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Fadl Elmula FEM, Mariampillai JE, Heimark S, Kjeldsen SE, Burnier M. Medical Measures in Hypertensives Considered Resistant. Am J Hypertens 2024; 37:307-317. [PMID: 38124494 PMCID: PMC11016838 DOI: 10.1093/ajh/hpad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. METHODS All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. RESULTS Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. CONCLUSIONS Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
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Affiliation(s)
- Fadl Elmula M Fadl Elmula
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | | | - Sondre Heimark
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Ullevaal University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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2
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Heimark S, Hove C, Stepanov A, Boysen ES, Gløersen Ø, Bøtke-Rasmussen KG, Gravdal HJ, Narayanapillai K, Fadl Elmula FEM, Seeberg TM, Larstorp ACK, Waldum-Grevbo B. Accuracy and User Acceptability of 24-hour Ambulatory Blood Pressure Monitoring by a Prototype Cuffless Multi-Sensor Device Compared to a Conventional Oscillometric Device. Blood Press 2023; 32:2274595. [PMID: 37885101 DOI: 10.1080/08037051.2023.2274595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE 24-hour ambulatory blood pressure monitoring (24ABPM) is state of the art in out-of-office blood pressure (BP) monitoring. Due to discomfort and technical limitations related to cuff-based 24ABPM devices, methods for non-invasive and continuous estimation of BP without the need for a cuff have gained interest. The main aims of the present study were to compare accuracy of a pulse arrival time (PAT) based BP-model and user acceptability of a prototype cuffless multi-sensor device (cuffless device), developed by Aidee Health AS, with a conventional cuff-based oscillometric device (ReferenceBP) during 24ABPM. METHODS Ninety-five normotensive and hypertensive adults underwent simultaneous 24ABPM with the cuffless device on the chest and a conventional cuff-based oscillometric device on the non-dominant arm. PAT was calculated using the electrocardiogram (ECG) and photoplethysmography (PPG) sensors incorporated in the chest-worn device. The cuffless device recorded continuously, while ReferenceBP measurements were taken every 20 minutes during daytime and every 30 minutes during nighttime. Two-minute PAT-based BP predictions corresponding to the ReferenceBP measurements were compared with ReferenceBP measurements using paired t-tests, bias, and limits of agreement. RESULTS Mean (SD) of ReferenceBP compared to PAT-based daytime and nighttime systolic BP (SBP) were 129.7 (13.8) mmHg versus 133.6 (20.9) mmHg and 113.1 (16.5) mmHg versus 131.9 (23.4) mmHg. Ninety-five % limits of agreements were [-26.7, 34.6 mmHg] and [-20.9, 58.4 mmHg] for daytime and nighttime SBP respectively. The cuffless device was reported to be significantly more comfortable and less disturbing than the ReferenceBP device during 24ABPM. CONCLUSIONS In the present study, we demonstrated that a general PAT-based BP model had unsatisfactory agreement with ambulatory BP during 24ABPM, especially during nighttime. If sufficient accuracy can be achieved, cuffless BP devices have promising potential for clinical assessment of BP due to the opportunities provided by continuous BP measurements during real-life conditions and high user acceptability.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christine Hove
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Elin Sundby Boysen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Øyvind Gløersen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | | | | | | | | | - Trine M Seeberg
- Aidee Health AS, Oslo, Norway
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
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3
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Mariampillai JE, Halvorsen LV, Larstorp AC, Heimark S, Waldum-Grevbo B, Kjeldsen SE, Nordby G, Stenehjem AE, Berg JP, Høieggen A. Diabetes og kronisk nyresykdom. Tidsskr Nor Laegeforen 2023; 143:22-0822. [PMID: 37668137 DOI: 10.4045/tidsskr.22.0822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Chronic kidney disease is one of the most serious complications of diabetes. One of the challenges in the follow-up of patients with diabetes is to discover signs of kidney disease. Recent research shows that several drugs have renal protective effects. In this clinical review article we present markers used in the follow-up of patients with diabetes and chronic kidney disease, and new treatment options.
