for Journals by Title or ISSN
for Articles by Keywords
help
Journal Cover The Lancet
  [SJR: 11.563]   [H-I: 514]   [1539 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [2801 journals]
  • Oral misoprostol is as safe as Foley catheter for labour
           induction…or is it'
    • Abstract: Publication date: Available online 3 February 2016
      Source:The Lancet
      Author(s): G Justus Hofmeyr



      PubDate: 2016-02-10T07:42:18Z
       
  • Concern over Zika virus grips the world
    • Abstract: Publication date: Available online 3 February 2016
      Source:The Lancet
      Author(s): Udani Samarasekera, Marcia Triunfol



      PubDate: 2016-02-10T07:42:18Z
       
  • El Niño and climate change—contributing factors in the
           dispersal of Zika virus in the Americas'
    • Abstract: Publication date: Available online 2 February 2016
      Source:The Lancet
      Author(s): Shlomit Paz, Jan C Semenza



      PubDate: 2016-02-10T07:42:18Z
       
  • Increasing worldwide access to medical opioids
    • Abstract: Publication date: Available online 3 February 2016
      Source:The Lancet
      Author(s): James F Cleary, Asra Husain, Martha Maurer



      PubDate: 2016-02-10T07:42:18Z
       
  • Induction of labour at term with oral misoprostol versus a Foley catheter
           (PROBAAT-II): a multicentre randomised controlled non-inferiority trial
    • Abstract: Publication date: Available online 3 February 2016
      Source:The Lancet
      Author(s): Mieke L G ten Eikelder, Katrien Oude Rengerink, Marta Jozwiak, Jan W de Leeuw, Irene M de Graaf, Mariëlle G van Pampus, Marloes Holswilder, Martijn A Oudijk, Gert-Jan van Baaren, Paula J M Pernet, Caroline Bax, Gijs A van Unnik, Gratia Martens, Martina Porath, Huib van Vliet, Robbert J P Rijnders, A Hanneke Feitsma, Frans J M E Roumen, Aren J van Loon, Hans Versendaal, Martin J N Weinans, Mallory Woiski, Erik van Beek, Brenda Hermsen, Ben Willem Mol, Kitty W M Bloemenkamp
      Background Labour is induced in 20–30% of all pregnancies. In women with an unfavourable cervix, both oral misoprostol and Foley catheter are equally effective compared with dinoprostone in establishing vaginal birth, but each has a better safety profile. We did a trial to directly compare oral misoprostol with Foley catheter alone. Methods We did an open-label randomised non-inferiority trial in 29 hospitals in the Netherlands. Women with a term singleton pregnancy in cephalic presentation, an unfavourable cervix, intact membranes, and without a previous caesarean section who were scheduled for induction of labour were randomly allocated to cervical ripening with 50 μg oral misoprostol once every 4 h or to a 30 mL transcervical Foley catheter. The primary outcome was a composite of asphyxia (pH ≤7·05 or 5-min Apgar score <7) or post-partum haemorrhage (≥1000 mL). The non-inferiority margin was 5%. The trial is registered with the Netherlands Trial Register, NTR3466. Findings Between July, 2012, and October, 2013, we randomly assigned 932 women to oral misoprostol and 927 women to Foley catheter. The composite primary outcome occurred in 113 (12·2%) of 924 participants in the misoprostol group versus 106 (11·5%) of 921 in the Foley catheter group (adjusted relative risk 1·06, 90% CI 0·86–1·31). Caesarean section occurred in 155 (16·8%) women versus 185 (20·1%; relative risk 0·84, 95% CI 0·69–1·02, p=0·067). 27 adverse events were reported in the misoprostol group versus 25 in the Foley catheter group. None were directly related to the study procedure. Interpretation In women with an unfavourable cervix at term, induction of labour with oral misoprostol and Foley catheter has similar safety and effectiveness. Funding FondsNutsOhra.


