Browsing by Subject "blood pressure"

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  • Palmu, Joonatan; Salosensaari, Aaro; Havulinna, Aki S.; Cheng, Susan; Inouye, Michael; Jain, Mohit; Salido, Rodolfo A.; Sanders, Karenina; Brennan, Caitriona; Humphrey, Gregory C.; Sanders, Jon G.; Vartiainen, Erkki; Laatikainen, Tiina; Jousilahti, Pekka; Salomaa, Veikko; Knight, Rob; Lahti, Leo; Niiranen, Teemu J. (2020)
    Background Several small-scale animal studies have suggested that gut microbiota and blood pressure (BP) are linked. However, results from human studies remain scarce and conflicting. We wanted to elucidate the multivariable-adjusted association between gut metagenome and BP in a large, representative, well-phenotyped population sample. We performed a focused analysis to examine the previously reported inverse associations between sodium intake and Lactobacillus abundance and between Lactobacillus abundance and BP. Methods and Results We studied a population sample of 6953 Finns aged 25 to 74 years (mean age, 49.212.9 years; 54.9% women). The participants underwent a health examination, which included BP measurement, stool collection, and 24-hour urine sampling (N=829). Gut microbiota was analyzed using shallow shotgun metagenome sequencing. In age- and sex-adjusted models, the alpha (within-sample) and beta (between-sample) diversities of taxonomic composition were strongly related to BP indexes (P diversity was only associated with diastolic BP (P=0.032). However, we observed significant, mainly positive, associations between BP indexes and 45 microbial genera (P Conclusions Although the associations between overall gut taxonomic composition and BP are weak, individuals with hypertension demonstrate changes in several genera. We demonstrate strong negative associations of certain Lactobacillus species with sodium intake and BP, highlighting the need for experimental studies.
  • Nykänen, Tarja; Pihlainen, Kai; Kyröläinen, Heikki; Fogelholm, Mikael (2020)
    Objectives: This observational follow-up study investigated the associations of nutrition and body composition with cardiovascular disease (CVD) risk factors, including pro-inflammatory biomarkers, in soldiers during a 6-month deployment. Material and Methods: Thirty-five male soldiers were assessed at months 0, 3 and 6, and their parameters, i.e., M +/- SD, were as follows: age 30.0 +/- 8.7 years, height 179 +/- 6 cm, and BMI 24.2 +/- 2.5 kg/m(2). Three-day food diaries were used for monitoring macronutrient intake. Body composition was estimated using bioimpedance. Fasting blood samples for lipids and pro-inflammatory biomarkers were collected, and blood pressure measurements were performed. Results: Carbohydrate intake increased and protein intake decreased at month 3 (p = 0.034, p <0.001), while body composition remained stable. Systolic blood pressure increased at month 6, while other CVD risk factors remained within the reference values. Fat mass and body fat percentage were associated positively with total and low density lipoprotein (LDL) cholesterol concentrations at all measurement points. A negative association was found between the change in fiber intake vs. the change in total (r = -0.36, p = 0.033) and LDL cholesterol (R = -0.39, p = 0.019). Conclusions: Lower fiber intake and a greater amount of body fat were associated with high total and LDL cholesterol concentrations. Nevertheless, the measured CVD risk factors remained within the reference values, except for the higher systolic blood pressure. A regular screening of body composition and a higher consumption of fiber-rich foods may promote cardiometabolic health in soldiers.
