bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of metformin on blood pressure and metabolism in nondiabetic hypertensive patients
Authors: Snorgaard O. , Køber L. , Carlsen J. 
Published: November 2003

Snorgaard O, Køber L, Carlsen J (Department of Cardiology and Endocrinology, Frederiksberg Hospital, Department of Cardiology, Gentofte University Hospital, and MEDICON A/S, Copenhagen, Denmark). The effect of metformin on blood pressure and metabolism in nondiabetic hypertensive patients. J Intern Med 1997; 242: 407–412.ObjectivesTo study the effect of metformin on blood pressure and metabolism in nondiabetic hypertensives.DesignA six‐week single‐blind placebo wash‐out, followed by a double‐blind placebo‐ controlled parallel group design with skew randomization (2:2:1) to metformin 850 mg b.i.d. (n= 10), metformin 500 mg b.i.d. (n= 10), or placebo b.i.d. (n= 5) for 12 weeks. Office blood pressure (oBP), ambulatory blood pressure (aBP), lipoproteins, and oral glucose tolerance (OGTT) were measured/performed before and during treatment.SubjectsSixteen male and nine female nondiabetic (OGTT) patients (median age 57 (39–74) years) with verified hypertension (White‐coat excluded) for 4 (0–20) years.ResultsThe possible effect of metformin treatment and dosage was tested with a two‐factor analysis of variance. Treatment induced a significant decline in diastolic oBP, P < 0.05. This decline was, however, not significantly different comparing metformin and placebo. Systolic oBP, diastolic aBP, and systolic aBP showed no significant change by treatment. The decline in diastolic oBP was 5 mmHg in the pooled group of metformin‐ treated patients, P < 0.005. Different gender and the presence of obesity had no impact on the decline in diastolic oBP within this group. Changes in fasting C‐peptide and fasting insulin during treatment were unrelated to blood pressure changes. High fasting insulin (> 60 pmol L−1) or high fasting C‐peptide (> 1000 pmol L−1) at baseline did not favour an effect of metformin on diastolic oBP. Glucose metabolism and lipoproteins were unchanged in all groups.ConclusionsAlthough metformin treatment induced a decline in diastolic office blood pressure in nondiabetic hypertensives, the decline was not different from that during placebo treatment. Metformin had no significant effect on ambulatory blood pressure. Thus, metformin has, if any, only a minor clinically insignificant effect on blood pressure in nondiabetic hypertensives. The study does not support the hypothesis that circulating insulin is a major regulator of blood pressure in hypertension.
Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study
Authors: Bots M. L. , Launer L. J. , Lindemans J. , Hofman A. , Grobbee D. E. 
Published: November 2003

Bots ML, Launer LJ, Lindemans J, Hofman A, Grobbee DE (Erasmus University Medical School and University Hospital Rotterdam, Rotterdam; Utrecht University, Utrecht; and the National Institute of Public Health, Bilthoven; The Netherlands). Homocysteine, atherosclerosis and prevalent cardiovascular disease in the elderly: The Rotterdam Study. 1997; 242: 339–47.ObjectivesElevated homocysteine increases the risk of vascular disease, in particular amongst younger subjects (<60 years). Very few studies have been performed amongst older subjects. We evaluated the relation of plasma total homocysteine (tHcy) to atherosclerosis and symptomatic cardiovascular disease amongst older men and women.DesignA cross‐sectional study.SettingGeneral population.SubjectsA random sample of 630 men and women, participating in the Rotterdam Study, a prospective population‐based cohort study amongst 7983 subjects aged 55 years and over residing in the Ommoord district of Rotterdam, the Netherlands.Main outcome measuresCarotid atherosclerosis (carotid plaques and common carotid intima–media thickness) assessed by ultrasonography; lower extremity (peripheral) artery atherosclerosis measured by the ratio of the ankle to arm systolic blood pressure; prevalent cardiovascular disease assessed as a history of myocardial infarction or stroke.ResultsSubjects, 55–74 years of age, with elevated tHcy levels (≥18.6 μmol L−1) had a thicker common carotid intima–media (difference 0.037 mm; 95% CI 0.001, 0.073), a lower ankle‐arm index (−0.054; −0.104, −0.004), and an increased risk of cardiovascular disease (odds ratio 3.0; 1.5, 6.1), after adjusting for sex and age. There was no appreciable association of tHcy levels to atherosclerosis and cardiovascular disease in subjects aged 75 years and older.ConclusionsIn subjects aged 55–74 years elevated tHcy is associated with an increased risk of atherosclerosis and cardiovascular disease. The lack of association in those aged ≥75 years most probably reflect selective mortality.
Blood pressure in relation to medical, psychological and social variables in a population of 80‐year‐olds. Survival during 6 years
Authors: JENSEN E. , DEHLIN O. , HAGBERG B. , SAMUELSSON G. , SVENSSON T. , LIDFELDT J. 
Published: November 2003

