No abstract

The data of this HOT study sub-analysis suggest somewhat differentiated optimal gender- and age-dependent effects of anti-hypertensive and anti-platelet therapies; lowering of diastolic BP to about 80 mmHg in hypertensive women and, in addition, the administration of 75 mg of ASA to well-treated hypertensive men appear to effectively reduce the most common cardiovascular complication, i.e. myocardial infarction, in patients with essential hypertension.

Preoperative nutritional status was assessed by: the percentage weight loss (% WL), body weight in relation to reference weight (WI), arm muscle circumference (AMC), and S-albumin (S-Alb) in a prospective study of 215 noncancer patients classified into three groups according to type of surgery: major vascular, minor vascular, and abdominal. The clinical significance of the nutritional markers was assessed by correlations to postoperative outcome and the time spent in the hospital after surgery. The influence of age on nutritional markers and clinical variables was evident but was ruled out in all correlations. If malnutrition was classified as two or more abnormal values in the nutritional markers (% WL, WI, AMC, S-Alb), the overall frequency was 12%, highest in the major vascular surgery group (18%) and lowest in the minor vascular group (4%). Patients with low nutritional status stayed an average of 29 days in the hospital compared to 14 days if the nutritional status was normal (p less than 0.01). The overall complication frequency was higher in patients with low nutritional status compared to normal status (48% and 23%, respectively, p less than 0.01). The frequency of serious complications was 31% in undernourished and 9% in well-nourished patients (p less than 0.05). Various nonnutritional variables such as age, diagnosis, and duration of surgery were shown to increase the predictive ability of nutritional status. The results of this study confirm that nutritional state per se is predictive for postoperative outcome even when variables were stabilized for different backgrounds with covariation to nutritional status.

The present study in hypertensive men (40-64 years old) with untreated diastolic blood pressure above 100 mm Hg was aimed at investigating whether metoprolol (n = 1,609) given as initial treatment would lower the risk for coronary events (sudden death and myocardial infarction) more effectively than thiazide diuretics (n=1,625). A substantial part of this study was the metoprolol arm of the Heart Attack Primary Prevention in Hypertension (HAPPHY) study. The HAPPHY study was a pooling of the effect of different /J-blockers, mainly metoprolol and atenolol, in which no favorable effect in relative risk was observed for atenolol as compared with diuretics. In the present study, 255 patients suffered definite coronary events during follow-up; 25% of these events were fatal, 39% were acute myocardial infarctions, and 36% were silent myocardial infarctions. The risk for coronary events was significantly lower in patients on metoprolol than in patients on diuretics (111 versus 144 cases, p=0.001, corresponding to 143 versus 18.8 cases/1,000 patient years and a relative risk of 0.76 at the end of the trial; 95% confidence interval 0.58-0.98). This difference in risk has potentially important implications for clinical practice because of the large number of hypertensive patients who are at increased risk for coronary events. Because a placebo group, for ethical reasons, could not be included, relative risk can only be expressed in relation to diuretics. There was no difference between the two treatment groups in baseline characteristics, blood pressure during follow-up, or stroke rates. Thus, the difference in risk for coronary events is probably mediated via mechanisms other than blood pressure control. However, present data might suggest that different /3-blockers may have different efficacy in preventing coronary events. The reasons for this possibility are as yet unknown. (Hypertension 1991:17:579-588) C ontrolled studies with thiazide diuretics in mild-to-moderate hypertension have demonstrated an approximately 40% reduction in strokes as compared with placebo.1 However, because pooled analyses of all studies performed with thiazide diuretics have only shown a modest 8-10% beneficial effect on coronary events, 1 comparative trials to assess the effects of other antihypertensive drugs are needed. These are of particular interest since the risk for coronary events is much greater than the risk for stroke.