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Alexithymia, hypochondriacal beliefs, and psychological distress among frequent attenders in primary health care.

https://arctichealth.org/en/permalink/ahliterature52562
Source
Compr Psychiatry. 1999 Jul-Aug;40(4):292-8
Publication Type
Article
Author
S. Jyväsjärvi
M. Joukamaa
E. Väisänen
P. Larivaara
S L Kivelä
S. Keinänen-Kiukaanniemi
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Oulu University Hospital, Finland.
Source
Compr Psychiatry. 1999 Jul-Aug;40(4):292-8
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Affective Symptoms - diagnosis - psychology
Comparative Study
Female
Finland
Humans
Hypochondriasis - psychology
Male
Mental Health Services - utilization
Patient Acceptance of Health Care - psychology
Primary Health Care
Psychiatric Status Rating Scales
Questionnaires
Research Support, Non-U.S. Gov't
Retrospective Studies
Severity of Illness Index
Abstract
Frequent use of health services has been associated with such concepts as alexithymia, hypochondriasis, and psychological distress. The aim of this case-control study was firstly to assess whether alexithymia, hypochondriasis, and psychological distress are associated with frequent attendance and secondly to assess the gender differences of these associations in a primary health care setting. A sample of 304 frequent attenders (eight or more visits during 1 year), including all of the frequent attenders during 1994, and 304 randomly selected age- and sex-matched controls were selected. Half of the sample (every second individual selected in date-of-birth order) was invited for an interview, 113 frequent attenders and 107 controls completed a questionnaire during the interview. Alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20), hypochondriasis was screened with the Whiteley Index (WI), and Symptom Checklist-36 (SCL-36) was used to determine psychological distress. We found a distinct gender difference in the associations of these characteristics with frequent attending. Significant associations of alexithymia, hypochondriasis, and psychological distress with frequent attending were found among men, but not among women. Alexithymia, hypochondriasis, and psychological distress should be considered when treating frequent attenders, especially males.
PubMed ID
10428189 View in PubMed
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Antihypertensive drugs as predictors of type 2 diabetes among subjects with impaired glucose tolerance.

https://arctichealth.org/en/permalink/ahliterature47792
Source
Diabetes Res Clin Pract. 2000 Dec;50(3):231-9
Publication Type
Article
Date
Dec-2000
Author
U. Rajala
Q. Qiao
M. Laakso
S. Keinänen-Kiukaanniemi
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Aapistie 1, 90220, Oulu, Finland. urajala@ccoulu.fi
Source
Diabetes Res Clin Pract. 2000 Dec;50(3):231-9
Date
Dec-2000
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Body mass index
Cohort Studies
Diabetes Mellitus, Type 2 - epidemiology
Disease Progression
Finland - epidemiology
Glucose Intolerance - epidemiology - physiopathology
Glucose Tolerance Test
Humans
Hypertension - drug therapy - epidemiology
Incidence
Insulin - blood
Lipoproteins, HDL Cholesterol - blood
Male
Middle Aged
Predictive value of tests
Prevalence
Prognosis
Research Support, Non-U.S. Gov't
Risk factors
Triglycerides - blood
Abstract
AIMS: to examine the incidence rate of progression to Type 2 diabetes and baseline prognostic risk factors, focusing on hypertension and antihypertensive medication, in a cohort (n=207) with impaired glucose tolerance (IGT). METHODS: after 2 and 4.6 (1. 9-6.4) years new cases of diabetes were diagnosed by the oral glucose tolerance test (OGTT). Hypertension (BP 160/95 or antihypertensive medication) was included in multiple regression analyses to assess the effect of risk factors on the development of diabetes. RESULTS: diabetes developed in 32 subjects (19%), an incidence of 41/1000 (95% CI 28-57/1000) person-years. In univariate analyses, progression to diabetes was associated with a high (>9.0 mmol/l) 2-h OGTT value (P=0.008), a high fasting insulin (>12.0 mU/l) level (P=0.000), a high triglyceride (>/=1.3 mmol/l) level (P=0.028), a high BMI (>/=28.0 kg/m(2)) (P=0.013) and hypertension (P=0.003). The risk for the development of diabetes was not increased in hypertensive subjects without antihypertensive medication compared with normotensive subjects (OR 0.8, 95% CI 0.3-2. 6). However, it was increased in subjects with on medication, especially diuretics alone or in combination with other drugs. Hypertensive subjects on diuretics had higher levels of fasting insulin and triglycerides and higher BMIs at baseline than normotensive subjects. After adjustment for 2-h OGTT, fasting insulin, triglycerides and BMI, the OR for diabetes was 7.7 (95% CI 2.1-28.2) in hypertensive subjects using diuretics alone or in combination with other drugs and 2.6 (95% CI 1.0-6.7) in those using other drugs compared with normotensive subjects. The OR of diabetes corresponding to a one-unit increase in the 2-h OGTT concentration was 2.5 (95% CI 1.6-4.0) in the whole cohort. CONCLUSIONS: the rate of progression from IGT to Type 2 diabetes in this population was similar to that seen in other studies among Caucasian populations. The use of antihypertensive medication, especially diuretics, and a high 2-h OGTT level were significant predictors of subsequent deterioration to diabetes.
