Sverre E Kjeldsen

Oslo University Hospital, Kristiania (historical), Oslo, Norway

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Publications (688)3257.29 Total impact

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    ABSTRACT: The blood pressure (BP)-lowering effect of renal sympathetic nervous denervation (RDN) in resistant hypertension (rHT) shows large variation among studies. We meta-analyzed summary statistics of randomized clinical trials on RDN in rHT. For continuous outcomes, we assessed heterogeneity by Cochran's Q test and used random-effect models weighted for the inverse of the variance. We assessed safety by assessing the risk of major adverse events from stratified contingency tables. Of 5652 patients screened in seven trials, 985 (17.4%) qualified and were randomized to control (n = 397) or RDN with SYMPLICITY(™) catheters (n = 588). Follow-up was 6 months. In both control and RDN patients, antihypertensive treatment was continued or optimized. At enrolment, age averaged 58.1 years, systolic/diastolic office and 24 h BP 168.5/93.3 mmHg and 151.8/86.1 mmHg, respectively, and estimated glomerular filtration rate (eGFR) 79.3 ml/min/1.73 m². For BP outcomes, there was heterogeneity among trials. Pooled effects (control minus RDN) were -4.9/-3.5 mmHg (95% confidence interval, -20.9 to 11.1/-8.9 to 1.9) for office BP, -2.8/-1.5 mmHg (-6.5 to 0.8/-3.3 to 0.4) for 24 h BP and 0.81 ml/min/1.73 m² (-1.69 to 3.30) for eGFR. Removing one trial at a time produced confirmatory results. Adverse events occurred in 7.4% and 9.9% of control and RDN patients, respectively (p = 0.24). In selected rHT patients maintained on antihypertensive drugs, RDN with the SYMPLICITY systems does not significantly decrease BP but is safe. Future trials with next-generation catheters should aim at identifying responders in patients with evidence of sympathetic nervous overactivity.
    Blood pressure 07/2015; DOI:10.3109/08037051.2015.1058595 · 1.61 Impact Factor
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    ABSTRACT: Low insulin sensitivity is closely related to both cardiovascular diseases and diabetes development. Still, correlates of insulin sensitivity have mainly been examined in cross-sectional studies. As far as we are aware, the longitudinal stability of insulin sensitivity in young men is largely unknown. We aimed for the first time to examine both the stability (tracking) and longitudinal predictors of future insulin sensitivity in healthy young men with and without a family history of diabetes or hypertension. We performed a 17-year follow-up study of a cohort of 100 healthy young men. Cardiovascular risk markers, including insulin sensitivity measured by the gold standard method - hyperinsulinaemic isoglycaemic glucose clamp - were examined both at baseline and at follow-up. Baseline insulin sensitivity showed no significant correlation with insulin sensitivity at follow-up, whereas all other measured cardiovascular risk markers had significant correlation (tracking coefficients 0.4-0.7). In multiple regression analyses, family history of hypertension and baseline triglycerides remained the negative predictors of future insulin sensitivity. This was driven by the strong correlations in men with family history of diabetes. Our data suggest that clamp-derived insulin sensitivity is not a stable feature in young men, and that family history of hypertension and baseline triglycerides were associated with future insulin sensitivity, especially in men with a family history of diabetes, and irrespective of blood pressure status 17 years earlier. These findings provide further insight into the development of insulin sensitivity and related diseases.
