Abbreviations ACE: angiotensin-converting enzyme; BP: blood pressure; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; ESC: European Society of Cardiology; ESH: European Society of Hypertension; ET: endothelin; IMT: carotid intima-media thickness; JNC: Joint National Commit

Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document.

ACEangiotensin-converting enzymeBPblood pressureDBPdiastolic blood pressureeGFRestimated glomerular filtration rateESCEuropean Society of CardiologyESHEuropean Society of HypertensionETendothelinIM...

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Reappraisal of European guidelines on hypertension management:: A European Society of Hypertension Task Force document

BackgroundThe excess risks of death from any cause and death from cardiovascular causes among persons with type 2 diabetes and various levels of glycemic control and renal complications are unknown. In this registry-based study, we assessed these risks according to glycemic control and renal complications among persons with type 2 diabetes. MethodsWe included patients with type 2 diabetes who were registered in the Swedish National Diabetes Register on or after January 1, 1998. For each patient, five controls were randomly selected from the general population and matched according to age, sex, and county. All the participants were followed until December 31, 2011, in the Swedish Registry for Cause-Specific Mortality. ResultsThe mean follow-up was 4.6 years in the diabetes group and 4.8 years in the control group. Overall, 77,117 of 435,369 patients with diabetes (17.7%) died, as compared with 306,097 of 2,117,483 controls (14.5%) (adjusted hazard ratio, 1.15; 95% confidence interval [CI], 1.14 to 1.16). T...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1504347

Excess Mortality among Persons with Type 2 Diabetes

BACKGROUND The excess risk of death from any cause and of death from cardiovascular causes is unknown among patients with type 1 diabetes and various levels of glycemic control. We conducted a registry-based observational study to determine the excess risk of death according to the level of glycemic control in a Swedish population of patients with diabetes.

Glycemic Control and Excess Mortality in Type 1 Diabetes

Aims Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden.

Methods and results This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan–Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60–69 vs. 80 vs. <60 years: 3.96 (3.78–4.15)], prior MI [1.44 (1.40–1.49)], stroke [1.49 (1.44–1.54)], diabetes [1.37 (1.34–1.40)], heart failure [1.57 (1.53–1.62)] and no index MI revascularisation [1.88 (1.83–1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months.

Conclusions Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.

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Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective

The new Swedish Prescribed Drug Register-Opportunities for pharmacoepidemiological research and experience from the first six months.

The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six months

Background:Potentially inappropriate drug use (IDU) is an important and preventable safety concern in the care of elderly patients and has been associated with adverse drug reactions, hospitalization, and mortality.Objective:To estimate the prevalence of potentially IDU among the elderly in Sweden and investigate whether age. sex, and number of dispensed drugs are associated with IDU.Methods:We analyzed data on age, sex, and dispensed drugs for people aged 75 years and older who were listed in the Swedish Prescribed Drug Register from October–December 2005 (N = 732 226). The main outcome measures of IDU were prescription of anticholinergics, prescription of long-acting benzodiazepines, concurrent use of 3 or more psychotropic drugs, and an indication of potentially serious drug-drug interactions.Results:Prevalence for IDU was 17%; for anticholinergic drugs 6%, long-acting benzodiazepines 5%, 3 or more psychotropic drugs 5%, and potentially serious drug–drug interactions 4%. After adjustment for age and se...

Inappropriate drug use in the elderly: a nationwide register-based study.

Objectives To compare rates of treatment discontinuation of and changes in initial antihypertensive drug therapy in the natural setting of treatment dispensation of Italy, Sweden and the Netherlands Methods The cohorts included all the 23 715 (Italy), 20 289 (Sweden), and 5801 (the Netherlands) patients aged 40–70 years who received their first antihypertensive drug prescription from July 1, 2006 to September 30, 2006 Discontinuation was assumed if no antihypertensive drug was issued within 90 days following the end of the latest antihypertensive dispensation Addition or replacement of the initial medication during the 90-day interval were defined as treatment combination or treatment switching Results At 9 months after treatment initiation, the discontinuation rate of any antihypertensive drug was 24% Compared with Italian patients, the discontinuation rate was significantly lower in Swedish [hazard ratios: 052, 95% confidence interval (CI): 050–054] and Dutch patients (hazard ratio: 079, 95% CI: 075–084) Almost 21 and 16% of patients who started on monotherapy respectively combined with and switched to another antihypertensive drug Compared with Italian patients, the adjusted hazard rate of combining was lower in Swedish patients (hazard ratio: 083, 95% CI: 079–087) The hazard rate of switching was lower in Swedish and Dutch patients than in Italians (hazard ratios: 083, 95% CI: 079–088 and hazard ratio: 077, 95% CI: 071–084 respectively) Conclusion Management of hypertension is unsatisfactory worldwide due to a very high rate of treatment discontinuation or insufficient use of proper treatment strategies

Andrejs Leimanis

Papers

The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six months

Inappropriate drug use in the elderly: a nationwide register-based study.

Management of antihypertensive drugs in three European countries.

Läkemedelsanvändningen hos äldre brister i kvalitet Analys utifrån nationella läkemedelsregistret visar regionala skillnader

Low quality of drug use among the elderly. An analysis based on the national drug registry shows regional differences