Biomedical subjects

D Elmfeldt

Publications and source records attributed to D Elmfeldt.

At least 55 records · Page 3Linked to original sources

PubMed1987

Felodipine in hypertension--a review.

Felodipine lowers blood pressure by reducing peripheral vascular resistance through a highly selective action on smooth muscle in arteriolar resistance vessels. The selective action may be considered a safeguard against untoward effects on cardiac contractility and conduction. Felodipine does not cause orthostatic hypotension since it has no effect in clinical doses on venous smooth muscle. Felodipine has a natriuretic/diuretic effect, which counteracts the salt and water retention that is often seen during treatment with other potent vasodilators. In clinical studies, felodipine has proved more effective than several established antihypertensive drugs. The combination of felodipine and a beta-adrenergic blocker appears to be a good alternative to standard triple treatment, and felodipine is often effective in patients with previously "refractory" hypertension. The antihypertensive effect of felodipine is dose related. In patients with moderate hypertension, a dose regimen of 5 mg twice a day is usually sufficient, and doses greater than 10 mg twice a day are not often required. Felodipine is generally well tolerated. The most common adverse effects are those expected from a potent arteriolar dilator: ankle swelling, headache, dizziness, flushing, etc. Adverse effects are usually transient or diminish in intensity with continued treatment. The overall frequency of adverse effects with felodipine appears to be similar to that for the established antihypertensive drugs, although the adverse effects differ. Felodipine is a potent arteriolar dilator with therapeutic advantages, especially for patients with moderate to severe hypertension.

Blood Pressure↗

PubMed1986

Treatment of essential hypertension with felodipine in combination with a diuretic.

In a double-blind cross-over study, the effect on blood pressure (BP), heart rate (HR) and plasma noradrenaline concentration (pNA) of placebo or felodipine given in addition to hydrochlorothiazide was studied in 12 male patients with essential hypertension, not satisfactorily controlled with the diuretic alone. The first dose of felodipine decreased BP and increased HR for about 6 h. After 4 weeks of treatment with felodipine, BP was reduced for 24 h, whereas HR was only transiently increased. The elimination half-life of felodipine was about 23 h. The plasma noradrenaline concentration increased after felodipine and serum uric acid decreased. Side-effects were few and usually mild.

Blood Pressure↗

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

The multifactor primary prevention trial in Göteborg, Sweden.

The effect of a multifactorial intervention programme on coronary heart disease (CHD), stroke incidence and total mortality was determined in a random sample of men, 47-55 years old at entry. The intervention group comprised 10 004 men, and the two control groups were of similar size. The intervention consisted of antihypertensive treatment in subjects with screening blood pressure above 175 mmHg systolic or 115 mmHg diastolic, dietary advice to men with serum cholesterol levels above 260 mg per 100 ml (= 6.8 mMol l-1), advice to stop smoking to subjects who smoked more than 15 cigarettes per day. The intervention was applied for 10 years during which time CHD and stroke incidence and mortality were followed by means of special registers. Participation rate at first screening examination was 75%. The risk factor levels, i.e. blood pressure, serum cholesterol and smoking decreased markedly during 10 years in the intervention group, but also among the control groups. Total mortality, stroke and CHD incidence did not differ significantly between the intervention group and any of the two control groups. We conclude that a decrease has taken place in all three major risk factors for CHD in the general male population in Göteborg, Sweden. Strategies other than intervention on high-risk individuals must be chosen if a major impact on disease incidence is to be achieved in the general population.

Aged↗

PubMed1986

The Multifactor Primary Prevention Trial in Göteborg, Sweden. Comparison with a previously untreated population sample.

All male inhabitants of the city of Göteborg, who were born between 1915-1922 and 1924-1925 were included in the trial, and were 47 to 55 years of age on entry to the study in 1970 to 1973. One-third of these men were randomly allocated to an intervention group, whilst the other two-thirds acted as controls. Men of all social classes, employed as well as unemployed, health conscious as well as careless, were invited, with 75% of these responding to the invitation. The intervention group contained 10,000 men and the control group 20,000 men. The intervention group were given advice on diet, both individually and in groups, the type of advice depending upon serum cholesterol level. Smokers were advised to stop smoking, and men with elevated blood pressure were treated with antihypertensive drugs. Due to the large size of the groups and because they formed a random population sample, it was assumed that they had similar characteristics at the start of the trial. Risk factors were only measured in the intervention group at this time, followed by intervention. This design feature solved several ethical problems with regard to no treatment in the control group. These men were, however, subjected to health examinations and treatment as well as general health advice. Risk factor levels were measured in the intervention group, and also in random subsamples (11%) of the control group after 4 and 10 years. Serum cholesterol, blood pressure and smoking decreased among men in both groups, and only slightly more in the intervention group.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrovascular Disorders↗

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

Antihypertensive effects of felodipine compared with placebo.