  • Rovio, Suvi P.; Pahkala, Katja; Nevalainen, Jaakko; Juonala, Markus; Salo, Pia; Kahonen, Mika; Hutri-Kahonen, Nina; Lehtimaki, Terho; Jokinen, Eero; Laitinen, Tomi; Taittonen, Leena; Tossavainen, Paivi; Viikari, Jorma S. A.; Rinne, Juha O.; Raitakari, Olli T. (2017)
    BACKGROUND In adults, high blood pressure (BP), adverse serum lipids, and smoking associate with cognitive deficits. The effects of these risk factors from childhood on midlife cognitive performance are unknown. OBJECTIVES This study sought to investigate the associations between childhood/adolescence cardiovascular risk factors and midlife cognitive performance. METHODS From 1980, a population-based cohort of 3,596 children (baseline age: 3 to 18 years) have been followed for 31 years in 3- to 9-year intervals. BP, serum lipids, body mass index, and smoking were assessed in all follow-ups. Cumulative exposure as the area under the curve for each risk factor was determined in childhood (6 to 12 years), adolescence (12 to 18 years), and young adulthood (18 to 24 years). In 2011, cognitive testing was performed in 2,026 participants aged 34 to 49 years. RESULTS High systolic BP, elevated serum total-cholesterol, and smoking from childhood were independently associated with worse midlife cognitive performance, especially memory and learning. The number of early life risk factors, including high levels (extreme 75th percentile for cumulative risk exposure between ages 6 and 24 years) of systolic BP, total-cholesterol, and smoking associated inversely with midlife visual and episodic memory and visuospatial associative learning (-0.140 standard deviations per risk factor, p <0.0001) and remained significant after adjustment for contemporaneous risk factors. Individuals with all risk factors within recommended levels between ages 6 and 24 years performed 0.29 standard deviations better (p = 0.006) on this cognitive domain than those exceeding all risk factor guidelines at least twice. This difference corresponds to the effect of 6 years aging on this cognitive domain. CONCLUSIONS Cumulative burden of cardiovascular risk factors from childhood/adolescence associate with worse midlife cognitive performance independent of adulthood exposure. (C) 2017 by the American College of Cardiology Foundation.
  • Huang, Yisong; Ollikainen, Miina; Sipilä, Pyry; Mustelin, Linda; Wang, Xin; Su, Shaoyong; Huan, Tianxiao; Levy, Daniel; Wilson, James; Snieder, Harold; Kaprio, Jaakko; Wang, Xiaoling (2018)
    Recently, 2 transcriptome-wide studies identified 40 genes that were differentially expressed in relation to blood pressure. However, to what extent these BP-related gene expression signatures and their associations with BP are driven by genetic or environmental factors has not been investigated. In this study of 391 twins (193 twin pairs and 5 singletons; age 55-69 years; 40% male; 57% monozygous) recruited from the Finnish Twin Cohort, transcriptome-wide data on peripheral leukocytes were obtained using the Illumina HT12 V4 array. Our transcriptome-wide analysis identified 1 gene (MOK [MAPK/MAK/MRK overlapping kinase], P=7.16x10(-8)) with its expression levels associated with systolic BP at the cutoff of false-discovery rate
  • SUMMIT Steering Comm; CARDIOGRAMplusC4D Steering Comm; van Zuydam, Natalie R.; Ladenvall, Claes; Vlachopoulou, Efthymia; Perola, Markus; Sinisalo, Juha; Salomaa, Veikko; Groop, Leif; Ripatti, Samuli (2020)
    BACKGROUND: Coronary artery disease (CAD) is accelerated in subjects with type 2 diabetes mellitus (T2D). METHODS: To test whether this reflects differential genetic influences on CAD risk in subjects with T2D, we performed a systematic assessment of genetic overlap between CAD and T2D in 66 643 subjects (27 708 with CAD and 24 259 with T2D). Variants showing apparent association with CAD in stratified analyses or evidence of interaction were evaluated in a further 117 787 subjects (16 694 with CAD and 11 537 with T2D). RESULTS: None of the previously characterized CAD loci was found to have specific effects on CAD in T2D individuals, and a genome-wide interaction analysis found no new variants for CAD that could be considered T2D specific. When we considered the overall genetic correlations between CAD and its risk factors, we found no substantial differences in these relationships by T2D background. CONCLUSIONS: This study found no evidence that the genetic architecture of CAD differs in those with T2D compared with those without T2D.
