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S Ljungman

Publications and source records attributed to S Ljungman.

At least 19 recordsLinked to original sources
PubMed2007

Glomerular filtration rate as measured by serum cystatin C is an important determinant of plasma homocysteine and serum methylmalonic acid in the elderly.

OBJECTIVES: To explore the dependence of glomerular filtration rate (GFR) on plasma total homocysteine (tHcy) and serum methylmalonic acid (MMA), as well as the consequences for the diagnosis of cobalamin and/or folic acid deficiency in an elderly community-dwelling population. DESIGN AND SETTING: Population-based study of 209 community-dwelling subjects, mean age 76 years. INTERVENTIONS: Four months' treatment study with oral vitamin B(12), folic acid and B(6) or placebo. MAIN OUTCOME MEASURES: Determinants of tHcy and MMA: cystatin C as a marker of GFR and serum/plasma concentrations of vitamin B(12) and folate, age and sex. RESULTS: Elevated cystatin C (>1.55 mg L(-1)) was found in 31.3% (men) and 13.0% (women). Elevated tHcy (> or = 16 micromol L(-1)) occurred in 53% and elevated MMA (> or = 0.34 micromol L(-1)) in 11% of all subjects. When GFR was taken into consideration, the proportion of elevated tHcy was reduced to 10% (20/209), whilst the proportion of elevated MMA was unchanged. Cystatin C was correlated with tHcy (r = 0.45, P < 0.001) and with MMA (r =0.28, P < 0.001), independently of vitamin B(12)- and folate status. According to multiple regression, independent predictors for tHcy were plasma folate (15%), cystatin C (11%) and vitamin B(12) (4%), and for MMA, cystatin C (8%) and vitamin B(12) (2%). CONCLUSIONS: The prevalence of elevated tHcy may be overestimated in elderly populations unless GFR is taken into account. Nomograms for evaluation of tHcy and MMA in relation to both cystatin C and serum creatinine are presented.

Aged↗
PubMed2003

Renal function in hypoxaemic chronic obstructive pulmonary disease: effects of long-term oxygen treatment.

UNLABELLED: Impaired renal function is an important cause for the oedema formation, which often occurs in severe chronic obstructive pulmonary disease (COPD). In the present study, the importance of nocturnal hypoxaemia (measured by a nocturnal pulse oximetry) for the renal function was determined in 19 COPD patients, with normal levels of serum creatinine. The effects on kidney function of alleviating the nocturnal hypoxaemia [using 6 months of long-term oxygen treatment (LTOT)], was assessed in 12 patients. Renal function was assessed by determining the clearances of intravenously administered inulin (C(In)) and para-amino-hippurate (C(PAH)) and orally supplemented lithium (C(Li)) and of circulating sodium (C(Na)). The 19 patients had a mean PaO2 of 7.63 +/- 1.08 kPa, a PaCO2 of 5.98 +/- 0.85 kPa, a mean nocturnal oxygen saturation (MnSaO2) of 87.7 +/- 2.8% and an FEV1 in %P of 25.6 +/- 14.6%. C(In) and C(PAH) were 35 and 45% lower than normal, respectively, whereas C(In)/C(PAH)=filtration fraction (FF) was 31% higher than normal. Six months of LTOT in 12 of the patients was not followed by any significant change in renal function in the entire study group. However, low pretreatment MnSaO2 correlated with reductions in post-treatment (FF) (r=0.73, P<0.05). Post-treatment PaCO2 did not change significantly in patients treated with oral diuretics, but increased (P<0.05) in patients without diuretics. C(Na) decreased after LTOT in six patients with an increase in PaCO2>6%, but C(Na) increased in four patients with unchanged or decreased PaCO2 following LTOT. CONCLUSIONS: Renal function (including filtration fraction) is impaired in hypoxaemic COPD. Filtration fraction is decreased following 6 months of LTOT solely in patients with severe pretreatment hypoxaemia and sodium clearance seems to be increased if improved oxygenation is not accompanied by increased PaCO2.

Body Mass Index↗
PubMed2003

Peritoneal leukocyte survival and respiratory burst responses in patients treated with a low glucose degradation and high pH peritoneal dialysis fluid.

