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Nurses are the largest professional group within the health care workforce, and their work is perceived as being physically demanding. Regular physical activity helps to prevent or ameliorate cardiometabolic conditions (e.g. cardiovascular disease, diabetes). It is not known whether Canadian nurses are meeting current physical activity guidelines.To assess the influence of the workplace on the physical activity and cardiometabolic health of nurses from hospitals in the Champlain region of Ontario, Canada.A multi-centre, cross-sectional study.Hospitals in the Champlain Local Health Integration Network of Ontario.Nurses wore an ActiGraph accelerometer to objectively assess levels of moderate-to-vigorous intensity physical activity measured in minutes/day in bouts ≥10 min. All completed the Perceived Workplace Environment (PWE) scale and International Physical Activity Questionnaire (IPAQ). Height, body mass, waist circumference, blood pressure and heart rate were measured, and body mass index (BMI) was determined. Each nurse's 5-year cardiovascular risk was calculated using the Harvard Score.A total of 410 nurses (94% female; mean ± SD: age = 43 ± 12 years) from 14 hospitals participated. Nurses spent an average of 96 ± 100 min/week in bouts ≥10 min of moderate-to-vigorous intensity physical activity; 23% of nurses met recommended physical activity guidelines. Nurses working 8- vs. 12-h shifts (16 ± 16 vs. 10 ± 11 min/day, p = 0.026), fixed vs. rotating shifts (15 ± 15 vs. 12 ± 13 min/day, p = 0.012) and casual vs. full-time (29 ± 17 vs. 13 ± 15 min/day, p 0.001) or vs. part-time (29 ± 17 vs. 13 ± 12 min/day, p = 0.001) accumulated more moderate-to-vigorous intensity physical activity in bouts ≥10 min. The average PWE score was 2.4 ± 0.9, with no association between PWE scores and moderate-to-vigorous intensity physical activity in bouts ≥10 min (p 0.05). Nurses working 8-h shifts, fixed shifts and in urban hospitals reported better PWE scores (p 0.05). Nurses working fixed vs. rotating shifts had higher systolic blood pressure (median: 114 vs. 112 mmHg, p = 0.043), and nurses working in rural vs. urban hospitals had higher BMI (median: 27.8 vs. 25.6 kg/mNurses are not meeting current physical activity guidelines (150 min of moderate-to-vigorous intensity physical activity per week in 10-min bouts), yet exceeded these recommendations when examining their continuous (i.e. non bouts) physical activity levels. No association between the PWE and moderate-to-vigorous intensity physical activity was observed. Rotating vs. fixed shifts, 12- vs. 8-h shifts, and/or full-time or part-time vs. casual hours may impede nurses' ability to meet recommended physical activity levels. The low physical activity levels and poor cardiometabolic health of Canadian nurses warrant attention.

We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2013. This year's update includes 2 new recommendations. First, among nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise does not adversely influence blood pressure (BP) (Grade D). Thus, such patients need not avoid this type of exercise for fear of increasing BP. Second, and separately, for very elderly patients with isolated systolic hypertension (age 80 years or older), the target for systolic BP should be150 mm Hg (Grade C) rather than140 mm Hg as recommended for younger patients. We also discuss 2 additional topics at length (the pharmacological treatment of mild hypertension and the possibility of a diastolic J curve in hypertensive patients with coronary artery disease). In light of several methodological limitations, a recent systematic review of 4 trials in patients with stage 1 uncomplicated hypertension did not lead to changes in management recommendations. In addition, because of a lack of prospective randomized data assessing diastolic BP thresholds in patients with coronary artery disease and hypertension, no recommendation to set a selective diastolic cut point for such patients could be affirmed. However, both of these issues will be examined on an ongoing basis, in particular as new evidence emerges.

The aim of this paper was to critically evaluate recent publications on hypertension treatment and control in regions by income. Prevalence of hypertension is increasing worldwide, most prominently in low-income countries. Awareness, treatment, and control are most successful in North America while remaining a challenge in middle- and low-income countries. Easy access to medical care and aggressive use of pharmacotherapy are the key strategies which have proved to be successful in reducing the burden of hypertension on the population level.

Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a β-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates.

Cardiovascular diseases (CVD) are now the number one cause of death in low- and middle-income countries (LMIC), such as those in South East Asia (SEA). It is projected that SEA countries will have the greatest total number of deaths due to non-communicable diseases (NCDs) by 2020. In low resource countries, the rising burden of CVDs imposes severe economic consequences that range from impoverishment of families to high health system costs and the weakening of country economies. There are two possible options to be considered for addressing this issue: a “population-based strategy” and/or a “high risk” strategy. The question is, what is the optimal way to reduce the excessive burden of these diseases in the LMICs. We believe that by applying systematic policy and smoking cessation programs with proven effectiveness, there is a chance that the high smoking prevalence, particularly among SEA.

We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2012. The new recommendations are: (1) use of home blood pressure monitoring to confirm a diagnosis of white coat syndrome; (2) mineralocorticoid receptor antagonists may be used in selected patients with hypertension and systolic heart failure; (3) a history of atrial fibrillation in patients with hypertension should not be a factor in deciding to prescribe an angiotensin-receptor blocker for the treatment of hypertension; and (4) the blood pressure target for patients with nondiabetic chronic kidney disease has now been changed to < 140/90 mm Hg from < 130/80 mm Hg. We also reviewed the recent evidence on blood pressure targets for patients with hypertension and diabetes and continue to recommend a blood pressure target of less than 130/80 mm Hg.

BACKGROUND Hungary has one of the highest mortality rates due to strokes among the European Union countries. As elevated blood pressure (BP) is the principal risk factor for strokes, we assessed BP levels, as well as awareness and treatment status of hypertension and prehypertension in a working population sample in Hungary. METHODS Worksite employees in Budapest and Szeged were screened for their BP using an automated BP measuring instrument (BpTRU). BpTRU readings of heart rate (HR) were also recorded. Respondents were classified as normotensives (NT), prehypertensives (PHTN) and hypertensives (HTN) according to their BP levels, as defined by the JNC 7 guidelines. Body height and body weight were measured and body mass index (BMI) was calculated. Self-reported information regarding smoking was collected. RESULTS In total, 2,012 respondents were recruited (1,000 white collar; 1,012 blue-collar workers), with a mean (±s.d.) age of 34.8 (±9.9) years. Of all respondents, 22.6% were identified as HTN and 39.8% as PHTN. Among HTN, 40% were unaware of their condition and only 18.5% were adequately treated. PHTN were similar in age as NT, but showed significantly higher HR. CONCLUSIONS A high proportion of relatively young and apparently healthy Hungarian employees were diagnosed with prehypertension and hypertension. Only a small proportion of HTN had their BP controlled. BMI and HR were significantly higher among individuals with prehypertension compared to NT. Whether the high rates of hypertension, prehypertension, and low levels of control explain the high stroke mortality and unfavorable cardiovascular disease (CVD) profile of Hungary needs further study.