    Journal of Hypertension 06/2015; DOI:10.1097/HJH.0000000000000632 · 4.22 Impact Factor
  • Peter M Okin · Sverre E Kjeldsen · Richard B Devereux
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    ABSTRACT: Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear. All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in 541 hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan- or atenolol-based treatment who had new strokes during follow-up. Patients with on-treatment SBP<144 mm Hg (lowest tertile) and SBP>157 (highest tertile) were compared with patients with average SBP between 144 and 157. During 2.02±1.65 years mean follow-up after incident stroke, 170 patients (31.4%) died, 135 (25.0%) from cardiovascular causes. In multivariate Cox analyses, adjusting for significant univariate predictors of mortality, compared with average SBP between 144 and 157, an average SBP<144 was a significant predictor of all-cause (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) and cardiovascular mortality (hazard ratio, 1.60; 95% confidence interval, 1.02-2.54), whereas patients who had an average SBP>157 had no significant increased risk of death. Lower achieved SBP (<144 mm Hg) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensive patients during short-term follow-up. Further study is required to determine ideal SBP goals after stroke. URL: Unique identifier: NCT00338260. © 2015 American Heart Association, Inc.
    Stroke 06/2015; DOI:10.1161/STROKEAHA.115.009592 · 6.02 Impact Factor
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    ABSTRACT: : There is a well-established association between hypertension and atrial fibrillation (AF); indeed, even upper normal systolic blood pressures (SBP) are long-term predictors of incident AF. These findings suggest that more aggressive BP control may reduce the risk of new AF. However, whether lower achieved SBP is associated with a lower incidence of AF remains unclear. The risk of new-onset AF was examined in relation to last in-treatment SBP before AF diagnosis or last in-study measurement in the absence of new AF in 8831 hypertensive patients with ECG left ventricular hypertrophy with no history of AF, in sinus rhythm on their baseline ECG, randomly assigned to losartan- or atenolol-based treatment. Patients with in-treatment SBP ≤130 mm Hg (lowest quintile at last measurement) and SBP between 131 and 141 mm Hg were compared with patients with in-treatment SBP ≥142 mm Hg (median SBP at last measurement). During follow-up of 4.6±1.1 years, new-onset AF was diagnosed in 701 patients (7.9%). In multivariate Cox analyses, compared with in-treatment SBP ≥142 mm Hg, in-treatment SBP ≤130 mm Hg entered as a time-varying covariate was associated with a 40% lower risk (95% confidence interval, 18%-55%) and in-treatment SBP of 131 to 141 mm Hg with a 24% lower risk (95% confidence interval, 7%-38%) of new AF. Thus, achieved SBP ≤130 mm Hg is associated with a lower risk of new-onset AF in hypertensive patients with ECG left ventricular hypertrophy. Further study is needed to determine whether targeting hypertensive patients without AF to lower SBP goals can reduce the burden of new AF in this high-risk population. URL: Unique identifier: NCT00338260. © 2015 American Heart Association, Inc.
    Hypertension 06/2015; DOI:10.1161/HYPERTENSIONAHA.115.05728 · 7.63 Impact Factor
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    ABSTRACT: A hypertensive response to exercise at moderate workload is associated with future risk of coronary heart disease (CHD) and mortality. Yet there is still no consensus regarding the cut-off value for an inappropriate increase in exercise systolic blood pressure. We have previously shown that exercise blood pressure at 100W workload (SBP100W) > 200 mmHg is associated with increased risk of CHD and mortality. We now aimed to investigate the possible association between SBP100W >/= 190mmHg and risk of CHD over up to 28 years follow-up. Of the 1999 apparently healthy, middle-aged men who underwent thorough medical examination and laboratory testing, including a symptom-limited bicycle ergometer test, during 1972-1975, 1392 men were still healthy at survey 2 seven years later and completed a workload of 100 W at both surveys. Systolic blood pressure was measured near completion of the 100W stage (SBP100W). By comparing subjects having SBP100W >/=190 mmHg at baseline, follow-up or both(n=365) with subjects having SBP100W < 190 mmHg at both surveys (n = 1027), we estimated the risk of CHD (angina pectoris, non-fatal myocardial infarction and death from coronary heart disease). The combined endpoint of CHD occurred in 452 of the 1392 men; 243 events among the 365 men with SBP100W >/= 190 mmHg. When adjusting for survey 1 smoking status, age, systolic blood pressure at rest, total cholesterol and family history of coronary heart disease, there was a 1.38-fold (CI 1.11-1.71, p < 0.005) increased risk of CHD. When further adjusting for physical fitness, SBP100W >/=190mmHg was associated with a 1.35-fold (1.08-1.65) increased risk of CHD. Our findings indicate that a systolic blood pressure of 190 mmHg or more at moderate workload is associated with future risk of CHD among apparently healthy middle-aged men.(Figure is included in full-text article.).
