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Abstract-Our aim was to assess the prognostic significance of nighttime and daytime ambulatory blood pressure and their ratio for mortality and cause-specific cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from 4 prospective studies performed in Europe. Age of the subjects averaged 61Ϯ13 years, 45% were men, 13.7% smoked, 8.4% had diabetes, and 61% were under antihypertensive treatment at the time of ambulatory blood pressure monitoring. Office, daytime, and nighttime blood pressure averaged 159Ϯ20/91Ϯ12, 143Ϯ17/87Ϯ12, and 130Ϯ18/75Ϯ12 mm Hg. Total follow-up amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the hazard ratios associated with 1 standard deviation higher blood pressure. Daytime and nighttime systolic blood pressure predicted all-cause and cardiovascular mortality, coronary heart disease, and stroke, independently from office blood pressure and confounding variables. When these blood pressures were entered simultaneously into the models, nighttime blood pressure predicted all outcomes, whereas daytime blood pressure did not add prognostic precision to nighttime pressure. Appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients, and in treated and untreated patients The systolic night-day blood pressure ratio predicted all outcomes, which only persisted for all-cause mortality after adjustment for 24-hour blood pressure. In conclusion, nighttime blood pressure is in general a better predictor of outcome than daytime pressure in hypertensive patients, and the night-day blood pressure ratio predicts mortality, even after adjustment for 24-hour blood pressure. Key Words: ambulatory blood pressure Ⅲ coronary heart disease Ⅲ daytime blood pressure Ⅲ mortality Ⅲ nighttime blood pressure Ⅲ stroke A mbulatory blood pressure (ABP) monitoring (ABPM) has become increasingly important for the management of patients with hypertension. [1][2][3] Most studies have shown that mean 24-hour ABP is a better predictor of morbidity and mortality than office BP (OBP). 4 However, there is still debate on the relative importance of daytime and nighttime ABP and on the prognostic significance of the night-day BP ratio. Studies that reported on daytime and nighttime ABP separately found that both BPs carried significant prognostic information in patients with hypertension. 4 -9 Whereas the prognostic value of daytime and nighttime ABP was about similar in 2 studies, 5,7 others directly compared the prognostic value of the 2 BPs and found that nighttime ABP was a significantly better predictor than daytime ABP. 6,8,9 Also results on the night-day BP ratio are not consistent in hypertension. Some studies observed a significantly better prognosis in patients with a greater decline in nighttime ABP 6,10 but this was not confirmed by others. 7,11 Divergent results among studies may be attributable to differences in me...

SummaryBackground Cadmium is a ubiquitous environmental pollutant, which accumulates in the human body such that 24-h urinary excretion is a biomarker of lifetime exposure. We aimed to assess the association between environmental exposure to cadmium and cancer.Methods We recruited a random population sample (n=994) from an area close to three zinc smelters and a reference population from an area with low exposure to cadmium. At baseline (1985-89), we measured cadmium in urine samples obtained over 24 h and in the soil of participants' gardens, and followed the incidence of cancer until June 30, 2004. We used Cox regression to calculate hazard ratios for cancer in relation to internal (ie, urinary) and external (ie, soil) exposure to cadmium, while adjusting for covariables.

Abstract-Blood pressure-lowering therapy reduces left ventricular mass, but the question of whether differences exist among drug classes has not been fully resolved. Our aim was to compare the effects of diuretics, ␤-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers on left ventricular mass regression in patients with hypertension on the basis of prospective, randomized comparative studies. We performed meta-analyses, involving pooled pairwise comparisons of the drug classes and of each class versus other classes statistically combined, and meta-regression analyses to identify the determinants of the regression. The 75 relevant publications involved 84 pairwise comparisons and 6001 patients. Regression of left ventricular mass was significantly less (Pϭ0.01) with ␤-blockers (9.8%) than with angiotensin receptor blockers (12.5%), but none of the other analyzable pairwise comparisons between drug classes revealed significant differences (PϾ0.10). In addition, ␤-blockers showed less regression than the other 4 classes statistically combined (PϽ0.01), and regression was more pronounced with angiotensin receptor blockers versus the others (PϽ0.01). In multivariable meta-regression analysis on all of the treatment arms, ␤-blocker treatment was a significant and negative predictor of the regression (Ϫ3.6%; PϽ0.01), but this was not the case for the other drug classes, including angiotensin receptor blockers. In conclusion, ␤-blockers show less regression of left ventricular mass, whereas angiotensin receptor blockers may induce larger regression. The inferiority of ␤-blockers appears to be more convincing than the superiority of angiotensin receptor blockers. Key Words: angiotensin-converting enzyme inhibitor Ⅲ angiotensin receptor blocker Ⅲ ␤-blocker Ⅲ calcium channel blocker Ⅲ diuretic Ⅲ left ventricular mass Ⅲ meta-analysis T here is little doubt that blood pressure (BP)-lowering therapy reduces left ventricular (LV) mass (LVM) in patients with hypertension in comparison with placebo treatment. 1-3 However, the question of whether differences exist among drug classes remains a matter of debate. Meta-analyses have suggested that angiotensin-converting enzyme (ACE) inhibitors might be more effective than other first-line therapies 1,2 ; that ACE inhibitors and, to a lesser extent, calcium channel blockers, rather than diuretics and ␤-blockers, emerge as first-line candidates to reduce LVM 3 ; and, more recently, that angiotensin receptor blockers also favorably reduce LVM. 4 Advantages of the meta-analytic technique are the increased statistical power and the more accurate estimate of the magnitude of the effect, 5 but the results largely depend on the criteria for the inclusion of studies. In early meta-analyses on the regression of LVM, the majority of the included studies were open, uncontrolled, single-drug studies, which may seriously hamper their interpretation. 1,2 A subsequent meta-analysis 3 only included studies that compared different drug classe...