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34 records – page 1 of 4.

A 1-year, placebo-controlled, double-blind house-dust-mite immunotherapy study in asthmatic adults.

https://arctichealth.org/en/permalink/ahliterature15782
Source
Allergy. 1997 Aug;52(8):853-9
Publication Type
Article
Date
Aug-1997
Author
O T Olsen
K R Larsen
L. Jacobsan
U G Svendsen
Author Affiliation
Department of Pulmonery Medicine and Allergology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Source
Allergy. 1997 Aug;52(8):853-9
Date
Aug-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenergic beta-Agonists - therapeutic use
Adult
Antigens, Dermatophagoides
Asthma - diagnosis - drug therapy - therapy
Bronchial Provocation Tests
Double-Blind Method
Female
Forced expiratory volume
Glycoproteins - administration & dosage - adverse effects - immunology
Humans
Immunoglobulin E - analysis - blood - immunology
Immunotherapy
Male
Middle Aged
Peak Expiratory Flow Rate
Severity of Illness Index
Skin Tests
Steroids - therapeutic use
Vital Capacity
Abstract
Thirty-one adult patients with asthma caused by house-dust mites (HDM) were included in this placebo-controlled, double-blind study to evaluate the efficacy and safety of specific immunotherapy (SIT) with biologically standardized extracts of HDM. The specific diagnosis was confirmed by skin prick tests, specific IgE, and bronchial provocation tests with HDM allergens. The patients were randomized to receive active treatment with extracts of either Dermatophagoides pteronyssinus (Dpt) or D. farinae (Dfa) (Alutard SQ, ALK, Denmark) or placebo injections. Twenty-three patients completed the study. After 1 year of treatment, we found a clinically important and significant reduction in both asthma medicine consumption (inhaled steroids 38% and beta 2-agonists 46%) and symptom score (57%) in the actively treated group, but not the placebo group. These findings were confirmed by a significant decrease in skin and bronchial sensitivity to HDM in the active group. Additionally, there was a significant difference in the patients' scores for effect in favor of the actively treated group. Total IgE and specific IgE to HDM showed no significant changes before and after treatment for either group. Spirometric lung-function measurements showed a significant increase in forced expiratory volume in 1 s (FEV1) from 85% before to 89% of predicted values after treatment for the actively treated group. Peak-flow measurements at home showed no significant changes during the study. It is concluded that allergen SIT is an effective treatment in adult patients suffering from asthma due to HDM.
PubMed ID
9284985 View in PubMed
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Adult Asthma Consensus Guidelines update 2003.

https://arctichealth.org/en/permalink/ahliterature179197
Source
Can Respir J. 2004 May-Jun;11 Suppl A:9A-18A
Publication Type
Conference/Meeting Material
Article
Author
Catherine Lemière
Tony Bai
Meyer Balter
Charles Bayliff
Allan Becker
Louis-Philippe Boulet
Dennis Bowie
André Cartier
Andrew Cave
Kenneth Chapman
Robert Cowie
Stephen Coyle
Donald Cockcroft
Francine M Ducharme
Pierre Ernst
Shelagh Finlayson
J Mark FitzGerald
Frederick E Hargreave
Donna Hogg
Alan Kaplan
Harold Kim
Cheryle Kelm
Paul O'Byrne
Malcolm Sears
Andrea White Markham
Author Affiliation
Université de Montréal, Montreal, Quebec. C-Lemiere@crhsc.umontreal.ca
Source
Can Respir J. 2004 May-Jun;11 Suppl A:9A-18A
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Adrenal Cortex Hormones - therapeutic use
Adrenergic beta-Agonists - therapeutic use
Adult
Asthma - drug therapy
Canada
Education, Medical, Continuing
Humans
Leukotriene Antagonists - therapeutic use
Patient Education as Topic
Abstract
Several sets of Canadian guidelines for the diagnosis and management of asthma have been published over the past 15 years. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies have highlighted the need to incorporate new information into the asthma guidelines.
To review the literature on adult asthma management published between January 2000 and June 2003; to evaluate the influence of the new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Guidelines and its 2001 update; and to report new recommendations on adult asthma management.
Three specific topics for which new evidence affected the previous recommendations were selected for review: initial treatment of asthma, add-on therapies in the treatment of asthma and asthma education. The resultant reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Thoracic Society, and recommendations for adult asthma management were reviewed.
