Lutgarde Thijs

Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: Objectives, protocol, and organization

SummaryThe Syst-Eur Trial is a concerted action of the European Community’s Medical and Health Research Programme. The trial is carried out in consultation with the World Health Organization, the International Society of Hypertension, the European Society of Hypertension and the World Hypertension League. This article describes the objectives and the protocol of Syst-Eur, a multicentre trial designed by the European Working Party on High Blood. Pressure in the Elderly (EWPHE), to test the hypothesis that antihypertensive treatment of elderly patients with isolated systolic hypertension results in a significant change in stroke morbidity and mortality. Secondary endpoints include cardiovascular events, such as myocardial infarction and congestive heart failure.To be eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160–219 mmHg with a diastolic pressure less than 95 mmHg. Patients must give their informed consent and be free of major cardiovascular and non-cardiovascular diseases at entry. The patients are randomized to active treatment or placebo. Active treatment consists of nitrendipine (10–40 mg/day), combined with enalapril (5–20 mg/day) and hydrochlorothiazide (12.5–25 mg/day), as necessary. The patients of the control group receive matching placebos. The drugs (or matching placebos) are stepwise titrated and combined in order to reduce systolic blood pressure by 20 mmHg at least to a level below 150 mmHg. Morbidity and mortality are monitored to enable an intention-to-treat and perprotocol comparison of the outcome in the 2 treatment groups.A one-year pilot trial (1989) showed that the protocol is practicable. The Ethics Committee therefore decided to start the definite study (1990), in which randomized patients will be followed for 5 years. Recruitment of new centres and of the required 3,000 patients will last 3 years (until 1993).

Determinants of serum zinc in a random population sample of four Belgian towns with different degrees of environmental exposure to cadmium

This report investigated the distribution of serum zinc and the factors determining serum zinc concentration in a large random population sample. The 1977 participants (959 men and 1018 women), 20–80 years old, constituted a stratified random sample of the population of four Belgian districts, representing two areas with low and two with high environmental exposure to cadmium. For each exposure level, a rural and an urban area were selected. The serum concentration of zinc, frequently used as an index for zinc status in human subjects, was higher in men (13.1 μmole/L, range 6.5–23.0 μmole/L) than in women (12.6 μmole/L, range 6.3–23.2 μmole/L). In men, 20% of the variance of serum zinc was explained by age (linear and squared term, R = 0.29), diurnal variation (r = 0.29), and total cholesterol (r = 0.16). After adjustment for these covariates, a negative relationship was observed between serum zinc and both blood (r = −0.10) and urinary cadmium (r = −0.14). In women, 11% of the variance could be explained by age (linear and squared term, R = 0.15), diurnal variation in serum zinc (r = 0.27), creatinine clearance (r = −0.11), log γ-glutamyltranspeptidase (r = 0.08), cholesterol (r = 0.07), contraceptive pill intake (r = −0.07), and log serum ferritin (r = 0.06). Before and after adjustment for significant covariates, serum zinc was, on average, lowest in the two districts where the body burden of cadmium, as assessed by urinary cadmium excretion, was highest. These results were not altered when subjects exposed to heavy metals at work were excluded from analysis.

Vitamin-K-Dependent Protection of the Renal Microvasculature: Histopathological Studies in Normal and Diseased Kidneys

Vitamin-K-dependent carboxylation of matrix Gla protein (MGP) protects the macrocirculation against calcification. We recently reported in a multiethnic population study that the estimated glomerular filtration rate, a microvascular trait, decreased and the risk of chronic kidney disease increased with higher circulating levels of inactive dephospho-uncarboxylated MGP, a marker of vitamin K deficiency. These findings highlighted the possibility that vitamin K might have a beneficial effect on the renal microcirculation. To substantiate these epidemiological findings, we undertook a pilot study, in which we stained renal tissue samples obtained by biopsy from 2 healthy kidney donors and 4 patients with nephropathy for carboxylated and uncarboxylated MGP and calcium deposits. Three patients had renal calcifications, which were consistently associated with carboxylated and uncarboxylated MGP. Normal renal tissue was devoid of microcalcifications and staining for carboxylated and uncarboxylated MGP. Pending confirmation in a larger study covering a wider range of renal pathologies, these histopathological findings suggest that MGP might inhibit calcification not only in large arteries, as was known before, but in renal tissue as well, thereby highlighting potentially new avenues for promoting renal health, for instance by vitamin K supplementation.

Risk of cancer and environmental exposure to cadmium in a prospective population study

Katholieke Univ Leuven, Louvain, Belgium. Univ Hasselt, Hasselt, Belgium. Univ Louvain, Brussels, Belgium.

The Pulse of Asia 2016 Seoul, September 24-26, 2016, Seoul, Republic of Korea: Abstracts

s: The Pulse of Asia 2016 Seoul www.karger.com/pls

Front & Back Matter

of Review Articles: Should be divided into the following subsections: Background, Summary and Key Messages. The Background should provide a brief clinical context for the review and is followed by the Summary, which should include a concise description of the main topics covered in the text. The Key Messages encapsulate the main conclusions of the review. Submit the abstract on a separate page. The abstract should be less than 300 words. Abstracts of Original Papers: Each paper needs an abstract of up to 300 words. It should be structured as follows:s of Original Papers: Each paper needs an abstract of up to 300 words. It should be structured as follows: Background/Aims: What is the major problem that prompted the study? Methods: How was the study performed? Results: Most important findings? Conclusion: Implications, future directions

Contents Vol. 2, 2014

Walter Abhayaratna, Canberra, A.C.T. Fabio Angeli, Perugia Chen-Huan Chen, Taipei Julio Chirinos, Philadelphia, Pa. Olga Fedorova, Baltimore, Md. Jong-Won Ha, Seoul Berthold Hocher, Nuthetal Sae Young Jae, Seoul Xiongjing Jiang, Beijing Yuhei Kawano, Osaka Jae-Ryong Kim, Daegu Kee-Sik Kim, Daegu Kwang-il Kim, Seoul Carmen McEniery, Cambridge Abdul Rashid Rahman, Cyberjaya Ernst R. Rietzschel, Ghent Arno Schmidt-Trucksäss, Basel Jim Sharman, Hobart, Tas. Kohji Shirai, Sakura-shi Jun Tao, Guangzhou Hirofumi Tomiyama, Tokyo Raymond Townsend, Philadelphia, Pa. Hongyu Wang, Beijing Editor

Therapeutic trials in elderly hypertensives: meta-analysis and implications for daily practice

During the last years, several outcome trials in elderly hypertensive patients have been published.