Sverre E Kjeldsen

University of Oslo, Kristiania (historical), Oslo County, Norway

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Publications (634)2321.5 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite the availability of effective pharmacological treatments to aid the control of blood pressure, the global rate of uncontrolled blood pressure remains high. As such, further measures are required to improve blood pressure control. Recently, several national and international guidelines for the management of hypertension have been published. These aim to provide easily accessible information for healthcare professionals and patients to aid the diagnosis and treatment of hypertension. In this review, we have compared new and current guidelines from the American and International Societies of Hypertension; the American Heart Association, American College of Cardiology and the US Center for Disease Control and Prevention; the panel appointed to the Eighth Joint National Committee; the European Societies of Hypertension and Cardiology; the French Society of Hypertension; the Canadian Hypertension Education Program; the National Institute for Health and Clinical Excellence (UK); the Taiwan Society of Cardiology and the Chinese Hypertension League. We have identified consensus opinion regarding best practises for the management of hypertension and have highlighted any discrepancies between the recommendations. In general there is good agreement between the guidelines, however, in some areas, such as target blood pressure ranges for the elderly, further trials are required to provide sufficient high-quality evidence to form the basis of recommendations.
    Drugs. 10/2014;
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    ABSTRACT: Risk factors for first stroke are well established, but less is known about risk factors for recurrent stroke. In the present analysis, we aimed to assess the effect of heart rate and other possible predictors of stroke in a hypertensive population with previous stroke or transient ischemic attack (TIA).
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 10/2014;
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    ABSTRACT: Heart rate reserve (HRR) has been reported to be inversely associated with cardiovascular (CV) disease and death. The impact of physical fitness (PF) on this relationship has not, however, been described in detail. We investigated how different levels of PF influenced the association between HRR and CV death during a 35-year follow-up.
    European Journal of Preventive Cardiology 10/2014; · 3.90 Impact Factor
  • Blood pressure. 10/2014; 23(5):256-61.
  • Blood Pressure. 09/2014; 23(5).
  • Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række. 09/2014; 134(17):1643-4.
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    ABSTRACT: Background. Treatment of resistant hypertension has attained much attention during the past few years and naturally so has the prevalence of resistant hypertension. In the search for sources of such documentation, the lack of blood pressure (BP) control in randomized clinical outcome trials in hypertension has been used as indication of treatment-resistant hypertension. In the present study, we aimed at using previously unpublished information from monitoring of clinical trials in investigating the mechanism explaining why large fractions of patients in the trials remained uncontrolled for their high BP. Methods. We report insight information from LIFE (n = 9193), VALUE (n = 15,245), ASCOT (n = 19,257) and ACCOMPLISH (n = 11,506). Data stored during the course of the trials for monitoring purposes were scrutinized for fractions of patients with BP control, which was BP < 140/90 mmHg in all trials, and we identified monitoring data showing fractions of patients who had been uptitrated to the various dosing levels or combinations of study drugs in the trials. Fractions of patients who had not been uptitrated on drugs and who remained without BP control identified the level of physician (investigator) inertia in these trials. Results. In the LIFE Study the majority of patients remained with systolic BP > 140 mmHg throughout. Approximately 1500 patients remained on the first dose titration step despite not having reached target BP. In the VALUE Trial 59.5% had reached systolic BP target 2 years into the study; 23.9% of patients remained on the lowest study dose and only 15.1% had been uptitrated to the highest study dose. In the ASCOT Trial, as many as 28% of participants had not reached target diastolic BP at year 4 in the study, and of these patients 37% still remained on the first drug dose titration step. In the ACCOMPLISH Trial approximately 80% had achieved the systolic BP target at study end; however, during the course of the trial approximately 25% of participants remained uncontrolled and at 6 months almost 60% of these patients had not been titrated to the highest drug dose level. Conclusion. These data, taken from the monitoring phases of large outcome trials in hypertension, show that inertia, the lack of titration of study drugs to higher dosing levels or drug combinations according to the study protocols, is a major cause of not reaching BP targets in the trials. Thus, fractions of patients not reaching BP targets in outcome trials cannot be taken as evidence of treatment-resistant hypertension.
    Blood Pressure. 08/2014;
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    ABSTRACT: DISTINCT (reDefining Intervention with Studies Testing Innovative Nifedipine GITS - Candesartan Therapy) aimed to determine the dose-response and tolerability of nifedipine GITS and/or candesartan cilexetil therapy in participants with hypertension.