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e28. DOI:10.1097/01.hjh.0000467422.11441.b2 · 4.22 Impact Factor
  • Article: 3D.01
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    ABSTRACT: High blood pressure variability has been associated with an increased risk of cardiovascular events. We aimed to assess if increased visit-to-visit variability in systolic blood pressure increases the risk of stroke or cardiac events (fatal/non-fatal coronary or heart failure events) in the VALUE population. The VALUE trial was a randomised-controlled, double-masked investigation of valsartan versus amlodipine in patients 50 years or older with hypertension and high risk of cardiovascular events. Mean follow-up time was 4.2 years. We calculated the standard deviation (SD) of mean systolic blood pressure from visits from 6 months onward, excluding patients with less than 2 visits, or stroke or cardiac events during the first 6 months. In the pooled treatment arms, we grouped SD in quintiles and compared the risk of stroke or cardiac events in the highest and the lowest quintile, using a Cox regression model, adjusting for a number of prognostic variables, including randomised treatment and mean BP from 6 months onwards. Of 14.146 patients included, 1278 (9.0%) experienced a cardiac event and 473 (3.3%) experienced a stroke. Compared to patients with the lowest variability, those in the highest quintile had an increased risk of stroke or cardiac events (HR 1.4, 95% CI 1.0-1.8, p = 0.045 and HR 1.9, 95% CI 1.6-2.3, p < 0.0001, respectively, Figure). Visit-to-visit systolic BP variability predicts stroke and cardiac events in high risk hypertensive patients receiving valsartan or amlodipine, and independent of mean BP. Systolic blood pressure variability was a stronger predictor of cardiac events than of stroke.(Figure is included in full-text article.).
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e40. DOI:10.1097/01.hjh.0000467454.55397.ea · 4.22 Impact Factor
  • Article: 8B.01
    F Fadl Elmula · Y Jin · A.C. Larstorp · A Persu · S E Kjeldsen · J A Staessen
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    ABSTRACT: Renal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with treatment resistant hypertension (TRH), a condition defined as persistent blood pressure (BP) elevation despite prescription of at least 3 antihypertensive drugs, including a diuretic. However, the randomized controlled evidence that RDN effectively lowers BP is scarce and contradictory. This study investigated the current effectiveness of RDN for TRH. We performed a systematic review and meta-analysis of the randomized controlled trials (RCT) that reported office and ambulatory systolic BP in RDN and control (sham control or drug adjustment) groups at 6 months of follow-up in patients with TRH. Pooled effect sizes were derived, using a random-effects model. The literature search identified five RCTs with 867 randomized patients. In the pooled analysis, RDN was not associated with a significant decrease, either in office systolic BP (weighted mean difference (WMD): - 4.21 mmHg, 95% confidence interval: -17.12 to 8.69, p = 0.52), or in 24-h ambulatory systolic BP (WMD: -1.94 mmHg, 95% confidence interval: -6.05 to 2.17 mmHg, p = 0.36) compared to control at 6-months of follow-up.(Figure is included in full-text article.) CONCLUSIONS:: In patients with TRH, the overall BP lowering effect of RDN is not superior to control. Accordingly, RDN should not be considered as a treatment modality of RHT in clinical practice. Future research should identify the characteristics of patients who might respond to RDN, effective ablation dose and measure that could confirm that RDN do occur.
