2This study was performed to investigate whether intensive antihypertensive treatment with achieved blood pressure (BP) 140/90 mm Hg, as compared with standard treatment with achieved BP 150/90 mm Hg, could further improve cardiovascular outcomes in Chinese hypertensive patients older than 70 years. A total of 724 participants were randomly assigned to intensive or standard antihypertensive treatment. After a mean follow-up of 4 years, the mean achieved BP was 135.7/76.2 mm Hg in the intensive treatment group and 149.7/82.1 mm Hg in the standard treatment group. The visit-to-visit variability in systolic BP and diastolic BP was lower in the intensive group than that in the standard group. Intensive antihypertensive treatment, compared with the standard treatment, decreased total and cardiovascular mortality by 41.7% and 50.3%, respectively, and reduced fatal/nonfatal stroke by 42.0% and heart failure death by 62.7%. Cox regression analysis indicated that the mean systolic BP (P=.020; 95% confidence interval, 1.006-1.069) and the standard deviation of systolic BP (P=.033; 95% confidence interval, 1.006-1.151) were risk factors for cardiovascular endpoint events. Intensive antihypertensive treatment with achieved 136/76 mm Hg was beneficial for Chinese hypertensive patients older than 70 years. Longterm visit-to-visit variability in systolic BP was positively associated with the incidence of cardiovascular events. J Clin Hypertens (Greenwich). 2013;15:420-427. ª2013 Wiley Periodicals, Inc.Hypertension is one of the most common diseases associated with the elderly. It is a significant risk factor for senile congestive heart failure, stroke, coronary heart disease, renal failure, and aortic aneurysm and has become an important public-health challenge worldwide.1 The risks associated with hypertension are greater in older than in younger patients, and antihypertensive treatment is reported to be actually more cost-effective for the elderly.2 The results of the study for the Hypertension in the Very Elderly Trial (HYVET) suggest that antihypertensive treatment with the achieved blood pressure (BP) of 143.5/77.9 mm Hg was beneficial in hypertensive patients older than 80 years, associated with a 30% reduction in the rate of fatal or nonfatal stroke, a 39% reduction in the rate of death from stroke, a 21% reduction in the rate of death from any cause, a 23% reduction in the rate of death from cardiovascular causes, and a 64% reduction in the rate of heart failure, compared with the placebo group with the achieved BP of 158.5/84.0 mm Hg.3 Thus, BP reduction in preventing stroke and other cardiovascular events for elderly hypertensive patients has evoked great focus in the past decade. Although many guidelines for the management of hypertension proposed the goal of systolic BP (SBP) as <150 mm Hg for the elderly, 4,5 it is unclear whether further reduction is still beneficial. In addition, although it has been suggested that BP variability derived from 24-hour ambulatory monitoring may be an independent risk factor for ...

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BackgroundLidocaine is widely used as a general and local anesthetic in minor or major surgeries. The objective of the study was to compare postoperative pain relief and adverse events using different forms of lidocaine administration in patients following closed nasal bone reduction surgery.Material/MethodsA total of 381 patients with a solitary nasal fracture that could be managed with closed reduction were included in this study and divided into 3 groups of 127 patients in each group. Patients had received 1% lidocaine HCl with epinephrine (LL group), inserted a mesh impregnated with lidocaine spray (TL group), or 1 mg/kg/h lidocaine infusion (GL group) before surgeries. Patients also received morphine when the pain was not controlled. The postoperative pain was assessed at 6 hours and 48 hours after surgery. Postoperative vomiting and nausea were evaluated. Repeated ANOVA/Tukey-Kramer multiple comparisons test was performed at 95% confidence level.ResultsAt 6 hours after surgery, patients in the general lidocaine (GL) group reported decreased postoperative pain compared with those in the topical lidocaine (TL) group (P<0.001, q=6.633) and LL group (P<0.001, q=8.056). The morphine consumption within 48 hours was least in GL group than TL group (P<0.001, q=172.9) and LL group (P<0.001, q=226.42). Lidocaine infusion caused nausea (P<0.001, q=6.742) and vomiting (P<0.001, q=4.306).ConclusionsTopical lidocaine anesthesia had the same postoperative pain relief and the least adverse events as local and general lidocaine anesthesia.