bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond words: dance and movement sessions with young people with social, emotional and behavioural difficulties in Estonia
Authors: GOODGAME JENNA
Published: May 2007

This article details an experimental project in Estonian schools, using therapeutic dance and movement as a basis to explore beyond the boundaries of language in supporting young people to develop their creative expression. The author visited three residential schools in different areas of Estonia in September 2006 to lead sessions with groups of young people who had a range of social, emotional and behavioural problems. This personal account details the aims of the project, the sessions and the experiences of those involved. It asks: can dance and movement offer a creative and dynamic form for expression, beyond the boundaries of culture and language, for those troubled and damaged young people who often struggle to communicate and express with words?
Tuition for children who cannot attend school due to illness in Scotland: experiences of home tutors
Authors: ACEVEDO MERCEDES , GILCHRIST ANNE
Published: May 2007

We have explored the working patterns and perceptions of a group of teachers who provide home tuition for children who cannot attend school due to medical problems. These teachers reported high levels of experience in teaching, enthusiasm for their work, and clear managerial structures. Home tutors found it very rewarding to build relationships with children and families, and see children making progress. Challenging aspects of the work included relationship issues, both with the children and their families and with the professional network around the child. Liaison with other professionals was reported to be variable, sometimes helpful and well structured, and sometimes very poor. Those interviewed felt additional training on specific issues related to their work in this context would be beneficial.
Urban Governance and the Transition of Energy Systems: Institutional Change and Shifting Energy and Climate Policies in Berlin
Authors: MONSTADT JOCHEN
Published: May 2007

Energy systems in Germany and in all western OECD countries are currently undergoing transformations that have profound implications for their urban and regional governance, as well as for regional development in general. New technologies, regulatory regimes, management styles, marketing strategies and environmental priorities have emerged, dramatically reconfiguring patterns of governance within cities and regions. This is particularly obvious in the city region of Berlin, where utility restructuring coincides with a dramatic fiscal crisis in the city. The privatization of the energy utilities and of many public services, the opening of the regional energy markets, public and private climate protection initiatives and the emergence of new market participants are radically changing the conditions of regional governance and energy planning. However, although substantial recasting of policy issues and traditional forms of governance in the energy sector is underway in Berlin, energy management is confronted with severe institutional problems of interpolicy coordination and regional cooperation, entrepreneurial governance and contract management. Thus, this article argues in favour of new policy approaches and institutional reforms to shape the development of energy networks according to local and regional sustainability needs.

En Allemagne et dans tous les pays occidentaux de l’OCDE, les systèmes énergétiques connaissent des transformations qui affectent profondément la gouvernance urbaine et régionale, de même que l’évolution des régions en général. Nouvelles technologies, mécanismes régulateurs, styles de gestion, stratégies de marketing et priorités environnementales ont vu le jour, reconfigurant considérablement les modèles de gouvernance des villes et régions. Cette transformation est évidente dans la région métropolitaine de Berlin où la restructuration des services à la population coïncide avec une énorme crise fiscale de la municipalité. La privatisation de la distribution d’énergie et de nombreux services publics, l’ouverture des marchés régionaux de l’énergie, les initiatives publiques et privées de préservation du climat, ainsi que l’apparition de nouveaux acteurs sur les marchés ont affecté radicalement les conditions de la gouvernance régionale et la planification énergétique. Toutefois, malgré une large refonte des enjeux politiques et des formes traditionnelles de gouvernance dans le secteur énergétique, la gestion de l’énergie à Berlin est confrontée à de graves problèmes institutionnels de coordination entre politiques et de coopération régionale, de gouvernance de type entrepreneurial et d’administration des marchés. C’est pourquoi cet article préconise à la fois de nouvelles approches de politique publique et des réformes institutionnelles pour configurer l’aménagement des réseaux énergétiques en fonction des besoins en durabilité locaux et régionaux.
Megalopolis 50 Years On: The Transformation of a City Region
Authors: VICINO THOMAS J. , HANLON BERNADETTE , SHORT JOHN RENNIE
Published: May 2007

This article examines Megalopolis 50 years after Gottmann’s seminal study of the most urbanized region of the US Eastern Seaboard. His study provides an invaluable datum point, and we use it as a benchmark for reexamining the socio‐spatial transformations of a city region. After redefining Megalopolis and showing major aggregate trends since 1950, we analyze 39 selected variables for place level census data for 2,353 places to perform a principal components analysis (PCA). Our analysis shows that Megalopolis remains a significant center for the nation’s population and economic activity. A half century of urban restructuring demonstrates that the forces of urban decentralization have made the region a more fully suburbanized agglomeration. We reveal a complex socioeconomic pattern of a vast urban area structured by class, education, housing tenure, housing age, and race and ethnicity. The cluster analysis reveals five distinct clusters of urban places identified by our PCA: ‘affluent places’, ‘places of poverty’, ‘Black middle class places’, ‘immigrant gateway places’ and ‘middle America places’.

