Left ventricular (LV) hypertrophy is diagnosed on the basis of LV mass measurement at echocardiog... more Left ventricular (LV) hypertrophy is diagnosed on the basis of LV mass measurement at echocardiography. However, various thresholds for defining LV hypertrophy have been published, ranging from 111 to 134 g/m2 and from 100 to 125 g/m2 in men and women, respectively. The aim of our study was to evaluate variations in the prevalence of LV hypertrophy induced by the application of different threshold values among hypertensive subjects. LV mass was calculated in 349 hypertensive patients from an M-mode LV tracing obtained by left parasternal view in 83% and by subcostal view in 17% of patients. The prevalence of LV hypertrophy ranged from 17% to 39%, according to the threshold value applied (from 10% to 47%, and from 19% to 39% in women and men, respectively). As expected, the prevalence of LV hypertrophy in obese patients of both sexes was higher when applying the usual height-indexed threshold (143 and 102 g/m for men and women, respectively) than when applying the usual body surface area-indexed threshold (134 and 110 g/m2 for men and women, respectively). The use of normalized thresholds when comparing different indexation methods (in this case, 145 g/m for men, 120 g/m for women) will minimize these variations in part due to the threshold choice. Considering the clinical and therapeutic implications associated with the presence of LV hypertrophy, better standardization of definitions is needed; this could be based either on better-designed cooperative normality studies or meta-analysis of risk stratification.
Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiote... more Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers has been shown to lessen the rate of decrease in glomerular filtration rate in patients with diabetic nephropathy. A multicenter open-label randomized controlled trial to compare the efficacy of combining the angiotensin-converting enzyme inhibitor lisinopril and the angiotensin II receptor blocker irbesartan with that of each drug in monotherapy (at both high and equipotent doses) in slowing the progression of type 2 diabetic nephropathy. 133 patients with type 2 diabetic nephropathy (age, 66 ± 8 years; 76% men) from 17 centers in Spain. Patients were randomly assigned (1:1:2) to lisinopril (n = 35), irbesartan (n = 28), or the combination of both (n = 70). The primary composite outcome was a >50% increase in baseline serum creatinine level, end-stage renal disease, or death. Baseline values for mean estimated glomerular filtration rate and blood pressure were 49 ± 21 mL/min/1.73 m(2) and 153 ± 19/81 ± 11 mm Hg. Mean geometric baseline proteinuria was protein excretion of 1.32 (95% CI, 1.10-1.62) g/g creatinine. After a median follow-up of 32 months, 21 (30%) patients in the combination group, 10 (29%) in the lisinopril group, and 8 (29%) in the irbesartan group reached the primary outcome. HRs were 0.96 (95% CI, 0.44-2.05; P = 0.9) and 0.90 (95% CI, 0.39-2.02; P = 0.8) for the combination versus the lisinopril and irbesartan groups, respectively. There were no significant differences in proteinuria reduction or blood pressure control between groups. The number of adverse events, including hyperkalemia, was similar in all 3 groups. The study was not double blind. The sample size studied was small. We were unable to show a benefit of the combination of lisinopril and irbesartan compared to either agent alone at optimal high doses on the risk of progression of type 2 diabetic nephropathy.
... A large number of patients do not Tirana have access to health-care centres because of an ina... more ... A large number of patients do not Tirana have access to health-care centres because of an inadequate Albania health care infrastructure. ... The Albanian chronic dialysis programme began in 1985. refugees. ... enteritis. Campylobacter jejuni and E. coli have been ...
Left ventricular (LV) hypertrophy is diagnosed on the basis of LV mass measurement at echocardiog... more Left ventricular (LV) hypertrophy is diagnosed on the basis of LV mass measurement at echocardiography. However, various thresholds for defining LV hypertrophy have been published, ranging from 111 to 134 g/m2 and from 100 to 125 g/m2 in men and women, respectively. The aim of our study was to evaluate variations in the prevalence of LV hypertrophy induced by the application of different threshold values among hypertensive subjects. LV mass was calculated in 349 hypertensive patients from an M-mode LV tracing obtained by left parasternal view in 83% and by subcostal view in 17% of patients. The prevalence of LV hypertrophy ranged from 17% to 39%, according to the threshold value applied (from 10% to 47%, and from 19% to 39% in women and men, respectively). As expected, the prevalence of LV hypertrophy in obese patients of both sexes was higher when applying the usual height-indexed threshold (143 and 102 g/m for men and women, respectively) than when applying the usual body surface area-indexed threshold (134 and 110 g/m2 for men and women, respectively). The use of normalized thresholds when comparing different indexation methods (in this case, 145 g/m for men, 120 g/m for women) will minimize these variations in part due to the threshold choice. Considering the clinical and therapeutic implications associated with the presence of LV hypertrophy, better standardization of definitions is needed; this could be based either on better-designed cooperative normality studies or meta-analysis of risk stratification.
Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiote... more Blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers has been shown to lessen the rate of decrease in glomerular filtration rate in patients with diabetic nephropathy. A multicenter open-label randomized controlled trial to compare the efficacy of combining the angiotensin-converting enzyme inhibitor lisinopril and the angiotensin II receptor blocker irbesartan with that of each drug in monotherapy (at both high and equipotent doses) in slowing the progression of type 2 diabetic nephropathy. 133 patients with type 2 diabetic nephropathy (age, 66 ± 8 years; 76% men) from 17 centers in Spain. Patients were randomly assigned (1:1:2) to lisinopril (n = 35), irbesartan (n = 28), or the combination of both (n = 70). The primary composite outcome was a >50% increase in baseline serum creatinine level, end-stage renal disease, or death. Baseline values for mean estimated glomerular filtration rate and blood pressure were 49 ± 21 mL/min/1.73 m(2) and 153 ± 19/81 ± 11 mm Hg. Mean geometric baseline proteinuria was protein excretion of 1.32 (95% CI, 1.10-1.62) g/g creatinine. After a median follow-up of 32 months, 21 (30%) patients in the combination group, 10 (29%) in the lisinopril group, and 8 (29%) in the irbesartan group reached the primary outcome. HRs were 0.96 (95% CI, 0.44-2.05; P = 0.9) and 0.90 (95% CI, 0.39-2.02; P = 0.8) for the combination versus the lisinopril and irbesartan groups, respectively. There were no significant differences in proteinuria reduction or blood pressure control between groups. The number of adverse events, including hyperkalemia, was similar in all 3 groups. The study was not double blind. The sample size studied was small. We were unable to show a benefit of the combination of lisinopril and irbesartan compared to either agent alone at optimal high doses on the risk of progression of type 2 diabetic nephropathy.
... A large number of patients do not Tirana have access to health-care centres because of an ina... more ... A large number of patients do not Tirana have access to health-care centres because of an inadequate Albania health care infrastructure. ... The Albanian chronic dialysis programme began in 1985. refugees. ... enteritis. Campylobacter jejuni and E. coli have been ...
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