Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics

Blood Press. 2000;9(2-3):146-51. Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics. Hansson L, Lithell H, Skoog I, Baro F, Bánki CM, Breteler M, Castaigne A, Correia M, Degaute JP, Elmfeldt D, Engedal K, Farsang C, Ferro J, Hachinski V, Hofman A, James OF, Krisin E, Leeman M, de Leeuw PW, Leys D, Lobo A, Nordby G, Olofsson B, Opolski G, Prince M, Reischies FM. University of Uppsala, Department of Public Health, Clinical Hypertension Research, Sweden. Abstract The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multi-centre, prospective, randomized, double-blind, parallel-group study. The primary objective of SCOPE is to assess the effect of the angiotensin II type 1 (AT1) receptor blocker, candesartan cilexetil 8-16 mg once daily, on major cardiovascular events in elderly patients (70-89 years of age) with mild hypertension (DBP 90-99 and/or SBP 160-179 mmHg). The secondary objectives of the study are to test the hypothesis that antihypertensive therapy can prevent cognitive decline (as measured by the Mini Mental State Examination, MMSE) and dementia, and to assess the effect of therapy on total mortality, myocardial infarction (MI), stroke, renal function, and hospitalization. A total of 4964 patients from 15 participating countries were recruited during the randomization phase of SCOPE, exceeding the target population of 4000. The mean age of the patients at enrolment was 76 years, the ratio of male to female patients was approximately 1:2, and 52% of patients were already being treated with an antihypertensive agent at enrolment. The majority of patients (88%) were educated to at least primary school level. At randomization, mean sitting blood pressure values were SBP 166 mmHg and DBP 90 mmHg, and the mean MMSE score was 28. Previous cardiovascular disease in the study population included myocardial infarction (4%), stroke (4%) and atrial fibrillation (4%). Men, more often than women, had a history of previous MI, stroke and atrial fibrillation. A greater percentage of men were smokers (13% vs 6% in women) and had attended university (11% vs 3% of women). Of the randomized patients, 21% were 80 years of age. In this age group smoking was less common (4% vs 10% for 70-79-year-olds) and fewer had attended university (4% vs 7% for 70-79-year-olds). The incidence of MI was similar in both age groups. However, stroke and atrial fibrillation had occurred approximately twice as frequently in the older patients. The patients' mean age at baseline was similar in the participating countries, and most countries showed the approximate 1:2 ratio for male to female patients. There was also little inter-country variation in terms of mean SBP, DBP or MMSE score. However, there was considerable regional variation in the percentage of patients on therapy prior to enrolment. PMID: 10855739 [PubMed - indexed for MEDLINE

Study on COgnition and Prognosis in the Elderly (SCOPE)

Blood Press. 1999;8(3):177-83. Study on COgnition and Prognosis in the Elderly (SCOPE). Hansson L, Lithell H, Skoog I, Baro F, Bánki CM, Breteler M, Carbonin PU, Castaigne A, Correia M, Degaute JP, Elmfeldt D, Engedal K, Farsang C, Ferro J, Hachinski V, Hofman A, James OF, Krisin E, Leeman M, de Leeuw PW, Leys D, Lobo A, Nordby G, Olofsson B, Zanchetti A, et al. University of Uppsala, Department of Public Health, Sweden. Abstract The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multicentre, prospective, randomized, double-blind, parallel-group study designed to compare the effects of candesartan cilexetil and placebo in elderly patients with mild hypertension. The primary objective of the study is to assess the effect of candesartan cilexetil on major cardiovascular events. The secondary objectives of the study are to assess the effect of candesartan cilexetil on cognitive function and on total mortality, cardiovascular mortality, myocardial infarction, stroke, renal function, hospitalization, quality of life and health economics. Male and female patients aged between 70 and 89 years, with a sitting systolic blood pressure (SBP) of 160-179 mmHg and/or diastolic blood pressure (DBP) of 90-99 mmHg, and a Mini-Mental State Examination (MMSE) score of 24 or above, are eligible for the study. The overall target study population is 4000 patients, at least 1000 of whom are also to be assessed for quality of life and health economics data. After an open run-in period lasting 1-3 months, during which patients are assessed for eligibility and those who are already on antihypertensive therapy at enrolment are switched to hydrochlorothiazide 12.5 mg o.d., patients are randomized to receive either candesartan cilexetil 8 mg once daily (o.d.) or matching placebo o.d. At subsequent study visits, if SBP remains >160 mmHg, or has decreased by 85 mmHg, study treatment is doubled to candesartan cilexetil 16 mg o.d. or two placebo tablets o.d. Recruitment was completed in January 1999. At that time 4964 patients had been randomized. All randomized patients will be followed for an additional 2 years. If the event rate is lower than anticipated, the follow-up will be prolonged. PMID: 10595696 [PubMed - indexed for MEDLINE

