Medtronic.

The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; =1330) or<140 mm Hg (standard group; =1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD ( values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (-0.47 versus -0.32 ml/min per 1.73 m per year; <0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.

Background-Exercise capacity is inversely related to mortality risk in healthy individuals and those with cardiovascular diseases. This evidence is based largely on white populations, with little information available for blacks. Methods and Results-We assessed the association between exercise capacity and mortality in black (nϭ6749; age, 58Ϯ11 years) and white (nϭ8911; age, 60Ϯ11 years) male veterans with and without cardiovascular disease who successfully completed a treadmill exercise test at the Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, Calif. Fitness categories were based on peak metabolic equivalents (METs) achieved. Subjects were followed up for all-cause mortality for 7.5Ϯ5.3 years. Among clinical and exercise test variables, exercise capacity was the strongest predictor of risk for mortality. The adjusted risk was reduced by 13% for every 1-MET increase in exercise capacity (hazard ratio, 0.87; 95% confidence interval, 0.86 to 0.88; PϽ0.001). Compared with those who achieved Ͻ5 METs, the mortality risk was Ϸ50% lower for those with an exercise capacity of 7.1 to 10 METs (hazard ratio, 0.51; 95% confidence interval, 0.47 to 0.56; PϽ0.001) and 70% lower for those achieving Ͼ10 METs (hazard ratio, 0.31; 95% confidence interval, 0.26 to 0.36; PϽ0.001). The findings were similar for those with and without cardiovascular disease and for both races. Conclusions-Exercise capacity is a strong predictor of all-cause mortality in blacks and whites. The relationship was inverse and graded, with a similar impact on mortality outcomes for both blacks and whites. (Circulation. 2008;117: 614-622.)

Abstract-Left ventricular (LV) hypertrophy and concentric remodeling have been defined by using a variety of indexation methods and partition values (PVs) for LV mass and relative wall thickness (RWT). The effects of these methods on the distribution of LV geometric patterns in hypertensive subjects remain unclear. RWT was calculated by either 2ϫend-diastolic posterior wall thickness (PWT)/enddiastolic LV internal dimension (LVID) or end-diastolic interventricular septum dimensionϩend-diastolic PWT/enddiastolic LVID. LV hypertrophy or remodeling was present in 63% to 86% of subjects, and LV hypertrophy was present in 42% to 77%. By any index, eccentric hypertrophy was the common LV geometric pattern. Use of interventricular septum dimensionϩPWT/LVID to calculate RWT slightly increased the prevalence of normal geometry and eccentric hypertrophy compared with the use of 2ϫPWT/LVID. Subjects with LV hypertrophy identified by only LV mass/height 2.7 PV 49.2/46.7 were more obese, whereas those identified by only LV mass/body surface area PV 116/104 were taller and thinner than those in the 2 concordant groups with or without LV hypertrophy by both criteria. By either criterion, there were no significant differences between different LV geometric patterns in clinical cardiovascular disease. Hypertensive patients with LV hypertrophy by ECG have a high prevalence of geometric abnormalities, especially eccentric hypertrophy, irrespective of method of indexation or PV. LV mass indexation by body surface area or height 2.7 identifies lean and obese subjects, respectively. We found no difference in prevalent cardiovascular disease in subjects identified by either criterion, suggesting a similar high risk. (Hypertension. 2000;35:6-12.) Key Words: echocardiography Ⅲ electrocardiography Ⅲ hypertrophy, left ventricular Ⅲ hypertension, essential L eft ventricular (LV) hypertrophy, as determined by echocardiography, has been shown to be a strong predictor of adverse prognosis independent of and, in most instances, stronger than conventional risk factors. 1-3 On the basis of distributions of indexed echocardiographic LV mass in normal populations, LV hypertrophy has been identified by calculation of LV mass that has been indexed for body surface area (BSA) 1,4 -6 or for BSA 1.5 , 7 height, height 2.0 , 8 height 2.13 , 9 height 2.7 , 7,9,10 or height 3.0 . 11 The combination of LV mass index (LVMI) and relative wall thickness (RWT) has been used to identify 3 different abnormal LV geometric patterns. 2,12 RWT has been calculated either as the ratio of 2ϫposterior wall thickness/LV internal diameter 13 or as the ratio of (interventricular septalϩposterior wall thickness)/LV internal diameter. 14 The relation between LVMI and RWT seems important in view of the fact that several studies have shown that stratification by different geometric patterns gives valuable information concerning morbidity and mortality. In these studies, subjects with concentric hypertrophy (ie, increased RWT and LVMI) had the highest incidence of cardiovascula...