Il s’agit ici de revenir sur Mégalopolis 50 ans après l’étude majeure de Gottmann sur la région la plus urbanisée du littoral Est des Etats‐Unis. Son étude procure un point de départ inestimable utilisé ici comme référence à partir de laquelle rééxaminer les transformations socio‐spatiales d’une région métropolitaine. Dans un premier temps, ce travail redéfinit Mégalopolis et présente les grandes tendances à la concentration depuis 1950. Il analyse ensuite 39 variables choisies, portant sur les données de recensement des lieux par niveau (2.353 lieux traités), afin d’effectuer une analyse en composantes principales (PCA). Celle‐ci montre que Mégalopolis demeure un nœud important pour la population et l’activitééconomique nationales. Un demi‐siècle de restructuration urbaine met en évidence que, à cause des forces de décentralisation urbaine, la région est devenue une agglomération aux banlieues plus étendues. Il se dégage un schéma socioéconomique complexe propre à une vaste zone urbaine structurée par classe, niveau d’éducation, type de jouissance du logement, ancienneté des habitations, ainsi que par race et ethnicité. Une analyse des pôles (clusters) révèlent cinq pôles de lieux urbains repérés par l’analyse PCA: ‘lieux aisés’, ‘lieux pauvres’, ‘lieux pour classes moyennes noires’, ‘lieux d’entrée des immigrants’, et ‘lieux pour Américains moyens’.
Re‐thinking the Nature of the Informal Economy: Some Lessons from Ukraine
Authors: WILLIAMS COLIN C. , ROUND JOHN
Published: May 2007

This article provides a critical evaluation of the competing discourses that variously represent the informal economy as a residue or leftover of some pre‐capitalist era, a by‐product of a new type of emergent formal economy, an alternative mode of work organization or a complement to the formal economy. Drawing upon evidence from a study of 600 households in Ukraine that unravels the heterogeneous forms of work in the informal economy, the finding is that although each and every representation is wholly valid in relation to specific types of informal work, no one articulation fully captures the diverse nature and multiple meanings of the informal economy. Here, in consequence, it is contended that only by using all of them will a finer‐grained and more comprehensive understanding of the complex and multifarious character of the informal economy be achieved. To display how this can be achieved, a conceptual framework is then presented that couples together these contrasting representations in order to provide a more multi‐layered and nuanced depiction of the informal economy, followed by a discussion of the implications for urban and regional development and policy of recognizing the multiple and diverse types of informal work.

Cet article donne une appréciation critique des différents discours selon lesquels l’économie informelle apparaît respectivement comme un résidu ou un vestige d’une ère précapitaliste, un sous‐produit issu d’un nouveau genre d’économie officielle émergente, un mode alternatif d’organisation du travail ou un complément à l’économie officielle. A partir des résultats d’une étude effectuée sur 600 foyers ukrainiens, qui décortique les formes hétérogènes du travail au sein de l’économie informelle, il est déduit que, même si chacune des représentations est tout à fait exacte pour des types donnés de travail informel, aucune explication n’appréhende entièrement la nature diverse et les sens multiples de cette économie. En conséquence, ce n’est qu’en les utilisant toutes qu’on obtiendra une compréhension plus fine et plus exhaustive du caractère complexe et varié de l’économie informelle. Pour ce faire, il est présenté un cadre conceptuel qui associe ces représentations contradictoires afin d’aboutir à un tableau plus nuancé, composé de plusieurs niveaux. Suit une étude des implications pour la politique et l’aménagement urbains et régionaux si les divers et multiples types de travail informel étaient reconnus.
Autonomic dysfunction in unselected and untreated primary open angle glaucoma patients: a pilot study
Authors: Gherghel Doina , Hosking Sarah Louise , Armstrong Richard , Cunliffe Ian Andrew
Published: May 2007

Purpose:  To investigate the presence of silent cardiac ischaemic episodes and the status of autonomic function in consecutive, newly diagnosed and untreated primary open‐angle glaucoma patients.

Methods:  Twenty‐four consecutively diagnosed glaucoma patients and 22 age‐matched controls were subjected to ambulatory 24‐h blood pressure (BP) and electrocardiogram (ECG) monitoring by using Cardiotens‐01 (Meditech Ltd). Based on the ECG recordings, heart rate variability (HRV) frequency domain parameters [low‐frequency (LF), high‐frequency (HF) and LF/HF ratio] were calculated and analysed in the two study groups.

Results:  Glaucoma patients demonstrated higher LF and LF/HF values than normal subjects for both the active period (p = 0.020 and 0.029) and the passive period (p = 0.044 and 0.049 respectively). HRV parameters were similar in patients and controls suffering from silent cardiac ischaemia (p > 0.05); however, glaucoma patients with normal ECG demonstrated higher LF and LF/HF values during the active period of the 24‐h measurement period than control subjects characterized by the same cardiac activity (p = 0.010 and 0.021 respectively).

