PubMed Health⌕ Search

Biomedical subjects

J Wikstrand

Publications and source records attributed to J Wikstrand.

At least 127 records · Page 7Linked to original sources
PubMed1988

Renal function before and after withdrawal of long term antihypertensive treatment in primary hypertension.

Glomerular filtration rate (GFR) and renal plasma flow (inulin and para-aminohippurate clearance) were measured in a random sample of 17 normotensive and 20 untreated patients with primary hypertension. At the 7-year follow-up, 19 patients were on metoprolol (as the sole drug or in combination with either hydrochlorothiazide or hydralazine) and 1 patient was on hydrochlorothiazide. They were re-examined after withdrawal of treatment and return of hypertension. At the 7-year follow-up GFR was more reduced in the hypertensive (-17%) than in the normotensive group (-9%). The percentage decrease in renal blood flow was the same in both groups. No significant renal function changes appeared after withdrawal of treatment. In conclusion, there was a slightly greater deterioration in GFR in the hypertensive patients after long term treatment with metoprolol than can be explained by normal ageing.

Antihypertensive Agents↗
PubMed1987

Antihypertensive treatment in elderly hypertensives: implications of the MEHP study.

Present evidence from several secondary and primary preventive trials indicates that if antihypertensive treatment is initiated with a beta-blocker, a better preventive effect on total mortality, cardiovascular mortality, and atherosclerotic complications can be expected than if diuretics are used as initial therapy. Results from a recent large-scale multicenter international study (MEHP) have shown that a regimen initiating antihypertensive treatment with 100 mg metoprolol once daily is effective, safe, and well-tolerated in elderly hypertensive patients. This might be of particular importance since a steep increase in cardiovascular mortality and other atherosclerotic complications is seen with age.

Aged↗
PubMed1987

The relationship between obesity-related metabolic factors and vascular changes in early hypertension.

The relationships of obesity, glucose metabolism and hormonal variables to mean arterial pressure (MAP) regional vascular resistance and signs of structural vascular changes, were determined in 70 men aged 49 years with normal to mildly elevated MAP randomly selected from a population sample. Regional vascular resistances and signs of structural vascular changes were measured in the calf by plethysmography at rest and during maximal dilatation, and in the kidneys by renal blood flow determination during graded subpressor doses of angiotensin II. MAP was positively correlated to body fat, waist circumference, fat cell size, and to blood glucose 60 minutes after an oral load. This supports an association between central obesity, impairment of glucose tolerance and hypertension. MAP was, however, unrelated to sodium intake, blood volume and indices of sympathetic nervous activity and the renin-angiotensin system. Resting vascular resistance in the calf was unrelated to MAP, while renal vascular resistance rose significantly with increasing MAP. Signs of structural change were significantly correlated to MAP in both these vascular areas. These signs were also associated with central obesity of the hypertrophic type and with impairment of glucose tolerance, even when the association to MAP was accounted for. These factors may be involved in the pathogenesis of the structural adaptation of resistance vessels as hypertension develops.

Blood Glucose↗
PubMed1986

Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60 to 75 years. Report from a double-blind international multicenter study.

In a randomized double-blind study (N = 562), a traditional treatment schedule, starting antihypertensive treatment in elderly hypertensive patients (60 to 75 years old) with 25 mg of hydrochlorothiazide once daily and doubling the dose if a satisfactory response was not achieved, was compared with antihypertensive treatment of 100 mg of metoprolol once daily, adding 12.5 mg of hydrochlorothiazide for patients whose response was not satisfactorialy achieved with metoprolol alone. Systolic and diastolic blood pressure was significantly reduced with both regimens. The frequency rates of responders (diastolic blood pressure, less than or equal to 95 mm Hg) in the metoprolol group and the hydrochlorothiazide group were 50% and 47% after four weeks and 65% and 61% after eight weeks, respectively. There were no significant differences in total symptom score or single symptoms between the regimens, but significantly more patients had hypokalemia and hyperuricemia with the hydrochlorothiazide regimen. Thus, we conclude that beginning antihypertensive treatment with 100 mg of metoprolol once daily and adding a small dose of hydrochlorothiazide (12.5 mg) in patients whose response is not satisfactory with metoprolol alone appears to be effective and safe in elderly hypertensive patients.