Background Analyses of medication databases indicate marked increases in prescribing of antihypertensive drugs in Canada over the past decade. This study was done to examine the trends in the prevalence of hypertension and in control rates in Canada between 1992 and 2009. Methods Three population-based surveys, the 1986–1992 Canadian Heart Health Surveys, the 2006 Ontario Survey on the Prevalence and Control of Hypertension and the 2007–2009 Canadian Health Measures Survey, collected self-reported health information from, and measured blood pressure among, community-dwelling adults. Results The population prevalence of hypertension was stable between 1992 and 2009 at 19.7%–21.6%. Hypertension control improved from 13.2% (95% confidence interval [CI] 10.7%–15.7%) in 1992 to 64.6% (95% CI 60.0%–69.2%) in 2009, reflecting improvements in awareness (from 56.9% [95% CI 53.1%–60.5%] in 1992 to 82.5% [95% CI 78.5%–86.0%] in 2009) and treatment (from 34.6% [95% CI 29.2%–40.0%] in 1992 to 79.0% [95% CI 71.3%–86.7%] in 2009) among people with hypertension. The size of improvements in awareness, treatment and control were similar among people who had or did not have cardiovascular comorbidities Although systolic blood pressures among patients with untreated hypertension were similar between 1992 and 2009 (ranging from 146 [95% CI 145–147] mm Hg to 148 [95% CI 144–151] mm Hg), people who did not have hypertension and patients with hypertension that was being treated showed substantially lower systolic pressures in 2009 than in 1992 (113 [95% CI 112–114] v. 117 [95% CI 117–117] mm Hg and 128 [95% CI 126–130] v. 145 [95% CI 143–147] mm Hg). Interpretation The prevalence of hypertension has remained stable among community-dwelling adults in Canada over the past two decades, but the rates for treatment and control of hypertension have improved markedly during this time.

BACKGROUND Blood pressure (BP) awareness is a main focus of public health efforts. In Austria, an increase of knowledge and perception regarding hypertension was seen after a nationwide educational campaign in 1978, but subsequent surveys documented only short-term impact. We report results of the latest survey in 2009 in comparison to 1978 and 1998. METHODS Balanced for Austrian demographic characteristics 1,005 men and women older than 15 years of age were randomly selected for face-to-face interviews about BP awareness, risk factors, and hazards of hypertension and treatment options including life-style interventions. RESULTS Overall, 15% identified themselves as hypertensive, which is similar to results from 1978 (14%) but significantly higher than 1998 (12%; P < 0.01). The proportion of hypertensives not undertaking any measure (i.e., pharmacotherapy or life-style changes) significantly decreased since 1998 (5% vs. 10%; P < 0.0001). Thirty-three percent recalled to have measured their BP within the last 3 months, which is comparable to 1998 (34%) but lower than in 1978 (49%) after the nationwide educational BP campaign (P < 0.0001). Alarmingly, an unchanged proportion of 8% reported no BP measurement ever (1978 and 1998: 8%, respectively). Sixty-one percent believed they would be able to clearly identify symptoms of hypertension, while only 19% knew that hypertension might not be noticeable. Heart attack and stroke were considered the most common sequelae of hypertension. CONCLUSION Despite a high understanding of the risks of hypertension among the Austrian population, a widespread misconception regarding BP symptoms and infrequent personal checks are worrisome and might also be valid in other Western countries.

There are large differences in all-cause and cardiovascular disease (CVD) mortality between eastern and western countries in Europe. We reviewed the development of these mortality trends in countries of the European Union (EU) over the past 40 years and evaluated available data regarding possible determinants of these differences.We summarized all-cause mortality and specific cardiovascular mortality for two country groups - 10 countries that joined the European Union (EU) after 2004 (East), and 15 countries that joined before 2004 (West). Standardized mortality rates were retrieved from the World Health Organization "European Health for All" database for each country between 1970 and 2007. Currently (in the 2000s), mortality due to circulatory system disease, ischemic heart disease (IHD), cerebrovascular disease (CBVD), and all-causes in the 'new' EU countries (East) is approximately twice that in the 'old' EU countries (West). These differences were much smaller in the 1970s. The increasing gap in mortality between West and East is primarily the result of a continuous and rapid improvement in the West.Differences in lifestyle (i.e. diet, alcohol consumption, physical activity, and smoking) provide insufficient explanation for the observed mortality gap in these two groups of EU countries. Higher expenditures on health, better access to invasive and acute cardiac care, and better pharmacological control of hypertension and hypercholesterolemia in the West are well documented. Socioeconomic and psychosocial factors may also contribute to the changes in mortality trends.

BACKGROUND We evaluated the association of body weight with the prevalence of hypertension by age and sex, as well as the treatment and control rates in obese and nonobese hypertensives among adults in the province of Ontario, Canada. METHODS Cross-sectional, population-based survey of 2,510 adults, 20-79 years of age representative of the Ontario population of 7,996,653. Height, weight, arm and waist circumference, and blood pressure (BP) were directly measured by a trained nurse. RESULTS Prevalence of obesity (body mass index (BMI) > or =30) increased from 16% in the 20-39 years age-group to 33% in the 60-79 years age group, similarly in men and women. Prevalence of hypertension increased as BMI and age increased: in the older age group (60+) from 36% in the lean to 51% for the overweight, 59% in the obese stage I, and 68% in the obese stage II/III. Prevalence of self-reported diabetes followed a similar pattern. Presence of other risk factors (diabetes and dyslipidemia) was independently associated with higher hypertension rates. Treatment and control rates of hypertension varied by BMI and gender. Lean hypertensive males had the lowest control rates (42%) and the highest systolic BPs compared to overweight (79%) and obese (64%) males. This difference was not apparent in females. CONCLUSIONS Obesity is associated with markedly higher prevalence of hypertension and diabetes with age. If obesity per se is indeed a contributing factor, public health strategies to reduce the obesity epidemic would also markedly reduce the burden of hypertension and diabetes.

