Abstract-The detection of left ventricular (LV) hypertrophy on echocardiography is a powerful risk indicator in essential hypertension. However, the prognostic impact of LV mass values within the "normal" range and the shape of the relation between LV mass and prognosis remain unclear. Thus, 1925 white subjects with uncomplicated essential hypertension underwent off-therapy 24-hour blood pressure monitoring and M-mode echocardiography. During 4.0Ϯ2 years of follow-up, there were 181 major cardiovascular events (2.4/100 patient-years) and 49 deaths from all causes. In the 5 gender-specific quintiles of LV mass distribution (partition values: 92, 105, 120, and 138 g/m 2 in men and 79, 91, 102, and 116 g/m 2 in women), cardiovascular event rates were 0.8, 1.7, 2.2, 2.9, and 4.3 per 100 patient-years. After adjustment for several risk factors, including 24-hour ambulatory blood pressure, the relative risk (RR) of developing a cardiovascular event increased progressively from the first quintile (RR 1) to the second (RR 1.6, 95% CI 0.8 to 3.1), third (RR 1.9, 95% CI 1.01 to 4.0), fourth (RR 3.0, 95% CI 1.5 to 5.8), and fifth (RR 3.5, 95% CI 1.8 to 6.8) quintile. For all-cause death, the RR in the fifth quintile compared with the first quintile was 4.3 (95% CI 1.2 to 13.4). In conclusion, the powerful relation between LV mass and risk of cardiovascular disease in subjects with uncomplicated essential hypertension is continuous over a wide range of LV mass values, even below the current "upper normal" limits. The relation remains significant after control for traditional risk factors, including ambulatory blood pressure. Key Words: echocardiography Ⅲ hypertension, arterial Ⅲ hypertension, essential Ⅲ hypertrophy Ⅲ morbidity Ⅲ mortality L eft ventricular (LV) hypertrophy detected on echocardiography is a powerful and independent predictor of cardiovascular complications and death in subjects with uncomplicated essential hypertension. 1-3 Furthermore, regression of LV hypertrophy appears to be a favorable prognostic marker independent of the treatment-induced reduction in blood pressure (BP). 4,5 LV mass shows a continuous distribution in the general population, 6 whereas LV hypertrophy is an operational category that defines the upper end of LV mass distribution. 1-3 LV hypertrophy on echocardiography is generally found in 20% to 30% of relatively unselected subjects with mild-tomoderate hypertension, 7,8 and its prevalence varies according to the selected cutoff value. 9 The Framingham Heart Study showed an apparently continuous relation between LV mass and cardiovascular event rate in the general population. 10 However, the important clinical issues regarding the shape of the relation between LV mass and cardiovascular risk in essential hypertension and the prognostic impact of LV mass values below the commonly agreed-on upper normal limits have not been addressed. The present study was specifically designed to establish the link between LV mass and cardiovascular risk in subjects with essential hypertension over a wid...

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Gout/allopurinol intake has a high prevalence in elderly patients acutely admitted to hospital and are associated with renal and cardiovascular diseases, an increased rate of adverse events and a high degree of drug consumption. In contrast, this finding did not affect the length of hospitalization nor hospital mortality.

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