Cardiovascular prognosis of "masked hypertension" detected by blood pressure self-measurement in elderly treated hypertensive patients

Context  Blood pressure (BP) measurement in clinicians' offices with a mercury sphygmomanometer has numerous drawbacks. In contrast, the use of home BP measurement improves measurement precision and reproducibility. However, data about its prognostic value are lacking. Objective  To assess the prognostic value of home vs office BP measurement by general practitioners in a European population of elderly patients being treated for hypertension. Design, Setting, and Participants  Office and home BP and cardiac risk factors were measured at baseline in a cohort of 4939 treated hypertensive patients (mean age, 70 [SD, 6.5] years; 48.9% men) who were recruited and followed up by their usual general practitioners without specific recommendations about their management. The cohort was then followed up for a mean of 3.2 (SD, 0.5) years. The thresholds defining uncontrolled hypertension were at least 140/90 mm Hg for office BP and 135/85 mm Hg for home BP. Main Outcome Measures  The primary end point was cardiovascular mortality. Secondary end points were total mortality and the combination of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for angina or heart failure, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery. Results  At the end of follow-up, clinical status was known for 99.9% of patients. At least 1 cardiovascular event had occurred in 324 (incidence, 22.2/1000 patient-years). For BP self-measurement at home, each 10-mm Hg increase in systolic BP increased the risk of a cardiovascular event by 17.2% (95% confidence interval [CI], 11.0%-23.8%) and each 5-mm Hg increase in diastolic BP increased that risk by 11.7% (95% CI, 5.7%-18.1%). Conversely, for the same increase in BP observed using office measurement, there was no significant increase in the risk of a cardiovascular event. In a multivariable model with patients having controlled hypertension (normal home and office BP) as the referent, the hazard ratio of cardiovascular events was 1.96 (95% CI, 1.27-3.02) in patients with uncontrolled hypertension (high BP with both measurement methods), 2.06 (95% CI, 1.22-3.47) in patients with normal office BP and elevated home BP, and 1.18 (95% CI, 0.67-2.10) in patients with elevated office BP and normal home BP. Conclusions  Our findings suggest that home BP measurement has a better prognostic accuracy than office BP measurement. Blood pressure should systematically be measured at home in patients receiving treatment for hypertension.      

Why is hypertension so frequently uncontrolled in secondary prevention?

OBJECTIVE: To analyze blood pressure (BP) control in secondary prevention. DESIGN: Individual data of two cross-sectional studies on preventive cardiology (PRATIK and ESPOIR studies conducted, respectively, in general practice and with private cardiologists) were analyzed. SETTING: Primary care. PARTICIPANTS: Patients both with treated hypertension and coronary disease. MAIN OUTCOME MEASURES: Risk factors, treatments, cardiovascular history and BP were recorded. Each population was divided in three groups: group I, no other risk factor; group II, one or two risk factors; group III, three or more risk factors or diabetes. RESULTS: A total of 1423 and 2596 patients, respectively, recruited in general practice and by cardiologists were analyzed. Of these, 473 (33.24%) and 1060 (40.83%) patients, respectively, had controlled hypertension. Among uncontrolled hypertensives, more than 50% had borderline isolated systolic hypertension. Associated risk factors negatively affect hypertension control, which had been achieved in a lower percentage of patients in group III than in group I (general practice, 26.28 versus 42.20%; cardiological practice, 32.42 versus 56.13%). In general practice, the percentage of patients receiving beta-blockers was significantly lower in group III. Among individuals with uncontrolled hypertension, only 17.58 and 26.69% received at least three-drug treatment including diuretics in general and in cardiological practice, respectively. CONCLUSION: The negative influence of associated risk factors and the under-use of combination therapy contribute to poor BP control. In addition the high frequency of borderline isolated systolic hypertension suggests that the prerequisite to improve hypertension control should be to convince practitioners of the beneficial effect of tight systolic BP control (below 140 mmHg) in secondary prevention.     

The glycogen content in the liver and muscles of rats in relation to the time elapsed after administration of chloropropamide and to the duration of fasting

Summary A study was made of the effect of chloropropamide (100 mg per kg) on the blood sugar level and the content of glycogen in the liver and skeletal muscles of rats in 4,6,8,17,19,21,25,28,42 and 45 hours after the food intake was stopped and the preparation was administered. Marked reduction of the blood sugar level was noted for a period of 28 hours, whereas the glycogen content in the liver increased considerably only in 4,6 and 8 hours; in the muscles it increased in 8,17 and 19 hours. The content of glycogen in the liver and muscles depends not only on the chloropropamide action but also on the duration of the previous starvation.(Presented by Active Member Academy of Medical Sciences USSR V. V. Parin) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 52, No. 7, pp. 65–68, July, 1961     

Ultrasound finding of peripelvic urine extravasation in ureteropelvic junction obstruction

Pylosinus backflow is usually associated with acute obstruction and occurs as the result of increased hydrostatic pressure in the renal pelvis. Microruptures or tears occur at the calyceal fornix. The extravasating urine may then be absorbed by lymphatics, rupture into veins, or dissect in the renal sinus [1]. As extravasating urine extends from the peripelvic tissues into the perirenal space, it becomes easily visualized by ultrasound as a perirenal fluid collection. We describe the ultrasound finding of decreased peripelvic echogenicity in an infant with ureteropelvic junction obstruction and peripelvic urine extravasation. To our knowledge this finding on ultrasound has not been previously described. If not for the peripelvic decreased echogenicity, the resulting pelvic decompression may have otherwise mimicked a nonobstructed kidney.     

Construction of HLA／Peptide Tetramer with Peptide-Linked β2 Microglobulin

Ever since their first introduction in 1996 to the immunolo-gy community [1], the MHC class /peptide tetramershave become a useful tool to directly analyze MHC class-restricted, antigen-specific CTLs isolated from hostswith viral or malignant diseases. Th…     

靶向于胰岛素样生长因子受体的基因导入系统

目的：建立一种新的以细胞表面受体为靶向的基因导入系统。方法：根据胰岛素样生长因子Ⅰ号及Ⅱ号受体（IGFIR,IGFⅡR）在人原发性肝癌中过量表达,设计并合成了针对IGFIR及IGFⅡR的14肽E5,同时合成了流感病毒血凝素功能域20肽HA20作为内吞小体释放寡肽（Endosome releasing loigopeptide,EROP),将它们分别与多聚阳离子多肽（Polycatiomic polypeptide,PCP)－多聚赖氨酸（Polylysine,PL)共价连接,通过静电效应与DNA形成受体介导的靶向性非病毒性基因导入系统（E5－PCP,PCP－HA20）。结果：体内、外实验证实此基因导入系统能高效且 相对靶向地将外源基因导入人肝癌细胞并表达。应用此系统将细胞周期素依赖的蛋白激酶抑制物基因p15,p16,p21导入肝癌细胞,明显抑制肝癌细胞生长。体内将p21导入荷瘤裸鼠,显著抑制裸鼠皮下肿瘤的生长。结论：受体介导的非病毒型基因导入系统高效具有相对靶向性,有可能成为新的肝癌基因治疗途径。