Biomedical subjects

Per Omvik

Publications and source records attributed to Per Omvik.

26 records · Page 2Linked to original sources

PubMed2003

The Norwegian office-, home-, and ambulatory blood pressure study (NOHA).

OBJECTIVES: To evaluate the use of ambulatory blood pressure monitoring in comparison with home and office blood pressure in every-day general practice. METHODS: In a multicenter survey sixty-two practitioners previously unfamiliar with ambulatory blood pressure monitoring performed a total of 1162 (mean 18 +/- 16; range 3-94) 24-h ambulatory- and home blood pressure measurements in normotensive subjects or patients with untreated or treated hypertension. RESULTS: In subjects with office blood pressure <140/90 mmHg average 24-h ambulatory blood pressure (Tenso 24 monitors) was 126/79 mmHg, home blood pressure (Tenso Plus semiautomatic sphygmomanometers) was 128/ 84 mmHg, and office blood pressure (standard sphygmomanometer) was 130/82 mmHg. Patients with office blood pressure > or = 140/90 mmHg had 24-h ambulatory blood pressure averaging 141/88 mmHg, home blood pressure 149/93 mmHg, and office blood pressure 157/95 mmHg. The difference between office-, home-, and ambulatory blood pressure increased with age. Expected differences were found between the three blood pressure modalities according to indication of examination (borderline -, "white-coat" -, and therapy refractory hypertension). Indices of hypertension related end-organ damage were positively correlated with home and ambulatory blood pressure but not with office blood pressure. Overall the performance of home- and ambulatory blood pressure in this general practice setting was similar to that seen by specialized blood pressure units. CONCLUSION: This study demonstrates the practical utility of home- and ambulatory blood pressure measurement in every-day general practice. Both methods are easy to introduce and the quality of blood pressure data obtained in every-day general practice are comparable to those obtained in hypertension clinics and trial centers.

Adult↗

PubMed2002

Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) substudy.

CONTEXT: Drug intervention in placebo-controlled trials has been beneficial in isolated systolic hypertension. OBJECTIVE: To test the hypothesis that losartan improves outcome better than atenolol in patients with isolated systolic hypertension and electrocardiographically documented left ventricular hypertrophy (ECG-LVH). DESIGN: Double-blind, randomized, parallel-group study conducted in 1995-2001. SETTING AND PARTICIPANTS: A total of 1326 men and women aged 55 through 80 years (mean, 70 years) with systolic blood pressure of 160 to 200 mm Hg and diastolic blood pressure of less than 90 mm Hg (mean, 174/83 mm Hg) and ECG-LVH, recruited from 945 outpatient settings in the Nordic countries, the United Kingdom, and the United States. INTERVENTIONS: Patients were randomly assigned to receive once-daily losartan (n = 660) or atenolol (n = 666) with hydrochlorothiazide as the second agent in both arms, for a mean of 4.7 years. MAIN OUTCOME MEASURE: Composite end point of cardiovascular death, stroke, or myocardial infarction. RESULTS: Blood pressure was reduced by 28/9 and 28/9 mm Hg in the losartan and atenolol arms. The main outcome was reduced by 25% with losartan compared with atenolol, 25.1 vs 35.4 events per 1000 patient-years (relative risk [RR], 0.75; 95% confidence interval [CI], 0.56-1.01; P =.06, adjusted for risk and degree of ECG-LVH; unadjusted RR, 0.71; 95% CI, 0.53-0.95; P =.02). Patients receiving losartan had reductions in the following without a difference in the incidence of myocardial infarction: cardiovascular mortality (8.7 vs 16.9 events per 1000 patient-years; RR, 0.54; 95% CI, 0.34-0.87; P =.01), nonfatal and fatal stroke (10.6 vs 18.9 events per 1000 patient-years; RR, 0.60; 95% CI, 0.38-0.92; P =.02), new-onset diabetes (12.6 vs 20.1 events per 1000 patient-years; RR, 0.62; 95% CI, 0.40-0.97; P =.04), and total mortality (21.2 vs 30.2 events per 1000 patient-years; RR, 0.72; 95% CI, 0.53-1.00; P =.046). Losartan decreased ECG-LVH more than atenolol (P<.001) and was better tolerated. CONCLUSION: These data suggest that losartan is superior to atenolol for treatment of patients with isolated systolic hypertension and ECG-LVH.