The discovery of toxicity related to glucose degradation products (GDP) has initiated the development of new PD fluids with low GDP concentrations and higher, more physiological, pH levels. Cell numbers, differential counts and the respiratory burst responses of peritoneal leukocytes were compared between patients treated with the low GDP, high pH fluid Gambrosol-trio (n=10) and a conventional fluid (n=12). Effluents from over-night dwells were collected and leukocytes were evaluated morphologically and by luminol-amplified chemiluminescence (CL) after stimulation with opsonized zymosan. The frequency of necrosis and early apoptosis was quantified by means of annexin V binding and propidium iodide uptake. The Gambrosol-trio group produced significantly higher (p<5%) macrophage counts and stronger CL responses (p<10%) than did the conventional fluid group. The cell compositions did not differ significantly between the groups. Necrosis was significantly more common among the cells in the conventional fluid group. The occurrence of apoptosis did not differ between the fluids.

Adult↗
PubMed2001

Microproteinuria and long-term prognosis with respect to renal function and survival in normotensive and hypertensive women--a 24-year follow-up of a representative population sample of women in Gothenburg, Sweden.

OBJECTIVE: This study aimed to assess albuminuria and subclinical proteinuria, their association with hypertension and their role as predictors of hypertension, impaired renal function and mortality. MATERIAL AND METHODS: A baseline population study comprising 1462 women in five different age groups in Gothenburg, Sweden, was carried out in 1968-69. Comprehensive clinical examinations and laboratory tests were performed, including blood pressure measurement and an Albustix test. A systematic subsample of women additionally collected a 24 h urine sample for quantitative protein analysis. Values of urinary protein (u-protein) excretion between 80 and 300 mg/24 h were defined as microproteinuria. The results described in this paper are based on a 24-year follow-up. RESULTS: The baseline Albustix test was positive in 6.8% of 1458 women, from whom a urine sample was obtained. Of 741 baseline urine collections for u-protein excretion, 16.9% were in the microproteinuric range (80-300 mg/24 h), 1.1% in the macroproteinuric range (> 300 mg/24 h) and 82.1% in the normoproteinuric range (< 80 mg/24 h). Hypertension was more common in Albustix-positive women than in those with negative Albustix, and hypertension was also more prevalent in women with microproteinuria than in women with normoproteinuria. Neither positive Albustix nor microproteinuria was related to later renal impairment. Hypertension was associated with increased mortality in both Albustix-positive and Albustix-negative women, and in women with both normoproteinuria and microproteinuria at baseline. The mortality ratio during the follow-up period was, however, not significantly influenced by positive Albustix or by microproteinuria at baseline, in either hypertensive or non-hypertensive women. CONCLUSIONS: This study demonstrated that both a positive Albustix test and microproteinuria were associated with hypertension. Hypertension at baseline increased the risk for death during the follow-up period, while neither albuminuria, defined as a positive Albustix test, nor microproteinuria was associated with an impaired long-term prognosis with respect to renal function or survival in this cohort of Swedish middle-aged women during 24 years of follow-up. Microproteinuria in otherwise healthy normotensive or hypertensive women does not appear to impair the long-term prognosis.

Adult↗
PubMed2001

Physical activity, muscle performance and quality of life in patients treated with chronic peritoneal dialysis.

OBJECTIVE: Today's medical treatment of patients with end-stage renal failure has increased their opportunities for an active lifestyle. The aim of this study was to describe the muscle performance, level of physical activity, independence in activities of daily living and quality of life in patients treated with chronic peritoneal dialysis. MATERIAL AND METHODS: The study investigated 33 patients (30-81 years old) treated with chronic peritoneal dialysis. The results were compared with an age-matched healthy reference group. Muscle mass was determined by measuring total body potassium, while maximal grip strength was measured with an electric force transducer. The ability to perform heel-lifts, walking speed and level of physical activity were also assessed, along with the extent to which patients were independent in activities of daily living (ADL) and satisfied with their health. RESULTS: Total body potassium was 97 +/- 11.6% of normal and correlated positively with the maximal grip strength (r = 0.658, p < 0.0002) and the maximal walking speed (r = 0.558, p < 0.0027). Maximal grip strength was 70% of the reference, the ability to perform heel-lifts was 49% of the reference, the walking speed was 85% the reference and the level of physical activity was 56% of expected. The patients were independent in ADL to a great extent and 52% of the patients were satisfied with their health. CONCLUSION: The peritoneal dialysis patients had a relatively good quality of life and were largely independent in ADL Further studies are needed to investigate whether it is possible to improve muscle performance and the level of physical activity with exercise and muscle training in these patients.