    Journal of hypertension. 08/2014;
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    ABSTRACT: After three years of excessive confidence, overoptimistic expectations and performance of 15 to 20,000 renal denervation procedures in Europe, the failure of a single well-designed US trial-Symplicity HTN-3-to meet its primary efficacy endpoint has cast doubt on renal denervation as a whole. The use of a sound methodology, including randomisation and blinded endpoint assessment was enough to see the typical 25-30 mmHg systolic blood pressure decrease observed after renal denervation melt down to less than 3 mmHg, the rest being likely explained by Hawthorne and placebo effects, attenuation of white coat effect, regression to the mean and other physician and patient-related biases. The modest blood pressure benefit directly assignable to renal denervation should be balanced with unresolved safety issues, such as potentially increased risk of renal artery stenosis after the procedure (more than ten cases reported up to now, most of them in 2014), unclear long-term impact on renal function and lack of morbidity-mortality data. Accordingly, there is no doubt that renal denervation is not ready for clinical use. Still, renal denervation is supported by a strong rationale and is occasionally followed by major blood pressure responses in at-risk patients who may otherwise have remained uncontrolled. Upcoming research programmes should focus on identification of those few patients with truly resistant hypertension who may derive a substantial benefit from the technique, within the context of well-designed randomised trials and independent registries. While electrical stimulation of baroreceptors and other interventional treatments of hypertension are already "knocking at the door", the premature and uncontrolled dissemination of renal denervation should remain an example of what should not be done, and trigger radical changes in evaluation processes of new devices by national and European health authorities.
    Current Hypertension Reports 08/2014; 16(8):460. · 3.90 Impact Factor
  • Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række. 08/2014; 134(15):1449-50.
  • Blood pressure. 07/2014;
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    ABSTRACT: Differences in clinical effectiveness between angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in the primary treatment of hypertension are unknown. The aim of this retrospective cohort study was to assess the prevention of type 2 diabetes and cardiovascular disease (CVD) in patients treated with ARBs or ACEis. Patients initiated on enalapril or candesartan treatment in 71 Swedish primary care centers between 1999 and 2007 were included. Medical records data were extracted and linked with nationwide hospital discharge and cause of death registers. The 11 725 patients initiated on enalapril and 4265 on candesartan had similar baseline characteristics. During a mean follow-up of 1.84 years, 36 482 patient-years, the risk of new diabetes onset was lower in the candesartan group (hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69-0.96, P=0.01) compared with the enalapril group. No difference between the groups was observed in CVD risk (HR 0.99, 95% CI 0.87-1.13, P=0.86). More patients discontinued treatment in the enalapril group (38.1%) vs the candesartan group (27.2%). In a clinical setting, patients initiated on candesartan treatment had a lower risk of new-onset type 2 diabetes and lower rates of drug discontinuation compared with patients initiated on enalapril. No differences in CVD risk were observed.Journal of Human Hypertension advance online publication, 26 June 2014; doi:10.1038/jhh.2014.43.
    Journal of human hypertension. 06/2014;
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    Sverre E Kjeldsen, Tonje A Aksnes, Luis M Ruilope
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    ABSTRACT: The European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2013 guidelines for the management of arterial hypertension included simplified blood pressure (BP) targets across patient groups, more balanced discussion on monotherapy vs. combination therapy, as well as reconfirmation of the importance of out-of-office BP measurements. In light of these updates, we wished to review some issues raised and take a fresh look at the role of calcium channel blocker (CCB) therapy; an established antihypertensive class that appears to be a favorable choice in many patients. Relaxed BP targets for high-risk hypertensive patients in the 2013 ESH/ESC guidelines were driven by a lack of commanding evidence for an aggressive approach. However, substantial evidence demonstrates cardiovascular benefits from more intensive BP lowering across patient groups. Individualized treatment of high-risk patients may be prudent until more solid evidence is available. Individual patient profiles and preferences and evidence for preferential therapy benefits should be considered when deciding upon the optimal antihypertensive regimen. CCBs appear to be a positive choice for monotherapy, and in combination with other agent classes, and may provide specific benefits beyond BP lowering. Ambulatory and home BP monitoring have an increasing role in defining the diagnosis and prognosis of hypertension (especially non-sustained); however, their value for comprehensive diagnosis and appropriate treatment selection should be more widely acknowledged. In conclusion, further evidence may be required on BP targets in high-risk patients, and optimal treatment selection based upon individual patient profiles and comprehensive diagnosis using out-of-office BP measurements may improve patient management.
