The predictive ability of blood pressure in elderly trial patients

Objectives: To assess the impact of the blood pressure (BP) profile on cardiovascular risk in the Medical Research Council (UK) elderly trial; investigate whether the effects of hypertensive drugs in reducing event rates are solely a product of systolic pressure reduction. Methods: Using longitudinal BP data from 4396 hypertensive patients, the general trend over time was estimated using a first-stage multilevel model. We then investigated how BP acted alongside other BP-related covariates in a second-stage 'time-to-event' statistical model, assessing risk for stroke events and coronary heart disease (CHD). Differences in outcome prediction between diuretic, β-blocker and placebo treatment arms were investigated. Results: The β-blocker arm experienced comparatively poor control of current SBP, episodic peaks and variability in BP levels. After adjusting for the mean level, variability in SBP over time was significant: risk ratio was 1.15 [95% confidence interval (CI): 1.01-1.31] across all patients for stroke events. The risk ratio for current SBP was 1.36 (95% CI: 1.16-1.58). Current DBP and variability in DBP also predicted stroke independently: risk ratios was 1.43 and 1.18, respectively. The risk factors exhibited weaker associations with CHD risk; only the highest measured value and variability in SBP showed a statistically significant association: risk ratios were 1.26 and 1.16, respectively. CONCLUSION:: Individual risk characterization could be augmented with additional prognostic information, besides current SBP, including current diastolic pressure, temporal variability over and above general trends and historical measurements. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

In situ cosmogenic 10Be–14C–26Al measurements from recently deglaciated bedrock as a new tool to decipher changes in Greenland Ice Sheet size

International audienceAbstract. Sometime during the middle to late Holocene (8.2 ka to ∼ 1850–1900 CE), the Greenland Ice Sheet (GrIS) was smaller than its current configuration. Determining the exact dimensions of the Holocene ice-sheet minimum and the duration that the ice margin rested inboard of its current position remains challenging. Contemporary retreat of the GrIS from its historical maximum extent in southwestern Greenland is exposing a landscape that holds clues regarding the configuration and timing of past ice-sheet minima. To quantify the duration of the time the GrIS margin was near its modern extent we develop a new technique for Greenland that utilizes in situ cosmogenic 10Be–14C–26Al in bedrock samples that have become ice-free only in the last few decades due to the retreating ice-sheet margin at Kangiata Nunaata Sermia (n=12 sites, 36 measurements; KNS), southwest Greenland. To maximize the utility of this approach, we refine the deglaciation history of the region with stand-alone 10Be measurements (n=49) and traditional 14C ages from sedimentary deposits contained in proglacial–threshold lakes. We combine our reconstructed ice-margin history in the KNS region with additional geologic records from southwestern Greenland and recent model simulations of GrIS change to constrain the timing of the GrIS minimum in southwest Greenland and the magnitude of Holocene inland GrIS retreat, as well as to explore the regional climate history influencing Holocene ice-sheet behavior. Our 10Be–14C–26Al measurements reveal that (1) KNS retreated behind its modern margin just before 10 ka, but it likely stabilized near the present GrIS margin for several thousand years before retreating farther inland, and (2) pre-Holocene 10Be detected in several of our sample sites is most easily explained by several thousand years of surface exposure during the last interglaciation. Moreover, our new results indicate that the minimum extent of the GrIS likely occurred after ∼5 ka, and the GrIS margin may have approached its eventual historical maximum extent as early as ∼2 ka. Recent simulations of GrIS change are able to match the geologic record of ice-sheet change in regions dominated by surface mass balance, but they produce a poorer model–data fit in areas influenced by oceanic and dynamic processes. Simulations that achieve the best model–data fit suggest that inland retreat of the ice margin driven by early to middle Holocene warmth may have been mitigated by increased precipitation. Triple 10Be–14C–26Al measurements in recently deglaciated bedrock provide a new tool to help decipher the duration of smaller-than-present ice over multiple timescales. Modern retreat of the GrIS margin in southwest Greenland is revealing a bedrock landscape that was also exposed during the migration of the GrIS margin towards its Holocene minimum extent, but it has yet to tap into a landscape that remained ice-covered throughout the entire Holocene