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Biomedical subjects

E Thaulow

Publications and source records attributed to E Thaulow.

At least 73 records · Page 4Linked to original sources
PubMed1994

Prognostic implications of asymptomatic cardiac ischemia.

The Oslo Ischemia Study was initiated between 1972 and 1975 in 2,014 men (age, 40-59 years), with the aim of detecting previously unknown and unsuspected coronary heart disease. Of the men who were eligible, 86% participated and were apparently free from cardiovascular disorders. Following a positive symptom-limiting bicycle test, 109 of the men underwent diagnostic coronary angiography and 105 were evaluable; the angiograms were normal in 36 and pathologic in 69. Nineteen of the men with pathologic angiograms had mild angina on the exercise test, while 50 (72%; 2.5% of total study population) remained completely asymptomatic. During a mean follow up of 15 years, 14 of the 50 completely asymptomatic men died (12 suddenly, 1 of whom had angina pectoris for 5 years). Eighteen of the surviving 36 men remained completely asymptomatic and free from signs of coronary artery disease, other than exercise-induced ST-segment depression. One man had ECG signs of a previous myocardial infarction, on the annual follow up; chest pain as a first presenting symptom was observed in a further 17 of 36 survivors. Repeat angiography was performed in 22 men who experienced either chest pain or worsening symptoms following exercise test; of these, 14 underwent coronary bypass surgery and are still alive. The data appear to refute a 'wait-and-see' policy among subjects with asymptomatic cardiac ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMed1994

Exercise blood pressure predicts cardiovascular mortality in middle-aged men.

The outcome of 1999 apparently healthy men aged 40 to 59 years investigated from 1972 through 1975 was ascertained after 16 years to determine whether systolic blood pressure measured with subjects in the sitting position during a bicycle ergometer exercise test adds prognostic information on cardiovascular mortality beyond that of casual blood pressure measured after 5 minutes of supine rest. During a total follow-up of 31,984 patient years, 278 patients died, 150 from cardiovascular causes. Casual blood pressure and pulse pressure as well as peak exercise systolic blood pressure during 6 minutes on the starting workload of 600 kpm/min (approximately 100 W, 5880 J/min) were all related to cardiovascular mortality. The relative risk (RR) of dying from cardiovascular causes associated with an increment of 48.5 mmHg (= 2 SD) in systolic blood pressure at 600 kilopondmeter (kpm)/min was significant (RR = 1.5, 95% confidence interval [CI] = 1.1-2.3, P = .040) even when adjusting for a large number of variables measured in the present study, including age, exercise capacity, smoking habits, and casual blood pressures. The influence of blood pressure at 600 kpm/min was so strong that the predictive value of resting casual blood pressures became nonsignificant when these were analyzed as continuous variables also including exercise blood pressure as a covariate. However, the maximal systolic blood pressure during the exercise test was unrelated to cardiovascular mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A long-term, double-blind, comparative study on quality of life during treatment with amlodipine or enalapril in mild or moderate hypertensive patients: a multicentre study.

The efficacy, tolerability and impact on quality of life of amlodipine and enalapril were compared in a multicentre, double-blind, general practice study in 461 mild and moderate hypertensives over a 50-week active treatment period. Amlodipine (5-10 mg, once daily) and enalapril (10-40 mg, once daily) were found to be similarly effective in lowering blood pressure while not adversely affecting quality-of-life parameters. However, 20% of the enalapril group compared with 11% of the amlodipine group required the addition of hydrochlorothiazide for blood pressure control (P < 0.01). Diastolic blood pressure was normalised or reduced by 10 mmHg in 204 (90%) patients on amlodipine and in 190 (85%) patients on enalapril. Side-effects were, in general, mild or of little clinical significance. The major side-effects recorded were class-typical of ACE inhibitors and calcium antagonists, namely cough (enalapril) and oedema (amlodipine), respectively. Tolerability was very good, with only 17 patients (8 amlodipine, 4%; 9 enalapril, 4%) being withdrawn from the study due to side-effects definitely related to treatment. Amlodipine monotherapy produced a slightly beneficial effect on blood lipid concentration, and both drugs reduced the calculated 10-year risk of coronary heart disease. It was concluded that the calcium antagonist amlodipine compared favourably with the ACE inhibitor enalapril in terms of antihypertensive efficacy, tolerability and impact on quality of life.