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e107. DOI:10.1097/01.hjh.0000467637.16752.63 · 4.22 Impact Factor
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    European Heart Journal 05/2015; DOI:10.1093/eurheartj/ehv192 · 14.72 Impact Factor
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    ABSTRACT: The Symplicity HTN-1 and 2 studies proposed renal denervation (RDN) as an effective and safe approach to treat patients with resistant hypertension, and were followed by an unprecedented wave of enthusiasm. The announcement that Symplicity HTN-3 failed to meet its primary efficacy endpoint put an abrupt stop to these overoptimistic expectations. The use of a sound methodology was enough to see the typical 25-30mmHg systolic blood pressure decrease observed after RDN melt down to <3mmHg. RDN certainly deserves further investigation but is not ready for wide clinical application. For the time being, physicians should focus on improvement of drug adherence and skilful drug treatment adjustment, which allow reaching blood pressure target in the large majority of hypertensive patients. Copyright © 2015. Published by Elsevier Ltd.
    Current Opinion in Pharmacology 04/2015; 21. DOI:10.1016/j.coph.2014.12.013 · 4.23 Impact Factor
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    ABSTRACT: Approximately 10-20% of the general population have masked hypertension. However, how best to identify affected individuals is uncertain, and what predicts future masked hypertension is largely unknown. This study aimed to identify longitudinal predictors of masked hypertension. A long-term follow-up study of 100 healthy young men who had normal (n = 28) or high (n = 72) screening blood pressure (BP) at the compulsory military draft was carried out. They were examined in a detailed and highly standardized way for cardiovascular risk markers at baseline and at follow-up after a mean of 17.4 years. At follow-up, 40% had masked hypertension. Participants with high screening BP had a 4.8 times higher likelihood of having masked hypertension at follow-up compared to men with low screening BP (odds ratio 4.8, 95% confidence interval 1.7-13.5, p = 0.003). Furthermore, only 25% of the men with masked hypertension had high normal office BP at follow-up, and the remaining 75% would, according to guidelines, not be recommended ambulatory BP measurements, and thus go undiagnosed. Our data suggest that high screening BP at a young age is an important predictor of future masked hypertension in young men, and that BP measurement according to guidelines is insufficient to uncover masked hypertension.
    Blood pressure 04/2015; 24(3):1-8. DOI:10.3109/21695717.2015.1030889 · 1.61 Impact Factor
  • Sverre E Kjeldsen · Fadl Elmula M Fadl Elmula · Alexandre Persu
    Journal of the American College of Cardiology 04/2015; 65(13):1322-3. DOI:10.1016/j.jacc.2015.01.038 · 15.34 Impact Factor
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    ABSTRACT: Digoxin is widely used for rate control of atrial fibrillation. However, recent studies have reported conflicting results on the association of digoxin with mortality when used in patients with atrial fibrillation. Moreover, the relationship of digoxin use to mortality in hypertensive patients with atrial fibrillation has not been examined. All-cause mortality was examined in relation to in-treatment digoxin use in 937 hypertensive patients with ECG left ventricular hypertrophy in atrial fibrillation at baseline (n = 134) or who developed atrial fibrillation during follow-up (n = 803), randomly assigned to losartan or atenolol-based treatment, in post-hoc analysis of a substudy of the Losartan Intervention For Endpoint Reduction in hypertension (LIFE) trial. During 4.7 ± 1.1 years of mean follow-up, 167 patients died (17.8%) and 372 (39.7%) were treated with digoxin. In univariate Cox analyses, in-treatment digoxin use, entered as a time-varying covariate, was associated with a 61% higher risk of dying (hazard ratio 1.61, 95% confidence interval 1.18-2.19, P = 0.003). After adjusting for other univariate predictors of death in this population, including age, diabetes, history of ischemic heart disease, stroke, or heart failure, baseline Cornell product, QRS duration, heart rate, serum glucose, creatinine and high-density lipoprotein cholesterol, and a propensity score for digoxin use entered as standard covariates, and for in-treatment heart rate, pulse pressure, and Sokolow-Lyon voltage treated as time-varying covariates, digoxin use was no longer a significant predictor of mortality (hazard ratio 1.04, 95% confidence interval 0.73-1.48, P = 0.839). In hypertensive patients with ECG left ventricular hypertrophy with existing or new atrial fibrillation, digoxin use is not associated with a significantly increased risk of all-cause mortality after adjusting for other independent predictors of death and for the factors associated with the propensity to use digoxin in this population. These findings suggest that factors other than digoxin use may account for the increased mortality found with digoxin use in some studies. .