Aged↗
PubMed1986

QRS-amplitudes during antihypertensive treatment: a comparison between beta-blocker and thiazide diuretic regimens.

QRS-amplitudes and other ECG variables have been studied in 168 middle-aged men with uncomplicated, mild-to-moderate untreated primary hypertension. They were randomized to treatment with either the beta-adrenoceptor blocker metoprolol (n = 88) or the thiazide diuretic hydrochlorothiazide (n = 80). Significant reductions in combined precordial voltages (S1 + R5-6, S2 + R4, Smax + Rmax) were achieved on both regimens, probably reflecting a regression of hypertensive cardiac involvement. In the group treated with beta-blockers the reduction in all three combined voltage measurements was significant after one year's treatment. A longer period of treatment seemed to be necessary to achieve equal reductions with hydrochlorothiazide although a non-significant reduction was observed after the first year of follow-up in this group. A small increase in 1st degree AV-block was observed on both regimens, but no 2nd degree or total AV-block was recorded.

Adult↗
PubMed1986

Left ventricular function before and after kidney transplantation. A prospective study in patients with juvenile-onset diabetes mellitus.

The aim of the present investigation was to discover whether disturbed left ventricular (LV) function limits renal replacement therapy in patients with juvenile onset diabetes mellitus. Seventeen patients given functioning kidney grafts were studied non-invasively (M-mode echocardiography, apexcardiography, phonocardiography) before renal transplant and an average of six, 13 and 44 months after transplant. The main pretransplant findings were pronounced LV hypertrophy with impaired diastolic LV function (prolonged relaxation time + signs of decreased LV distensibility) and a hyperdynamic circulation. Most of these abnormalities were significantly less severe after successful kidney transplantation. LV mass decreased by 37% 44 months after transplant (p less than 0.01) and LV diastolic and systolic volumes decreased with a subsequent increase in ejection fraction from 0.65 to 0.78 (p less than 0.01). The LV distensibility and filling pattern improved significantly while the prolonged relaxation time was unchanged. These findings imply that pretransplant disturbances in LV function are related more to factors such as hypertension, volume overload and uraemia than to diabetes per se because no pronounced improvement in the metabolic disorder resulting from diabetes can be expected, even after the most successful transplant. Disturbed LV function should not, therefore, exclude uraemic diabetics from renal replacement.

Adult↗
PubMed1985

Predictors of cardiovascular morbidity in treated hypertension: results from the primary preventive trial in Göteborg, Sweden.

Prognostic factors for cardiovascular disease (CVD) were studied in treated, middle-aged male hypertensives, derived from a random population sample and followed for more than 10 years. In multivariate analysis diastolic blood pressure, smoking, serum cholesterol, proteinuria, angina pectoris and previous stroke were found to be independent predictors of CVD morbidity (non-fatal myocardial infarction (MI), non-fatal stroke, or CVD death). Multivariate analyses for coronary heart disease (CHD), stroke and CVD mortality were also performed and the results are given. Life-table analyses showed a three times higher CVD incidence among smokers than amongst non-smokers and a doubled incidence for subjects with a serum cholesterol in the highest quartile, i.e. above 7.3 mmol/l, compared with those with levels below, and a three times higher incidence for subjects with proteinuria than those without. Non-smokers with a serum cholesterol below 7.3 mmol/l and free of any hypertensive organ manifestation at entry did not differ significantly in CVD morbidity from a normotensive comparison group that was derived from the same population sample. These findings in a well-defined population sample show that in spite of treatment for hypertension the CVD risk is still substantial if organ damage or other risk factors are present. These findings underline the importance of multiple risk intervention.