The effects of felodipine and placebo on blood pressure, heart rate and tolerability were investigated in 4 different groups of patients. One group had not received previous therapy, whereas the other 3 groups received concomitant antihypertensive compounds (beta-blockers, diuretics or beta-blocker + diuretics). The haemodynamic effects and tolerability were studied after a single dose, as well as during steady-state conditions. After a single dose of felodipine there was a rapid and significant decrease in blood pressure and increase in heart rate with felodipine alone as well as with combination therapy. During long term treatment, blood pressure was significantly decreased after felodipine during the dosing interval (12h), irrespective of concomitant treatment. Heart rate, however, was not increased, even in patients without a beta-blocker. The reduction in blood pressure was correlated with the plasma concentration of felodipine after single-dose administration, but not during long term treatment. Felodipine was generally well tolerated. In the short term, headache was the most common side effect, while swelling of the ankles was the most frequent adverse effect during long term treatment. In conclusion, felodipine is a promising antihypertensive compound, which may be used in the treatment of high blood pressure, either alone or in combination with other agents.

Adrenergic beta-Antagonists↗

PubMed1985

Long term experience of felodipine in combination with beta-blockade and diuretics in refractory hypertension.

Felodipine, a new dihydropyridine, was given to 58 hypertensive patients in combination with an adrenergic beta-receptor antagonist and a diuretic agent. In all but 2 patients the blood pressure was unsatisfactorily controlled on standard triple therapy, i.e. alpha beta-blocker, a diuretic and a vasodilator. A 48-week follow-up was completed by 54 patients. After an initial dose titration period, the maintenance dose of felodipine was 5 mg twice daily in 14 patients and 10 mg twice daily in 34 patients. In the remaining 6 patients, the dose ranged from 5 mg every morning to 25 mg twice daily. The dosages of beta-blocking agent and diuretic were considerably reduced during the study period. Mean supine blood pressure was reduced from 170/101 mm Hg on triple therapy before felodipine to 145/86 mm Hg (p less than 0.001) after 2 weeks on felodipine. This improvement was sustained throughout the study and was measured at 144/86 mm Hg (p less than 0.001) after 48 weeks. There was no increase in resting heart rate and no orthostatic fall in blood pressure. Bodyweight was not increased and felodipine was generally well tolerated. Three patients were withdrawn owing to side effects and 1 was socially non-compliant. It is concluded that felodipine is a potent and well tolerated vasodilator, and will be useful in the long term combination treatment of previously refractory hypertension.

Adrenergic beta-Antagonists↗

PubMed1985

Acute diuretic/natriuretic properties of felodipine in man.

The natriuretic/diuretic effect of felodipine was investigated in 2 studies. The first was performed as an open study using intravenous and oral felodipine in healthy male subjects. The second was a double-blind study where a high and a low dose of oral felodipine were given to hypertensive patients on long term treatment with beta-blockers; the different doses of felodipine were chosen to decrease and to have no effect on the blood pressure, respectively. In both studies an oral placebo solution was used as a reference. Felodipine caused a significant increase in natriuresis. Compared with placebo and corrected for total 24-hour excretion, the sodium output during the first 4 hours after drug administration was increased by 219 +/- 53% (mean +/- SEM) after intravenous administration in healthy subjects (p less than 0.01) and by 80 +/- 43% in the first 3 hours after the high dose in hypertensive patients (p less than 0.05). For the same period, the urine excretion was increased by 114 +/- 38% (p less than 0.05) in the healthy subjects and by 36 +/- 22% in the hypertensive patients (not significant). However, the 24-hour excretion of urine, Na+ and K+ was not significantly changed from placebo. A significantly lower blood pressure was recorded after the higher dose (0.10 mg/kg) when given to hypertensive patients, but no such effect was seen after the lower dose (0.01 mg/kg) or in healthy subjects. The changes in diastolic blood pressure seem to be negatively correlated with the diuretic but not with the natriuretic effect.

Adult↗

PubMed1984

Göteborg Metoprolol Trial: mortality and causes of death.

During the 3-month blind treatment period there were 40 deaths in the metoprolol group compared with 62 deaths in the placebo group (p = 0.024). During the first year (after 3 months the 2 groups were treated similarly) there were 64 deaths in the metoprolol group vs 93 in the placebo group (p = 0.017) and during 2 years 92 patients died in the metoprolol group vs 120 in the placebo group (p = 0.043). The relative incidence of different causes of death did not differ significantly between the 2 treatment groups, indicating that metoprolol reduced all causes of death to the same extent as its effect on overall mortality.

Aged↗

PubMed1984

Short-term effects of felodipine, a new dihydropyridine, in hypertension.

