Global policies for mitigation of global warming GW will require countries to rely as possible upon renewable, clean energy sources. This includes developing countries, in need to foster suitable ...life conditions under population growth. Hydropower can deliver such renewable energy, pending water availability and proper management. In central Asia, water resources management is an urgent challenge, especially given desert climate, and the expected impacts of transient climate change hereon. While some catchments will still receive large shares of water from transient melting of the water towers in the Himalayas, others will not, given their little ice cover, in spite of the high altitudes. This is the case of Kabul River of Afghanistan, displaying low rainfall and high altitude, and yet displaying very small ice cover, and where further the present hydropower network is limited and partly damaged by recent conflicts. The goal of this work is to evaluate hydropower potential of the Kabul River and subsequently potential hydropower coverage of energy demand, under the hypotheses that (i) the present network would work at its largest potential and (ii) that hydrological regimes will change in response to scenarios of climate change, until the end of XXI century. To do so, we use a sparse array of data to tune the
Poli-Hydro
model, able to model hydrology of high altitude, poorly monitored catchments as here. Using modelled (and otherwise unknown) streamflows entering the present power plants (reservoirs + power-houses), we then simulate water management for hydropower purposes. We use two conditions, namely (i) run-of-river ROR and (ii) storage, and (optimal) regulation STO, allowing multipurpose use of water when necessary (e.g. irrigation needs). We then feed
Poli-Hydro
with IPCC climate scenarios (plus downscaling) until 2100, to carry out a sensitivity analysis (
what if?
scenarios) of (i) hydrological cycle and (ii) hydropower production. The future hydrological regimes are largely affected by uncertain future precipitation, and so is hydropower production. In spite of potentially increased hydropower on average (+ 1.4% at mid-century, + 1.7% at 2100), driven by variably changing stream flows, some scenarios indicate decreased overall production (down to − 3%) at half century. We provided here a tool usable to (i) assess present and future hydropower potential in the Kabul River, (ii) direct improvement of the present plants network and (iii) benchmark proposals for future network extension.
Purpose of Review
The paper examines the patterns of BP control achieved in two large scale observational studies, i.e., the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study and the ...Blood Pressure control rate and CArdiovascular Risk profilE (BP-CARE), carried out in the general population and in treated hypertensive patients, respectively.
Recent Findings
It is well known that only a minor fraction among the treated hypertensive patients exhibits a good blood pressure control. However, few study investigated blood pressure control on the basis not only of office, but also home and ambulatory blood pressure measurement, examining its impact on organ damage.
Summary
In the whole sample of the PAMELA study, only in about 21.1% of cases treated hypertensive subjects exhibit a well-controlled office BP. Control of systolic blood pressure was rarer than the diastolic one. Control of home and, even more, ambulatory blood pressure was more frequent. Left ventricular mass was not normalized even when blood pressure was adequately controlled. Most subjects of BP-CARE study show high or very high cardiovascular risk, due to concomitant risk factors and organ damage. The percentage of well-treated hypertensive patients is lower when CV risk is higher.
OBJECTIVE:In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, clinical, metabolic variables as well as office, home, and ambulatory blood pressure (BP) values were measured ...contemporaneously at baseline and after a ten-year period of follow-up, which allowed us to assess the value of selective and combined elevation of these BPs in predicting new onset metabolic syndrome (MetS).
DESIGN AND METHOD:The present analysis included 1,182 participants without MetS at baseline, as defined by the APT III criteria. Based on office, 24-hour ambulatory BP and home values, subjects were divided into 4 groupsnormal, with coat hypertension (WCH), masked hypertension (MH); and sustained hypertension (SH).
RESULTS:As compared to subjects with in-office and out-of-office BP normality a greater age- and gender-adjusted incidence of new onset Mets was observed in WCH (OR = 2.03, CI:1,21-3.41, p = 0.007), MH (OR = 2.55, CI:1.26–5.17; p = 0.009) and SH (OR = 2.28, CI:1.43–3.99, p = 0.0009) when out-of-office BP was defined by ambulatory criteria. This was not the same when out-of-office BP was based on home criteria, as only the WCH group showed a significant greater OR risk (2.16, CI1.28–3.63, p = 0.003).
