Search PubMed⌕ Search

Biomedical subjects

G Berglund

Publications and source records attributed to G Berglund.

At least 19 recordsLinked to original sources
PubMed1995

Fasting blood glucose in determining the prevalence of diabetes in a large, homogeneous population of Caucasian middle-aged women.

OBJECTIVES: To determine the usefulness of a single, fasting blood glucose (FBG) value in measuring the prevalence of diabetes mellitus in a large, homogeneous population. DESIGN: Fasting blood glucose and 2-h oral glucose tolerance test (OGTT) values were determined. Based on the results of the OGTT, the sensitivity and specificity of different cut-off levels of FBG for the diagnosis of diabetes were assessed. ROC (receiver operating characteristic) analysis was performed on the data. SETTING: A health screening unit at the University Hospital in Malmö, Sweden. SUBJECTS: A total of 1843 Caucasian women without known diabetes aged 55-57 years. RESULTS: The prevalence of previously undiagnosed diabetes was 3.9% and the prevalence of impaired glucose tolerance (IGT) was 27.9% using the WHO cut-off values for 2-h blood glucose values after an OGTT. With an FBG cut-off value of 6.7 mmol L-1, the sensitivity of a single FBG value was 36.6%. Reducing the cut-off value to 6.0 mmol L-1 increased the sensitivity to 53.4%. At a cut-off level of 4.8 mmol L-1, the sensitivity reached the high value of 85.9%, but the specificity was only 45% and the predictive value of a positive test as low as 5.9%. ROC analysis showed that the optimal cut-off value for FBG in this population was 5.3 mmol L-1, giving a sensitivity and specificity of 77% but a positive predictive value of only 11.9%. CONCLUSIONS: This study has shown that in a large and homogeneous Caucasian population of women aged 55-57 years with a high prevalence of IGT, a single FBG value is not useful as a screening tool for diabetes mellitus.

Blood Glucose↗
PubMed1995

Insulin and forearm vasodilation in hypertension-prone men.

Insulin-stimulated peripheral glucose uptake and insulin-mediated forearm vasodilation were investigated in 38 normotensive men with a family history of hypertension (relatives) compared with 27 age- and body mass index-matched normotensive men with no family history of hypertension (control subjects). The euglycemic hyperinsulinemic clamp technique was used to measure peripheral glucose uptake (insulin sensitivity index) and the metabolic clearance rate of insulin. Intra-arterial blood pressure and forearm blood flow were determined simultaneously, and forearm vascular resistance was calculated. The insulin sensitivity index was lower in relatives than in control subjects. The metabolic clearance rate of insulin was reduced and did not correlate to glucose disposal in the relatives as opposed to the control subjects. Forearm blood flow increased and forearm vascular resistance decreased to a similar extent in the two groups during the clamp. The vasodilator response was positively correlated to glucose disposal only in the relatives. In conclusion, impaired insulin-stimulated peripheral glucose uptake in normotensive sons from hypertensive families was accompanied by retained insulin-mediated forearm vasodilation. Thus, skeletal muscle blood flow supply does not seem to be the major determinant for glucose disposal. On the other hand, the positive correlation between glucose disposal and decrease in forearm vascular resistance in the relatives suggests that insulin-mediated vasodilation may be a limiting factor for peripheral glucose uptake in insulin-resistant individuals.

Disease Susceptibility↗
PubMed1995

Glucose modulation of insulin and glucagon secretion is altered in impaired glucose tolerance.

Insulin and glucagon secretion was compared in women with impaired glucose tolerance (IGT; n = 19, age 58.4 +/- 0.3 yr; mean +/- SD) and women with normal glucose tolerance (NGT; n = 40, age 58.4 +/- 0.3 yr). Fasting plasma insulin levels were higher in IGT than in NGT (P = 0.026), whereas fasting glucose and glucagon levels were not different. Arginine was injected intravenously (5 g), which rapidly stimulated insulin and glucagon secretion in all subjects. Raising the blood glucose (BG) to 14 and 28 mmol/L potentiated insulin secretion and inhibited glucagon secretion. The acute insulin response to arginine (AIR = 2-5 min postload increase) at BG 14 mmol/L, but not at fasting BG or BG 28 mmol/L, was lower in IGT than in NGT (P = 0.033), as was the glucose potentiation of AIR (slopeAIR) (P = 0.020). The acute glucagon response (AGR) was higher in IGT than in NGT at BG 14 mmol/L (P = 0.016). SlopeAGR (glucose inhibition of AGR) was reduced in IGT (P = 0.001). In NGT, there was a significant inverse correlation between slopeAIR and slopeAGR (P = 0.002) not seen in IGT. We conclude that in IGT with normal fasting BG, the glucose modulation of islet function is impaired, indicating that islet dysfunction is an early lesion during the development of noninsulin-dependent diabetes mellitus.