  • Salo, Perttu P.; Havulinna, Aki S.; Tukiainen, Taru; Raitakari, Olli; Lehtimäki, Terho; Kähönen, Mika; Kettunen, Johannes; Männikkö, Minna; Eriksson, Johan G.; Jula, Antti; Blankenberg, Stefan; Zeller, Tanja; Salomaa, Veikko; Kristiansson, Kati; Perola, Markus (2017)
    Background Cardiomyocytes secrete atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) in response to mechanical stretching, making them useful clinical biomarkers of cardiac stress. Both human and animal studies indicate a role for ANP as a regulator of blood pressure with conflicting results for BNP. Methods and Results We used genome-wide association analysis (n=6296) to study the effects of genetic variants on circulating natriuretic peptide concentrations and compared the impact of natriuretic peptide-associated genetic variants on blood pressure (n=27059). Eight independent genetic variants in 2 known (NPPA-NPPB and POC1B-GALNT4) and 1 novel locus (PPP3CC) associated with midregional proANP (MR-proANP), BNP, aminoterminal proBNP (NT-proBNP), or BNP:NT-proBNP ratio. The NPPA-NPPB locus containing the adjacent genes encoding ANP and BNP harbored 4 independent cis variants with effects specific to either midregional proANP or BNP and a rare missense single nucleotide polymorphism in NT-proBNP seriously altering its measurement. Variants near the calcineurin catalytic subunit gamma gene PPP3CC and the polypeptide N-acetylgalactosaminyltransferase 4 gene GALNT4 associated with BNP:NT-proBNP ratio but not with BNP or midregional proANP, suggesting effects on the post-translational regulation of proBNP. Out of the 8 individual variants, only those correlated with midregional proANP had a statistically significant albeit weak impact on blood pressure. The combined effect of these 3 single nucleotide polymorphisms also associated with hypertension risk (P=8.2x10(-4)). Conclusions Common genetic differences affecting the circulating concentration of ANP associated with blood pressure, whereas those affecting BNP did not, highlighting the blood pressure-lowering effect of ANP in the general population.
  • Singh, Sonal; Warren, Helen R.; Hiltunen, Timo P.; McDonough, Caitrin W.; El Rouby, Nihal; Salvi, Erika; Wang, Zhiying; Garofalidou, Tatiana; Fyhrquist, Frej; Kontula, Kimmo K.; Glorioso, Valeria; Zaninello, Roberta; Glorioso, Nicola; Pepine, Carl J.; Munroe, Patricia B.; Turner, Stephan T.; Chapman, Arlene B.; Boerwinkle, Eric; Johnson, Julie A.; Gong, Yan; Cooper-DeHoff, Rhonda M. (2019)
    Background-There exists a wide interindividual variability in blood pressure (BP) response to beta(1)-blockers. To identify the genetic determinants of this variability, we performed a pharmacogenomic genome-wide meta-analysis of genetic variants beta(1)-influencing blocker BP response. Methods and Results-Genome-wide association analysis for systolic BP and diastolic BP response to beta(1)-blockers from 5 randomized clinical trials consisting of 1254 patients with hypertension of European ancestry were combined in meta-analysis and single nucleotide polymorphisms (SNPs) with P Conclusions-Data from randomized clinical trials of 8 European ancestry and 2 black cohorts support the assumption that BST1 containing locus on chromosome 4 is associated with beta(1)-blocker BP response. Given the previous associations of this region with BP, this is a strong candidate region for future functional studies and potential use in precision medicine approaches for BP management and risk prediction.
  • Cooper, Mark E.; Perkovic, Vlado; Groop, Per-Henrik; Hocher, Berthold; Hehnke, Uwe; Meinicke, Thomas; Koitka-Weber, Audrey; van der Walt, Sandra; von Eynatten, Maximilian (2019)
    Objective: Concomitant treatment with angiotensin-converting enzyme (ACE) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors is increasingly common. Pharmacological studies have suggested a potential adverse drug interaction between ACE inhibitors and DPP-4 inhibitors resulting in unfavorable hemodynamic changes; very few studies have examined such an interaction between angiotensin II receptor blockers (ARBs) and DPP-4 inhibitors. We investigated blood pressure (BP) and heart rate (HR) during treatment with the DPP-4 inhibitor linagliptin in individuals receiving either ACE inhibitors or ARBs in the MARLINA-T2D trial. Methods: In this study, 360 individuals with type 2 diabetes and albuminuria receiving unchanged doses of ACE inhibitors or ARBs were randomized to linagliptin or placebo. Twenty-four-hour ambulatory BP monitoring, an exploratory endpoint, was conducted at baseline and after 24 weeks. Results: Ambulatory BP monitoring data were available for 208 individuals (linagliptin: n = 111; placebo: n = 97). Baseline mean +/- SD 24-h SBP and DBP were 132.5 +/- 12.4 mmHg and 75.9 +/- 9.4 mmHg, respectively; mean 24-h HR was 76.3 +/- 10.1 bpm. At week 24, no overall effect of the DPP-4 inhibitor versus placebo was seen on mean 24-h SBP, DBP, or HR. Furthermore, in the subgroups receiving either an ACE inhibitor or an ARB, no effect on these hemodynamic parameters was seen as a result of concomitant DPP-4 inhibitor treatment. Conclusion: Adding linagliptin to treatment with ACE inhibitors or ARBs was not associated with any hemodynamic changes, supporting their concomitant use in individuals with type 2 diabetes and albuminuria.