Aged↗

PubMed2002

Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.

BACKGROUND: Blood pressure reduction achieved with beta-blockers and diuretics is the best recorded intervention to date for prevention of cardiovascular morbidity and death in patients with hypertension. Left ventricular hypertrophy (LVH) is a strong independent indicator of risk of cardiovascular morbidity and death. We aimed to establish whether selective blocking of angiotensin II improves LVH beyond reducing blood pressure and, consequently, reduces cardiovascular morbidity and death. METHODS: We did a double-masked, randomised, parallel-group trial in 9193 participants aged 55-80 years with essential hypertension (sitting blood pressure 160-200/95-115 mm Hg) and LVH ascertained by electrocardiography (ECG). We assigned participants once daily losartan-based or atenolol-based antihypertensive treatment for at least 4 years and until 1040 patients had a primary cardiovascular event (death, myocardial infarction, or stroke). We used Cox regression analysis to compare regimens. FINDINGS: Blood pressure fell by 30.2/16.6 (SD 18.5/10.1) and 29.1/16.8 mm Hg (19.2/10.1) in the losartan and atenolol groups, respectively. The primary composite endpoint occurred in 508 losartan (23.8 per 1000 patient-years) and 588 atenolol patients (27.9 per 1000 patient-years; relative risk 0.87, 95% CI 0.77-0.98, p=0.021). 204 losartan and 234 atenolol patients died from cardiovascular disease (0.89, 0.73-1.07, p=0.206); 232 and 309, respectively, had fatal or non-fatal stroke (0.75, 0.63-0.89, p=0.001); and myocardial infarction (non-fatal and fatal) occurred in 198 and 188, respectively (1.07, 0.88-1.31, p=0.491). New-onset diabetes was less frequent with losartan. Interpretation Losartan prevents more cardiovascular morbidity and death than atenolol for a similar reduction in blood pressure and is better tolerated. Losartan seems to confer benefits beyond reduction in blood pressure.

Aged↗

PubMed2002

Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.

BACKGROUND: The most suitable antihypertensive drug to reduce the risk of cardiovascular disease in patients with hypertension and diabetes is unclear. In prespecified analyses, we compared the effects of losartan and atenolol on cardiovascular morbidity and mortality in diabetic patients. METHODS: As part of the LIFE study, in a double-masked, randomised, parallel-group trial, we assigned a group of 1195 patients with diabetes, hypertension, and signs of left-ventricular hypertrophy (LVH) on electrocardiograms losartan-based or atenolol-based treatment. Mean age of patients was 67 years (SD 7) and mean blood pressure 177/96 mm Hg (14/10) after placebo run-in. We followed up patients for at least 4 years (mean 4.7 years [1.1]). We used Cox regression analysis with baseline Framingham risk score and electrocardiogram-LVH as covariates to compare the effects of the drugs on the primary composite endpoint of cardiovascular morbidity and mortality (cardiovascular death, stroke, or myocardial infarction). FINDINGS: Mean blood pressure fell to 146/79 mm Hg (17/11) in losartan patients and 148/79 mm Hg (19/11) in atenolol patients. The primary endpoint occurred in 103 patients assigned losartan (n=586) and 139 assigned atenolol (n=609); relative risk 0.76 (95% CI 0.58-.98), p=0.031. 38 and 61 patients in the losartan and atenolol groups, respectively, died from cardiovascular disease; 0.63 (0.42-0.95), p=0.028. Mortality from all causes was 63 and 104 in losartan and atenolol groups, respectively; 0.61 (0.45-0.84), p=0.002. INTERPRETATION: Losartan was more effective than atenolol in reducing cardiovascular morbidity and mortality as well as mortality from all causes in patients with hypertension, diabetes, and LVH. Losartan seems to have benefits beyond blood pressure reduction.

