N 1993 AND AGAIN IN 1997, THE Joint National Committee on the Detection, Evaluation, and Treatment of High Blood Pressure recommended low-dose diuretics and -blockers as first-line treatment for patients with uncomplicated hypertension. 1,2 This recommendation reflected the wealth of clinical trial evidence about the health benefits associated with lowdose diuretics and -blockers. [3][4][5][6][7][8] The early trials of diuretics and -blockers had generally randomized patients with high blood pressure to active therapy or to placebo. Early answers were clearest for patients with the highest level of blood pressure. 4,5 These studies answered the question of whether several specific antihypertensive treatments improved health outcomes.Clear evidence of health benefits associated with diuretics and -blockers precluded further long-term placebocontrolled trials. Thus, the recent large long-term trials have evaluated one active treatment against another active treatment in terms of their ability to prevent cardiovascular events. [9][10][11][12][13][14][15] In these Author Affiliations and Financial Disclosures are listed at the end of this article.
Even moderate changes in prepregnancy weight can apparently affect the risk of gestational diabetes among obese women. This may offer further motivation for interventions aimed at reducing obesity among women of reproductive age.
Congestive heart failure (CHF) definitions vary across epidemiologic studies. The Framingham Heart Study criteria include CHF signs and symptoms assessed by a physician panel. In the Cardiovascular Health Study, a committee of physicians adjudicated CHF diagnoses, confirmed by signs, symptoms, clinical tests, and/or medical therapy. The authors used data from the Cardiovascular Health Study, a population-based cohort study of 5,888 elderly US adults, to compare CHF incidence and survival patterns following onset of CHF as defined by Framingham and/or Cardiovascular Health Study criteria. They constructed an inception cohort of nonfatal, hospitalized CHF patients. Of 875 participants who had qualifying CHF hospitalizations between 1989 and 2000, 54% experienced a first CHF event that fulfilled both sets of diagnostic criteria (concordant), 31% fulfilled only the Framingham criteria (Framingham only), and 15% fulfilled only the Cardiovascular Health Study criteria (Cardiovascular Health Study only). No significant survival difference was found between the Framingham-only group (hazard ratio = 0.87, 95% confidence interval: 0.71, 1.07) or the Cardiovascular Health Study-only group (hazard ratio = 0.89, 95% confidence interval: 0.68, 1.15) and the concordant group (referent). Compared with Cardiovascular Health Study central adjudication, Framingham criteria for CHF identified a larger group of participants with incident CHF, but all-cause mortality rates were similar across these diagnostic classifications.
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