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  • 1. Brorsson, B
    et al.
    Herlitz, Johan
    [external].
    Werkö, L
    Evaluation of patients referred for possible coronary revascularization among patients with and without a history of hypertension1998In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 8, no 2, p. 151-157Article in journal (Refereed)
    Abstract [en]

    Patients with and without a history of hypertension referred for eventual coronary revascularization were compared on the basis of a national survey including previous history, indications for coronary angiography, use of medication, findings at exercise test and cardioangiography, and long-term prognosis. As part of a national study of the appropriateness of coronary revascularization, data were prospectively collected on patients referred for possible coronary revascularization to 7/8 public Swedish heart centers that performed approximately 92% of all bypass operations in Sweden in 1994. The study included 2764 patients of whom 986 (36%) had a history of hypertension. Indications for coronary angiography were similar in patients with and without a history of hypertension. Triple therapy (a combination of beta-blockers, long-acting nitrates and calcium channel-blockers) was more frequently used among patients with hypertension (32.6% as compared with 21.4% among patients without hypertension; p < 0.001). With the exception of ST depression > 6 min after discontinuation of exercise test, which was more frequent among hypertensive patients (30.9% vs 25.7%; p < 0.05), the various indicators of myocardial ischemia were similar in the two groups during exercise. Patients with hypertension had a somewhat lower exercise capacity (mean of 109.6 w) than patients without hypertension (113.7; p < 0.05). The extent of coronary artery disease was more severe among hypertensives (p < 0.001). Overall mortality during the subsequent 21 months was 5.6% for patients with hypertension and 3.1% for patients without hypertension (p < 0.01). This was caused mainly by a difference in cardiovascular mortality (3.9% vs 2.5%; p < 0.05) and cerebrovascular mortality (1.0% vs 0.3%; p < 0.05). Among patients referred for possible coronary revascularization, those with a history of hypertension differed from those without such a history, in that they more frequently had ST depression at exercise test, a lower exercise capacity, more severe coronary artery disease, a higher frequency of triple-therapy use and a higher mortality rate.

  • 2.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Caidahl, K
    Hartford, M
    Haglid, M
    Mortality, risk indicators mode and place of death and symptoms of angina pectoris in the five years after coronary artery bypass grafting in patients with and without a history of hypertension1999In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 8, no 4, p. 200-206Article in journal (Refereed)
    Abstract [en]

    AIM: To describe mortality, risk indicators for death, place and mode of death, and symptoms of angina pectoris among survivors in the 5 years after coronary artery bypass grafting (CABG) in patients with and without a history of hypertension. METHODS: All patients in western Sweden who underwent CABG without concomitant valve surgery and without previously performed CABG between June 1988 and June 1991. RESULTS: A total of 1997 patients were included in the analysis, 740 (37%) of whom had a history of hypertension. Patients with no history had a 5-year mortality of 12.4%. The corresponding relative risk for hypertensives was 1.4 (95% CI 1.1-1.8). Risk factors for death appeared similar in patients with and without a history of hypertension. Patients with hypertension had an increased risk of death in hospital and an increased risk of a non-cardiac death. Among survivors after 5 years, patients with a history of hypertension tended to have a higher prevalence of symptoms equivalent to angina pectoris. CONCLUSIONS: Patients with a history of hypertension have an increased risk of death in the 5 years after CABG. Risk factors for death appear similar in patients with and without a history of hypertension. Patients with hypertension have a particularly increased risk of death in hospital and of death judged as non-cardiac.