PubMed ID
11106838 View in PubMed
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Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study.

https://arctichealth.org/en/permalink/ahliterature153274
Source
Diabetologia. 2009 Mar;52(3):433-42
Publication Type
Article
Date
Mar-2009
Author
C. Herder
M. Peltonen
W. Koenig
K. Sütfels
J. Lindström
S. Martin
P. Ilanne-Parikka
J G Eriksson
S. Aunola
S. Keinänen-Kiukaanniemi
T T Valle
M. Uusitupa
H. Kolb
J. Tuomilehto
Author Affiliation
Institute for Clinical Diabetology, German Diabetes Centre, Leibniz Centre at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Source
Diabetologia. 2009 Mar;52(3):433-42
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Blood Glucose - metabolism
Blood pressure
Body mass index
Body Weight
C-Reactive Protein - metabolism
Calorimetry
Diabetes Mellitus - epidemiology - etiology - prevention & control
Dietary Fiber
Energy intake
Exercise
Finland
Glucose Intolerance - prevention & control
Humans
Inflammation - complications - prevention & control
Insulin - blood
Leisure Activities
Life Style
Middle Aged
Patient Education as Topic
Risk factors
Waist Circumference
Abstract
Subclinical inflammation confers an increased risk of type 2 diabetes, cardiovascular disease, neurodegenerative disorders and other age-related chronic diseases. Physical activity and diet can attenuate systemic immune activation, but it is not known which individual components of a comprehensive lifestyle intervention are most effective in targeting subclinical inflammation.
We used data from the baseline examination and the 1 year follow-up of a subsample of 406 of 522 participants of the Finnish Diabetes Prevention Study (DPS) to estimate the effect of individual components of lifestyle intervention on C-reactive protein (CRP) and IL-6 levels, which represent the best characterised proinflammatory risk factors for type 2 diabetes. Changes in metabolic markers, dietary patterns and exercise were analysed to determine which were most strongly associated with the anti-inflammatory effect of lifestyle changes.
Lifestyle intervention reduced circulating levels of CRP (p
PubMed ID
19130041 View in PubMed
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Association between a deletion/insertion polymorphism in the alpha2B-adrenergic receptor gene and insulin secretion and Type 2 diabetes. The Finnish Diabetes Prevention Study.