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Affiliation(s)
| | - Lene Vernås Halvorsen
- Nyremedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Anne Cecilie Larstorp
- Avdeling for medisinsk biokjemi, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | - Sondre Heimark
- Nyremedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | | - Sverre Erik Kjeldsen
- Hjertemedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | | | | - Jens Petter Berg
- Institutt for klinisk medisin, Universitetet i Oslo, og, Avdeling for medisinsk biokjemi, Oslo universitetssykehus
| | - Aud Høieggen
- Nyremedisinsk avdeling, Oslo universitetssykehus, Ullevål, og, Institutt for klinisk medisin, Universitetet i Oslo
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4
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Heimark S, Mehlum MH, Mancia G, Søraas CL, Liestøl K, Wachtell K, Larstorp AC, Rostrup M, Mariampillai JE, Kjeldsen SE, Julius S, Weber MA. Middle-Aged and Older Patients With Left Ventricular Hypertrophy: Higher Mortality With Drug Treated Systolic Blood Pressure Below 130 mm Hg. Hypertension 2023. [PMID: 37350267 DOI: 10.1161/hypertensionaha.123.21454] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Approximately 40% of people with hypertension have left ventricular hypertrophy (LVH) detected by ECG or echocardiography. Because patients with LVH have poor myocardial microcirculation, they may be too sensitive to lowering systolic blood pressure (SBP) too much due to a lack of myocardial perfusion pressure. We aimed to investigate whether the average achieved SBP <130 mm Hg may cause harm in patients with LVH in the Valsartan Antihypertensive Long-Term Use Evaluation trial (VALUE). METHODS Of the 15 245 VALUE participants, we identified 13 803 patients without cardiovascular events during the first 6 months after randomization. Of these, 2458 patients had electrocardiographic LVH (ECG-LVH). Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other prespecified end points for patients who achieved average SBP 130 to 139 mm Hg (No-LVH group n=4863; ECG-LVH group n=929) and <130 mm Hg (No-LVH group n=2107; ECG-LVH group n=305). Reference groups were patients who achieved average SBP ≥140 mm Hg following the first excluded 6 months (No-LVH group n=4375; ECG-LVH group n=1224). RESULTS The No-LVH group achieving average SBP <130 mm Hg had a significantly lower incidence of several cardiovascular end points. The ECG-LVH group achieving average SBP <130 mm Hg had higher cardiac mortality (hazard ratio, 1.98 [95% CIs, 1.06-3.70]; P=0.032) and all-cause mortality (hazard ratio, 1.74 [95% CIs, 1.17-2.60]; P=0.007), and SBP <130 mm Hg was not associated with a reduction in any end point. CONCLUSIONS Our findings may be seen as a signal that caution is warranted when treating middle-aged and older patients with electrocardiographic or echocardiographic LVH to SBP <130 mm Hg.
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Affiliation(s)
- Sondre Heimark
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Department of Nephrology, Oslo University Hospital, Ullevaal, Norway. (S.H.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Maria H Mehlum
- Department of Geriatrics, Oslo University Hospital, Ullevaal, Norway. (M.H.M.)
| | | | - Camilla L Søraas
- Department of Environmental and Occupational Medicine, Oslo University Hospital, Ullevaal, Norway. (C.L.S.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Knut Liestøl
- Institute of Informatics, University of Oslo, Norway. (K.L.)
| | - Kristian Wachtell
- Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY (K.W.)
| | - Anne C Larstorp
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Norway. (A.C.L.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Morten Rostrup
- Institute of Basic Medical Sciences University of Oslo, Norway. (M.R.)
- Department of Acute Medicine, Oslo University Hospital, Ullevaal, Norway. (M.R.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | | | - Sverre E Kjeldsen
- Institute of Clinical Medicine, University of Oslo, Norway. (S.H., S.E.K., A.C.L.)
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway. (S.E.K.)
- Department of Cardiovascular & Renal Research Center, Oslo University Hospital, Ullevaal, Norway. (S.H., C.L.S., S.E.K., A.C.L., M.R.)