Angina Pectoris↗
PubMed1985

Haemodynamics in young normotensive men with familial predisposition to hypertension. Studies on normal and increased salt intake.

Central and peripheral haemodynamics were studied noninvasively (echocardiography, plethysmography) in normotensive young men (mean age 30 years) with (n = 17) (H), and without (n = 15) (C) a positive history of hypertension during normal salt intake and after four weeks of ordinary diet plus 12 g NaCl daily. No changes in blood pressure were noted during the course of the study in either group. After three days of high salt an increased cardiac output and decreased total peripheral resistance was seen in H but not in C. The former might be due to a salt induced volume load occurring in a less distensible venous system. The difference in response disappeared during the course of the study. Both on normal and high salt intake resting resistance and resting vascular tone were significantly higher in H reflecting an increased contractile state of the smooth muscles of the resistance vessels. The increased smooth muscle tone of the resistance vessels and the less distensible venous system in these young men with family history of hypertension might be a genetically determined basis for a future increase in blood pressure.

Adolescent↗
PubMed1984

Blood pressure, intraerythrocyte content, and transmembrane fluxes of sodium during normal and high salt intake in subjects with and without a family history of hypertension: evidence against a sodium transport inhibitor.

Seventeen young normotensive men with a family history of hypertension in two generations (H) and 15 age-matched control subjects (C) were studied with respect to blood pressure (BP), intraerythrocyte sodium content (IeNa), sodium influx, and rate of sodium efflux. The investigations were done during normal salt intake and after 4 weeks of ordinary intake plus 12 g NaCl daily. BP did not increase significantly in either of the two groups during increased salt intake. During normal salt intake H had a significantly (p less than 0.01) higher IeNa (9.5 +/- 1.5 mmol/L) compared with C (8.2 +/- 1.4 mmol/L). During high salt intake IeNa in H decreased significantly to 8.1 +/- 1.2 mmol/L, the difference from C (7.6 +/- 1.2 mmol/L) not being significant. While the Na influx was similar in the two groups, the rate constant for Na efflux was significantly lower during normal salt intake in H (0.23 +/- 0.08 vs 0.29 +/- 0.1 h-1, p less than 0.05). Salt intake increased the efflux rate constant significantly in H (0.28 +/- 0.08 h-1, p less than 0.05), while it did not change significantly in C (0.32 +/- 0.08 h-1) compared with the value for normal salt intake. Our results suggest that young men with a hereditary predisposition to hypertension have a higher IeNa secondary to a lower rate of Na efflux, while a normal Na influx indicates normal cell permeability to Na. The findings in H during high Na intake--a decreased IeNa and an increased efflux rate of Na--do not favor the existence of a sodium transport inhibitor, in subjects predisposed to hypertension, increasing during high salt intake and volume expansion and acting through inhibition of the Na efflux.

Biological Transport, Active↗
PubMed1984

Sodium elimination rate and blood pressure during normal and high salt intake in subjects with and without familial predisposition to hypertension.

We have assessed the elimination rate of 22Na (ER-22Na), total exchangeable sodium (NaE), blood pressure, plasma volume (PV), haematocrit, urinary noradrenaline (U-NA) and urinary 3-methoxy-4-hydroxymandelic acid (U-VMA) in normotensive men with (n = 17) and without (n = 15) familial predisposition to hypertension. All measurements were done during habitual salt intake and after four weeks of increased salt intake (ordinary intake + 12 g NaCl/daily). On ordinary salt intake, ER-22Na, NaE, blood pressure, PV, haematocrit, U-NA and U-VMA did not differ between the groups thus indicating a normal sodium turnover in both groups and a comparable activity of the sympathetic nervous system. After 10 days of high salt intake those without familial predisposition showed signs of volume expansion and decreased sympathetic activity and those with such predisposition showed insignificant changes in the same direction. After four weeks of increased salt intake, ER-22Na had increased significantly and equally in both groups, while blood pressure and NaE remained unchanged. This indicates that the predisposed individuals had a normal ability to cope with a prolonged increase in salt intake.