Conclusion:  Independent of a history and/or clinical signs of cardiovascular disease, glaucoma patients exhibit abnormal autonomic function.
Evaluating the performance of a soil compaction sensor
Authors: Sharifi A. , Godwin R. J. , O'Dogherty M. J. , Dresser M. L.
Published: May 2007

One of the most significant soil parameters affecting root growth is soil compaction. It is therefore important to be able to determine the presence of compacted layers, their depth, thickness and spatial location without the necessity of digging a large number of holes in the field with either a spade or backhoe. Previous investigations have identified soil compaction by different methods such as: using ground penetrating radar, acoustic systems, vertical and horizontal penetrometers and instrumented wings mounted on the faces of tines. Linking the output from these sensors to global positioning systems would give an indication of the spatial patent variation. The aim of this study was to evaluate the performance of a soil compaction profile sensor in both controlled laboratory and field conditions. The sensor consisted of a series of instrumented flaps; a flap is defined as the sensing element which comprises one half of a pointed leading edge to the leg of a tine to which strain gauges are placed on the rear face of the flap. Studies measured the effect of compaction on the changes in the soil resistance acting upon a flap face in a soil bin laboratory and under field conditions. The results indicated that the sensor was sensitive to differences in soil strength at different depths in soils. A technique was developed to identify the soil compaction resulting from different tyre inflation pressures and loads. The soil compaction profile sensor was tested on a number of fields in south‐eastern England to determine the changes in soil strength below the wheelings of a pea harvester operating at different tyre inflation pressures.
Decomposing the Value of Agricultural Multifunctionality: Combining Contingent Valuation and the Analytical Hierarchy Process
Authors: Kallas Zein , Gómez‐Limón José A. , Hurlé Jesús Barreiro
Published: May 2007

Agricultural multifunctionality is the recognition of the joint exercise of economic, environmental and social functions by this sector. Nevertheless, not all these contributions to society are valued in markets, moreover a large share of them are public goods. For this reason, in order to make this concept of multifunctionality operative for the design of public policies, it is necessary to estimate the social demand of such functions. The objective of this article was to implement an empirical application along these lines. For this purpose, the agricultural system of cereal steppes in Tierra de Campos in Spain is taken as a case study. The economic valuation technique used relies on a combined implementation of contingent valuation and the analytical hierarchy process. The results obtained demonstrate the existence of a significant demand for the different attributes included in the multifunctionality concept, although this demand is heterogeneous and is based on the socioeconomic characteristics of individual persons.
Equivalence of Input Quotas and Input Charges under Asymmetric Information in Agri‐environmental Schemes
Authors: Ozanne Adam , White Ben
Published: May 2007

A model of adverse selection and moral hazard in agri‐environmental schemes is developed based on the input quota mechanism of Moxey et al. (Journal of Agricultural Economics, Vol. 50, (1999) pp. 187–202) and Ozanne et al. (European Review of Agricultural Economics, Vol. 28, (2001) pp. 329–347), rather than the input charge mechanism of White (Journal of Agricultural Economics, Vol. 53, (2002) pp. 353–360), but the variable fine of the latter rather than the fixed fine assumed by Ozanne et al. (European Journal of Agricultural Economics, Vol. 28, (2001) pp. 329–347) is used. Incentive‐compatible contracts, including the optimal probabilities of detection (and, therefore, monitoring frequencies and costs) for more and less efficient farmers, are identified. It is shown that the input charge and input quota approaches lead to identical outcomes – in terms of abatement levels, compensation payments, monitoring costs and probabilities of detection – confirming the equivalence of input quotas and input charges under asymmetric information. It is also shown that the optimal contracts are independent of the risk preferences of farmers with regard to being caught cheating.
Assessing the Potential Impact of Avian Influenza on Poultry in West Africa: A Spatial Equilibrium Analysis
Authors: You Liangzhi , Diao Xinshen
Published: May 2007

We analyse the potential economic impacts of avian influenza (AI) in Nigeria, using a spatial equilibrium simulation model. Depending on the size of the affected areas, the direct impact of the spread of AI along the two major migratory bird flyways would be a loss of about 4% of national chicken production. However, the indirect effect – consumers’ reluctance to consume poultry if AI is detected, causing a decline in chicken prices – is generally larger than the direct effect in our simulation. We estimate that Nigerian chicken production would fall by 21% and chicken farmers would lose US$250 million of revenue if the worst‐case scenario occurs. The negative impact would be unevenly distributed in the country, and some states and districts would be seriously affected. The study shows that, while most attention has focused on preventing a global influenza pandemic, preventive measures are also needed at the national, regional and local levels, because AI could potentially have a major negative impact on the poultry industry and the livelihood of smallholder farmers in many regions in West Africa.
Spanish Demand for Food Away from Home: Analysis of Panel Data
Authors: Angulo Ana M. , Gil José M. , Mur Jesús
Published: May 2007

We analyse the Spanish demand for food away from home (FAFH). A panel dataset is built and appropriate techniques for estimating limited dependent variable models are applied. Results indicate that where there are zero expenditures, these are largely due to infrequency of purchase rather than to abstention, or for economic reasons. Furthermore, important differences appear among households. Households whose head is a highly educated person, male, young and living on a salary in a large town is more likely to purchase FAFH. FAFH expenditure responses to an increase in total per capita expenditure are markedly different depending on the age of the household's head, their employment status and also the size of the resident's town. The lowest elasticity is shown by single‐person households, between 36 and 55 years old, employed and living in large towns, for whom FAFH has become a necessity. On the other hand, FAFH remains a luxury for unemployed couples with one or two children.
Relationships between Technical Efficiency and Financial Management for Czech Republic Farms
Authors: Davidova Sophia , Latruffe Laure
Published: May 2007

