6This 8-week, randomized, double-blind, controlled study compared efficacy and tolerability of telmisartan ⁄ amlodipine (T ⁄ A) single-pill combination (SPC) vs the respective monotherapies in 858 patients with severe hypertension (systolic ⁄ diastolic blood pressure [SBP ⁄ DBP] !180 ⁄ 95 mm Hg). At 8 weeks, T ⁄ A provided significantly greater reductions from baseline in seated trough cuff SBP ⁄ DBP ()47.5 mm Hg ⁄ )18.7 mm Hg) vs T (P<.0001) or A (P=.0002) monotherapy; superior reductions were also evident at 1, 2, 4, and 6 weeks. Blood pressure (BP) goal and response rates were consistently higher with T ⁄ A vs T or A. T ⁄ A was well tolerated, with less frequent treatmentrelated adverse events vs A (12.6% vs 16.4%) and a numerically lower incidence of peripheral edema and treatment discontinuation. In conclusion, treatment of patients with substantially elevated BP with T ⁄ A SPCs resulted in high and significantly greater BP reductions and higher BP goal and response rates than the respective monotherapies. T ⁄ A SPCs were well tolerated. J Clin Hypertens (Greenwich). 2012;14:206-215. Ó2012 Wiley Periodicals, Inc.Based on evidence from a number of large antihypertensive trials, 1-9 most guidelines acknowledge that combination therapy is needed to reduce blood pressure (BP) successfully to goal in the majority of patients; only a minority of patients achieve their BP goal with a single agent.10-14 Also, the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) study showed a significant reduction of cardiovascular (CV) events and death in hypertensive patients at high CV risk treated with a combination of an angiotensin-converting enzyme (ACE) inhibitor and a calcium channel blocker (CCB).15 Nevertheless, despite rigorous and comprehensive guidelines, and a trend towards an increase in the use of combination therapy in treatment practice, 16 several studies have demonstrated the persistence of poor BP goal rates in treated patients. [17][18][19] The impact of poor BP control is compounded by the often high prevalence of other CV risk factors in hypertensive patients (eg, hypercholesterolemia, obesity, type 2 diabetes mellitus [T2DM], and smoking).13 Therefore, an urgent need still remains to improve the management of hypertension. One logical approach would be to use 2 drugs from different classes and complementary mechanisms of action in combination. Such combinations may result in additional BP decreases and improved goal rates, compared with either agent used alone. 20-23Furthermore, single-pill combinations (SPCs) are known to increase treatment adherence and reduce health care costs. [24][25][26][27] A combination of a CCB and an angiotensin II receptor blocker (ARB) is a rational approach for managing hypertension and there is increasing evidence that this combination is effective. 11,13,28,29 The aim of the current study was to compare the efficacy and tolerability of the SPC of telmisartan 80 mg ⁄ amlodipine 10 mg (T80 ⁄ A10) with that of...

Oxidative stress and systemic inflammation resulting from repeated hypoxia/reoxygenation cycles in obstructive sleep apnea-hypopnea syndrome (OSAHS) play a role in atherogenesis. It is unclear, however, if this association is independent of obesity. The aims of the present study were to compare markers of oxidative stress and systemic inflammation between patients with and without OSAHS independent of obesity, and to examine their interrelations. In experiment 1, 20 OSAHS patients, age 42.1 ± 10.0 years, body mass index 26.3 ± 2.7 kg/m 2 , and apnea-hypopnea index 28.8 ± 10.8 events/h, were individually matched with 20 control subjects, age 41.5 ± 11.1 years, body mass index 26.0 ± 2.9, and apnea-hypopnea index 6.5 ± 2.4 events/h. In experiment 2, 15 OSAHS patients with body mass index > 27 were individually matched with 15 OSAHS patients having the same age and similar apnea severity with body mass index < 27. In both experiments, blood was drawn at the end of the sleep study for determination of lipid peroxidation markers, thiobarbituric-acid-reactive substances (TBARS) and peroxides and the antioxidant enzyme paraoxonase-1, and the systemic inflammatory markers C-reactive protein (CRP), ceruloplasmin and haptoglobin. OSAHS patients had significantly higher concentrations of TBARS (P < 0.0002) and peroxides (P < 0.03) and lower paraoxonase-1 (P < 0.02) than controls. No differences were found for the inflammatory markers but only in OSAHS patients there were significant correlations between the lipid peroxidation and inflammatory markers. There were no differences in lipid peroxidation between obese and non-obese patients, but CRP was higher (P < 0.03) in the obese patients. We conclude that sleep apnea is primarily associated with increased oxidative stress. Possibly, OSAHS influences systemic inflammatory pathways indirectly through oxidative stress.

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The Cossack of the Orenburg Cossack army, 23 years old, received 4 years ago in a fight with a knife in the chest in the area of the sixth intercostal space. After that, two years later, he fell ill with dropsy of the abdomen, which was released according to the patient 3 times.