Aged↗

PubMed2002

Impact of diastolic Doppler indices on exercise capacity in hypertensive patients with electrocardiographic left ventricular hypertrophy (a LIFE substudy).

OBJECTIVE: To assess whether Doppler evidence of impaired early diastolic relaxation during exercise is associated with lesser exercise capacity in hypertensive patients. DESIGN: Single center addition to the echocardiographic substudy in the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. SETTING: University hospital out-patient clinic. METHODS: A total of 60 patients (29 women and 31 men) with essential hypertension and electrocardiographic LV hypertrophy. INTERVENTIONS: Assessment of Doppler echocardiography and ergospirometry during semi-upright bicycling. MAIN OUTCOME MEASURE: Exercise capacity and its relation to diastolic Doppler indices at rest and during exercise. RESULTS: Average resting blood pressure was 181/97 +/- 18/9 mmHg, LV mass/body surface area 127 +/- 26 g/m2, midwall shortening 16 +/- 2%, and isovolumic relaxation time (IVRT) and transmitral early to atrial filling velocity (E/A) ratio 121 ms and 0.80, respectively. Exercise capacity, assessed as peak oxygen uptake and exercise load at exhaustion in all patients, were 20 and 25% higher, respectively, in men than women (both P < 0.01). In multivariate analysis, higher peak exercise load was related to male gender, higher E/A ratio at rest, greater reduction in IVRT during exercise and higher peak exercise heart rate (multiple R2 = 0.59, P < 0.01). Younger age, greater reduction in IVRT during exercise, higher midwall shortening and peak exercise heart rate were associated with higher peak oxygen uptake (multiple R2 = 0.47, P < 0.01). CONCLUSION: Diastolic LV performance significantly influences exercise capacity in hypertensive patients with LV hypertrophy. Impaired exercise capacity is more strongly associated with blunted reduction in IVRT during exercise than with lower E/A ratio at rest.

Aged↗

PubMed2002

Risk of new-onset diabetes in the Losartan Intervention For Endpoint reduction in hypertension study.

BACKGROUND: There has been uncertainty about the risk of new-onset diabetes in hypertensive individuals treated with different blood pressure-decreasing drugs. OBJECTIVES: To study this risk in hypertensive individuals who were at risk of developing diabetes mellitus in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. METHODS: In the LIFE study, with a double-masked, randomized, parallel-group design, 9193 patients (46% men) with hypertension (mean age 67 years, average pressure 174/98 mmHg after placebo run-in) and electrocardiogram-documented left ventricular hypertrophy were randomly assigned to once-daily losartan- or atenolol-based antihypertensive treatment and followed for at least 4 years (mean 4.8 years). At baseline, 7998 patients did not have diabetes mellitus and were thus at risk of developing this condition during the study. To demonstrate ability to predict new-onset diabetes, we developed a prediction score using the significant variables from multivariate analyses (serum glucose, body mass index, serum high-density lipoprotein cholesterol, systolic blood pressure and history of prior use of antihypertensive drugs). RESULTS: There was a steadily increasing risk of diabetes with increasing level-of-risk score; patients in the highest quartile were at considerably greater risk than those in the three lower ones. Treatment with losartan was associated with lower risk of development of diabetes within each of the four quartiles of the risk score. As previously reported, new-onset diabetes mellitus occurred in 242 patients receiving losartan (13.0 per 1000 person-years) and 320 receiving atenolol (17.5 per 1000 person-years); relative risk 0.75 (95% confidence interval 0.63 to 0.88; P<0.001). CONCLUSIONS: New-onset diabetes could be strongly predicted by a newly developed risk score using baseline serum glucose concentration (non-fasting), body mass index, serum high-density lipoprotein cholesterol concentration, systolic blood pressure and history of prior use of antihypertensive drugs. Independently of these risk factors, fewer hypertensive patients with left ventricular hypertrophy developed diabetes mellitus if they were treated with losartan than if they were treated with atenolol.