Objectives. To relate elevated blood pressure in 80‐year‐olds to symptoms, life satisfaction and survival. Design. Examinations of medical, psychological and social factors every year between 80 and 86 years of age. Setting. Primary health care in the city of Lund in southern Sweden. Subjects. Three‐hundred and thirty‐three persons living in the city of Lund and born in 1908. Participation rate was 67%. Intervention. Abnormal findings were further examined and treated. Main outcome measures. Symptoms, blood pressure, laboratory values, psychological factors, cognition, living conditions, and survival. Results. Hypertension according to the definition used was found in 70%. Women were over‐represented (P<0.05). Amongst persons with alleged hypertension, diuretics (P<0.001) and ‘other cardiovascular drugs’ (P<0.001) were more often used. Analgesics were more often used amongst assessed hypertensives (P<0.05). Those with assessed hypertension scored better in testing of cognition compared to nonhypertensives (P<0.05), and less often lived in institutions (P<0.001). Assessed hypertensives had a better survival than alleged hypertensives during the following 7 years (P<0.01). Conclusions. Eighty‐year‐olds with assessed hypertension in the consulting room showed fewer symptoms and had a better cognition and survival than alleged hypertensives (those with a history of hypertension).
The impact of the accessibility of cranial CT scans on patient evaluation and management decisions
Authors: MARIK P. E. , RAKUSIN A. , SANDHU S. S. 
Published: November 2003

Objectives. Cranial CT scans are amongst the most frequently performed radiological investigations performed in most developed countries. However, these tests are relatively expensive and economic realities should compel physicians to re‐evaluate the utilization of this technology. The aim of this study was to review the utilization pattern and effect on management decisions of cranial CT scanning. Design. Retrospective chart review. Setting. University‐affiliated community teaching hospital. Subjects. The clinical data on 451 consecutive patients undergoing cranial CT scanning in our radiology department were reviewed. Eighty‐five patients were referred from outside the hospital and were subsequently excluded from further analysis. Interventions. None. Main outcome measures. The following data was abstracted from each patient's chart: the presenting clinical syndrome, the physician ordering the scan, details of the neurological examination performed prior to scanning, the CT scan findings and the impact the CT scan findings had on management decisions. Results. The largest percentage of patients were referred from the emergency department (61%). Chronic intracranial lesions were present in 77 (21%) patients. New pathological findings were found in 91 (25%) patients. The commonest new lesions were ischaemic infarcts (43%), followed by intracerebral haemorrhage (13%) and space occupying lesions (11%). Ninety‐seven per cent of patients presenting with new focal neurological signs had new findings on the CT scan, compared to 28% of patients with severe headache and 27% with a history of loss of consciousness. Head trauma was the presenting problem in 139 patients. New pathological findings were diagnosed in 24 of these patients. Fifty‐four patients had no signs or symptoms referable to the central nervous system. None of these patients had new findings on CT scan. In the vast majority of patients the neurological examination performed prior to CT scanning was incomplete. CT scanning was considered to have altered the management or provided a new diagnosis in 162 (44%) patients; of these patients 61 (67%) were in the group with new findings on CT scanning and 101 (37%) in the group with no new findings. Conclusion. In this study cranial CT scanning affected clinical management decisions in less than half of the patients. Furthermore, a careful history and neurological examination was performed in the minority of patients undergoing CT scanning. It would therefore appear that the easy accessability of CT scans largely determines the utilization of this diagnostic tool.
Cholesterol issues and management
Authors: GRUNDY S. M. 
Published: November 2003