This paper provides the first analysis of the relationship between farm financial structure and technical efficiency in Central and Eastern European farming during the transition to a market economy. First, technical efficiency scores for a sample of Czech farms are computed with data envelopment analysis, accounting for sampling variability by using the Simar and Wilson bootstrapping procedure. The confidence intervals show that corporate livestock farms are the most homogenous in terms of technical efficiency. Second, a Tobit model is applied for the investigation of factors, including financial considerations, which influence the variation in technical efficiency. The potential endogeneity of the financial variables in the explanation of efficiency is examined, following Smith and Blundell. The Amemiya estimator is used for those cases which are revealed as endogenous. The analysis indicates substantial differences in the way in which the different management structures are treated by lenders. De novo, individual farms are subject to stringent evaluation of their loan applications, which is not the case for the successors of the former collective and state farms.
Will the TRIPS Agreement Foster Appropriate Biotechnologies for Developing Countries?
Authors: Gaisford James D. , Hobbs Jill E. , Kerr William A.
Published: May 2007

While almost all of the investment in agricultural biotechnology to date has been in temperate crops suitable for developed countries, developing countries are the greatest potential beneficiaries of this major technological advance. To realise this potential requires investment in crops appropriate to climatic and agronomic conditions in developing countries. Protection of intellectual property rights is a necessary condition for the private sector to invest in appropriate biotechnologies. This paper develops a game theoretic model of a bioscience firm that adapts a new technology to a range of agronomic conditions in response to the enforcement of intellectual property rights in a developed and a developing country. Over a range of potential penalties, low levels of enforcement by the developing country remain endemic despite the desire to have the bioscience firm adapt the biotechnology to its local conditions. In particular, the trade penalties contained in the Agreement on Trade‐Related Aspects of Intellectual Property Rights are likely to be ineffective. The developing country might increase enforcement if the developed country was more aggressive in liberalising agriculture trade because there would be greater symmetry in the benefits of the technology.
Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed‐Dose Combination Approaches
Authors: Bakris George L. , Weir Matthew R. ,   on behalf of the Study of Hypertension and the Efficacy of Lotrel in Diabetes (SHIELD) Investigators
Published: May 2007

Data from the Third National Health and Nutrition Examination Survey (NHANES III) demonstrate that only 11% of people with diabetes who are treated for high blood pressure achieve the blood pressure goal of <130/85 mm Hg recommended in the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The current study tests the hypothesis that initial therapy with a fixed‐dose combination will achieve the recommended blood pressure goal in patients with type 2 diabetes faster than conventional monotherapy. This randomized, double‐blind, placebo‐controlled study had as a primary end point achievement of blood pressure <130/85 mm Hg. Participants (N=214) with hypertension and type 2 diabetes received either amlodipine/benazepril 5/10 mg (combination) or enalapril 10 mg (conventional) once daily for 4 weeks, titrated to 5/20 mg/day or 20 mg/day, respectively at this time, if target blood pressure was not achieved. Hydrochlorothiazide (HCTZ) 12.5 mg/day was added for the final 4 weeks, if target blood pressure was still not reached. Time from baseline to achieve blood pressure <130/85 mm Hg was shorter in the combination group (5.3±3.1 weeks combination vs. 6.4±3.8 weeks conventional; p=0.001). At 3 months, more participants in the combination group achieved treatment goal (63% combination vs. 37% conventional; p=0.002). Data analysis at 3 months comparing blood pressure control rates between the fixed‐dose combination group (with out HCTZ) to the conventional group (receiving HCTZ) showed an even greater disparity in blood pressure goal achievement (87% combination without HCTZ vs. 37% conventional group with HCTZ; p=0.0001). We conclude that initial therapy with a fixed‐dose combination may be more efficacious than conventional monotherapy approaches for achieving blood pressure goals in the diabetic patient. A fixed‐dose combination approach appears as safe as the current conventional approaches.
Improving Patient Compliance: A Major Goal in the Management of Hypertension
Authors: Neutel Joel M. , Smith David H.G.
Published: May 2007

The primary goal in the treatment of hypertension is to reduce the incidence of cardiovascular events in hypertensive patients. Studies performed to assess the impact of treating hypertension have revealed very disappointing reductions in the incidence of coronary heart disease. There are several reasons for these poor reductions in the incidence of cardiovascular disease; however, the most important is related to the fact that worldwide less than one quarter of hypertensive patients are adequately controlled for hypertension. Again, there are multiple reasons for these poor blood pressure (BP) control rates; however, most physicians would agree that patient compliance with their antihypertensive treatment is a major contributing factor. This is an area that we need to re focus on in our management of hypertensive patients. Issues such as safety, convenience, polypharmacy, cost, and education in the selection of antihypertensive agents are all critically important issues in the treatment of hypertensive patients. In addition, the level of patient involvement in their treatment seems to be essential in obtaining goal BP. Newer approaches to the management of hypertension such as earlier control of BP and the more aggressive use of low‐dose combination therapy as first‐line treatment of hypertension also need to be considered in our effort to improve BP control rates. Achieving goal BP in hypertensive patients is one of the most important clinical dilemmas facing physicians. There is little doubt that an improvement in control rates will result in substantial reductions in cardiovascular disease.
The Effect of Nonsteroidal Anti‐Inflammatory Drugs on Blood Pressure in Patients Treated With Different Antihypertensive Drugs
Authors: Morgan Trefor , Anderson Adrianne
Published: May 2007