Aged↗

PubMed2002

Twenty-four-hour ambulatory blood pressure monitoring in atrial fibrillation.

BACKGROUND: Due to large beat-to-beat blood pressure variation the use of 24-h ambulatory blood pressure monitoring in patients with atrial fibrillation has been questioned. METHODS: Repeatability and variability of 24-h ambulatory blood pressure (Accutraccer II or Diasys Integra), and daily blood pressure variation was examined in 42 patients aged 51-81 (median 73.5) years admitted for elective electrocardioversion of atrial fibrillation. RESULTS: Before cardioversion 24-h ambulatory systolic blood pressure was slightly lower and nocturnal blood pressure reduction was larger in the group of patients who achieved sinus rhythm than in the group who maintained atrial fibrillation (11.5/10.5 versus 4.1/4.7 mmHg; P < 0.05). No statistically significant change was observed in ambulatory blood pressure after cardioversion in any of the two groups. Blood pressure variability (SD/mean) was 10-14% both in patients with and without conversion to sinus rhythm. Coefficient of repeatability (2 SD of difference) was 13.6 mmHg (16.6%) for diastolic blood pressure and 30.2 mmHg (24.7%) for systolic blood pressure in patients with normalized heart rhythm and 17.0 and 29.0 mmHg (21.5 and 22.4%) in patients with maintained atrial fibrillation, respectively. CONCLUSION: Ambulatory blood pressure monitoring provides data with similar variability and repeatability in patients with atrial fibrillation as in subjects with normal cardiac rhythm. Twenty-four-hour ambulatory blood pressure measurement is applicable in atrial fibrillation in the same way as during sinus rhythm.

Aged↗

PubMed1994

Equal Efficacy and Improved Tolerability with 50 mg Controlled-Release Metoprolol Compared with 100 mg Conventional Metoprolol in Hypertensive Patients.

The clinical efficacy and tolerability of 50 mg of a new controlled-release formulation of metoprolol (metoprolol CR) was compared with that of a double dose (100 mg) of conventional immediate-release metoprolol tablets in 64 hypertensives in a randomized, double-blind, crossover study. At the end of a 6-week placebo run-in period and after each of two 8-week active treatment periods, 3-min bicycle exercise tests were performed at 25, 1.3, and 5 h after dose intake. Twenty-five hours after dose the mean supine SBP/DBP on metoprolol CR 50 mg was 147/95 mm Hg and on conventional metoprolol 100 mg 148/94 mm Hg, respectively. The percentage of responders (DBP less-than-or-equal 90 mm Hg or reduction in DBP greater-than-or-equal 10 mm Hg) was 45% on both regimens. At 25 h after dose, exercise heart rate was lower on 50 mg metoprolol CR (136 versus 140 beats min(minus sign1); p < 0.001) than on 100 mg conventional metoprolol, whereas the opposite was found at 1.3 h (131 versus 107 beats min(minus sign1); p < 0.001) and at 5 h (131 versus 113 beats min(minus sign1); p < 0.001). In agreement with the more even plasma metoprolol concentration and exercise heart rate, the patients perceived less fatigue during exercise on 50 mg metoprolol CR at 1.3 h after dose, the approximate time of maximum plasma concentration for 100 mg conventional metoprolol. The total number of adverse events recorded on metoprolol CR 50 mg and conventional metoprolol 100 mg were 62 and 103, respectively (p < 0.01). Thus, this study has demonstrated that the new controlled-release formulation of metoprolol has made it possible to halve the dose of metoprolol and yet achieve the same blood pressure control as well as greater beta(1)-blockade at the end of 24-h dosing intervals. Corresponding to lower peak plasma metoprolol concentrations, perceived fatigue and overall tolerability was improved on metoprolol CR 50 mg compared to conventional metoprolol 100 mg.

Journal Article↗