    Drugs in R&D. 05/2014;
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    ABSTRACT: Abstract Objective: To compare the efficacy and safety of telmisartan 40 mg (T40) or 80 mg (T80) plus hydrochlorothiazide 12.5 mg (H12.5) single-pill combinations (SPCs) with telmisartan monotherapies, in a pooled analysis of patients with mild to moderate hypertension. Methods: Six phase 3, double-blind studies of 8 weeks' duration that assessed the T/H12.5 SPC and T40 or T80 monotherapy, were included in the analysis. Data was pooled separately for the two T40 non-responder studies (T40 NR group, two T80 non-responder studies (T80 NR group), and the two factorial design dose-response studies (FD-DR group). Results: After 8 weeks' treatment, the adjusted mean reduction in systolic blood pressure (SBP) and diastolic BP (DBP), and the SBP, DBP, and BP goal rates were significantly higher with the T40/H12.5 SPC than T40 in T40 NR group and with the T80/H12.5 SPC than T80 in T80 NR group. In FD-DR group, the adjusted mean reduction in SBP and DBP, and DBP goal rates were significantly higher for T40/H12.5 versus T40. The percentage of patients with an adverse event was numerically higher with T40/H12.5 versus T40 in the T40 NR group, and was similar in telmisartan monotherapies and the T/H12.5 SPCs in the T80 NR group and FD-DR group. A limitation of this study is the retrospective and pooled nature of the analysis. Also, >75% of patients were <65 years of age, which limits the applicability of the results to older patients. Conclusions: In patients with mild to moderate hypertension, 8 weeks' treatment with the T/H12.5 SPC is significantly more efficacious than telmisartan monotherapies. The safety and tolerability of the T/H12.5 SPC are comparable to that of telmisartan monotherapy and consistent with that reported in previous studies.
    Current Medical Research and Opinion 05/2014; · 2.37 Impact Factor
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    ABSTRACT: Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.
    Hypertension 03/2014; · 6.87 Impact Factor
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    ABSTRACT: We aimed to investigate for the first time the blood pressure (BP)-lowering effect of renal sympathetic denervation (RDN) versus clinically adjusted drug treatment in true treatment-resistant hypertension (TRH) after excluding patients with confounding poor drug adherence. Patients with apparent TRH (n=65) were referred for RDN, and those with secondary and spurious hypertension (n=26) were excluded. TRH was defined as office systolic BP (SBP) >140 mm Hg, despite maximally tolerated doses of ≥3 antihypertensive drugs including a diuretic. In addition, ambulatory daytime SBP >135 mm Hg after witnessed intake of antihypertensive drugs was required, after which 20 patients had normalized BP and were excluded. Patients with true TRH were randomized and underwent RDN (n=9) performed with Symplicity Catheter System versus clinically adjusted drug treatment (n=10). The study was stopped early for ethical reasons because RDN had uncertain BP-lowering effect. Office SBP and diastolic BP in the drug-adjusted group changed from 160±14/88±13 mm Hg (±SD) at baseline to 132±10/77±8 mm Hg at 6 months (P<0.0005 and P=0.02, SBP and diastolic BP, respectively) and in the RDN group from 156±13/91±15 to 148±7/89±8 mm Hg (P=0.42 and P=0.48, SBP and diastolic BP, respectively). SBP and diastolic BP were significantly lower in the drug-adjusted group at 6 months (P=0.002 and P=0.004, respectively), and absolute changes in SBP were larger in the drug-adjusted group (P=0.008). Ambulatory BPs changed in parallel to office BPs. Our data suggest that adjusted drug treatment has superior BP lowering effects compared with RDN in patients with true TRH.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.
    Hypertension 03/2014; · 6.87 Impact Factor
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    ABSTRACT: Blacks have a higher prevalence of risk factors for atrial fibrillation (AF), such as hypertension, obesity, and heart failure, than nonblacks. Although population-based studies have demonstrated a lower prevalence and incidence of AF in blacks, the relationship of incident AF to race among hypertensive patients undergoing blood pressure lowering has been less extensively examined. Incident AF was examined in 518 black and 8,313 nonblack hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) with no history of AF in sinus rhythm on their baseline electrocardiogram, who were randomly assigned to losartan- or atenolol-based treatment. During a mean of 4.7±1.1 years of follow-up, new-onset AF occurred in 701 patients (7.9%); 5-year AF incidence was significantly lower in black than nonblack patients (6.1 vs. 8.3%; P = 0.03). In univariable Cox analyses, black race was associated with a 37% lower risk of new AF (hazard ratio (HR) = 0.63; 95% confidence interval (CI) = 0.45-1.00; P = 0.05). In multivariable Cox analyses adjusting for randomized treatment, age, sex, diabetes, history of heart failure, myocardial infarction, ischemic heart disease, stroke, peripheral vascular disease, smoking status, baseline body mass index, serum total and high-density lipoprotein cholesterol, creatinine, glucose, and urine albumin/creatinine ratio as standard risk factors, and for incident myocardial infarction, in-treatment heart rate, systolic and diastolic pressure, Cornell product, and Sokolow-Lyon voltage LVH treated as time-varying covariables, black race remained associated with a 45% decreased risk of developing new AF (HR = 0.55; 95% CI = 0.35-0.87; P = 0.01). Incident AF is substantially less common among black than nonblack hypertensive patients.
    American Journal of Hypertension 02/2014; · 3.67 Impact Factor
  • Blood Pressure. 02/2014; 23(1).