Hypertension and arthritis are both common diseases in the older age group and require pharmacologic treatment. Nonsteroidal anti‐inflammatory drugs (NSAIDs) alter renal function if given in high enough doses, reducing renal blood flow and the glomerular filtration rate and causing sodium retention. In salt sensitive subjects, this retention of sodium will cause blood pressure to rise. Salt sensitivity is more common in elderly patients, in diabetics, and in people with renal failure. When most antihypertensive drugs are used, people become salt sensitive, as shown by the additive effect of salt restriction or diuretics on blood pressure response. The responses to dihydropyridine and possibly other calcium channel blocking drugs are not affected to any major extent by sodium intake or by diuretics. Studies are described which indicate that indomethacin elevates blood pressure in elderly people treated with enalapril, but not in people whose blood pressure is controlled with amlodipine or felodipine. It is unclear whether the various NSAIDs have different effects on blood pressure. It is proposed that if the same analgesic effect is achieved with the same amount of cyclooxygenase inhibition, the response will be similar. Aspirin, used in a prophylactic dose, does not inhibit to this extent and does not elevate blood pressure. If elderly people require NSAIDs, it would appear that dihydropyridine calcium channel blocking drugs are more effective at lowering and maintaining blood pressure control and should be one of the drugs used. If patients are on other antihypertensive agents, it is important to monitor blood pressure when a NSAID is added to therapy.
Blood Pressure, Arterial Function, Structure, and Aging: The Role of Hormonal Replacement Therapy in Postmenopausal Women
Authors: Scuteri Angelo , Ferrucci Luigi
Published: May 2007

The occurrence of natural menopause may indicate that a woman is entering a period of increased risk for cardiovascular disease, due to both chronologic aging and lower levels of estrogen. This brief review aims to demonstrate the relevance of changes in blood pressure and large artery structure and function occurring after menopause. These changes, i.e., thickening and stiffening of large arteries (which, in turn would also result in increased systolic and pulse pressures), were found to predict subsequent cardiovascular events, independently of other known cardiovascular risk. The benefits of early hormone replacement therapy on the life expectancy of women have dramatically lost consensus since publication of the women's Health Initiative study results. However, the authors believe that those results should increase the attention paid by clinicians and public health researchers to the individualization of hormone replacement therapy prescription for postmenopausal women, and to a better characterization of those vascular parameters and profiles identifying postmenopausal women who are most likely to benefit from specific hormone replacement therapy in terms of cardiovascular protection.
Dietary Calcium Lowers the Age‐Related Rise in Blood Pressure in the United States: The NHANES III Survey
Authors: Hajjar Ihab M. , Grim Clarence E. , Kotchen Theodore A.
Published: May 2007

This analysis of the third National Health and Nutrition Examination Survey (NHANES III) was designed to investigate the impact of dietary calcium intake on age‐related changes in blood pressure and pulse pressure. Data on 17,030 participants 20 years or older (mean age, 48.8±0.2 years; 47% male, 42% Caucasian, and 28% African American) were used. Data included demographics, body mass index, blood pressure, and daily dietary calcium. Overall, average calcium intake was 761 mg/day. After adjusting for demographic and anthropomorphic variables, as well as total energy consumption, higher calcium intake was associated with lower rates of age‐related increases of systolic blood pressure and pulse pressure (p<0.001). If the calcium intake of the general population were to increase to above 1200 mg, the incidence of isolated systolic hypertension in the elderly might be decreased.
Drugs That Interrupt the Renin‐Angiotensin System Should Be Among the Preferred Initial Drugs to Treat Hypertension
Authors: Moore Michael A.
Published: May 2007

The goal of antihypertensive therapy is to provide effective treatment that can be sustained lifelong, while lowering elevated blood pressure and preventing hypertensive end‐organ damage and mortality. Angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II antagonists (AIIAs) control blood pressure as well as other available classes of antihypertensive drugs. The ACE inhibitors have been demonstrated to reduce the incidence of stroke, reverse left ventricular hypertrophy, and improve congestive heart failure symptomatology and mortality to a similar degree as diuretics and β‐adrenergic blockers. ACE inhibitors reduce postmyocardial infarction recurrence, improve congestive heart failure symptomatology and mortality, and slow the progression of glomerular renal disease. The AIIAs reverse left ventricular hypertrophy. Several of these agents have been shown to improve congestive heart failure symptomology and mortality, to reduce the occurrence of early atherosclerotic vascular disease, and to slow the progression of renal failure in type 2 diabetes mellitus nephropathy. One AHA has reduced the incidence of end‐stage renal disease in non‐insulin‐dependence diabetes mellitus nephropathy over 3 years. Ideally, antihypertensive therapy should maintain or improve the patient's quality of life without creating side effects or adverse laboratory effects. Among the available nine classes of antihypertensive drugs, ACE inhibitors and the AIIAs come close to meeting the description of an ideal drug. AIIAs and ACE inhibitors, two classes of antihypertensive drugs that reduce the activity of the renin‐angiotensin II system, should be among the preferred first‐step drugs for the treatment of hypertension.
The Relationship Between Systolic Blood Pressure and Cardiovascular Risk—Results of the Brisighella Heart Study
Authors: Borghi Claudio , Dormi Ada , L'Italien Gilbert , Lapuerta Pablo , Franklin Stanley S. , Collatina Stefano , Gaddi Antonio
Published: May 2007