The aim of this Minisymposium is to address current cholesterol issues as viewed from the United States. During the past decade the term ‘cholesterol’ has become a household word in the US. This fact can be attributed in large to the efforts of the National Cholesterol Education Program (NCEP). This program has wide support from a large number of member organizations such as the American Heart Association, the American College of Cardiology, and the American Medical Association. The NCEP has developed programs in both public health and professional education. NCEP efforts have led to increased public and professional awareness of high blood cholesterol as a major risk factor for coronary heart disease, to increased testing for high cholesterol levels, to modification of the American diet, and to increased use of cholesterol‐lowering drugs. The use of drugs has been supported by the recent publication of three major clinical trials: the Scandinavian Simvastatin Survival Study, the West of Scotland Coronary Prevention Study, and the Cholesterol and Recurrent Events study. All three of these trials demonstrated a major reduction in coronary risk accompanying aggressive cholesterol‐lowering therapy. They have been highly influential in thinking about cholesterol management in high‐risk patients in the US.This Minisymposium considers various issues related to primary and secondary prevention, cholesterol management in special populations, and the problem of adherence to medication.
Associations between atrial natriuretic peptides, echocardiographic findings and mortality in an elderly population sample
Authors: IIVANAINEN A. M. , TIKKANEN I. , TILVIS R. , HEIKKILÄ J. , HELENIUS T. , KUPARI M. 
Published: November 2003

Objectives. To examine associations of N‐terminal and C‐terminal components of the proatrial natriuretic peptide [ANP (1–98) and ANP (99–126), respectively], with echocardiographic measurements of left ventricular structure and performance and with the function of the aortic and mitral valves in old age. To compare the predictive value of the atrial peptides and echocardiographic data for short‐term mortality. Design. A population‐based survey with 1.5‐year mortality follow‐up. Setting. University hospital. Subjects. Three‐hundred and thirty‐three people aged 78–88 years. Main outcome measures. (i) Plasma ANP (1–98) and ANP (99–126); (ii) M‐mode and Doppler echocardiographic measurements of left atrial diameter; left ventricular diameters, mass and fractional shortening; peak transmitral velocities; aortic valve area, aortic regurgitation jet length and mitral regurgitant jet area; (iii) total and cardiovascular 1.5‐year mortality. Results. ANP (1–98) correlated with left atrial diameter (r=0.33; P<0.001), left ventricular mass (r=0.19; P<0.001), fractional shortening (r=−0.16; P<0.01) and the early‐to‐atrial peak transmitral velocity ratio (r=0.23; P<0.001). Also, ANP (1–98) predicted the degree of aortic valve obstruction and the severity of aortic and mitral regurgitation. Associations of ANP (99–126) with echocardiographic data were much weaker. Aortic valve stenosis and ANP (1–98) were independent predictors of age‐and sex‐adjusted total and cardiovascular mortality at 1.5 years of entry. Conclusions. Circulating ANP (1–98) correlates with left atrial size, with left ventricular mass and performance and with the severity of aortic and mitral valve dysfunction in persons representing the general elderly population. ANP (1–98) also predicts both total and cardiovascular mortality.
Changes in autonomic nervous function during the 4‐year follow‐up in middle‐aged diabetic and nondiabetic subjects initially free of coronary heart disease
Authors: MUSTONEN J. , UUSITUPA M. , MÄNTYSAARI M. , LÄNSIMIES E. , PYÖRÄLÄ K. , LAAKSO M. 
Published: November 2003

