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Biomedical subjects

I Hjermann

Publications and source records attributed to I Hjermann.

At least 55 records · Page 3Linked to original sources
PubMed1995

Diet and exercise intervention have favourable effects on blood pressure in mild hypertensives: the Oslo Diet and Exercise Study (ODES).

The purpose of this study was to investigate the effect of 1-year diet intervention, exercise intervention and both combined on blood pressure (BP) in normotensives and mild hypertensives. Two hundred and nineteen sedentary middle aged men and women with slightly deranged coronary heart disease (CHD) risk factors were randomised to a control, a diet, an exercise and a diet + exercise group. Based on baseline diastolic BP, participants were divided into tertiles, giving baseline average BP of 141.4/96.7 in tertile 1, 130.7/87.6 in tertile 2 and 121.9/79.0 in tertile 3. The 1-year net-difference in BP between the intervention groups and the control group decreased across the tertiles; in tertile 1 being -11.2/-6.7 (p < 0.05), -11.3/-6.7 (p < 0.05 for systolic BP only) and -7.0/-5.1 (NS) in the combined, diet and exercise group respectively. Triglycerides, HDL cholesterol, and insulin variables were significantly and favourably changed, the changes being most marked in the combined group. The results show that diet and diet + exercise are about equally effective in reducing BP, and the effects may be dependent on the baseline level. Within the upper tertile of baseline BP, the decline in BP in the combined intervention and the diet group are almost comparable to those obtained with drug treatment. In addition, other important CHD risk factors were all changed in a beneficial direction.

Adult↗
PubMed1994

[Antihypertensive treatment and risk of coronary disease. How significant is the antihypertensive effect for metabolic factors?].

A recent meta-analysis of hypertension treatment trials showed a marked reduction in cerebrovascular disease and a less pronounced reduction in coronary heart disease. Treatment has consisted of diuretics and betablockers, and this paper discusses the possible influence of their metabolic side effects as compared with the new vasodilating agents (angiotensin converting enzyme inhibitors, alpha receptor antagonists and calcium channel blockers). Several studies have now been started to compare the effect of these compounds with diuretics and betablockers with respect to long-term cardiovascular morbidity and mortality. Until the results of these studies are available, young patients (i.e. < 60-65 years) at high risk of coronary heart disease, especially patients with the insulin resistance syndrome or diabetes mellitus, should in our opinion be treated with ACE-inhibitors, alpha receptor blockers or calcium channel blockers.

Age Factors↗
PubMed1994

LPS-induced release of IL-1 beta, IL-6, IL-8, TNF-alpha and sCD14 in whole blood and PBMC from persons with high or low levels of HDL-lipoprotein.

We have examined basal and lipopolysaccharide (LPS)-induced release of interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6), interleukin 8 (IL-8), tumour necrosis factor-alpha (TNF-alpha) and soluble CD14 (sCD14) in whole blood and peripheral blood mononuclear cells (PBMC) from 20 persons with either high (1.62-2.47 mmol/L) or low (0.43-1.29 mmol/L) levels of high-density lipoprotein (HDL). Whole blood was incubated at 37 degrees C for 2 h with 100 ng LPS/ml, while PBMC were incubated with 100 ng LPS/ml for up to 160 h. The LPS-induced release of IL-1 beta, IL-6, IL-8 and TNF-alpha into plasma showed no differences between the two HDL-groups; whereas levels of sCD14 were significantly higher in plasma in persons with low HDL (P < 0.01). PBMC incubated with LPS showed a significantly higher release of IL-1 beta (P = 0.01) and IL-6 (P = 0.02) in persons with high HDL at all sampling times. sCD14 was found not to be released by PBMC. These findings indicate that PBMC from persons with high or low levels of HDL have different functional properties, possibly of importance in inflammation and atherogenesis.

Antigens, CD↗
PubMed1994

Quality-adjusted meta-analysis of the hypertension/coronary dilemma.