      PubDate: 2016-02-10T07:42:18Z
       
  • Tackling cancer: time for a global response
    • Abstract: Publication date: Available online 4 February 2016
      Source:The Lancet
      Author(s): Franco Cavalli



      PubDate: 2016-02-10T07:42:18Z
       
  • Use of and barriers to access to opioid analgesics: a worldwide, regional,
           and national study
    • Abstract: Publication date: Available online 3 February 2016
      Source:The Lancet
      Author(s): Stefano Berterame, Juliana Erthal, Johny Thomas, Sarah Fellner, Benjamin Vosse, Philip Clare, Wei Hao, David T Johnson, Alejandro Mohar, Jagjit Pavadia, Ahmed Kamal Eldin Samak, Werner Sipp, Viroj Sumyai, Sri Suryawati, Jallal Toufiq, Raymond Yans, Richard P Mattick
      Background Despite opioid analgesics being essential for pain relief, use has been inadequate in many countries. We aim to provide up-to-date worldwide, regional, and national data for changes in opioid analgesic use, and to analyse the relation of impediments to use of these medicines. Methods We calculated defined daily doses for statistical purposes (S-DDD) per million inhabitants per day of opioid analgesics worldwide and for regions and countries from 2001 to 2013, and we used generalised estimating equation analysis to assess longitudinal change in use. We compared use data against the prevalence of some health disorders needing opioid use. We surveyed 214 countries or territories about impediments to availability of these medicines, and used regression analyses to establish the strength of associations between impediments and use. Findings The S-DDD of opioid analgesic use more than doubled worldwide between 2001–03 and 2011–13, from 1417 S-DDD (95% CI −732 to 3565; totalling about 3·01 billion defined daily doses per annum) to 3027 S-DDD (−1162 to 7215; totalling about 7·35 billion defined daily doses per annum). Substantial increases occurred in North America (16 046 S-DDD [95% CI 4032–28 061] to 31 453 S-DDD [8121–54 785]), western and central Europe (3079 S-DDD [1274–4883] to 9320 S-DDD [3969–14 672]), and Oceania (2275 S-DDD [763–3787] to 9136 S-DDD [2508–15 765]). Countries in other regions have shown no substantial increase in use. Impediments to use included an absence of training and awareness in medical professionals, fear of dependence, restricted financial resources, issues in sourcing, cultural attitudes, fear of diversion, international trade controls, and onerous regulation. Higher number of impediments reported was significantly associated with lower use (unadjusted incidence rate ratio 0·39 [95% CI 0·29–0·52]; p<0·0001), but not when adjusted for gross domestic product and human development index (0·91 [0·73–1·14]; p=0·4271). Interpretation Use of opioid analgesics has increased, but remains low in Africa, Asia, Central America, the Caribbean, South America, and eastern and southeastern Europe. Identified impediments to use urgently need to be addressed by governments and international agencies. Funding International Narcotics Control Board, UN.


      PubDate: 2016-02-10T07:42:18Z
       
  • Antiangiogenic therapy in oncology: current status and future directions
    • Abstract: Publication date: Available online 5 February 2016
      Source:The Lancet
      Author(s): Gordon C Jayson, Robert Kerbel, Lee M Ellis, Adrian L Harris
      Angiogenesis, the formation of new blood vessels from pre-existing vessels, has been validated as a target in several tumour types through randomised trials, incorporating vascular endothelial growth factor (VEGF) pathway inhibitors into the therapeutic armoury. Although some tumours such as renal cell carcinoma, ovarian and cervical cancers, and pancreatic neuroendocrine tumours are sensitive to these drugs, others such as prostate cancer, pancreatic adenocarcinoma, and melanoma are resistant. Even when drugs have yielded significant results, improvements in progression-free survival, and, in some cases, overall survival, are modest. Thus, a crucial issue in development of these drugs is the search for predictive biomarkers—tests that predict which patients will, and will not, benefit before initiation of therapy. Development of biomarkers is important because of the need to balance efficacy, toxicity, and cost. Novel combinations of these drugs with other antiangiogenics or other classes of drugs are being developed, and the appreciation that these drugs have immunomodulatory and other modes of action will lead to combination regimens that capitalise on these newly understood mechanisms.


