Papers by K. Björklund-bodegård
Hipertensión y Riesgo Vascular, 2006
ABSTRACT Antecedentes A nivel poblacional, la hipertensión es el factor de riesgo más importante ... more ABSTRACT Antecedentes A nivel poblacional, la hipertensión es el factor de riesgo más importante para la aparición de insuficiencia cardíaca; sin embargo, la relación entre un patrón tensional actividadsueño alterado y entre la incidencia de insuficiencia cardíaca se desconoce Objetivos Evaluar las características del registro de 24 horas de presión arterial (monitorización ambulatoria de la presión arterial [MAPA]) como predictor de insuficiencia cardíaca e investigar si un patrón actividad-sueño alterado aporta alguna información adicional a las tomas tensionales en la consulta sobre el riesgo de insuficiencia cardíaca. Diseño, ámbito y participantes. Cohorte poblacional prospectiva en Uppsala (Suecia), que incluyó a 951 varones ancianos en la visita basal (70 años) y sin insuficiencia cardíaca, enfermedad valvular ni hipertrofia ventricular izquierda por criterios electrocardiográficos entre 1990 y 1995. La cohorte se siguió hasta el final de 2002 (seguimiento medio de 9,1 años). Se realizó MAPA basal y las variables tensionales se analizaron como posibles predictores de insuficiencia cardíaca. Variable principal de medida. Primera hospitalización por insuficiencia cardíaca Resultados Setenta varones desarrollaron insuficiencia cardíaca durante el seguimiento, con una tasa de incidencia de 8,6 por 1.000 personas-año. En el análisis multivariante de Cox, tras ajuste por tratamiento antihipertensivo y por factores conocidos de insuficiencia cardíaca (infarto de miocardio, diabetes, tabaquismo, índice de masa corporal y perfil lipídico), el incremento de una desviación estándar (9 mmHg) en la presión diastólica nocturna (hazard risk [HR]: 1,26; intervalo de confianza al 95% [IC 95%]: 1,02–1,55) y un patrón circadiano no-dipper (cociente de presión ambulatoria noche-día: ≥ 1; HR: 2,29; IC 95%: 1,16–4,52) se asociaron con un incremento de riesgo de desarrollar insuficiencia cardíaca. Tras ajustar por las cifras tensionales de la consulta, el patrón no-dipper siguió siendo predictor de insuficiencia cardíaca (HR: 2,21; IC 95%: 1,12–4,36; en comparación con el patrón noche-día normal). La presión arterial diastólica nocturna y el patrón no-dipper siguieron siendo predictores de insuficiencia cardíaca tras excluir del análisis los pacientes que habían sufrido un infarto antes de la visita basal o durante el seguimiento Conclusiones La presión arterial nocturna aporta información adicional sobre el riesgo de insuficiencia cardíaca, más allá de las lecturas tensionales de consulta o los factores de riesgo clásicos. El papel clínico de este hallazgo deberá ser evaluado en futuros estudios
Blood Pressure Monitoring, 2007
The International Database on Ambulatory Blood Pressure Monitoring (1993-1994) lacked a prospecti... more The International Database on Ambulatory Blood Pressure Monitoring (1993-1994) lacked a prospective dimension. We are constructing a new resource of longitudinal population studies to investigate with great precision to what extent the ambulatory blood pressure improves risk stratification. The acronym IDACO refers to the new International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome. Eligible studies are population based, have fatal as well as nonfatal outcomes available for analysis, comply with ethical standards, and have been previously published in peer-reviewed journals. In a meta-analysis based on individual patient data, composite and cause-specific cardiovascular events will be related to various indexes derived by ambulatory blood pressure monitoring. The analyses will be stratified by cohort and adjusted for the conventional blood pressure and other cardiovascular risk factors. To date, the international database includes 7609 patients from four cohorts recruited in Copenhagen, Denmark (n=2311), Noorderkempen, Belgium (n=2542), Ohasama, Japan (n=1535), and Uppsala, Sweden (n=1221). In these four cohorts, during a total of 69,295 person-years of follow-up (median 9.3 years), 1026 patients died and 929 participants experienced a fatal or nonfatal cardiovascular event. Follow-up in five other eligible cohorts, involving a total of 4027 participants, is still in progress. We expect that this follow-up will be completed by the end of 2007. The international database of ambulatory blood pressure in relation to cardiovascular outcome will provide a shared resource to investigate risk stratification by ambulatory blood pressure monitoring to an extent not possible in any earlier individual study.