Primary investigators of randomized drug trials in hypertension were invited to rate quality of such trials. The intention of the survey was to ask if antihypertensive drug therapy reduces incidence of coronary heart disease (CHD) in hypertensive patients. Response was obtained for 7 of the 11 invited investigators, covering 69% of patients and 75% of CHD cases. Principal component analysis was used to construct a quality score based on answers to 12 questions along visual analog scales. The score correlated well with the answer to a global question of overall quality given by the raters. No systematic tendency toward favoring one's own trial could be demonstrated, therefore, all raters have contributed to the rating. The trials with the highest rated quality to answer the research question were Systolic Hypertension in the Elderly Program (SHEP), Australian National Blood Pressure Study, Medical Research Council, Veterans Administration, and European Working Party of Hypertension in the Elderly. The large Heart Detection and Follow-up Program (HDFP) trial was rated at 11th place among the trials with a score of < 40% of the SHEP. The small trials performed in the 1960s were placed at the bottom of the ranking list. Because SHEP is the only trial without diastolic hypertension, results were given with and without SHEP results. When incorporating the quality score into a meta-analysis of CHD outcome, results were dependent on whether SHEP was included or not. For diastolic hypertension only, the effect of therapy was estimated to be about 8% for all higher quality studies, whereas inclusion of the lower quality HDFP changed it to 14%. When isolated systolic hypertension trial was pooled with the others, no major relation to quality rating was observed. A 14% CHD preventive efficacy was established when pooling the three top quality studies. This stayed unchanged until HDFP at rank 11 was included raising this estimate to 16%. Inclusion of the two latest published trials in the elderly, the Medical Research Council trial of treatment of hypertension in older adults and the Swedish Trial in Old Patients with hypertension, did not change this overall estimate of 16% (standard error = 3.8%). It is concluded that if all randomized drug trials in hypertension had the same treatment efficacy, the estimated CHD prevention would be in the range of 15%. Subgroup analyses revealed no relationship to age, but a difference in efficacy was shown depending on whether the trials were performed in the United States or elsewhere. Also, patients at higher risk levels showed better benefit than lower risk patients.

Adult↗
PubMed1993

Lipopolysaccharide-induced monocyte procoagulant activity, fibrinopeptide A, and PAI-I levels in persons with high or low levels of HDL-lipoprotein.

We have examined basal and stimulated monocyte procoagulant activity (PCA) in 10 persons with high HDL (1.62-2.47 mmol/L) and 10 persons with low HDL (0.43-1.29 mmol/L). Heparinized whole blood was incubated at 37 degrees C for 2 hours with 100 ng/ml of E. Coli lipopolysaccharide (LPS). Monocytes were isolated by density gradient centrifugation (purity > 70%), and PCA measured with a chromogenic peptide substrate assay. LPS-induced PCA was significantly higher in the high HDL group (p = 0.02), whereas basal levels were similar. Furthermore, the levels of total HDL, HDL2, as well as apo-A1 were all significantly correlated with LPS-induced monocyte PCA (p < 0.01, p < 0.01, and p = 0.03), whereas VLDL was inversely correlated (p = 0.02). PAI-I activity was significantly lower in the high HDL group (p < 0.01). LPS recovery in plasma after incubation, by LAL test, was significantly higher in the high HDL group (p = 0.02) and correlated to HDL2 (p = 0.04), and inversely correlated with triglycerides (p = 0.04). There was no significant difference between the two groups in plasma fibrinopeptide A (FPA) levels after LPS incubation.

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 activity and the metabolic syndrome].

Hypertension may be accompanied by decreased insulin sensitivity, lipid abnormalities and increased haemostatic risk, all of which, constitute risk factors for coronary artery disease. Modifications of lifestyle, including more physical exercise, are important, and may reduce the coronary risk profile. Physical activity has been shown to lower blood pressure, reduce hypertriglyceridemia, improve insulin sensitivity and increase the fibrinolytic capacity. Hypertensive patients should be encouraged to increase physical activity as an adjuvans to both pharmacological and non-pharmacological treatment of high blood pressure.

