholesterolaemic patients on antihypertensive drug therapy.

This double-blind, placebo-controlled, six month trial evaluated the efficacy and safety of pravastatin in hypercholesterolaemic, hypertensive patients on antihypertensive treatment, who on a standard lipid-lowering diet maintained a plasma total cholesterol level of at least 250 mg%. Fifty hypertensive patients were randomised to placebo or pravastatin treatment. Once daily dosing consisted of 10 mg pravastatin during the first month, 20 mg during the second month and 40 mg during an additional 4 months or matching placebos. Compared with placebo, pravastatin reduced (P < 0.001) the plasma level of total cholesterol, LDL-cholesterol and phospholipids during the six month study period whereas plasma HDL-cholesterol and triglycerides did not change significantly. These changes in plasma lipids were independent of age and of the nature of the concomitant antihypertensive treatment. No serious side-effects were observed and pravastatin was generally well tolerated. In conclusion, pravastatin 10-40 mg once daily reduced plasma total and LDL-cholesterol in hypercholesterolaemic, hypertensive patients, independent of age and concurrent antihypertensive drug therapy.

Adolescent↗
PubMed1994

Number of measurements required for the analysis of diurnal blood pressure profile.

The aim of this study was to investigate how frequent blood pressure (BP) readings need to be obtained to reproduce the diurnal BP profile without loss or distortion of information. The subjects were 97 normotensives aged 23-84 years. Noninvasive ambulatory BP readings were programmed with an interval of 7.5 minutes during the day (from 8 am to 8 pm) and at 15 minutes intervals at night. Readings were stepwise omitted from the original recordings. For each step the diurnal BP profile was modelled with five different techniques. The concordance between original and reduced recordings was quantified using the repeatability coefficient, i.e. twice the standard deviation of the differences between these recordings (expressed as a percentage of the 5th to 95th percentile range of the parameter under investigation). The concordance between original and reduced recordings tended to be better for the level of pressure than for the parameters of the diurnal profile. If the sampling frequency was two readings per hour, concordance for SBP was < 10% for the BP level, 19% for the 24h standard deviation, 12% for the nocturnal fall in BP, 23% for the amplitude of the Fourier curve and 17% for the cusum derived circadian alteration magnitude. Concordance worsened to > 25% for most parameters of the diurnal BP curve when the interval between consecutive measurements exceeded 30 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