Activities of Daily Living↗
PubMed1999

[A 100-year perspective on renal function and hypertension. Anti-renin therapy has made hypertensive renal failure a rarity].

One hundred years ago, in 1898, Professor Robert Tigerstedt, Karolinska institutet, Sweden, discovered renin. The subsequent elaboration in 1960 of the renin-angiotensin-aldosterone system signalled the start of modern hypertension research. The kidney takes part in blood pressure regulation in a number of ways. Indications are that increased renovascular resistance due to increased renin-angiotensin activity is of importance for the barostatic function of the kidneys and for the pathogenesis of human hypertension. Several commonly used, efficacious and well tolerated antihypertensive agents act by blocking the renin-angiotensin system, thus normalising kidney function. A number of current large-scale trials--utilising ACE inhibitors and angiotensin receptor antagonists--will, it is hoped, elucidate the proper role of 'anti-renin therapy' in the treatment of hypertension. Thanks to effective modern management of hypertension, renal failure due to hypertensive kidney disease is rare in Sweden today.

Acute Kidney Injury↗
PubMed1999

Apolipoprotein B-containing lipoproteins in renal failure: the relation to mode of dialysis.

BACKGROUND: The aim of this study was to establish whether there is a differential effect of mode of dialysis, hemodialysis (HD), or continuous ambulatory peritoneal dialysis (CAPD) on the dyslipidemia of renal failure. METHODS: The lipoprotein profile was determined in 61 non-diabetic patients on chronic HD (N = 30) and CAPD treatment (N = 31), and in a control group of 27 healthy subjects. The analysis included the measurement of individual apolipoprotein (apo) A- and apo B-containing lipoproteins (LPs) separated by sequential immunoaffinity chromatography. Apo A-containing lipoproteins include lipoprotein A-I with apo A-I and lipoprotein A-I:A-II with apo A-I and apo A-II as the main protein constituents, whereas apo B-containing lipoproteins comprise simple cholesterol-rich lipoprotein B (LP-B), with apo B as the only protein moiety and complex triglyceride (TG)-rich lipoprotein B complex (LP-Bc) particles with apo B, apo A-II, apo C, and/or apo E as the protein constituents. RESULTS: CAPD patients had significantly higher concentrations of total cholesterol (6.8 vs. 5.1 mmol/liter), low-density lipoprotein (LDL) cholesterol (4.6 vs. 3.2 mmol/liter), TG (2.3 vs. 1.5 mmol/liter), apo B (155.3 vs. 105.7 mg/dl), LP-B (136.0 vs. 91.9 mg/dl), and LP-Bc (19.3 vs. 13.8 mg/dl) than HD patients. Both HD and CAPD patients had significantly higher TG, VLDL cholesterol, apo C-III, and apo E and significantly lower high-density lipoprotein cholesterol, apo A-II, and lipoprotein A-I:A-II levels than control subjects. The distribution of apo C-III in high-density lipoprotein and VLDL-LDL was altered in CAPD patients in comparison with control subjects. This suggests that the removal of TG-rich lipoproteins is less efficient in patients on CAPD. Normotriglyceridemic (NTG; TG < or = 1.7 mmol/liter, 150 mg/dl) CAPD patients had significantly higher levels of TC, LDL cholesterol, apo B, and LP-B than NTG-HD patients. There was little difference in the LP-Bc levels between NTG-CAPD, NTG-HD, and controls. Similarly, hypertriglyceridemic (HTG) CAPD patients had significantly higher TC, LDL cholesterol, apo B, and LP-B levels than HTG-HD patients. The LP-Bc levels were significantly increased in HTG-HD and HTG-CAPD patients compared with controls, but the slightly higher levels in the CAPD patients did not differ significantly from the HD group. CONCLUSION: CAPD and HD patients have a lipoprotein profile characteristic of renal failure. Patients on long-term CAPD have higher levels of cholesterol-rich apo B-containing lipoproteins unrelated to TG levels. Many patients on CAPD also have a substantial elevation of the plasma concentrations of TG-rich LPs. The clinical significance of increased levels of potentially atherogenic LP-B during CAPD remains to be investigated.