      PubDate: 2016-02-10T07:42:18Z
       
  • Offline: Brazil—the unexpected opportunity that Zika presents
    • Abstract: Publication date: Available online 4 February 2016
      Source:The Lancet
      Author(s): Richard Horton



      PubDate: 2016-02-10T07:42:18Z
       
  • Microcephaly in Brazil: how to interpret reported numbers'
    • Abstract: Publication date: Available online 7 February 2016
      Source:The Lancet
      Author(s): Cesar Gomes Victora, Lavinia Schuler-Faccini, Alicia Matijasevich, Erlane Ribeiro, André Pessoa, Fernando Celso Barros



      PubDate: 2016-02-10T07:42:18Z
       
  • A crucial time for public health preparedness: Zika virus and the 2016
           Olympics, Umrah, and Hajj
    • Abstract: Publication date: Available online 7 February 2016
      Source:The Lancet
      Author(s): Habida Elachola, Ernesto Gozzer, Jiatong Zhuo, Ziad A Memish



      PubDate: 2016-02-10T07:42:18Z
       
  • From epidemiological transition to modern cardiovascular epidemiology:
           hypertension in the 21st century
    • Abstract: Publication date: Available online 6 February 2016
      Source:The Lancet
      Author(s): Jacques Blacher, Bernard I Levy, Jean-Jacques Mourad, Michel E Safar, George Bakris



      PubDate: 2016-02-10T07:42:18Z
       
  • Suicide risk in people with chronic fatigue syndrome
    • Abstract: Publication date: Available online 10 February 2016
      Source:The Lancet
      Author(s): Nav Kapur, Roger Webb



      PubDate: 2016-02-10T07:42:18Z
       
  • Mortality of people with chronic fatigue syndrome: a retrospective cohort
           study in England and Wales from the South London and Maudsley NHS
           Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record
           Interactive Search (CRIS) Register
    • Abstract: Publication date: Available online 10 February 2016
      Source:The Lancet
      Author(s): Emmert Roberts, Simon Wessely, Trudie Chalder, Chin-Kuo Chang, Matthew Hotopf
      Background Mortality associated with chronic fatigue syndrome is uncertain. We investigated mortality in individuals diagnosed with chronic fatigue syndrome in secondary and tertiary care using data from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) register. Methods We calculated standardised mortality ratios (SMRs) for all-cause, suicide-specific, and cancer-specific mortality for a 7-year observation period using the number of deaths observed in SLaM records compared with age-specific and sex-specific mortality statistics for England and Wales. Study participants were included if they had had contact with the chronic fatigue service (referral, discharge, or case note entry) and received a diagnosis of chronic fatigue syndrome. Findings We identified 2147 cases of chronic fatigue syndrome from CRIS and 17 deaths from Jan 1, 2007, to Dec 31, 2013. 1533 patients were women of whom 11 died, and 614 were men of whom six died. There was no significant difference in age-standardised and sex-standardised mortality ratios (SMRs) for all-cause mortality (SMR 1·14, 95% CI 0·65–1·85; p=0·67) or cancer-specific mortality (1·39, 0·60–2·73; p=0·45) in patients with chronic fatigue syndrome when compared with the general population in England and Wales. This remained the case when deaths from suicide were removed from the analysis. There was a significant increase in suicide-specific mortality (SMR 6·85, 95% CI 2·22–15·98; p=0·002). Interpretation We did not note increased all-cause mortality in people with chronic fatigue syndrome, but our findings show a substantial increase in mortality from suicide. This highlights the need for clinicians to be aware of the increased risk of completed suicide and to assess suicidality adequately in patients with chronic fatigue syndrome. Funding National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.


