Alcohol Consumption and the Risk of Hypertension in Men and Women: A Systematic Review and Meta‐Analysis

J Clin Hypertens (Greenwich). 2012;14:792–798. ©2012 Wiley Periodicals, Inc. Heavy alcohol intake increases the risk of hypertension, but the relationship between light to moderate alcohol consumption and incident hypertension remains controversial. The authors sought to analyze the dose‐response relationship between average daily alcohol consumption and the risk of hypertension via systematic review and meta‐analysis. Electronic databases were searched for prospective control studies examining quantitative measurement of alcohol consumption and biological measurement of outcome. The primary endpoint was the risk of developing hypertension based on alcohol consumption. The level of alcohol consumption from each study was assigned to categorical groups based on the midpoint of their alcohol consumption classes to make possible the comparison of heterogeneous classification of alcohol intake. A total of 16 prospective studies (33,904 men and 193,752 women) were included in the analysis. Compared with nondrinkers, men with alcohol consumption with <10 g/d and 11 to 20 g/d had a trend toward increased risk of hypertension (relative risk [RR], 1.03; 95% confidence interval [CI], 0.94–1.13; P=.51) and (RR, 1.15; 95% CI, 0.99–1.33; P=.06), respectively, whereas a significantly increased risk of hypertension was found with heavy alcohol consumption of 31 to 40 g/d (RR, 1.77; 95% CI, 1.39–2.26; P<.001) and >50 g/d (RR, 1.61; 95% CI, 1.38–1.87; P<.001). Among women, the meta‐analysis indicated protective effects at <10 g/d (RR, 0.87; 95% CI, 0.82–0.92; P<.001) and a trend toward decreased risk of hypertension with alcohol consumption 11 to 20 g/d (RR, 0.9; 95% CI, 0.87–1.04; P=.17), whereas a significantly increased risk of hypertension was indicated with heavy alcohol consumption of 21 to 30 g/d (RR, 1.16; 95% CI, 0.91–1.46; P=.23) and 31 to 40 g/d (RR, 1.19; 95% CI, 1.07–1.32; P=.002). In men, heavy alcohol consumption is associated with increased risk of hypertension, whereas there is a trend toward increased risk of hypertension with low and moderate alcohol consumption. The relationship between alcohol consumption and hypertension is J‐shaped in women. Limiting alcohol intake should be advised for both men and women.     

Several Conventional Risk Markers Suggesting Presence of Albuminuria Are Weak Among Rural Africans With Hypertension

The objective of this cross‐sectional study was to investigate risk markers indicating the presence of albuminuria in patients with hypertension in rural sub‐Saharan Africa (SSA). Urine albumin‐creatinine ratio, glycated hemoglobin (HbA_1c), blood pressure, anthropometry, and other patient characteristics including medications were assessed. We identified 160 patients with hypertension, of whom 68 (42.5%) were co‐diagnosed with diabetes mellitus (DM). Among the included participants, 57 (35.6%) had albuminuria (microalbuminuria [n=43] and macroalbuminuria [n=14]). A backward multivariate logistic regression model identified age (per 10‐year increment) (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.03–1.95), HbA_1c >53 compared with <48 mmol/mol (OR, 3.81; 95% CI, 1.74–8.35), and treatment with dihydropyridine calcium channel blockers (OR, 2.59; 95% CI, 1.09–6.16) as the variables significantly associated with albuminuria. Only dysregulated DM and age were the conventional risk markers that seemed to suggest albuminuria among patients with hypertension in rural SSA.     

The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension

J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc. Delayed blood pressure (BP) and heart rate (HR) decline at recovery post‐exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non‐CAD patients (374 normotensive) were followed for new‐onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow‐up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New‐onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28–2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08–2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03–4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14–4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components.     

