Valsartan combination therapy in the management of hypertension – patient perspectives and clinical utility

The morbidity and mortality benefits of lowering blood pressure (BP) in hypertensive patients are well established, with most individuals requiring multiple agents to achieve BP control. Considering the important role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension, a key component of combination therapy should include a RAAS inhibitor. Angiotensin receptor blockers (ARBs) lower BP, reduce cardiovascular risk, provide organ protection, and are among the best tolerated class of antihypertensive therapy. In this article, we discuss two ARB combinations (valsartan/hydrochlorothiazide [HCTZ] and amlodipine/valsartan), both of which are indicated for the treatment of hypertension in patients not adequately controlled on monotherapy and as initial therapy in patients likely to need multiple drugs to achieve BP goals. Randomized, double-blind studies that have assessed the antihypertensive efficacy and safety of these combinations in the first-line treatment of hypertensive patients are reviewed. Both valsartan/HCTZ and amlodipine/valsartan effectively lower BP and are well tolerated in a broad range of patients with hypertension, including difficult-to-treat populations such as those with severe BP elevations, prediabetes and diabetes, patients with the cardiometabolic syndrome, and individuals who are obese, elderly, or black. Also discussed herein are patient-focused perspectives related to the use of valsartan/HCTZ and amlodipine/valsartan, and the rationale for use of single-pill combinations as one approach to enhance patient compliance with antihypertensive therapy

Zero Temperature Chiral Phase Transition in (2+1)-Dimensional QED with a Chern-Simons Term

We investigate the zero temperature chiral phase transition in (2+1)-dimensional QED in the presence of a Chern-Simons term, changing the number of fermion flavors. In the symmetric phase, there are no light degrees of freedom even at the critical point. Unlike the case without a Chern-Simons term, the phase transition is first-order.Comment: 7 pages, RevTeX, no figure

Hot dense capsule implosion cores produced by z-pinch dynamic hohlraum radiation

Hot dense capsule implosions driven by z-pinch x-rays have been measured for the first time. A ~220 eV dynamic hohlraum imploded 1.7-2.1 mm diameter gas-filled CH capsules which absorbed up to ~20 kJ of x-rays. Argon tracer atom spectra were used to measure the Te~ 1keV electron temperature and the ne ~ 1-4 x10^23 cm-3 electron density. Spectra from multiple directions provide core symmetry estimates. Computer simulations agree well with the peak compression values of Te, ne, and symmetry, indicating reasonable understanding of the hohlraum and implosion physics.Comment: submitted to Phys. Rev. Let

Where are the Hedgehogs in Nematics?

In experiments which take a liquid crystal rapidly from the isotropic to the nematic phase, a dense tangle of defects is formed. In nematics, there are in principle both line and point defects (``hedgehogs''), but no point defects are observed until the defect network has coarsened appreciably. In this letter the expected density of point defects is shown to be extremely low, approximately $10^{-8}$ per initially correlated domain, as result of the topology (specifically, the homology) of the order parameter space.Comment: 6 pages, latex, 1 figure (self-unpacking PostScript)

2+1 Dimensional QED and a Novel Phase Transition

We investigate the chiral phase transition in 2+1 dimensional QED. Previous gap equation and lattice Monte-Carlo studies of symmetry breaking have found that symmetry breaking ceases to occur when the number of fermion flavors exceeds a critical value. Here we focus on the order of the transition. We find that there are no light scalar degrees of freedom present as the critical number of flavors is approached from above (in the symmetric phase). Thus the phase transition is not second order, rendering irrelevant the renormalization group arguments for a fluctuation induced transition. However, the order parameter vanishes continuously in the broken phase, so this transition is also unlike a conventional first order phase transition.Comment: 11 pages, Late

Development of singularities for the compressible Euler equations with external force in several dimensions

We consider solutions to the Euler equations in the whole space from a certain class, which can be characterized, in particular, by finiteness of mass, total energy and momentum. We prove that for a large class of right-hand sides, including the viscous term, such solutions, no matter how smooth initially, develop a singularity within a finite time. We find a sufficient condition for the singularity formation, "the best sufficient condition", in the sense that one can explicitly construct a global in time smooth solution for which this condition is not satisfied "arbitrary little". Also compactly supported perturbation of nontrivial constant state is considered. We generalize the known theorem by Sideris on initial data resulting in singularities. Finally, we investigate the influence of frictional damping and rotation on the singularity formation.Comment: 23 page

Discrete Anomaly and Dynamical Mass in 2+1 dimensional U(1)V×U(1)AU(1)_V\times U(1)_A Model

We note that in (2+1)-dimensional gauge theories with even number of massless fermions, there is anomalous $Z_2$ symmetry if theory is regularized in a parity-invariant way. We then consider a parity invariant $U(1)_V\times U(1)_A$ model, which induces a mutual Chern-Simons term in the effective action due to $Z_2$ anomaly. The effect of the discrete anomaly is studied in the induced spin and in the dynamical fermion mass.Comment: 14 pages, latex, two figures (available upon request

Discussing sudden unexpected death in epilepsy: Are we empowering our patients? A questionnaire survey

OBJECTIVE: To examine patient knowledge about sudden unexpected death in epilepsy (SUDEP) compared to other risks in epilepsy. To explore patients' experiences surrounding SUDEP disclosure and opinions on how information should be delivered. DESIGN: A cross-sectional questionnaire. SETTING: Royal Free Hospital, London outpatient epilepsy clinics. PARTICIPANTS: New and follow-up patients attending epilepsy clinics at a London teaching hospital over six months. Patients identified as being at risk of suffering negative emotional or psychological consequences of SUDEP discussions were excluded. MAIN OUTCOME MEASURES: Patient knowledge about epilepsy risks; patient opinion regarding source, timing and delivery of SUDEP information; impact on health seeking behaviour. RESULTS: Ninety-eight per cent of patients were aware of medication adherence, 84% of factors influencing seizure frequency, 78% of driving regulations, 50% of SUDEP and 38% of status epilepticus; 72% of patients felt that SUDEP information should be given to all patients. Preferences for timing of SUDEP discussions varied between those wanting information at diagnosis (40%) and those preferring to receive it after three clinic appointments (18%) to avoid information overload at the first consultation. Emotional responses (48% positive, 38% negative) predominated over measurable behavioural change following SUDEP discussions. CONCLUSIONS: Less than half the patients knew about SUDEP and status epilepticus. Although the majority of patients with epilepsy wish to be informed about SUDEP early on in their diagnosis, information must be delivered in a way that promotes patient knowledge and empowerment