  • Mellembakken, Jan Roar; Mahmoudan, Azita; Morkrid, Lars; Sundström-Poromaa, Inger; Morin-Papunen, Laure; Tapanainen, Juha S.; Piltonen, Terhi T.; Hirschberg, Angelica Linden; Stener-Victorin, Elisabet; Vanky, Eszter; Ravn, Pernille; Jensen, Richard Christian; Andersen, Marianne Skovsager; Glintborg, Dorte (2021)
    Objective: Obesity is considered to be the strongest predictive factor for cardio-metabolic risk in women with polycystic ovary syndrome (PCOS). The aim of the study was to compare blood pressure (BP) in normal weight women with PCOS and controls matched for age and BMI. Methods: From a Nordic cross-sectional base of 2615 individuals of Nordic ethnicity, we studied a sub cohort of 793 normal weight women with BMI <25 k g/m(2) (512 women with PCOS according to Rotterdam criteria and 281 age and BMI-matched controls). Participants underwent measurement of BP and body composition (BMI, waist-hip ratio), lipid status, and fasting BG. Data were presented as median (quartiles). Results: The median age for women with PCOS were 28 (25, 32) years and median BMI was 22.2 (20.7, 23.4) kg/m(2). Systolic BP was 118 (109, 128) mmHg in women with PCOS compared to 110 (105, 120) mmHg in controls and diastolic BP was 74 ( 67, 81) vs 70 (64, 75) mmHg, both P <0.001. The prevalence of women with BP >= 140/90 mmHg was 11.1% (57/ 512) in women with PCOS vs 1.8% (5/281) in controls, P <0.001. In women >= 35 years the prevalence of BP >= 140/90 mmHg was comparable in women with PCOS and controls (12.7% vs 9.8%, P = 0.6). Using multiple regression analyses, the strongest association with BP was found for age, waist circumference, and total cholesterol in women with PCOS. Conclusions: Normal weight women with PCOS have higher BP than controls. BP and metabolic screening are relevant also in young normal weight women with PCOS.
  • Benetos, Athanase; Petrovic, Mirko; Strandberg, Timo (2019)
    The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide. This is mainly the clinical expression of arterial stiffening as a result of the population's aging. Chronic elevation in blood pressure represents a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life. Clinical evidence obtained in community-dwelling older people with few comorbidities and preserved autonomy supports the beneficial effects of lowering blood pressure in older hypertensive subjects even after the age of 80 years. However, observational studies in frail older individuals treated for hypertension have shown higher morbidity and mortality rates compared with those with lower blood pressure levels. Clearly, in very old subjects, the therapeutic strategy of one size fits all cannot be applied because of the enormous functional heterogeneity in these individuals. Geriatric medicine proposes taking into account the function/ frailty/ autonomy status of older people. In the present review, we propose to adapt the antihypertensive treatment using an easy-to-apply visual numeric scale allowing the identification of 3 different patient profiles according to the functional status and autonomy for activities of daily living. For the preserved function profile, strategies should be those proposed for younger old adults. For the loss of function/ preserved activities of daily living' profile, a more detailed geriatric assessment is needed to define the benefit/ risk balance as well as requirements for the tailoring of the various therapeutic strategies. Lastly, for the loss of function and altered activities of daily living' profile, therapeutic strategies should be thoroughly reassessed, including deprescribing (when considered appropriate). In the near future, controlled trials are necessary for the most frail older subjects (ie, in those systematically excluded from previous clinical trials) to gain stronger evidence regarding the benefits of the various therapeutic strategies.
