Endothelin in hypertension--a matter ignored or to be ignored?
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Endothelins↗
Biomedical subjects
L Hansson
Publications and source records attributed to L Hansson.
The E.L.S.A. trial: protocol of a randomized trial to explore the differential effect of antihypertensive drugs on atherosclerosis in hypertension.
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Aged↗
Treatment of isolated systolic hypertension.
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Humans↗
Treatment of hypertension in the elderly with special reference to urapidil.
During 1991 and 1992 three major intervention trials were published that dealt with the value of antihypertensive treatment in the elderly. The three studies were the American Systolic Hypertension in the Elderly Program (SHEP), the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) and the British Medical Research Council Trial of Treatment of Hypertension in Older Adults. (MRC trial.) The three trials all compared active antihypertensive treatment, mainly consisting of diuretics or beta-adrenoceptor blocking agents or the two in combination, with placebo. Two of the trials were double-blind (SHEP and STOP) whereas the MRC trial was single-blind. All three were multicenter and prospective, and patients were randomized to either of the treatment modalities. One of the trials (SHEP) was specifically designed to evaluate antihypertensive treatment in patients with isolated systolic hypertension. The SHEP, STOP and MRC trials all showed that treatment of hypertension in the elderly reduces the risk of stroke and cardiovascular events. In the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. It could be argued that novel antihypertensive compounds offer equal or better results than the ones obtained with beta blockers and/or diuretics. Angiotensin converting enzyme inhibitors and calcium antagonists are currently being compared with diuretics and beta-blockers in the STOP-Hypertension-2 study which prospectively evaluates morbidity and mortality in hypertensive patients aged 70-84 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
Mortality matters.
When treating cardiovascular disorders such as arterial hypertension, the major goal of treatment is to reduce morbidity and mortality. The present review will concentrate on how the treatment of cardiovascular disorders affects mortality. Hypertension studies performed in the 1950s showed that treatment of malignant hypertension improved five year survival dramatically. More recent studies in patients with nonmalignant hypertension have shown positive effects on mortality as well, especially with regard to the treatment of hypertension in the elderly. Other cardiovascular disorders have also been treated successfully with regard to mortality. This is true in particular of postmyocardial infarction patients, in whom beta-blocker treatment has been effective. Moreover, patients with congestive heart failure have been shown to benefit from treatment with angiotensin converting enzyme (ACE) inhibitors as regards total mortality. The most recent addition to our knowledge stems from the GISSI-3 trials in which lisinopril, alone or in combination with nitrates, was shown to reduce mortality in patients with acute myocardial infarction.
Angiotensin-Converting Enzyme Inhibitors↗
The Captopril Prevention Project (CAPPP): description and status.
The Captopril Prevention Project (CAPPP) is an ongoing prospective intervention study in 10,800 hypertensive patients in Sweden and Finland. Patients are randomized to treatment with either conventional antihypertensive therapy, ie, diuretics or beta-blockers, or the angiotensin-converting enzyme inhibitor captopril. The purpose of the CAPPP Study is to compare the two therapeutic alternatives with regard to cardiovascular mortality.
Antihypertensive Agents↗
Isolation of mRNA and genomic DNA from epithelial cells in human milk and amplification by PCR.
Studies on the regulation of human milk protein genes and suitable cell culture systems have been limited due to restricted availability of tissue samples from lactating women. Although mammary gland tissue has been available from mammary reduction surgery, studies on tissue-specific expression of milk protein genes require samples obtained during specific stages of expression in the tissue, i.e., lactation. We have therefore developed a technique to isolate mRNA and genomic DNA directly from epithelial cells isolated from human milk and used PCR methodology to specifically amplify the cDNA and genomic DNA for human beta-casein. When comparing fresh human milk with milk that has been stored for five hours at 37 degrees C or frozen and thawed, we found that the amount of mRNA isolated was considerably higher from fresh milk. However, in spite of this, we could still isolate intact mRNA from frozen milk. The described methodology should be useful in studies on milk protein gene expression during lactation and studies on variants of milk protein genes.
Base Sequence↗
Relationship between change in erythrocyte sodium and antihypertensive response to enalapril.
