860 research outputs found
Blood Pressure Management in Cardiovascular Risk Stratification. Procedure, Progression, Process.
No full textContains fulltext :
74853.pdf (Publisher’s version ) (Open Access)In this thesis we have explored different aspects of blood pressure measurement and related it to the risk of cardiovascular disease.
In the first part we showed that when the arm is positioned under heart level, for example when the arm is placed on a desk or a chair support, the blood pressure and the cardiovascular risk is overstimated. We demonstrated that crossing the legs at the level of the knee, but not at the level of the ankle, causes a rise of blood pressure. We proved that the physiological mechanism causing the blood pressure rise was a rise in stroke volume and cardiac output.
In the second part, we have investigated the separate contribution of the hospital environment and the presence of the physician on the white coat effect (a higher blood pressure at home, than in the hospital in the presence of a doctor). We concluded that the hospital environment had a larger influence on the white coat effect than the presence of a physician. We also reviewed the present literature regarding diagnostic and therapeutic thresholds of the self-measured blood pressure at home and proposed new cut-off values for optimal, normal and high cardiovascular risk.
In the third and last part we reviewed and explored a new index for arterial stiffness (the ambulatory arterial stiffness index, AASI). Arterial stiffness marks the ageing of arteries and is a precursor and marker of cardiovascular disease. The AASI is determined by simple 24-hour blood pressure monitoring. We studied the reproducibility of the AASI and concluded that is was as reproducible as other ambulatory markers of cardiovascular risk. We have set quality criteria for the AASI and demonstrated that this new index is ready to be used in cardiovascular risk stratification on a large scale.RU Radboud Universiteit Nijmegen, 22 december 2009Promotores : Thien, Th., Staessen, J.A. Co-promotor : Deinum, J.216 p
Low-denisty lipoprotein cholesterol and mortality in older people
No full textOBJECTIVES:
To investigate the role of low-density lipoprotein cholesterol (LDL-C) as a predictor of mortality in elderly subjects.
DESIGN:
Population-based prospective cohort study.
SETTING:
Two communities in northern Italy.
PARTICIPANTS:
Three thousand one hundred twenty Caucasian subjects aged 65 and older recruited in for the Cardiovascular Study in the Elderly and followed up for 12 years.
MEASUREMENTS:
Anthropometric measures: fasting plasma total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C, glucose, creatinine, and body mass index. Clinical measures: medical assessment, diabetes mellitus, hypertension, stroke, coronary disease, heart failure, and smoking and drinking habits. Vital status measures: death certificates from the Registry Office and causes of death according to the International Classification of Diseases. After plotting mortality rates using quartiles of LDL-C, relative hazard rates (RHRs) were calculated using multivariate Cox regression analyses. When the trend was nonlinear, the RHRs were further calculated for the 25th, 50th, and 75th percentiles of the distribution to confirm curvilinearity.
RESULTS:
The distribution of risk of total mortality in women and of fatal heart failure in all subjects was curvilinear (non J-shaped), decreasing nonlinearly with LDL-C. For total mortality in men and cardiovascular mortality in both sexes, the relationship with LDL-C was J-shaped. The risk of fatal myocardial infarction was J-shaped in men, whereas it increased linearly with higher LDL-C in women. In both sexes, the association between stroke mortality and LDL-C was not significant.