The present report emphasises the importance of the early introduction of inhaled corticosteroids in symptomatic patients with mild asthma; stresses the benefit of adding additional therapy, preferably long-acting beta2-agonists, to patients incompletely controlled on low doses of inhaled corticosteroids; and documents the essential role of asthma education.
The present report generally supports many of the previous recommendations published in the 1999 Canadian Asthma Consensus Report and provides higher levels of evidence for a number of those recommendations.
PubMed ID
15254605 View in PubMed
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Ambulatory use of inhaled beta(2)-agonists for the treatment of asthma in Quebec : a population-based utilization review.

https://arctichealth.org/en/permalink/ahliterature194701
Source
Chest. 2001 May;119(5):1316-21
Publication Type
Article
Date
May-2001
Author
R. Blais
J P Grégoire
R. Rouleau
A. Cartier
J. Bouchard
L P Boulet
Author Affiliation
Département d'administration de la santé et Groupe de recherche interdisciplinaire en santé, Université de Montréal, Montréal, Québec, Canada. Regis.Blais@umontreal.on.ca
Source
Chest. 2001 May;119(5):1316-21
Date
May-2001
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adolescent
Adrenal Cortex Hormones - therapeutic use
Adrenergic beta-Agonists - therapeutic use
Adult
Aged
Albuterol - administration & dosage
Ambulatory Care
Asthma - drug therapy
Child
Child, Preschool
Delayed-Action Preparations
Female
Humans
Male
Middle Aged
Quebec
Retrospective Studies
Abstract
To assess whether the utilization of inhaled short-acting beta(2)-agonists (ISAB) and inhaled long-acting beta(2)-agonists (ILAB) for the treatment of asthma was appropriate according to the 1996 Canadian Asthma Consensus Conference recommendations.
Population-based retrospective drug utilization review using pharmacists' billing data of the Prescription Drug Insurance Plan administered by the Quebec health insurance board. However, the database used did not contain complete patient clinical information to accurately assess severity of asthma.
Province of Quebec, Canada.
Persons who received at least one outpatient prescription of ISAB (age range, 5 to 45 years) or ILAB (age range, 12 to 45 years) for the treatment of asthma between August 1997 and April 1998.
Percentages of patients whose use was appropriate according to three criteria regarding the average daily dose of ISAB (criterion 1), the renewal interval of ILAB (criterion 2), and the concomitant daily use of corticosteroids for the expected length of utilization of ILAB (criterion 3).
Overall proportions of appropriate use according to criterion 1 were as follows: 75% (without inhaled corticosteroids [ICS]) and 84% and 43% (with one or more than one prescription of ICS, respectively). Appropriateness was slightly higher for female patients, younger patients (5 to 18 years old), and those treated by pediatricians. However, appropriateness was only 9% among patients who received at least two prescriptions of ISAB during the study period. The proportion of appropriate use was 19% according to criterion 2 and 15% according to criterion 3; there were few differences by gender or by age, but the appropriateness according to criterion 2 was somewhat higher for patients of respirologists.
Compared to the 1996 Canadian asthma consensus conference recommendations, ISAB are overused, ICS are underused, and ILAB are often used improperly. Close collaboration between health professionals and patients is essential to improve the pharmacotherapy of asthma.
PubMed ID
11348934 View in PubMed
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Are young adults with asthma treated sufficiently with inhaled steroids? A population-based study of prescription data from 1991 and 1994.

https://arctichealth.org/en/permalink/ahliterature15857
Source
Br J Clin Pharmacol. 1996 Apr;41(4):285-9
Publication Type
Article
Date
Apr-1996
Author
D. Gaist
J. Hallas
N C Hansen
L F Gram
Author Affiliation
Department of Clinical Pharmacology, Odense University, Denmark.
