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T Ekbom

Publications and source records attributed to T Ekbom.

28 records · Page 2Linked to original sources
PubMed1993

Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) analyses performed up to 1992.

Hypertension is increasingly common with advancing age and a risk factor for all kinds of cardiovascular complications. Moreover, cardiovascular disease is a major cause of morbidity and mortality in the elderly. The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was set up by the Swedish Hypertension Society to investigate the value of antihypertensive treatment in the elderly. In this placebo controlled randomised prospective study 1,627 men and women aged 70-84 years with a supine blood pressure > or = 180/105 mmHg (and/or) but not isolated systolic hypertension participated. Three beta-blockers and one diuretic were used as blood pressure lowering agents and the average follow-up in the study was 25 months (3,390 patient-years). Administration of active antihypertensive therapy, reduced supine blood pressure from 195/102 mmHg to 167/87 mmHg at longest follow-up in comparison with placebo. A majority of the patients needed combined treatment to reach the goal blood pressure (160/95 mmHg). Associated with a fall in blood pressure were significant reductions in all cardiovascular primary endpoints (-40%, p = 0.0031), in fatal and non-fatal stroke (-47%, p = 0.0081) and in total mortality (-43%, p = 0.0079). In addition to the substantial effects on primary endpoints active treatment also showed clinically relevant effects on secondary endpoints (e.g. heart failure). The impact on cardiovascular morbidity and mortality with antihypertensive treatment in this elderly cohort was greater than previously seen in middle-aged hypertensive patients, with maintained tolerability and a favourable cost-effectiveness ratio. Finally, women benefited from treatment at least as much as men.

Adrenergic beta-Antagonists↗
PubMed1993

Hypertension in the elderly.

Several studies have demonstrated an increased risk of cardiovascular disease (CVD) in relation to high blood pressure in elderly patients aged below 70-75, whereas the risk seemed to decline with age in the older elderly. Early studies on the effect of treatment of mild to moderate hypertension in the elderly indicated (but did not convincingly show) a reduction of CVD. In the 1980s, both the EWPHE trial (European Working Party on High Blood Pressure in the Elderly) and the HEP study (The Randomised Trial of the Treatment of Hypertension in Elderly Patients in Primary Care) provided evidence of the benefit of treating high blood pressure in the elderly, at least up to the age of 70-74. These results have lately been confirmed by three major trials SHEP (Systolic Hypertension in the Elderly Program), STOP (Swedish Trial in Old Patients with Hypertension) and MRC (Medical Research Council), also including older patients (STOP) and those with isolated systolic hypertension (SHEP). This satisfactory effect was not impaired by a low tolerability of the drugs used (beta-blockers and diuretics). In conclusion, drug treatment with beta-blockers and diuretics in hypertensive men and women aged 70 and above confers highly significant and clinically relevant reductions in cardiovascular (especially stroke) morbidity and mortality. The clinical implication of this is that blood pressure lowering therapy should be considered in elderly hypertensives, at least up until they are 80. It should also be remembered that elderly hypertensives often have other diseases as well and that the drug treatment should be adjusted accordingly.

Aged↗
PubMed1992

Antihypertensive efficacy and side effects of three beta-blockers and a diuretic in elderly hypertensives: a report from the STOP-Hypertension study.

