Manual för medicinsk kontroll av hand-arm vibrationer

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Decrease in high density lipoprotein cholesterol during prolonged storage. CELL Study Group

Different studies on the stability of high density lipoprotein cholesterol (HDL) in frozen serum or plasma have yielded conflicting results, namely increase, decrease, or no change at all during prolonged storage under freezing conditions. As part of a major trial on lipid-lowering strategies we statistically demonstrated a time-related decrease in HDL cholesterol during storage up to 46 months at -20 degrees C. We therefore re-analysed 85 frozen samples that had been analysed fresh and then stored from 26 to 46 months, using the dextran sulphate 500/Mg2+ method. A linear regression analysis of change in HDL cholesterol on time was performed. The slope was significantly negative (p < 0.0005). The regression equation was (decrease in HDL) = 0.05 - 0.008 x (time in months), i.e. after 6 months' storage at -20 degrees C there was almost a 1% decrease in the HDL cholesterol concentration per month of storage

Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials

Background : A beneficial clinical effect of antihypertensive drug treatment has been observed in middle age and in those hypertensive patients over 60 years old, but uncertainty remains on its benefit after 80 years of age. The ageing of the general population, and the increasing prevalence of hypertension with age, make this an important public health question. Methods : We collected data from all participants aged 80 years and over in randomised controlled trials of antihypertensive drug treatment, through direct contacts of study investigators. Our primary outcome was fatal and non-fatal stroke. Secondary outcomes were death from all causes, cardiovascular death, fatal and non-fatal major coronary and cardiovascular events, and heart failure. Findings : The meta-analysis of data from 1670 participants aged 80 years or more suggested that treatment prevented 34% (95% CI : 8 to 52%) of strokes. Also, major cardiovascular events and heart failure were significantly reduced by 22% and 39%, respectively. However, there was no benefit for cardiovascular death, and a non-significant 6% relative excess of death from all causes (95% CI : -5% to 18%). Interpretation : The inconclusive findings for mortality contrast with the benefit observed on non-fatal events, and illustrate the need to have the results of a large scale specific trial, before definitely concluding that antihypertensive treatment is beneficial in very elderly hypertensives. Meanwhile, there is no solid argument to fix a threshold of age above which hypertension should not be treated

Relation between drug treatment and cancer in hypertensives in the Swedish Trial in Old Patients with Hypertension 2: a 5-year, prospective, randomised, controlled trial

BACKGROUND: Is cancer related to hypertension and blood pressure? Do antihypertensive drugs promote cancer? Do antihypertensive drugs protect against cancer? We previously analysed the frequency of cardiovascular mortality and morbidity in elderly people who participated in the Swedish Trial in Old Patients with Hypertension 2 (STOP-Hypertension-2). We have also looked at the frequency of cancer in these patients. METHODS: We randomly assigned 6614 elderly patients with hypertension (mean age 76 years, median time of follow-up 5.3 years) to one of three treatment strategies: conventional drugs (diuretics or b-blockers), calcium antagonists, or ACE inhibitors. We matched the patients to the Swedish Cancer Registry and compared our findings with expected values based on age, sex, and calendar-year-specific reference frequencies for the general Swedish population. We also compared the number of cancers between the three treatment groups. FINDINGS: At baseline, 607 (9%) patients had previous malignant disease. Diagnoses were closely similar to the distribution of cancer types that might be seen in elderly patients. During follow-up, there were 625 new cases of cancer in 590 patients. The frequency of cancer did not differ significantly between the treatment strategies, including all cancers and those at individual sites. The standardised incidence ratios (SIRs) for all cancers were also close to unity: 0.92 (95% CI 0.80-1.06) for conventional drugs, 0.96 (0.83-1.10) for calcium antagonists, and 0.99 (0.86-1.13) for ACE inhibitors. INTERPRETATIONS: No difference in cancer risk was seen between patients randomly assigned to conventional drugs, calcium antagonists, or ACE inhibitors. Thus, the general message to the practising physician is that more attention should be given to getting the blood pressure down than to the risk of cancer