Arginine↗
PubMed1994

One-year follow-up of the 'Starting Again' group rehabilitation programme for cancer patients.

In a randomised prospective study, a brief structured rehabilitation programme, 'Starting Again', was evaluated over a follow-up year. 98 patients were assigned to the programme, and 101 to the control condition. The 11, 2-h sessions emphasised physical training, information and coping skills. Patients in the programme improved significantly more than the controls with respect to appraisal of having received sufficient information, physical training, physical strength and fighting spirit. Results indicate improvement with respect to the three areas focused on in the 'Starting Again' programme: physical training, information and coping skills training.

Adaptation, Psychological↗
PubMed1994

The role of diabetes mellitus and hypertriglyceridaemia as coronary risk factors in treated hypertension: 15 years of follow-up of antihypertensive treatment in middle-aged men in the Primary Prevention Trial in Göteborg, Sweden.

OBJECTIVE: To analyse the importance of diabetes mellitus and hypertriglyceridaemia as potential risk factors for coronary heart disease (CHD) in middle-aged, treated hypertensive men. DESIGN: A prospective, long-term observational study. SUBJECTS: Derived from a random population sample--686 hypertensive men aged 47-54 years at entry--followed for 15 years at a special out-patient hypertension clinic. INTERVENTION AND OUTCOME MEASURES: The patients were mainly treated with beta-adrenoceptor blockers and/or thiazide diuretics. Cardiovascular morbidity was closely monitored during follow-up. RESULTS: In all, 133 subjects suffered a CHD event during follow-up. The presence of diabetes mellitus at entry more than doubled the CHD risk and a 1 mmol l-1 increment of the serum triglyceride level at entry increased the CHD risk by 21%. In multivariate analyses, smoking, the presence of diabetes mellitus at entry, serum cholesterol and signs or symptoms of hypertensive end organ damage were found to be independent risk factors for CHD. In absolute terms the existence of cardiovascular damage was of much greater prognostic importance than were the presence of various metabolic abnormalities. Of the mean in-study variables, both the average serum cholesterol level and the achieved diastolic blood pressure were significantly associated with CHD. However, new diabetes mellitus which developed during follow-up as well as mean serum triglyceride levels were not associated with CHD. CONCLUSIONS: Diabetes mellitus and hypertriglyceridaemia present at the start of treatment have a prognostic impact in treated hypertensive men, whereas when such metabolic disorders develop during drug treatment they seem to be of much less importance. Smoking and already existing evidence of hypertensive end organ damage are of utmost importance for the prognosis in this type of patient.

Adrenergic beta-Antagonists↗
PubMed1994

Diabetes mellitus in treated hypertension: incidence, predictive factors and the impact of non-selective beta-blockers and thiazide diuretics during 15 years treatment of middle-aged hypertensive men in the Primary Prevention Trial Göteborg, Sweden.

The objective of this study was to analyse predictive factors for the development of diabetes mellitus during long-term treatment of hypertension and to compare the diabetogenic potential of thiazide diuretics and non-selective beta-adrenoceptor blockers. The study population comprised 686 hypertensive men, aged 47-54 years, who were followed for 15 years. Patients were treated with either thiazide diuretics or beta-adrenoceptor blockers as monotherapy or in combination with one another or alternative other antihypertensive drugs. During the first part of the study, i.e. during the 1970s, only non-selective beta-adrenoceptor blockers were used. The average yearly incidence of the development of diabetes mellitus during follow-up was 1.3%. In univariate analysis body mass index, serum triglyceride level, radiographic heart enlargement and beta-blocker therapy were significantly associated with the development of diabetes mellitus. Predictors selected by stepwise Cox regression were body mass index, radiological heart enlargement and beta-blocker therapy. Two subgroups with patients treated with nonselective beta-adrenoceptor blockers but not with thiazide diuretics during the first five years of follow-up (the beta-blocker group; n = 93) or with thiazide diuretics but not with nonselective beta-adrenoceptor blockers during the first five years of follow-up (the thiazide-group; n = 96) were identified. The relative risk for developing diabetes mellitus was significantly higher in the beta-blocker group being 6.1 after 10 years and 3.5 after 15 years treatment in comparison with the thiazide group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1992

Increased systemic and renal vascular sensitivity to angiotensin II in normotensive men with positive family histories of hypertension.