Adult↗
PubMed1993

Initial clinical presentation of cardiac disease in asymptomatic men with silent myocardial ischemia and angiographically documented coronary artery disease (the Oslo Ischemia Study).

Data concerning the natural history of asymptomatic coronary artery disease (CAD) has been limited to epidemiologic rather than angiographic studies, thus leading to uncertainty as to whether warning symptoms and signs will identify subjects with silent myocardial ischemia before morbid events. To address this issue, 50 apparently healthy men with angiographically proven CAD and asymptomatic exercise-induced ST depression have been followed prospectively for 15 years in the Oslo Ischemia Study. Fourteen men died. The initial presenting clinical event in these 14 men was chest pain in 4 (30%)--but in only 1 case was it recognized as typical angina--silent myocardial infarction in 5 (35%) and sudden death in 5 (35%). Thirty-six men survived, with 19 developing symptoms. Overall, chest pain was the first clinical event in 22 of the total of 33 men with symptoms (66%), whereas myocardial infarction occurred in 6 (18%) and sudden death in 5 (16%). Although chest pain occurred in 22 men, it was clinically diagnosed as typical angina pectoris in only 6. These observations suggest that there is an absence of clear-cut ischemic symptoms in many asymptomatic patients before morbid events.

Adult↗
PubMed1993

[Does antihypertensive treatment with amlodipine or enalapril affect quality of life? A multicenter study in general practice].

In this multicentre trial in general practice the effect of one year of therapy with amlodipine or enalapril on quality of life and blood pressure was studied in 461 hypertensive patients. Quality of life was evaluated by means of a questionnaire administered on five occasions during the study. A total of 125 questions were distributed between psychological general well-being, own perception of health, social relations, sexual and cognitive functioning, and a combined index for frequency and intensity of symptoms. Both drugs were equally effective in reducing blood pressure, from 162/106 to 142/91 mm Hg, and had the same effect on quality of life. Neither of the drugs reduced quality of life, and in some of the variables a slight improvement (2-5%) was observed. The two compounds were tolerated equally well. Apart from class-typical effects (coughing for enalapril and edema for amlodipine) no clinically significant side effects were experienced.

Adult↗
PubMed1993

[Alpha blockaders--first or second line antihypertensive agents?].

Alpha-receptor blockers reduce blood pressure by blocking of the alpha 1-receptors in the smooth muscle cells in the arteriolar walls. The heart pump function is not disturbed. Most studies have shown that the alpha-receptor blockers induce a reduction in plasma-triglycerides and an increase in the ratio between HDL- and LDL-cholesterol. They do not interfere with the metabolism of electrolytes, glucose or uric acid and have no negative effect on pulmonary function. Although long-term use does not induce a permanent increase in heart rate, some patients respond to initial therapy with faster heart rate and palpitations. The alpha-receptor blockers should not be used in patients with coronary heart disease if the patient is not on chronic beta-blockade. When these precautions are followed, the alpha-blockers can be used as first-line treatment--just like ACE-inhibitors and calcium-antagonists.

Adrenergic alpha-Antagonists↗
PubMed1993

Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men.

BACKGROUND: Despite many studies suggesting that poor physical fitness is an independent risk factor for death from cardiovascular causes, the matter has remained controversial. We studied this question in a 16-year follow-up investigation of Norwegian men that began in 1972. METHODS: Our study included 1960 healthy men 40 to 59 years of age (84 percent of those invited to participate). Conventional coronary risk factors and physical fitness were assessed at base line, with physical fitness measured as the total work performed on a bicycle ergometer during a symptom-limited exercise-tolerance test. RESULTS: After an average follow-up time of 16 years, 271 men had died, 53 percent of them from cardiovascular disease. The relative risk of death from any cause in fitness quartile 4 (highest) as compared with quartile 1 (lowest) was 0.54 (95 percent confidence interval, 0.32 to 0.89; P = 0.015) after adjustment for age, smoking status, serum lipids, blood pressure, resting heart rate, vital capacity, body-mass index, level of physical activity, and glucose tolerance. Total mortality was similar among the subjects in fitness quartiles 1, 2, and 3 when the data were adjusted for these same variables. The adjusted relative risk of death from cardiovascular causes in fitness quartile 4 as compared with quartile 1 was 0.41 (95 percent confidence interval, 0.20 to 0.84; P = 0.013). The corresponding relative risks for quartiles 3 and 2 (as compared with quartile 1) were 0.45 (95 percent confidence interval, 0.22 to 0.92; P = 0.026) and 0.59 (95 percent confidence interval, 0.28 to 1.22; P = 0.15), respectively. CONCLUSIONS: Physical fitness appears to be a graded, independent, long-term predictor of mortality from cardiovascular causes in healthy, middle-aged men. A high level of fitness was also associated with lower mortality from any cause.