Source
Br J Clin Pharmacol. 1996 Apr;41(4):285-9
Date
Apr-1996
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adrenergic beta-Agonists - therapeutic use
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Cross-Sectional Studies
Denmark
Drug Information Services
Female
Humans
Male
Pharmacoepidemiology
Abstract
1. We conducted a descriptive cross-sectional study of asthma therapy among young adults to assess to what extent the current guidelines for asthma therapy have been implemented. In particular, we examined the use of inhaled corticosteroids in heavy users of inhaled beta-adrenoceptor agonists. 2. Data were retrieved from a population-based prescription database. For each of the years 1991 and 1994, all 20 to 44-year-olds who redeemed anti-asthma medication in the Odense area (210,000 inhabitants) were studied. 3. We identified the number of users and total sales volume for specific anti-asthma medications in defined daily doses (DDD) as well as the number of users and median annual doses of common regimens. Combined use of inhaled corticosteroids and inhaled beta-adrenoceptor agonists was also described. 4. The annual sales volume of anti-asthma drugs increased by 23% to 927,636 DDD from 1991 to 1994. Inhaled corticosteroids were mainly responsible for this with a 52% increase in number of users and an 88% increase in DDD. Inhaled beta-adrenoceptor agonists used in monotherapy remained the most popular regimen in 1994 (1685 users = 39%). Inhaled corticosteroids in combination with inhaled beta-adrenoceptor agonist were the second most popular regimen in 1994 (1308 users = 30%), increasing by 64% as compared with 1991. However, among patients with an annual use of inhaled beta-adrenoceptor agonist of 200 DDD (1600 "puffs') or more the percent of patients not receiving inhaled corticosteroids at all only fell from 37 to 33%. Though the number of patients being treated with inhaled corticosteroids has increased, there is still evidence of a substantial underuse.
PubMed ID
8730973 View in PubMed
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Asthma, ear problems, and dental anxiety among 6- to 8-yr-olds in Denmark: a population-based cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature15217
Source
Eur J Oral Sci. 2003 Dec;111(6):472-6
Publication Type
Article
Date
Dec-2003
Author
Pia Wogelius
Sven Poulsen
Henrik Toft Sørensen
Author Affiliation
Department of Community Oral Health and Pediatric Dentistry, Dental School, Faculty of Health Sciences, University of Aarhus, Aarhus, Denmark.
Source
Eur J Oral Sci. 2003 Dec;111(6):472-6
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Agonists - therapeutic use
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology - psychology
Child
Comorbidity
Cross-Sectional Studies
Denmark - epidemiology
Dental Anxiety - epidemiology - psychology
Dental Care for Children - psychology
Dental Health Surveys
Humans
Otitis - epidemiology
Personality Tests
Prevalence
Research Support, Non-U.S. Gov't
Risk factors
Statistics
Abstract
The aim of this study was to examine the association between asthma, ear problems, and dental anxiety in children in a population-based cross-sectional study. The population included four municipalities in the County of North Jutland, Denmark, in 2001. A total of 1235 children aged 6-8 yr, and their parents, were identified. Data were obtained from a prescription database, from parental-answered questionnaires, and from dental records. Children with asthma were defined as children that had received prescriptions for both inhaled beta2-agonists and corticosteroids during the past year. Data on ear problems and dental anxiety were obtained from the questionnaires. Dental anxiety was measured using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Use of asthma-drugs was associated with dental anxiety (odds ratio = 1.70; 95% confidence interval 0.90-3.22). A history of often ear problems was also associated with dental anxiety (odds ratio = 1.83; 95% confidence interval 1.20-2.80). It is concluded that asthma and ear problems may be risk factors for dental anxiety in children.
PubMed ID
14632682 View in PubMed
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Asthma in Canada: missing the treatment targets.

https://arctichealth.org/en/permalink/ahliterature157872
Source
CMAJ. 2008 Apr 8;178(8):1027-8
Publication Type
Article
Date
Apr-8-2008
Author
Kenneth R Chapman
Author Affiliation
Asthma and Airway Centre, University Health Network, Toronto Western Hospital, and the University of Toronto, Toronto, Ont. kchapman@ca.inter.net
Source
CMAJ. 2008 Apr 8;178(8):1027-8
Date
Apr-8-2008
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adrenal Cortex Hormones - therapeutic use
Adrenergic beta-Agonists - therapeutic use
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology
Canada
Data Collection
Drug Prescriptions - statistics & numerical data
Humans
Quality of Health Care
Notes
Cites: CMAJ. 1999 Nov 30;161(11 Suppl):S1-6110906907
Cites: CMAJ. 2008 Apr 8;178(8):1013-2118390944
Cites: Eur Respir J. 2000 Nov;16(5):802-711153575
Cites: Can Respir J. 2001 Mar-Apr;8 Suppl A:35A-40A11360046
Cites: Can Respir J. 2001 Nov-Dec;8(6):416-2011753454
Cites: J Allergy Clin Immunol. 2002 Oct;110(4):576-8112373264
Cites: J Allergy Clin Immunol. 2004 Jul;114(1):40-715241342
Cites: Can Respir J. 2004 May-Jun;11 Suppl A:9A-18A15254605
Cites: J Asthma. 2004 Aug;41(5):559-6515360065
Cites: CMAJ. 1987 Oct 1;137(7):620-43651927
Cites: N Engl J Med. 1992 Feb 20;326(8):501-61346340
Cites: CMAJ. 1996 Mar 15;154(6):821-318634960
Cites: Can Respir J. 2006 Jul-Aug;13(5):253-916896426
Cites: Eur Respir J. 2008 Feb;31(2):320-517959642
Comment On: CMAJ. 2008 Apr 8;178(8):1013-2118390944
PubMed ID
18390947 View in PubMed
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Attenuation of the September epidemic of asthma exacerbations in children: a randomized, controlled trial of montelukast added to usual therapy.

