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Aim: To investigate whether phase II cardiac rehabilitation (CR) conducted by a community model of shared care CR (SC-CR) including health care centres and general practice was feasible and provided acceptable results and to compare SC-CR to hospital-based CR (H-CR) in a randomised controlled trial. Methods: Patients were randomised to H-CR or SC-CR after admission for acute coronary syndrome. In SC-CR, the general practitioner took over the responsibility of the remaining rehabilitation, pharmacological treatment and risk factor management after the initial visit to the hospital outpatient clinic. The Municipal Health Care Centres provided courses on smoking cessation, nutrition, and exercise training and contributed to disease education and psychosocial support. The main endpoint was adherence to the CR programme and compliance with lifestyle modifications. Results: In total, 1364 patients were screened, 327 (24%) were eligible, and 212 (65%) accepted participation. Phase II CR was completed by 192 (91%) of the participants. Full adherence to the CR programme was seen in 53% in SC-CR versus 54% in H-CR (relative risk (RR): 0.98, 95% confidence interval: 0.73–1.32). In H-CR, patients had higher rates of adherence to dietary advice and health education. In SC-CR, 12% of patients did not attend the risk factor evaluation and clinical assessment with their general practitioner. No difference in risk factor improvement was found. Exercise training was declined by 25% in both groups. Conclusion: Adherence to phase II CR was high in both groups. SC-CR did not improve adherence and efficacy, but had comparable effects on medication and risk factors. Thus, SC-CR was safe and effective. [ABSTRACT FROM AUTHOR]

Aim: Young individuals genetically predisposed for essential hypertension have increased renal vascular resistance. We evaluated whether 1 year of angiotensin II receptor blockade decreases afferent arteriolar resistance (RA) and induces a sustained blood pressure (BP) reduction during a 10-year follow-up period in offspring of parents both diagnosed with essential hypertension., Methods: Based on renal plasma flow (p-aminohippurate clearance) and glomerular filtration rate (Cr-EDTA clearance) RA was calculated according to the model originally established by Gomez. Following baseline measurements, the participants (n = 110, mean age 30 years) were randomly allocated to 12 months of treatment with either candesartan or placebo followed by repetition of measurements and withdrawal of medication. Four-hour ambulatory BP (ABP) was recorded at baseline, by end of active treatment and after 6 months, 1, 2, 3, 5, and 10 years. ABP was analyzed according to RA achieved at the end of active treatment., Results: Candesartan reduced RA by 14% (P < 0.01). Ten years posttreatment systolic ABP increased by 2.1 mmHg (P = 0.04) and diastolic by 4.2 mmHg (P < 0.01) compared with baseline, without any difference between treatment arms. A high posttreatment RA was associated with higher BP levels during follow-up, but long-term alterations in 24-h BP were similar in participants with low and high RA and not different between treatment arms., Conclusion: RA is associated with 24-h BP levels, but temporary lowering of BP and RA by candesartan does not prevent BP from increasing further. Prevention of hypertension appears not feasible by short-term inhibition of the rennin-angiotensin system in young adults.

Background and Purpose: Traffic noise <60 dB(A) has been associated with an increased risk of stroke. We investigated this relationship for 80 to 86 dB(A) occupational noise., Methods: We followed 116,568 industrial and 47,679 financial workers by linkage to Danish registries 2001 through 2007. Full-shift noise levels were estimated from subsets of workers at baseline and end of follow-up., Results: We identified 981 stroke patients and observed a 27% increased confounder-adjusted risk of stroke for industrial compared with financial workers. However, longer duration or higher noise level within the industrial workers were unrelated to the risk of stroke., Conclusions: Our study did not support an association between occupational noise exposure and stroke, and the higher risk among industrial workers may reflect lifestyle differences.

Background: Noise may increase the risk of hypertension, but findings are inconsistent with respect to both community and occupational noise exposure. We used a large sample of noise-exposed industrial trades to analyze the association of occupational noise exposure and the risk of hypertension., Methods: The 7-year prospective cohort study included 145,190 workers from 625 companies representing 10 industrial trades and 100 companies from the finance sector. They were followed from 2001 to 2007 by record linkage with several Danish national registries. Full-shift noise exposure levels, measured in a random subset of 710 workers at the start and the end of follow-up, ranged from 70 to 86 dB(A); based on this information, historical levels back to the 1960s were estimated. Hypertension (defined by the prescription of antihypertensive medication or a hospital discharge diagnosis of hypertension) was regressed on the trade mean sound levels (LAEq) adjusting for a number of covariates., Results: Women had increased rate ratios for hypertension when comparing blue-collar industrial workers with white-collar financial workers (adjusted rate ratio = 1.17 [95% confidence interval = 1.09-1.26]). For men, the corresponding relative risk value was 1.06 (0.98-1.14). Within blue-collar industrial workers, however, increasing noise exposure level was not associated with an increasing risk of hypertension among either men or women., Conclusion: Our study shows no increased risk of hypertension with exposure to noise in the lower half of the 80-90 dB(A) range.