The relationship between the incidence of myocardial infarction in the 10 year follow-up period and the length of the QT interval and its two components (the time elapsing between the Q wave and the beginning of the T wave, and the duration of the T wave) was investigated in a study of the records of a group of men drawn from a random sample of all 55-year-old men living in Göteborg, Sweden. A significant association was found between the incidence of myocardial infarction and the first component but not with the second component or the QT interval itself. The two components were found to be independent and thus to have the potential to act as confounding factors if the QT interval is examined alone. Further, our results suggest that correcting the QT interval for heart rate needs careful reassessment.

Several randomized controlled trials indicate that a low density lipoprotein cholesterol (LDL-C) target2.0 mmol/L is appropriate for individuals at high risk of coronary artery disease (CAD). Recently released Canadian lipid management guidelines (2006) have incorporated this evidence into their recommendations. A cross-sectional study of patients treated with statins for at least 8 weeks (CALIPSO) was used as a basis to project the ability of statin monotherapy in getting high CAD-risk patients to an LDL-C level2.0 mmol/L.The analysis was restricted to CALIPSO patients on statin monotherapy who were at high CAD-risk (including patients with established CAD). Assuming all patients could have their statin titrated up to the maximum dose, the proportion of patients that would reach an LDL-C level of2.0 mmol/L was projected. To do this, the additional LDL-C reduction patients would achieve with maximal titration of their statin was estimated based on a meta-analysis of clinical trials evaluating LDL-C responses to various statin regimens, and applied to patients' current LDL-C level.A total of 1795 high CAD-risk patients treated with statin monotherapy were included in the analysis, of whom 69.8% had an LDL-Cor =2.0 mmol/L. Depending on the statin that was used, it was projected that between 28.2% and 62.7% of high CAD-risk patients would not attain an LDL-C of2.0 mmol/L following statin titration to maximum dose.Although the accuracy of our projections may be limited by the application of clinical trials data to an external sample of patients, our results suggest that for 38% of patients at high CAD-risk, titration of statin monotherapy will not be sufficient to achieve an LDL-C target of2.0 mmol/L. For these patients, additional treatment approaches may be needed to further reduce the risk of coronary events.

BACKGROUND The Ontario Blood Pressure (ON-BP) survey reported high treatment and control rates for hypertension in the province of Ontario, Canada, in a survey performed in 2006. This study examined patterns of utilization of antihypertensive drug classes and their impact on blood pressure (BP) control. METHODS Cross-sectional, population-based survey of adults, 20-79 years of age (population 7,996,653). Responses are weighted to the Ontario hypertensive population of 1,498,045. RESULTS Of all hypertensives, 51 and 49% were on monotherapy vs. 2+ drug therapy with similar control rates (86 vs. 80%, respectively). In those on monotherapy a renin-angiotensin system (RAS) blocker was the most commonly used drug class (62%) and use of other drug classes was only approximately 10%. In those on 2+ therapy, a RAS blocker was also the most common class (80%), followed by a diuretic (67%). In diabetics with hypertension 46 and 54% were on monotherapy vs. 2+ drug therapy with significantly higher control rates on monotherapy (90 vs. 46%). RAS blocker was also the most common drug class (85 and 80%, respectively), but in those on 2+ drugs only 45% were on a diuretic. Control rates did not differ by type of drug treatment in the overall hypertensive population and those with a comorbidity, but were low in diabetics on 2+ therapy and particularly in those on a calcium channel blocker (CCB) or diuretic. CONCLUSIONS High treatment and control rates of hypertension in Ontario are associated with high utilization of RAS blockers. Diabetics on 2+ therapy are the least effectively controlled, possibly reflecting the limited use of diuretics.

Background. Elevated plasma homocysteine levels are reported to be associated with higher rates of vascular diseases. Plasma homocysteine increases in chronic kidney disease (CKD) and could contribute to the increased cardiovascular risk in CKD. Methods. Participants aged 55 years or older with CKD, defined as estimated GFR

Background: Central obesity, diabetes mellitus, dyslipidaemia and chronic hypertension-features of the metabolic syndrome-have been individually associated with venous thromboembolism (VTE). However, whether each of these factors additively increases the risk of VTE is uncertain. Aim: To determine whether features of the metabolic syndrome independently increase the risk of VTE. Design: Prospective cohort study derived from the Heart Outcomes Prevention Evaluation 2 (HOPE-2) randomized clinical trial. Setting: One hundred and forty-five clinical centres in 13 countries. Methods: We studied 5522 adults aged >55 years with cardiovascular disease or diabetes mellitus. At enrolment, 35% had 0-1 features of the metabolic syndrome, 30% had two, 24% had three and 11% had four. We defined symptomatic VTE as an objectively confirmed new episode of deep-vein thrombosis or pulmonary embolism. Results: VTE occurred in 88 individuals during a median 5.0 years of follow-up. The incidence rate of VTE (per 100 person-years) was 0.30 with 0-1 features, 0.36 with two features, 0.38 with three features and 0.40 with four features of the metabolic syndrome (trend p=0.43). Relative to the presence of 0-1 features of the metabolic syndrome, the adjusted hazard ratio (95%Cl) for VTE was 1.22 (0.71-2.08) with two features, 1.25 (0.70-2.24) with three features, and 1.26 (0.59-2.69) with four features. Discussion: The number of features of the metabolic syndrome present was not a clinically important risk factor for VTE in older adults with vascular arterial disease.

Objective To provide updated, evidence-based recommendations for the prevention and management of hypertension in adults. Options and Outcomes For lifestyle and pharmacological interventions, evidence was reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. For treatment of patients with kidney disease, the progression of kidney dysfunction was also accepted as a clinically relevant primary outcome. Evidence A Cochrane collaboration librarian conducted an independent MEDLINE search from 2005 to August 2006 to update the 2006 Canadian Hypertension Education Program recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence. Recommendations Dietary lifestyle modifications for prevention of hypertension, in addition to a well-balanced diet, include a dietary sodium intake of less than 100mmol/day. In hypertensive patients, the dietary sodium intake should be limited to 65mmol/day to 100mmol/day. Other lifestyle modifications for both normotensive and hypertensive patients include: performing 30min to 60 min of aerobic exercise four to seven days per week; maintaining a healthy body weight (body mass index of 18.5kg/m2 to 24.9kg/m2) and waist circumference (less than 102cm in men and less than 88 cm in women); limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women; following a diet reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and considering stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and any comorbid conditions: blood pressure should be lowered to lower than 140/90 mmHg in all patients and lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients require more than one agent to achieve these blood pressure targets. In adults without compelling indications for other agents, initial therapy should include thiazide diuretics; other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin-converting enzyme (ACE) inhibitors (except in black patients), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age). First-line therapy for isolated systolic hypertension includes long-acting dihydropyridine CCBs or ARBs. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction, or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor plus diuretic combination is preferred; in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered. Validation All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.