    Journal of Hypertension 03/2015; 33(7). DOI:10.1097/HJH.0000000000000559 · 4.22 Impact Factor
  • Sverre E. Kjeldsen · Alexandre Persu · Michel Azizi
    Journal of the American Society of Hypertension (JASH) 03/2015; 9(5). DOI:10.1016/j.jash.2015.02.015 · 2.68 Impact Factor
  • Peter M. Okin · Sverre Kjeldsen · Richard Devereux
    Journal of the American College of Cardiology 03/2015; 65(10):A1459. DOI:10.1016/S0735-1097(15)61459-0 · 15.34 Impact Factor
  • Ingar Holme · Sverre E. Kjeldsen
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    ABSTRACT: In the Oslo cardiovascular study of 1972–3 a 5-year randomized trial in mild to moderate hypertension was performed. Several changes in treatment practices have been recommended since that time. We followed the mortality patterns up to 40 years.
    European Journal of Internal Medicine 02/2015; 26(2). DOI:10.1016/j.ejim.2015.01.013 · 2.30 Impact Factor
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    ABSTRACT: Renal sympathetic denervation (RDN) has been and is still proposed as a new treatment modality in patients with apparently treatment resistant hypertension (TRH), a condition defined as persistent blood pressure elevation despite prescription of at least 3 antihypertensive drugs including a diuretic. However, the large fall in blood pressure after RDN reported in the first randomized study, Symplicity HTN-2 and multiple observational studies has not been confirmed in five subsequent prospective randomized studies and may be largely explained by non-specific effects such as improvement of drug adherence in initially poorly adherent patients (the Hawthorne effect), placebo effect and regression to the mean. The overall blood-pressure lowering effect of RDN seems rather limited and the characteristics of true responders are largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparently TRH, drug monitoring and improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those patients with truly TRH who may respond to RDN.
    Frontiers in Physiology 02/2015; 6. DOI:10.3389/fphys.2015.00009 · 3.50 Impact Factor
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    ABSTRACT: Pulse pressure (PP) is an independent risk factor for cardiovascular (CV) disease and death but few studies have investigated the effect of antihypertensive treatments in relation to PP levels before treatment. The Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial showed that the combination of benazepril+amlodipine (B+A) is superior to benazepril+hydrochlorothiazide (B+H) in reducing CV events. We aimed to investigate whether the treatment effects in the ACCOMPLISH trial were dependent on baseline PP. High-risk hypertensive patients (n=11,499) were randomized to double-blinded treatment with single-pill combinations of either B+A or B+H and followed for 36 months. Patients were divided into tertiles according to their baseline PP and events (CV mortality/myocardial infarction or stroke) were compared. Hazard ratios (HRs) for the treatment effect (B+A over B+H) were calculated in a Cox regression model with age, coronary artery disease, and diabetes mellitus as covariates and were compared across the tertiles. The event rate was increased in the high tertile of PP compared with the low tertile (7.2% vs 4.4% P<.01). In the high and medium PP tertiles, HRs were 0.75 (95% confidence interval [CI], 0.60-0.95; P=.018) and 0.74 (CI, 0.56-0.98, P=.034), respectively, in favor of B+A. There was no significant difference between the treatments in the low tertile and no significant differences in treatment effect when comparing the HRs between tertiles of PP. B+A has superior CV protection over B+H in high-risk hypertensive patients independent of baseline PP although the absolute treatment effect is enhanced in the higher tertiles of PP where event rates are higher. © 2014 Wiley Periodicals, Inc.