ETUDE ANATOMO CLINIQUE D'UN CAS MORTEL D'HISTOPLASMOSE GENERALISEE

A young Zairian patient (25 yr) died from a suspected tuberculous meningitis. This diagnosis was supported by the presence of acid fast bacilli in the sputum and the gastric liquid. At autopsy, performed to discover the primary tuberculous focus, no bacillar lesion was found. Histopathologic examinations disclosed a widespread histoplasmic infestation (Histoplasma Duboisii); there were foci in the brain and heart and massive necrotizing lesions were found in the lymph nodes and testes. There were small foci of infection in the lungs, while the hepatosplenomegaly appeared to be caused by hemosiderosis.SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Differential characteristics of neural circulatory control : early versus late after cardiac transplantation

BACKGROUND: Reappearance of low-frequency (LF) (+/-0.10 Hz) oscillations in RR interval (RR) after cardiac transplantation is indicative of sympathetic efferent reinnervation. We hypothesized that restored LF oscillations in RR in heart transplant recipients (HTRs) are linked to oscillations in muscle sympathetic nerve traffic (MSNA). METHODS AND RESULTS: RR, RR variability, and MSNA were recorded 5+/-2 months (n=7, short-term HTRs) and 138+/-8 months (n=7, long-term HTRs) after heart transplantation and compared with matched hypertensive patients (n=7). A coherence function determined the coupling between LF oscillations in MSNA and RR. RR variance did not differ between short-term and long-term HTRs. However, LF variability was only 1+/-0.5 ms(2) in the short-term HTRs but was 15+/-8 ms(2) in the long-term HTRs (P<0.05). Normalized LF variability was also higher in the long-term HTRs (40+/-14 normalized unites) versus the short-term HTRs (6+/-3 normalized united, P<0.05) but did not differ from the LF variability of the hypertensive patients. Long-term HTRs were taking less cyclosporine (P<0.01) but had higher MSNA than the short-term HTRs (62+/-7 versus 31+/-7 burst/min, respectively, P<0.05). Coherence between LF oscillations in MSNA and RR was similar in the long-term HTRs (0.59+/-0.11) and the hypertensive patients (0.60+/-0.07) and was 3-fold greater than in the short-term HTRs (0.20+/-0.06, P<0.05). CONCLUSIONS: Cardiac reinnervation after long-term heart transplantation is characterized by a restoration of the coherence between LF oscillations in RR and MSNA. Higher MSNA in long-term than in short-term HTRs suggests that time elapsed after cardiac transplantation may be a major determinant of sympathetic excitation in heart transplant recipients

Effet de l’interaction entre consommation d’alcool et surpoids sur la pression arterielle des adolescents Congolais. Résultats de l’étude vitaraa

