The relationship between blood pressure and left ventricular mass in essential hypertension is observed only in the presence of the angiotensin-converting enzyme gene deletion allele

An insertion/deletion polymorphism in the angiotensin-convertingenzyme (ACE) gene accounts for approximately 50% of the variancein plasma ACE concentration: deletion homozygotes (DD) havethe highest, and insertion homozygotes (II) the lowest ACE concentrations.ACE is responsible for the generation of angiotensin II, whichis implicated in the development of left ventricular hypertrophy,an independent risk factor for morbidity and mortality in hypertension.The aim of this study was to investigate the contribution ofACE genotype to the development of left ventricular hypertrophyin patients with essential hypertension. Eighty-five patientswith essential hypertension underwent echocardiographic assessmentof left ventricular mass index (LVMI) and determination of ACEgenotype from leukocyte DNA by polymerase chain reaction. Therewas no significant difference in LVMI among the genotypes (II,ID, DD). Analysis of covariance modelled for LVMI showed a significantinteraction with systolic blood pressure (p = 0.036). but notdiastolic blood pressure (p = 0.453). The relationship betweenLVMI and systolic blood pressure was strongest in the deletionhomozygotes (p = 0.002, R² = 0.47), and also present in theheterozygotes (p = 0.013, R² = 0.40). No relationship was seenin the insertion homozygotes (p = 0.914, R² = 0.23) These findingssuggest that the effect of blood pressure on LVMI in essentialhypertension is expressed only in the presence of the ACE genedeletion allele.     

A randomized controlled trial of electromagnetic therapy in the primary care management of venous leg ulceration

OBJECTIVE: The aim was to establish the potential efficacy, tolerabilityand side-effect profile of electromagnetic therapy as an adjunctto conventional dressings in the treatment of venous leg ulcers. METHOD: A prospective, randomized, double blind controlled clinicaltrial was carried out in a dedicated leg ulcer clinic basedin one urban general practice. Nineteen patients with leg ulcersof confirmed venous aetiology were assessed. The main outcomemeasures were rate and scale of venous leg ulcer healing, changesin patient-reported pain levels, quality of life, degree ofmobility, side effect profile and acceptability to patientsand staff. RESULTS: Sixty-eight per cent of patients attending this dedicated clinicachieved improvements in the size of their ulcer (4, 21%, healedfully) and in reduced pain levels (P < 0.05) during the trial,despite the chronicity of ulcer histories. Patients treatedwith electromagnetic therapy at 800 Hz were found at day 50to have significantly greater healing (P < 0.05) and paincontrol (P < 0.05) than placebo therapy or treatment with600 Hz. All patients reported improved mobility at the end ofthe study. The electromagnetic therapy was well tolerated bypatients, with no differences between groups in reporting adverseevents, and proved acceptable to staff. CONCLUSION: Despite the small numbers in this pilot study, electromagnetictherapy provided significant gains in the healing of venousleg ulcers and reduction in pain. Keywords. Electromagnetic therapy, RCT, leg ulcers, primary care.