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Comment Hypertension in China: the gap between policy and practice
The high prevalence of hypertension in China is well known, with stroke being the most common cause of death and disability.1 Two large nationwide studies reported in The Lancet2,3 highlight that although the prevalence of hypertension in China is similar to that suggested in previous studies, it is simple deficiencies in the country's health system that make a large contribution to the disease burden. Both studies used data from the PEACE (Patient-Centred Evaluative Assessment of Cardiac Events) Million Persons Project (MPP), which enrolled 1 ·7 million adults aged 35–75 years from across China.
Source: LANCET - October 25, 2017 Category: General Medicine Authors: Therese Hesketh, Xudong Zhou Tags: Comment Source Type: research

Correspondence Hypertension control and cardiovascular disease
On the basis of Omran's theory of epidemiological transition, Jacques Blacher and colleagues (July 30, p 530)1 provocatively propose six strategies to reduce the burden of hypertensive cardiovascular disease. Notably, missing from their list are strategies to minimise blood pressure variability. In several large randomised trials, such as ALLHAT2 and ASCOT,3 blood pressure variability has been identified as a powerful independent risk factor for stroke and cardiovascular events.4 –6 Of note, not all antihypertensive drugs are equally effective in reducing blood pressure variability.
Source: LANCET - January 13, 2017 Category: Journals (General) Authors: Franz H Messerli, Urs Fischer, Stefano F Rimoldi, Sripal Bangalore Tags: Correspondence Source Type: research

Correspondence The INTERSTROKE study on risk factors for stroke
The INTERSTROKE study1 aimed to estimate the contributions of modifiable risk factors to stroke risk. The reported associations could be unreliable for at least three reasons. First, because of the case-control design, diet was evaluated after the outcome had developed, raising the possibility that cases responded to diet questions differently than controls (recall bias).2 Second, the association between the modified Alternative Healthy Eating Index (mAHEI) and stroke was evaluated together with hypertension and apolipoproteins.
Source: LANCET - January 6, 2017 Category: Journals (General) Authors: Anwar T Merchant Tags: Correspondence Source Type: research

Correspondence The INTERSTROKE study on risk factors for stroke – Authors' reply
Xianwei Zeng and collagues suggest our analysis of the INTERSTROKE study1 overestimated the population attributable for ten risk factors of stroke due to the selection of variables included. Although we did not include a variable for metabolic syndrome, we did include the key domains for metabolic syndrome, namely obesity, diabetes, hypertension, and apolipoproteins. Our analysis also included a measure of dietary quality, namely modified alternative healthy index (mAHEI). Variables for health education and hormones were not included, because these were not measured, although certain hormones could be measured in future an...
Source: LANCET - January 6, 2017 Category: Journals (General) Authors: Martin O'Donnell, Salim Yusuf Tags: Correspondence Source Type: research

World Report Profile: NIMHD—NIH's institute for minority health
For many Americans, health disparities are a fact of life—and death. Compared with white people, minorities are more likely to have and die from obesity, hypertension, heart attacks, cancer, stroke, and diabetes. On average, African-American people live 4 years less than do white people. The causes of these health disparities are a complex mixture of social and genetic factors, and they affect everything from the choices people make to how they interact with medical providers to how the system interacts with them.
Source: LANCET - November 6, 2015 Category: Journals (General) Authors: Carrie Arnold Tags: World Report Source Type: research

Correspondence The promise of personalised medicine
I read with great interest the Viewpoint by Victor Dzau and colleagues (May 23, p 2118)1 who suggested that personalised and precision medicine would result in identification of patients at highest risk of six high-prevalence diseases (cancer, diabetes, heart disease, hypertension, lung disease, and stroke) and lead to subsequent early prophylactic intervention. The authors also suggested that personalised medicine could lead to substantial cumulative gains (expressed using US$100 000 per quality-adjusted life-year, with a $33 billion gain at a reduced disease incidence of 10% and up to a $607 billion gain at a 50% incid...
Source: LANCET - August 21, 2015 Category: Journals (General) Authors: Claude Matuchansky Tags: Correspondence Source Type: research

Comment Gestational hypertension before term: observe or deliver?
Pre-eclampsia and other hypertensive disorders of pregnancy are common, and carry risks for both mother and baby. The only cure is delivery. Severe hypertension and severe pre-eclampsia are associated with increased risk of maternal morbidities such as stroke, coagulopathy, and eclampsia, and of maternal death.1 For these women, if gestation is over 34 weeks, the aim should be medical management with timely delivery. If gestation is less than 34 weeks, expectant care with stabilisation and careful monitoring of the woman to delay delivery might be better for the baby than immediate delivery.
Source: LANCET - March 25, 2015 Category: Journals (General) Authors: Jim Thornton, Lelia Duley Tags: Comment Source Type: research

Department of Error Department of Error
The ENOS Trial Investigators. Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial. Lancet 2015; 385: 617–28—In figure 1 in this Article, the number of patients assigned to the GTN patch who completed assessment on day 7 should have been 1996 rather than 1966. Data for TICS-M score and verbal fluency score for both analyses in table 2 were incorrect; the table has been corrected.
Source: LANCET - February 14, 2015 Category: Journals (General) Tags: Department of Error Source Type: research

Articles Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial
In patients with acute stroke and high blood pressure, transdermal glyceryl trinitrate lowered blood pressure and had acceptable safety but did not improve functional outcome. We show no evidence to support continuing prestroke antihypertensive drugs in patients in the first few days after acute stroke.
Source: LANCET - October 21, 2014 Category: Journals (General) Authors: The ENOS Trial Investigators Tags: Articles Source Type: research

Comment Focus on blood pressure as a major risk factor
The main risk factor for disease and premature death worldwide is high blood pressure. The associations between blood pressure and fatal coronary artery disease and fatal stroke have been well demonstrated. However, little evidence exists from contemporary clinical practice on the associations between blood pressure and morbidity and mortality from specific cardiovascular disease conditions in different age groups. Also missing are results concerning lifetime risk for specific cardiovascular complications associated with hypertension.
Source: LANCET - May 30, 2014 Category: Journals (General) Authors: Thomas Kahan Tags: Comment Source Type: research

Articles Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants
Interventions that reduce high blood pressure, cholesterol, and glucose might address about half of excess risk of coronary heart disease and three-quarters of excess risk of stroke associated with high BMI. Maintenance of optimum bodyweight is needed for the full benefits.
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: The Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects) Tags: Articles Source Type: research

Seminar Intracranial atherosclerosis
Atherosclerotic disease often involves the intracranial arteries including those encased by cranial bones and dura, and those located in the subarachnoid space. Age, hypertension, and diabetes mellitus are independent risk factors for intracranial atherosclerosis. Intracranial atherosclerosis can result in thromboembolism with or without hypoperfusion leading to transient or permanent cerebral ischaemic events. High rates of recurrent ischaemic stroke and other cardiovascular events mandate early diagnosis and treatment.
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: Adnan I Qureshi, Louis R Caplan Tags: Seminar Source Type: research