Objectif: Evaluer l’interaction de la consommation d’alcool avec le surpoids sur la pression artérielle des adolescents Congolais en milieu urbain.Méthodes: Les habitudes de vie (questionnaire), la pression artérielle (Tensiomètre Omron M6, HEM 7001E) et l’indice de masse corporelle ont été obtenus chez 532 adolescents (268 filles; 50,4%) âgés de 10 à 19 ans résidant au Quartier Adoula (Bandalungwa, Kinshasa, RDC) dans le cadre de l’étude VITARAA. Le surpoids selon le genre et l’âge était dérivé des tables internationales. Nous avons évalué l’influence de la consommation d’alcool et du surpoids sur le niveau de la pression artérielle au moyen de la procédure General linear model (GLM) avec l’âge des participants comme co-variable, Nous avons recherché les déterminants de la pression artérielle dans une régression linéaire multiple pas à pas.Résultats: La pression artérielle était de 110±13/69±11mmHg et augmentait en fonction de l’âge, Le surpoids/obésité (13,2%) prédominait parmi les filles (18,7% vs 8,1%). La consommation d’alcool était rapportée par 23.1% des adolescents (21,5% des filles vs 24,7% des garçons (p=0,496). Les adolescents consommateurs d’alcool étaient plus âgés que les abstinents (15,9 ± 2,7 vs 14,5 ± 2,0 ans; P&lt;0,0001). Leur proportion était similaire parmi les participants en surpoids (22,2%) et ceux avec poids normal (23,4%). La pression systolique (113,5 [111,0 - 115,9] vs 109,3[108,0 - 110,7]mmHg; P=0,004) et diastolique (70,1 [67,9-72,2] vs 68,7[67,5-69,9]mmHg; P=0,271) ajustée pour l’âge était plus élevée chez les consommateurs d’alcool pour l’ensemble des adolescents et pour les filles et les garçons considérés séparément. La systolique (115,3 ± 15,4 vs 110,0 ± 12,7 mmHg; P=0,007) et la diastolique (72,6 ± 10,2 vs 68,9 ± 11,1 mmHg; P=0,028) étaient aussi plus élevées chez les adolescents en surpoids. Par comparaison aux sujets abstinents, la pression systolique était de 3,7 [0,8 – 6,5] mmHg (P=0,013) et de 2,45 [-5,46 – 11,37 mmHg ; (P=0,320) plus élevée chez les consommateurs d’alcool, respectivement en absence et en présence du surpoids. La pression diastolique ne présentait aucune différence significative.Conclusion: Le surpoids et la consommation d’alcool sont associés à une pression artérielle plus élevée chez les adolescents mais l’effet de l’alcool est plus marqué en absence qu’en présence du surpoids. Ces résultats suggèrent que la prévention de la maladie cardiovasculaire chez l’Africain implique des stratégies visant la surcharge pondérale et la consommation d’alcool déjà chez les jeunes.Mots clés: Consommation d’alcool, surpoids, pression artérielle, adolescents CongolaisEnglish Title: Effect of interaction between alcohol consumption and overweight on arterial pressure of Congolese adolescents. Results of the vitaraa studyEnglish AbstractAims: to evaluate the interaction between alcohol consumption and overweight on Congolese youths’ blood pressure.Methods: lifestyle habits (by questionnaire), blood pressure (by Omron M6, HEM 7001E), body mass index and lipids were obtained in 532 youths (268 girls; 50.4%) aged 10 to 19 years from Adoula Quarter, (Kinshasa, DRC) in the framework of the VITARAA study. Overweight according to age and sex was derived from international tables. We assessed the impact of alcohol and overweight on blood pressure using a generalized linear model procedure with age as a covariate. Determinants of BP were obtained by stepwise linear regression analysis.Results: BP averaged 110±13/69±11mmHg and increased with age. Overweight/obesity (13.2%) predominated among girls (18,7% vs 8.1%). Alcohol consumption was reported by 23.1% of youths (21.5% of girls and 24.7% of boys, p=0,496). Youths drinking alcohol were older than the abstinents (15.9 ± 2.7 vs 14.5 ± 2.0 years; P&lt;0.0001) with higher age-adjusted systolic (113.5 [111.0 - 115.9] vs 109.3[108.0 - 110.7]mmHg; P=0.004) and diastolic (70.1 [67.9-72.2] vs 68.7[67.5-69.9]mmHg; P=0.271) BP. Prevalence of alcohol drinkers was similar among youths with (22.2%) and those without overweight (23.4%) but systolic (115.3 ± 15.4 vs 110.0 ± 12.7 mmHg; P=0.007) and diastolic (72.6 ± 10.2 vs 68.9 ± 11.1 mmHg; P=0.028) BP were higher among overweight youths.Compared to abstinents, age-adjusted systolic BP in alcohol drinkers was 3.7 [0.8 – 6.5] mmHg (P=0.013) and 2,45 [-5,46 – 11,37 mmHg] (P=0.320) higher, respectively in the absence and the presence of overweight. The differences in age-adjusted diastolic BP were not significant.Conclusion: Overweight and alcohol increase blood pressure in youths with the effect of alcohol being greater among slim than obese subjects. Our results suggest that prevention of cardiovascular disease in the Africans should encompass the strategies to address overweight and alcohol intake at younger age.Keywords: alcohol consumption, overweight, blood pressure, youth

Prevalence, awareness, treatment, and control of hypertension among rural and urban dwellers of the Far North Region of Cameroon.

