US Department of Veterans Affairs Cooperative Studies Program.

No abstract

Overlapping DES in normal-appearing coronary segments showed a higher incidence of uncovered or malapposed struts, while restenosis occurred exclusively in overlapping stents at HGS. These findings should be considered when deploying overlapping stents.

Nighttime systolic blood pressure (BP) from ambulatory blood pressure monitoring (ABPM) is more predictive than clinic BP for cardiovascular disease, stroke, and death even after controlling for clinic BP. However, ABPM is expensive and burdensome to obtain regularly. BPs obtained in the hospital may provide a window into nighttime BP. We conducted a retrospective cohort study of all hypertensive patients admitted to the Cleveland VAMC in 2002 and 2003 with one or more BP recorded between midnight and 6am on the day of or the day before discharge. The mean age of the study population (n=1085) was 62 (years and 96% were male. 22% had coronary artery disease and 34% had diabetes. The mean nighttime systolic BP was 132 mmHg, baseline GFR was 83 mL/min per 1.73m2. Over a median follow up period of 4.3 years, 266 subjects died, 22 developed ESRD, 99 had a 50% decline in GFR, and 136 developed MI. The adjusted hazard ratios associated with a 10mmHg increase in nighttime systolic BP were 1.04 (95% confidence interval, 0.93 to 1.16) for death, 1.31 (0.95 to 1.80) for ESRD, 1.26 (1.08 to 1.47) for a 50% decline in GFR, 1.07 (0.92 to 1.23) for MI, and 1.12 (1.03 to 1.23) for a composite of death, ESRD, or a 50% decline in GFR. In conclusion, nighttime systolic BP in hospitalized patients is an independent predictor of important clinical outcomes such as a composite of death, ESRD, or a 50% decline in GFR.