      PubDate: 2016-02-10T07:42:18Z
       
  • Global, regional, and national levels and trends in maternal mortality
           between 1990 and 2015, with scenario-based projections to 2030: a
           systematic analysis by the UN Maternal Mortality Estimation Inter-Agency
           Group
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Leontine Alkema, Doris Chou, Daniel Hogan, Sanqian Zhang, Ann-Beth Moller, Alison Gemmill, Doris Ma Fat, Ties Boerma, Marleen Temmerman, Colin Mathers, Lale Say
      Background Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100 000 livebirths globally by 2030. Methods We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. Results We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100 000 livebirths (80% UI 359–427) in 1990, to 216 (207–249) in 2015, corresponding to a relative decline of 43·9% (34·0–48·7), with 303 000 (291 000–349 000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0–3·1) in the Caribbean to 5·0% (4·0–6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100 000 livebirths (11–14) for high-income regions to 546 (511–652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. Interpretation Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths. Funding National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.


      PubDate: 2016-01-31T07:34:10Z
       
  • Sustained efficacy of pulmonary artery pressure to guide adjustment of
           chronic heart failure therapy: complete follow-up results from the
           CHAMPION randomised trial
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): William T Abraham, Lynne W Stevenson, Robert C Bourge, Jo Ann Lindenfeld, Jordan G Bauman, Philip B Adamson
      Background In the CHAMPION trial, significant reductions in admissions to hospital for heart failure were seen after 6 months of pulmonary artery pressure guided management compared with usual care. We examine the extended efficacy of this strategy over 18 months of randomised follow-up and the clinical effect of open access to pressure information for an additional 13 months in patients formerly in the control group. Methods The CHAMPION trial was a prospective, parallel, single-blinded, multicentre study that enrolled participants with New York Heart Association (NYHA) Class III heart failure symptoms and a previous admission to hospital. Patients were randomly assigned (1:1) by centre in block sizes of four by a secure validated computerised randomisation system to either the treatment group, in which daily uploaded pulmonary artery pressures were used to guide medical therapy, or to the control group, in which daily uploaded pressures were not made available to investigators. Patients in the control group received all standard medical, device, and disease management strategies available. Patients then remained masked in their randomised study group until the last patient enrolled completed at least 6 months of study follow-up (randomised access period) for an average of 18 months. During the randomised access period, patients in the treatment group were managed with pulmonary artery pressure and patients in the control group had usual care only. At the conclusion of randomised access, investigators had access to pulmonary artery pressure for all patients (open access period) averaging 13 months of follow-up. The primary outcome was the rate of hospital admissions between the treatment group and control group in both the randomised access and open access periods. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00531661. Findings Between Sept 6, 2007, and Oct 7, 2009, 550 patients were randomly assigned to either the treatment group (n=270) or to the control group (n=280). 347 patients (177 in the former treatment group and 170 in the former control group) completed the randomised access period in August, 2010, and transitioned to the open access period which ended April 30, 2012. Over the randomised access period, rates of admissions to hospital for heart failure were reduced in the treatment group by 33% (hazard ratio [HR] 0·67 [95% CI 0·55–0·80]; p<0·0001) compared with the control group. After pulmonary artery pressure information became available to guide therapy during open access (mean 13 months), rates of admissions to hospital for heart failure in the former control group were reduced by 48% (HR 0·52 [95% CI 0·40–0·69]; p<0·0001) compared with rates of admissions in the control group during randomised access. Eight (1%) device-related or system related complications and seven (1%) procedure-related adverse events were reported. Interpretation Management of NYHA Class III heart failure based on home transmission of pulmonary artery pressure with an implanted pressure sensor has significant long-term benefit in lowering hospital admission rates for heart failure. Funding St Jude Medical Inc.


