24-Hour ambulatory blood pressure levels and control in a large cohort of adult outpatients with different classes of obesity

Effective and sustained blood pressure (BP) control in hypertensive patients with moderate-to-severe obesity is often difficult to achieve. We evaluated clinic, 24h, day-time and night-time systolic/diastolic BP levels and control in a large cohort of adult outpatients with different classes of obesity. A single center, prospective, cohort study was conducted at Hypertension Unit, Division of Cardiology, Sant’Andrea Hospital, Rome Italy. All BP measurements were performed and BP thresholds were set according to guidelines. Study population was stratified according to BMI. We included 4,766 individuals (women 48.6%, age 60.3 ± 11.6 years, clinic BP 143.8 ± 18.2/90.9 ± 12.3 mmHg, 24h BP 130.2 ± 13.3/79.1 ± 9.5 mmHg), among whom 36.0% had normal weight, 43.5% were overweight, 15.7% had class I, and 4.8% class II/III obesity. Obese outpatients had higher prevalence of risk factors, and were treated more frequently and with more antihypertensive drugs than those with normal body weight. Obese outpatients showed higher systolic BP levels at all BP measurements, mostly 24h and night-time periods, than those observed in normal weight outpatients. BMI resulted significantly related with clinic (r = 0.053; P < 0.001), 24h (r = 0.098; P < 0.001) and night-time systolic BP (r = 0.126; P < 0.001), and left ventricular mass indexed by height^2.7 (r = 0.311; P < 0.001). BMI was also negatively and independently associated with predefined BP goals at all types of BP measurements. Obesity was associated with higher systolic BP levels during the entire 24h period and increased left ventricular mass. These effects were independently observed, even after correction for major cardiovascular risk factors and comorbidities, as well as the number and type of antihypertensive drug classes

Management pathways for the floodplain wetlands of the southern Murray–Darling Basin: Lessons from history

The condition of floodplain wetlands of the Murray–Darling Basin (MDB) reflects the combined effects of climate variability, river regulation, vegetation clearance, and the impacts of human settlement and industry. Today, these systems are degraded, in large part due to changes in the hydroecology of waterways arising from water diversion and abstraction to sustain irrigated agriculture. The MDB Plan directs substantial investment towards the restoration of ecosystems largely via the buy-back of water allocations, under a cap-and-trade system, for use as environmental flows. This region is projected to receive less winter rainfall and run-off, which could exacerbate the impact of water diversions. Long-term climate records suggest a higher level of resilience to drying than may be inferred from modern studies. Further, palaeoecological records of change reveal that many wetlands that are perennial today were once naturally seasonal or intermittent, and that much wetland degradation predates regulation and can be attributed to declines in water quality, rather than quantity. A mix of approaches to rehabilitate this long-degraded system, planned and implemented over an extended period, may meet the demands of the Water Act of 2007, but also support the regional economy. An adaptive management approach offers a framework within which to map system vulnerabilities, characterize climate pressures, identify adaptation options, and monitor outcomes along a pathway to a sustainable future. Early lessons show the extent to which such a deliberative framework can assist water reform under changing socio-economic priorities and external hydroclimatic pressures