To investigate the effects of enalapril and hydrochlorothiazide on erythrocyte sodium and potassium in relation to their effects on BP, 28 men (mean age 46 years, range 22-64 years) with previously untreated essential hypertension (casual DBP > or = 95 mmHg) were randomised to enalapril (n = 14) or hydrochlorothiazide (n = 14) treatment. BP was also measured intraarterially (brachial artery) and the mean arterial pressure (MAP) recorded. Intraerythrocyte sodium and potassium were measured by flame photometry at baseline and after 26 weeks of active treatment in the hypertensive patients and also in 28 age- and sex-matched normotensive control subjects. There was a significant positive relationship between intra-arterial BP and intraerythrocyte sodium in untreated hypertensives, but there was no significant difference in mean intraerythrocyte sodium or potassium content between hypertensive and normotensive subjects at baseline. The distribution of values of intraerythrocyte sodium, however, differed between hypertensive and normotensive subjects. Supine MAP was lowered from 113 +/- 4 to 97 +/- 3 mmHg and from 110 +/- 3 to 102 +/- 2 mmHg on enalapril and hydrochlorothiazide treatment, respectively. BP reduction with enalapril was associated with a significant decrease in intraerythrocyte sodium (P = 0.02), while hydrochlorothiazide had no effect. There was no significant correlation between delta MAP and delta intraerythrocyte sodium after 26 weeks in any of the groups. Intraerythrocyte potassium did not change on treatment with either drug. In conclusion, there wa a significant relationship between intra-arterial BP and intraerythrocyte sodium in untreated hypertensives. Both enalapril and hydrochlorothiazide reduced BP effectively while enalapril only reduced intraerythrocyte sodium.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Influence of sex on blood pressure and left ventricular mass in adolescents: the Hypertension in Pregnancy Offspring Study.
The aim of the present longitudinal study was to describe determinants of blood pressure (BP) and echocardiographically calculated left ventricular mass in adolescents with a variable risk of future hypertension. BP was measured and M-mode echocardiography was performed in 52 children, 29 male and 23 female, at a mean age of 12.6 +/- 1.5 years. A re-examination was performed after 5.6 years. Thirty-six children were born to mothers who had hypertension during pregnancy whereas 16 children were born after a normotensive pregnancy. During follow-up a difference in body weight (P < 0.01) and height (P < 0.001) developed between male and female subjects. At the same time a difference in systolic blood pressure (SBP) appeared between sexes (P < 0.01). At follow-up there were significant correlations between sex and SBP (r = 0.37, P < 0.01) and left ventricular mass (r = 0.54, P < 0.001). In multivariate analyses sex emerged as a factor explaining the variance of both SBP and left ventricular mass at follow-up. In conclusion a difference in BP between male and female subjects emerges concomitantly with differences in body size during adolescence. An independent influence of sex on both BP and left ventricular mass appears in parallel with this.
Adolescent↗
Five-year follow-up of blood pressure and left ventricular mass in children with different maternal histories of hypertension: the Hypertension in Pregnancy Offspring Study.
OBJECTIVE: To follow the changes in blood pressure and echocardiographically determined left ventricular mass in offspring of mothers who had hypertension during pregnancy. DESIGN: Longitudinal study with a 5-year follow-up. METHODS: Nineteen offspring of mothers who had hypertension during pregnancy, and sustained hypertension at follow-up 7-12 years after term, were examined, by blood pressure measurement and M-mode echocardiography, at a mean age of 12.8 years (range 10.6-16.4) and were re-examined 5.6 years later. For comparison, 17 children born to mothers who had hypertension during pregnancy, but were normotensive at follow-up, were also examined. A control group of children born following a normotensive pregnancy was also recruited. Comparisons were made by analysis of variance among the three groups. RESULTS: At the initial examination systolic blood pressure was significantly higher in the children born to mothers who had hypertension during pregnancy and were hypertensive at follow-up. This difference persisted in the adolescents at follow-up. No differences among the three groups in echocardiographically determined left ventricular mass were seen, either at the initial examination or at follow-up. There was a significant correlation between left ventricular masses determined 5 years apart (r = 0.53, P < 0.001). CONCLUSIONS: The present longitudinal study demonstrates that offspring of mothers with hypertension during pregnancy, that was sustained at follow-up, have higher blood pressure than controls. Children with different maternal histories of hypertension maintain their rank with regard to left ventricular mass during adolescence.
Adolescent↗
Recombinant human milk bile salt-stimulated lipase. Catalytic activity is retained in the absence of glycosylation and the unique proline-rich repeats.
Human milk bile salt-stimulated lipase ensures efficient utilization of triacylglycerol by breast-fed infants. Cloning and sequencing of cDNA have revealed that the peptide chain consists of 722 amino acid residues showing only little homology to typical lipases. The sequence is identical to that of pancreatic carboxylic-ester hydrolase. The COOH-terminal part contains 16 proline-rich repeats of 11 residues with O-linked carbohydrate. The only N-linked sugar chain is situated close to the active-site serine. Using C127 cells and a bovine papilloma virus vector, high and stable expression of full-length lipase and of several variants, obtained by site-directed mutagenesis, was achieved. The produced proteins were purified and further characterized. Variants lacking all, or all but two, repeats were active with similar specific activity and the same bile salt dependence as the native milk enzyme. Changing the asparagine necessary for N-glycosylation gave the same principal results. Active recombinant full-length lipase was also produced in a bacterial system. We conclude that neither glycosylation (N- or O-linked) nor the proline-rich repeats are essential for catalytic activity or bile salt activation of human milk bile salt-stimulated lipase.