OBJECTIVE: To compare the blood pressure-lowering efficacy, the frequency of side effects and changes in laboratory values of three beta-blockers and a potassium-sparing diuretic combination in elderly hypertensive patients. DESIGN: The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomized, double-blind, multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70-84 years. METHODS: The study group consisted of 1627 elderly hypertensive patients (mean +/- SD age 75.7 +/- 3.7 years; 37% males, 63% females). Supine and standing blood pressure, heart rate and side effects were recorded at each visit. Blood was drawn for routine analysis. The mean length of follow-up was 25 months (range 6-65). No patient was lost to follow-up. RESULTS: After 2-months' single-drug therapy, all four active drugs were found to be equally effective in reducing diastolic blood pressure (DBP). However, there were differences in their efficacy in reducing systolic blood pressure (SBP); the diuretic was significantly more effective than the beta-receptor blockers. The results of a series of multiple linear regression analyses showed that the observed differences in effect on SBP could not be explained by the different effects of the drugs on heart rate. More than two-thirds of the patients were given supplementary treatment, most of them already by the 2-month visit, after which there was no significant difference in blood pressure among the treatment regimens. The changes in laboratory values and in the prevalence of symptoms were minor for all four regimens. CONCLUSION: Metoprolol (controlled release), atenolol, pindolol and the combination hydrochlorothiazide + amiloride were equally effective as single drugs in reducing DBP. There were differences in their efficacy in reducing SBP, the diuretic being more effective than the beta-blockers. After addition of supplementary treatment (beta-blocker to diuretic, or vice versa) there were no significant differences in blood pressure reduction among the groups. The changes in laboratory values and in the prevalence of symptoms were minor for all active treatment regimens. Thus, the satisfactory effect on cardiovascular morbidity and mortality was not impaired by low tolerability of the drugs.

Aged↗
PubMed1992

The stroke preventive effect in elderly hypertensives cannot fully be explained by the reduction in office blood pressure--insights from the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension).

OBJECTIVE: To study whether the cardiovascular preventive effect of antihypertensive therapy can be explained solely by the reduction in office blood pressure, and to what extent the risk of stroke and cardiac events is associated with in-study diastolic blood pressure (DBP) and systolic blood pressure (SBP). DESIGN: The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomized, double-blind, multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70-84 years. The study group comprised 1,627 elderly patients (mean blood pressure 195/102 mm Hg; mean age 75.7, SD 3.7; 63% females). The average follow-up was 25 months (range 6-65 months). No patient was lost to follow-up. METHOD: We applied a Poisson model taking current age, sex, treatment, DBP and SBP into account for all patients in the study. The constants of the model were estimated by the maximum likelihood method. RESULTS: The risk of stroke was significantly lower (42%, p = 0.0402) for a patient on active therapy than for a patient on placebo having the same blood pressure level, age, and sex. There was a corresponding, non-significant, reduction in cardiac events of 21%. In the whole study group the risk of stroke increased by 3% per mmHg (p = 0.0247) with increasing diastolic blood pressure for a given systolic pressure. The corresponding value for cardiac events was 2% per mmHg (p = 0.0376). CONCLUSION: In STOP-Hypertension we found a substantial risk reduction in stroke in actively treated patients, which was not solely explained by the blood pressure reduction obtained by treatment with beta-blockers and a potassium-sparing diuretic combination.

Aged↗
PubMed1991

Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension)

Although the benefits of antihypertensive treatment in "young" elderly (under 70 years) hypertensive patients are well established, the value of treatment in older patients (70-84 years) is less clear. The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomised, double-blind, intervention study set up to compare the effects of active antihypertensive therapy (three beta-blockers and one diuretic) and placebo on the frequency of fatal and non-fatal stroke and myocardial infarction and other cardiovascular death in hypertensive Swedish men and women aged 70-84 years. We recruited 1627 patients at 116 health centres throughout Sweden, who were willing to participate, and who met the entry criteria of three separate recordings during a 1-month placebo run-in period of systolic blood pressure between 180 and 230 mm Hg with a diastolic pressure of at least 90 mm Hg, or a diastolic pressure between 105 and 120 mm Hg irrespective of the systolic pressure. The total duration of the study was 65 months and the average time in the study was 25 months. 812 patients were randomly allocated active treatment and 815 placebo. The mean difference in supine blood pressure between the active treatment and placebo groups at the last follow-up before an endpoint, death, or study termination was 19.5/8.1 mm Hg. Compared with placebo, active treatment significantly reduced the number of primary endpoints (94 vs 58; p = 0.0031) and stroke morbidity and mortality (53 vs 29; p = 0.0081). Although we did not set out to study an effect on total mortality, we also noted a significantly reduced number of deaths in the active treatment group (63 vs 36; p = 0.0079). The benefits of treatment were discernible up to age 84 years. We conclude that antihypertensive treatment in hypertensive men and women aged 70-84 confers highly significant and clinically relevant reductions in cardiovascular morbidity and mortality as well as in total mortality.