Felodipine, a dihydropyridine, is a new vasodilating calcium antagonist which lowers blood pressure (BP) by selective action on vascular smooth muscle, especially in the resistance vessels. The effects on BP, heart rate (HR) and tolerance of different single oral doses of felodipine were studied in two series of hypertensive patients. When felodipine was given as single drug to 14 previously untreated hypertensives in a single-blind manner, BP was rapidly reduced by about 15% while HR increased by 25%. Felodipine given in a double-blind manner to eight patients on chronic beta-adrenoceptor blockade reduced BP by some 15-20% compared to placebo, while HR did not change. There was a significant correlation between the pre-treatment mean arterial BP (MAP) and the maximal relative change in MAP, i.e. the higher the initial BP the greater the reduction after felodipine. A significant correlation was also found between the plasma concentration of felodipine and the relative change in MAP. Felodipine was generally well tolerated. When given alone felodipine caused the side effects expected from a pure vasodilator, i.e. headache, flushing and palpitations. When given together with a beta-adrenoceptor blocker, the side effects were much less apparent.

Adult↗

PubMed1984

Intraerythrocyte sodium content and transmembrane sodium flux in hypertensive patients treated with diuretics or beta-adrenoceptorblockers.

Forty-seven male patients with essential hypertension were randomized to treatment with either a beta-adrenoceptorblocker (metoprolol), (n = 24), or a diuretic (hydrochlorothiazide), (n = 23). If their diastolic blood pressure was not lowered below 95 mm Hg by the maximum dose of either drug, hydralazine (15 patients) and in a few cases (6 patients) spironolactone was given. After five years of treatment all the patients were examined with respect to intraerythrocyte sodium (IeNa) and potassium (IeK), sodium influx and sodium efflux. Patients treated with the diuretic (D) tended to have a higher IeNa (9.8 +/- 0.4 mmol/l red cells) and sodium influx (0.044 +/- 0.002 mmol Na/l X min) compared with those taking the beta-adrenoceptorblocker (B) (8.9 +/- 0.3 mmol/l and 0.041 +/- 0.002 mmol Na/l X min), but neither of these differences was statistically significant. Sodium efflux, however, was significantly increased in D (0.073 +/- 0.003 mmol Na/l X min vs 0.061 +/- 0.003 mmol/l X min). No difference in IeK was noted between the two groups. Six patients taking spironolactone had a low IeNa (7.3 +/- 0.4 mmol/l), sodium influx (0.039 +/- 0.001 mmol Na/l X min) and sodium efflux (0.050 +/- 0.006 mmol Na/l X min).

Adrenergic beta-Antagonists↗

PubMed1984

Emotional reaction, health preoccupation and sexual activity two months after a myocardial infarction.

Emotional reaction, health preoccupation and sexual adjustment two months after a first myocardial infarction (MI) were studied in relation to social, psychological and somatic factors prior to, during and after the MI in 201 consecutive male patients. Psychological and social data were covered by means of questionnaires and a brief interview and somatic data by a standardized medical examination. New concepts were introduced after factor analysis. The degree of preoccupation varied very much and was considered as a reaction to the diagnosis of MI. Seventy-nine percent of the patients complained about fatigue and 65% felt anxious and depressed. Fatigue and nervousness were regarded by the patients as more disabling than cardiac symptoms. Emotional distress was related to a previous history of emotional complaints and to psychological factors and self-reported coronary symptoms but was unrelated to severity of the infarction, medically rated cardiac symptoms, demographic and social data. Sexual maladjustment, mainly due to fear, was frequent and associated with both emotional and somatic variables. Emotional disturbance after MI is considerable and further measures ought to be taken in order to prevent future disability.

Adult↗

PubMed1983

Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction.

In a double-blind randomized trial, 1,395 patients with suspected acute myocardial infarction (MI) were investigated to evaluate the possibility of limiting indirect signs of the size and severity of acute MI with the beta 1-selective adrenoceptor antagonist metoprolol. Metoprolol (15 mg) was given intravenously and followed by oral administration for 3 months (200 mg daily). Placebo was given in the same way. The size of the MI was estimated by heat-stable lactate dehydrogenase (LD[EC 1.1.1.27]) analyses and precordial electrocardiographic mapping. Lower maximal enzyme activities compared with placebo were seen in the metoprolol group (11.1 +/- 0.5 mukat X liter-1) when the patient was treated within 12 hours of the onset of pain (13.3 +/- 0.6 mukat X liter-1; n = 936; p = 0.009). When treatment was started later than 12 hours, no difference was found between the 2 groups. Enzyme analyses were performed in all but 20 patients (n = 1,375). Precordial mapping with 24 chest electrodes was performed in patients with anterior wall MI. The final total R-wave amplitude was higher and the final total Q-wave amplitude lower in the metoprolol group than in the placebo group. Patients treated with metoprolol less than or equal to 12 hours also showed a decreased need for furosemide, a shortened hospital stay, and a significantly reduced 1-year mortality compared with the placebo group, whereas no difference was observed among patients treated later on. After 3 months, however, there was a similar reduction in mortality among patients in whom therapy was started less than or equal to 12 hours and greater than 12 hours after the onset of pain. The results support the hypothesis that intravenous metoprolol followed by oral treatment early in the course of suspected myocardial infarction can limit infarct size and improve long-term prognosis.