      PubDate: 2016-01-31T07:34:10Z
       
  • Immediate delivery compared with expectant management after preterm
           pre-labour rupture of the membranes close to term (PPROMT trial): a
           randomised controlled trial
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Jonathan M Morris, Christine L Roberts, Jennifer R Bowen, Jillian A Patterson, Diana M Bond, Charles S Algert, Jim G Thornton, Caroline A Crowther
      Background Preterm pre-labour ruptured membranes close to term is associated with increased risk of neonatal infection, but immediate delivery is associated with risks of prematurity. The balance of risks is unclear. We aimed to establish whether immediate birth in singleton pregnancies with ruptured membranes close to term reduces neonatal infection without increasing other morbidity. Methods The PPROMT trial was a multicentre randomised controlled trial done at 65 centres across 11 countries. Women aged over 16 years with singleton pregnancies and ruptured membranes before the onset of labour between 34 weeks and 36 weeks and 6 days weeks who had no signs of infection were included. Women were randomly assigned (1:1) by a computer-generated randomisation schedule with variable block sizes, stratified by centre, to immediate delivery or expectant management. The primary outcome was the incidence of neonatal sepsis. Secondary infant outcomes included a composite neonatal morbidity and mortality indicator (ie, sepsis, mechanical ventilation ≥24 h, stillbirth, or neonatal death); respiratory distress syndrome; any mechanical ventilation; and duration of stay in a neonatal intensive or special care unit. Secondary maternal outcomes included antepartum or intrapartum haemorrhage, intrapartum fever, postpartum treatment with antibiotics, and mode of delivery. Women and caregivers could not be masked, but those adjudicating on the primary outcome were masked to group allocation. Analyses were by intention to treat. This trial is registered with the International Clinical Trials Registry, number ISRCTN44485060. Findings Between May 28, 2004, and June 30, 2013, 1839 women were recruited and randomly assigned: 924 to the immediate birth group and 915 to the expectant management group. One woman in the immediate birth group and three in the expectant group were excluded from the primary analyses. Neonatal sepsis occurred in 23 (2%) of 923 neonates whose mothers were assigned to immediate birth and 29 (3%) of 912 neonates of mothers assigned to expectant management (relative risk [RR] 0·8, 95% CI 0·5–1·3; p=0·37). The composite secondary outcome of neonatal morbidity and mortality occurred in 73 (8%) of 923 neonates of mothers assigned to immediate delivery and 61 (7%) of 911 neonates of mothers assigned to expectant management (RR 1·2, 95% CI 0·9–1·6; p=0·32). However, neonates born to mothers in the immediate delivery group had increased rates of respiratory distress (76 [8%] of 919 vs 47 [5%] of 910, RR 1·6, 95% CI 1·1–2·30; p=0·008) and any mechanical ventilation (114 [12%] of 923 vs 83 [9%] of 912, RR 1·4, 95% CI 1·0–1·8; p=0·02) and spent more time in intensive care (median 4·0 days [IQR 0·0–10·0] vs 2·0 days [0·0–7·0]; p<0·0001) compared with neonates born to mothers in the expectant management group. Compared with women assigned to the immediate delivery group, those assigned to the expectant management group had higher risks of antepartum or intrapartum haemorrhage (RR 0·6, 95% CI 0·4–0·9), intrapartum fever (0·4, 0·2–0·9), and use of postpartum antibiotics (0·8, 0·7–1·0), and longer hospital stay (p<0·0001), but a lower risk of caesarean delivery (RR 1·4, 95% CI 1·2–1·7). Interpretation In the absence of overt signs of infection or fetal compromise, a policy of expectant management with appropriate surveillance of maternal and fetal wellbeing should be followed in pregnant women who present with ruptured membranes close to term. Funding Australian National Health and Medical Research Council, the Women's and Children's Hospital Foundation, and The University of Sydney.


      PubDate: 2016-01-31T07:34:10Z
       
  • Prophylactic antibiotics to reduce pneumonia after acute stroke –
           Author's reply
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Lalit Kalra



      PubDate: 2016-01-31T07:34:10Z
       
  • The promise of personalised medicine
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Brett Doble, Deborah J Schofield, Tony Roscioli, John S Mattick



      PubDate: 2016-01-31T07:34:10Z
       
  • Frailty in emergency departments
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Elsa Dent, Emiel O Hoogendijk, Magnolia Cardona-Morrell, Kenneth Hillman