Cardiovascular Diseases↗
PubMed1993

Sex differences in essential hypertension.

A group of 41-year-old hypertensive men (n = 35, blood pressure (BP) 149.9 +/- 2.1/98.9 +/- 1.1 mmHg, mean +/- SEM) who had never received treatment for their condition were compared with hypertensive women of the same age (n = 18, BP 155.9 +/- 4.3/98.1 +/- 1.6 mmHg) with comparable body mass index (BMI, 25.9 +/- 0.5 vs. 24.9 +/- 4.5 kg m-2) who, also, had never received treatment. The lipid profile was more atherogenic in the men, with lower HDL cholesterol (1.21 +/- 0.04 vs. 1.38 +/- 0.06 mmol l-1, P = 0.04), higher total cholesterol (6.04 +/- 0.14 vs. 5.54 +/- 0.18 mmol l-1, P = 0.04) and triglycerides (1.80 +/- 0.16 vs. 0.96 +/- 0.10 mmol l-1, P < 0.001). The hypertensive men had higher haemoglobin (P < 0.001) and haematocrit. Plasma catecholamines were inversely related to BMI in the women only (r = -0.52, P < 0.05 for both noradrenaline and adrenaline). Women with BMI above 25 kg m-2 had significantly lower arterial plasma adrenaline and noradrenaline than those with BMI below 25 kg m-2 (28 +/- 5 vs. 78 +/- 16 pg ml-1, P < 0.01 and 101 +/- 17 vs. 206 +/- 33 pg ml-1, P < 0.01 respectively). A negative curvilinear relationship appeared between arterial adrenaline and insulin (r = 0.49, P = 0.05). These results suggest a male propensity for athero-thrombogenic risk factors in otherwise comparable hypertensive subjects. A close relationship between metabolic risk factors within the normal range seems to exist even in hypertensive women. The decreased sympathetic activity at rest in the obese hypertensive women indicates different pathophysiological mechanism for hypertension in lean and obese. Decreased sympathetic activity and thus reduced energy expenditure, promotes a risk for weight gain, and could explain the inverse relationship between insulin and adrenaline.

Adult↗
PubMed1993

The predictability of risk factors with respect to incidence and mortality of myocardial infarction and total mortality. A 12-year follow-up of the Oslo Study, Norway.

OBJECTIVES: To study the prognostic value of several risk factors on incidence and mortality of myocardial infarction (MI) and total mortality in men. DESIGN: Prospective cohort study of 12 years' follow-up. SETTING: All men in Oslo aged 40-49 and a 7% sample of men aged 20-39 were invited for screening. SUBJECTS: Of all 30,025 invited men, of whom 25,015 were aged 40-49, a total of 16,209 men aged 40-49 attended the screening and risk factors were recorded for these men. MAIN OUTCOME MEASURES: Incidence of first MI (non-fatal and fatal), mortality of MI, total mortality. RESULTS: When examining the rate ratio of the fifth to the first quintile of risk factors we found that systolic and diastolic blood pressures were stronger predictors for mortality than incidence of MI. The rate ratios (95% confidence interval) of systolic blood pressure were 3.73 (2.56, 5.44) and 2.56 (2.01, 3.25) respectively. For diastolic blood pressure the corresponding rate ratios were 4.14 (2.84, 6.04) and 2.78 (2.18, 3.54). Small differences in the rate ratios for these end-points were found for total serum cholesterol and triglycerides. Daily cigarette smoking versus non-cigarette smoking was a stronger predictor for MI mortality than incidence, with rate ratios of 3.16 (2.45, 4.24) and 2.34 (2.00, 2.79) respectively. The Cox proportional hazards regression analysis confirmed the above results. CONCLUSIONS: Total serum cholesterol and triglycerides predicted incidence and mortality of MI equally well. Whereas blood pressure and daily cigarette smoking predicted mortality of MI more strongly.

