Publications by authors named "Sverre E Kjeldsen"

423 Publications

Attended vs. unattended blood pressure - learnings beyond SPRINT.

Blood Press 2021 Oct 29:1-3. Epub 2021 Oct 29.

University of Milano-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1080/08037051.2021.1995981DOI Listing
October 2021

The five RADIANCE-HTN and SPYRAL-HTN randomised studies suggest that the BP lowering effect of RDN corresponds to the effect of one antihypertensive drug.

Blood Press 2021 Oct 29:1-5. Epub 2021 Oct 29.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1995975DOI Listing
October 2021

The Oslo Ischaemia Study: cohort profile.

BMJ Open 2021 10 13;11(10):e049111. Epub 2021 Oct 13.

Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Purpose: The Oslo Ischaemia Study was designed to investigate the prevalence and predictors of silent coronary disease in Norwegian middle-aged men, specifically validating exercise electrocardiography (ECG) findings compared with angiography. The study has been important in investigating long-term predictors of cardiovascular morbidity and mortality, as well as investigating a broad spectrum of epidemiological and public health perspectives.

Participants: In 1972-1975, 2014 healthy men, 40-59 years old, were enrolled in the study. Comprehensive clinical examination included an ECG-monitored exercise test at baseline and follow-ups. The cohort has been re-examined four times during 20 years. Linkage to health records and national health registries has ensured complete endpoint registration of morbidity until the end of 2006, and cancer and mortality until the end of 2017.

Findings To Date: The early study results provided new evidence, as many participants with a positive exercise ECG, but no chest pain ('silent ischaemia'), did not have significant coronary artery stenosis after all. Still, they were over-represented with coronary disease after years of follow-up. Furthermore, participants with the highest physical fitness had lower risk of cardiovascular disease, and the magnitude of blood pressure responses to moderate exercise was shown to influence the risk of cardiovascular disease and mortality. With time, follow-up data allowed the scope of research to expand into other fields of medicine, with the aim of investigating predictors and the importance of lifestyle and risk factors.

Future Plans: Recently, the Oslo Ischaemia Study has been found worthy, as the first scientific study, to be preserved by The National Archives of Norway. All the study material will be digitised, free to use and accessible for all. In 2030, the Oslo Ischaemia Study will be linked to the Norwegian Cause of Death Registry to obtain complete follow-up to death. Thus, a broad spectrum of additional opportunities opens.
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http://dx.doi.org/10.1136/bmjopen-2021-049111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515426PMC
October 2021

Combining proteomics, home blood pressure telemonitoring and patient empowerment to improve cardiovascular and renal protection.

Blood Press 2021 10;30(5):267-268

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1975878DOI Listing
October 2021

Cuff-less measurements of blood pressure: are we ready for a change?

Blood Press 2021 08 26;30(4):205-207. Epub 2021 Jul 26.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1956178DOI Listing
August 2021

Why we do not need a single independent international hypertension clinical practice guideline.

J Hypertens 2021 11;39(11):2125-2127

University of Milano-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1097/HJH.0000000000002940DOI Listing
November 2021

Hypertension and heart failure with preserved ejection fraction: position paper by the European Society of Hypertension.

J Hypertens 2021 08;39(8):1522-1545

Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany.

Hypertension constitutes a major risk factor for heart failure with preserved ejection fraction (HFpEF). HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality. Specific guideline-directed medical therapy (GDMT) for HFpEF is not established due to lack of positive outcome data from randomized controlled trials (RCTs) and limitations of available studies. Although available evidence is limited, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers provides the backbone of BP-lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, we propose that this core drug treatment strategy is also applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor. In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors, currently already indicated for high-risk patients with diabetes to reduce heart failure hospitalizations, and finerenone represent promising therapies and results from ongoing RCTs are eagerly awaited. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high-quality RCTs are major unmet needs in hypertension research and calls for action.
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http://dx.doi.org/10.1097/HJH.0000000000002910DOI Listing
August 2021

Novel insights into stroke risk beyond resting and maximal bicycle exercise systolic blood pressure.

J Hypertens 2021 10;39(10):2022-2029

Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo.