Normotensive young men (mean age 36 years) with positive (PFH) (n = 13) and negative (n = 29) family histories of hypertension were investigated in order to study systemic and renal hemodynamics at baseline conditions and during infusion of low doses (0.1 and 0.5 ng/min/kg) of angiotensin II (AII). The control group with negative family histories of hypertension was subdivided into one group matched for body mass index (n = 15) to subjects with PFH, and one lean control group (n = 14). Baseline blood pressure and sodium intake, measured as urinary excretion, were higher in PFH and in matched controls than in the lean control group. At baseline, renal blood flow (para-aminohippurate clearance) did not differ significantly among the three groups, while glomerular filtration rate (inulin clearance) was higher in PFH than in matched controls. Both doses of angiotensin II infusion increased the blood pressure significantly in PFH. In matched controls a small increase in blood pressure was seen with the highest dose only, while no change in blood pressure was observed in the lean control group. In PFH both doses of AII infusion caused diminished renal blood flow (P less than .01) and increased renal vascular resistance (P less than .001). The two control groups remained unchanged with both AII doses. These results could indicate that normotensive subjects with positive family histories of hypertension are characterized by an increased sensitivity to AII in the systemic and renal circulation as compared with subjects with negative family histories of hypertension.

Adult↗
PubMed1992

Reduced venous compliance in normotensive men with positive family histories of hypertension.

OBJECTIVE: To test the hypothesis of reduced venous compliance and increased cardiovascular responses to volume expansion and alpha-agonist stimulation. METHOD: Non-hypertensive healthy young men with positive (PFH) and negative family histories of hypertension were investigated regarding peripheral haemodynamics and changes in central venous pressure (CVP) and arterial blood pressure in response to graded doses of phenylephrine and acute i.v. fluid volume loading (1000 saline solution in 10 min). The control group was divided into one group matched for body mass index to PFH subjects (NFHO) and one lean control group (NFHN). RESULTS: Supine blood pressure was higher in PFH and NFHO subjects compared with NFHN subjects, whilst CVP was similar in the three groups at baseline. No significant differences in calf or forearm haemodynamics or blood volume were observed between the three groups. Cardiovascular responses to bolus doses of phenylephrine did not differ between the three groups. Saline infusion significantly increased CVP and systolic blood pressure, and effective vascular compliance (change in blood volume: CVP ratio) was reduced in PFH subjects. CONCLUSION: PFH subjects have decreased effective vascular compliance and altered arterial blood pressure responses to acute increases in vascular fluid volume. This may result from multiple factors such as increased venous vascular tone, structural reduction of venous distensibility and/or an altered neurohormonal response to increased CVP.

Adult↗
PubMed1992

Withdrawal of antihypertensive drug treatment: time-course for redevelopment of hypertension and effects upon left ventricular mass.

OBJECTIVES: To examine: (1) in how many treated hypertensive patients it was possible to discontinue drug treatment; (2) the time-course for redevelopment of hypertension after discontinuation of therapy; and (3) whether drug withdrawal was associated with an increase in left ventricular mass (LVM). DESIGN: Fifty-four men with primary hypertension treated for a mean period of 6 years (primarily beta 1-selective beta-blockade) were evaluated for withdrawal of treatment. Exclusion criteria were signs of organ damage, severe hypertension, other serious disease and unwillingness. Treatment was reinstituted if blood pressure increased above a safety level or if symptoms occurred. Echocardiographic estimations of LVM were obtained before withdrawal and 1, 4 and 8 weeks after withdrawal or before return to treatment. SETTING: Outpatient clinic in a city hospital. PATIENTS: A random sample of 56-year-old hypertensive men. INTERVENTION: Gradual discontinuation of treatment with close follow-up of blood pressure. MAIN OUTCOME MEASURES: Number of patients who could withdraw from treatment and who had to return to pharmacological therapy; time-courses for development of hypertension; absolute changes in LVM. RESULTS: Thirty-two patients withdrew from treatment for 1-1000 days. Therapy was reinstituted in all owing to hypertension or symptoms. Serial echocardiograms were obtained in 22 patients. During the drug-free period, relative wall thickness increased, but LVM did not. Patients with rapid redevelopment of hypertension had larger prewithdrawal LVM than patients whose blood pressure increased more slowly. CONCLUSION: It was possible to withdraw treatment and obtain readable echocardiograms in a minority of the patients. After drug-withdrawal, relative wall thickness increased, but not LVM. We suggest that previously treated patients should be avoided in studies examining reversal of left ventricular hypertrophy.

