Prevalence and risk factors for hypertension and association with ethnicity in Nigeria: results from a national survey.

OBJECTIVE: Non-communicable diseases are now a global priority. We report on the prevalence of hypertension and its risk factors, including ethnicity, in a nationally representative sample of Nigerian adults recruited to a survey of visual impairment. METHODS: multi-stage, stratified, cluster random sample with probability proportional to size procedures was used to obtain a nationally representative sample of 13 591 subjects aged ≥ 40 years. Of these, 13 504 (99.4%) had a blood pressure measurement. RESULTS: The prevalence of hypertension was 44.9% [95% confidence interval (CI): 43.5-46.3% ]. Increasing age, gender, urban residence and body mass index were independent risk factors (p < 0.001). The Kanuri ethnic group had the highest prevalence of hypertension (77.5%, 95% CI: 71.0-84.0%). CONCLUSIONS: The high prevalence of hypertension in Nigeria is a cause for concern and suggests that it is inevitable that the impact of hypertension-related ill health is imminent, with the accompanying financial and societal costs to families and the state of Nigeria

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Relationships between components of blood pressure and cardiovascular events in patients with stable coronary artery disease and hypertension

Observational studies have shown a J-shaped relationship between diastolic blood pressure (BP) and cardiovascular events in hypertensive patients with coronary artery disease. We investigated whether the increased risk associated with low diastolic BP reflects elevated pulse pressure (PP). In 22 672 hypertensive patients with coronary artery disease from the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease), followed for a median of 5.0 years, BP was measured annually and averaged. The relationships between PP and diastolic BP, alone or combined, and the primary composite outcome (cardiovascular death or myocardial infarction) were analyzed using multivariable Cox proportional hazards models. Adjusted hazard ratios for the primary outcome were 1.62 (95% confidence interval [CI], 1.40–1.87), 1.00 (ref), 1.07 (95% CI, 0.94–1.21), 1.54 (95% CI, 1.32–1.79), and 2.34 (95% CI, 1.95–2.81) for PP&lt;45, 45 to 54 (reference), 55 to 64, 65 to 74, and ≥75 mm Hg, respectively, and 1.50 (95% CI, 1.31–1.72), 1.00 (reference), and 1.58 (95% CI, 1.42–1.77) for diastolic BPs of &lt;70, 70 to 79 (ref), and ≥80 mm Hg, respectively. In a cross-classification analysis between diastolic BP and PP, the relationship between diastolic BP and the primary outcome remained J-shaped when the analysis was restricted to patients with the lowest-risk PP (45–64 mm Hg), with adjusted hazard ratios of 1.53 (95% CI, 1.27–1.83), 1.00 (ref), and 1.54 (95% CI, 1.34–1.75) in the &lt;70, 70 to 79 (reference), and ≥80 mm Hg subgroups, respectively. The J-shaped relationship between diastolic BP and cardiovascular events in hypertensive patients with coronary artery disease persists in patients within the lowest-risk PP range and is therefore unlikely to be solely the consequence of an increased PP reflecting advanced vascular disease

Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease: data from the international observational CLARIFY registry

Importance: In the era of widespread revascularization and effective antianginals, the prevalence and prognostic effect of anginal symptoms and myocardial ischemia among patients with stable coronary artery disease (CAD) are unknown.&lt;p&gt;&lt;/p&gt; Objective: To describe the current clinical patterns among patients with stable CAD and the association of anginal symptoms or myocardial ischemia with clinical outcomes.&lt;p&gt;&lt;/p&gt; Design, Setting, and Participants: The Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) registry enrolled outpatients in 45 countries with stable CAD in 2009 to 2010 with 2-year follow-up (median, 24.1 months; range, 1 day to 3 years). Enrollees included 32 105 outpatients with prior myocardial infarction, chest pain, and evidence of myocardial ischemia, evidence of CAD on angiography, or prior revascularization. Of these, 20 291 (63.2%) had undergone a noninvasive test for myocardial ischemia within 12 months of enrollment and were categorized into one of the following 4 groups: no angina or ischemia (n = 13 207 [65.1%]); evidence of myocardial ischemia without angina (silent ischemia) (n = 3028 [14.9%]); anginal symptoms alone (n = 1842 [9.1%]); and angina and ischemia (n = 2214 [10.9%]).&lt;p&gt;&lt;/p&gt; Exposures: Stable CAD.&lt;p&gt;&lt;/p&gt; Main Outcome and Measure: The composite of cardiovascular (CV)–related death or nonfatal myocardial infarction.&lt;p&gt;&lt;/p&gt; Results: Overall, 4056 patients (20.0%) had anginal symptoms and 5242 (25.8%) had evidence of myocardial ischemia on results of noninvasive testing. Of 469 CV-related deaths or myocardial infarctions, 58.2% occurred in patients without angina or ischemia, 12.4% in patients with ischemia alone, 12.2% in patients with angina alone, and 17.3% in patients with both. The hazard ratios for the primary outcome relative to patients without angina or ischemia and adjusted for age, sex, geographic region, smoking status, hypertension, diabetes mellitus, and dyslipidemia were 0.90 (95% CI, 0.68-1.20; P = .47) for ischemia alone, 1.45 (95% CI, 1.08-1.95; P = .01) for angina alone, and 1.75 (95% CI, 1.34-2.29; P &#60;.001) for both. Similar findings were observed for CV-related death and for fatal or nonfatal myocardial infarction.&lt;p&gt;&lt;/p&gt; Conclusions and Relevance: In outpatients with stable CAD, anginal symptoms (with or without ischemia on noninvasive testing) but not silent ischemia appear to be associated with an increased risk for adverse CV outcomes. Most CV events occurred in patients without angina or ischemia

