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Background and Aims Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment. Methods Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes. Results Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10–1.17], P <.001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18–1.26), P <.001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72–0.93), P =.003], total CV events [HR 0.93 (95% CI 0.88–0.98), P =.008], total coronary events [HR 0.92 (95% CI 0.86–0.99), P =.024], and atrial fibrillation [HR 0.91 (95% CI 0.83–0.99), P =.030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82–1.01), P =.073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality. Conclusions Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period. [ABSTRACT FROM AUTHOR]

THE TRANSNATIONAL COMMERCIAL TOBACCO COMPANIES are expanding their empires--denying the health evidence on the effects of smoking; advertising and promoting their products in every corner of the earth; obstructing government […]

China's first anti-tobacco law went into effect Jan 1992. The law aims to reduce smoking through a series of measures such as reducing the tar in tobacco products, banning of smoking by elementary and high school students, smoking in public places and the banning of tobacco advertising. There are about 250 million smokers in China. However, multinational tobacco companies are trying enter China's market since the foreign investment climate has improved. Health activists say that these companies have the financial and political power, as well as the advanced marketing and advertising techniques that will increase the number of smokers, especially among the youth.