https://arctichealth.org/en/permalink/ahliterature161582
Source
Pediatrics. 2007 Sep;120(3):e702-12
Publication Type
Article
Date
Sep-2007
Author
Neil W Johnston
Piush J Mandhane
Jennifer Dai
Joanne M Duncan
Justina M Greene
Kim Lambert
Malcolm R Sears
Author Affiliation
Firestone Institute for Respiratory Health, St Joseph's Healthcare, 50 Charlton Ave E, Hamilton, Ontario, Canada L8N 4A6. njohnsto@mcmaster.ca
Source
Pediatrics. 2007 Sep;120(3):e702-12
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Acetates - therapeutic use
Adolescent
Adrenal Cortex Hormones - therapeutic use
Adrenergic beta-Agonists - therapeutic use
Age Factors
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy - epidemiology
Child
Child, Preschool
Common Cold - epidemiology
Disease Outbreaks - prevention & control
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Male
Multivariate Analysis
Office visits - statistics & numerical data
Ontario - epidemiology
Questionnaires
Quinolines - therapeutic use
Schools
Seasons
Severity of Illness Index
Sex Factors
Abstract
A recurring epidemic of asthma exacerbations in children occurs annually in September in North America when school resumes after summer vacation.
Our goal was to determine whether montelukast, added to usual asthma therapy, would reduce days with worse asthma symptoms and unscheduled physician visits of children during the September epidemic.
A total of 194 asthmatic children aged 2 to 14 years, stratified according to age group (2-5, 6-9, and 10-14 years) and gender, participated in a double-blind, randomized, placebo-controlled trial of the addition of montelukast to usual asthma therapy between September 1 and October 15, 2005.
Children randomly assigned to receive montelukast experienced a 53% reduction in days with worse asthma symptoms compared with placebo (3.9% vs 8.3%) and a 78% reduction in unscheduled physician visits for asthma (4 [montelukast] vs 18 [placebo] visits). The benefit of montelukast was seen both in those using and not using regular inhaled corticosteroids and among those reporting and not reporting colds during the trial. There were differences in efficacy according to age and gender. Boys aged 2 to 5 years showed greater benefit from montelukast (0.4% vs 8.8% days with worse asthma symptoms) than did older boys, whereas among girls the treatment effect was most evident in 10- to 14-year-olds (4.6% [montelukast] vs 17.0% [placebo]), with nonsignificant effects in younger girls.
Montelukast added to usual treatment reduced the risk of worsened asthma symptoms and unscheduled physician visits during the predictable annual September asthma epidemic. Treatment-effect differences observed between age and gender groups require additional investigation.
Notes
Comment In: Pediatrics. 2008 Jun;121(6):1289; author reply 1289-9018519503
PubMed ID
17766511 View in PubMed
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Comparison of the efficacy of salmeterol/fluticasone propionate combination in Japanese and Caucasian asthmatics.

https://arctichealth.org/en/permalink/ahliterature94002
Source
Respir Med. 2007 Dec;101(12):2488-94
Publication Type
Article
Date
Dec-2007
Author
Kawai M.
Kempsford R.
Pullerits T.
Takaori S.
Hashimoto K.
Takemoto Y.
Lötvall J.
Author Affiliation
Department of Respiratory Disease, Kawai Chest Clinic, 43 Koyamakitaohno-cho, Kita-ku, Kyoto 603-8161, Japan.