Background Hypertension is highly prevalent among adults, and is the most important modifiable risk factor for cardiovascular events, in particular stroke. Decreasing sodium intake has the potential to prevent or delay the development of hypertension and improve blood pressure control, independently of blood pressure lowering drugs, among hypertensive patients. Despite guidelines recommending a low sodium diet, especially for hypertensive individuals, sodium intake remains higher than recommended. A recent systematic review indicated that the efficacious counselling methods described in published trials are not suitable for hypertension management by primary care providers in Canada in the present form. The primary reason for the lack of feasibility is that interventions for sodium restriction in these trials was not limited to counselling, but included provision of food, prepared meals, or intensive inpatient training sessions. Methods/design This is a parallel, randomized, controlled, open-label trial with blinded endpoints. Inclusion criteria are adult patients with hypertension with high dietary sodium intake (defined as ≥100 mmol/day). The control arm will receive usual care, and the intervention arm will receive usual care and an additional structured counselling session by a registered dietitian, with four follow-up telephone support sessions over four weeks. The two primary outcomes are change in sodium intake from baseline, as measured by a change in 24-hour urinary sodium measurements at four weeks and one year. Secondary outcomes include change in blood pressure (as measured by 24-hour ambulatory monitoring), change in 24-hour urinary potassium, and change in body weight at the same time points. Discussion Though decreasing sodium intake has been reported to be efficacious in lowering blood pressure, there exists a gap in the evidence for an effective intervention that could be easily translated into clinical practice. If successful, our intervention would be suitable for outpatient programs such as hypertension clinics or interprofessional family practices (family health teams). A negative, or partially negative (positive effect at four weeks with attrition by 12 months) trial outcome also has significant implications for healthcare delivery and use of resources. Trial registration The trial was registered with Clinicaltrials.gov (identifier: NCT02283697) on 2 November 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0794-y) contains supplementary material, which is available to authorized users.

The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.

Background The rapid pace of modern life requires working-age women to juggle occupational, family, and social demands. Despite the large numbers of working-age women in developed countries and the proven benefits of regular moderate-to-vigorous intensity aerobic physical activity (MVPA) in chronic disease prevention, few women meet current physical activity (PA) recommendations of 150 min of MVPA per week. It is important that appropriate and effective behavioral interventions targeting PA are identified and developed to improve the MVPA levels of working-age women. As women worldwide embrace modern technologies, e-health innovations may provide opportune and convenient methods of implementing programs and strategies to target PA in an effort to improve MVPA levels and cardiometabolic health. Previous reviews on this topic have been limited; none have focused on working-age women from developed countries who exhibit inappropriately low PA levels. It remains unknown as to which e-health interventions are most effective at increasing MVPA levels in this population. The purpose of this systematic review is to examine the effectiveness of e-health interventions in raising MVPA levels among working-age women in developed countries and to examine the effectiveness of these interventions in improving the health of women. Methods Eight electronic databases will be searched to identify all prospective cohort and experimental studies examining the impact of e-health interventions for increasing MVPA levels among working-age women (mean age 18–65 years) in developed countries. Gray literature including theses, dissertations, and government reports will also be examined. Study quality will be assessed using a modified Downs and Black checklist, and risk of bias will be assessed within and across all included studies using the Cochrane’s risk of bias tool and Grades of Recommendation, Assessment, Development and Evaluation approach. A quantitative synthesis in the form of meta-analyses for measures of MVPA and health outcomes will be conducted where possible. Discussion This review will determine the effectiveness of e-health interventions in raising MVPA levels in working-age women in developed countries. It will form a contemporary, rigorously developed, and reliable research base for policy makers and stakeholders; and inform and influence the development and implementation of effective e-health interventions designed to increase MVPA levels and improve health outcomes in this population. Systematic review registration PROSPERO CRD42014009534

OBJECTIVES: To create awareness of cardiovascular health status by screening for cardiovascular risk factors, and thereby motivate people to improve their life style habits. This was carried out in form of a project within the framework of the government prevention programme "A Heart for Vienna" focussing on urban blue-collar workers, a population at greatest risk for developing cardiovascular disease. RESULTS: The prevalence of hypertension, overweight, obesity, abdominal obesity and smoking were 29.7 %, 62.4 %, 16.4 %, 29.3 %, and 49.8 %, respectively. 87.6 % presented at least one of the screened cardiac risk factors. The prevalence of hypertension, overweight, obesity and abdominal obesity increased with age. Hypertension, overweight and abdominal obesity were significantly more prevalent among unskilled compared to skilled male bluecollar workers. The prevalence of obesity and abdominal obesity was more than 1.5 times higher among female compared to male blue-collar workers. CONCLUSION: Blue-collar workers represent a population where health promotion and prevention of cardiovascular disease should have high priority. Within the bluecollar group itself the cardiovascular risk profile worsened with reduction in skill level.

In observational studies, lower homocysteine levels are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine levels. We assessed whether supplementation reduced the risk of major cardiovascular events in patients with vascular disease.We randomly assigned 5522 patients 55 years of age or older who had vascular disease or diabetes to daily treatment either with the combination of 2.5 mg of folic acid, 50 mg of vitamin B6, and 1 mg of vitamin B12 or with placebo for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke.Mean plasma homocysteine levels decreased by 2.4 micromol per liter (0.3 mg per liter) in the active-treatment group and increased by 0.8 micromol per liter (0.1 mg per liter) in the placebo group. Primary outcome events occurred in 519 patients (18.8 percent) assigned to active therapy and 547 (19.8 percent) assigned to placebo (relative risk, 0.95; 95 percent confidence interval, 0.84 to 1.07; P=0.41). As compared with placebo, active treatment did not significantly decrease the risk of death from cardiovascular causes (relative risk, 0.96; 95 percent confidence interval, 0.81 to 1.13), myocardial infarction (relative risk, 0.98; 95 percent confidence interval, 0.85 to 1.14), or any of the secondary outcomes. Fewer patients assigned to active treatment than to placebo had a stroke (relative risk, 0.75; 95 percent confidence interval, 0.59 to 0.97). More patients in the active-treatment group were hospitalized for unstable angina (relative risk, 1.24; 95 percent confidence interval, 1.04 to 1.49).Supplements combining folic acid and vitamins B6 and B12 did not reduce the risk of major cardiovascular events in patients with vascular disease. (ClinicalTrials.gov number, NCT00106886; Current Controlled Trials number, ISRCTN14017017.).