  • 3.
    Herlitz, Johan
    et al.
    [external].
    Caidahl, K
    Albertsson, P
    Karlsson, T
    Hartford, M
    Haglid, M
    Lurje, L
    Karlson, BW
    Sjöland, H
    Limitation of physical activity, dyspnea and chest pain prior to and during two years after coronary artery bypass grafting in relation to a history of hypertension1998In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 6, no 6, p. 349-356Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the limitation of physical activity, the cause of limitation of physical activity and symptoms of dyspnea and chest pain before and 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. METHODS: All patients from western Sweden who underwent CABG between 1988 and 1991 were approached with a questionnaire--prior to, 3 months and 2 years after CABG--evaluating the issues raised above. RESULTS: Of 2121 patients, 37% had a history of hypertension. By 3 months after CABG, physical activity tolerance had improved markedly and in a similar way for both hypertensive (p<0.001) and non-hypertensive patients (p<0.001); this level was sustained for 2 years. Absence of dyspnea increased markedly and similarly among both hypertensive and non-hypertensive patients (p < 0.001) after CABG. The presence of chest pain decreased markedly and similarly among hypertensive (p<0.001) and non-hypertensive patients (p<0.001), both 3 months and 2 years after compared to prior to the operation. CONCLUSION: There was a marked improvement in terms of physical activity and cardiovascular symptoms 3 months and 2 years after CABG as compared with the situation prior to the operation. A previous history of hypertension did not seem to affect these results.

  • 4.
    Herlitz, Johan
    et al.
    [external].
    Caidahl, K
    Wiklund, I
    Sjöland, H
    Karlson, BW
    Karlsson, T
    Haglid, M
    Hartford, M
    Impact of a history of hypertension on symptoms and Quality of Life prior to and at five years after coronary artery bypass grafting2000In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 9, no 1, p. 52-63Article in journal (Refereed)
    Abstract [en]

    AIM: To describe symptoms and other aspects of health-related quality of life (QoL) prior to and 5 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. METHODS: Patients who underwent CABG in western Sweden were approached prior to surgery and 5 years after the operation. Health-related QoL was estimated with the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-Being Index. RESULTS: In patients with a history of hypertension (n = 740) the 5-year mortality was 16.9% versus 12.4% among patients with no history (n = 1257; p = 0.004). Of 1717 patients available for the survey, 876 (51%) responded both prior to and 5 years after CABG. Of these, 36% had a history of hypertension. Compared with the situation prior to surgery there was an improvement in both hypertensive and non-hypertensive patients in terms of physical activity, symptoms of dyspnea and chest pain and other estimates of health-related QoL. However, physical activity and dyspnea improved less in hypertensive than in non-hypertensive patients. CONCLUSION: Five years after CABG, a marked and significant improvement in terms of symptoms and other aspects of health-related QoL was observed among both hypertensive and non-hypertensive patients. However, improvement in physical activity was less marked in patients with a history of hypertension. Overall, a history of hypertension seemed to have a minor impact on improved well-being 5 years after coronary surgery. However, because of the limited response rate the results may not be applicable in a non-selected CABG population.

  • 5.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Lindqvist, J
    Sjölin, M
    Prognosis during five years of follow up among patients admitted to the emergency department with acute chest pain in relation to a history of hypertension1998In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 7, no 2, p. 81-88Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the mortality, mode and place of death and risk indicators of death during 5 years of follow-up among patients admitted to the emergency department (ED) with acute chest pain or other symptoms raising a suspicion of acute myocardial infarction (AMI) in relation to a history of hypertension. METHODS: All the patients admitted to the ED at Sahlgrenska University Hospital during a period of 21 months with acute chest pain or other symptoms raising a suspicion of AMI were followed up prospectively for 5 years. RESULTS: Of 5,355 patients fulfilling the inclusion criteria, 22% had a history of hypertension. Hypertensive patients differed from non-hypertensive patients in that there were more females, they were older and had a higher prevalence of previous cardiovascular disease. Patients with a history of hypertension had a 5-year mortality rate of 37.4% as compared with 22.2% among non-hypertensive patients (p < 0.001). The difference in mortality appeared to be more marked among patients without a history of cardiovascular disease. A history of hypertension was an independent predictor of death. Risk indicators of death appeared to be relatively similar among patients with and without a history of hypertension. Of the patients who died, those with a history of hypertension were more frequently judged to have suffered a cardiac death and died more frequently in association with an AMI. CONCLUSION: Among patients admitted to the ED with acute chest pain and with a history of hypertension, 37% died during the following 5 years. A history of hypertension was an independent predictor of death.

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