Source
Respir Med. 2007 Dec;101(12):2488-94
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adrenergic beta-Agonists - therapeutic use
Adult
Aged
Airway Resistance
Albuterol - analogs & derivatives - therapeutic use
Analysis of Variance
Androstadienes - therapeutic use
Anti-Asthmatic Agents - therapeutic use
Asian Continental Ancestry Group
Asthma - drug therapy - ethnology - physiopathology
Body Height
Cross-Over Studies
Double-Blind Method
Drug Therapy, Combination
European Continental Ancestry Group
Female
Humans
Japan
Lung - physiopathology
Male
Middle Aged
Nebulizers and Vaporizers
Respiratory Function Tests
Sweden
Treatment Outcome
Abstract
INTRODUCTION: The effect of ethnicity on the efficacy of salmeterol (S)+fluticasone propionate (FP) has not been examined in Japanese and Caucasian asthmatics. In this study, the efficacy of combination treatment with S and FP from a single inhaler (SFC) was compared with concurrent treatment with S and FP administration from separate inhalers (S+FP) in Japanese and Caucasian asthmatics. METHODS: This was a randomised, double-blind, crossover study in male and female Japanese (n=18) and Caucasian (n=17) asthmatics (50-100% predicted FEV(1); >35% reversibility in sGaw). Subjects received SFC (S 50 mcg/FP 250 mcg b.i.d.) and S+FP (S 50 mcg b.i.d.+FP 250 mcg b.i.d.) for 14 days. sGaw and FEV(1) were determined 0-12h after the first and last doses. RESULTS: Treatment with both SFC and S+FP produced marked bronchodilation, which was maintained 0-12h after the first dose. Baseline sGaw and FEV(1) increased up to 51% and 180 mL, respectively, in Japanese subjects over 2 weeks of treatment, with similar improvements in Caucasian subjects. On Day 14 the 0-12h S+FP:SFC treatment ratios (90% CI) for sGaw AUC and peak were 1.05 (0.98, 1.12) and 1.05 (0.97, 1.14), respectively, in Japanese subjects, and 0.99 (0.92, 1.07) and 0.98 (0.89, 1.07), respectively, in Caucasian subjects, with no difference between the two ethnic groups. CONCLUSIONS: The finding of a similar significant bronchodilator response in Japanese and Caucasian asthmatics following concurrent and combination treatment with salmeterol and FP suggests that the therapeutic response to these agents is comparable and independent of ethnicity in Japanese and Caucasian asthma patients.
PubMed ID
17900887 View in PubMed
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Compliance with the Canadian Association of Emergency Physicians' asthma clinical practice guidelines at a tertiary care emergency department.

https://arctichealth.org/en/permalink/ahliterature122464
Source
CJEM. 2012 Jul;14(4):224-32
Publication Type
Article
Date
Jul-2012
Author
Lyne Filiatrault
David Harriman
Riyad B Abu-Laban
J. Mark FitzGerald
Anthony M Chahal
R. Douglas McKnight
Author Affiliation
Department of Emergency Medicine, University of British Columbia, Vancouver, BC. filiatra@interchange.ubc.ca
Source
CJEM. 2012 Jul;14(4):224-32
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Agonists - therapeutic use
Adult
Asthma - drug therapy - physiopathology
Canada
Cholinergic Antagonists - therapeutic use
Continuity of Patient Care
Documentation
Drug Prescriptions - statistics & numerical data
Emergency Medicine - standards
Emergency Service, Hospital
Female
Glucocorticoids - therapeutic use
Guideline Adherence
Humans
Length of Stay
Logistic Models
Male
Methylprednisolone - therapeutic use
Middle Aged
Patient Discharge
Peak Expiratory Flow Rate - physiology
Practice Guidelines as Topic
Prednisone - therapeutic use
Referral and Consultation - statistics & numerical data
Severity of Illness Index
Young Adult
Abstract
Although evidence-based clinical practice guidelines (CPGs) exist, emergency department (ED) asthma management remains highly variable. Our objective was to compare asthma management at a tertiary care ED with that advised by the Canadian Association of Emergency Physicians' (CAEP) asthma CPG and current best practice.
This medical record study enrolled patients between the ages of 19 and 60 years with a previous diagnosis of asthma who were seen for an acute asthma exacerbation at the Vancouver General Hospital ED in 2008. Standard methodology guidelines for medical record review were followed, including explicitly defined criteria and determination of interrater reliability. Primary outcomes were the proportion of cases with the following: objective assessment of severity using peak expiratory flow (PEF), use of systemic corticosteroids (SCSs) in the ED and at discharge, prescription for any inhaled corticosteroids (ICSs), and documentation of outpatient follow-up.