Background The rapid pace of modern life requires working-age women to juggle occupational, family and social demands. This modern lifestyle has been shown to have a detrimental effect on health, often associated with increased smoking and alcohol consumption, depression and cardiovascular disease risk factors. Despite the proven benefits of regular moderate-to-vigorous intensity physical activity (MVPA), few are meeting the current physical activity (PA) recommendations of 150 min of MVPA/week. It is important that appropriate and effective behavioural interventions targeting PA are developed and identified to improve the MVPA levels of working-age women. As these women spend a substantial proportion of their waking hours at work, workplaces may be an opportune, efficient and relatively controlled setting to implement programmes and strategies to target PA in an effort to improve MVPA levels and impact cardiometabolic health. The purposes of this systematic review are to compare the effectiveness of individual-level workplace interventions for increasing MVPA levels in working-age women in high-income/developed countries and examine the effectiveness of these interventions for improving the known beneficial health sequelae of MVPA. Methods/Design Eight electronic databases will be searched to identify all prospective cohort and experimental studies that examine the impact of individual-level workplace interventions for increasing MVPA levels among working-age (mean age 18–65 years) women from high-income/developed countries. Grey literature including theses, dissertations and government reports will also be included. Study quality will be assessed using a modified Downs and Black checklist, and risk of bias will be assessed within and across all included studies using the Cochrane’s risk of bias tool and Grades of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses will be conducted where possible among studies with sufficient homogeneity. Discussion This review will determine the effectiveness of individual-level workplace interventions for increasing MVPA levels in working-age women in high-income/developed countries, and form a current, rigorous and reliable research base for policy makers and stakeholders to support the development and implementation of effective workplace interventions that increase MVPA levels in this population. Systematic review registration PROSPERO CRD42014009704

Background. The majority of the population is inactive, and strategies to date for promoting regular physical activity have been limited in their effectiveness. Further research is needed to identify correlates of physical activity in different subgroups to design more efficacious interventions. This study sought to identify correlates of physical activity across men and women, urban and rural geographical locations, and four distinct age groups (18–25; 26–45; 46–59; and 60+). Methods. This study employed data from a large provincial household random sample (N = 20,606) of Canadians. Analyses were utilized to examine the amount of variance explained in self-reported physical activity by a number of demographic and/or biological, psychological, behavioral, social, and environmental variables within each subgroup. Results. Proportion of friends who exercise, injury from past physical activity, educational level, perceived health status, and alcohol consumption were among the strongest correlates across subgroups. Conclusions. A number of correlates were identified as being significant across all subgroups examined. Most differences in the correlates of physical activity were found within different age groups rather than among urban and rural residents and gender.

This paper presents a reusable framework for coordinating a team of mobile robots that can accomplish high level or tightly coupled missions, which could not be easily achieved using single robot solutions. To complete this task, we consider the behavior-based architecture model for the basic control layer. For coordinating the team of autonomous mobile robots, we use the agent-oriented software engineering paradigm. We apply the combination of a single and of multiagent techniques for evaluating a search-and-rescue mission. The experiments are using the Pioneer 2 DX robot and the Saphira simulator.

Coronary heart disease (CHD) is the leading cause of death in developed countries. Gender has a significant influence on the cause, clinical manifestation and prognosis of CHD. Men develop CHD approximately 10 to 15 years earlier than women. Non-modifiable CHD risk factors such as age and family history have a different effect in men than in women. Modifiable risk factors also show differences between the sexes. Smoking is more prevalent and hypertension less controlled in men. Overweight and obesity appear to be more potent risk factors in men, and the higher prevalence of abdominal obesity in men increases their risk for CHD. According to some studies this could explain gender differences in the incidence of CHD but women’s significant protection against CHD during their reproductive years could be another explanation. Myocardial infarction is usually the first manifestation of CHD in men and the risk of its recurrence is twice as high in men as in women. A robust database provides evidence that routine thorough cardiovascular risk assessment in men over 40 years of age and in postmenopausal females is a prudent procedure. Lifestyle changes and timely and aggressive therapy for lipid disorders, hypertension and diabetes mellitus can improve the prognosis of high-risk patients.

In a re-analysis of data collected during the 2006 Ontario Survey on the Prevalence and Control of Hypertension (Leenen et al, CMAJ 2008), we focussed on the actual blood pressures in treated and untreated older and middle-aged hypertensives. In the older (60-79 years of age) population of 1,426,752 subjects, using traditional definitions the prevalence of hypertension was 49% compared to 21% in the middle-aged (40-59 years of age) population. Hypertension treatment and control rates were similarly high in middle-aged and older hypertensives at 67% and 64% respectively. 39% of older hypertensives were treated with a single antihypertensive drug, and of these 54% had a systolic BP level of < 130 mmHg, and 23% had a systolic BP < 120 mmHg. Of the 61% treated with combination therapy, 44% had a systolic BP < 120 mmHg. 13% of older hypertensives were untreated, and out of those approximately 90% had Stage 1 hypertension, with ~70% without additional risk factors. Considering that monotherapy may lower systolic BP by < 10 mmHg, these findings suggest that there may be a major problem of over-diagnosis and/or over-treatment of hypertension in older adults overestimating substantially the actual prevalence of hypertension, creating an unnecessary burden on the health care system and exposing many older subjects to unnecessary risks of drug therapy.

To evaluate whether efficacious counseling methods on sodium restriction can be successfully incorporated into primary care models for the management of hypertension.We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment to identify randomized controlled trials of dietary counseling for salt intake reduction that reported significant reduction in 24-h urinary sodium and blood pressure levels among adults with untreated hypertension. Data extraction and assessment of reproducibility and feasibility were done in duplicate and any disagreements were resolved by consensus.Six trials were included for assessment of methods as they were efficacious in reducing sodium intake (24-h urinary sodium excretion) by 73 to 93 mmol/day (intervention) vs. 3.2 to 12.5 mmol/day (control). This was paralleled with a reduction in blood pressure (-4 to -27 mmHg) between groups. In four of the six trials, the methods were described in sufficient detail to be reproducible, but in none of these trials were the 'counseling methods' feasible for application in primary care settings. Apart from multiple sessions of counseling, the reported interventions were supplemented with provision of prepared food, community cooking classes, and intensive inpatient training sessions.Despite the availability of efficacious counseling methods for the reduction of sodium intake among newly diagnosed hypertensive patients (feasible within a clinical trial setting), none of these methods, in their present form, are suitable for incorporation into existing primary care settings in countries such as Canada, United States, and UK.