Adolescent↗
PubMed1984

Acute and subacute haemodynamic effects of enalapril. Non-invasive studies of a new converting enzyme inhibitor for antihypertensive treatment.

After a run-in period on placebo, 15 patients with primary hypertension got antihypertensive treatment with enalapril in single therapy during six weeks. Before and four hours after drug administration simultaneous non-invasive recordings of ECG, phonocardiogram and carotid pulse tracing or apexcardiogram or impedance cardiogram were made. After six weeks' therapy the recordings were repeated 12 hours and four hours after dose intake. The results showed enalapril to be a potent antihypertensive agent with considerable effect already four hours after the first dose intake. The blood pressure reduction was explained by a decrease in total peripheral resistance, semiquantitatively measured with impedance cardiography. Cardiac output was significantly higher during long-term treatment than before therapy started, due to a significant increase in stroke volume. Lef ventricular (LV) diastolic function was not altered but a considerable improvement in LV systolic function was achieved as judged from the systolic time intervals. Open questioning regarding side effects indicated good tolerance.

Aged↗
PubMed1984

Heart and kidney involvement during antihypertensive treatment. Results from the primary preventive trial in Göteborg, Sweden.

The prevalence of signs of heart (Minnesota-coded ECG, chest X-ray) and kidney involvement (proteinuria, abnormal serum creatinine) was studied before and after 5 years' antihypertensive treatment in 686 middle-aged, hypertensive men derived from a screening examination of a random population sample. The prevalences of heart enlargement (X-ray) and abnormally high serum creatinine increased. A pronounced regression of S-T and T wave changes in the ECG was achieved. In a subgroup of 375 patients without digitalis therapy and not having had myocardial infarction, ECG signs of left ventricular hypertrophy decreased.

Antihypertensive Agents↗
PubMed1984

Hemodynamic findings before and after resection of abdominal aortic aneurysm.

A preoperative and postoperative hemodynamic study was performed in 20 consecutive patients undergoing elective resection of abdominal aortic aneurysm. Screening for venous thrombosis and pulmonary embolism with 125I uptake test, measurements of maximal venous emptying and pulmonary perfusion scintigraphy were also done before and after the operation. Only five patients complained of intermittent claudication preoperatively, but the laboratory investigations revealed signs of peripheral arterial insufficiency in 15 cases. Maximal venous emptying from the legs was markedly decreased on the first postoperative day and remained significantly below normal on the sixth day. Signs of postoperative thromboembolism appeared in eight patients. These patients did not differ from the others in regard to the pattern of maximal venous emptying. In the three-year follow-up period, the calf blood flow and the ratio of systolic toe pressure to systemic systolic blood pressure were further decreased, despite significant rise in systemic blood pressure.

Aged↗
PubMed1983

The relation between cardiac hypertrophy and hypertension.

Left ventricular mass determined echocardiographically was related to blood pressure in a stratified random sample (n = 120) of 49-year-old men selected from a blood pressure screening and covering a wide range of blood pressures. Only subjects not on antihypertensive treatment were studied. Left ventricular mass was also related to sympathetic activity, the renin-angiotensin-aldosterone system and glucose metabolism. A poor correlation between left ventricular mass and blood pressure was found in the entire study group. In the upper blood pressure range only blood pressure during isometric exercise was significantly correlated with left ventricular mass. In this range there were significant correlations between left ventricular mass and 24 hour urinary noradrenaline excretion and plasma aldosterone. In the intermediate blood pressure range there was an association between left ventricular mass and blood glucose and plasma insulin. It is concluded that in mild to moderate hypertension other factors probably modify the hypertrophic response to rising arterial pressure.

Aldosterone↗