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Biomedical subjects

L Westlie

Publications and source records attributed to L Westlie.

At least 19 recordsLinked to original sources
PubMed1998

A 5-year comparison of doxazosin and atenolol in patients with mild-to-moderate hypertension: effects on blood pressure, serum lipids, and coronary heart disease risk.

The long-term efficacy and safety of once-daily treatment with doxazosin or atenolol were compared in a 5-year study in patients with mild-to-moderate hypertension. The study consisted of a 1-year, multicenter, double-blind, parallel-group phase, followed by a 4-year, open-label extension phase. Of the 228 patients enrolled, 100 patients (54/111 doxazosin and 46/117 atenolol) completed the 5-year study. Both treatments were similarly efficacious in controlling blood pressure. As assessed by the Framingham risk equation, which incorporates lipid parameter values, patients receiving doxazosin had significantly less chance of developing coronary heart disease (CHD) within 10 years compared with those patients receiving atenolol (p < 0.05). Doxazosin significantly (p=0.0005) reduced the mean CHD risk from baseline to final visit by 12.3%; whereas, atenolol produced essentially no change in mean risk (0.2% increase). In patients receiving doxazosin, statistically significant (p < 0.05) increases from baseline were observed in serum concentrations of high-density lipoprotein (HDL) cholesterol and the HDL/total cholesterol ratio during the first 2 and 3 years of treatment, respectively. In contrast, significant (p < 0.05) percent reductions from baseline in both these lipid parameters were seen in atenolol-treated patients during most of the 5-year trial. Between-group differences were statistically significant (p < 0.01) at all time points. Decreases in total cholesterol were similar between the two treatment groups. Triglycerides, however, significantly increased with atenolol treatment (p < 0.0001 vs baseline) while remaining essentially unchanged with doxazosin treatment. The safety profiles of doxazosin and atenolol were comparable. Thus, while demonstrating similar antihypertensive efficacy and safety during this 5-year study, once-daily treatment with doxazosin produced a significantly greater beneficial effect on both 10-year CHD risk and serum lipid parameters compared with atenolol.

Adolescent↗
PubMed1993

Quality of life in Norwegian kidney donors.

The Norwegian kidney transplant programme is based on more extensive use of living donors than in other countries. Re-examination of the physical health of kidney donors has in the majority of studies revealed no long-term medical risk. The quality of life after donation has only been described in very few studies, and with a small number of donors. This report concerns a cross-sectional study of 494 donors with a mean observation time from donation of 6.7 years. A standardized questionnaire containing 19 items related to quality of life was used. The donors were compared to the general adult population in a county in mid-Norway. Out of the 19 quality of life items, the donors scored significantly better in 13. Donors who had experienced that the corresponding recipient had died have been tested separately. The results in this subgroup were equal to the population, but inferior compared to the rest of the donors. We conclude that the quality of life of Norwegian kidney donors is better than the general population. We will continue our policy of an extensive use of living kidney donors.

Adult↗
PubMed1992

Spectrum of disease in bacteraemic patients during a Streptococcus pyogenes serotype M-1 epidemic in Norway in 1988.

All 87 known cases of bacteraemia due to Streptococcus pyogenes (beta-haemolytic group A streptococci) occurring during the peak of a nationwide outbreak in Norway (population 4.2 million) between January and June 1988 were reviewed. Clinical features varied widely and appeared largely to be dependent on the patients' age. The case fatality rate ranged from 11% in the age group under 30 years to 44% in patients over 60 years. Clinical complications such as shock, severe renal or respiratory failure or serious local infection occurred particularly in 30-to 59-year old individuals. Shock was manifest in 32% of the patients and carried a 68% case fatality rate. Chronic heart disease in the elderly and pneumonia seemed to be associated with a fatal outcome. In the 25 patients (29%) who died the disease showed a fulminant course, 80% dying within 48 hours after admission. However, 56% of the patients had experienced symptoms for more than two days before admission, suggesting that early diagnosis and treatment might possibly have prevented the development of a serious disease. This study revealed a wide spectrum of clinical manifestations in bacteraemia cases in a unique epidemiological situation caused largely by a single serotype of Streptococcus pyogenes; 89% of the 27 preserved bacteraemia strains carried the M-1 antigen. The observations call attention to the ability of these organisms to cause fulminant clinical illness, indicating a probable increase in both invasiveness and toxicity of group A streptococci responsible for the epidemic.

Adolescent↗
PubMed1991

Doxazosin and atenolol as monotherapy in mild and moderate hypertension: a randomized, parallel study with a three-year follow-up.

