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Journal of Internal Medicine 04/2009; 220(S714):183 - 186. · 5.48 Impact Factor
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Per Lund‐Johansen
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ABSTRACT: Thirty-eight men with untreated essential hypertension in WHO stage 1 or II, aged 19–57 years, all working, have been studied ambulatorily. Oxygen consumption, heart rate, cardiac output (Cardiogreen) and intra-arterial brachial pressure were recorded at rest in supine, sitting and standing position and during steady state work. At rest plasma volume and serum electrolytes were measured. The subjects were divided into four groups: I, untreated 7; II, chlorthalidone 100 mg every second day 9; III, polythiazide 1 mg every second day 7; and IV, hydrochlorothiazide 50 mg twice daily 15.The subjects were restudied after 8–12 months. In the untreated group none of the results at the second examination were significantly different from those at the first. In the treated groups the causal resting blood pressure and intra-arterial pressure at rest and during work were significantly lower after treatment than before. At rest when sitting, the mean arterial pressure was reduced 21, 15 and 18% in groups II, III and IV and during work a little less. Serum-K dropped significantly in all groups, the mean drop being about 0.7 mEq/1 in all groups. Plasma volume (hydrochlorothiazide group only) was 0.24 1 lower after therapy, but the difference was not significant. In the thiazide groups the pressure drop was usually associated with a drop in peripheral resistance, both at rest and during exercise. In the chlorothalidone group the pressure drop was usually caused by a reduction in cardiac index, with little or no effect on the peripheral resistance.
Journal of Internal Medicine 04/2009; 187(1‐6):509 - 518. · 5.48 Impact Factor
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ABSTRACT: New guidelines adopted in Norway for antihypertensive medication implies prescription of a thiazide diuretic as the drug of first choice. The background for the change in the rules for prescription drugs paid for by the National Insurance system with a capped co-payment is a resolution of the Norwegian parliament as part of a budget compromise for 2004. The resolution was supported by results from the ALLHAT study (antihypertensive and lipid-lowering treatment to prevent heart attack trial).
ALLHAT was carried out in a group of elderly, high-risk patients with a large proportion of Afro-Americans.
ALLHAT has important shortcomings with regard to design, results, analysis and interpretation. The trial is considered unfit as a basis for general guidelines on antihypertensive treatment in Norway.
Tidsskrift for den Norske laegeforening 06/2004; 124(10):1419-20.
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ABSTRACT: Beta-blockers with less cardiodepressive effect than traditional nonselective beta1+2-blocking agents could be useful in the treatment of hypertension, provided the reduction in blood pressure was satisfactory. Epanolol, a selective beta1-receptor blocker with intrinsic sympathomimetic activity, induced a fall in intraarterial pressure of 8% at rest sitting and 11% during 100 W bicycle exercise after the first dose of 200 mg in 12 patients with essential hypertension. Heart rate, stroke index, and cardiac index initially fell by 14%, 11%, and 23%, respectively. The total peripheral resistance index increased by 21% after 2 hours, and then reverted towards the pretreatment level. After 10 months of epanolol treatment (mean 300 mg/day), the reduction in arterial pressure was 5% at rest and 10% during exercise. Cardiac index and heart rate were still reduced 14–21%, while total peripheral resistance was unchanged or slightly increased (2–10%). Twenty-four hour ambulatory blood pressure was higher on epanolol (300 mg/day) than on atenolol (150 mg/day) treatment (137/97 vs. 128/91 mmHg). Thus, the achieved blood pressure reduction induced by epanolol was moderate, while other characteristics of beta-receptor blockade, in particular, the reduction of heart rate and cardiac output, were maintained. This suggests that the compound may be useful for other cardioavascular disorders, e.g., angina pectoris in patients without hypertension or cardiac arrhythmia.
Cardiovascular Drugs and Therapy 01/1993; 7(1):125-132. · 3.13 Impact Factor
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Cognitive Behaviour Therapy. 01/1984; 13(1):3-24.