Impact of disease duration and cardiovascular dysautonomia on hypertension in Parkinson's disease

The authors evaluated the association of Parkinson’s disease (PD) duration with hypertension, assessed by office measurements and 24‐hour (ambulatory) monitoring, in 167 patients. Hypertension was evaluated through both office and ambulatory blood pressure (BP) measurements. Among participants (mean age 73.4±7.6 years; 35% women), the prevalence of hypertension was 60% and 69% according to office and ambulatory BP measurements, respectively (Cohen's k=0.61; P<.001). PD duration was inversely associated with hypertension as diagnosed by office measurements (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.86–0.98) but not by ambulatory monitoring (OR, 0.94; 95% CI, 0.81–1.01). Ambulatory BP patterns showed higher nocturnal BP among patients with long‐lasting disease. In conclusion, ambulatory BP monitoring improves the detection of hypertension by 15% in PD, compared with office evaluation. The likelihood of having hypertension does not decrease during the PD course; rather, BP pattern shifts towards nocturnal hypertension.     

Psychoactive medications and crash involvement requiring hospitalization for older drivers: a population-based study

OBJECTIVES: To determine the association between psychoactive medications and crash risk in drivers aged 60 and older. DESIGN: Retrospective population‐based case‐crossover study. SETTING: A database study that linked the Western Australian Hospital Morbidity Data System and the Pharmaceutical Benefits Scheme. PARTICIPANTS: Six hundred sixteen individuals aged 60 and older who were hospitalized as the result of a motor vehicle crash between 2002 and 2008 in Western Australia. MEASUREMENTS: Hospitalization after a motor vehicle crash. RESULTS: Greater risk for a hospitalization crash was found for older drivers prescribed benzodiazepines (odds ratio (OR)=5.3, 95% confidence interval (CI)=3.6–7.8, P<.001), antidepressants (OR=1.8, 95% CI=1.0–3.3, P=.04), and opioid analgesics (OR=1.5, 95% CI=1.0–2.3, P=.05). Crash risk was significantly greater in men prescribed a benzodiazepine (OR=6.2, 95% CI=3.2–12.2, P<.001) or an antidepressant (OR=2.7, 95% CI=1.1–6.9, P=.03). Women prescribed benzodiazepines (OR=4.9, 95% CI=3.1–7.8, P<.001) or opioid analgesics (OR=1.8, 95% CI=1.1–3.0, P=.03) also had a significantly greater crash risk. Subgroup analyses further suggested that drivers with (OR=4.0, 95% CI=2.9–8.1, P<.001) and without (OR=6.0, 95% CI=3.8–9.5, P<.001) a chronic condition who were prescribed benzodiazepines were at greater crash risk. Drivers with a chronic condition taking antidepressants (OR=3.4, 95% CI=1.3–8.5, P=.01) also had a greater crash risk. CONCLUSION: Psychoactive medication usage was associated with greater risk of a motor vehicle crash requiring hospitalization in older drivers.     

Risk of Methylphenidate‐Induced Prehypertension in Normotensive Adult Smokers With Attention Deficit Hyperactivity Disorder

The authors studied predictors of methylphenidate‐induced increases in blood pressure (BP). In this secondary analysis of a randomized, double‐blind, placebo‐controlled smoking cessation trial, nonhypertensive adult smokers with attention deficit hyperactivity disorder randomized to osmotic‐release oral system methylphenidate (OROS‐MPH) (n=115) were matched one‐to‐one on baseline systolic BP (SBP) (±5 mm Hg) with participants randomized to placebo (n=115) and followed for 10 weeks. In adjusted mixed linear models of SBP and diastolic BP (DBP), baseline normal SBP (P<.0001) and DBP (P<.0001) were associated with significant OROS‐MPH–induced increases compared with placebo, whereas significant increases were not observed in participants with baseline prehypertensive SBP (P=.27) and DBP (P=.79). Participants randomized to OROS‐MPH with baseline normal BP had increased odds of developing either systolic (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.41–8.37; P=.006) or diastolic prehypertension (OR, 4.32; 95% CI, 1.56–14.0; P=.004) compared with placebo using simple logistic regression. The authors demonstrated an augmented OROS‐MPH–induced BP elevation and risk of prehypertension in adults with baseline normal BP. Significantly increased BP was not observed in adults with baseline prehypertension. J Clin Hypertens (Greenwich). 2012; 00:00–00. ©2012 Wiley Periodicals, Inc.     