The efficacy and safety of doxazosin (n = 83) and atenolol (n = 81) have been compared during a 3-year period. Doxazosin (mean dose at 3 years, 5.2 mg/day) and atenolol (mean dose, 66.4 mg/day) produced a sustained and overall similar reduction in blood pressure, with no evidence of tolerance. Doxazosin decreased mean blood pressure from 158/104 mm Hg to 146/90 mm Hg; with atenolol the decrease was from 160/103 mm Hg to 144/88 mm Hg. Whereas the reduction in blood pressure with atenolol was paralleled by a significant (p less than 0.05) decrease in heart rate (from a mean of 74 to 60 beats/min), doxazosin produced no clinically meaningful changes in heart rate. In contrast to atenolol, doxazosin reduced triglyceride levels by -5.9% (atenolol +22.5%), increased high-density lipoprotein cholesterol levels by +3.7% (atenolol, -11.2%), and increased the high-density lipoprotein/total cholesterol ratio by +5.9% (atenolol, -10.3%); all of these values were significantly (p less than 0.001) different from those of atenolol-treated patients. Doxazosin also reduced the calculated low-density lipoprotein cholesterol levels by -3.3% (atenolol, unchanged). The adverse effect of atenolol on lipid levels apparently negated any beneficial effect of blood pressure reduction, because the calculated coronary heart disease (CHD) risk actually increased significantly. In contrast, the reduction in calculated CHD risk in the doxazosin group was statistically significant at all points during the study. The safety profile of the drugs was similar. With the added potential of the reduction in the calculated risk of CHD among hypertensive patients,doxazosin represents an appropriate first-line drug for the treatment of essential hypertension.

Antihypertensive Agents↗
PubMed1990

Long-term effects of doxazosin and atenolol on serum lipids and blood pressure in hypertensive smokers.

On the basis of a 1-year double-blind comparative study of doxazosin and atenolol in hypertensive patients, we have previously described sustained and significantly different drug effects on the blood lipid profile. The present paper presents a retrospective analysis of the smoking subgroups for each drug regimen, for both the original 12-month double-blind period and for a further 12-month open-label period. The changes in blood lipids were qualitatively and quantitatively similar in both the smoking subgroup and in the full study population (smokers and non-smokers). In the hypertensive smokers doxazosin increased high-density lipoprotein (HDL) cholesterol (+9.4%) and decreased triglycerides (-10.9%) whereas atenolol had the opposite effect, decreasing HDL cholesterol (-5.6%) and increasing triglycerides (+20.7%). The antihypertensive effects of doxazosin (n = 24) and atenolol (n = 23) were comparable over 24 months of treatment. Eighteen (75%) doxazosin and 17 (73.9%) atenolol patients reached the blood pressure goal (sitting diastolic blood pressure less than or equal to 90 mmHg with at least a 5-mmHg reduction, or a greater than or equal to 10-mmHg reduction from baseline). As a consequence of the lowered blood pressure and favourable lipid changes, doxazosin decreased the risk of coronary heart disease (as calculated from the Framingham risk equation) by -24.4% (P less than 0.05). However, the calculated risk was not significantly reduced by atenolol (-2.1%). It is concluded that the smoking status of the patient has no obvious implications for the safety, efficacy or metabolic effects of doxazosin.

Adolescent↗
PubMed1990

A long-term study of atenolol and doxazosin in mild and moderate hypertension.

The efficacy and tolerability of doxazosin and atenolol in the management of mild and moderate hypertension were compared in a multicentre, parallel study, the first year of which was randomized and double-blind. Patients who completed this first year were invited to enter a two-year extension phase; the results after the first year are presented. A total of 228 patients entered the double-blind phase (118 received atenolol). A reduction in dose was required by 4% in each group; eight patients on doxazosin and 11 on atenolol were withdrawn due to adverse effects. Ninety-three of the 100 doxazosin patients and 88 of the 104 atenolol patients who completed the double-blind phase agreed to participate in the open extension study. At 24 months, the mean dose of doxazosin was 5.2 mg/day, and of atenolol 66.7 mg/day. From baseline levels of BP of 158/104 mmHg in the doxazosin group and 161/103 mmHg in the atenolol group, average reductions at 24 months were -16/-14 and -19/-15 mmHg respectively. Neither drug had a significant effect on total cholesterol levels. At all four points of measurement over the two years, doxazosin decreased blood triglyceride levels and increased high density lipoprotein (HDL) cholesterol and the HDL: total cholesterol ratio. Atenolol had the opposite effect on each of these lipid values with the differences between the treatment groups being significant. Doxazosin was well tolerated and was shown to be effective as monotherapy in mild and moderate hypertension. Its effect on blood lipids was potentially favourable, and it should therefore be regarded as an alternative first-line drug in hypertensive patients.

Adolescent↗
PubMed1988

Comparison of the effects of doxazosin and atenolol on blood pressure and blood lipids: a one-year, double-blind study in 228 hypertensive patients.