  • Blood pressure 02/2014; 23(1):1-2. · 1.26 Impact Factor
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    ABSTRACT: BACKGROUND Renal denervation (RDN) has been introduced as a potential new treatment for patients with treatment-resistant hypertension, defined as a blood pressure above 140/90 mm Hg despite treatment with at least three antihypertensive drugs. We present an overview of this type of treatment, describe the method and discuss its possible future uses.METHOD The review is based on a discretionary selection of relevant articles from our archive, our own experience and a literature search in PubMed.RESULTS The use of RDN for treatment-resistant hypertension is based on a single randomised study with a total of 104 patients, in which the intervention group experienced a fall in blood pressure of 32/12 mm Hg, while blood pressure in the control group remained unchanged. More than 16,000 patients, particularly in Germany, have been treated on this basis. In the USA, data from a larger randomised study (n = 530) that includes sham surgery are awaited before any decision is made on whether to approve the method for use.INTERPRETATION Before RDN can become recommended treatment in Norway, more evidence is required that the method lowers blood pressure, and that this reduces morbidity and mortality.
    Tidsskrift for den Norske laegeforening 01/2014; 134(1):32-6.

Publication Stats

24k Citations
2,321.50 Total Impact Points

Institutions

  • 1986–2014
    • University of Oslo
      • • Department of Cardiology
      • • Department of Acute Medicine
      • • Department of General Internal Medicine
      • • Department of Obstetrics and Gynaecology (OBSTGYN)
      Kristiania (historical), Oslo County, Norway
  • 2006–2013
    • Weill Cornell Medical College
      • • Division of Cardiology
      • • Division of Hospital Medicine
      New York City, New York, United States
    • University of Padova
      Padua, Veneto, Italy
  • 1999–2013
    • Sahlgrenska University Hospital
      • Department of Cardiology
      Goeteborg, Västra Götaland, Sweden
  • 1986–2013
    • Oslo University Hospital
      • • Department of Cardiology
      • • Department of Nephrology
      Oslo, Oslo, Norway
  • 2012
    • Policlinico San Matteo Pavia Fondazione IRCCS
      Ticinum, Lombardy, Italy
  • 2009–2012
    • Lund University
      • Department of Clinical Sciences
      Lund, Skane, Sweden
    • Medical University of Łódź
      Łódź, Łódź Voivodeship, Poland
    • Ochsner
      • Department of Cardiology
      New Orleans, LA, United States
    • Charité Universitätsmedizin Berlin
      • Department of Nephrology
      Berlin, Land Berlin, Germany
  • 2011
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 2009–2011
    • University of Lodz
      • Department of Cytobiochemistry
      Łódź, Łódź Voivodeship, Poland
  • 2000–2011
    • Glostrup Hospital
      • • Department of Internal Medicine
      • • Department of Cardiology
      • • Department of Clinical Physiology and Nuclear Medicine
      København, Capital Region, Denmark
    • Cornell University
      • Department of Medicine
      Ithaca, NY, United States
  • 1989–2011
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2005–2009
    • University of Naples Federico II
      Napoli, Campania, Italy
    • Università degli Studi di Milano-Bicocca
      Milano, Lombardy, Italy
    • Helsinki University Central Hospital
      • • Division of Cardiology
      • • Department of Medicine
      Helsinki, Province of Southern Finland, Finland
    • University of California, Irvine
      Irvine, California, United States
  • 2001–2009
    • University of Milan
      Milano, Lombardy, Italy
  • 2008
    • The University of Chicago Medical Center
      • Department of Medicine
      Chicago, IL, United States
  • 2006–2008
    • Malmö University
      Malmö, Skåne, Sweden
  • 2004–2008
    • Imperial College London
      • Faculty of Medicine
      London, ENG, United Kingdom
    • State University of New York
      New York City, New York, United States
    • University of Glasgow
      • Institute of Cardiovascular and Medical Sciences
      Glasgow, SCT, United Kingdom
    • University of Bergen
      Bergen, Hordaland, Norway
  • 1990–2008
    • University of Michigan
      • • Division of Cardiovascular Medicine
      • • Division of Pediatric Cardiology
      • • Department of Internal Medicine
      Ann Arbor, MI, United States
  • 2002–2005
    • Umeå University
      • Department of Public Health and Clinical Medicine
      Umeå, Västerbotten, Sweden
    • Steno Diabetes Center
      Gjentofte, Capital Region, Denmark
    • Frederiksberg Hospital
      Фредериксберг, Capital Region, Denmark
  • 1997
    • Akademiska Sjukhuset
      Uppsala, Uppsala, Sweden
  • 1996
    • Vestfold Hospital Trust
      Drammen, Buskerud county, Norway
    • Norsk Treteknisk Institutt
      Kristiania (historical), Oslo County, Norway
  • 1986–1993
    • Universitetet i Tromsø
      Tromsø, Troms, Norway