Adult↗
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

Risk factors of stroke incidence and mortality. A 12-year follow-up of the Oslo Study.

BACKGROUND AND PURPOSE: The objective of this study was to determine the risk factors of stroke incidence and mortality. METHODS: Our data are based on a prospective cohort study of men aged 40 to 49 years after 12 years of follow-up. RESULTS: In age-adjusted Cox proportional-hazards regression analysis of 14,403 healthy men, diastolic blood pressure was a stronger predictor for stroke incidence and mortality than systolic blood pressure. Smoking was a stronger predictor of mortality than of incidence. However, there was no dose-response relation among smokers by increased cigarette consumption. Total serum cholesterol was a significant (P < .05) risk factor for stroke mortality and of borderline significance (P = .08) for stroke incidence. Increased physical activity at leisure was associated with reduced stroke incidence but not mortality. The myocardial infarction risk score comprising systolic blood pressure, total serum cholesterol, and daily cigarette smoking was a strong predictor of mortality and incidence. Body mass index, triglycerides, blood glucose, and physical activity at work were not found to be risk factors for stroke. CONCLUSIONS: Reduction of blood pressure, cessation of smoking, lowered cholesterol, and increased physical activity at leisure are individual measures to reduce the risk of stroke.

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

Long-term effect of lovastatin alone and in combination with cholestyramine on lipoprotein (a) level in familial hypercholesterolemic subjects.

We have determined the effect of lovastatin alone or in combination with cholestyramine on lipoprotein (a) [Lp(a)] levels in 59 heterozygotes for familial hypercholesterolemia (FH) treated for 33.8 (+/- 6.1) months. The median pretrial Lp(a) value was 10.2 mg/100 ml, which is twice the median value in healthy people examined at the Institute of Medical Genetics, University of Oslo. The median Lp(a) level was insignificantly reduced by 10.3% during the first 20 weeks when the subjects were on a standardized medication of increasing doses of lovastatin and cholestyramine. The first 20 weeks were followed by usual care treatment period, and a further decrease in Lp(a) level to 16.2% (P = 0.0012) was observed at the end of the study. Comparison between the 20 subjects on lovastatin monotherapy and the 31 subjects on the combined therapy of lovastatin and cholestyramine, revealed that the subjects on monotherapy had a median reduction of 20.1%, and the subjects on the combined therapy had a reduction of 15.4%. Thus, it appears that the reduction in Lp(a) level could be ascribed to lovastatin alone.

Adolescent↗
PubMed1992

The influence of dietary change on hemostatic risk variables.

In the 1970s in the Diet-Antismoking Trial, of the Oslo Study, colleagues and I found that the majority of high-risk men with elevated serum cholesterol and elevated triglyceride concentrations had impaired fibrinolytic capacity. Later on, both our group and others found a similar negative correlation between serum triglyceride levels and fibrinolytic capacity. Furthermore, in a prospective study of dietary intervention in individuals with both elevated cholesterol and triglyceride levels, we found that dietary lowering of serum triglyceride levels was significantly and positively correlated with an improvement in fibrinolytic capacity. In another study, we made the same observation for the coagulation factor VII-phospholipid complex: the more the triglycerides were reduced by diet, the greater was the change in factor VII complex. This correlation was highly significant and independent of changes in serum cholesterol. Platelet function is also influenced by dietary habits, but except for the effects of a fish oil-enriched diet, few data are available about the dietary effects on platelet function. It seems, however, that in individuals with elevated lipid levels and elevated blood pressure, increased platelet reactivity is a highly prevalent finding. Many of the hemostatic risk variables are associated with the so-called "metabolic risk syndrome" characterized by an increase in serum insulin level, together with increased relative body weight, mild hypertension, hyperlipidemia, and physical inactivity. This syndrome can often be influenced favorably by life-style changes. A controlled study with interventions in diet and activity level has just been started by our group.