A total of 204 patient encounters were enrolled. Kappa values for interrater assessment ranged from 0.93 to 1.00. Compliance with primary outcomes was as follows: measurement of PEF, 90% (95% CI 85-94); use of SCSs in the ED, 64% (95% CI 57-71); prescription of SCSs at discharge, 59% (95% CI 51-67); prescription of any ICS at discharge, 51% (95% CI 41-61); and documentation of outpatient follow-up, 78% (95% CI 71-84).
This study indicates an improvement in ED asthma care compared to previously published studies; however, discordance still exists between asthma management at a tertiary care ED and the CAEP asthma CPG and current best practice. Further research is warranted to understand the reasons for this finding.
PubMed ID
22813396 View in PubMed
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Diabetes mellitus and raised serum triglyceride concentration in treated hypertension--are they of prognostic importance? Observational study.

https://arctichealth.org/en/permalink/ahliterature48262
Source
BMJ. 1996 Sep 14;313(7058):660-3
Publication Type
Article
Date
Sep-14-1996
Author
O. Samuelsson
K. Pennert
O. Andersson
G. Berglund
T. Hedner
B. Persson
H. Wedel
L. Wilhelmsen
Author Affiliation
Department of Medicine, Sahlgrenska Hospital, Gothenburg, Sweden.
Source
BMJ. 1996 Sep 14;313(7058):660-3
Date
Sep-14-1996
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Agonists - therapeutic use
Benzothiadiazines
Cholesterol - blood - metabolism
Coronary Disease - blood - etiology - metabolism
Diabetes Complications
Diabetes Mellitus - blood - metabolism
Diuretics
Follow-Up Studies
Humans
Hypertension - complications - drug therapy - metabolism
Male
Middle Aged
Multivariate Analysis
Prognosis
Research Support, Non-U.S. Gov't
Risk factors
Sodium Chloride Symporter Inhibitors - therapeutic use
Triglycerides - blood - metabolism
Abstract
OBJECTIVE: To analyse whether metabolic changes during long term treatment with antihypertensive drugs are associated with an increased risk of coronary heart disease. DESIGN: Observational study. SETTING: Gothenburg, Sweden. SUBJECTS: 686 middle aged hypertensive men, recruited after screening of a random population sample, and followed for 15 years during treatment with predominantly beta adrenoceptor blockers or thiazide diuretics, or both. Coronary heart disease and diabetes mellitus were registered at yearly patient examinations. Entry characteristics, as well as within study serum concentrations of cholesterol and triglycerides and the development of diabetes mellitus, were related to the incidence of coronary heart disease in a time dependent Cox's regression analysis. MAIN OUTCOME VARIABLE: Coronary heart disease morbidity. RESULTS: Diabetes mellitus, raised serum cholesterol and triglyceride concentrations present at the beginning of the study were all significantly predictive of coronary heart disease in univariate analysis. The relative risk of diabetes mellitus and of a 1 mmol/l increase in the cholesterol and triglyceride concentrations was 2.12 (95% confidence interval 1.11 to 4.07), 1.21 (1.05 to 1.39), and 1.21 (1.03 to 1.43) respectively. However, when the within study metabolic variables were analysed, only the serum cholesterol concentration was significantly and independently associated with coronary heart disease (relative risk 1.07 (1.02 to 1.13)). Although the triglyceride concentrations increased slightly during the follow up, the within study serum triglyceride concentrations were not associated with the incidence of coronary heart disease (1.04 (0.96 to 1.10)). New diabetes mellitus-that is, onset during follow up-was not significantly associated with an increased risk for coronary heart disease (1.48 (0.37 to 6.00)). CONCLUSIONS: Metabolic disturbances such as diabetes mellitus and hyperlipidaemia presenting before the start of antihypertensive treatment have a prognostic impact in middle aged, treated hypertensive men. Moreover, while within study cholesterol concentration was an independent predictor of coronary heart disease, drug related diabetes mellitus and raised serum triglyceride concentrations that are associated with treatment do not seem to have any major impact on the coronary heart disease prognosis in this category of patients.
Notes
Comment In: BMJ. 1997 Jan 18;314(7075):223-49022455
PubMed ID
8811759 View in PubMed
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34 records – page 1 of 4.