Influence of high risk of obstructive sleep apnea on adherence to antihypertensive treatment in outpatients

Obstructive sleep apnea (OSA) is a common cause of high blood pressure (BP). Many patients, however, have uncontrolled BP because of nonadherence to antihypertensive medication. The possibility that OSA influences adherence has not been investigated to date. The authors sought to explore the possible association between high risk of OSA and nonadherence. This study was carried out in a hypertension outpatient clinic. Adherence to medication, high risk of OSA, and sleepiness were evaluated in a cross‐sectional study. These variables were identified using the eight‐item Morisky, STOP‐Bang, and Epworth scales, respectively. A total of 416 patients with hypertension were enrolled (32% male, aged 65±11 years). Nonadherence was identified in 71 (17%) individuals. The prevalence of high risk of OSA was 323 (78%) and of somnolence was 136 (33%). High risk of OSA was associated with nonadherence, showing a prevalence ratio (PR) of 2.6 (95% confidence interval [CI], 1.3–5.6) and retained significance after adjustment for sleepiness (PR, 2.3; 95% CI, 1.1–4.9 [P=.011]). Sleepiness was also associated with nonadherence (PR, 1.7; 95% CI, 1.1–2.6 [P=.003]). High risk of OSA and sleepiness are associated with nonadherence. These conditions, if treated, may allow for achieving better outcomes and improvement of adherence to medication.     

Angiotensin System Blockade Combined With Calcium Channel Blockers Is Superior to Other Combinations in Cardiovascular Protection With Similar Blood Pressure Reduction: A Meta‐Analysis in 20,451 Hypertensive Patients

The authors aimed to investigate the superiority of angiotensin system blockade (angiotensin‐converting enzyme [ACE] inhibitor/angiotensin receptor blocker [ARB]) plus a calcium channel blocker (CCB) (A+C) over other combination therapies in antihypertensive treatment. A meta‐analysis in 20,451 hypertensive patients from eight randomized controlled trials was conducted to compare the A+C treatment with other combination therapies in terms of blood pressure (BP) reduction, clinical outcomes, and adverse events. The results showed that BP reduction did not differ significantly among the A+C therapy and other combination therapies in systolic and diastolic BP (P=.87 and P=.56, respectively). However, A+C therapy, compared with other combination therapies, achieved a significantly lower incidence of cardiovascular composite endpoints, including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.70–0.91; P<.001), but similar all‐cause mortality (RR, 0.90; 95% CI, 0.77–1.04; P=.15) and stroke rates (RR, 0.90; 95% CI, 0.77–1.04; P=.09). Moreover, A+C therapy yielded a 4.21 mL/min/1.73 m² lower estimated glomerular filtration rate reduction than other combinations (P<.001). Finally, A+C therapy showed a similar incidence of adverse events as other combination therapies (P=.34) but presented a significantly lower incidence of serious adverse events (RR, 0.85; 95% CI, 0.73–0.98; P=.03). In conclusion, A+C therapy is superior to other combinations of antihypertensive treatment as it shows a lower incidence of cardiovascular events and adverse events, while it has similar effects in lowering BP and preserving renal function.     