CONCLUSION:
This study adds to the uncertainty of the role of elevated levels of LDL-C as a risk factor for mortality in old people
Haematological phenotypes in relation to the C1797T beta-adducin polymorphism in a Caucasian population
No full textbeta-Adducin plays a role in maintaining the structural integrity of the red blood cell (erythrocyte) membrane. Moreover, beta-adducin-deficient knock-out mice show a phenotype characterized by mild anaemia and compensated haemolysis. We therefore investigated whether, in humans, common haematological phenotypes of red blood cells were associated with a polymorphism in exon 15 of the human beta-adducin gene (C1797T). We studied 802 unrelated individuals and 294 families (459 parents and 609 offspring) randomly selected from a Caucasian population. We employed generalized estimating equations to allow for the non-independence of the observations within families, while controlling for co-variables. In 917 men, with adjustments applied for age, body mass index, serum total cholesterol, smoking and alcohol intake, CC homozygotes had significantly ( P =0.02) lower values for red blood cell count (4.93 x 10(12)/l compared with 4.86 x 10(12)/l), haemoglobin level (9.30 compared with 9.18 mmol/l) and haematocrit (45.0% compared with 44.4%) than T allele carriers. In the 329 men who consumed alcohol, the differences between CC homozygotes and T allele carriers were 0.13 x 10(12)/l ( P =0.02) for red blood cell count, 0.23 mmol/l ( P =0.005) for haemoglobin and 1.08% ( P =0.02) for haematocrit. In 953 women, none of these associations was significant ( P >/=0.06), regardless of alcohol intake [13.3% of women ( n =127) consmued alcohol]. In conclusion, in men consuming alcohol, the beta-adducin CC genotype was associated with lower red blood cell count, haemoglobin level and haematocrit. We hypothesize that, in CC homozygotes, alcohol consumption may unveil the greater fragility of the red blood cell membrane. This genotype may slightly potentiate the structural and functional haematological disturbances associated with alcohol intake
Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial
No full textstatus: Publishe
Randomized study of traditional versus aggressive systolic blood pressure control (Cardio-Sis): rationale, design and characteristics of the study population
No full textRandomized study of traditional versus aggressive systolic blood pressure control (Cardio-Sis): rationale, design and characteristics of the study population
Cardio-Sis Study Group (see appendix)
ABSTRACT
The hypothesis that a therapeutic strategy aimed at lowering systolic blood pressure (SBP) below 130 mm Hg is superior to a conventional strategy targeted at below 140 mm Hg in hypertensive subjects has never been tested in randomized intervention studies. The Studio Italiano Sugli Effetti Cardiovascolari del Controllo della Pressione Arteriosa Sistolica (Cardio-Sis) is a multi-centre study in non-diabetic, treated hypertensive subjects aged >55 years with uncontrolled SBP ( 150 mm Hg) and at least one additional cardiovascular risk factor (ClinicalTrials.gov identifier: NCT00421863). Subjects are randomized to an SBP goal <140 mm Hg (conventional) or <130 mm Hg (aggressive), independently of baseline and achieved diastolic blood pressure (BP). Anti-hypertensive drugs dispensed for the study are restricted to a list of specific drugs. The primary outcome of the study is based on regression of left ventricular hypertrophy (LVH) using electrocardiography (ECG). The hypothesis is that subjects without LVH regression or with new development of LVH 2 years after randomization are 19% with conventional strategy and 12% with aggressive strategy. Secondary outcome is a composite pool of pre-specified fatal and non-fatal events. Randomization of 1111 subjects was completed by February 2007. Mean age of subjects (41% men) at entry was 67 years. BP was 158/87 mm Hg (systolic/diastolic) and prevalence of LVH by ECG was 21.0%. Cardio-Sis is the first randomized study specifically designed to compare two different SBP goals. Results will be broadly applicable to subjects with uncontrolled SBP under anti-hypertensive treatment
Characterisation of hypertensive patients according to 24 H peripheral resistance.