https://arctichealth.org/en/permalink/ahliterature178849
Source
Diabetologia. 2004 Aug;47(8):1416-24
Publication Type
Article
Date
Aug-2004
Author
N. Siitonen
J. Lindström
J. Eriksson
T T Valle
H. Hämäläinen
P. Ilanne-Parikka
S. Keinänen-Kiukaanniemi
J. Tuomilehto
M. Laakso
M. Uusitupa
Author Affiliation
Department of Clinical Nutrition and Food and Health Research Center, University of Kuopio, Kuopio, Finland. nsiitone@hytti.uku.fi
Source
Diabetologia. 2004 Aug;47(8):1416-24
Date
Aug-2004
Language
English
Publication Type
Article
Keywords
Blood Glucose - metabolism
Body mass index
Diabetes Mellitus, Type 2 - genetics - prevention & control
Female
Finland
Genotype
Glucose Tolerance Test
Humans
Insulin - blood
Male
Middle Aged
Mutagenesis, Insertional - genetics
Receptors, Adrenergic, alpha-2 - genetics
Sequence Deletion
Abstract
Impaired insulin secretion has a strong genetic component. In this study we investigated whether the 12Glu9 polymorphism in the gene encoding the alpha2B-adrenergic receptor ( ADRA2B) is associated with insulin secretion and/or the incidence of Type 2 diabetes in individuals with impaired glucose tolerance.
We investigated a total of 506 subjects with impaired glucose tolerance participating in the Finnish Diabetes Prevention Study (DPS). Participants were randomly assigned to an intervention group or a control group. Anthropometric measurements and an oral glucose tolerance test were performed at baseline and at annual follow-up. In a subgroup of patients (n=83), a frequently sampled intravenous glucose tolerance test (FSIGT) was performed at baseline.
All patients had similar anthropometric measurements and insulin and glucose levels at baseline. Multiple logistic regression analysis revealed significant interaction (p=0.003) between study group and genotype across the entire study population. In the control group, subjects with the Glu9 allele had an increased risk of developing Type 2 diabetes compared with subjects with the Glu12/12 genotype (odds ratio [OR]=2.68, 95% CI 1.02-7.09, p=0.047 for Glu12/12, and OR=5.17, 95% CI 1.76-15.21, p=0.003 for Glu9/9). This increased risk was not observed in the intervention group, who showed significant weight loss during the trial. In the subgroup who underwent the FSIGT, subjects with the Glu9/9 genotype showed the lowest acute insulin response (p=0.005 for trend).
The 12Glu9 polymorphism of ADRA2B is associated with impaired first-phase insulin secretion and may predict the development of Type 2 diabetes in subjects with impaired glucose tolerance who are not subjected to a lifestyle intervention.
PubMed ID
15309292 View in PubMed
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Association of Long-Term Dietary Fat Intake, Exercise, and Weight with Later Cognitive Function in the Finnish Diabetes Prevention Study.

https://arctichealth.org/en/permalink/ahliterature276114
Source
J Nutr Health Aging. 2016 Feb;20(2):146-54
Publication Type
Article
Date
Feb-2016
Author
J. Lehtisalo
J. Lindström
T. Ngandu
M. Kivipelto
S. Ahtiluoto
P. Ilanne-Parikka
S. Keinänen-Kiukaanniemi
J G Eriksson
M. Uusitupa
J. Tuomilehto
J. Luchsinger
Source
J Nutr Health Aging. 2016 Feb;20(2):146-54
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Aged
Body mass index
Body Weight
Cognition
Cognition Disorders - etiology
Dementia - etiology
Diabetes Mellitus - prevention & control
Diet
Dietary Fats - administration & dosage - adverse effects
Energy intake
Exercise
Female
Finland
Food Habits
Glucose Intolerance - complications
Humans
Life Style
Male
Middle Aged
Obesity - complications
Waist Circumference
Weight Loss
Abstract
To investigate associations of long-term nutrient intake, physical activity and obesity with later cognitive function among the participants in the Finnish Diabetes Prevention Study, in which a lifestyle intervention was successful in diabetes prevention.
An active lifestyle intervention phase during middle age (mean duration 4 years) and extended follow-up (additional 9 years) with annual lifestyle measurements, followed by an ancillary cognition assessment.
5 research centers in Finland.
Of the 522 middle-aged, overweight participants with impaired glucose tolerance recruited to the study, 364 (70%) participated in the cognition assessment (mean age 68 years).
A cognitive assessment was executed with the CERAD test battery and the Trail Making Test A on average 13 years after baseline. Lifestyle measurements included annual clinical measurements, food records, and exercise questionnaires during both the intervention and follow-up phase.