American Journal of Hypertension, 2013
on behalf of the International Database on Ambulatory blood pressure in relation to Cardiovascula... more on behalf of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators
Journal of Hypertension, 2007
Objective To investigate the multivariate-adjusted predictive value of systolic and diastolic blo... more Objective To investigate the multivariate-adjusted predictive value of systolic and diastolic blood pressures on conventional (CBP) and daytime (10-20 h) ambulatory (ABP) measurement.
Journal of Hypertension, 2010
We and other investigators previously reported that isolated nocturnal hypertension on ambulatory... more We and other investigators previously reported that isolated nocturnal hypertension on ambulatory measurement (INH) clustered with cardiovascular risk factors and was associated with intermediate target organ damage. We investigated whether INH might also predict hard cardiovascular endpoints. We monitored blood pressure (BP) throughout the day and followed health outcomes in 8711 individuals randomly recruited from 10 populations (mean age 54.8 years, 47.0% women). Of these, 577 untreated individuals had INH (daytime BP <135/85 mmHg and night-time BP ≥120/70 mmHg) and 994 untreated individuals had isolated daytime hypertension on ambulatory measurement (IDH; daytime BP ≥135/85 mmHg and night-time BP <120/70 mmHg). During follow-up (median 10.7 years), 1284 deaths (501 cardiovascular) occurred and 1109 participants experienced a fatal or nonfatal cardiovascular event. In multivariable-adjusted analyses, compared with normotension (n = 3837), INH was associated with a higher risk of total mortality (hazard ratio 1.29, P = 0.045) and all cardiovascular events (hazard ratio 1.38, P = 0.037). IDH was associated with increases in all cardiovascular events (hazard ratio 1.46, P = 0.0019) and cardiac endpoints (hazard ratio 1.53, P = 0.0061). Of 577 patients with INH, 457 were normotensive (<140/90 mmHg) on office BP measurement. Hazard ratios associated with INH with additional adjustment for office BP were 1.31 (P = 0.039) and 1.38 (P = 0.044) for total mortality and all cardiovascular events, respectively. After exclusion of patients with office hypertension, these hazard ratios were 1.17 (P = 0.31) and 1.48 (P = 0.034). INH predicts cardiovascular outcome in patients who are normotensive on office or on ambulatory daytime BP measurement.
Hypertension, 2012
The significance of white-coat hypertension in older persons with isolated systolic hypertension ... more The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular
Hypertension, 2011
To analyze sex-specific relative and absolute risks associated with blood pressure (BP), we perfo... more To analyze sex-specific relative and absolute risks associated with blood pressure (BP), we performed conventional and 24-hour ambulatory BP measurements in 9357 subjects (mean age, 52.8 years; 47% women) recruited from 11 populations. We computed standardized multivariable-adjusted hazard ratios for associations between outcome and systolic BP. During a course of 11.2 years (median), 1245 participants died, 472 of cardiovascular causes. The number of fatal combined with nonfatal events was 1080, 525, and 458 for cardiovascular and cardiac events and for stroke, respectively. In women and men alike, systolic BP predicted outcome, irrespective of the type of BP measurement. Women compared with men were at lower risk (hazard ratios for death and all cardiovascular eventsϭ0.66 and 0.62, respectively; PϽ0.001). However, the relation of all cardiovascular events with 24-hour BP (Pϭ0.020) and the relations of total mortality (Pϭ0.023) and all cardiovascular (Pϭ0.0013), cerebrovascular (Pϭ0.045), and cardiac (Pϭ0.034) events with nighttime BP were steeper in women than in men. Consequently, per a 1-SD decrease, the proportion of potentially preventable events was higher in women than in men for all cardiovascular events (35.9% vs 24.2%) in relation to 24-hour systolic BP (1-SD, 13.4 mm Hg) and for all-cause mortality (23.1% vs 12.3%) and cardiovascular (35.1% vs 19.4%), cerebrovascular (38.3% vs 25.9%), and cardiac (31.0% vs 16.0%) events in relation to systolic nighttime BP (1-SD, 14.1 mm Hg). In conclusion, although absolute risks associated with systolic BP were lower in women than men, our results reveal a vast and largely unused potential for cardiovascular prevention by BP-lowering treatment in women. (Hypertension. 2011;57:397-405.) • Online Data Supplement
Hypertension, 2014
Outcome-driven recommendations about time intervals during which ambulatory blood pressure should... more Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascul...
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Papers by K. Björklund-bodegård