Adult↗
PubMed1998

The impact of birth weight and gestational age on blood pressure in adult life: a population-based study of 49-year-old men.

The impact of birth weight and gestational age on blood pressure in adult life was studied in a population of 49-year-old men born in 1926-27 who took part in a screening investigation of blood pressure performed in 1975-76 in Göteborg, Sweden. Birth records were traced in 430 subjects and compared with screening records. The adult systolic blood pressure (SBP) was not correlated with birth weight but was inversely correlated with gestational age in the whole study group (r = -0.10, P = .04; n = 430). The correlation between adult blood pressure and gestational age was stronger in preterm subjects, ie, those with a gestational age less than 38 weeks (for SBP, r = -0.46, P = .001 and for diastolic blood pressure [DBP], r = -0.44, P = .01; n = 44), and these correlations were independent of birth weight. There was, however, no correlation between adult blood pressure and gestational age in subjects born at term (between 38 and 41 complete weeks of gestation) or postterm (more than 42 weeks of gestation). The inverse correlation between adult SBP and gestational age was stronger in low-birth-weight subjects (< or = 2500 g; r = -0.86, P < .001; n = 14). After adjustment for birth weight, in this group an increase by 1 week of gestation was associated with a decrease in adult SBP of 7.2 mm Hg (95% CI, 10.1-4.2). In the whole study group, a positive correlation was found between adult blood pressure and adult body mass index (BMI) (r = 0.30, P < .001 for SBP and r = 0.33, P < .001 for DBP). In preterm subjects, however, no such correlation was found, but in subjects born at term or postterm, adult blood pressure was significantly correlated with BMI (for SBP at term, r = 0.34, P < .001 and postterm, r = 0.47, P < .001 and for DBP at term, r = 0.36, P < .001 and postterm, r = 0.30, P < .05). This study indicates that adult blood pressure appears to be related to different variables in different ranges of gestation. In preterm subjects, gestational age appears to have a great impact on adult blood pressure. In subjects born at term or later, however, adult blood pressure was not associated with factors related to birth, but only to the adult BMI.

Birth Weight↗
PubMed1998

Does treated primary hypertension lead to end-stage renal disease? A 20-year follow-up of the Primary Prevention Study in Göteborg, Sweden.

BACKGROUND: Hypertension is reported to be one of the most common causes of end-stage renal disease (ESRD) in Europe and in the United States. However, the frequency with which treated primary hypertension leads to renal failure is not known. The majority of patients with ESRD have hypertension. Whether this is the cause or the consequence of the impaired renal function is often not possible to establish. METHODS: To determine if treated primary hypertension can lead to ESRD, we studied the development of serum creatinine levels in 686 white hypertensive men, recruited from a random third of the male population aged 47-55 years living in Göteborg, Sweden (n=9998; 7495 participants). At entry and during 20 years follow-up, all signs of kidney disease, secondary hypertension, or increase in blood pressure were investigated. Records of patients with a serum creatinine value > or = 130 micromol/l at any time during the observation period were thoroughly studied to ascertain the cause of the impaired renal function. RESULTS: A serum creatinine level above 130 micromol was seen in 8.9% (61/686) of the treated hypertensives during the 20 years of follow-up. An underlying renal disorder was found in 7.2% (49/686) of the patients; renoparenchymal disease (2.2%), renovascular disease (1.5%), diabetic nephropathy (1.2%) or a urological disease (1.6%). Only 1.7% (12/686) of the hypertensives showed a moderate progressive increase in serum creatinine of unknown cause. The serum creatinine in this group was 133+/-8 micromol/l (mean+/-SD; range 124-144) after 15 years and 139+/-7 micromol/l (range 132-151) after 20 years. Thus, none of these patients aged 66-71 years had developed ESRD or a clinically important reduction in renal function. CONCLUSION: The main finding in this population-based study of white middle-aged men with primary nonmalignant hypertension was that long-term antihypertensive treatment was not associated with development of end-stage renal disease or even an abnormal progressive decline in kidney function.

