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The synthesis and antimicrobial activity of new pyrrole derivatives structurally related to monodeoxypyoluteorin are described. The insertion of a keto or methylene spacer between the phenol group and the pyrroloyl moiety of brominated 2-(2'-hydroxybenzoyl)pyrroles leads to a decrease of the antibacterial activity.

High blood pressure (BP), a major established predictor of cardiovascular disease, is the leading risk factor for mortality worldwide.1,2 Both systolic BP (SBP) and diastolic BP (DBP) have continuous, independent relations with the risk of cardiovascular disease3; however, considerable uncertainty persists about the relative importance of SBP, DBP, and their combination in predicting cardiovascular risk. Article p 243 Increased peripheral resistance, which is considered to be caused by arterial vasoconstriction, traditionally has been viewed as the key determinant of DBP.4 This has led to the long-standing conviction that the cardiovascular risks associated with hypertension derive principally from the diastolic component of BP. As a matter of fact, the early releases of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defined hypertension on the basis of elevated DBP values only (Table). View this table: Table. Evolving Definition of Hypertension in Adults According to the Joint National CommitteeGuidelines This view has been challenged by a number of studies demonstrating that SBP outweighs DBP as a predictor of cardiovascular morbidity and mortality3,5 and is not just a natural and innocuous consequence of the stiffening of the large arteries caused by aging. It was only in 1988 that the prognostic role of isolated systolic hypertension was acknowledged in the Joint National Committee Report, and since the Fifth Report published in 1993, hypertension has been defined as an elevation of SBP and/or DBP.6 Given the stronger prognostic value of SBP compared with DBP and the prominent role of aortic stiffness as a predictor of cardiovascular outcomes, a simplified definition of hypertension has been proposed.7 According to this view, the thresholds for diagnosing and treating hypertension should be based on SBP only, and DBP values should be discarded, at least in individuals 50 years of age …

OBJECTIVE: Clinicians are often confronted with the incidental finding of isolated minor, non-specific repolarization changes on the electrocardiogram (ECG) in hypertensive patients. The aim of this study was to investigate the prognostic significance of such changes. DESIGN: Prospective, observational study. METHODS: A total of 1970 hypertensive patients without prevalent cardiovascular disease were followed for up to 9.1 years (mean 4.7 years). Patients with ECG abnormalities including ischaemia, previous infarction, bundle branch block, atrial fibrillation and ventricular pre-excitation were excluded. Patients were divided into three groups: normal left ventricular (LV) repolarization (n = 1355); minor repolarization changes (n = 504); and typical LV strain (n = 111). RESULTS: During follow-up, 78 patients developed new-onset ischaemic heart disease. The event rates were 0.50, 1.28 and 3.08 per 100 patient-years in the groups with normal repolarization, minor changes, and typical LV strain, respectively (P < 0.001). After adjustment for the effect of age, sex, diabetes, serum cholesterol, smoking, LV hypertrophy and 24-h pulse pressure, the risk for developing coronary events was higher in patients with minor repolarization changes (hazard ratio 2.07, 95% confidence interval 1.23-3.47; P < 0.01) or LV strain (hazard ratio 4.00, 95% confidence interval 2.09-7.65; P < 0.001) than in patients with normal repolarization (reference category). Population-attributable risks were 21 and 14%, respectively. Minor ST-T changes also retained an adverse prognostic value among patients without LV hypertrophy (hazard ratio 1.90, 95% confidence interval 1.08-3.33; P = 0.026). CONCLUSION: We have identified minor, non-specific LV repolarization changes as a novel, independent risk factor for ischaemic heart disease in patients with uncomplicated hypertension.