Adult↗
PubMed1992

The metabolic cardiovascular syndrome: syndrome X, Reaven's syndrome, insulin resistance syndrome, atherothrombogenic syndrome.

A short review of the metabolic cardiovascular risk syndrome (MCVS) is given. Traditionally, cardiovascular risk has been associated with three so-called "main" risk factors; hypercholesterolemia, hypertension, and smoking. In addition, the association between diabetes and cardiovascular disease has been known for many years in clinical medicine. Primarily, these risk factors have been regarded separately as independent factors, although epidemiological studies showed intercorrelations between them. However, it is now well accepted that relatively few at-risk individuals have only one risk factor, and in many cases a whole "symphony" of factors play together to create what we might call an individuals' risk profile. As an example, very often essential hypertension has been regarded as a disease in itself, which can be successfully treated just by lowering the blood pressure by drugs. When such a strategy obviously failed, the association of elevated blood pressure with dyslipoproteinemia and impaired glucose tolerance attracted more attention, particularly when it was realized that many antihypertensive drugs affected risk in MCVS in a possible negative way. The most important etiologic factor of MCVS is (besides genetics) an excessive caloric intake compared to what the individual spends in physical activity. In the clinical setting, the most important findings of MCVS are central obesity, dyslipoproteinemia with low high-density lipoprotein (HDL) cholesterol, hypertension, reduced insulin sensitivity in peripheral tissues, and increased thrombogenicity. The reduced insulin sensitivity leads to a compensatory increase in beta-cell insulin production, and thereby hyperinsulinemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1992

StyI polymorphism in an enhancer region of the second intron of the apolipoprotein B gene in hyper- and hypocholesterolemic subjects.

The regulation of the human apolipoprotein (apo) B gene that plays a crucial role in lipid metabolism is apparently very complex, with multiple cis- and trans-acting regulatory factors. One of these factors is an enhancer region in the second intron. In this region a point mutation at position + 722 has been found that is detectable by the restriction enzyme StyI. The report of Levy-Wilson et al. (1991) could suggest that the mutant allele (abolished StyI site) is associated with hypocholesterolemia. To investigate further the possible effect of this mutation on plasma cholesterol levels, we have compared the frequency of the mutant allele between 206 hypercholesterolemic Norwegian or Czech subjects on one hand, and 165 hypocholesterolemic Norwegian or Czech subjects on the other hand. No significant difference in frequency was found between the hypercholesterolemic and the hypocholesterolemic groups. This finding indicates either that the mutation at position + 722 does not affect the enhancer activity or that this in vitro enhancer activity is of little or no clinical significance. One of the Norwegian hypercholesterolemic subjects who was of Czech descent possessed the apoB 3500 mutation that leads to defective binding of low density lipoprotein (LDL) to the LDL receptors. Haplotype analysis of the apoB gene in her family showed that the mutation-bearing allele was identical to that reported in other countries, indicating a common gene source.

Adult↗
PubMed1991

[Hypertension as a part of metabolic cardiovascular syndrome].

Hypertension is only one of several cardiovascular risk factors that tend to cluster. Hypertension is associated with glucose intolerance, hyperinsulinemia, decreased HDL-cholesterol, high triglycerides and decreased fibrinolytic activity. One possible link is insulin resistance, which also links hypertension to obesity and diabetes mellitus type II. The authors review the literature and discuss clinical and therapeutic implications in the treatment of hypertension. Since the hypertensive patient may have an unfavourable cardiovascular risk profile, a non-pharmacological approach is essential in the treatment. Furthermore, if antihypertensive agents have to be used, metabolic side effects should be monitored closely, since they may reduce the beneficial effects of the blood pressure reduction on the cardiovascular risk profile.

Antihypertensive Agents↗