Calprotectin represents an interesting peptide known to be involved in the pathophysiology of various inflammatory processes. Being secreted from activated neutrophils and monocytes under various conditions, it can also be found in the extracellular fluids and serve as a biomarker of ongoing inflammation, which property is currently used in the monitoring of inflammatory bowel diseases. Recent studies, however, suggest that calprotectin could serve as an important prognostic factor for cardiovascular and cardiometabolic diseases, since these are occurring on the basis of low-grade chronic inflammation. We assume that calprotectin may represent a useful marker in predicting the course of atherosclerotic process, coronary artery disease and acute coronary syndromes. Our review is focused on the importance of calprotectin in the diagnosis and prognostic stratification in the field of cardiometabolic risk.

Two North American population based surveys, the Third National Health and Nutrition Examination Survey (NHANES III) and the Canadian Heart Health Surveys (CHHS) have similar time frames and methods that allow comparisons between these countries in terms of the distribution of systolic (SBP) and diastolic (DBP) blood pressure and the levels of hypertension awareness, treatment, and control.Cross-sectional population surveys using similar methods conducted home interviews and clinic visits (CHHS), and medical examinations (NHANES III). The CHHS included the ten Canadian provinces (1986-1992) and NHANES III, a representative sample of the United States population (1988-1994). Blood pressure measurements were available for 23,111 Canadians (age 18-74 years), and restricted to the 15,326 US participants in the same age range (age 18-74 years) with both systolic and diastolic mean values. Standardized techniques were used for BP measurements. Mean of all available measurements was used from four measurements for the CHHS and six measurements for NHANES III. A mean SBP/DBP of 140/90 mm Hg or treated with medication defined hypertension. All measures were weighted to represent population values.Both surveys showed similar trends in mean BP by age, with slightly higher levels in the CHHS. Hypertension prevalence using the same definitions and the same age range (18-74 years) was NHANES III: 20.1%, CHHS: 21.1%. Although the prevalence of isolated systolic hypertension (ISH) was similar in both studies, around 8% to 9%, the CHHS had higher ISH prevalence than NHANES III in the younger age groups and lower prevalence in the older age groups. Elevated SBP dominated the prevalence figures after the 1950s in both studies. Compared to NHANES III, the CHHS showed a lower proportion (43% v 50%) of individuals with optimal BP (120/80 mm Hg) and a very low proportion of hypertensives under control (13% v 25%). About half of diabetic participants were hypertensive (using 140/90 mm Hg) in both countries with a very low level of control in Canada (9%) v the US (36%) for ages 18 to 74 years.The results of these two surveys highlight the importance of SBP, in the later decades of life, an overall low control of hypertension in both countries, and a better overall awareness, treatment, and control of hypertension in the US than in Canada for that period. Dissemination of hypertension guidelines and a more aggressive focus on SBP are urgently needed in Canada, with special attention to diabetics.

During the 1970s, 2 Danish investigators, Bang and Dyerberg, on being informed that the Greenland Eskimos had a low prevalence of coronary artery disease (CAD) set out to study the diet of this population. Bang and Dyerberg described the "Eskimo diet" as consisting of large amounts of seal and whale blubber (ie, fats of animal origin) and suggested that this diet was a key factor in the alleged low incidence of CAD. This was the beginning of a proliferation of studies that focused on the cardioprotective effects of the "Eskimo diet." In view of data, which accumulated on this topic during the past 40 years, we conducted a review of published literature to examine whether mortality and morbidity due to CAD are indeed lower in Eskimo/Inuit populations compared with their Caucasian counterparts. Most studies found that the Greenland Eskimos and the Canadian and Alaskan Inuit have CAD as often as the non-Eskimo populations. Notably, Bang and Dyerberg's studies from the 1970s did not investigate the prevalence of CAD in this population; however, their reports are still routinely cited as evidence for the cardioprotective effect of the "Eskimo diet." We discuss the possible motives leading to the misinterpretation of these seminal studies.

In previous work we have introduced and discussed the execution monitoring paradigm Ontological Control (OC). The fundamental idea of OC is that the execution of a controller for a hybrid system should be monitored and that discrepancies between expected behavior (according to some model) and real behavior should be detected and classified as being either due to external actions (disturbances) or due to violations of ontological assumptions (faulty expectations or inadequate model). In this paper we report a first set of experimental results where the OC theory has been implemented and tested on data from a real process control system: The ABB STRESSOMETER rolling mill flatness control system.

Background The presently available Canadian data, based on direct measurements of blood pressure (BP) from the Canadian Heart Health Surveys, are more than 15 years old. In view of major changes in the demographics and health status of the Ontario population, there is an urgent need to update this information. On the initiative of the Heart and Stroke Foundation of Ontario, the University of Ottawa Heart Institute, jointly with Statistics Canada, designed and implemented a population-based cross-sectional survey of hypertension in the Province of Ontario: the 2006 Ontario Survey on the Prevalence and Control of Hypertension (ON-BP). Objectives To establish the prevalence of hypertension in the Ontario adult population between the ages of 20 and 79 years; to assess the awareness, current status and management of hypertension; and to gather respondent information about sex, age, physical measurements, personal health practices, socioeconomic measures, ethnicity and comorbidities. Methods The present paper describes the background history and the successive steps undertaken during the implementation of this project. Conclusions The authors' experiences from the ON-BP indicate that close co-operation between research scientists, statisticians, governmental and nongovernmental organizations – in the present case, the Heart and Stroke Foundation of Ontario – is essential to conduct a successful, large-scale survey of BP distribution.

The World Health Report 2002 identified hypertension, or high blood pressure, as the third ranked factor for disability-adjusted life years. Hypertension is one of the primary risk factors for heart disease and stroke, the leading causes of death worldwide. Recent analyses have shown that as of the year 2000, there were 972 million people living with hypertension worldwide, and it is estimated that this number will escalate to more than 1.56 billion by the year 2025. Nearly two-thirds of hypertensives live in low- and middle-income countries, resulting in a huge economic burden. Awareness, prevention, treatment and control of hypertension is a significant public health measure. The World Hypertension League, through its national member societies, launched World Hypertension Day in 2005 and, due to its success throughout the world, it has been made an annual event. The 2006 World Hypertension Day was held on May 13; the theme of the day was ‘Treat to Goal', with a clear intent to ensure patient adherence and control of hypertension worldwide. In Canada, all stakeholders – professional societies, government, nongovernment organizations and industry – are working together to promote awareness of hypertension and to control it.

