Improving blood pressure control in patients with diabetes mellitus and high cardiovascular risk

Patients with diabetes mellitus and symptomatic coronary artery disease are also likely to be hypertensive and, overall, are at very high cardiovascular (CV) risk. This paper reports the findings of a posthoc analysis of the 1113 patients with diabetes mellitus in the ACTION trial: ACTION itself showed that outcomes in patients with stable angina and hypertension were significantly improved when a long-acting calcium channel blocking drug (nifedipine GITS) was added to their treatment regimens. This further analysis of the ACTION database in those patients with diabetes has identified a number of practical therapeutic issues which are still relevant because of potential outcome benefits, particularly in relation to BP control. For example, despite background CV treatment and, specifically, despite the widespread use of ACE Inhibitor drugs, the addition of nifedipine GITS was associated with significant benefits: improvement in BP control by an average of 6/3 mmHg and significant improvements in outcome. In summary, this retrospective analysis has identified that the addition of nifedipine GITS resulted in improved BP control and significant outcome benefits in patients with diabetes who were at high CV risk. There is evidence to suggest that these findings are of direct relevance to current therapeutic practice

South Atlantic Interbasin Exchanges of Mass, Heat, Salt and Anthropogenic Carbon

The exchange of mass, heat, salt and anthropogenic carbon (Cant) between the South Atlantic, south of 24°S, and adjacent ocean basins is estimated from hydrographic data obtained during 2008-2009 using an inverse method. Transports of anthropogenic carbon are calculated across the western (Drake Passage), eastern (30°E) and northern (24°S) boundaries. The freshwater overturning transport of 0.09 Sv is southward, consistent with an overturning circulation that exports freshwater from the North Atlantic, and consistent with a bistable Meridional Overturning Circulation (MOC), under conditions of excess freshwater perturbation. At 30°E, net eastward Antarctic Circumpolar Current (ACC) transport, south of the Subtropical Front, is compensated by a 15.9±2.3 Sv westward flow along the Antarctic boundary. The region as a whole is a substantial sink for atmospheric anthropogenic carbon of 0.51±0.37 PgC yr-1, of which 0.18±0.12 PgC yr-1 accumulates and is stored within the water column. At 24°S, a 20.2 Sv meridional overturning is associated with a 0.11 PgC yr-1 Cant overturning. The remainder is transported into the Atlantic Ocean north of 24°S (0.28±0.16 PgC yr-1) and Indian sector of Southern Ocean (1.12±0.43 PgC yr-1), having been enhanced by inflow through Drake Passage (1.07±0.44 PgC yr-1). This underlines the importance of the South Atlantic as a crucial element of the anthropogenic carbon sink in the global oceans