Do we need out-of-office blood pressure in every patient?

PURPOSE OF REVIEW: The limitations affecting office blood pressure readings have spurred the development of techniques for measuring blood pressure out of a clinical environment. The increasing use of home and ambulatory blood pressure monitoring has allowed the identification of specific blood pressure patterns related either to a discrepancy between office and out-of-office blood pressure or to alterations in the 24-h blood pressure profiles. This review offers an update on the most recent data published on the above issues. RECENT FINDINGS: A critical overview is provided on recent data published on blood pressure patterns suggested to have clinical relevance. These include white coat hypertension, the so-called masked hypertension, enhanced overall blood pressure variability over 24 h, a steeper morning blood pressure surge and a blunted or an excessive blood pressure fall at night. SUMMARY: All of these different conditions have been variably reported to carry prognostic implications, and may represent specific targets for antihypertensive treatment. Their identification and management require information on out-of-office blood pressure, which suggests that self blood pressure monitoring at home or 24-h ambulatory blood pressure monitoring should be used more frequently in clinical practice, following the indications issued in recent guidelines.     

Can every patient be mobilized?

There are several ways to mobilize hematopoietic stem cells for autologous and allogeneic hematopoietic stem cell transplant by manipulating the bone marrow microenvironment. Granulocyte colony-stimulating factor (G-CSF) and chemotherapy have been commonly used to mobilize stem cells, but several new agents, such as the CXCR4 inhibitor plerixafor, inhibit stromal-stem cell interactions to improve stem cell yield. The minimum threshold for engraftment is 2 × 10? CD34+ cells/kg, but it has been shown that higher CD34+ stem cell dose, such as 5 × 10? CD34+ cells/kg, is associated with improved survival. Efforts to increase stem cell yield remain important to improve outcomes.     

Drug-eluting stents: effective and safe for every patient and every lesion?

When Andreas Grüntzig performed the first percutaneoustransluminal coronary angioplasty in 1978, he did not expectthat this procedure would become one of the most often performedinterventions in medicine worldwide. The Achilles' heels ofballoon angioplasty were early reocclusions and restenosis.However, >60% of the patients after plain old balloon angioplastydid well without any need for repeat target lesion revascularizations.With the introduction of stents, the procedure became more predictablewith respect to early reocclusions and the rate of clinicallydriven repeat revascularization procedures declined to 20%,depending on lesion characteristics such as vessel diameterand lesion length     

Is chronic hepatitis C treatment as efficient in the general population as in randomised trials?

AIMS: The aim of this population-based study was to determine the effectiveness of antiviral therapy in non selected chronic hepatitis C patients. METHODS: The study was performed in all new patients with anti-HCV antibodies who had registered in a specialised viral hepatitis registry since 1994 and who lived in the French departments of C?te-d'Or and Doubs (1 005 817 inhabitants). RESULTS: 1251 of the 1508 recorded cases were studied; 262 were treated. Results of treatment were available in 238 cases, 157 were treated with interferon alone and 81 with interferon + ribavirine. Sustained virological response was observed in 18% of cases after interferon alone and 46.9% after interferon + ribavirine. In multivariate analysis, age under 40 and combined therapy were positively correlated to sustained virological response. Premature treatment discontinuation was associated with a lack of sustained response which was unrelated to gender or liver fibrosis. Fifty seven patients received combined therapy after unsuccessful monotherapy: sustained virological response rates were 33.3% in responders-relapsers and 23.7% in non-responders to initial therapy. CONCLUSIONS: This study showed that sustained response rates were similar in non selected patients from the general population and in highly selected patients from randomised trials. These results emphasize the necessity of increasing the ratio of treated patients which is still too low in general population.     

Alcohol septal ablation in elderly patients: Is it as effective as in young patients?

Hypertrophic cardiomyopathy (HCM) is a common genetic abnormality that can occur in as many as 1 in 500persons. 1 Researchers have found multiple mutations in 10different sarcomeric proteins such as myosin heavy chain and tropomyosin can cause this disease. ……     

Alcohol septal ablation in elderly patients:Is it as effective as in young patients?

Hypertrophic cardiomyopathy (HCM) is a common genetic abnormality that can occur in as many as 1 in 500 persons. Researchers have found multiple mutations in 10 different sarcomeric proteins such as myosin heavy chain and tropomyosin can cause this disease. HCM is the most common monogenic cardiac disorder and the most common