Houston. We suggest that the elevated flash densities could result from several factors, including, 1) the convergence due to the urban heat island effect, and 2) the increasing levels of air pollution from anthropogenic sources producing numerous small droplets and thereby suppressing mean droplet size.The latter effect would enable more cloud water to reach the mixed phase region where it is involved in the formation of precipitation and the separation of electric charge, leading to an enhancement of lightning.

This article represents the recommendations for the management of spontaneous intracerebral haemorrhage of the European Stroke Initiative (EUSI). These recommendations are endorsed by the 3 European societies which are represented in the EUSI: the European Stroke Council, the European Neurological Society and the European Federation of Neurological Societies.

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Abstract-The Canadian Hypertension Education Program, an extensive professional education program to improve the management of hypertension, was started in 1999. There were very large increases in diagnosis and treatment of hypertension in the first 4 years after initiation of the program. The purpose of this study was to examine the association between the changes in antihypertensive therapy with changes in hospitalization and death from major hypertensionrelated cardiovascular diseases in Canada between 1992 and 2003. Using various national databases, Canadian standardized yearly mortality and hospitalization rates per 1000 for stroke, heart failure, and acute myocardial infarction were calculated for individuals aged Ն20 years and regressed against antihypertensive prescription rates. Changes in rates were examined in a time series analysis. There were significant reductions (PϽ0.0001) in the rate of death from stroke, heart failure, and myocardial infarction starting in 1999. There was also a reduction in hospitalization rate from stroke (PϽ0.0001) and heart failure (PϽ0.0001) but not myocardial infarction in 1999. The changes in death (PϽ0.001 for all 3 diseases) and hospitalization (PϽ0.0001 for stroke and heart failure; Pϭ0.018 for acute myocardial infarction) were associated with the increases in antihypertensive prescriptions. This study demonstrates that the reduction in cardiovascular death and hospitalization rates is associated with an increase in antihypertensive prescriptions and that it coincides with the introduction of the Canadian Hypertension Education Program. The Canadian Hypertension Education Program educational model for improving health care could be adopted by other countries with well-developed professional and scientific societies. Key Words: hypertension Ⅲ antihypertensive treatment Ⅲ stroke Ⅲ myocardial infarction Ⅲ heart failure Ⅲ epidemiology Ⅲ clinical practice guideline I ncreased blood pressure is the leading risk for death in the world. 1 Large randomized, controlled trials and meta-analyses have demonstrated that the treatment of hypertension results in significant reductions in mortality and disability from cardiovascular disease. 2,3 Hence, the World Health Organization has advised countries to improve the management of hypertension as a mechanism to improve population health. 1 However, despite robust randomized trial evidence confirming the benefits of lowering blood pressure with antihypertensive agents, the expected benefits of antihypertensive treatment in reducing cardiovascular events have not been seen in several observational studies of usual clinical practice. 4 -7 Recently, population changes in antihypertensive therapy were found not to be associated with the expected changes in blood pressure. 8 There are few national programs to use as models for successfully improving hypertension management. 9 -11 In Canada, a program to improve the management of hypertension (the Canadian Hypertension Education Program [CHEP]) was started in 1999. [12][13][14] The CHEP w...