Antihypertensive Agents↗
PubMed1997

Usefulness of microalbuminuria in predicting cardiovascular mortality in treated hypertensive men with and without diabetes mellitus. Risk Factor Intervention Study Group.

In the present study we report on the predictive power of microalbuminuria for total and cardiovascular mortality in a prospective study (mean follow up 6.3 years) of treated hypertensive men, aged 50 to 72 years, with (n = 94) and without (n = 345) maturity onset diabetes mellitus. Thirty-three (35.1%) of the hypertensive patients with diabetes mellitus died during the follow-up period compared with 57 patients (16.5%) in the hypertensive group without diabetes mellitus (p <0.0002). In those with diabetes mellitus and hypertension, a log-rank test revealed a lower cardiovascular mortality in the normoalbuminuric group compared with both the microalbuminuric (p = 0.035) and the macroalbuminuric group (p = 0.002). The logarithm of urinary albumin excretion was a predictor of both total (p = 0.009) and cardiovascular (p = 0.001) mortality during the follow-up period using Cox regression analysis. This relation remained significant even after adjustment for other risk factors. HbA1c was also an independent predictor of total and cardiovascular mortality. In patients without diabetes mellitus, the small group of patients with macroalbuminuria had a markedly increased cardiovascular mortality compared with both the microalbuminuric (p <0.0001) and the normoalbuminuric groups (p <0.0001). No difference was observed between the normoalbuminuric and the microalbuminuric groups. Smoking at entry and concomitant cardiovascular disease at entry were independent predictors of cardiovascular mortality in these patients. We conclude that microalbuminuria was an independent predictor for cardiovascular mortality in treated hypertensive men with maturity onset diabetes mellitus. Macroalbuminuria, but not microalbuminuria, predicted cardiovascular mortality in nondiabetic treated hypertensive men.

Aged↗
PubMed1996

Urinary albumin excretion--a predictor of risk of cardiovascular disease. A prospective 10-year follow-up of middle-aged nondiabetic normal and hypertensive men.

To study how the risk of cardiovascular disease changes with increasing levels of urinary albumin excretion (UAE), we prospectively studied a random sample of 120 49-year-old men with a wide range of blood pressures. Based on diastolic blood pressure (DBP), the subjects were divided into normotensives (DBP < 90 mm Hg; n = 21), borderline hypertensives (DBP 90 to 94 mm Hg; n = 30), mild hypertensives (DBP 95 to 104 mm Hg; n = 45) and moderate to severe hypertensives (DBP > 105 mm Hg; n = 24). None had been previously treated for hypertension or had secondary hypertension, diabetes mellitus, or other cardiovascular diseases at baseline. Heart and kidney function and metabolic and hormonal variables were with beta-blockade, diuretics, or hydralazine. The cardiovascular morbidity during 10 years of follow-up was studied. The hypertensives were treated with beta-blockade, diuretics, or hydralazine. The cardiovascular morbidity during 10 years of follow-up was studied. The 19 subjects who developed cardiovascular disease had significantly higher baseline UAE than the group that did not (median value 16.6 mg/24 h; range 3.5 to 73, and 9.7 mg/24 h, range 0 to 308, respectively). UAE correlated to systolic blood pressure (P = .0115) and DBP (P = .031), but not to smoking behavior or serum cholesterol. The risk of cardiovascular disease was associated with UAE and smoking independently of blood pressure (P = .001 and P = .015, respectively), and the risk increased continuously with increasing UAE. The initial UAE thus emerged as an efficient and independent predictor of cardiovascular disease in middle-aged hypertensive and normotensive men. UAE appeared to be a stronger predictor than blood pressure and serum cholesterol.