We examined the relationship of systolic (SBP) and diastolic (DBP) blood pressure, and pulse pressure to coronary heart disease and cerebrovascular disease risk in a prospective population‐based European cohort. The Brisighella Heart Study included 2939 men and women between the ages of 14–84 without prior coronary heart disease or cerebrovascular disease and not taking antihypertensive therapy at baseline. Cox regression was used to obtain hazard ratios (HRs) for coronary heart disease and cerebrovascular disease as a function of baseline blood pressure parameters over a 23‐year follow‐up. Higher combined coronary heart disease and cerebrovascular disease risk was evident in comparison to the referent of <120 mm Hg, with a 44% increased risk at SBP 120–139 mm Hg (HR, 1.44; 95% confidence interval [CI], 1.00–2.09; p=0.052), 76% increased risk at SBP 140–159 mm Hg (HR, 1.76; 95% CI, 1.16–2.69; p=0.009), and 109% increased risk at SBP ≥160 mm Hg (HR, 2.09; 95% CI, 1.31–3.35; p=0.0021). Trends of increasing risk with increasing levels of blood pressure were significant for SBP and pulse pressure, (p<0.0001) but not for DBP (p=0.058). In this European cohort, SBP was a stronger predictor of coronary heart disease and cerebrovascular disease events than DBP, and an increase in risk was already evident with highnormal SBP (120–139 mm Hg). The prognostic significance of pulse pressure was also demonstrated. The importance of SBP as seen in the Framingham Heart Study may be generalized to a European population with differences in diet and other risk factors.
High Prevalence of Target Organ Damage in Young, African American Inner‐City Men With Hypertension
Authors: Post Wendy S. , Hill Martha N. , Dennison Cheryl R. , Weiss James L. , Gerstenblith Gary , Blumenthal Roger S.
Published: May 2007

Young, urban, African American men are at particularly high risk of hypertension and its cardiovascular complications. Left ventricular hypertrophy and renal dysfunction are manifestations of target organ damage from hypertension that predict adverse cardiovascular events. The subjects of this study were 309 African American men, age 18–54 years, with hypertension, residing in inner‐city Baltimore. Echocardiograms, electrocardiograms, serum creatinine, and the urinary albumin‐creatinine ratio were obtained to evaluate hypertensive target organ damage. Fifty‐three percent of the men reported use of antihypertensive medications, of whom 80% were on monotherapy. Calcium channel blockers were used most frequently. The mean echocardiographic left ventricular mass was 211±68 g, with a prevalence of echocardiographic left ventricular hypertrophy of 30%. There were 14 men (5%) with extremely high left ventricular mass, >350 grams. Left ventricular systolic dysfunction was seen in 9% of the men with uncontrolled hypertension, and none of the men with controlled hypertension (p=0.02). Renal dysfunction was found in 12% of the subjects, and microalbuminuria or gross proteinuria in 34%. The authors conclude that there is a high prevalence of cardiac and renal abnormalities in inner‐city African American men with hypertension, especially in men on antihypertensive therapy with uncontrolled hypertension. It is imperative that cost‐effective medications and culturally acceptable health care delivery programs be developed, tested, and integrated into health systems, with strategies specifically relevant to this high‐risk population, to decrease the largely preventable morbidity and mortality associated with hypertension.
Low Birth Weight as a Risk Factor for Hypertension
Authors: Lackland Daniel T. , Egan Brent M. , Ferguson Pamela L.
Published: May 2007

While the geographic and demographic disparities in the prevalence of hypertension have been recognized for decades, the reasons for these differences in disease risks remain unknown. The demographic and geographic patterns of hypertension are similar to those of low birth weight, giving support to the “Barker Hypothesis” which proposes a fetal origin of adult‐onset disease. In fact, ecologic and observational studies throughout the world have detected significant associations of low birth weight and increased risks of hypertension. Nonetheless, the mechanisms for the association have not been fully described and documented. With some supportive evidence, proposed mechanisms include reduced nephrogenesis with a higher threshold for pressure natriuresis and greater susceptibility to progressive renal disease, impaired development of the endothelium, and increased sensitivity to glucocorticoids. Still, considerable work needs to be done to explain the birth weight/blood pressure relationship. The findings to date and the clinical significance warrant continued research in this intriguing area of study.
No Evidence That Panic Attacks Are Associated With the White Coat Effect in Hypertension
Authors: Davies Simon J.C. , Jackson Peter R. , Ramsay Lawrence E. , Ghahramani Parviz , Palmer Rosemary L. , Hippisley‐Cox Julia
Published: May 2007

