From 'essential' hypertension to intensive blood pressure lowering: the pros and cons of lower target values

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Comparison of three creatinine-based equations to predict adverse outcome in a cardiovascular high-risk cohort:an investigation using the SPRINT research materials

Background:Novel creatinine-based equations have recently been proposed but their predictive performance for cardiovascular outcomes in participants at high cardiovascular risk in comparison to the established CKD-EPI 2009 equation is unknown. Method:In 9361 participants from the United States included in the randomized controlled SPRINT trial, we calculated baseline estimated glomerular filtration rate (eGFR) using the CKD-EPI 2009, CKD-EPI 2021, and EKFC equations and compared their predictive value of cardiovascular events. The statistical metric used is the net reclassification improvement (NRI) presented separately for those with and those without events. Results:During a mean follow-up of 3.1 ± 0.9 years, the primary endpoint occurred in 559 participants (6.0%). When using the CKD-EPI 2009, the CKD-EPI 2021, and the EKFC equations, the prevalence of CKD (eGFR &lt;60 ml/min/1.73 m2 or &gt;60 ml/min/1.73 m2 with an ACR ≥30 mg/g) was 37% vs. 35.3% (P = 0.02) vs. 46.4% (P &lt; 0.001), respectively. The corresponding mean eGFR was 72.5 ± 20.1 ml/min/1.73 m2 vs. 73.2 ± 19.4 ml/min/1.73 m2 (P &lt; 0.001) vs. 64.6 ± 17.4 ml/min/1.73 m2 (P &lt; 0.001). Neither reclassification according to the CKD-EPI 2021 equation [CKD-EPI 2021 vs. CKD-EPI 2009: NRIevents: −9.5% (95% confidence interval (CI) −13.0% to −5.9%); NRInonevents: 4.8% (95% CI 3.9% to 5.7%)], nor reclassification according to the EKFC equation allowed better prediction of cardiovascular events compared to the CKD-EPI 2009 equation (EKFC vs. CKD-EPI 2009: NRIevents: 31.2% (95% CI 27.5% to 35.0%); NRInonevents: −31.1% (95% CI −32.1% to −30.1%)). Conclusion. Substituting the CKD-EPI 2009 with the CKD-EPI 2021 or the EKFC equation for calculation of eGFR in participants with high cardiovascular risk without diabetes changed the prevalence of CKD but was not associated with improved risk prediction of cardiovascular events for both those with and without the event.</p

Comparison of three creatinine-based equations to predict adverse outcome in a cardiovascular high-risk cohort:an investigation using the SPRINT research materials

Background:Novel creatinine-based equations have recently been proposed but their predictive performance for cardiovascular outcomes in participants at high cardiovascular risk in comparison to the established CKD-EPI 2009 equation is unknown. Method:In 9361 participants from the United States included in the randomized controlled SPRINT trial, we calculated baseline estimated glomerular filtration rate (eGFR) using the CKD-EPI 2009, CKD-EPI 2021, and EKFC equations and compared their predictive value of cardiovascular events. The statistical metric used is the net reclassification improvement (NRI) presented separately for those with and those without events. Results:During a mean follow-up of 3.1 ± 0.9 years, the primary endpoint occurred in 559 participants (6.0%). When using the CKD-EPI 2009, the CKD-EPI 2021, and the EKFC equations, the prevalence of CKD (eGFR &lt;60 ml/min/1.73 m2 or &gt;60 ml/min/1.73 m2 with an ACR ≥30 mg/g) was 37% vs. 35.3% (P = 0.02) vs. 46.4% (P &lt; 0.001), respectively. The corresponding mean eGFR was 72.5 ± 20.1 ml/min/1.73 m2 vs. 73.2 ± 19.4 ml/min/1.73 m2 (P &lt; 0.001) vs. 64.6 ± 17.4 ml/min/1.73 m2 (P &lt; 0.001). Neither reclassification according to the CKD-EPI 2021 equation [CKD-EPI 2021 vs. CKD-EPI 2009: NRIevents: −9.5% (95% confidence interval (CI) −13.0% to −5.9%); NRInonevents: 4.8% (95% CI 3.9% to 5.7%)], nor reclassification according to the EKFC equation allowed better prediction of cardiovascular events compared to the CKD-EPI 2009 equation (EKFC vs. CKD-EPI 2009: NRIevents: 31.2% (95% CI 27.5% to 35.0%); NRInonevents: −31.1% (95% CI −32.1% to −30.1%)). Conclusion. Substituting the CKD-EPI 2009 with the CKD-EPI 2021 or the EKFC equation for calculation of eGFR in participants with high cardiovascular risk without diabetes changed the prevalence of CKD but was not associated with improved risk prediction of cardiovascular events for both those with and without the event.</p

Gain without population inversion in V-type systems driven by a frequency-modulated field

We obtain gain of the probe field at multiple frequencies in a closed three-level V-type system using frequency modulated pump field. There is no associated population inversion among the atomic states of the probe transition. We describe both the steady-state and transient dynamics of this system. Under suitable conditions, the system exhibits large gain simultaneously at series of frequencies far removed from resonance. Moreover, the system can be tailored to exhibit multiple frequency regimes where the probe experiences anomalous dispersion accompanied by negligible gain-absorption over a large bandwidth, a desirable feature for obtaining superluminal propagation of pulses with negligible distortion.Comment: 10 pages + 8 figures; To appear in Physical Review

Migration and "Low-Skilled" Workers in Destination Countries

In the fourth article in a six-part PLoS Medicine series on Migration & Health, Joan Benach and colleagues discuss the specific health risks and policy needs associated with migration in destination countries, especially for low-skilled and illegal migrant workers