Effect of Allopurinol on Blood Pressure: A Systematic Review and Meta‐Analysis

J Clin Hypertens (Greenwich). 2013; 15:435–442 ©2012 Wiley Periodicals, Inc. Allopurinol is a potent xanthine oxidase inhibitor that is used in hyperuricemic patients to prevent gout. It has also been shown to decrease cardiovascular complications in a myriad of cardiovascular conditions. However, studies have reported conflicting evidence on its effects on blood pressure (BP). A systematic review was conducted using Medline, PubMed, Embase, and the Cochrane Library for all the longitudinal studies that assessed the efficacy of allopurinol on systolic and diastolic BP. A total of 10 clinical studies with 738 participants were included in the analysis. Compared with the control group, systolic BP decreased by 3.3 mm Hg (95% confidence interval [CI], 1.4–5.3 mm Hg; P=.001) and diastolic BP decreased by 1.3 mm Hg (95% CI, 0.1–2.5 mm Hg; P=.03) in patients treated with allopurinol. When analysis was restricted to the higher‐quality randomized controlled trials, similar changes in systolic and diastolic BPs were found: 3.3 mm Hg (95% CI, 0.8–5.8 mm Hg; P<.001) and 1.4 mm Hg (95% CI, 0.1–2.7 mm Hg; P=.04), respectively. Allopurinol is associated with a small but significant reduction in BP. This effect can be potentially exploited to aid in controlling BP in hypertensive patients with hyperuricemia.     

Relationship Between Inter‐Arm Difference in Systolic Blood Pressure and Arterial Stiffness in Community‐Dwelling Older Adults

A significant inter‐arm difference in systolic blood pressure (IADSBP) has recently been associated with worse cardiovascular outcomes. The authors hypothesized that part of this association is mediated by arterial stiffness, and examined the relationship between significant IADSBP and carotid‐femoral pulse wave velocity (CF‐PWV) in a sample from the Baltimore Longitudinal Study of Aging. Of 1045 participants, 50 (4.8%) had an IADSBP ≥10 mm Hg at baseline, and 629 had completed data from ≥2 visits (for a total of 1704 visits during 8 years). CF‐PWV was significantly higher in patients with an IADSBP ≥10 mm Hg (7.3±1.9 vs 8.2±2, P=.002). Compared with others, patients with IADSBP ≥10 mm Hg also had higher body mass index, waist circumference, and triglycerides; higher prevalence of diabetes; and lower high‐density lipoprotein (HDL) cholesterol (P<.001 for all). A significant association with IADSBP ≥10 mm Hg was observed for CF‐PWV in both cross‐sectional (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06–1.87; P=.01) and longitudinal (OR, 1.15; 95% CI, 1.03–1.29; P=.01) multivariate analyses. Female sex, Caucasian race, high body mass index (plus diabetes and low HDL cholesterol only cross‐sectionally) were other independent correlates of IADSBP ≥10 mm Hg. Significant IADSBP is associated with increased arterial stiffness in community‐dwelling older adults.     

Incidence and Risk of Sorafenib‐Induced Hypertension: A Systematic Review and Meta‐Analysis

Hypertension is one of the major side effects of sorafenib, and reported incidences vary substantially among clinical trials. A systematic review was conducted using Medline, PubMed, Embase, and the Cochrane Library for all longitudinal studies to investigate the incidence and risk of hypertension events in cancer patients treated with sorafenib. A total of 14 randomized controlled trials and 39 prospective single‐arm trials involving 13,555 patients were selected for the meta‐analysis. The relative risk of all‐grade and high‐grade hypertension associated with sorafenib were 3.07 (95% confidence interval [CI], 2.05–4.60; P<.01) and 3.31 (95% CI, 2.21–4.95; P<.01), respectively. The overall incidence of sorafenib‐induced all‐grade and high‐grade hypertension were 19.1% (95% CI, 15.8%–22.4%) and 4.3% (95% CI, 3.0%–5.5%), respectively. A significantly higher incidence of hypertension was noted in patients with renal cell carcinoma (RCC) compared with those with non‐RCC malignancies (all‐grade: 24.9% [95% CI, 19.7%–30.1%] vs 15.7% [95% CI, 12.1%–19.3%]; P<.05; high‐grade:8.6% [95% CI, 6.0%–11.2%] vs 1.8% [95% CI, 0.9%–2.6%]; P<.05). The trials with median progression‐free survival (PFS) longer than 5.3 months (mean PFS) demonstrated a significantly higher incidence of high‐grade hypertension than trials with shorter PFS (6.3% [95% CI, 4.1%–8.5%] vs 2.6% [95% CI, 1.4%–3.8%]; P<.05). Findings of the meta‐analysis indicated a significantly high risk of sorafenib‐induced hypertension. Patients with RCC have a significantly higher incidence of hypertension and the occurrence of hypertension may be associated with improved prognosis.     