The authors aimed to determine whether hypertensive patients with panic attacks or panic disorder have a larger white coat effect (difference between clinic blood pressure measured under standard conditions and mean daytime ambulatory blood pressure) than hypertensive patients without panic attacks. White coat effect was compared in a hospital hypertension clinic between 24 patients with panic attacks in the previous 6 months (12 with panic disorder) and 23 hypertensive controls. There were no significant differences between cases and controls in clinic blood pressure, mean daytime ambulatory blood pressure, or white coat effect (18/3 vs. 19/6 mm Hg; difference for systolic, −1.9 mm Hg; 95% confidence interval, −15.8 to +12.0; difference for diastolic, −3.0 mm Hg; 95% confidence interval, −10.2 to +4.3). Comparing only patients with panic disorder with controls, there were again no significant differences in clinic blood pressure, mean daytime ambulatory blood pressure, or white coat effect. This study provides no evidence for an exaggerated white coat effect in hypertensive patients who have experienced panic attacks or panic disorder. However, only larger studies could exclude differences in white coat effect <12/4 mm Hg, or an exaggerated white coat effect in a minority of patients with panic attacks.
The Effects of Amlodipine Compared to Losartan in Patients With Mild to Moderately Severe Hypertension
Authors: Phillips Robert A. , Kloner Robert A. , Grimm Richard H. , Weinberger Myron
Published: May 2007

The calcium channel blocker amlodipine and angiotensin ll receptor blocker losartan, with or without hydrochlorothiazide (HCTZ), were compared for the treatment of mild to moderate hypertension in a multicenter, double‐blind, parallel‐group clinical trial. Following a 2‐week placebo run‐in, 440 adults (45–80 years old) were randomized to receive either amlodipine 5 mg once daily or losartan 50 mg once daily. Patients who failed to meet the sitting diastolic blood pressure (BP) reduction goal of ≥90 mm Hg after 6 weeks had their dose increased to 10 mg amlodipine or had 12.5 mg of HCTZ added to the losartan 50 mg. A total of 42.3% of losartan and 43.6% of amlodipine subjects achieved a diastolic BP of ≥90 mm Hg at initial dose (low dose). Of those who completed treatment at the low dose, 71% of the amlodipine‐ and 81% of the losartan‐treated patients met BP goal. This difference was not statistically significant. Of those who received a dosage adjustment, a significantly greater percentage of amlodipine‐treated patients (59%) than losartan/HCTZ‐treated patients (42%) reached BP goal at the last visit (p=0.009). Including both high‐ and low‐dose subjects, 63.8% of amlodipine and 55.1% of losartan patients achieved a diastolic BP of ≤90 mm Hg at the last maintenance visit; this difference was not significant (p=0.07). Overall, reductions in mean sitting BP from baseline to the end of treatment were significantly greater in the amlodipine group than in the losartan group for both diastolic BP (−12.6 vs. −10.3 mm Hg; p=0.002) and systolic BP (−16.1 vs. −13.7 mm Hg; p=0.018). Additionally, the response rate was significantly greater after treatment with amlodipine than with losartan in African Americans (62.5% vs. 41.4%; p=0.033) and the other mostly Hispanic patients (67.7% vs. 53.5%; p=0.039). Both treatment groups showed significant reductions from baseline in 24‐hour ambulatory BP at the end of treatment, with no difference between them. Adverse events were consistent with the safety profile of each drug. It is concluded that, while both amlodipine and losartan demonstrated a significant benefit for the treatment of mild to moderate hypertension, there were greater reductions in most BP measurements following treatment with amlodipine in comparison to losartan with or without HCTZ.
How Pharmacists Can Assist Physicians With Controlling Blood Pressure
Authors: Carter Barry L. , Zillich Alan J. , Elliott William J.
Published: May 2007

The goals for hypertension in the publication Healthy People 2010 require a much more intensive approach in order to achieve desired blood pressure control rates. The pharmacist is uniquely positioned in the health care system to assist with improving blood pressure control by utilizing strategies to solve medication‐related problems. Studies within integrated health systems have demonstrated that when pharmacists are included as members of health care teams, control rates for hypertension increase. In addition, drug interactions, nonadherence, and costs can be reduced. The authors suggest that incorporating a pharmacist or some services typically provided by traditional pharmacists into physician practices can improve blood pressure control. This review summarizes studies involving pharmacist participation in hypertension management and provides recommendations for obtaining pharmacist involvement.
Meta‐Analysis, Meta‐Regression, and Meta‐Physics
Authors: Kostis John B.
Published: May 2007

Παντɛςανθρωποιτοv ɛιδɛναιορɛγονταιφvσɛι. σημɛιονδɛητωναισθησɛωναγαπησις. Kαιγαρχωριςτηςχρɛιαςαγαπωνταιδι' αvτας, καιμαλλιστατωναλλωνηδιατωνομματων.