  • Huang, Yisong; Ollikainen, Miina; Muniandy, Maheswary; Zhang, Tao; van Dongen, Jenny; Hao, Guang; van Der Most, Peter J.; Pan, Yue; Pervjakova, Natalia; Sun, Yan; Hui, Qin; Lahti, Jari; Fraszczyk, Eliza; Lu, Xueling; Sun, Dianjianyi; Richard, Melissa A.; Willemsen, Gonneke; Heikkila, Kauko; Leach, Irene Mateo; Mononen, Nina; Kähönen, Mika; Hurme, Mikko A.; Raitakari, Olli T.; Drake, Amanda J.; Perola, Markus; Nuotio, Marja-Liisa; Huang, Yunfeng; Khulan, Batbayar; Räikkönen, Katri; Wolffenbuttel, Bruce H. R.; Zhernakova, Alexandra; Fu, Jingyuan; Zhu, Haidong; Dong, Yanbin; van Vliet-Ostaptchouk, Jana V.; Franke, Lude; Eriksson, Johan G.; Fornage, Myriam; Milani, Lili; Lehtimäki, Terho; Vaccarino, Viola; Boomsma, Dorret; van Der Harst, Pim; de Geus, Eco J. C.; Salomaa, Veikko; Li, Shengxu; Chen, Wei; Su, Shaoyong; Wilson, James; Snieder, Harold; Kaprio, Jaakko; Wang, Xiaoling (2020)
    We conducted an epigenome-wide association study meta-analysis on blood pressure (BP) in 4820 individuals of European and African ancestry aged 14 to 69. Genome-wide DNA methylation data from peripheral leukocytes were obtained using the Infinium Human Methylation 450k BeadChip. The epigenome-wide association study meta-analysis identified 39 BP-related CpG sites withP
  • Skrifvars, Markus B.; Aneman, Anders; Ameloot, Koen (2020)
    Purpose of review To discuss recent findings relevant to optimizing blood pressure targets in adult, postcardiac arrest (PCA) patients and whether to tailor these based on specific patient, cardiac arrest or treatment characteristics. Recent findings Observational data suggest that mean arterial pressure (MAP) below 65-75 mmHg in PCA patients is associated with worse outcome. A higher MAP could be beneficial in patients with chronic hypertension who more frequently have a right shift of the cerebral autoregulation curve. Two recent randomized pilot trials compared lower and higher MAP targets during PCA care and found no significant effect on biomarkers of neurological injury. The haemodynamic interventions in those studies did not use any cerebral perfusion endpoints beyond a static MAP targets during ICU stay. Individualized, dynamic MAP targets based on assessments of cerebral perfusion and tailored to the specifics of the patient, cardiac arrest circumstances and treatment responses may be more conducive to improved outcomes. Pilot data suggest that near infrared spectroscopy monitoring may be used to determine the cerebral autoregulatory capacity and an optimal MAP, but this approach is yet to be tested in clinical trials. Current evidence suggests targeting a MAP of at least 65-75 mmHg in PCA patients. Future studies should focus on whether certain patient groups could benefit from higher and dynamic MAP targets.
  • Heiskanen, Jarkko S.; Hernesniemi, Jussi A.; Ruohonen, Saku; Hutri-Kähönen, Nina; Kähönen, Mika; Jokinen, Eero; Tossavainen, Paivi; Kallio, Merja; Laitinen, Tomi; Lehtimäki, Terho; Viikari, Jorma; Juonala, Markus; Nevalainen, Jaakko; Raitakari, Olli T. (2021)
    Background Increased left ventricular mass (LVM) predicts cardiovascular events and mortality. The objective of this study was to determine whether early-life exposures to body mass index (BMI) and systolic blood pressure (SPB) affects the left ventricular structure in adulthood. Methods We used longitudinal data from a 31-year follow-up to examine the associations between early-life (between ages 6-18) BMI and SPB on LVM in an adult population (N = 1864, aged 34-49). The burden of early-life BMI and SBP was defined as area under the curve. Results After accounting for contemporary adult determinants of LVM, early-life BMI burden associated significantly with LVM (3.61 g/SD increase in early-life BMI; [1.94 - 5.28], p <0.001). Overweight in early-life (age- and sex-specific BMI values corresponding to adult BMI > 25 kg/m(2)) associated with 4.7% (2.5-6.9%, p <0.0001) higher LVM regardless of BMI status in adulthood. Overweight in early-life combined with obesity in adulthood (BMI > 30kg/m(2)) resulted in a 21% (17.3-32.9%, p <0.0001) increase in LVM. Higher early-life BMI was associated with a risk of developing eccentric hypertrophy. The burden of early-life SPB was not associated with adult LVM or left ventricular remodeling. Conclusions High BMI in early-life confers a sustained effect on LVM and the risk for eccentric hypertrophy independently of adulthood risk factors. KEY MESSAGES Excess in BMI in early-life has an independent effect on LVM and the risk of developing eccentric hypertrophy regardless of overweight status in adulthood. Systolic blood pressure levels in early-life did not have an independent effect on LVM or LV remodeling. The clinical implication of this study is that primary prevention of obesity in early-life may prevent the development of high LVM and eccentric hypertrophy.