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (S.E.K., S.J.)
| | - Michael A Weber
- Department of Cardiovascular Medicine, SUNY Downstate College of Medicine, NY (M.A.W.)
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Heimark S, Bøtker-Rasmussen KG, Stepanov A, Haga ØG, Gonzalez V, Seeberg TM, Fadl Elmula FEM, Waldum-Grevbo B. Accuracy of non-invasive cuffless blood pressure in the intensive care unit: Promises and challenges. Front Med (Lausanne) 2023; 10:1154041. [PMID: 37138759 PMCID: PMC10150697 DOI: 10.3389/fmed.2023.1154041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
Objective Continuous non-invasive cuffless blood pressure (BP) monitoring may reduce adverse outcomes in hospitalized patients if accuracy is approved. We aimed to investigate accuracy of two different BP prediction models in critically ill intensive care unit (ICU) patients, using a prototype cuffless BP device based on electrocardiogram and photoplethysmography signals. We compared a pulse arrival time (PAT)-based BP model (generalized PAT-based model) derived from a general population cohort to more complex and individualized models (complex individualized models) utilizing other features of the BP sensor signals. Methods Patients admitted to an ICU with indication of invasive BP monitoring were included. The first half of each patient's data was used to train a subject-specific machine learning model (complex individualized models). The second half was used to estimate BP and test accuracy of both the generalized PAT-based model and the complex individualized models. A total of 7,327 measurements of 15 s epochs were included in pairwise comparisons across 25 patients. Results The generalized PAT-based model achieved a mean absolute error (SD of errors) of 7.6 (7.2) mmHg, 3.3 (3.1) mmHg and 4.6 (4.4) mmHg for systolic BP, diastolic BP and mean arterial pressure (MAP) respectively. Corresponding results for the complex individualized model were 6.5 (6.7) mmHg, 3.1 (3.0) mmHg and 4.0 (4.0) mmHg. Percentage of absolute errors within 10 mmHg for the generalized model were 77.6, 96.2, and 89.6% for systolic BP, diastolic BP and MAP, respectively. Corresponding results for the individualized model were 83.8, 96.2, and 94.2%. Accuracy was significantly improved when comparing the complex individualized models to the generalized PAT-based model in systolic BP and MAP, but not diastolic BP. Conclusion A generalized PAT-based model, developed from a different population was not able to accurately track BP changes in critically ill ICU patients. Individually fitted models utilizing other cuffless BP sensor signals significantly improved accuracy, indicating that cuffless BP can be measured non-invasively, but the challenge toward generalizable models remains for future research to resolve.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Sondre Heimark,
| | | | | | | | - Victor Gonzalez
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Trine M. Seeberg
- Aidee Health AS, Oslo, Norway
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | | | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
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6
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Heimark S, Eitzen I, Vianello I, Bøtker-Rasmussen KG, Mamen A, Hoel Rindal OM, Waldum-Grevbo B, Sandbakk Ø, Seeberg TM. Blood Pressure Response and Pulse Arrival Time During Exercise Testing in Well-Trained Individuals. Front Physiol 2022; 13:863855. [PMID: 35899026 PMCID: PMC9309297 DOI: 10.3389/fphys.2022.863855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/08/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: There is a lack of data describing the blood pressure response (BPR) in well-trained individuals. In addition, continuous bio-signal measurements are increasingly investigated to overcome the limitations of intermittent cuff-based BP measurements during exercise testing. Thus, the present study aimed to assess the BPR in well-trained individuals during a cycle ergometer test with a particular focus on the systolic BP (SBP) and to investigate pulse arrival time (PAT) as a continuous surrogate for SBP during exercise testing. Materials and Methods: Eighteen well-trained male cyclists were included (32.4 ± 9.4 years; maximal oxygen uptake 63 ± 10 ml/min/kg) and performed a stepwise lactate threshold test with 5-minute stages, followed by a continuous test to voluntary exhaustion with 1-min increments when cycling on an ergometer. BP was measured with a standard automated exercise BP cuff. PAT was measured continuously with a non-invasive physiological measurements