Adult↗
PubMed1993

Heart volume and cardiovascular mortality. A 16 year follow-up study of 1984 healthy middle-aged men.

The possible association between heart size measured during a cardiovascular screening examination and cardiovascular mortality was studied in 1984 healthy men aged 40-59 years. At the 16-year follow-up 278 had died, 150 from cardiovascular diseases. Cardiovascular mortality was 2.2 times higher among the 122 men with heart size > or = 500 ml.m-2 than among those with heart size < 500 ml.m-2. This association was, however, exclusively confined to men with physical fitness below median in whom the corresponding mortality ratio was 4.6 (95% confidence interval 2.5-8.4; P < 0.001) after adjustment for age, smoking, cholesterol, blood pressure and heart rate. Heart size measurements from routine chest X-rays is fast, easy, inexpensive and appears to provide valuable, independent screening information in healthy, middle-aged men.

Adult↗
PubMed1993

Double-blind, parallel, comparative study on quality of life during treatment with amlodipine or enalapril in mild or moderate hypertensive patients: a multicentre study.

OBJECTIVE: To compare tolerance, antihypertensive efficacy and impact on quality of life of amlodipine and enalapril in patients with mild or moderate hypertension. DESIGN: Multicentre, double-blind, double-dummy, comparative trial in general practice. Three phases were conducted: 4 weeks on placebo, 12 weeks of dose adjustment (amlodipine or enalapril) and a 38-week maintenance period. PATIENTS: Four hundred and sixty-one patients of both sexes were enrolled; 451 were available for efficacy evaluation at the end of the trial. TREATMENT: The patients were allocated to either amlodipine (231) or enalapril (230) treatment. If at the end of dose adjustment (amlodipine 5-10 mg/day, enalapril 10-40 mg/day) diastolic blood pressure was > or = 95 mmHg, hydrochlorothiazide (25-50 mg/day) was added (27 amlodipine patients and 45 enalapril patients). MAIN OUTCOME MEASURES: Blood pressure changes after 1 year of treatment; between- and within-group changes in quality of life as assessed by psychological general well-being, social and sexual functioning, health-risk perception, alertness, behaviour, and impact of symptom and side effects. RESULTS: Indices on quality of life were unchanged or increased (2-9%) in both groups. Blood pressure was normalized or reduced by > or = 10 mmHg in 204 (90%) and 190 (85%) patients on amlodipine and enalapril, respectively. Cough was the most frequently reported adverse event in the enalapril group (13%) and oedema in the amlodipine group (22%). Only eight (4%) patients on amlodipine and nine (4%) on enalapril were withdrawn because of drug-related adverse events. CONCLUSION: At similar blood pressure reduction in mild and moderate hypertension, quality of life is equally well maintained on amlodipine and enalapril therapy.

Adaptation, Psychological↗
PubMed1993

Haematocrit: a predictor of cardiovascular mortality?

OBJECTIVES: The main purpose of the study was to assess a possible association between haematocrit (Hct) and long-term cardiovascular disease (CVD) mortality. DESIGN: An extensive examination programme was carried out in 2014 men, defined as apparently healthy, during the period 1972 to 1975, including Hct measurements in a 25% random subsample. Sequential, cause-specific mortality was followed prospectively over a period of 16 years. SETTING: The survey was conducted at Medical Department B, Rikshospitalet, Oslo, Norway. SUBJECTS: The participants represented 86% of all eligible apparently healthy men working in five preselected companies in Oslo. INTERVENTIONS: No intervention was given by the study group during follow-up. MAIN OUTCOME MEASURES: Complete, cause-specific mortality figures after 8-16 years were obtained from the Norwegian Central Bureau of Statistics. RESULTS: Hct measures were obtained in 488 men (24.2%). Mean Hct was 47.2% (SD 2.9%). After correcting for differences in age, plasma cholesterol, systolic blood pressure, erythrocyte sedimentation rate and smoking habits (Cox proportional hazards model), an increase in Hct by 2 SDS was associated with an increase in CVD mortality by a factor ranging between 2.9 at 10, and 1.9 at 16 years (P < 0.05). A similar increased risk was observed earlier during follow-up but the number of deaths was too small for meaningful statistical analysis. No association was found between Hct and non-CVD mortality. CONCLUSIONS: Our data show that increased Hct is associated with an increased risk of dying from CVD--independent of conventional CVD risk factors.