To assess the prevalence and determinants of high blood pressure (BP) and awareness, treatment, and control rates in the Far North Region of Cameroon, where these variables have not been explored so far. In total, 889 individuals (41.5% women) aged at least 18 years participated in a cross-sectional survey conducted in Maroua (urban area) and Tokombere (rural area) from November 2014 to May 2015, using a multistage cluster sampling frame. Anthropometric variables, BP, and fasting capillary glucose were assessed in all participants. Hypertension was defined as BP at least 140/90 mmHg or antihypertensive therapy and BP control as BP less than 140/90 mmHg. Prevalence estimates were age standardized to the Cameroon population. The prevalence of hypertension was 37.8% (rural: 34%; urban: 41.2%; men: 38.8%; women: 37.9%). Hypertension was associated with urban environment (odds ratio: 1.42; 95%; confidence interval 1.06-1.89), age at least 70 years (4.06; 2.02-6.14), male sex (4.06; 2.02-6.14), abdominal obesity (2.36; 1.54-3.61), and high blood sugar (2.01; 1.31-3.08). Among individuals with hypertension, 18.6% (rural: 17.9%; urban: 19.5%) were aware of having high BP. Among those aware, 29.3% (rural: 17.3%; urban: 36.3%) reported receiving treatment, of whom 16.3% (rural: 22.6%; urban: 4.2%) had BP controlled. Awareness, treatment, and BP control levels were higher in women than men. Hypertension is highly prevalent in Far North Cameroon and awareness, treatment, and control rates are low. Efforts to improve detection, treatment, and control of hypertension in Cameroon are needed

Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trial

BACKGROUND: In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial the primary outcome (cardiac morbidity and mortality) did not differ between valsartan and amlodipine-based treatment groups, although systolic blood pressure (SBP) and diastolic blood pressure reductions were significantly more pronounced with amlodipine. Stroke incidence was non-significantly, and myocardial infarction was significantly lower in the amlodipine-based regimen, whereas cardiac failure was non-significantly lower on valsartan. OBJECTIVES: The study protocol specified additional analyses of the primary endpoint according to: sex; age; race; geographical region; smoking status; type 2 diabetes; total cholesterol; left ventricular hypertrophy; proteinuria; serum creatinine; a history of coronary heart disease; a history of stroke or transient ischemic attack; and a history of peripheral artery disease. Additional subgroups were isolated systolic hypertension and classes of antihypertensive agents used immediately before randomization. METHODS: The 15 245 hypertensive patients participating in VALUE were divided into subgroups according to baseline characteristics. Treatment by subgroup interaction analyses were carried out by a Cox proportional hazard model. Within each subgroup, treatment effects were assessed by hazard ratios and 95% confidence intervals. RESULTS: For cardiac mortality and morbidity, the only significant subgroup by treatment interaction was of sex (P = 0.016), with the hazard ratio indicating a relative excess of cardiac events with valsartan treatment in women but not in men, but SBP differences in favour of amlodipine were distinctly greater in women. No other subgroup showed a significant difference in the composite cardiac outcome between valsartan and amlodipine-based treatments. For secondary endpoints, a sex-related significant interaction was found for heart failure (P < 0.0001), with men but not women having a lower incidence of heart failure with valsartan. CONCLUSION: As in the whole VALUE cohort, in no subgroup of patients were there differences in the incidence of the composite cardiac endpoint with valsartan and amlodipine-based treatments, despite a greater blood pressure decrease in the amlodipine group. The only exception was sex, in which the amlodipine-based regimen was more effective than valsartan in women, but not in men, whereas the valsartan regimen was more effective in preventing cardiac failure in men than in women. © 2006 Lippincott Williams & Wilkins, Inc