    Journal of Clinical Hypertension 12/2014; 17(2). DOI:10.1111/jch.12460 · 2.96 Impact Factor
  • Sverre E Kjeldsen · Ingrid Os
    Journal of Hypertension 12/2014; 32(12):2357-8. DOI:10.1097/HJH.0000000000000385 · 4.22 Impact Factor
  • Hypertension 10/2014; 65(1). DOI:10.1161/HYPERTENSIONAHA.114.04057 · 7.63 Impact Factor
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    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; 74(17). DOI:10.1007/s40265-014-0306-5 · 4.13 Impact Factor

Publication Stats

37k Citations
3,257.29 Total Impact Points


  • 1986–2015
    • Oslo University Hospital
      • Department of Cardiology
      Kristiania (historical), Oslo, Norway
  • 1984–2015
    • University of Oslo
      • • Department of Cardiology
      • • Department of General Internal Medicine
      • • Department of Obstetrics and Gynaecology (OBSTGYN)
      • • Division of Medicine
      Kristiania (historical), Oslo, Norway
  • 2013
    • University of Leuven
      • Department of Cardiovascular Sciences
      Louvain, Flanders, Belgium
  • 2006–2013
    • Weill Cornell Medical College
      • Division of Cardiology
      New York City, New York, United States
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
    • Medical University of Gdansk
      • Department of Hypertension and Diabetes
      Danzig, Pomeranian Voivodeship, Poland
    • Malmö University
      Malmö, Skåne, Sweden
  • 1989–2012
    • University of Michigan
      • • Division of Cardiovascular Medicine
      • • Department of Internal Medicine
      Ann Arbor, Michigan, United States
  • 2006–2011
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2010
    • University of Massachusetts Medical School
      • Department of Medicine
      Worcester, Massachusetts, United States
  • 2009
    • Medical University of Łódź
      Łódź, Łódź Voivodeship, Poland
  • 2000–2009
    • Glostrup Hospital
      • Department of Clinical Physiology and Nuclear Medicine
      Glostrup, Capital Region, Denmark
  • 2007
    • Imperial College London
      • International Centre for Circulatory Health
      London, ENG, United Kingdom
    • Semmelweis University
      Budapeŝto, Budapest, Hungary
  • 2005–2007
    • Università degli Studi di Milano-Bicocca
      • Department of Statistics and Quantitative Methods
      Milano, Lombardy, Italy
    • Umeå University
      • Department of Public Health and Clinical Medicine
      Umeå, Västerbotten, Sweden
    • Royal College of Surgeons in Ireland
      Dublin, Leinster, Ireland
    • University of Naples Federico II
      Napoli, Campania, Italy
  • 2001–2007
    • University of Milan
      Milano, Lombardy, Italy
    • Cornell University
      • Department of Medicine
      Ithaca, NY, United States
  • 2002–2006
    • University of Helsinki
      • Department of Oral Medicine
      Helsinki, Uusimaa, Finland
    • Steno Diabetes Center
      Gjentofte, Capital Region, Denmark
    • Frederiksberg Hospital
      Фредериксберг, Capital Region, Denmark
    • Copenhagen University Hospital
      København, Capital Region, Denmark
  • 2004
    • University of Bergen
      Bergen, Hordaland, Norway
  • 2003
    • University of Alabama at Birmingham
      Birmingham, Alabama, United States
  • 1997
    • Akershus universitetssykehus
      Kristiania (historical), Oslo, Norway
  • 1996
    • Norsk Treteknisk Institutt
      Kristiania (historical), Oslo County, Norway
  • 1986–1993
    • Universitetet i Tromsø
      Tromsø, Troms, Norway
  • 1988
    • Hospital Bærum
      Drammen, Buskerud, Norway