  • Virtanen, Marianna; Hansson, Linda Magnusson; Goldberg, Marcel; Zins, Marie; Stenholm, Sari; Vahtera, Jussi; Westerlund, Hugo; Kivimäki, Mika (2019)
    Background Although long working hours have been shown to be associated with the onset of cardiometabolic diseases, the clinical risk factor profile associated with long working hours remains unclear. We compared the clinical risk profile between people who worked long hours and those who reported being never exposed to long hours. Methods A cross-sectional study in 22 health screening centres in France was based on a random population-based sample of 75 709 participants aged 18-69 at study inception in 2012-2016 (the CONSTANCES study). The data included survey responses on working hours (never, former or current exposure to long working hours), covariates and standardised biomedical examinations including anthropometry, lung function, blood pressure and standard blood-based biomarkers. Results Among men, long working hours were associated with higher anthropometric markers (Body Mass Index, waist circumference and waist:hip ratio), adverse lipid levels, higher glucose, creatinine, white blood cells and higher alanine transaminase (adjusted mean differences in the standardised scale between the exposed and unexposed 0.02-0.12). The largest differences were found for Body Mass Index and waist circumference. A dose-response pattern with increasing years of working long hours was found for anthropometric markers, total cholesterol, glucose and gamma-glutamyltransferase. Among women, long working hours were associated with Body Mass Index and white blood cells. Conclusion In this study, men who worked long hours had slightly worse cardiometabolic and inflammatory profile than those who did not work long hours, especially with regard to anthropometric markers. In women, the corresponding associations were weak or absent.
  • Niini, Tarmo; Laakso, Aki; Tanskanen, Päivi; Niemelä, Mika; Luostarinen, Teemu (Helsingin yliopisto, 2018)
    Tutkimuksen tarkoitus Tutkimuksessa arvioimme kuinka Helsingin yliopistollisen sairaalan neurokirurgian klinikassa vuosina 2006-2014 mikrokirurgisesti hoidettujen aivojen arteriovenoosi malformaatio (AVM) potilaiden perioperatiivinen hoitoprotokolla on toteutunut. Lisäksi selvitimme viivästyneiden postoperatiivisten vuotojen (VPV) ilmaantuvuuden protokollaa käytettäessä. Aineisto ja menetelmät HYKSin neurokirurgian klinikan aivojen arteriovenoosien malformaatioiden perioperatiivisen hoidon protokollaa käytettiin koko tutkimuksen 121 operatiivisen hoidon saaneen potilaan kohortille. Neurokirurgian klinikan AVM- tietokantaa sekä potilastietojärjestelmää käyttäen kerättiin perioperatiiviseen hoitoon liittyvät tiedot (mm. päivittäiset systoliset verenpainetavoitteet sekä näiden toteutuminen, laskimonsisäinen nestehoito, nestetasapaino ja hengityskonehoidon sekä tehohoitojakson pituus). Potilaat, joille ilmaantui VPV, käytiin läpi tutkimuksessa yksityiskohtaisesti. Tulokset Viidelle potilaalle 121:stä (4.1%) ilmaantui VPV. Näiden potilaiden arteriovenoosi malformaatio oli keskimäärin korkeampaa Spetzler-Martin luokkaa (p=0.043) kuin niiden potilaiden, joille ei ilmaantunut viivästynyttä postoperatiivista vuodoa. Näiden potilaiden AV- malformaatioiden vievät suonet olivat monimutkaisempaa tyyppiä (p=0.003) ja heille annettiin enemmän laskimonsisäistä nestehoitoa neurokirurgisella teho-osastolla (keskimäärin 3726 ml/vrk vs keskimäärin 2980 ml/vrk ei vuotaneilla) (p=0.040). Kaikki VPV:n saaneet potilaat olivat miehiä (p=0.040). Johtopäätökset HYKSin Neurokirurgian klinikan aivojen AV-malformaatioiden perioperatiivinen hoitoprotokolla on yhtä hyvä, ellei hieman parempi (4.1% vs 5.0% VPV:n ilmaantuvuus), kuin aiemmin julkaistu, monimutkaisempi hoitoprotokolla. Tutkimustuloksemme tukevat Spetzler-Martin luokituksen käyttöä potilaiden postoperatiivista hoitoa suunnitellessa. Tutkimuksemme kaikki viivästyneet postoperatiiviset vuodot tapahtuivat potilaille, jotka olivat Spetzler-Martin luokkia 2-5. Avainsanat: intracranial arteriovenous malformations, neurosurgical intensive care unit, postoperative hemorrhage, retrospective study, blood pressure, clinical protocols