Adult↗
PubMed1993

Regional differences of atrial natriuretic factors in humans.

During sinus coronarius catheterization in humans undergoing diagnostic right-sided cardiac catheterization, levels of atrial natriuretic factor (ANF) measured in sinus coronarius (n = 12) were four times higher than in peripheral arterial blood. Atrial natriuretic factor underwent average extractions of 0.57, 0.40, and 0.28 in the kidneys (n = 14), liver (n = 15), and forearm (n = 15) respectively. However, a close relationship was observed between arterial and peripheral venous concentrations. The substantial clearance of ANF even over the forearm indicates that arterial sampling may be preferred in conditions with altered peripheral vascular resistance, since an uptake of ANF in the peripheral vascular bed is likely to have occurred.

Aged↗
PubMed1993

Selective alpha-1 inhibitors: first- or second-line antihypertensive agents?

It is well documented that in the treatment of mild or moderate hypertension selective alpha 1-inhibitors such as doxazosin and prazosin lower blood pressure to approximately the same extent as beta-blockers, diuretics, ACE inhibitors and calcium antagonists. However, treatment with selective alpha 1-inhibitors is also associated with a number of other favourable effects. For example, in contrast to most beta-blockers, selective alpha 1-inhibitors have a favourable effect on serum lipids, primarily lowering the triglycerides but also increasing the ratio of high-density lipoprotein (HDL) cholesterol:total cholesterol. In addition, selective alpha 1-inhibitors do not aggravate glucose metabolism or increase uric acid concentration, as thiazide diuretics frequently do. Some patients gain particular benefit from treatment with a selective alpha 1-inhibitor, namely those with noninsulin-dependent diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, and kidney failure. While no controlled mortality trials with selective alpha 1-inhibitors have yet been completed, new vasodilator drugs such as these do lower blood pressure in a more physiological manner than traditional antihypertensive agents, and appear to cause fewer side effects. In this respect, with the exception of patients with manifest or strongly suspected coronary heart disease who are not receiving beta-blocker treatment, selective alpha 1-inhibitors should be recommended as first-line agents for the treatment of hypertension.

Adrenergic alpha-Antagonists↗
PubMed1993

A double-blind, long-term, comparative study on quality of life, safety, and efficacy during treatment with amlodipine or enalapril in mild or moderate hypertensive patients: a multicenter study.

Amlodipine (5-10 mg, once daily) and enalapril (10-40 mg, once daily) were compared in terms of quality of life, efficacy, and tolerability, in a multicenter, double-blind trial lasting for 50 weeks in 461 mild or moderate hypertensive patients. Both drugs were similarly effective in lowering blood pressure while maintaining quality of life. Apart from class-typical effects, such as edema for calcium antagonists, and cough for angiotensin-converting enzyme inhibitors, both drugs were equally well tolerated, with few adverse effects of clinical significance. Only a few patients [eight amlodipine (4%); nine enalapril (4%)] were withdrawn from the trial due to drug-related adverse events, demonstrating that tolerability was good. Neutral to slightly beneficial effects were found in blood lipid concentrations after treatment with amlodipine. Both drugs reduced the calculated risk of coronary heart disease over the next 10 years. It was concluded that amlodipine compared favorably with enalapril as an effective and well-tolerated antihypertensive drug.

Adult↗
PubMed1993

Effects of fish oil, nifedipine and their combination on blood pressure and lipids in primary hypertension.

