[Multicenter prospective survey of prognosis of hypertensive elderly outpatient under antihypertensive treatment--morbidity and mortality of cardiovascular diseases and cancer]

The Relationship Between Anti-Hypertensive Drugs and Cancer: Anxiety to be Resolved in Urgent

Hypertension is the prevailing independent risk factor for cardiovascular disease worldwide. Anti-hypertensive drugs are the common and effective cure for lowering blood pressure in patients with hypertension. However, some large-scale clinical studies have pointed out that long-term ingestion of some oral anti-hypertensive drugs was associated with risks of incident cancer and the survival time. In contrast, other studies argue that anti-hypertensive drugs are not related to the occurrence of cancer, even as a complementary therapy of tumor treatment. To resolve the dispute, numerous recent mechanistic studies using animal models have tried to find the causal link between cancer and different anti-hypertensive drugs. However, the results were often contradictory. Such uncertainties have taken a toll on hypertensive patients. In this review, we will summarize advances of longitudinal studies in the association between anti-hypertensive drugs and related tumor risks that have helped to move the field forward from associative to causative conclusions, in hope of providing a reference for more rigorous and evidence-based clinical research on the topic to guide the clinical decision making.

A prediction model of 1-year mortality for acute ischemic stroke patients

OBJECTIVE

To develop a prediction model for 1-year mortality in patients with acute ischemic stroke, with the model to be at least as useful and accurate as other previously developed prediction models.

DESIGN

Retrospective cohort study.

SETTING

Neurology department at an Australian tertiary teaching hospital.

PARTICIPANTS

Four hundred forty consecutive patients diagnosed with acute ischemic stroke between July 1, 1995, and June 30, 1997.

INTERVENTIONS

Two hundred twenty-three (51%) patients were randomly assigned to the derivation sample to develop a prediction model using the Cox proportional hazards model. The model was then validated in a validation sample of 217 (49%) patients.

MAIN OUTCOME MEASURE

One-year mortality.

RESULTS

Eight clinical predictors were included in the final model: unconsciousness (3 points), dysphagia (7 points), urinary incontinence (9 points), both sides affected (4 points), hyperthermia (4 points), ischemic heart disease (3 points), peripheral vascular disease (3 points), and diabetes mellitus (2 points). Patients with scores of 10 or higher were allocated to the high-risk group, which had a 1-year mortality rate of 76%, compared with a 1-year mortality rate of 8% in the low-risk group. There was no statistically significant difference in terms of sensitivity, specificity, and positive predictive value in the validation sample.

CONCLUSION

We developed a predictive model for 1-year mortality in acute ischemic stroke patients. The model is easy to use and is comparable in its accuracy with other predictive models.