Amino Acid Sequence↗
Expression of human milk beta-casein in Escherichia coli: comparison of recombinant protein with native isoforms.
Studies on physiological function and on structure-function relationships of human milk beta-casein have been limited. In this study, we have introduced the human beta-casein cDNA into vectors designed for expression in Escherichia coli. The inducible T7-based expression system resulted in high-level expression of recombinant beta-casein. The recombinant beta-casein, localized intracellularly in E. coli, was purified to homogeneity and compared with purified native beta-casein, in particular with respect to phosphorylation. The E. coli-produced beta-casein was found to comigrate with the full-length, nonphosphorylated native human beta-casein isoform on SDS-PAGE. An N-terminal peptide containing all tentative phosphorylation sites was isolated from the recombinant protein and analyzed by mass spectrometry. The molecular mass as well as the migration of this peptide on reversed-phase chromatography confirmed that it was unphosphorylated.
Amino Acid Sequence↗
Test characteristics of the Hopkins Symptom Check List-25 (HSCL-25) in Sweden, using the Present State Examination (PSE-9) as a caseness criterion.
The Hopkins Symptom Check List-25 (HSCL-25) is a screening instrument designed to identify common psychiatric symptoms. It has been widely used in different settings outside Sweden and also compared to assessment of psychiatric illness made by general practitioners. The aim of the present study was to validate the HSCL-25 against a psychiatric interview using the Present State Examination (PSE-9) in a Swedish sample of patients in general practice. Validity coefficients of the HSCL-25 were calculated for two different thresholds of caseness, > or = 1.55 and > or = 1.75, respectively. When > or = 1.75 was chosen as a cutoff point, the validity coefficients obtained by the HSCL-25 in this study were comparable to those obtained in other studies.
Adult↗
Perceived health and high consumers of care: a study of mental health problems in a Swedish primary health care district.
Many patients with mental health problems are treated in primary health care services. They are often multi-users of care. In the present investigation we have studied patients visiting primary health care clinics who have been assessed for mental health problems according to the Hopkins Symptom Check List (HSCL-25). Two quality-of-life instruments (the Nottingham Health Profile and the Mood Adjective Check List) were applied to describe further the perceived health of the sample. A random sample of 93 patients was chosen out of 388 patients visiting a primary health care clinic in a Swedish health care district during four weeks in January and February 1990, and these patients were followed prospectively during one year. High consumers of health care during the follow-up period scored a poor perceived health. 'Feeling worthless', predicted a high number of days of sickness absenteeism. Hidden cases, not detected by the GPs, consumed more resources than those identified by the GPs. The importance of training and educating general practitioners in the early detection of patients with mental health problems is discussed.
Attitude to Health↗
Improved accuracy of indirect blood pressure measurement in patients with obese arms.
We studied 20 patients with moderate to severe obesity (body mass index 37 +/- 8 kg/m2) with obese arms (arm circumference 37 +/- 4 cm). Their blood pressure was measured directly in the brachial artery in one arm and simultaneously indirectly in the other arm using either a large standard cuff (rubber bag 12 x 35 cm) or a new cuff (the Tricuff, Pressure Group AB, Stockholm) containing three rubber bags of different sizes, which automatically selected the appropriately sized bag in relation to arm circumference. Both cuffs showed a significant overestimation of the diastolic blood pressure (standard cuff 13 mm Hg, P < .001, Tricuff 6 mm Hg, P < .01). The error of the standard cuff was significantly greater than that of the Tricuff (P < .001). The differences in systolic blood pressure between the intraarterially and the indirectly measured results were small (0.2 to 3 mm Hg) and not statistically significant with either cuff. The new Tricuff offered an advantage as compared to a large standard cuff in terms of a lesser overestimation of the diastolic blood pressure. In practical terms, this should lead to a reduction in the overestimation of diastolic hypertension in obese individuals.
Adult↗
Future goals for the treatment of hypertension in the elderly with reference to STOP-Hypertension, SHEP, and the MRC trial in older adults.