Albuminuria↗
PubMed1996

Effect of 14 years of antihypertensive treatment on renal function and urinary albumin excretion in primary hypertension.

The effects on blood pressure (BP), renal function, and urinary albumin excretion (UAE) of 14 years of antihypertensive treatment were studied and compared to the changes seen with normal aging. The studied groups included randomly selected men with newly diagnosed primary hypertension at baseline (n = 23) and normotensive (NT) men of the same age (n = 11). The hypertensives (HT) were treated with beta-blockers either as monotherapy or combined with diuretics or hydralazine. Glomerular filtration rate (GFR; inulin clearance), renal blood flow (RBF, para-aminohippurate clearance), renal vascular resistance (RVR), and 24-h UAE were determined. The two groups were investigated at baseline (before treatment) and after 7 and 14 years. At baseline, BP and RVR were significantly increased and RBF was significantly decreased in the HT over that in the NT. The BP in the HT was significantly reduced after 7 years of treatment and a further but nonsignificant reduction to 139 +/- 14/88 +/- 6 mm Hg (mean +/- SD) was seen after 14 years. GFR in the HT was significantly reduced from 103 +/- 15 mL/min to 84 +/- 19 mL/min (mean +/- SD) after 7 years, but no further reduction was seen after 14 years. During the 14 years RBF decreased and RVR increased in the HT but these changes were of the same magnitude as in the NT. The UAE did not change significantly during the study. In conclusion, good blood pressure control with conventional antihypertensive treatment in mild to moderate primary hypertension seems to protect the kidney from progressive decline in GFR and increase in UAE. The increase in RVR and the decrease in RBF seen during 14 years of antihypertensive treatment was of the same magnitude as that seen with normal aging.

Adrenergic beta-Antagonists↗
PubMed1995

Effects of intensified blood-pressure reduction on renal function and albumin excretion in primary hypertension. Addition of felodipine or ramipril to long-term treatment with beta-blockade.

The effect of intensified blood pressure (BP) control with a reduction of the diastolic BP to < or = 85 mm Hg on renal function and urinary albumin excretion (UAE) was studied in 28 men with primary hypertension (aged 62 to 72 years) treated for 13 +/- 5 years with beta-blockade, diuretics, or hydralazine. They were compared with 25 normotensive (NT) men of similar age. At baseline (BL), glomerular filtration rate (GFR), renal plasma flow (RPF) (clearance of inulin and para-aminohippurate), and the UAE were studied. Thereafter, all antihypertensive drugs except beta-blockers were withdrawn and either felodipine (5 to 20 mg; n = 13) or ramipril (2.5 to 10 mg; n = 15) was added in a double blind, randomized fashion. Hydrochlorothiazide was added if necessary. The investigations were repeated after 6 weeks and 1 year of double-blind treatment. At BL, the BP and the renal vascular resistance (RVR) were significantly higher and GFR and RPF were significantly lower in both hypertensive groups than in NT. After 1 year, the BP treatment goal was reached by all patients in the felodipine group but only by two-thirds in the ramipril group in spite of addition of diuretics to 60% of the latter group. In the felodipine group, the BP, GFR, and RVR after 1 year no longer differed significantly from normal. The UAE and the fractional albumin clearance increased significantly after 1 year's treatment in the felodipine group but did not change in the ramipril group. The fractional albumin clearance, however, did not differ significantly from normal either at BL or after 1 year's treatment in any of the hypertensive groups. It is therefore possible to reduce BP and improve renal function in primary hypertension to levels not significantly different from normal after treatment with felodipine in combination with beta-blockade. Although this regimen increased the low UAE slightly, the fractional albumin clearance changed less and did not differ significantly from normal. The ramipril/beta-blocker combination reduced BP less and did not change the slightly reduced renal function or the UAE.

Adrenergic beta-Antagonists↗
PubMed1995

Does microalbuminuria predict cardiovascular events in nondiabetic men with treated hypertension? Risk Factor Intervention Study Group.