White‐Coat Effect Among Older Adults: Data From the Jackson Heart Study

Many adults with elevated clinic blood pressure (BP) have lower BP when measured outside the clinic. This phenomenon, the “white‐coat effect,” may be larger among older adults, a population more susceptible to the adverse effects of low BP. The authors analyzed data from 257 participants in the Jackson Heart Study with elevated clinic BP (systolic/diastolic BP [SBP/DBP] ≥140/90 mm Hg) who underwent ambulatory BP monitoring (ABPM). The white‐coat effect for SBP was larger for participants 60 years and older vs those younger than 60 years in the overall population (12.2 mm Hg, 95% confidence interval [CI], 9.2–15.1 mm Hg and 8.4 mm Hg, 95% CI, 5.7–11.1, respectively; P=.06) and among those without diabetes or chronic kidney disease (15.2 mm Hg, 95% CI, 10.1–20.2 and 8.6 mm Hg, 95% CI, 5.0–12.3, respectively; P=.04). After multivariable adjustment, clinic SBP ≥150 mm Hg vs <150 mm Hg was associated with a larger white‐coat effect. Studies are needed to investigate the role of ABPM in guiding the initiation and titration of antihypertensive treatment, especially among older adults.     

Association between HIV infection and attenuated diurnal blood pressure rhythm in untreated hypertensive individuals*

Objective

Hypertensive cardiovascular complications are more closely associated with ambulatory blood pressure (ABP), particularly the attenuated diurnal blood pressure (BP) rhythm (i.e. a fall in systolic blood pressure <10% during the night compared with the day), than with casual BP. The aim of the study was to assess the ABP pattern in an HIV‐infected cohort in which hypertension was newly diagnosed.

Methods

ABP over 24 h was compared between 77 newly diagnosed, untreated hypertensive HIV‐positive individuals and 76 HIV‐uninfected untreated hypertensive controls.

Results

More HIV‐infected subjects had an attenuated ABP rhythm with a reduced nocturnal fall than HIV‐negative hypertensive control subjects (60 vs. 33%, respectively; P=0.001). The dipping pattern was observed despite newly diagnosed hypertension, a low prevalence of microalbuminuria, and the absence of signs of overt kidney disease. Furthermore, the prevalence of nondipping in the HIV‐infected subjects was independent of combination antiretroviral treatment. Multiple logistic regression analysis with dipping pattern as the dependent variable showed that HIV status was an independent predictor of nondipping BP [P=0.002; odds ratio (OR) 0.33; 95% confidence interval (CI) 0.17–0.66]; casual SBP (P=0.37; OR 1.001; 95% CI 0.99–1.04) and microalbuminuria (P=0.39; OR 1.56; 95% CI 0.57–4.28) were not associated with dipping pattern.

Conclusions

The prevalence of a nondipping BP pattern in HIV‐infected subjects with newly diagnosed hypertension who had not received antihypertensive treatment was high and significantly greater than in hypertensive control subjects.     

A Large Cohort Study Evaluating Risk Factors Associated With Uncontrolled Hypertension

Hypertension is the most common primary diagnosis in the United States. Risks for long‐term consequences such as myocardial infarction, heart failure, stroke, and kidney disease continue to significantly increase as long as hypertension remains uncontrolled. This retrospective cohort study of 661,075 patients identified with uncontrolled hypertension, defined as systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg, from a large integrated healthcare organization was conducted to examine multiple patient characteristics to determine their association with uncontrolled hypertension. Multivariate analysis revealed that compared with Caucasians, African Americans (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.16–1.20) were significantly associated with uncontrolled hypertension, as were unpartnered populations (OR, 1.15; 95% CI, 1.14–1.17), number of antihypertensive medications prescribed (OR, 1.37; 95% CI, 1.33–1.41), and adherence to most antihypertensive medications. A secondary analysis found an association between uncontrolled blood pressure and Patient Health Questionnaire‐9 (PHQ‐9) score (OR, 1.21; 95% CI, 1.16–1.26). Our findings suggest that the presence of these identified risk factors recommends a commitment to a more aggressive hypertension management program to prevent cardiovascular disease caused by uncontrolled hypertension.     