During 1991 and 1992, three major interventional trials were published that dealt with the value of antihypertensive treatment in the elderly. The three studies were the American Systolic Hypertension in the Elderly Program (SHEP), the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension), and the British Medical Research Council (MRC) Trial of Treatment of Hypertension in Older Adults. The three trials all compared active antihypertensive treatment, mainly diuretics or beta-adrenoceptor blocking agents, or the two in combination, with placebo. Two of the trials were double-blind (SHEP and STOP) whereas the MRC trial was single-blind. All three were multicentered, prospective, and included randomization. One of the trials (SHEP) was specifically designed to evaluate antihypertensive treatment in patients with isolated systolic hypertension. The SHEP, STOP, and MRC trials all showed that treatment of hypertension in the elderly reduces the risk of stroke and cardiovascular events. In one of the trials, total mortality was also positively affected. Thus, in the STOP-Hypertension trial, which included the oldest patients with the most severe hypertension, total mortality was reduced by 43%. On the basis of these trials, it is apparent that antihypertensive treatment with low-dose thiazides or beta-blockers, or the two in combination, can produce highly beneficial results in elderly patients, including a reduction in the incidence of stroke and other cardiovascular events as well as in total mortality. Furthermore, special analyses indicate that the cost:benefit aspects of such treatment is at least as positive as in young and middle-aged hypertensive patients.
Adrenergic beta-Antagonists↗
Borderline hypertension. A 24-hour abnormality.
It has recently been questioned whether borderline hypertension (BH) is a reality or just an artefact due to the person's knowledge of his or her raised blood pressure. This issue was evaluated by measuring ambulatory blood pressure (ABP) in subjects with BH, compared to normotensive individuals (NC). In particular, we wanted to investigate whether the basal blood pressure levels during sleep at night were elevated in BH subjects, or whether these individuals would normalize blood pressure during periods of low psychological arousal. Twenty-four-hour ABP was measured using the Spacelabs monitor 90202. Forty-nine BH subjects (systolic blood pressure [SBP] 140 to 160 mm Hg or diastolic blood pressure [DBP] 85 to 95 mm Hg) and 18 NC (SBP 110 to 130 mm Hg and DBP 60 to 80 mm Hg) were recruited from an unbiased population sample (age 20 to 28 years). The classification of BH and NC, respectively, was confirmed by intraarterial BP recordings. There was the expected variation of blood pressure throughout the 24 h (the highest values in the afternoon and lowest at night). SBP was significantly higher in the BH than in the NC group for the entire 24 h as well as during the four 6-h periods (morning P = .007, afternoon P < .001, evening P < .001, and night P = .025). A smaller but significant difference between the groups was seen for DBP but only in the afternoon and in the evening (morning P = .167, afternoon P = .022, evening P = .038, night P = .310).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Interrelation of cardiac and vascular structure in young men with borderline hypertension.
It is not established whether left ventricular hypertrophy and structural vascular changes are primary phenomena or secondary consequences of raised blood pressure. In this study we investigated 54 borderline hypertensive men (BH) (SBP 140-160 mmHg and/or DBP 84-95 mmHg) and 20 normotensive men (NC) (SBP 110-130 mmHg and DBP 60-80 mmHg), recruited from an unbiased population sample (age 20 +/- 2 years). Blood pressure (BP) levels were confirmed by i.a. BP recordings. Left ventricular mass (LVM) was determined with M-mode echocardiography and minimal vascular resistance (Rmin) was calculated from the blood flow in the calf and forearm after maximal ischaemic work. Central haemodynamics were assessed by intra-arterial blood pressure recordings and cardiac output determinations by the dye dilution technique. In the BH group, LVM and Rmin were strongly correlated to body size, especially weight and body surface area. However, LVM and Rmin were only weakly correlated to blood pressure. In the normokinetic BH subgroup (NBH) (n = 38) minimal forearm vascular resistance was significantly higher than in the hyperkinetic BH individuals (HBH) (n = 16), indicating the presence of structural vascular changes in the former. Furthermore, in the NBH group there was a significant correlation between LVM and Rmin both in the calf (r = 0.490 P = 0.002) and in the forearm (r = 0.520 P = 0.001). This association remained after correction for body size. No such correlation was seen in the HBH subgroup or in the NC group. The present study does give long-reaching conclusions as regards the aetiological factors underlying the cardiovascular remodelling. However, our data show that (1) cardiovascular changes appear early in the course of blood pressure elevation, (2) the cardiac and vascular changes develop in parallel, and (3) structural remodelling is not solely explained by the degree of blood pressure elevation since blood pressure was similar in the two BH subgroups. Thus, other factors than blood pressure appear to be important determinants of structural adaptation in mildly hypertensive states.
Adolescent↗