Lower intake of total fat (p=0.021) and saturated fatty acids (p=0.010), and frequent physical activity (p=0.040) during the whole study period were associated with better cognitive performance. Higher BMI (p=0.012) and waist circumference (p=0.012) were also associated with worse performance, but weight reduction prior to the cognition assessment predicted worse performance as well (decrease vs. increase, p=0.008 for BMI and p=0.002 for waist).
Long-term dietary fat intake, BMI, and waist circumference have an inverse association with cognitive function in later life among people with IGT. However, decreases in BMI and waist prior to cognitive assessment are associated with worse cognitive performance, which could be explained by reverse causality.
PubMed ID
26812510 View in PubMed
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Association of neck circumference with insulin resistance-related factors.

https://arctichealth.org/en/permalink/ahliterature47538
Source
Int J Obes Relat Metab Disord. 2002 Jun;26(6):873-5
Publication Type
Article
Date
Jun-2002
Author
M. Laakso
V. Matilainen
S. Keinänen-Kiukaanniemi
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland. mauri.laakso@oulu.fi
Source
Int J Obes Relat Metab Disord. 2002 Jun;26(6):873-5
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Abdomen
Adipose Tissue
Anthropometry
Blood Glucose - metabolism
Body constitution
Body mass index
Comparative Study
Female
Glucose Intolerance - epidemiology
Humans
Hyperinsulinism - epidemiology
Hyperlipidemia - epidemiology
Hypertension - epidemiology
Insulin - blood
Insulin Resistance
Lipids - blood
Male
Neck - anatomy & histology
Obesity - epidemiology - physiopathology
Abstract
AIM: Overall and central obesity are associated with disorders in lipid and glucose metabolism, insulin resistance, hypertension, atherosclerosis and type 2 diabetes. Waist circumference and abdominal sagittal diameter have been suggested as the best simple anthropometric indexes of abdominal visceral fat accumulation. The aim of the present study was to test the association of neck circumference with abdominal and general obesity as well as with insulin resistance related factors. METHOD: Neck circumference was measured in addition to the traditional anthropometric measures and blood lipids, insulin and glucose concentrations and blood pressure. RESULTS: The prevalence rates of disorders in lipid or glucose metabolism and high fasting insulin concentrations were highest in the highest quintiles of all the anthropometric measures. CONCLUSION: We conclude that neck circumference is associated with the metabolic disorders related to insulin resistance. The measurement of neck circumference could be useful in clinical screening for persons at an enhanced risk for insulin resistance.
PubMed ID
12037660 View in PubMed
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Association of the Leu72Met polymorphism of the ghrelin gene with the risk of Type 2 diabetes in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study.

https://arctichealth.org/en/permalink/ahliterature168916
Source
Diabet Med. 2006 Jun;23(6):685-9
Publication Type
Article
Date
Jun-2006
Author
U. Mager
V. Lindi
J. Lindström
J G Eriksson
T T Valle
H. Hämäläinen
P. Ilanne-Parikka
S. Keinänen-Kiukaanniemi
J. Tuomilehto
M. Laakso
L. Pulkkinen
M. Uusitupa
Author Affiliation
Department of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland. ursula.mager@uku.fi
Source
Diabet Med. 2006 Jun;23(6):685-9
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Diabetes Mellitus, Type 2 - drug therapy - genetics - prevention & control
Female
Finland
Ghrelin
Glucose Intolerance - genetics
Health Surveys
Humans
Male
Middle Aged
Multicenter Studies as Topic
Peptide Hormones - genetics
Polymorphism, Genetic
Polymorphism, Restriction Fragment Length
Prospective Studies
Risk
Abstract
Ghrelin is a gut-brain regulatory peptide stimulating appetite and controlling energy balance. In previous studies, the Leu72Met polymorphism of the ghrelin gene has been associated with obesity and impaired insulin secretion. We investigated whether the Leu72Met polymorphism is associated with the incidence of Type 2 diabetes in subjects with impaired glucose tolerance (IGT) participating in the Finnish Diabetes Prevention Study (DPS).