Blood pressure control and mortality in US‐ and foreign‐born blacks in New York City

This retrospective cohort study compared blood pressure (BP) control (BP <140/90 mm Hg) and all‐cause mortality between US‐ and foreign‐born blacks. We used data from a clinical data warehouse of 41 868 patients with hypertension who received care in a New York City public healthcare system between 2004 and 2009, defining BP control as the last recorded BP measurement and mean BP control. Poisson regression demonstrated that Caribbean‐born blacks had lower BP control for the last BP measurement compared with US‐ and West African–born blacks, respectively (49% vs 54% and 57%; P<.001). This pattern was similar for mean BP control. Caribbean‐ and West African–born blacks showed reduced hazard ratios of mortality (0.46 [95% CI, 0.42–0.50] and 0.28 [95% CI, 0.18–0.41], respectively) compared with US‐born blacks, even after adjustment for BP. BP control rates and mortality were heterogeneous in this sample. Caribbean‐born blacks showed worse control than US‐born blacks. However, US‐born blacks experienced increased hazard of mortality. This suggests the need to account for the variations within blacks in hypertension management.     

Hypertension and the Risk of Incident Gout in a Population‐Based Study: The Atherosclerosis Risk in Communities Cohort

J Clin Hypertens (Greenwich). 2012; 14:675–679. ©2012 Wiley Periodicals, Inc. The authors quantified the impact of hypertension on gout incidence in middle-aged white and African American men and women. The Atherosclerosis Risk in Communities Study (ARIC) was a prospective population-based cohort that recruited patients between 1987 and 1989 from 4 US communities. Using a time-dependent Cox proportional hazards model, the authors estimated the adjusted hazard ratio (HR) of incident gout by time-varying hypertension and tested for mediation by serum urate level. There were 10,872 participants among whom 45% had hypertension during follow-up; 43% were men and 21% were African American. Over 9 years, 274 (2.5%) participants developed gout (1.8% of women and 3.5% of men). The unadjusted HR of incident gout was approximately 3 times (HR, 2.87; 95% confidence interval [CI], 2.24–3.78) greater for those with hypertension. Adjusting for confounders resulted in an attenuated but still significant association between hypertension and gout (HR, 2.00; 95% CI, 1.54–2.61). Adjustment for serum urate level further attenuated but did not abrogate the association (HR, 1.36, 95% CI, 1.04–1.79). There was no evidence of effect modification by sex (P=.35), race (P=.99), or obesity at baseline (P=.82). Hypertension was independently associated with increased gout risk in middle-aged African American and white adults. Serum urate level may be a partial intermediate on the pathway between hypertension and gout.     

Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub‐Saharan Africa: systematic review and meta‐analysis

Objectives To assess the proportion of patients lost to programme (died, lost to follow‐up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub‐Saharan Africa, and determine factors associated with loss to programme. Methods Systematic review and meta‐analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow‐up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random‐effects meta‐analysis. Results Twenty‐nine studies from sub‐Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta‐analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60–84) had a CD4 cell count measured, 40 (95% CI 26–55) were eligible for ART and 25 (95% CI 13–37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25%vs. 54%, P < 0.0001), but eligible patients were more likely to die (11%vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio‐economic status and in recent time periods. Conclusions Monitoring and care in the pre‐ART time period need improvement, with greater emphasis on patients not yet eligible for ART.     