device (IsenseU) and metabolic consumption was measured continuously during both tests. Results: At lactate threshold (281 ± 56 W) and maximal intensity test (403 ± 61 W), SBP increased from resting values of 136 ± 9 mmHg to maximal values of 219 ± 21 mmHg and 231 ± 18 mmHg, respectively. Linear within-participant regression lines between PAT and SBP showed a mean r2 of 0.81 ± 17. Conclusion: In the present study focusing on the BPR in well-trained individuals, we observed a more exaggerated systolic BPR than in comparable recent studies. Future research should follow up on these findings to clarify the clinical implications of the high BPR in well-trained individuals. In addition, PAT showed strong intra-individual associations, indicating potential use as a surrogate SBP measurement during exercise testing.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Sondre Heimark,
| | - Ingrid Eitzen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Isabella Vianello
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Asgeir Mamen
- Kristiania University College, School of Health Sciences, Oslo, Norway
| | | | | | - Øyvind Sandbakk
- Centre for Elite Sports Research, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine M. Seeberg
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
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7
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Heimark S, Rindal OMH, Seeberg TM, Stepanov A, Boysen ES, Bøtker-Rasmussen KG, Mobæk NK, Søraas CL, Stenehjem AE, Fadl Elmula FEM, Waldum-Grevbo B. Blood pressure altering method affects correlation with pulse arrival time. Blood Press Monit 2022; 27:139-146. [PMID: 34855653 PMCID: PMC8893131 DOI: 10.1097/mbp.0000000000000577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pulse arrival time (PAT) is a potential main feature in cuff-less blood pressure (BP) monitoring. However, the precise relationship between BP parameters and PAT under varying conditions lacks a complete understanding. We hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and both SBP and DBP. Therefore, this study aimed to investigate the correlation between PAT and BP during two exercise modalities with differing BP responses using an unobtrusive wearable device. METHODS Seventy-five subjects, of which 43.7% had a prior diagnosis of hypertension, participated in an isometric and dynamic exercise test also including seated periods of rest prior to, in between and after. PAT was measured using a prototype wearable chest belt with a one-channel electrocardiogram and a photo-plethysmography sensor. Reference BP was measured auscultatory. RESULTS Mean individual correlation between PAT and SBP was -0.82 ± 0.14 in the full protocol, -0.79 ± 0.27 during isometric exercise and -0.77 ± 0.19 during dynamic exercise. Corresponding correlation between PAT and DBP was 0.25 ± 0.35, -0.74 ± 0.23 and 0.39 ± 0.41. CONCLUSION The results confirm PAT as a potential main feature to track changes in SBP. The relationship between DBP and PAT varied between exercise modalities, with the sign of the correlation changing from negative to positive between type of exercise modality. Thus, we hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and BP with emphasis on DBP.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital
- Section for Cardiovascular and Renal Research, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo
| | | | | | | | | | | | | | - Camilla L. Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital
- Section for Environmental and Occupational Medicine, Oslo University Hospital
| | | | - Fadl Elmula M. Fadl Elmula
- Section for Cardiovascular and Renal Research, Oslo University Hospital
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
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8
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Bergland OU, Halvorsen LV, Søraas CL, Hjørnholm U, Kjær VN, Rognstad S, Brobak KM, Aune A, Olsen E, Fauchald YM, Heimark S, Thorstensen CW, Liestøl K, Solbu MD, Gerdts E, Mo R, Rostrup M, Kjeldsen SE, Høieggen A, Opdal MS, Larstorp ACK, Fadl Elmula FEM. Detection of Nonadherence to Antihypertensive Treatment by Measurements of Serum Drug Concentrations. Hypertension 2021; 78:617-628. [PMID: 34275336 DOI: 10.1161/hypertensionaha.121.17514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ola Undrum Bergland
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Lene V Halvorsen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Camilla L Søraas
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Section for Environmental and Occupational Medicine (C.L.S.)