Multi-site observations of Delta Scuti stars 7 Aql and 8 Aql (a new Delta Scuti variable): The twelfth STEPHI campaign in 2003

We present an analysis of the pulsation behaviour of the Delta Scuti stars 7 Aql (HD 174532) and 8 Aql (HD 174589) -- a new variable star -- observed in the framework of STEPHI XII campaign during 2003 June--July. 183 hours of high precision photometry were acquired by using four-channel photometers at three sites on three continents during 21 days. The light curves and amplitude spectra were obtained following a classical scheme of multi-channel photometry. Observations in different filters were also obtained and analyzed. Six and three frequencies have been unambiguously detected above a 99% confidence level in the range 0.090 mHz--0.300 mHz and 0.100 mHz-- 0.145 mHz in 7 Aql and 8 Aql respectively. A comparison of observed and theoretical frequencies shows that 7 Aql and 8 Aql may oscillate with p modes of low radial orders, typical among Delta Scuti stars. In terms of radial oscillations the range of 8 Aql goes from n=1 to n=3 while for 7 Aql the range spans from n=4 to n=7. Non-radial oscillations have to be present in both stars as well. The expected range of excited modes according to a non adiabatic analysis goes from n=1 to n=6 in both stars.Comment: 8 pages, 7 fugures, 5 tables, accepted for publication in Astronomical Journa

Quantum origin of the primordial fluctuation spectrum and its statistics

The usual account for the origin of cosmic structure during inflation is not fully satisfactory, as it lacks a physical mechanism capable of generating the inhomogeneity and anisotropy of our Universe, from an exactly homogeneous and isotropic initial state associated with the early inflationary regime. The proposal in [A. Perez, H. Sahlmann, and D. Sudarsky, Classical Quantum Gravity, 23, 2317, (2006)] considers the spontaneous dynamical collapse of the wave function, as a possible answer to that problem. In this work, we review briefly the difficulties facing the standard approach, as well as the answers provided by the above proposal and explore their relevance to the investigations concerning the characterization of the primordial spectrum and other statistical aspects of the cosmic microwave background and large-scale matter distribution. We will see that the new approach leads to novel ways of considering some of the relevant questions, and, in particular, to distinct characterizations of the non-Gaussianities that might have left imprints on the available data.Comment: 27 pages. Revision to match the published versio

Heart Rate and Use of Beta-Blockers in Stable Outpatients with Coronary Artery Disease

&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Heart rate (HR) is an emerging risk factor in coronary artery disease (CAD). However, there is little contemporary data regarding HR and the use of HR-lowering medications, particularly beta-blockers, among patients with stable CAD in routine clinical practice. The goal of the present analysis was to describe HR in such patients, overall and in relation to beta-blocker use, and to describe the determinants of HR.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods and Findings:&lt;/b&gt; CLARIFY is an international, prospective, observational, longitudinal registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization procedure, evidence of coronary stenosis of &#62;50%, or chest pain associated with proven myocardial ischemia. A total of 33,438 patients from 45 countries in Europe, the Americas, Africa, Middle East, and Asia/Pacific were enrolled between November 2009 and July 2010. Most of the 33,177 patients included in this analysis were men (77.5%). Mean (SD) age was 64.2 (10.5) years, HR by pulse was 68.3 (10.6) bpm, and by electrocardiogram was 67.2 (11.4) bpm. Overall, 44.0% had HR&#8805;70 bpm. Beta-blockers were used in 75.1% of patients and another 14.4% had intolerance or contraindications to beta-blocker therapy. Among 24,910 patients on beta-blockers, 41.1% had HR&#8805;70 bpm. HR&#8805;70 bpm was independently associated with higher prevalence and severity of angina, more frequent evidence of myocardial ischemia, and lack of use of HR-lowering agents.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Despite a high rate of use of beta-blockers, stable CAD patients often have resting HR&#8805;70 bpm, which was associated with an overall worse health status, more frequent angina and ischemia. Further HR lowering is possible in many patients with CAD. Whether it will improve symptoms and outcomes is being tested.&lt;/p&gt