The efficacy and toleration of doxazosin and atenolol were compared over a 52-week period in a double-blind, multicenter study of 228 patients with mild-to-moderate hypertension. Over the treatment period, both drugs significantly reduced blood pressure, and there were no clinically or statistically significant differences between treatment groups for reductions in standing systolic and diastolic blood pressures or in sitting diastolic blood pressure. However, atenolol treatment caused significantly greater reductions in sitting systolic blood pressure and heart rate. Neither drug significantly affected total serum cholesterol concentrations. Doxazosin treatment lowered serum triglycerides, whereas atenolol treatment produced an increase in serum triglycerides (p less than 0.001, week 30; p less than 0.01, week 50, between treatment groups). Increases in high-density lipoprotein cholesterol and high-density lipoprotein to total cholesterol ratio were obtained with doxazosin treatment, whereas atenolol treatment decreased these lipid fractions (p less than 0.0001, weeks 30 and 50, between treatment groups). Using the Framingham equation, it was calculated that at week 50 the risk of developing coronary heart disease was reduced by 22% for the group taking doxazosin (p less than 0.001 vs baseline) and by 4% (not significant) for patients taking atenolol (p = 0.01, between treatment groups). It is concluded that doxazosin is a well-tolerated and effective antihypertensive drug with a favorable effect on blood lipids. Doxazosin provides an attractive, new alternative first-line drug for the treatment of mild-to-moderate hypertension.

Adolescent↗
PubMed1987

Psychological, social, and somatic prognostic indicators in old patients undergoing long-term dialysis.

We prospectively studied the influence of 29 demographic, social, psychological, and somatic factors on survival of 78 patients over age 70 years receiving long-term dialysis. Three years after the prospective evaluation, 54% of the patients had died. Only four factors, all psychosocial, were prognostically important. The patients who survived rated higher on the Karnofsky scale (85 vs 78 points), gained less weight between dialyses (1.5 vs 1.9 kg), more often underwent home dialysis (44% vs 21%), and less often wished for transplantation (28% vs 57%). In stepwise and multiple regression analysis, home dialysis and Karnofsky scale resulted in best fit. No somatic variable predicted outcome. Thirty-one patients were reinterviewed three years later. At that time, more patients were depressed and had a lower income, fewer wanted a transplant, and five had lost their living companion. There was a decrease in the number of patients who cooked their own meals, spent time outdoors, went to church, or had hobbies. Activity on the Karnofsky scale decreased from 87 to 84 points. The home dialysis patients' perceived health decreased from 3.9 to 3.4 points. Our study shows that psychosocial, but not somatic variables, are prognostically important in survival of older patients undergoing dialysis, and there is a measurable decline in these variables during a three-year follow-up period.

Age Factors↗
PubMed1986

Hemoperfusion/hemodialysis in the treatment of acute theophylline poisoning--description of a fatal case.

Treatment of theophylline overdosage with hemodialysis and/or hemoperfusion is accepted as necessary in the most severe cases. We treated a 63 year-old woman who had an initial theophylline concentration of 1000 micromol/l with resin hemoperfusion (Extracorporeal XAD-4). The theophylline concentration before and after the filter was found to approach each other in a linear pattern, and it was possible to predict the time of saturation of the filter. This happened after 2 hours and the treatment was then changed to hemodialysis and charcoal hemoperfusion in series. This combination was highly efficient in removing theophylline and no saturation occurred during the rest of the treatment. Theophylline clearance fell from 200 ml/min to 28 ml/min in 2 hours using resin hemoperfusion and from 196 ml/min to 177 ml/min using the combination of dialysis and charcoal hemoperfusion. Despite this theoretical successful treatment, the patient died 24 hours later.

Asthma↗
PubMed1984

Mortality, morbidity, and life satisfaction in the very old dialysis patient.

The average age of dialysis patients is rapidly increasing. In our present program, 20-25% of all patients are 70 yrs or older. We performed survival analysis of all 157 patients 70 yrs and above (mean age 75 yrs) and evaluated risk factors associated with dialysis survival using the Cox proportional hazards model. Morbidity, biochemical status, clinical results and life satisfaction were evaluated in a prevalence study of all 53 in-center and 26 home dialysis patients. In the survival analysis, we found improved survival since January 1, 1976, indicating improvement in dialysis technique up until that time. The 1, 3, and 5 yr survival were 78%, 47%, and 22% respectively. Only arteriosclerotic heart disease and year of entry were significant risk factors; advancing age over age 70 and in-center dialysis were only of marginal importance. The home patients had fewer dialysis symptoms than in-center patients. Almost all patients lived at home. Five patients (6%) were in nursing homes. Most patients were very satisfied with their lives, regarded their health as better than other 70 year old persons, spent time outdoors, participated in church activities, had active hobbies, enjoyed life very much, and scored high on the Karnofsky activity scale. We conclude older patients are excellent dialysis candidates and it is wrong not to consider them for dialysis.

Aged↗