Objective: Previous research has shown an association between moderate workload exercise blood pressure (BP) and coronary disease, whereas maximal exercise BP is associated with stroke. We aimed to investigate the association between the increase in BP during maximal exercise and the long-term risk of stroke in healthy, middle-aged men.

Methods: Two thousand and fourteen men were included in the Oslo Ischemia Study in the 1970s. In the present study, we examined baseline data of the 1392 participants who remained healthy and performed bicycle exercise tests both at baseline and 7 years later. Cox proportional hazard was used to assess the risk of stroke in participants divided into quartiles based on the difference between resting and maximal workload SBP (ΔSBP) at baseline, adjusting for resting BP, age, smoking, serum cholesterol and physical fitness. Follow-up was until the first ischemic or hemorrhagic stroke through 35 years.

Results: There were 195 incident strokes; 174 (89%) were ischemic. In univariate analyses, there were significant positive correlations between age, resting SBP, resting DBP and SBP at moderate and maximal workload, and risk of stroke. In the multivariate analysis, there was a 2.6-fold (P < 0.0001) increase in risk of stroke in ΔSBP quartile 4 (ΔSBP > 99 mmHg) compared with ΔSBP quartile 2 (ΔSBP 73-85 mmHg), which had the lowest risk of stroke. ΔSBP quartile 1 had a 1.7-fold (P = 0.02) increased risk compared with quartile 2, suggesting a J-shaped association to stroke risk.

Conclusion: Stroke risk increased with increasing difference between resting and maximal exercise SBP, independent of BP at rest, suggesting that an exaggerated BP response to physical exercise may be an independent predictor of stroke.
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http://dx.doi.org/10.1097/HJH.0000000000002894DOI Listing
October 2021

Better drug adherence improves blood pressure control and lowers cardiovascular disease outcomes - from single pill combinations to monitoring of a nationwide health insurance database.

Blood Press 2021 06 29;30(3):143-144. Epub 2021 Apr 29.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1917192DOI Listing
June 2021

Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus compared to all middle-aged and elderly hypertensive study patients with high cardiovascular risk.

Blood Press 2021 04 6;30(2):90-97. Epub 2021 Jan 6.

Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, NY, USA.

Purpose: Event-based clinical outcome trials have shown limited evidence to support guidelines recommendations to lower blood pressure (BP) to <130/80 mmHg in middle-aged and elderly hypertensive patients with diabetes mellitus or with general high cardiovascular (CV) risk. We addressed this issue by post-hoc analysing the risk of CV events in patients who participated in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial and compared the hypertensive patients with type 2 diabetes mellitus with all high-risk hypertensive patients.

Materials And Methods: Patients were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (<25% to ≥75%) in which BP was reduced to <140/90 or <130/80 mmHg. Patients with diabetes mellitus ( = 5250) were compared with the entire VALUE population with high CV risk ( = 15,245).

Results: After adjustments for baseline differences between groups, a reduction in the proportion of visits in which BP was reduced to <140/90 mmHg, but not to <130/80 mmHg, was accompanied by a progressive increase in the risk of CV morbidity and mortality as well as stroke, myocardial infarction and heart failure in both diabetes mellitus and in all high-risk patients. Target BP <130/80 mmHg reduced stroke risk in the main population but not in the diabetes mellitus patients. Patients with diabetes mellitus had higher event rates for the primary cardiac endpoint and all-cause mortality driven by a higher rate of heart failure.

Conclusion: In the high-risk hypertensive patients of the VALUE trial achieving more frequently BP <140/90 mmHg, but not <130/80 mmHg, showed principally the same protective effect on overall and cause-specific cardiovascular outcomes in patients with diabetes mellitus and in the general high-risk hypertensive population.
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http://dx.doi.org/10.1080/08037051.2020.1856642DOI Listing
April 2021

Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus and hypertension.

Blood Press 2021 04 6;30(2):82-89. Epub 2021 Jan 6.

Department of Cardiovascular Medicine, State University of New York, Downstate College of Medicine, NY, USA.

Purpose: Available data of event-based clinical outcomes trials show that little evidence supports the guidelines recommendations to lower blood pressure (BP) to <130/80 mmHg in middle-aged and elderly people with type 2 diabetes mellitus and hypertension. We addressed this issue by post-hoc analysing the risk of cardiovascular (CV) events in mostly elderly high-risk hypertensive patients with type 2 diabetes mellitus participating in the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial.