DPS was a longitudinal intervention study carried out in five participating centres in Finland. A total of 522 subjects with IGT were randomized into either an intervention or a control group and DNA was available from 507 subjects. The Leu72Met polymorphism was screened by the restriction fragment length polymorphism method.
There were no differences in clinical and anthropometric characteristics among the genotypes at baseline. IGT subjects with the Met72 allele were at higher risk of developing Type 2 diabetes than subjects with the Leu72Leu genotype (P = 0.046). Our data also demonstrated that IGT subjects with the common Leu72Leu genotype developed Type 2 diabetes less frequently under intervention circumstances than subjects with the Met72 allele (OR = 0.28, 95% CI 0.10-0.79; P = 0.016).
Subjects with the Leu72Leu genotype had a lower risk for the development of Type 2 diabetes. This was observed particularly in the study subjects who underwent an intensive diet and exercise intervention. Defective first-phase insulin secretion related to the Met72 allele might be one factor contributing to the conversion to Type 2 diabetes.
PubMed ID
16759313 View in PubMed
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Associations of blood pressure with carotid intima-media thickness in elderly Finns with diabetes mellitus or impaired glucose tolerance.

https://arctichealth.org/en/permalink/ahliterature47350
Source
J Hum Hypertens. 2003 Oct;17(10):705-11
Publication Type
Article
Date
Oct-2003
Author
U. Rajala
M. Päivänsalo
M. Laakso
O. Pelkonen
I. Suramo
S. Keinänen-Kiukaanniemi
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland. urajala@cc.oulu.fi
Source
J Hum Hypertens. 2003 Oct;17(10):705-11
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Aged
Blood pressure
Carotid Artery Diseases - etiology - ultrasonography
Carotid Artery, Common - ultrasonography
Cohort Studies
Diabetes Complications
Diabetes Mellitus - physiopathology
Diastole
Female
Finland
Glucose Intolerance - complications - physiopathology
Humans
Male
Pulse
Systole
Tunica Media - ultrasonography
Abstract
The aim of the present study was to evaluate the associations of ultrasonographic manifestations of carotid atherosclerosis with systolic (SBP) and diastolic blood pressure (DBP) and pulse pressure (PP) in 65-year-old Finns drawn from a population-based cohort. Carotid ultrasonographic measurements were performed on 54 diabetic subjects, 97 subjects with impaired glucose tolerance (IGT) and 57 normoglycaemic subjects (NGT). The subjects were classified into four quartiles of SBP, DBP and PP. SBP, DBP, PP and the use of antihypertensive drugs increased along with the deterioration of glucose status. The maximal intima-media thickness (IMT) of the common carotid artery (CCA) from the lowest to the highest quartiles of SBP was 0.98+/-0.34, 1.00+/-0.35, 1.03+/-0.29, 1.18+/- 0.52 mm (P=0.038), respectively. SBP was higher (161+/-22 mmHg) in the subjects with severe intima-media thickening (maximal IMT CCA > or =1.2 mm) than in those with maximal IMT CCA of or =170 mmHg) and 20% in the subjects with lower SBP (P=0.008). In multiple regression analysis, the adjusted OR for severe intima-media thickening was 2.9 (95% CI 1.1-7.9) in the subjects in the highest SBP quartile compared to the subjects with lower SBP. In the present study, high SBP was associated with severe carotid intima-media thickening. We suggest that the results can be generalized to apply to elderly Finnish subjects with DM and IGT, but not to normoglycaemic subjects, on the basis of this study.
PubMed ID
14504629 View in PubMed
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Blood pressure and atherosclerotic plaques in carotid, aortic and femoral arteries in elderly Finns with diabetes mellitus or impaired glucose tolerance.