| | - Ulla Hjørnholm
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Vibeke N Kjær
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Stine Rognstad
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Pharmacology (S.R., C.W.T., M.S.O.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Karl Marius Brobak
- Metabolic and Renal Research Group (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø.,UiT The Arctic University of Norway, and Section of Nephrology (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø
| | - Arleen Aune
- Department of Clinical Science, University of Bergen (A.A., E.G.).,Department of Heart Disease, Haukeland University Hospital, Bergen (A.A., E.G.)
| | - Eirik Olsen
- Department of Cardiology, Trondheim University Hospital, University of Trondheim (E.O., R.M.)
| | - Ylva M Fauchald
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.)
| | - Sondre Heimark
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | | | - Knut Liestøl
- Department of Informatics (K.L.), University of Oslo
| | - Marit D Solbu
- Metabolic and Renal Research Group (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø.,UiT The Arctic University of Norway, and Section of Nephrology (K.M.B., M.D.S.), University Hospital of North Norway, Tromsø
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen (A.A., E.G.).,Department of Heart Disease, Haukeland University Hospital, Bergen (A.A., E.G.)
| | - Rune Mo
- Department of Cardiology, Trondheim University Hospital, University of Trondheim (E.O., R.M.)
| | - Morten Rostrup
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Acute Medicine (M.R., F.E.M.F.E.).,Department of Behavioral Sciences, Institute of Basic Medical Sciences (M.R.), University of Oslo
| | - Sverre E Kjeldsen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Cardiology (S.E.K.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Aud Høieggen
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Nephrology (L.V.H., S.H., A.H.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Mimi S Opdal
- Department of Pharmacology (S.R., C.W.T., M.S.O.)
| | - Anne Cecilie K Larstorp
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Medical Biochemistry (A.C.K.L.).,Oslo University Hospital Ullevål; Institute of Clinical Medicine (O.U.B., L.V.H., S.R., S.H., S.E.K., A.H., A.C.K.L.), University of Oslo
| | - Fadl Elmula M Fadl Elmula
- From the Section for Cardiovascular and Renal Research (O.U.B., L.V.H., C.L.S., U.H., V.N.K., S.R., Y.M.F., S.H., M.R., S.E.K., A.H., A.C.K.L., F.E.M.F.E.).,Department of Acute Medicine (M.R., F.E.M.F.E.)
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9
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Mariampillai JE, Eskås PA, Heimark S, Larstorp ACK, Fadl Elmula FEM, Høieggen A, Nortvedt P. Apparent treatment-resistant hypertension – patient–physician relationship and ethical issues. Blood Press 2017; 26:133-138. [DOI: 10.1080/08037051.2016.1277129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | | | - Anne Cecilie K. Larstorp
- Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Fadl Elmula M. Fadl Elmula
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Internal Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Aud Høieggen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Section of Cardiovascular and Renal Research, Oslo University Hospital, Ullevaal, Oslo, Norway
- Department of Nephrology, Oslo University Hospital, Ullevaal, Oslo, Norway
| | - Per Nortvedt
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Center for Medical Ethics, University of Oslo, Oslo, Norway
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10
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Mariampillai JE, Eskås PA, Heimark S, Kjeldsen SE, Narkiewicz K, Mancia G. A Case for Less Intensive Blood Pressure Control: It Matters to Achieve Target Blood Pressure Early and Sustained Below 140/90mmHg. Prog Cardiovasc Dis 2016; 59:209-218. [PMID: 27619341 DOI: 10.1016/j.pcad.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
Although high blood pressure (BP) is the leading risk factors for cardiovascular (CV) disease, the optimal BP treatment target in order to reduce CV risk is unclear in the aftermath of the SPRINT study. The aim of this review is to assess large, randomized, and controlled trials on BP targets, as well as review selected observational analyses from other large randomized BP trials in order to evaluate the benefit of intense vs. standard BP control. None of the studies, except SPRINT, favored intense BP treatment. Some of the studies suggested favorable effects of lowering treatment target in patients with diabetes or high risk of stroke. In SPRINT, a new BP measurement method was introduced, and the results must be interpreted in light of this. The results of the observational analyses indicated the best preventive effect when achieving early and sustained BP control rather than low targets. In conclusion, today's guidelines' recommended treatment target of <140/90mmHg seems sufficient for most patients. Early and sustained BP control should be the main focus.