Antihypertensive Agents↗
PubMed1992

Noninvasive quantification of atherosclerotic lesions. Reproducibility of ultrasonographic measurement of arterial wall thickness and plaque size.

A noninvasive method based on high-resolution B-mode ultrasonography and a computerized image-analyzing system were used for the quantification of early (thickening of the intima-media complex) and late (plaque) atherosclerosis in the carotid and the femoral artery. The difference between repeated measurements was assessed to estimate intraobserver and interobserver differences. The results were satisfactory, with a coefficient of variation for measurement of lumen diameter in the common carotid artery of 3.8 +/- 4.1% (r = 0.91) and for the femoral artery of 4.8 +/- 4.1% (r = 0.93). Corresponding figures for intima-media thickness in the common carotid artery and the femoral artery were 10.0 +/- 8.5% (r = 0.86) and 16.2 +/- 12.6% (r = 0.91), respectively. The coefficient of variation for measurements of maximal intima-media thickness at the site of the plaque was 14.6 +/- 10.5% (r = 0.88); for plaque base, 13.1 +/- 9.0% (r = 0.91); and for plaque area, 16.3 +/- 12.6% (r = 0.90). The method seems promising for the detection and quantification of early and late atherosclerotic lesions in the carotid and femoral arteries.

Aged↗
PubMed1992

Increased waist/hip ratio, metabolic disturbances, and family history of hypertension.

To test whether nonhypertensive subjects with a two-generation positive family history of hypertension (PFH) are characterized by disturbed glucose metabolism, 16 men (38 +/- 6 years old) with PFH and 25 subjects matched for age and with negative family histories of hypertension (NFH) were recruited. Blood pressure; serum lipids; erythrocyte transmembrane sodium transport; and the glucose, plasma insulin, and C-peptide responses to an oral glucose tolerance test were investigated. Subjects with PFH had higher blood pressure, body weight, body mass index (BMI), waist/hip ratio (WHR), and abdominal sagittal diameter than subjects with NFH. Baseline blood glucose, plasma insulin, serum lipids, and transmembrane sodium transport did not differ between the two groups. Blood glucose levels at 90 and 120 minutes after oral glucose were significantly higher in subjects with PFH than in controls. Blood glucose adjusted for BMI and WHR at 90 minutes was significantly related to a PFH. Plasma insulin level at 90 minutes during the glucose load was significantly higher in subjects with PFH. In multivariate analysis, WHR was significantly related to baseline blood pressure, insulin, and cholesterol, whereas BMI was significantly associated with the insulin response to the oral glucose tolerance test. Transmembrane sodium transport was significantly related to blood pressure only. In conclusion, subjects with PFH are characterized by increased body weight and BMI, increased visceral fat accumulation, and an altered blood glucose response to an oral glucose load. It was also shown that WHR was related to blood pressure and that BMI was more related to cholesterol and response to glucose loading than a PFH was.

Adult↗
PubMed1992

Increased response to physical and mental stress in men with hypertensive parents.