There are gender-specific differences in the significance of cardiovascular risk factors, as well as in the symptoms and in the diagnostic approach of cardiovascular events. From the point of view of everyday clinical practice, the differential approach toward both genders is based on gender-specific risk assessment. A global risk assessment should be carried out in males with >40 years of age and in females with >50 years or those who are postmenopausal. Diabetes and hypertriglyceridemia require aggressive therapy particularly in women. Depending on level of risk appropriate therapy should be instituted: life style counseling (smoking!), therapy of dyslipidemias, antihypertensive therapy and diabetes control. Symptoms of coronary attack are experienced by men more often "classically", whilst women commonly present with unspecific symptoms, which may delay proper medical care. Appropriate patient education is needed particularly in younger women to avoid unnecessary delay of intervention in acute coronary syndromes. Regarding diagnostics, there are gender differences in the specificity and sensitivity of some noninvasive diagnostic tests which should be taken into account.

The incidence of dyslipidaemia is high: in 2000, approximately 25% of adults in the USA had total cholesterol greater than 6.2 mmol/L or were taking lipid-lowering medication. Primary prevention in this context is defined as long-term management of people at increased risk but with no clinically overt evidence of CVD - such as acute MI, angina, stroke, and PVD - and who have not undergone revascularisation.We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of pharmacological cholesterol-lowering interventions in people at low risk (less than 0.6% annual CHD risk); at medium risk (0.6-1.4% annual CHD risk); and at high risk (at least 1.5% annual CHD risk)? What are the effects of reduced or modified fat diet? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.In this systematic review we present information relating to the effectiveness and safety of the following interventions: ezetimibe, fibrates, niacin (nicotinic acid), reduced- or modified-fat diet, resins, and statins.

We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2011. The major guideline changes this year are: (1) a recommendation was made for using comparative risk analogies when communicating a patient's cardiovascular risk; (2) diagnostic testing issues for renal artery stenosis were discussed; (3) recommendations were added for the management of hypertension during the acute phase of stroke; (4) people with hypertension and diabetes are now considered high risk for cardiovascular events if they have elevated urinary albumin excretion, overt kidney disease, cardiovascular disease, or the presence of other cardiovascular risk factors; (5) the combination of an angiotensin-converting enzyme (ACE) inhibitor and a dihydropyridine calcium channel blocker (CCB) is preferred over the combination of an ACE inhibitor and a thiazide diuretic in persons with diabetes and hypertension; and (6) a recommendation was made to coordinate with pharmacists to improve antihypertensive medication adherence. We also discussed the recent analyses that examined the association between angiotensin II receptor blockers (ARBs) and cancer.

The impact of treating hypertension on coronary artery disease has been less than anticipated from epidemiologic studies of cardiovascular risk factors. It has been suggested that adverse effects on lipids of traditional diuretic or β-blocker regimens may diminish the potential benefits of antihypertensive therapy. Patients with mild to moderate systemic hypertension and normal serum lipids (n = 191) were randomly assigned to doxazosin or atenolol. After dose titration to goal diastolic blood pressure of ≤ 90 mm Hg, patients continued treatment for a further 24 weeks. The principal outcome measurement was overall coronary artery disease risk using the Framingham formula. Relative risk of coronary artery disease was reduced to 92.4% of baseline (p = 0.144) for evaluable patients taking atenolol (n = 71), and to 74.6% (p = 0.0001) for patients taking doxazosin (n = 51): atenolol versus doxazosin, p = 0.0074. In patients who met the strict Framingham criteria for age, total cholesterol and high density lipoprotein cholesterol, the relative risk of coronary artery disease for patients taking atenolol (n = 23) was reduced to 86.2% of baseline (p = 0.082), and to 67.4% (p = 0.0004) for patients taking doxazosin (n = 18): atenolol versus doxazosin, p = 0.049. Alpha blockade with doxazosin was more effective than β blockade with atenolol in reducing the risk of coronary artery disease in hypertensive patients because of the beneficial effects of doxazosin on highdensity lipoprotein cholesterol. Overall withdrawal rate was greater in the α-blocker group because of a lower response rate and more adverse events.

To evaluate lifestyle changes and their impact on hypertension control in a sample of hypertensive respondents in Ontario, Canada, diet, physical activity, and other nonpharmacologic measures were recorded using a structured questionnaire during the 2006 Ontario Survey on the Prevalence and Control of Hypertension. Responses were weighted to the total adult population of 7,996,653 in Ontario. The prevalence of hypertension was 21%; 42% of hypertensive persons received therapy with antihypertensive drugs and lifestyle changes, and 41% received therapy with drugs only. Blood pressure was controlled in 85% of respondents who used only drugs and in 78% of those who stated that they received therapy with combined drug treatment and lifestyle changes. Fewer than half of hypertensive respondents practiced lifestyle changes (in combination with drug treatment) for blood pressure control. Lifestyle measures in addition to medication use did not result in better control of hypertension compared to only medication use.

Background: Angiotensin-receptor blockers (ARBs) blunt progression of advanced diabetic nephropathy, but their long-term renal effects in other patients are not clear. Objective: To examine the long-term renal effects of telmisartan versus placebo in adults at high vascular risk. Design: Randomized trial. Patients were randomly assigned by a central automated system between November 2001 and May 2004 and were followed until March 2008. Participants and investigators were blinded to intervention status. Setting: Multicenter, multinational study. Patients: 5927 adults with known cardiovascular disease or diabetes with end-organ damage but without macroalbuminuria or heart failure who cannot tolerate angiotensin-converting enzyme inhibitors. Intervention: Telmisartan, 80 mg/d (n = 2954), or matching placebo (n = 2972) plus standard treatment for a mean of 56 months. Measurements: Composite renal outcome of dialysis or doubling of serum creatinine, changes in estimated glomerular filtration rate (GFR), and changes in albuminuria. Results: No important difference was found in the composite renal outcome with telmisartan (58 patients [1.96%]) versus placebo (46 patients [1.55%]) (hazard ratio, 1.29 [95% CI, 0.87 to 1.89]; P = 0.20). Among the telmisartan and placebo groups, 7 and 10 patients had dialysis and 56 and 36 patients had doubling of serum creatinine, respectively (hazard ratio, 1.59 [CI, 1.04 to 2.41]; P = 0.031). Albuminuria increased less with telmisartan than with placebo (32% [CI, 23% to 41%] vs. 63% [CI, 52% to 76%]; P < 0.001). Decreases in estimated GFR were greater with telmisartan than with placebo (mean change in estimated GFR, ―3.2 mL/min per 1.73 m 2 [SD, 18.3] vs. ―0.26 mL/min per 1.73 m 2 [SD, 18.0]; P < 0.001). Limitation: Only 17 participants had dialysis. Conclusion: In adults with vascular disease but without macroalbuminuria, the effects of telmisartan on major renal outcomes were similar to those of placebo. Primary Funding Source: Boehringer Ingelheim.