      PubDate: 2016-01-31T07:34:10Z
       
  • Effects of intensive blood pressure lowering on cardiovascular and renal
           outcomes: updated systematic review and meta-analysis
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Xinfang Xie, Emily Atkins, Jicheng Lv, Alexander Bennett, Bruce Neal, Toshiharu Ninomiya, Mark Woodward, Stephen MacMahon, Fiona Turnbull, Graham S Hillis, John Chalmers, Jonathan Mant, Abdul Salam, Kazem Rahimi, Vlado Perkovic, Anthony Rodgers
      Background Recent hypertension guidelines have reversed previous recommendations for lower blood pressure targets in high-risk patients, such as those with cardiovascular disease, renal disease, or diabetes. This change represents uncertainty about whether more intensive blood pressure-lowering strategies are associated with greater reductions in risk of major cardiovascular and renal events. We aimed to assess the efficacy and safety of intensive blood pressure-lowering strategies. Methods For this updated systematic review and meta-analysis, we systematically searched MEDLINE, Embase, and the Cochrane Library for trials published between Jan 1, 1950, and Nov 3, 2015. We included randomised controlled trials with at least 6 months' follow-up that randomly assigned participants to more intensive versus less intensive blood pressure-lowering treatment, with different blood pressure targets or different blood pressure changes from baseline. We did not use any age or language restrictions. We did a meta-analysis of blood pressure reductions on relative risk (RR) of major cardiovascular events (myocardial infarction, stroke, heart failure, or cardiovascular death, separately and combined), and non-vascular and all-cause mortality, end-stage kidney disease, and adverse events, as well as albuminuria and progression of retinopathy in trials done in patients with diabetes. Findings We identified 19 trials including 44 989 participants, in whom 2496 major cardiovascular events were recorded during a mean 3·8 years of follow-up (range 1·0–8·4 years). Our meta-analysis showed that after randomisation, patients in the more intensive blood pressure-lowering treatment group had mean blood pressure levels of 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group. Intensive blood pressure-lowering treatment achieved RR reductions for major cardiovascular events (14% [95% CI 4–22]), myocardial infarction (13% [0–24]), stroke (22% [10–32]), albuminuria (10% [3–16]), and retinopathy progression (19% [0–34]). However, more intensive treatment had no clear effects on heart failure (15% [95% CI −11 to 34]), cardiovascular death (9% [–11 to 26]), total mortality (9% [–3 to 19]), or end-stage kidney disease (10% [–6 to 23]). The reduction in major cardiovascular events was consistent across patient groups, and additional blood pressure lowering had a clear benefit even in patients with systolic blood pressure lower than 140 mm Hg. The absolute benefits were greatest in trials in which all enrolled patients had vascular disease, renal disease, or diabetes. Serious adverse events associated with blood pressure lowering were only reported by six trials and had an event rate of 1·2% per year in intensive blood pressure-lowering group participants, compared with 0·9% in the less intensive treatment group (RR 1·35 [95% CI 0·93–1·97]). Severe hypotension was more frequent in the more intensive treatment regimen (RR 2·68 [1·21–5·89], p=0·015), but the absolute excess was small (0·3% vs 0·1% per person-year for the duration of follow-up). Interpretation Intensive blood pressure lowering provided greater vascular protection than standard regimens. In high-risk patients, there are additional benefits from more intensive blood pressure lowering, including for those with systolic blood pressure below 140 mmHg. The net absolute benefits of intensive blood pressure lowering in high-risk individuals are large. Funding National Health and Medical Research Council of Australia.


      PubDate: 2016-01-31T07:34:10Z
       
  • Climate change and health
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Jessica Lugsdin, Caroline Hook



      PubDate: 2016-01-31T07:34:10Z
       
  • Climate change and health
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Jing Dai, Chuanhua Xu, Lianming Liao, Hanxiang An



      PubDate: 2016-01-31T07:34:10Z
       
  • Prophylactic antibiotics to reduce pneumonia after acute stroke
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Ioan Milosevic, Aaron Dale, Henry Drysdale, Kamal Mahtani



      PubDate: 2016-01-31T07:34:10Z
       
  • Prophylactic antibiotics to reduce pneumonia after acute stroke
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Hermann Neugebauer, Beate Lindner-Pfleghar, Eric Jüttler, Albert C Ludolph, Axel Riecker