The aim of this study was to investigate the predictive value of microalbuminuria (overnight urinary albumin excretion rate 17 to 100 mg/12 h) as a risk factor for future major cardiovascular events in nondiabetic patients with treated hypertension in a prospective study with follow-up time of 3.3 years. Overnight urinary albumin excretion was measured in 345 nondiabetic treated hypertensive men, aged 50 to 72 years, either with a serum cholesterol of > or = 6.5 mmol/L or smokers, or both. Cardiovascular morbidity was closely recorded during the follow-up period. At entry, microalbuminuria was found in 84 patients (24.3%) and 12 patients had macroalbuminuria (3.5%). During the follow-up period there were no differences in new cardiovascular events between patients with microalbuminuria and those with normoalbuminuria. However, an increase in the risk of future major cardiovascular events occurred in patients with urinary albumin excretion above 100 mg/12 h (macroalbuminuria). In a Cox regression analysis urinary albumin excretion was not associated with the incidence of future major cardiovascular events unless a more detailed approach was used, showing that this was the case for urinary albumin excretion above 100 mg/12 h (macroalbuminuria). Calculations with an alternative definition of microalbuminuria and mortality as end-point did not change the principal result. In conclusion, microalbuminuria does not seem to be a predictor of future mortality and cardiovascular morbidity in nondiabetic men with treated hypertension and at high risk of coronary heart disease. However, macroalbuminuria was associated with future major cardiovascular events in this group of patients.

Aged↗
PubMed1995

Microalbuminuria, insulin sensitivity and haemostatic factors in non-diabetic treated hypertensive men. Risk Factor Intervention Study Group.

OBJECTIVE: To examine whether microalbuminuria in non-diabetic, treated hypertensive men is associated with insulin resistance and measures of endothelial function, thrombogenesis and fibrinolysis. DESIGN: Cross-sectional study. SETTING: Outpatient clinic in city hospital. PATIENTS: Ninety-two treated hypertensive men, aged 57-77 years, either with a serum cholesterol of > or = 6.5 mmol L-1 or smokers, or both. Patients with diabetes mellitus or overnight urinary albumin excretion of > 100 mg 12 h-1 were excluded. MAIN OUTCOME MEASURES: Overnight urinary albumin excretion, insulin-mediated glucose disposal (hyperinsulinaemic euglycaemic clamp), blood glucose and plasma insulin during oral glucose tolerance test, fibrinogen, von Willebrand factor and plasminogen activator inhibitor activity. RESULTS: Microalbuminuric patients had increased blood glucose concentrations during the oral glucose tolerance test and higher plasma fibrinogen levels compared with the normoalbuminuric patients. In a randomly selected subgroup (n = 36), insulin-mediated glucose disposal was lower in microalbuminuric than in normoalbuminuric patients, and an inverse relationship between insulin sensitivity and albuminuria (r = -0.37; P = 0.028) was found. This relationship was not significant after adjustment for body-mass index (P = 0.098). In the univariate analyses including all patients, albuminuria was associated with blood glucose, serum creatinine, body-mass index, systolic blood pressure, fibrinogen, von Willebrand factor and cholesterol (negatively). In a multiple regression analysis, only the body-mass index was independently related to urinary albumin excretion. CONCLUSIONS: Microalbuminuria was associated with insulin resistance but obesity was a confounding factor. Relationships between microalbuminuria and fibrinogen as well as von Willebrand factor were found, but only in univariate analysis.