Blood pressure and heart rate responses to isometric handgrip exercise were studied at age 31 and after 5 years in young nonhypertensive men with positive family histories of hypertension (n = 13) and in those with negative family histories of hypertension (n = 13) for two generations to test whether subjects with positive family histories established a pattern of increased blood pressure and heart rate responses during the 5-year follow-up period. At follow-up the response to mental stress (Stroop's color word test) was also studied. Baseline blood pressure and heart rate at rest did not differ, initially or at follow-up, between the groups. At the initial examination, absolute blood pressure levels were significantly higher during isometric handgrip exercise just before exhaustion in subjects with positive family histories. At follow-up the absolute blood pressure level (p < 0.001) and the blood pressure responses (p < 0.01-0.001) were found to be significantly increased during handgrip exercise in subjects with positive family histories compared with subjects with negative family histories. In subjects with positive family histories the diastolic blood pressure response was significantly higher (p < 0.01) at follow-up than initially and was significantly related (r = 0.70, p < 0.01) to changes in baseline diastolic blood pressure during the follow-up period. In subjects with negative family histories the systolic blood pressure response was somewhat lower at follow-up than initially. During the mental stress test, the blood pressure response was significantly greater in subjects with positive than with negative family histories.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Stroke registry in Malmö, Sweden.

BACKGROUND AND PURPOSE: A stroke registry covering the city of Malmö, Sweden (population 232,000) was started in January of 1989 to prospectively follow up stroke incidence, recurrence, and fatality rates. METHODS: Patients with presumed stroke were interviewed within 1 week after admission to the hospital, and their medical records were examined. Continuous validation against hospital diagnosis showed well over 90% of all stroke cases in Malmö to have been included. RESULTS: Incidence rates per 100,000 residents were 300 for all stroke events and 225 for first-ever stroke, lower than those reported from other studies. The distribution of stroke diagnostic categories was 3% subarachnoid hemorrhage, 10% intracerebral hemorrhage, 50% cerebral infarction, and 38% unspecified stroke. The diagnosis was based on computed tomography in 51% of first-ever stroke cases. Median age was 73.1 years for men and 79.7 years for women. Incidence rates for all stroke diagnostic categories except subarachnoid hemorrhage increased with age. Prior stroke, hypertension, smoking, atrial fibrillation, and diabetes mellitus were major risk factors for all stroke events. The presenting symptoms were hemiparesis in 74%, speech disorder in 49%, and clouded consciousness in 19% of the patients. The overall case-fatality rate at 30 days was 15%; the rate for intracerebral hemorrhage was 37% and that for cerebral infarction was 10%. CONCLUSIONS: Our findings confirm the value of a stroke registry for stroke epidemiology purposes and as a tool for specific stroke research.

Cerebral Hemorrhage↗
PubMed1992

Weight reduction versus antihypertensive drug therapy in obese men with high blood pressure: effects upon plasma insulin levels and association with changes in blood pressure and serum lipids.

OBJECTIVES: First, to compare dietary and antihypertensive drug treatment in obese men with mild hypertension with respect to effects upon insulin, glucose, lipid metabolism and blood pressure. Second, to test the hypothesis that in the diet group changes in blood pressure and serum lipid concentration were associated with changes in plasma insulin concentration. DESIGN: A 6-week run-in period followed by random assignment to either diet or drug treatment, lasting for 1 year. Blood pressure measurements were performed blind after 5 and 45 min rest, and during isometric exercise. Plasma insulin and blood glucose concentrations were measured before and after an oral glucose load. SETTING: Outpatient clinic in a city hospital. PATIENTS: Sixty-four men aged 40-69 years with a body mass index > or = 26 kg/m2 and with a diastolic blood pressure of 90-104 mmHg when untreated were recruited (screening after an advertisement in a newspaper). Exclusion criteria were diabetes mellitus, organ damage secondary to hypertension and diseases that may have interfered with compliance and the interpretation of results. Sixty-one patients completed the study. INTERVENTIONS: Dietary treatment was based upon weight reduction and sodium restriction. Drug treatment used a stepped-care approach with atenolol as first choice drug. MAIN OUTCOME MEASURES: Absolute reductions in blood pressure, plasma insulin, blood glucose, serum lipid concentration and the waist:hip circumference ratio. RESULTS: Mean body weight decreased in the diet group and increased in the drug-treatment group. Plasma insulin concentrations, the waist:hip circumference ratio and serum lipid profile improved in the diet group compared with the drug group. Blood pressure control was significantly better in the drug group. In the diet group the changes in mean arterial pressure after 5 min rest and serum triglyceride levels correlated with changes in plasma insulin concentrations independent of changes in body mass index or body weight. CONCLUSIONS: Diet treatment was inferior to drug treatment in controlling hypertension, but superior in lowering plasma insulin concentrations and improving the serum lipid profile. The hypothesis of a relation between changes in blood pressure, serum triglycerides and plasma insulin was supported.

Adult↗