By nature humans thirst for knowledge. A sign of this is our love of the senses. Because irrespective of our needs we love our senses in themselves and most of all vision (eyesight).1
Evaluation of Angiotensin II Receptor Blockers for 24‐Hour Blood Pressure Control: Meta‐Analysis of a Clinical Database
Authors: Neutel Joel M. , Smith David H.G.
Published: May 2007

Angiotensin II receptor blockers are well tolerated and improve compliance in hypertensive patients. The need for 24‐hour blood pressure control has focused attention on whether all agents in this class maintain smooth antihypertensive effects over a 24‐hour period. Insight into this issue emerged from a meta‐analysis of five large, multicenter trials in which ambulatory blood pressure monitoring was used to compare the antihypertensive effects of three angiotensin II receptor blockers: telmisartan, losartan, and valsartan. These trials used either a double‐blind, placebo‐controlled or a prospective, randomized, open‐label, blinded‐end point design. Initial analysis established the validity of combining ambulatory blood pressure monitoring data from the double‐blind, placebo‐controlled and prospective, randomized, open‐label, blinded‐end point designs. Subsequent analyses revealed that telmisartan 80 mg was significantly more effective than losartan 50 mg and valsartan 80 mg for reducing 24‐hour mean blood pressure. Furthermore, telmisartan 80 mg was comparable to amlodipine 5 mg for controlling the early morning surge in blood pressure.
The Association Between Physical Activity and the Development of Acute Coronary Syndromes in Treated and Untreated Hypertensive Subjects
Authors: Chrysohoou Christine , Pitsavos Christos , Panagiotakos Demosthenes B. , Kokkinos Peter F. , Stefanadis Christodoulos , Toutouzas Pavlos
Published: May 2007

The objective of this study was to evaluate the effect of physical activity on the risk of coronary events in different groups of hypertensive patients. During 2000–2001, 848 patients hospitalized for a first event of coronary heart disease and 1078 hospitalized controls without any suspicion of coronary heart disease, paired by sex and age, were randomly selected from all Greek regions. A total of 418 (49%) of the patients and 303 (28%) of the controls were classified as hypertensives, while 88 (21%) of the hypertensive patients and 88 (29%) of the hypertensive controls, reported regular leisure‐time physical activity. Compared to physical inactivity, the analysis showed that light to moderate physical activity was associated with a reduction by 12% of the coronary risk in controlled hypertensive subjects (p=0.03), by 9% (p=0.04) in hypertensives who were untreated or unaware of their condition, and by 5% (p=0.087) in uncontrolled hypertensives. The practice of regular physical activity seems to be associated with lower coronary risk in various groups of hypertensives. However, these data cannot prove causality, and prospective studies will be necessary to confirm or refute the authors' findings.
Meeting the Challenge to Improve the Treatment of Hypertension in Blacks
Authors: Lopes Antonio Alberto , James Sherman A. , Port Friedrich K. , Ojo Akinlolu O. , Agodoa Lawrence Y. , Jamerson Kenneth A.
Published: May 2007

Hypertension is more prevalent and severe in African descendent populations living outside Africa than in any other population. Given this greater burden of hypertension in blacks, it is increasingly necessary to refine strategies to prevent the disorder as well as improve its treatment and control. This review assesses results from clinical trials on lifestyle and pharmacologic interventions to identify which approaches most effectively prevent adverse hypertension‐related outcomes in African descendent populations. The Dietary Approaches to Stop Hypertension (DASH) study provided evidence that a carefully controlled diet rich in fruits, vegetables, low‐fat dairy foods, and reduced in saturated fat, total fat, and cholesterol (i.e., the DASH diet) reduces blood pressure in blacks and is well accepted. The combination of the DASH diet with reduction in dietary sodium below 100 mmol/d may provide a reduction in blood pressure beyond that reached by the DASH diet alone. Physical exercise and interventions to reduce psychological stress may also reduce blood pressure in blacks. Strong evidence from numerous studies is a compelling argument for continuing to recommend diuretics and β blockers as first‐line antihypertensive therapy for persons of all races. Some new studies also favor angiotensin‐converting enzyme inhibitors as first‐line antihypertensive drugs. The African American Study of Kidney Disease and Hypertension provided evidence that an angiotensin‐converting enzyme inhibitor‐based treatment program is more beneficial than calcium channel blockers and β blockers in reducing the progression of renal failure in blacks with hypertensive nephropathy. Studies in patients with diabetes have also shown evidence that both angiotensin‐converting enzyme inhibitors and angiotensin receptor antagonists are more effective than other classes of antihypertensives in reducing adverse renal events. Studies to evaluate the effects of the new antihypertensives in improving outcomes in blacks living outside the United States are needed.
Insulin Resistance, Hypertension, and Coronary Heart Disease
Authors: Reaven Gerald
Published: May 2007

The goals of this review are two‐fold: to examine the evidence in support of a role for insulin resistance and compensatory hyperinsulinemia in the pathogenesis of essential hypertension, and to evaluate the hypothesis that insulin resistance and its manifestations play major roles in the development of coronary heart disease in patients with essential hypertension. In both instances, only experimental results in human beings will be considered. Although it remains a scientific issue of great importance, the scope of this review precludes a discussion of the mechanistic link between insulin resistance/hyperinsulinemia and essential hypertension.