Aged↗
PubMed1995

Urinary albumin excretion is associated with the intima-media thickness of the carotid artery in hypertensive males with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To examine the relationship between urinary albumin excretion and ultrasonographically assessed morphology of the common carotid artery in hypertensive men with and without non-insulin-dependent diabetes mellitus. DESIGN: Cross-sectional study. SETTING: An outpatient clinic in a city hospital. PATIENTS: Hypertensive male patients (n = 25) with non-insulin-dependent diabetes mellitus and non-diabetic hypertensive male patients (n = 94) aged 50-72 years, randomly selected from a larger study group. MAIN OUTCOME MEASURES: Overnight urinary albumin excretion and B-mode ultrasound examinations of the carotid artery. RESULTS: Among the diabetic patients the logarithm of the overnight urinary albumin excretion was independently and significantly associated with the common carotid artery intima-media thickness, which was also true after adjustment for concomitant cardiovascular disease. In the non-diabetic group there was no association between intima-media thickness and urinary albumin excretion. No relationship between the occurrence of plaque and urinary albumin excretion was observed in any of the study groups. The results were reproducible at a re-examination after 3 years using the same methods. CONCLUSION: Among the hypertensive men with non-insulin-dependent diabetes mellitus, an independent and significant relationship, reproducible after 3 years, was found between urinary albumin excretion and the intima-media thickness of the common carotid artery. No such relationship was found in the group of non-diabetic hypertensive males.

Aged↗
PubMed1993

Effects of long-term antihypertensive treatment and aging on renal function and albumin excretion in primary hypertension.

The effects on renal function and urinary albumin excretion of 7 years of antihypertensive treatment compared to the effects of normal aging were studied in a random sample of 40 men with newly diagnosed primary hypertension and in 17 normotensive men of the same age, respectively. The hypertensives were treated with metoprolol either as monotherapy (n = 21) or combined with hydrochlorothiazide or hydralazine. Glomerular filtration rate (GFR; inulin clearance), renal blood flow (RBF; para-aminohippurate clearance), renal vascular resistance (RVR), and the 24 h urinary albumin excretion were determined. GFR was significantly reduced from 104 +/- 15 mL/min (mean +/- SD) to 86 +/- 20 mL/min (P < .001) in the hypertensive group, but the reduction was not significantly greater than in the normotensive group. As judged from the study of a subgroup of the hypertensives, most of the decrease in GFR occurred early as an immediate drug-induced, functionally explained decrease. The changes in RBF and RVR after 7 years of treatment did not differ significantly from those due to normal aging. RVR remained higher and RBF remained lower in the hypertensives than in the normotensives. The urinary albumin excretion in the hypertensives was significantly reduced after 7 years but remained higher than in the normotensives. In conclusion, the changes in renal function and hemodynamics seen after long-term treatment with metoprolol in primary hypertension were not significantly different from the changes caused by normal aging in normotensives.

Aging↗
PubMed1993

Microalbuminuria in treated hypertensive men at high risk of coronary disease. The Risk Factor Intervention Study Group.

OBJECTIVE: To examine whether microalbuminuria is a marker of cardiovascular disease in treated hypertensive men without diabetes mellitus at high coronary risk and to examine the associations between microalbuminuria and recognized cardiovascular risk factors. DESIGN: Cross-sectional study. SETTING: Outpatient clinic in city hospital. PATIENTS: Three hundred and thirty-three treated hypertensive men, aged 50-72 years, either with a serum cholesterol of > or = 6.5 mmol/l or smokers, or both. The patients were recruited mainly from a population-based sample of hypertensive men. Patients with diabetes mellitus or overnight urinary albumin excretion of > 100 mg/12 h were excluded from the analyses. MAIN OUTCOME MEASURES: Overnight urinary albumin excretion, prevalence of microalbuminuria (defined as 17-100 mg/12 h) and organ damage (cardiovascular events or major electrocardiogram changes, or both), various well-established risk factor levels, blood glucose and plasma insulin responses to an oral glucose tolerance test. RESULTS: Microalbuminuria was found in 25% of the cohort. Among microalbuminuric patients, organ damage was significantly more common (47.6%) than in the normoalbuminuric group (30.9%). However, the sensitivity and specificity of microalbuminuria as a marker of organ damage were only 34 and 80%, respectively. Microalbuminuria was significantly related to body mass index and waist:hip ratio, age and plasma insulin during oral glucose tolerance testing. These relationships also persisted after adjustment for treatment with thiazides or beta-blockers. CONCLUSIONS: In treated hypertensive men without diabetes mellitus, microalbuminuria was associated with factors known to be related to insulin resistance. It had a low sensitivity as a marker of concomitant cardiovascular disease.

Aged↗