  • EFSA Panel Dietetic Products Nutr (2018)
    Following an application from Flan-Biotech GmbH, submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of Germany, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to Symbiosal((R)), lowering of blood pressure and reduced risk of hypertension. The Panel considers that the food, Symbiosal((R)), which is the subject of the health claim, and the food, table salt, which Symbiosal((R)) should replace, are sufficiently characterised. Lowering of blood pressure is a beneficial physiological effect. Increased blood pressure is a risk factor for hypertension. In weighing the evidence, the Panel took into account that one human study with some methodological limitations showed an effect of Symbiosal((R)) on blood pressure in the context of a self-selected diet with a maximum of 3 g/day added salt. The Panel also took into account that no other human studies in which these results have been replicated were provided, that the animal studies did not support the results of the human study, that no evidence was provided in support of a mechanism by which Symbiosal((R)) could induce a decrease in blood pressure upon oral consumption as compared to table salt in vivo in humans, and the low biological plausibility of the effect observed in the human intervention study. The Panel concludes that a cause and effect relationship has not been established between the consumption of Symbiosal((R)) and lowering of blood pressure. (C) 2018 European Food Safety Authority. EFSA Journal published by John Wiley and Sons Ltd on behalf of European Food Safety Authority.
  • Nilsson, Peter M.; Tuomilehto, Jaakko; Ryden, Lars (2019)
    A cluster of metabolic factors have been merged into an entity named the metabolic syndrome. Although the characteristics of this syndrome have varied over time the presently used definition was established in 2009. The presence of three abnormal findings out of five components qualifies a person for the metabolic syndrome: elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure and elevated fasting plasma glucose. Cut points have been defined for all components apart from waist circumference, for which national or regional values are used. The metabolic syndrome predicts cardiovascular disease and type 2 diabetes. This associated risk does not exceed its components whereof elevated blood pressure is the most frequent. A successful management should, however, address all factors involved. The management is always based on healthy lifestyle choices but has not infrequently to be supported by pharmacological treatment, especially blood pressure lowering drugs. The metabolic syndrome is a useful example of the importance of multiple targets for preventive interventions. To be successful management has to be individualized not the least when it comes to pharmacological therapy. Frail elderly people should not be over-treated. Knowledge transfer of how risk factors act should be accompanied by continuous trust building and motivation. In complex situations with a mix of biological risk factors, adverse social conditions and unhealthy lifestyle, everything cannot be changed at once. It is better to aim for small steps that are lasting than large, unsustainable steps with relapses to unhealthy behaviours. A person with the metabolic syndrome will always be afflicted by its components, which is the reason that management has to be sustained over a very long time. This review summarizes the knowledge on the metabolic syndrome and its management according to present state of the art.