https://arctichealth.org/en/permalink/ahliterature47181
Source
J Hum Hypertens. 2005 Jan;19(1):85-91
Publication Type
Article
Date
Jan-2005
Author
U. Rajala
M. Laakso
M. Päivänsalo
I. Suramo
S. Keinänen-Kiukaanniemi
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland. urajala@cc.oulu.fi
Source
J Hum Hypertens. 2005 Jan;19(1):85-91
Date
Jan-2005
Language
English
Publication Type
Article
Keywords
Aged
Aorta, Abdominal - ultrasonography
Arteriosclerosis - epidemiology - etiology - ultrasonography
Carotid Artery, Common - ultrasonography
Cohort Studies
Diabetes Mellitus, Type 2 - complications - epidemiology - ultrasonography
Female
Femoral Artery - ultrasonography
Finland - epidemiology
Glucose Intolerance - complications - epidemiology - ultrasonography
Humans
Hypertension - complications - epidemiology - ultrasonography
Male
Risk factors
Tunica Intima - ultrasonography
Tunica Media - ultrasonography
Abstract
The aim of the study was to evaluate the occurrence of atheromatous plaques in carotid, aortic and femoral arteries, focusing on blood pressure (BP). The study subjects consisted of 65-year-old Finns drawn from a population-based cohort. Ultrasonographic measurements were performed on 54 diabetic subjects, 97 subjects with impaired glucose tolerance (IGT) and 57 normoglycaemic subjects (NGT). High systolic BP (SBP) was defined as >or=160 mmHg and high diastolic BP as >or=95 mmHg. High pulse pressure (PP) was defined as the highest tertile (>or=75 mmHg) of PP and high mean BP (MBP) as the highest tertile (>or=111 mmHg) of MBP. The prevalence of atheromatous plaques was 77% (160/208) in carotid arteries, 94% (195/208) in aorta and 77% (161/208) in femoral arteries. A total of 64% (134/208) of the subjects had plaques in both carotid and femoral arteries, and they were compared with those who had plaques in 0-1 of these arteries. In addition to male gender and long-lasting smoking, the occurrence of plaques in both carotid and femoral arteries were associated with high SBP and high MBP. According to the results of multiple regression analyses, the adjusted odds ratio for plaques in both carotid and femoral arteries was 3.1 (95% CI 1.5-6.5) in subjects with high SBP compared to those with lower SBP. When SBP was replaced by high MBP, the adjusted odds ratio for it was 2.3 (95% CI 1.1-4.8).
PubMed ID
15343356 View in PubMed
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Blood pressure responses to whole-body cold exposure: effect of carvedilol.

https://arctichealth.org/en/permalink/ahliterature10286
Source
Eur J Clin Pharmacol. 2000 Dec;56(9-10):637-42
Publication Type
Article
Date
Dec-2000
Author
S. Komulainen
T. Tähtinen
H. Rintamäki
H. Virokannas
S. Keinänen-Kiukaanniemi
Author Affiliation
Department of Public Health Science and General Practice, University of Oulu, Oulun yliopisto, Finland. silja-komulainen@pp.fimnet.fi
Source
Eur J Clin Pharmacol. 2000 Dec;56(9-10):637-42
Date
Dec-2000
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - pharmacology
Adult
Blood Pressure - drug effects
Carbazoles - pharmacology
Cold
Cross-Over Studies
Double-Blind Method
Female
Heart Rate - drug effects
Heat
Humans
Male
Middle Aged
Propanolamines - pharmacology
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: The aim of this study was to test the effects of carvedilol on blood pressure (BP) and heart rate (HR) during whole-body cold exposure in hypertensive and normotensive subjects. METHODS: Ten hypertensive and twelve normotensive subjects were exposed to cold (-15 degrees C, wind 3.5 m/s) three times for 15 min with a 1-week interval between the exposures. The study design was made according to a randomised double-blind, crossover method. Before the cold exposures the subjects ingested carvedilol or placebo once a day (carvedilol 12.5 mg/day for 2 days and then 25 mg/day for 5 days) for 1 week. The systolic (SBP) and diastolic (DBP) blood pressure and HR were measured every 3 min during the test procedures using an indirect ambulatory blood pressure monitor device (ABPM-02, Meditech Co.). RESULTS: In the hypertensive group, the cold exposure increased SBP/DBP from 119/75 mmHg to 143/96 mmHg during carvedilol treatment (P
PubMed ID
11214769 View in PubMed
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61 records – page 1 of 7.