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Affiliation(s)
| | | | | | - Sverre E Kjeldsen
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Ullevaal, Oslo, Norway.
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Giuseppe Mancia
- IRCCS Instituto Auxologico Italiano, University of Milano-Bicocca, Milan, Italy
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11
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Eskås PA, Heimark S, Mariampillai JE, Larstorp ACK, Fadl Elmula FEM, Høieggen A. [Medication adherence and monitoring of antihypertensive treatment]. Tidsskr Nor Laegeforen 2016; 136:920-3. [PMID: 27272370 DOI: 10.4045/tidsskr.15.0978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Lack of adherence to medication may be the explanation for unsatisfactory drug efficacy and is often misinterpreted as resistance to treatment. When encountering patients with persistent high blood pressure despite antihypertensive treatment, it is therefore important to discover whether they are actually taking their medication. This article aims to provide an updated overview of methods of revealing and monitoring medication adherence. The article is based on non-systematic literature searches in PubMed and on the senior authors' own clinical experience.
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Affiliation(s)
| | | | | | - Anne Cecilie K Larstorp
- Avdeling for medisinsk biokjemi Klinikk for laboratoriemedisin og Enhet for indremedisinsk forskning Oslo universitetssykehus, Ullevål
| | - Fadl Elmula Mohamed Fadl Elmula
- Avdeling for hjertemedisin og avdeling for generell indremedisin Medisinsk klinikk Oslo universitetssykehus, Ullevål og Institutt for klinisk medisin, Medisinsk fakultet Universitetet i Oslo
| | - Aud Høieggen
- Nyremedisinsk avdeling Medisinsk klinikk Oslo universitetssykehus, Ullevål og Institutt for klinisk medisin Medisinsk fakultet Universitetet i Oslo
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12
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Heimark S, Eskås PA, Mariampillai JE, Larstorp ACK, Høieggen A, Fadl Elmula FEM. Tertiary work-up of apparent treatment-resistant hypertension. Blood Press 2016; 25:312-8. [DOI: 10.3109/08037051.2016.1172865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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13
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Eskås PA, Heimark S, Eek Mariampillai J, Larstorp ACK, Fadl Elmula FEM, Høieggen A. Adherence to medication and drug monitoring in apparent treatment-resistant hypertension. Blood Press 2016; 25:199-205. [PMID: 26729283 DOI: 10.3109/08037051.2015.1121706] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Poor drug adherence is one of the main reasons for the failure to achieve treatment targets in hypertensive patients. In patients who receive pharmacological treatment, assessment of drug adherence is of the utmost importance. The aim of this review is to present an update of the methods available to reveal and monitor non-adherence in patients with apparent treatment-resistant hypertension. Methods for monitoring adherence are divided into indirect and direct methods. The indirect methods are mainly based on self-reported adherence and can easily be manipulated by the patient. Directly observed therapy and therapeutic drug monitoring are examples of direct methods. There are limitations and advantages to all of the methods, and because of the patient's ability to manipulate the outcome of indirect methods, direct methods should be preferred. Therapeutic drug monitoring and directly observed therapy with subsequent ambulatory blood pressure measurement are considered to be reliable methods and should be used more in the routine assessment of patients with apparent treatment-resistant hypertension.
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Affiliation(s)
| | - Sondre Heimark
- a Faculty of Medicine , University of Oslo , Oslo , Norway
| | | | | | - Fadl Elmula M Fadl Elmula
- a Faculty of Medicine , University of Oslo , Oslo , Norway ;,c Section for Cardiovascular and Renal Research ;,d Department of Cardiology ;,e Department of Internal Medicine
| | - Aud Høieggen
- a Faculty of Medicine , University of Oslo , Oslo , Norway ;,c Section for Cardiovascular and Renal Research ;,f Department of Nephrology , Oslo University Hospital , Ullevaal , Oslo , Norway
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