"The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure" provides a new guideline
for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of
more than 140 mm Hg is a much more important cardiovascular disease
(CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75
mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive
at 55 years of age have a 90% lifetime risk for developing hypertension; (3)
Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80
to 89 mm Hg should be considered as prehypertensive and require health-promoting
lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should
be used in drug treatment for most patients with uncomplicated hypertension,
either alone or combined with drugs from other classes. Certain high-risk
conditions are compelling indications for the initial use of other antihypertensive
drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor
blockers, β-blockers, calcium channel blockers); (5) Most patients with
hypertension will require 2 or more antihypertensive medications to achieve
goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes
or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal
BP, consideration should be given to initiating therapy with 2 agents, 1 of
which usually should be a thiazide-type diuretic; and (7) The most effective
therapy prescribed by the most careful clinician will control hypertension
only if patients are motivated. Motivation improves when patients have positive
experiences with and trust in the clinician. Empathy builds trust and is a
potent motivator. Finally, in presenting these guidelines, the committee recognizes
that the responsible physician's judgment remains paramount.

https://jamanetwork.com/journals/jama/articlepdf/196589/JSC30096.pdf

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.

The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.

/pdf/cochrane-handbook-for-systematic-reviews-of-interventions-1xbdy6uvru.pdf

Cochrane Handbook for Systematic Reviews of Interventions

抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

The Modification of Diet in Renal Disease (MDRD) Study equation underestimates glomerular filtration rate (GFR) in patients with mild kidney disease. Levey and associates therefore developed and va...

/pdf/a-new-equation-to-estimate-glomerular-filtration-rate-5fqjpsnzwg.pdf

A New Equation to Estimate Glomerular Filtration Rate

Context Little is known about lifetime prevalence or age of onset of DSM-IV disorders. Objective To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Main Outcome Measures Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Results Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. Conclusions About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

https://www.ph.ucla.edu/epi/faculty/detels/PH150/Kessler_DSMIV_AGP2009.pdf

Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication

Left ventricular (LV) thrombus formation is a common complication of anterior wall acute myocardial infarction (AMI).1 However, not all patients with anterior AMI are at a similar risk for this complication. Indeed, we2 reported that severe distortion of LV shape was an independent predictor of LV thrombus formation. Therefore, we decided to test a clinical observation that in patients with a first anterior wall AMI, the development of lateral Q waves in addition to precordial Q waves is observed in those with distortion of LV contour. Because LV contour is an independent predictor of LV thrombus formation, we wished to extend this observation and determine whether the resting post-AMI electrocardiograms could be used to predict the presence or absence of LV thrombus.

Significance of a lateral Q wave following first anterior wall acute myocardial infarction

Myocardial infarction (MI) connotes an appropriate sense of urgency to both healthcare workers and the lay community. The heightened risk of death in the period immediately after the acute coronary event makes MI a medical emergency in which response times are measured in minutes. Clinical signs, symptoms, and electrocardiographic evaluations currently are supplemented by highly specific cardiac markers that detect even minor amounts of myocardial necrosis: the pathonomia of MI. Indeed, major components of the roots of the subspecialty of cardiology can be traced to the concentration of resources and expertise derived from the establishment of coronary care units and studies of MI.

Myocardial Infarct No One Size Fits All

To determine whether the electrocardiogram (ECG) could detect a reduction in ventricular mass with chronic antihypertensive therapy, ECGs were obtained in two year old female normotensive (NR) and spontaneously hypertensive rats (SHR) following nine months of treatment with captopril or water. The ECG of untreated SHR was considerably different than that of age- and sex-matched NR. The notable differences were the increased voltage, left axis deviation, a delay in the intrinsicoid deflection, and the increased frequency of left atrial abnormalities. Chronic captopril therapy produced a substantial reduction in left ventricular mass in the SHR (NR, 0.63 +/- 0.01; SHR, 1.08 +/- 0.03; captopril SHR, 0.80 +/- 0.04 g). The ECG reflected this regression of left ventricular hypertrophy since the voltage and axis of the treated SHR were no longer different than those of NR. Thus, the ECG may be effective in evaluating the regression of cardiac hypertrophy in response to chronic therapy in experimental hypertension.

Alterations in the Electrocardiogram of Spontaneously Hypertensive Rats by Chronic Antihypertensive Therapy With Captopril

SummaryDaily indirect systolic pressure was measured, without anesthesia, for 3 months to determine the relationship between variability and height of pressure in individual normotensive and spontaneously hypertensive (SHR) rats. Average systolic pressure correlated with its standard deviation indicating the higher the pressure the greater its variability. The empiric dividing line for hypertension in the rat of 150 mm Hg was reexamined and found appropriate. No SHR rat had an average weekly pressure less than 150 mm Hg and 28% of the controls had at least 1 weekly average above 150 mm Hg; we have termed these rats as “borderline hypertensives.” Daily variability of pressure of borderline hypertensives was greater than the remaining controls. Therefore, borderline hypertensives have greater lability of arterial pressure.The authors gratefully acknowledge the statistical advice of Drs. John McCoy (of the Veterans Administration Southern Research Support Center, Little Rock, AR) and Donald Parker (of the Un...

Marc A. Pfeffer

Papers

Significance of a lateral Q wave following first anterior wall acute myocardial infarction

Myocardial Infarct No One Size Fits All

Alterations in the Electrocardiogram of Spontaneously Hypertensive Rats by Chronic Antihypertensive Therapy With Captopril

Variability of arterial pressure in normotensive and spontaneously hypertensive rats.

The predictive value of LV systolic sphericity index, a magnification-independent assessment of LV shape