      PubDate: 2016-01-31T07:34:10Z
       
  • Faith-based health care
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Ian David Spillman



      PubDate: 2016-01-31T07:34:10Z
       
  • Faith-based health care
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): David McAdam



      PubDate: 2016-01-31T07:34:10Z
       
  • Climate change and health
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Natasha Kuruppu, Anthony Capon



      PubDate: 2016-01-31T07:34:10Z
       
  • Climate change and health
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Adithya Pradyumna, Renzo Guinto



      PubDate: 2016-01-31T07:34:10Z
       
  • Body images
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): John Quin



      PubDate: 2016-01-31T07:34:10Z
       
  • Charlotte Watts: from pure maths to HIV and gender-based violence
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Geoff Watts



      PubDate: 2016-01-31T07:34:10Z
       
  • The body politic
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Thomas Morris



      PubDate: 2016-01-31T07:34:10Z
       
  • Robert L Spitzer
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Alison Snyder



      PubDate: 2016-01-31T07:34:10Z
       
  • Faith-based health care
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Sima Barmania, Syed Mohamed Aljunid



      PubDate: 2016-01-31T07:34:10Z
       
  • Australia commits funds to curb hepatitis C epidemic
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Chris McCall



      PubDate: 2016-01-31T07:34:10Z
       
  • HIV in Mozambique: starting, and staying on, treatment
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Andrew Green



      PubDate: 2016-01-31T07:34:10Z
       
  • Profile: Boston University School of Public Health at 40
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Rita Rubin



      PubDate: 2016-01-31T07:34:10Z
       
  • Handcuffs London
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Richard Barnett



      PubDate: 2016-01-31T07:34:10Z
       
  • Spotlight on infant formula: coordinated global action needed
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Alison McFadden, Frances Mason, Jean Baker, France Begin, Fiona Dykes, Laurence Grummer-Strawn, Natalie Kenney-Muir, Heather Whitford, Elizabeth Zehner, Mary J Renfrew



      PubDate: 2016-01-31T07:34:10Z
       
  • Breastfeeding: a smart investment in people and in economies
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Keith Hansen



      PubDate: 2016-01-31T07:34:10Z
       
  • Retraction—Effect of vitamin and trace-element supplementation on
           immune responses and infection in elderly subjects
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): The Editors of The Lancet



      PubDate: 2016-01-31T07:34:10Z
       
  • Offline: Stillbirths—the last great myth
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Richard Horton



      PubDate: 2016-01-31T07:34:10Z
       
  • Modest global achievements in maternal survival: more focus on sub-Saharan
           Africa is needed
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Christian Holm Hansen, Joanna R M Armstrong Schellenberg



      PubDate: 2016-01-31T07:34:10Z
       
  • Pulmonary pressure, telemedicine, and heart failure therapy
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Nikolaos Dagres, Gerhard Hindricks



      PubDate: 2016-01-31T07:34:10Z
       
  • Ebola's legacy: UK deficits and their global lessons
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): The Lancet



      PubDate: 2016-01-31T07:34:10Z
       
  • Breastfeeding: achieving the new normal
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): The Lancet



      PubDate: 2016-01-31T07:34:10Z
       
  • US drug overdose deaths: a global challenge
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): The Lancet



      PubDate: 2016-01-31T07:34:10Z
       
  • Lower blood pressure targets: to whom do they apply'
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Mattias Brunström, Bo Carlberg



      PubDate: 2016-01-31T07:34:10Z
       
  • Late preterm rupture of membranes: it pays to wait
    • Abstract: Publication date: 30 January–5 February 2016
      Source:The Lancet, Volume 387, Issue 10017
      Author(s): Marian Knight, David Churchill



      PubDate: 2016-01-31T07:34:10Z
       
  • Time to take tobacco dependence treatment seriously
    • Abstract: Publication date: Available online 21 January 2016
      Source:The Lancet
      Author(s): Martin Raw, Judith Mackay, Srinath Reddy



      PubDate: 2016-01-21T07:30:18Z
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2015