BACKGROUND An automated sphygmomanometer, the BpTRU, was used in a blood pressure (BP) survey of 2,551 residents in the province of Ontario. Automated BP readings were compared with measurements taken by a mercury sphygmomanometer under standardized conditions in a random 10% sample. METHODS BP was recorded in 238 individuals in random order using both a standard mercury device and an automated BP recorder, the BpTRU. All subjects rested for 5 min prior to the first BP reading, which was then discarded. The mean of the next three readings was obtained using the mercury device whereas the BpTRU was set to record a mean of five readings taken at 1 min intervals with subjects resting alone in a quiet room. RESULTS The mean s.d. BP with the automated device was 115 +/- 16/71 +/- 10 mm Hg compared to 118 +/- 16/74 +/- 10 mm Hg for the manual BP (P or = 140 mm Hg was present for 16 automated and 19 manual readings. Similarly, the diastolic BP was > or = 90 mm Hg for 9 automated and 14 manual readings. Linear regression analysis showed that automated BP was a significant (P < 0.001) predictor of both manual systolic and diastolic BP. CONCLUSION Conventional manual BP readings can be replaced by readings taken using a validated, automated BP recorder in population surveys. The slightly lower readings obtained with the BpTRU device (in the context of reduced observer-subject interaction) may be a more accurate estimate of BP status.

Adherence or compliance, in the context of medical treatment, refers to how well a patient follows and sticks to the management plan developed with her/his health care provider, which may include pharmacologic agents as well as changes in lifestyle. Adherence is of great concern in asymptomatic conditions such as hypertension, where lack of control may have serious ramifications including end organ damage and premature mortality. To address this issue, the Canadian Coalition for High Blood Pressure Prevention and Control established a national Advisory Committee on Adherence to the Management of High Blood Pressure. The Advisory Committee consisted of 11 members from different disciplines of health care providers. The Committee reviewed all evidences to date and drew up four practical recommendations with respect to patient, provider and environment. Based on Canadian Task Force on Periodic Health Examination’s guidelines, all four recommendations can be classified as ‘level C’ with a quality of evidence of II.

Since the last publication of the recommendations for the management and treatment of dyslipidemia, new clinical trial data have emerged that support a more vigorous approach to lipid lowering in specific patient groups. The decision was made to update the lipid guidelines in collaboration with the Canadian Cardiovascular Society. A systematic electronic search of medical literature for original research consisting of blinded, randomized controlled trials was performed. Meta-analyses of studies of the efficacy and safety of lipid-lowering therapies, and of the predictive value of established and emerging risk factors were also reviewed. All recommendations are evidence-based, and have been reviewed in detail by primary and secondary review panels. Major changes include a lower low-density lipoprotein cholesterol (LDL-C) treatment target (lower than 2.0 mmol/L) for high-risk patients, a slightly higher intervention point for the initiation of drug therapy in most low-risk individuals (LDL-C of 5.0 mmol/L or a total cholesterol to high-density lipoprotein cholesterol ratio of 6.0) and recommendations regarding additional investigations of potential use in the further evaluation of coronary artery disease risk in subjects in the moderate-risk category.

Study objectives The aim of this study was to examine the extent of the general public's knowledge concerning HDL-cholesterol and to identify the role of gender, age, population size of the locality and socio-economic factors. Design Cross-sectional population-based telephone survey. Setting Austrian general population. Participants Nine hundred and ninety nine subjects aged 16 years or over, randomly selected from the official telephone directory in Austria. Main results 13.9% of the 999 participants were familiar with the term HDL-cholesterol, correctly identified HDL-cholesterol as the favourable cholesterol component and indicated that HDL-cholesterol should be high rather than low. Knowledge of HDL-cholesterol increased with population size of the locality, total net income of the household and educational level. Respondents in bigger localities had their HDL-cholesterol measured more frequently. Older people and males reported making significantly more attempts to positively influence their HDL-cholesterol level. 29.6% of those respondents familiar with the term HDL-cholesterol reported having had their HDL-cholesterol measured at some point. Physicians, newspapers and television were identified as the most important sources of information on HDL-cholesterol by 79.7, 19.9 and 10.3% of the study subjects, respectively. Conclusions Although measuring HDL-cholesterol plays a major role in the assessment of cardiovascular risk, public knowledge about HDL-cholesterol is scarce.

Although statins are widely used to reduce low density lipoprotein cholesterol (LDL-C), there is little information about patient profiles, treatment patterns and goal achievement among statin-treated patients in Canada.To assess the profile of statin-treated patients and to determine whether they are achieving recommended targets for LDL-C.The Canadian Lipid Study -- Observational (CALIPSO) was a cross-sectional study involving Canadian physicians who were among the top statin prescribers. Each physician enrolled up to 15 patients who were at least 18 years of age with a diagnosis of hyper-cholesterolemia and who had been using a statin for at least eight weeks. Sociodemographics, coronary artery disease (CAD) risk factors, pretreatment and current lipid levels, and history of lipid-lowering therapy were reported for 3721 patients.Sixty-eight per cent of statin-treated patients were at high CAD risk according to the 2003 Canadian guidelines, 46.4% had established cardiovascular disease, 33.9% had diabetes and 59.5% had hypertension. Average LDL-C reductions of 32% (37% for high-risk patients) were initially required to reach goal. At the study visit, patients had been treated for an average of 4.3 years and 24.2% were using a high statin dose. Despite statin therapy, 27.2% of all patients and 36.4% of those at high CAD risk had not achieved LDL-C targets. For 67.4% of these patients, the current therapy was not modified at the study visit.Despite effective therapies, many treated patients are not achieving recommended LDL-C targets. Strategies should be implemented to promote achievement of lipid treatment goals for high-risk patients, thereby reducing the risk of cardiovascular events and their associated clinical and economic burdens.