Adrenergic beta-Antagonists↗
PubMed1991

Key learnings from the STOP-Hypertension study: an update on the progress of the ongoing Swedish study of antihypertensive treatment in the elderly.

The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) is an ongoing multicenter, randomized, double-blind study of antihypertensive treatment (beta-blockers or diuretics) compared to placebo in hypertensive men and women aged 70-84 years. The main trial, which is now in progress, is being carried out at approximately 120 primary health care centers in Sweden, the aim being to recruit 2000 patients, who will be studied for an average period of 3 years. The main study was preceded by a 1-year pilot study in 31 centers. Almost 5000 patients were screened in the pilot study, 55% of whom were labelled hypertensive, i.e., their recumbent blood pressure was greater than or equal to 180/105 mmHg or they were already receiving antihypertensive therapy. After 1 year, 89 patients (1.9%) had been randomized to double-blind treatment and 66 patients (1.4%) were in the run-in/washout period, whereas the remainder had not been included in the trial. The most common reason for not being included as a failure to reach the inclusion blood pressure criteria (greater than or equal to 180 mmHg systolic and/or greater than or equal to 105 mmHg diastolic) following withdrawal of previous antihypertensive medication. In the main trial, recruitment of new centers and new patients has improved gradually and by April 1989 approximately 900 patients had been randomized to double-blind treatment. In an analysis of 961 elderly patients (mean age 70.1 years), the relation between systolic and diastolic blood pressure and mortality was not significant.

Aged↗
PubMed1990

Incidence of femoral and tibial shaft fractures. Epidemiology 1950-1983 in Malmö, Sweden.

We studied 362 fractures of the femur that had occurred during the years 1950-57 and 1973-83, and 849 fractures of the tibia that occurred during the the years 1950-55 and 1980-83. There was an increase in age-specific incidence over aged 60 years. The risk of low-energy femoral shaft fractures also had increased in elderly women. Both fracture types shifted their age- and sex-specific incidence in the direction of a fragility pattern. There was no increase in the incidence of tibial shaft fractures. Fracture type, site, and degree of displacement of the tibial fractures remained unchanged during the 30 years, i.e, they were predominantly distal, longitudinal fractures with moderate displacement.

Adolescent↗
PubMed1988

Blood pressure does not predict mortality in the elderly.

The purpose of our study was to estimate the extent to which casual blood pressure measurements can predict mortality in elderly people in a defined population. A random sample of subjects born between 1890 and 1914 was extracted and their medical records were studied. Their earliest blood pressure record was chosen, provided the patient was at least 60 years old at the time of measurement. The population consisted of 961 patients (49.8% women), 560 of whom died between 1968 and 1987. Their mean age was 70.1 years and the total number of person-years involved was 8625. The mortality risk was estimated as a function of sex, present age, systolic (SBP) and diastolic (DBP) blood pressures, by a version of the Cox regression model. On the basis of close confidence intervals we conclude that blood pressure in the elderly is a very weak predictor of mortality.

Aged↗
PubMedDate not supplied

INDANA: a meta-analysis on individual patient data in hypertension. Protocol and preliminary results.

The overall effect of antihypertensive drug treatment has been well documented. The proportion of patients who benefit varies according to their baseline cardiovascular risk, and is small for the majority of people treated. Some investigators propose limiting the treatment target population to patients at high cardiovascular risk, but several assumptions must be made to justify this procedure. The INDANA project is a meta-analysis based on individual patient data, and thus offers the opportunity to check the validity of these assumptions. Its main objective is to identify responders (and non-responders) in the drug treatment of hypertension. The rationale and methods for such an approach are presented here, with the solution for some technical problems. The conclusion of the data collection has shown that the project is feasible. The results of the main analysis should be available in 1996, and should contribute to the selection of responders and to the individualization of the treatment of hypertension.

Humans↗