Objectives. To study the changes in autonomic nervous function during the 4‐year follow‐up period in diabetic patients and to investigate factors predicting autonomic nervous dysfunction Design. A 4‐year follow‐up study. Setting. At baseline the study subjects without known cardiovascular disease were recruited from a large group of diabetic and nondiabetic subjects selected randomly from a baseline population. Subjects. Middle‐aged control subjects (n=44), patients with insulin‐dependent diabetes mellitus (n=32) and patients with non‐insulin‐dependent diabetes mellitus (n=32) were studied at baseline and after the 4‐year follow‐up. Interventions. Autonomic nervous function tests and exercise test at baseline and after the 4‐year follow‐up. Results. At the baseline, heart rate variation during deep breathing was significantly lower in patients with insulin‐dependent diabetes (13.0±1.2 beats min−1; P<0.05) and in patients with non‐insulin‐dependent diabetes (12.9±1.5 beats min−1; P<0.05) than in control subjects (16.6±1.1 beats min−1). At baseline, autonomic nervous function score was significantly higher indicating disturbed autonomic nervous function in patients with insulin‐dependent diabetes (1.74±0.19; P<0.01) than in control subjects (1.24±0.14), but the difference was not significant between control subjects and patients with non‐insulin‐dependent diabetes (1.47±0.12). During the follow‐up, autonomic nervous function score increased in patients with noninsulin‐dependent diabetes to 2.00±0.21 (P<0.001, as compared to baseline), but did not change in patients with insulin‐dependent diabetes (1.77±0.18) or control subjects (1.22±0.12). In both diabetic groups, the deterioration of autonomic nervous function score during the 4‐year follow‐up was associated with poor glycaemic control at baseline. Clinical manifestation of coronary heart disease was found in three (7%) control subjects, 12 (37%; P<0.001) patients with insulin‐dependent diabetes and 11 (34%; P<0.01) patients with non‐insulin‐dependent diabetes mellitus at follow‐up examination. Autonomic nervous function was more abnormal in those insulin‐dependent diabetic patients with coronary heart disease than those without. Conclusions. During the 4‐year follow‐up the impairment in autonomic nervous function occurred mainly in patients with noninsulin‐dependent diabetes. Poor glycaemic control appears to be an important determinant of the progression of autonomic nervous dysfunction in diabetes.
Paracetamol‐induced cholestatic and granulomatous liver injuries
Authors: LINDGREN A. , ALDENBORG F. , NORKRANS G. , OLAISON L. , OLSSON R. 
Published: November 2003

Objective. To describe uncommon (previously unreported) types of adverse liver reactions to paracetamol Design. In addition to describing patients, with uncommon types of liver reactions to paracetamol, admitted to our hospitals, we surveyed all the liver reactions to paracetamol reported to the Swedish Adverse Drug Reactions Advisory Committee from 1973 to 1993. Setting. The Swedish population of 8 million inhabitants. Measurement. Extensive medical evaluation. Results. We found one case with a cholestatic liver reaction and one with granulomatous hepatitis. The reactions were probably idiosyncratic and took several months to disappear. Conclusion. In addition to the well‐known dose‐related toxic liver damage paracetamol may rarely cause non‐dose‐related severe, prolonged cholestasis or granulomatous hepatitis with cirrhosis.
Interpretation of data from multiple trials: a critical review
Authors: CONN H. O. 
Published: November 2003

The objective was to review the current status of meta‐analysis, the process of combining the results of similar investigations, which was described in 1976. It has evolved rapidly, and thousands have already been published. Meta‐analysis may be performed in a narrative form or in the preferred statistical format, which is more rigorous and demanding. The criteria for designing and performing a meta‐analysis of high quality are presented and discussed in detail, including selection criteria, quality, biases and heterogeneity, both of component studies and of results. Critical reviews of meta‐analyses are presented. Examples are given from my own field – hepatology – and from my own research experience. Although meta‐analysis is simple in concept, it is complex in execution. If performed with insufficient insight or attention to detail, it may give ambiguous or erroneous results.
Interrelationships between weight loss, body fat distribution and sex hormones in pre‐ and postmenopausal obese women
Authors: TURCATO E. , ZAMBONI M. , DE PERGOLA G. , ARMELLINI F. , ZIVELONGHI A. , BERGAMO‐ANDREIS I. A. , GIORGINO R. , BOSELLO O. 
Published: November 2003