In a double-blind, crossover, placebo-controlled study the effects of four weeks' treatment with 4.55 g/day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on BP and serum lipids were assessed in 18 males with hypertension (WHO stage I-II). At the end of the double-blind phase, eight patients on placebo (olive oil) and ten patients on fish oil treatment were given nifedipine 20 mg twice daily added to their regimens for four weeks. Four weeks' fish oil treatment slightly reduced BP values; however, compared with placebo no changes were found. VLDL-cholesterol and triglycerides were significantly reduced by 24%, whereas total and LDL-cholesterol remained unchanged. Placebo did not change BP and lipid values. When nifedipine was added to fish oil/placebo, BP in the two groups was reduced to almost the same extent. When nifedipine was added to fish oil, total cholesterol was significantly reduced by 12% in comparison with baseline value and LDL-cholesterol was reduced by 15%, albeit insignificantly. Placebo plus nifedipine was lipid neutral. A significant correlation was found between the nifedipine-induced changes in supine mean arterial pressure and total, LDL- and VLDL-cholesterol, respectively, in those patients with and without fish oil treatment. In conclusion, the combined administration of fish oil and nifedipine possesses favourable antihypertensive and metabolic properties in hypertensive males with elevated lipid levels.

Adult↗
PubMed1992

[Glyceryl trinitrate patches during continuous intravenous infusions].

A randomized, double blind comparison of the incidence of removal of patches because of venous occlusion was performed in patients on continuous intravenous fluid therapy using 2.5 mg trinitroglycerine or placebo patches attached to the thorax. The sample comprised 90 patients, of whom nine were excluded for administrative reasons. Of the remaining 81,41 received active and 40 received placebo patches. Within one week 11 venflones occluded; ten in patients on placebo, and one in a patient with an active trinitroglycerine patch. Finally 14 (11 placebo and three trinitroglycerine) patches occluded. This tendency in favour of trinitroglycerine patches was statistically significant (p = 0.018). No difference in frequency of thrombophlebitis was observed: (14 versus 18 not leading to occlusion). Seven patients on trinitroglycerine and one on placebo developed moderate headache which did not necessitate withdrawal of treatment. It is concluded that 2.5 mg trinitroglycerine patches seem to improve survival of venflones used for continuous, intravenous fluid therapy, even when applied to the thorax.

Administration, Cutaneous↗
PubMed1992

Haemodynamic and neurohumoral effects of cold pressor test in severe heart failure.

The effect of a cold pressor test (CPT) on haemodynamics in relation to general and regional sympathetic activity and arginin vasopressin (AVP), was studied in eleven patients with severe congestive heart failure (CHF). Compared to an age-matched control group (C), resting arterial plasma noradrenaline (NA) (419 +/- 77 vs. 182 +/- 15 pg ml-1), and adrenaline (A) (142 +/- 28 vs 54 +/- 10 pg ml-1) were higher (P less than 0.05) in CHF. AVP showed no significant difference (14 +/- 4 vs. 9 +/- 4 pg ml-1). During CPT systolic and diastolic blood pressure and systemic vascular resistance increased (P less than 0.01), as did NA (delta 114 +/- 39 pg ml-1, P less than 0.01), A (delta 33 +/- 10 pg ml-1, P less than 0.01) and heart rate (delta 10 beats min-1, P less than 0.01). The myocardial v-a difference of NA decreased (P less than 0.05), but was unchanged across the renal vascular bed during CPT. The a-v difference of NA in the hepatic vascular bed, and fractional extraction of A in the coronary sinus, renal and hepatic vascular beds remained unchanged during CPT. AVP did not change significantly and no change in cardiac index or left ventricular filling pressure was observed during CPT. These data suggest that despite an increased activation of the sympathetic nervous system at rest, a further increase in blood pressure and catecholamines took place during CPT. Thus, the effect of a CPT which activates the central sympathetic system seems not to be altered in patients with severe CHF.

Aged↗
PubMed1991

[Stiffness of the heart--stunning].

The article describes "stunning", or "myocardial post-ischemic dysfunction". An animal model is presented to introduce the characteristics of the phenomenon, and data from a clinical trial are referred in order to demonstrate the clinical relevance of stunning. The long-standing lethargy experienced by many patients with coronary artery disease several hours after exercise may be caused by stunning. It is necessary to know the phenomenon in order to realize why myocardial contractility may be temporarily reduced, not only during but also after ischemic episodes.

Animals↗