  • Koskinen, Juha; Juonala, Markus; Dwyer, Terence; Venn, Alison; Petkeviciene, Janina; Ceponiene, Indre; Bazzano, Lydia; Chen, Wei; Sabin, Matthew A.; Burns, Trudy L.; Viikari, Jorma S. A.; Woo, Jessica G.; Urbina, Elaine M.; Prineas, Ronald; Hutri-Kähönen, Nina; Sinaiko, Alan; Jacobs, David R.; Steinberger, Julia; Daniels, Stephen; Raitakari, Olli; Magnussen, Costan G. (2019)
    Childhood blood pressure (BP) levels predict adult subclinical atherosclerosis. However, the best childhood BP component for prediction has not been determined. This study comprised 5925 participants aged 3 to 18 years from 6 cohorts who were followed into adulthood (mean follow-up 25.8 +/- 6.2 years). Childhood BP was measured by using a standard mercury sphygmomanometer in all cohorts. Study-specific carotid intima-media thickness 90th percentile was used to define subclinical atherosclerosis. Per SD change in the predictor, childhood systolic BP (SBP; age- and sex-adjusted odds ratio [95% CI], 1.24 [1.13-1.37]), mean arterial pressure (1.10 [1.07-1.13]), and pulse pressure (1.15 [1.05-1.27]) were associated with increased adulthood intima-media thickness. In age- and sex-adjusted analyses, area under the receiver operating characteristic curves for SBP (C value [95% CI], 0.677 [0.657-0.704]) showed significantly improved prediction compared with diastolic BP (0.669 [0.646-0.693], P=0.006) or mean arterial pressure (0.674 [0.653-0.699], P=0.01). Pulse pressure provided a C value that was not different from SBP (0.676 [0.653-0.699], P=0.16). Combining different BP components did not improve prediction over SBP measurement alone. Based on the associations with adult carotid intima-media thickness, cut points for elevated SBP were 105 mmHg for 3- to 6-year-old boys, 108 mmHg for 3- to 6-year-old girls, 108 mmHg for 7- to 12-year-old boys, 106 mmHg for 7- to 12-year-old girls, 123 mmHg for 13- to 18-year-old boys, and 115 mmHg for 13- to 18-year-old girls. Our analyses suggest that several childhood BP measurement components are related to adulthood carotid intima-media thickness. Of these, SBP provided the best predictive ability.
  • Sandell, Lia (Helsingin yliopisto, 2015)
    Previous results concerning the association between high blood pressure and work-related stress have been inconsistent, although both high blood pressure and work-related stress independently have adverse effects on health. The aim of this study was to investigate whether the personality trait conscientiousness reduces the adverse effects of work-related stress on blood pressure. Work-related stress was measured by Siegrist's Effort-Reward Imbalance model (ERI-model). The hypotheses were: 1) High effort-reward imbalance is associated with high systolic and high diastolic blood pressure and 2) Conscientiousness reduces the adverse effects of effort-reward imbalance on systolic and diastolic blood pressure. The study sample was from The Cardiovascular Risk in Young Finns study and the data for the present study was collected in 2011 and 2012. The subjects (n = 998) were both women (n = 568) and men (n = 430) who worked full-time and did not take medication to reduce blood pressure. The mean age of the subjects was 43 years. Hierarchical linear regression was used for the statistical analyses. Effort-reward imbalance was not directly associated with blood pressure. However, conscientiousness did moderate the association between effort-reward imbalance and systolic blood pressure. Individuals high in conscientiousness had lower systolic blood pressure than individuals low in conscientiousness when effort-reward imbalance was high. Conscientiousness also moderated the association between effort and systolic and diastolic blood pressure, although the effect on the diastolic blood pressure was only moderately significant (p = .051). Conscientiousness did not moderate the association between reward and blood pressure, but higher reward was independently associated with lower diastolic blood pressure. Conscientiousness seems to reduce the adverse effect of both effort-reward imbalance and effort on systolic blood pressure. The results from the present study suggest that personality traits can affect the associations between work-related stress and blood pressure.
  • Turck, Dominique; EFSA NDA Panel (2017)
    Following an application from Loc Troi group, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No1924/2006 via the Competent Authority of the Netherlands, the EFSA Panelon Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to Vibigaba (germinated brown rice) and contribution to the maintenance of normal blood pressure. The scope of the application was proposed to fall under a health claim based on newly developed scientific evidence. The food proposed by the applicant as the subject of the health claim is Vibigaba. The Panelconsiders that the germinated brown rice Vibigaba is sufficiently characterised. The claimed effect proposed by the applicant is contribution to the maintenance of normal blood pressure'. The Panelconsiders that maintenance of normal blood pressure is a beneficial physiological effect. The Panelnotes that the applicant did not perform a comprehensive literature search to identify human intervention studies which could be pertinent to theclaim. The applicant did not reply to a specific request from EFSA to provide this information. The applicant identified one human intervention study as being pertinent to the claim. The Panelnotes theimportant methodological limitations of the study (e.g. statistical methods used for data analysis not appropriate for the study design) and that the information provided on the design and conduct of the study is insufficient for a complete scientific evaluation. The Panelconsiders that no conclusions can be drawn from this study for the scientific substantiation of the claim. The Panelconcludes that a cause and effect relationship has not been established between the consumption of Vibigaba (germinated brown rice) and maintenance of normal blood pressure.