SSE may provide a useful and inexpensive screening method to reduce the incidence of melanoma. SSE may also reduce the development of advanced disease. The results of this study need to be replicated before strategies to increase the practice of SSE are further developed and promoted.
A mbulatory blood pressure (BP) monitoring (ABPM) has been increasingly used in clinical management of hypertension. 1,2 It has been consistently demonstrated that ambulatory 24-hour BPs are better cardiovascular risk predictors than office BPs 2,3 and that average nighttime sleep BPs are generally better predictors of adverse cardiovascular outcomes than average daytime awake BP levels on ABPM.2,4,5 There is a normal circadian BP variability, with higher levels during daytime and a 10% to 20% BP fall during sleep.2 In 1988, O'Brien et al 6 reported for the first time that hypertensives with a blunted nocturnal BP fall had a greater prevalence of strokes and named these patients nondippers, in contrast to the normal dippers. Since then, several prospective studies reported on the prognostic value of the nocturnal BP fall both in hypertensives 7-18 and in population-based samples. [19][20][21] However, these results were not consistent possibly because of differences in methodology, study populations, sample sizes, and end points. In particular, many previous studies either did not adjust the Abstract-The prognostic importance of the nocturnal systolic blood pressure (SBP) fall, adjusted for average 24-hour SBP levels, is unclear. The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) examined this issue in a meta-analysis of 17 312 hypertensives from 3 continents. Risks were computed for the systolic night-today ratio and for different dipping patterns (extreme, reduced, and reverse dippers) relative to normal dippers. ABC-H investigators provided multivariate adjusted hazard ratios (HRs), with and without adjustment for 24-hour SBP, for total cardiovascular events (CVEs), coronary events, strokes, cardiovascular mortality, and total mortality. Average 24-hour SBP varied from 131 to 140 mm Hg and systolic night-to-day ratio from 0.88 to 0.93. There were 1769 total CVEs, 916 coronary events, 698 strokes, 450 cardiovascular deaths, and 903 total deaths. After adjustment for 24-hour SBP, the systolic night-to-day ratio predicted all outcomes: from a 1-SD increase, summary HRs were 1.12 to 1.23.Reverse dipping also predicted all end points: HRs were 1.57 to 1.89. Reduced dippers, relative to normal dippers, had a significant 27% higher risk for total CVEs. Risks for extreme dippers were significantly influenced by antihypertensive treatment (P<0.001): untreated patients had increased risk of total CVEs (HR, 1.92), whereas treated patients had borderline lower risk (HR, 0.72) than normal dippers. For CVEs, heterogeneity was low for systolic night-to-day ratio and reverse/reduced dipping and moderate for extreme dippers. Quality of included studies was moderate to high, and publication bias was undetectable. In conclusion, in this largest meta-analysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels.
Glutathione transferase are divided into three classes: Alpha, Mu and Pi. Isoenzyme(s) from one of these classes, class Mu, is dominantly inherited and can be determined by activity measurements directed towards the substrate trans-stilbene oxide. The frequency of this phenotype has been measured in patients with bronchial carcinoma and in control subjects matched for age and smoking history. After combining an earlier study from our laboratory (Carcinogenesis, 7, 751-753, 1986) with the additional material presented here (control smokers, n = 114, lung cancers, n = 125) non-cancer smokers had an increased number of subjects who expressed class Mu isoenzymes (58.3% of total n = 192) compared with lung cancer patients (36.6% of total n = 191; P less than 0.0001). The pathology of lung tumors related to the lack of class Mu isoenzymes which occurred most frequently in patients with adenocarcinomas. It is concluded that the gene expressing class Mu isoenzymes may be a host determinant of genetic susceptibility to lung cancer among smokers.
This review and update focuses on the clinical features of hydrochlorothiazide (HCTZ), the thiazide-like agents chlorthalidone (CTDN) and indapamide (INDAP), potassium-sparing ENaC inhibitors and aldosterone receptor antagonists, and loop diuretics. Diuretics are the second most commonly prescribed class of antihypertensive medication, and thiazide-related diuretics have increased at a rate greater than that of antihypertensive medications as a whole. The latest hypertension guidelines have underscored the importance of diuretics for all patients, but particularly for those with salt-sensitive and resistant hypertension. HCTZ is 4.2-6.2 systolic mm Hg less potent than CTDN, angiotensin-converting enzyme inhibitors, beta blockers, and calcium channel blockers by 24-hour measurements and 5.1mm Hg systolic less potent than INDAP by office measurements. For reducing cardiovascular events (CVEs), HCTZ is less effective than enalapril and amlodipine in randomized trials, and, in network analysis of trials, it is less effective than CTDN and HCTZ-amiloride. Combined with thiazide-type diuretics, potassium-sparing agents decrease ventricular ectopy and reduce the risk for sudden cardiac death relative to thiazide-type diuretics used alone. A recent synthesis of 44 trials has shown that the relative potencies in milligrams among spironolactone (SPIR), amiloride, and eplerenone (EPLER) are approximately from 25 to 10 to 100, respectively, which may be important when SPIR is poorly tolerated. SPIR reduces proteinuria beyond that provided by other renin angiotensin aldosterone inhibitors. EPLER also reduces proteinuria and has beneficial effects on endothelial function. While guidelines often do not differentiate among specific diuretics, this review demonstrates that these distinctions are important for managing hypertension.
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