Objectives. Relationships between regional body fat distribution and sex hormones as well as changes in sex hormones after weight loss were evaluated. Setting. All subjects were hospitalized in the Institute of Internal Medicine of the University of Verona. Subjects. Twenty‐six premenopausal (age 33.7± 10.2 years) and 15 postmenopausal (age 57.9±5.9 years) obese women. Interventions. Body weight, body‐mass index, waist and hip circumferences, visceral fat by computed tomography and sex hormones were evaluated before and after 4 weeks on a very low energy diet. Results. Body‐mass index was higher in pre‐ than in postmenopausal women, although the difference was not significant. Total and free testosterone were significantly higher in the pre‐ than in the postmenopausal group (P<0.001). Significant negative correlations were found between age and total testosterone (r=−0.65; P<0.001), free testosterone (r=−0.54; P<0.001), androstenedione (r=−0.46; P<0.01) and urinary cortisol excretion (r=−0.50; P<0.01). A negative correlation was found between visceral fat and total testosterone (r=−0.41; P<0.01). After adjusting for age, the negative correlation between total testosterone and visceral fat encountered both in the subject group as a whole and in premenopausal women was no longer significant, whilst a significant negative association between visceral fat and sex hormone binding globulin (SHBG) (r=−0.56; P<0.001) was always found. When step‐down regression analysis was used to evaluate the joint effect of age, menopausal status, and anthropometric and metabolic variables on sex hormones, age was the most powerful independent variable for predicting total testosterone, free testosterone and androstenedione levels, whilst menopausal status was the most powerful predictor of FSH and LH levels. Changes in hormones after VLED were analysed separately in pre‐ and postmenopausal women. None of the hormones changed significantly after VLED in the postmenopausal group, except for FSH values. LH, free testosterone and urinary cortisol excretion values decreased significantly after VLED in the premenopausal group. Conclusions. Our data show that age, to a greater extent than visceral fat, seems to be negatively associated with steroid sex hormones. Weight loss seems to be associated with changes in sex hormones only in premenopausal women.
Atrial natriuretic peptides predict mortality in the elderly
Authors: WALLÉN THOMAS , LANDAHL STEN , HEDNER THOMAS , HALL CHRISTIAN , SAITO YOSHIHIKO , NAKAO KAZUWA 
Published: November 2003

Objectives. To ascertain whether atrial natriuretic peptides could be used as prospective and independent predictors of total mortality in an elderly population. Design. Atrial natriuretic peptides, ANP(1–98) and ANP(99–126), were measured in 541 subjects from the 85‐year‐old population of Gothenburg, Sweden. Before the study cardiovascular disorders such as congestive heart failure, ischaemic heart disease, hypertension and atrial fibrillation were defined. Total mortality was recorded during the prospective 60‐month follow‐up period. Setting. Individuals aged 85 years from the population of Gothenburg, Sweden, were visited once at home and made one visit to Vasa Hospital. Main outcome measures. Sixty‐month mortality in relation to circulating concentrations of atrial natriuretic peptides. Results. Circulating concentrations of ANP(1–98) and ANP(99–126) were significantly correlated with 60‐month mortality in the total study population (ANP(1–98), P<0.001; ANP(99–126), P<0.01). In subjects with cardiovascular disorders, 60‐month mortality was significantly correlated with increased concentrations of ANP(1–98) (P<0.01) and ANP(99–126) (P<0.05). In subjects with no defined cardiovascular disorder, 60‐month mortality was significantly correlated with increased ANP(1–98) concentrations (P<0.01). Conclusions. In the elderly population, atrial peptides predict mortality in subjects with defined cardiovascular disorders as well as in the total population and may predict future cardiovascular disorder.
Prevalence of activated protein C resistance and analysis of clinical profile in thromboembolic patients. A Belgian prospective study
Authors: HAINAUT P. , AZERAD M.‐A. , LEHMANN F. , SCHLIT A.‐F. , ZECH F. , HEUSTERSPREUTE M. , PHILIPPE M. , COL C. , LAVENNE E. , MORIAU M. 
Published: November 2003

Objectives. To assess the prevalence of activated protein C resistance (APC‐R) among healthy subjects and thromboembolic patients and to determine the clinical characteristics associated with APC‐R. Design. A prospective study. Setting. One academic medical centre. Subjects. 91 health controls and 126 thromboembolic patients. Measurements. Patients and control were genotyped for the factor V Leiden (VaQ506) mutation. The anticoagulant response of the patient's plasma to activated protein C was also determined. Results. The frequency of APC‐R was 3.3% among healthy control subjects and 22% among thrombotic patients of whom 18% were heterozygous and 4% were homozygous. The mean age at the first thrombotic event and the severity of thrombotic disease including the proportion of proximal deep vein thrombosis and the frequency of lung embolism were identical among APC‐R positive and negative patients. A family history of thromboembolic disease was elicited more frequently in APC‐R positive than in APC‐R negative patients (57% vs. 22%, P<0.001). The recurrence rate was higher for APCR‐R positive patients (57% vs. 34%, P<0.05). The percentage of cases with a factor predisposing to thrombosis was very similar in APC‐R positive (57%) and negative (68%) patients. Conclusions. A familial history of thromboembolic disease and recurrences are significantly more frequent among APC‐R positive than APC‐R negative patients.