Risk factors for preeclampsia in infertile Chinese women with polycystic ovary syndrome: A prospective cohort study

To explore preconception risk factors for preeclampsia (PE) in women with polycystic ovary syndrome (PCOS), a prospective cohort study was conducted in 92 infertile Chinese women with PCOS who had a singleton pregnancy by ovulation induction and were followed up for 6 weeks after delivery. The patients underwent assessment of physical, endocrine, and metabolic features before ovulation induction. Fifteen (16.3%) patients were diagnosed with PE. Logistic regression analysis showed that preconception sex hormone–binding globulin (SHBG), insulin level at 120 minutes, and body mass index were three independent risk factors for PE (odds ratio [OR], 0.981; 95% confidence interval [CI], 0.964–0.998 [P=.027]; OR, 1.011; 95% CI, 1.000–1.021 [P=.048]; and OR, 1.249; 95% CI, 0.992–1.572 [P=.059], respectively). Receiver operator characteristic analysis indicated the risk value of prepregnancy SHBG, insulin level at 120 minutes, and body mass index (area under the curve=.788, .686, and .697, respectively). Preconception low SHBG levels, overweight/obesity, and hyperinsulinism might be correlated with the subsequent development of PE in patients with PCOS.     

Prognostic impact of baseline low blood pressure in hypertensive patients with stable coronary artery disease of daily clinical practice

J Clin Hypertens (Greenwich). 2012;00:00–00 ©2012 Wiley Periodicals, Inc. The authors’ aim was to investigate the prognostic value of first‐visit systolic and diastolic blood pressure (SBP/DBP) in hypertensive patients with stable coronary artery disease (sCAD) in conditions of contemporary daily clinical practice. From February 1, 2000, to January 31, 2004, 690 consecutive hypertensive patients with sCAD (mean age 68±10 years, 65% male) were prospectively followed in the outpatient cardiology clinic for major events (acute coronary syndrome, revascularization, stroke, heart failure, or death) and associations with baseline SBP/DBP were investigated. At first visit, median SBP/SDP were 130/75 mm Hg (interquartile range, 25–75; 120–140/70–80 mm Hg). After 25 months of follow‐up (median), 19 patients died (2.8%); 10 from cardiovascular causes (1.5%), 87 patients experienced a coronary event (13%), and 130 patients (19%) a major event. After adjusting for baseline variables, DBP <75 mm Hg or SBP <130 mm Hg resulted in independent predictors of major events (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.07–2.16, P=.02; HR, 1.68; 95% CI, 1.18–2.40, P=.004, respectively), coronary events (HR, 1.78; 95% CI, 1.15–2.75, P=.009; HR, 1.84; 95% CI, 1.20–2.83, P=.005, respectively), and cardiovascular mortality (HR, 7.02; 95% CI, 1.26–39.04, P=.03; HR, 9.26; 95% CI, 1.33–64.32, P=.02, respectively). In this study, a low first‐visit SBP or DBP was associated with an adverse prognosis in hypertensive patients with sCAD of contemporary daily clinical practice.     

Do Combined Electrocardiographic and Echocardiographic Markers of Left Ventricular Hypertrophy Improve Cardiovascular Risk Estimation?

The authors estimated the risk of cardiovascular mortality associated with echocardiographic (ECHO) left ventricular hypertrophy (LVH) and subtypes of this phenotype in patients with and without electrocardiographic (ECG) LVH. A total of 1691 representatives of the general population were included in the analysis. During a follow‐up of 211 months, 89 cardiovascular deaths were recorded. Compared with individuals with neither ECHO LVH nor ECG LVH, fully adjusted risk of cardiovascular mortality increased (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.51–7.47; P=.003) in patients with both ECHO‐LVH and ECG‐LVH, whereas the risk entailed by ECHO‐LVH alone was of borderline statistical significance (P=.04). Combined concentric nondilated LVH and ECG‐LVH, but not concentric nondilated LVH alone, predicted cardiovascular death (HR, 3.79; 95% CI, 1.25–11.38; P=.01). Similar findings were observed for eccentric nondilated LVH (HR, 3.37; 95% CI, 1.05–10.78; P=.04.). The present analysis underlines the value of combining ECG and ECHO in the assessment of cardiovascular prognosis related to abnormal left ventricular geometric patterns.