Material And Methods: Patients ( = 5250) were divided into 4 groups according to the proportion of on-treatment visits before the occurrence of an event (<25% to ≥ 75%) in which BP was reduced to <140/90 or <130/80 mmHg.

Results: After adjustment for baseline demographic differences between groups, a reduction in the proportion of visits in which BP achieved <140/90 mmHg accompanied a progressive increase in the risk of CV mortality and morbidity as well as of cause-specific events such as stroke, myocardial infarction and heart failure. A progressive reduction in the proportion of visits in which BP was reduced <130/80 mmHg did not have any effect on CV risks.

Conclusion: In mostly elderly high-risk hypertensive patients with type 2 diabetes mellitus participating in the VALUE trial, achieving more frequently BP <140/90 mmHg showed a marked protective effect on overall and all cause-specific cardiovascular outcomes. This was not the case for a more frequent achievement of the more intensive BP target, i.e. <130/80 mmHg.
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http://dx.doi.org/10.1080/08037051.2020.1855968DOI Listing
April 2021

Potential protective effects of antihypertensive treatments during the Covid-19 pandemic: from inhibitors of the renin-angiotensin system to beta-adrenergic receptor blockers.

Blood Press 2021 02 21;30(1):1-3. Epub 2020 Dec 21.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2021.1862483DOI Listing
February 2021

In memoriam: Jiří Widimský Sr. 1925-2020.

Blood Press 2021 04 21;30(2):140-142. Epub 2020 Dec 21.

University of Milano-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1080/08037051.2020.1859212DOI Listing
April 2021

In memoriam: Peter Sleight 1929-2020.

Blood Press 2020 12 6;29(6):382-384. Epub 2020 Nov 6.

University of Milano-Bicocca, Milan, Italy.

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http://dx.doi.org/10.1080/08037051.2020.1839224DOI Listing
December 2020

Was it optimal to drop a diuretic as a first-line choice of drug treatment in the 2020 International Society of Hypertension Guidelines?

Blood Press 2020 12 3;29(6):341-343. Epub 2020 Nov 3.

Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2020.1838766DOI Listing
December 2020

Ten-year prediction of cardiovascular disease in healthy Norwegian men, based on NORRISK-2.

Tidsskr Nor Laegeforen 2020 09 7;140(12). Epub 2020 Sep 7.

Background: Norwegian guidelines for primary prevention of cardiovascular disease recommend the use of the NORRISK-2 risk model, with some additions. We wished to investigate whether NORRISK-2 could predict cardiovascular disease in healthy Norwegian men who took part in the Oslo Ischaemia Study.

Material: NORRISK-2 scores were calculated for 2 014 men in the age group 40-60 years who were included in the Oslo Ischaemia Study in 1972-75. Cox regression analyses were used to calculate the hazard ratio for death and cardiovascular disease within ten years of the participants' initial assessment.

Results: No participant was lost to follow-up of the 2 014 men, 125 died in the first ten years after inclusion, 61 of whom died from cardiovascular disease. Those who died were older than those who survived, with a larger proportion of daily smokers, and they had higher systolic blood pressure and resting pulse, increased total cholesterol and lower physical fitness. The majority of those who died from acute myocardial infarction and ischaemic stroke within ten years were classified in the high-risk group in NORRISK-2.

Interpretation: NORRISK-2 satisfactorily identified the high-risk persons in this cohort of healthy, middle-aged Norwegian men. This supports use of the Norwegian guidelines in the decision on possible primary protection against cardiovascular disease.
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http://dx.doi.org/10.4045/tidsskr.20.0089DOI Listing
September 2020

The International Society of Hypertension Guidelines 2020 - a new drug treatment recommendation in the wrong direction?

Blood Press 2020 10 18;29(5):264-266. Epub 2020 Aug 18.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2020.1806494DOI Listing
October 2020

Smoking and overweight associated with masked uncontrolled hypertension: a Hypertension Optimal Treatment (HOT) Sub-Study.

Blood Press 2021 02 7;30(1):51-59. Epub 2020 Jul 7.

Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.

