Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events.
We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m(2) [0.33 to 1.08 mL/s]) to initial antihypertensive treatment with either: (1) a beta-blocker, metoprolol; (2) an angiotensin-converting enzyme inhibitor, ramipril; or (3) a dihydropyridine calcium channel blocker, amlodipine, and either a usual-blood pressure (BP) or low-BP treatment goal. Using a design powered to detect renal outcome differences, we compared the effect of treatment on the CV event rate (cardiac death, myocardial infarction, stroke, and heart failure) during a mean follow-up period of 4.1 years and determined baseline factors that predict CV outcomes.
Thirty-one patients died of CV disease (0.7%/patient-year), and 149 patients experienced at least 1 CV outcome (3.3%/patient-year). Overall, 202 CV events (4.5%/patient-year) occurred. The CV outcome rate was not related significantly to randomized interventions. In multivariable analyses, 7 baseline risk factors remained independently associated with increased risk for the CV composite outcome after controlling for age, sex, baseline GFR, and baseline proteinuria group: pulse pressure, duration of hypertension, abnormal electrocardiogram result, non-high-density lipoprotein cholesterol level, serum urea nitrogen level, urine protein-creatinine ratio, urine sodium-potassium ratio, and annual income less than 15,000 dollars.
Neither randomized class of antihypertensive therapy nor BP level had a significant effect on the occurrence of CV events, possibly because of limited power. However, this analysis identifies unique and potentially modifiable CV risk factors in this high-risk cohort.
"list of preferred and acceptable articles . Classification was not based on the conclusions of the author but rather on study Krajewski , Doloresco , Wrobel et al . 166 design . Preferred articles were large , randomized , double - blind studies , systematic reviews , or consensus statements of an organization that studies hypertension in blacks ( Norris et al . , 2006 ; Julius et al . , 2004 ; Bakris et al . , 2005 ; Wright Jr . et al . , 2002 ; Douglas et al . , 2003 ; Wright Jr . et al . , 2005 ; Brewster et al . , 2004 ) . Acceptable articles were not inferior to preferred articles in terms of content but study design was not as rigorous ( Papademetriou et al . , 2004 ; Fenves & Ram , 2002 ; Saund"
[Show abstract][Hide abstract] ABSTRACT: Background: Few studies have evaluated literature searching skills of pharmacy students and how these skills change as student’s progress through school.
Aims: Determine if there is a difference in literature searching and search results evaluation skills between first and third professional year students.
Methods: Rubrics to assess search strategy and article quality evaluated a drug information assignment given to both classes of students. Scores were compared.
Results: A statistically significant difference in results evaluation skills (p=0.001) and no difference in quality of search skills (p=0.8) was found between first and third year students. Third year students scored higher in search evaluation.
Conclusion: With no difference in quality of literature searches between the two groups, and the superior performance of third year students in selection of appropriate results, improved clinical knowledge may be sufficient to overcome a suboptimal search strategy. Speed and efficiency may be the benefits of an improved search strategy and need further study.
"Randomized controlled trials of antihypertensive treatment provide strong evidence for J-shaped relationships between both DBP and SBP and main outcomes (all-cause mortality, CV mortality, nonfatal and fatal MI, HF, stroke) in the general population of hypertensive patients, as well as in high-risk populations, including patients with CAD, DM and LVH, as well as elderly subjects. Data are also available on a possible J-curve phenomenon in patients with chronic kidney disease (CKD) [47, 48, 68–71] (Table 1) and after stroke/TIA (as a result of secondary prevention therapy) [72, 73, 74•]. "
[Show abstract][Hide abstract] ABSTRACT: The blood pressure (BP) J-curve debate started in 1979, and we still cannot definitively answer all the questions. However, available studies of antihypertensive treatment provide strong evidence for J-shaped relationships between both diastolic and systolic BP and main outcomes in the general population of hypertensive patients, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and elderly patients. However, further studies are still necessary in order to clarify this issue. This is connected to the fact that most available studies were observational, and randomized trials did not have or lost their statistical power and were inconclusive. Perhaps only the Systolic Blood Pressure Intervention Trial (SPRINT) and Optimal Blood Pressure and Cholesterol Targets for Preventing Recurrent Stroke in Hypertensives (ESH-CHL-SHOT) will be able to finally answer all the questions. According to the current state of knowledge, it seems reasonable to suggest lowering BP to values within the 130-139/80-85 mmHg range, possibly close to the lower values in this range, in all hypertensive patients and to be very careful with further BP level reductions, especially in high-risk hypertensive patients.
Current Hypertension Reports 10/2012; 14(6). DOI:10.1007/s11906-012-0314-3 · 3.44 Impact Factor
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