Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program.

Pulse pressure has been related to higher risk of cardiovascular events in older persons. Isolated systolic hypertension is common among the elderly and is accompanied by elevated pulse pressure. Treatment of isolated systolic hypertension may further increase pulse pressure if diastolic pressure is lowered to a greater extent than systolic pressure. Little is known regarding pulse pressure as a predictor of cardiovascular outcomes in elderly persons with isolated systolic hypertension, and the influence of treatment on the pulse pressure effect. We assessed the relation between pulse pressure, measured throughout the follow-up period, and the incidence of coronary heart disease (CHD), heart failure (HF), and stroke in 4,632 participants in the Systolic Hypertension in the Elderly Program, a 5-year randomized, placebo-controlled clinical trial of treatment of isolated systolic hypertension in older adults. In the treatment group, a 10-mm Hg increase in pulse pressure was associated with a statistically significant 32% increase in risk of HF and a 24% increase in risk of stroke after controlling for systolic blood pressure and other known risk factors, as well as with a 23% increase in risk of HF and a 19% increase in risk of stroke after controlling for diastolic blood pressure and other risk factors. Pulse pressure was not significantly associated with HF or stroke in the placebo group, nor with incidence of CHD in either the placebo or treatment group. These results suggest that pulse pressure is a useful marker of risk for HF and stroke among older adults being treated for isolated systolic hypertension.

Garlic powder and plasma lipids and lipoproteins: a multicenter, randomized, placebo-controlled trial.

BACKGROUND: Garlic powder tablets have been reported to lower serum cholesterol levels. There is widespread belief among the general public that garlic powder tablets aid in controlling cholesterol levels. However, much of the prior data demonstrating the cholesterol-lowering effect of garlic tablets involved studies that were inadequately controlled. OBJECTIVE: To determine the lipid-lowering effect of garlic powder tablets in patients with hypercholesterolemia. METHODS: This was a randomized, double-blind, placebo-controlled, 12-week, parallel treatment study carried out in 2 outpatient lipid clinics. Entry into the study after 8 weeks of diet stabilization required a mean low-density lipoprotein cholesterol level on 2 visits of 4.1 mmol/L (160 mg/dL) or lower and a triglyceride level of 4.0 mmol/L (350 mg/dL) or lower. The active treatment arm received tablets containing 300 mg of garlic powder (Kwai) 3 times per day, given with meals (total, 900 mg/d). This is equivalent to approximately 2.7 g or approximately 1 clove of fresh garlic per day. The placebo arm received an identical-looking tablet, also given 3 times per day with meals. The main outcome measures included levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol after 12 weeks of treatment. RESULTS: Twenty-eight patients (43% male; mean +/- SD age, 58 +/- 14 years) received garlic powder treatment and 22 (68% male; mean +/- SD age, 57 +/- 13 years) received placebo treatment. There were no significant lipid or lipoprotein changes in either the placebo- or garlic-treated groups and no significant difference between changes in the placebo-treated group compared with changes in the garlic-treated patients. CONCLUSION: Garlic powder (900 mg/d) treatment for 12 weeks was ineffective in lowering cholesterol levels in patients with hypercholesterolemia.

The effects of modified atmospheres on the growth of psychrotrophic pseudomonads on a surface in a model system.

Atmospheres containing concentrations of CO2 as low as 20% (balance nitrogen) inhibited the growth of Pseudomonas fluorescens and Pseudomonas putida on the surface of buffered Brain Heart Infusion agar plates, pH 6.8, incubated at 5 or 15 degrees C in flexible packages. The modified atmospheres decreased the growth rates and reduced the populations attained at the end of the exponential phase of growth, but had no substantial effect on the lag phase. P. fluorescens was less tolerant of CO2 than P. putida. The inhibitory effect of CO2 increased with its concentration and inhibition was greater at 5 than at 15 degrees C. Growth occurred in packages flushed with 20, 40 and 100% CO2 and 100% N2 at 15 degrees C and 20 and 40% CO2 and 100% N2 at 5 degrees C. The residual O2 concentration in the packages after flushing was 0.2-0.5%. Storage of pseudomonads in CO2 under conditions that prevented growth (e.g., 100% CO2, 5 degrees C) did not cause substantial loss of viability. There was no detectable residual effect of CO2. If cultures were incubated in air after storage for up to 70 days in CO2-containing atmospheres which prevented growth, the subsequent growth curve did not differ noticeably from that observed when plates were incubated in air immediately after inoculation. When cultures in the exponential or stationary phases of growth in modified atmospheres were transferred to air, growth rates increased quickly to rates similar to those observed in air and the final populations observed in air were attained. A reduction in the pH of the medium to 5.5 substantially increased the inhibitory effect of CO2. At 5 degrees C and pH 5.5, substantial growth of P. fluorescens was not observed in any of the CO2 concentrations tested, nor in 40 or 100% CO2 for P. putida.

The systolic hypertension in the elderly program. Implications for nursing practice and research.

The Systolic Hypertension in the Elderly Program (SHEP) encompasses two clinical trials--a pilot study and a full-scale trial--investigating the safety and efficacy of antihypertensive therapy for patients aged 60 years and over with isolated systolic hypertension (ISH), that is, systolic blood pressure (SBP) greater than or equal to 160 mmHg and diastolic blood pressure (DBP) less than 90 mmHg. An optimal result of the full-scale trial should lead to recommendations for prescription of effective therapy that preserves the quality of life while reducing the long-term risks of stroke, other cardiovascular disease, and death. This article briefly describes the design, protocol, and organization for the pilot and fullscale SHEP studies. In these trials the nurses help plan study protocol, coordinate patient recruitment, provide patient care, and maintain protocol compliance. In order to accomplish their role in data collection and reporting, they undergo comprehensive training and certification. Nurses utilize the multicenter clinical trial as an opportunity to participate in research, both independently and collaboratively. The specific roles of nurses within these trials, as well as features of these trials that relate to nursing practice and research, are discussed.