Purpose: The Hypertension Optimal Treatment (HOT) Study investigated the relationship between target office diastolic blood pressure (BP) ≤80, ≤85 or ≤90 mmHg and cardiovascular morbidity and mortality in 18,790 patients aged 50-80 years. The home BP sub-study enrolled 926 patients and the aim was to clarify whether the separation into the BP target groups in the office prevailed in the out-of-office setting. The present study aimed to identify variables that characterised masked uncontrolled hypertension (MUCH) and white coat uncontrolled hypertension (WUCH).

Material And Methods: The sub-study participants took their home BP when office BP had been up titrated. The cut-off for normal or high BP was set to ≥135/85 mmHg at home and ≥140/90 mmHg in the office. We analysed data by using multivariate and stepwise multivariate logistic regression with home and office BP combinations as the dependent variables.

Results: WUCH was associated with lower body mass index (BMI) (odds ratio (OR) 0.92, 95% confident intervals (CIs) 0.88-0.96,  < 0.001). MUCH was associated with smoking (OR 1.89, 95% CIs 1.25-2.86,  = 0.0025) and with lower baseline heart rate (OR 0.98, 95% CIs 0.97-0.99,  = 0.03) and higher BMI (OR 1.03, CIs 1.00-1.06,  = 0.04). MUCH remained associated with smoking (OR 2.76, 95% CIs 1.76-4.35,  < 0.0001) also when using ≥140/90 mmHg as the cut-off for both home and office BP. MUCH was also associated with higher BMI (OR 1.05, 95% CIs 1.01-1.09,  = 0.009) while WUCH was associated with lower BMI (OR 0.93, 95% CIs 0.90-0.97,  = 0.0005) when using ≥140/90 mmHg as a cut-off.

Conclusion: Our data support that 'reversed or masked' treated but uncontrolled hypertension (MUCH) is common and constitutes about 25% of treated hypertensive patients. This entity (MUCH) is rather strongly associated with current smoking and overweight while uncontrolled white coat (office) hypertension (WUCH) is associated with lower BMI.
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http://dx.doi.org/10.1080/08037051.2020.1787815DOI Listing
February 2021

On-treatment HDL cholesterol predicts incident atrial fibrillation in hypertensive patients with left ventricular hypertrophy.

Blood Press 2020 10 25;29(5):319-326. Epub 2020 Jun 25.

Division of Cardiology, Weill Cornell Medical College, New York, NY, USA.

: Hypertensive patients are at increased risk of atrial fibrillation (AF). Although low baseline high density lipoprotein (HDL) cholesterol has been associated with a higher risk of AF, this has not been verified in recent population-based studies. Whether changing levels of HDL over time are more strongly related to the risk of new AF in hypertensive patients has not been examined.: Incident AF was examined in relation to baseline and on-treatment HDL levels in 8267 hypertensive patients with no history of AF, in sinus rhythm on their baseline electrocardiogram, randomly assigned to losartan- or atenolol-based treatment. HDL levels at baseline and each year of testing were categorised into quartiles according to baseline HDL levels.: During 4.7 ± 1.10 years of follow-up, 645 patients (7.8%) developed new AF. In univariate Cox analyses, compared with the highest quartile of HDL levels (>1.78 mmol/l), patients with on-treatment HDL in the lowest quartile (≤ 1.21 mmol/l) had a 53% greater risk of new AF. Patients with on-treatment HDL in the second and third quartiles had intermediate increased risks of AF. Baseline HDL in the lowest quartile was not a significant predictor of new AF (hazard ratio (HR): 1.14, 95% confidence interval (CI): 0.90-1.43). In multivariable Cox analyses adjusting for multiple baseline and time-varying covariates, the lowest quartile of on-treatment HDL remained associated with a nearly 54% increased risk of new AF (HR: 1.54, 95% CI: 1.16-2.05) whereas a baseline HDL≤ ⩽1.21 mmol/l was not predictive of new AF (HR: 1.01, 95% CI: 0.78-1.31).: Lower on-treatment HDL is strongly associated with risk of new AF. These findings suggest that serial assessment of HDL can estimate AF risk better than baseline HDL in hypertensive patients with left ventricular hypertrophy. Future studies may investigate whether therapies that increase HDL can lower risk of developing AF.: http://clinicaltrials.gov/ct/show/NCT00338260?order=1.
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http://dx.doi.org/10.1080/08037051.2020.1782171DOI Listing
October 2020

Intensive systolic blood pressure control and prevention of new onset atrial fibrillation in the SPRINT study: is the association really controversial?