Aged↗

PubMed1983

Felodipine--a new vasodilator, in addition to beta-receptor blockade in hypertension.

In a double-blind, cross-over trial, 10 men with primary hypertension, not adequately controlled with a beta-blocker alone, were also given felodipine or placebo for periods of one week. Placebo was administered single-blind for 2 weeks and 1 week, respectively, before randomization and between treatments. The dose of felodipine ranged from 6.25 mg to 25 mg. The addition of felodipine resulted in a pronounced (20%), statistically significant reduction in blood pressure (BP) and a small but significant increase in heart rate (HR). The effects were seen within 1-2 h and were maximal after 3-4 h. During steady state treatment the duration of BP reduction was at least 12 h. No orthostatic reaction was seen. There was a significant correlation between the plasma concentration of felodipine and change in BP. The most frequently reported side-effects were headache and ankle oedema, the latter probably being due to pronounced pre-capillary vasodilatation. There was no weight increase and thus no indication of general water retention. No clinically significant change in laboratory variables and no influence on the P-Q time were seen. Thus, felodipine in combination with a beta-blocker seems to be a useful addition to the treatment of hypertensive patients whose BP is not adequately controlled with a beta-blocker alone.

Adrenergic beta-Antagonists↗

PubMed1983

Incidence and importance of metabolic side-effects during antihypertensive therapy.

Three long-term, randomised trials examining antihypertensive treatment with either diuretics or beta-blockers are in progress. On the basis of these, the following conclusions may be drawn regarding metabolic side-effects. Diuretics decrease whereas beta-blockers increase serum potassium. Neither drug has any obvious influence on total body potassium. Serum urate increases on both drugs but more so in those taking diuretics. Serum triglycerides increase while total serum cholesterol is unchanged in both treatments. It is still a matter of controversy whether there is a decrease in glucose tolerance and an increase in the incidence of diabetes in patients on diuretics. The possible negative influence of metabolic side-effects on morbidity and mortality may limit the beneficial effects of blood pressure reduction, especially in patients with low pressures before treatment. Thus, it seems crucial to minimise theses side-effects. Since they are dose-related for both diuretics and beta-blockers, the use of low doses and, if needed, combination treatment is preferable.

Adrenergic beta-Antagonists↗

PubMed1983

Cause of death in relation to social and alcoholic problems among Swedish men aged 35-44 years.

There have been conflicting reports concerning the relationship between increased alcohol intake and mortality from ischaemic heart disease. In this investigation, social register data also containing life-long registration data for alcoholic intemperance were related to cause of death for 302 men aged 35-44 in 1968-74. A random population sample of 940 male survivors of the same age was used for comparison. "Social problems only" were less common for the deceased, irrespective of cause of death, than for the controls. Registration for alcoholic problems was significantly more common for ischaemic heart disease, accidents, suicide and "other deaths" but not for cancer. The variables "detained by the police for drunkenness" and "in prison for crime" showed similar associations. Possible explanations are discussed, especially the association between alcoholic intemperance and death from ischaemic heart disease. The most probable mechanism is effects on the myocardial cell enzyme functions with following arrhythmias in subjects susceptible to malignant arrhythmias due to coronary artery disease and myocardial ischaemia.

Accidents↗

PubMed1983

Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide.

The effects of metoprolol, propranolol and hydrochlorothiazide on lipoprotein metabolism were studied in three different but comparable groups of middle-aged men with previously untreated hypertension (n=10, n=10, and n=11, respectively). All three treatments were associated with an increase in serum triglyceride and VLDL-cholesterol levels. Propranolol treatment was associated with consistent and significant decreases in HDL-cholesterol, apoA-I and A-II levels, whereas these changes during the other treatments were neither significant nor consistent. An increase in adipose tissue LPL-activity and a decrease in serum free fatty acids were seen in the propranolol treatment group. Significant changes were not observed in glucose tolerance or catecholamine excretion. The blood pressure reduction was similar in the three groups. The design of the present study was in some important respects different from that of others. This may help to explain why we found a difference between the two beta-blockers in our study.

Adipose Tissue↗