No full textTo clarify whether a circadian rhythm of peripheral resistance exists in humans and whether hypertensive patients represent a homogeneous category in this respect, 15 normotensives aged 31 +/- 4 years and 30 hypertensives aged 41 +/- 13 years were confined to bed for 22 h and forearm flow recorded automatically. Night-time BP values were higher in hypertensive patients (Group B) whose night/day ratios of mean BP were below the 95% C.I. of the normal regression of the normotensives, than in those falling within the 95% C.I. (Group A). Forearm resistance was lower during sleep than during waking in Group A and in the normotensive controls, paralleling the nocturnal blood pressure fall. On the contrary, in the Group B hypertensives, despite a comparable night-time BP decrease, forearm resistance was higher during sleep than during waking
Longkankerrisico en blootstelling aan Cadmium via het milieu: antwoord op de kritiek met toetsing van de causaliteit
No full textWe investigated whether the risk of lung cancer is related to environmental exposure to cadmium. From 1985-1989 we randomly recruited 994 subjects from areas with low and high exposure to cadmium. We measured their 24-hour urinary cadmium excretion, an index of lifelong exposure, as well as the cadmium concentration in the soil of their kitchen gardens. The cadmium concentration in the soil ranged from 0.8 to 17.0 mg/kg. The 24-hour urinary cadmium excretion averaged 12.3 nmol in residents of the polluted area, compared to 7.7 nmol in the reference area (p < 0.0001). During 17.2 years (median) of follow-up, 53 fatal and 20 non-fatal cancers occurred, of which 18 and 1 were lung cancers (outcome updated until 31 October 2004). The hazard ratios for lung cancer adjusted for sex, age and smoking, were 1.70 (1.13-2.57; p = 0.011) for a doubling of the urinary cadmium excretion, 4.17 (1.21-14.4; p = 0.024) for residing in the high versus low exposure area, and 1.57 (1.11-2.24; p = 0.012) for a doubling of the cadmium concentration in the soil. In the first part of the present overview, we summarized our findings which were previously published in English. Next, we report the results of additional analyses, which we executed in response to the critical comments on our primary study. We also verified our primary and additional study results according to the Bradford-Hill criteria to detect a causal association. Finally, we reviewed possible mechanisms underlying the association between lung cancer and exposure to cadmium as well as the preventive measures which can be implemented in areas environmentally polluted by cadmium.status: Publishe
Treatment of hypertension in the elderly in 2010 - a brief review
No full textImportance of the field: Populations, the world over, age. Prevalence of hypertension increases with advancing age. Despite the advances over the past 30 years, there are still unresolved issues regarding antihypertensive therapy in the elderly. Areas covered in this review: The present review discusses the available evidence supporting treatment of hypertension in the elderly. What the reader will gain: In the 1980s and 1990s, a number of trials were performed and proved that active treatment of hypertension in individuals above the age of 60-65 years, compared with placebo or no treatment, reduces the risk of complications. In the 1990s, the same was proven in patients specifically affected with isolated systolic hypertension, the predominant form of hypertension in the elderly. The subsequent years witnessed the publication of trials that showed that most antihypertensive drugs are capable of substantially reducing risk. Finally, treatment of hypertension in the very elderly was proven to be beneficial. Take home message: In spite of these advances, we still lack evidence in elderly patients with mild isolated systolic hypertension and are therefore in need of a properly designed, randomized, placebo-controlled trial
The determinants and prognostic significance of serum uric acid in elderly patients of the European Working Party on High Blood Pressure in the Elderly trial
No full textURDICO - Urban Dimension of Cohesion Policy and other EU Programmes: Policy Brief
No full textThis policy brief, based on the ESPON URDICO final report, examines how the urban dimension of EU Cohesion Policy has been implemented across eight European cities. It highlights how cities interact with national and regional authorities, align EU funds with local long-term agendas, and contribute to broader EU goals. Cohesion Policy, accounting for nearly one-third of the EU budget, aims to promote balanced territorial development and reduce disparities between regions. Cities play a central role as engines of economic growth and social innovation, yet their influence and capacity vary widely. Over time, the urban dimension has evolved from a marginal concern to a strategic focus, from the early URBAN I and II programmes to the introduction of Sustainable Urban Development (SUD), Integrated Territorial Investments (ITI), and Community-Led Local Development (CLLD) in 2014–2020. These tools enabled cities to develop place-based, integrated strategies, supported by multi-level governance and dedicated funding. The 2021–2027 programming period reinforced these mechanisms, increasing urban earmarking and expanding the focus on climate, digital transformation, and social resilience. Nonetheless, challenges remain, including uneven administrative capacity, varying financial access, and limited autonomy for local authorities. URDICO’s findings illustrate both the potential and the constraints of urban-centred cohesion strategies, offering insights and recommendations to strengthen the role of cities in the post-2027 EU policy framework
- …