Blood Press 2020 08 25;29(4):199-201. Epub 2020 Jun 25.

Vascular Biology and Hypertension Programme, Department of Medicine, University of Alabama at Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2020.1782595DOI Listing
August 2020

Carotid Intima-Media Thickness Progression as Surrogate Marker for Cardiovascular Risk: Meta-Analysis of 119 Clinical Trials Involving 100 667 Patients.

Circulation 2020 08 17;142(7):621-642. Epub 2020 Jun 17.

Atherosclerosis Department (M. Safarova), National Medical Research Center of Cardiology, Moscow, Russia.

Background: To quantify the association between effects of interventions on carotid intima-media thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk.

Methods: We systematically collated data from randomized, controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were used. The primary outcome was a combined CVD end point defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the 2 using a Bayesian meta-regression approach.

Results: We analyzed data of 119 randomized, controlled trials involving 100 667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12 038 patients developed the combined CVD end point. Across all interventions, each 10 μm/y reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% Credible Interval, 0.87-0.94), with an additional relative risk for CVD of 0.92 (0.87-0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/y would yield relative risks of 0.84 (0.75-0.93), 0.76 (0.67-0.85), 0.69 (0.59-0.79), or 0.63 (0.52-0.74), respectively. Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary versus secondary prevention trials, type of cIMT measurement, and proportion of female patients.

Conclusions: The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.046361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7115957PMC
August 2020

Blood Pressure-Lowering Profiles and Clinical Effects of Angiotensin Receptor Blockers Versus Calcium Channel Blockers.

Hypertension 2020 06 27;75(6):1584-1592. Epub 2020 Apr 27.

Department of Cardiology (S.E.K., E.B.), Oslo University Hospital Ullevaal, Oslo, Norway.

Blood pressure-lowering drugs have different blood pressure-lowering profiles. We studied if differences in blood pressure mean and variability can explain the differences in risks of cardiovascular events and death among 15 245 high-risk hypertensive patients randomized to valsartan or amlodipine and followed for 4.2 years in the VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation). We selected patients with ≥3 visits and performed Cox regression analyses, defining mean blood pressure as a time-dependent covariate and visit-to-visit and within-visit blood pressure variability as the SD. Of 14 996 eligible patients, participants in the valsartan group had higher systolic mean blood pressure by 2.2 mm Hg, higher visit-to-visit systolic variability by 1.4 mm Hg, and higher within-visit systolic variability by 0.2 mm Hg ( values <0.0001). The higher risks of myocardial infarction and stroke in the valsartan group was attenuated after adjustment for mean and variability of systolic blood pressure, from HR 1.19 (95% CI, 1.02-1.39) to 1.11 (0.96-1.30) and from HR 1.13 (0.96-1.33) to 1.00 (0.85-1.18), respectively. The lower risk of congestive heart failure in the valsartan group was accentuated after adjustment, from HR 0.86 (0.74-1.00) to 0.76 (0.65-0.89). A smaller effect was seen on risk of death, from 1.01 (0.92-1.12) to 0.94 (0.85-1.04). In conclusion, the higher risks of myocardial infarction and stroke in patients randomized to valsartan versus amlodipine were related to the drugs' different blood pressure modulating profiles. The risk of congestive heart failure with valsartan was lower, independent of the less favorable blood pressure modulating profile.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.119.14443DOI Listing
June 2020

Eivind Berge, MD, PhD, 1964-2020: Cardiologist Who Was Fighting Stroke.

Stroke 2020 05 23;51(5):1353-1355. Epub 2020 Mar 23.

the Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.S.).

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http://dx.doi.org/10.1161/STROKEAHA.120.029351DOI Listing
May 2020

How to deal with the occurrence of rare drug-induced adverse events: the example of sprue-like enteropathy induced by olmesartan medoxomil and other angiotensin-receptor blockers.

Blood Press 2020 04 12;29(2):68-69. Epub 2020 Feb 12.

Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

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http://dx.doi.org/10.1080/08037051.2020.1726101DOI Listing
April 2020
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