CONCLUSIONS:Our study provides evidence that isolated or combined BP elevations when identified by office/ambulatory measurements, carry an increase in risk of new onset MetS, while classifying the population by combining office/home BPs only WCH is associated with a greater risk of incident MetS. In a clinical perspective, a comprehensive evaluation of BP status based on office/ambulatory measurements may substantially improve the risk stratification of new onset MetS and to activate measures for its prevention
OBJECTIVE:Pulse pressure (PP), is a simple measure of arterial stiffness. Several studies have shown that PP increases the risk of cardiovascular (CV) events but they were limited to clinic measure, ...mostly performed on individuals with high CV risk. Furthermore few studies reported PP-related risk of morbidity and mortality separately for genders.
DESIGN AND METHOD:3200 subjects, stratified for sex and decades of ages, were randomly selected to be representative of the general population of Monza (Northern Italy). In each subject we performed the following mesurements1) Clinic (C) Systolic (S) Blood Pressure (BP) and Diastolic (D) BP (sphygmomanometer), 2) Home SBP and DBP (Philips HP 5331), 3) Ambulatory (24 h) SBP and DBP (Spacelabs 90207), 4) Body Mass Index (BMI), 5) Blood Glucose and Serum Cholesterol. Each subject was followed for 12 years, during which all deaths were collected and classified by ICD-X codes as being a CV (ICD-X I-0 to I-99) or non CV death. Non-fatal CV events were identified by hospital diagnosis also using ICD-X codes and validated on the hospital clinical records.
RESULTS:The complete data set was obtained in 2045 subjects. PP was calculated as difference between SBP and DBP. Office, home and 24 h blood pressures were significantly higher in individuals who experienced a CV event or died during follow-up. Clinic, 24 h and Daytime PP were independent predictors of CV events after adjustment for main demographic and clinical parameters in the whole study population (HR 1.24, CI 1.03–1.49; HR 1.17, CI 1.01–1.36; HR 1.2, CI 1.03–1.39, respectively; p < 0.05 for all). Nighttime PP was an additional independent predictor in men (HR 1.23, CI 1.03–1.47, p < 0.05). None of measured PP (Clinic, Home, 24 h, Day- and Nighttime) was predictor of CV events in women. None of calculated PP was predictor of all-cause mortality in general population and in both genders.
CONCLUSIONS:Clinic and 24 h, but not home, PP represent a predictor of CV events in general population and in its male fraction. In females PP does not increase risk of CV events. All-cause death is not predicted by any of the PP measured.
OBJECTIVE:Studies addressing the association between a reduced drop of heart rate (HR) at night with subclinical organ damage and cardiovascular events in the general population are scanty. We ...evaluated this issue in subjects enrolled in the Pressioni Monitorate E Loro Associazioni (PAMELA) study.
DESIGN AND METHOD:At entry 2,021 subjects underwent diagnostic tests including laboratory investigations, 24-h ambulatory blood pressure (BP) monitoring and echocardiography. Participants were followed from the initial medical visit for a time interval of 148 ± 27 months. To explore the association of circadian HR rhythm and outcomes participants were classified in the primary analysis according to quartiles of nocturnal HR decrease. In secondary analyses the population was also classified according non-dipping nocturnal HR (defined as a drop in average HR at night lower than 10% compared to day-time values) and next in four categories(1) BP/HR dipper, 2) BP/HR non dipper, 3) HR dipper/BP non dipper, 4) HR non dipper/BP dipper).
RESULTS:A flattened circadian HR rhythm (i.e. lowest quartile of night-time HR dip) was independently associated to left atrial (LA) enlargement, but not to left ventricular hypertrophy; moreover, it was predictive of fatal and non-fatal cardiovascular events, independently of several confounders (hazard ratio 1.8, CI1.13–2.86, p < 0.01 vs highest quartile).
CONCLUSIONS:A blunted dipping of nocturnal HR is associated to preclinical cardiac damage in terms of LA enlargement and is predictive cardiovascular morbidity and mortality in the general population.
OBJECTIVE:Masked (MUCH) and white coat uncontrolled hypertension (WUCH) are more and more frequently investigated for their long-term prognostic significance Classification is usually made by a ...single set of office and out-of-office blood pressure (BP) measurements during the treatment period. To evaluate the long-term reproducibility of MUCH and WUCH, an information crucial for determining the long-term prognostic impact of these conditions.
DESIGN AND METHOD:Reproducibility of MUCH and WUCH was assessed in 1664 hypertensive patients recruited for the ELSA study treated with atenolol or lacidipine (+/– additional drugs) during a 4-year period. Office and 24-hour BP was measured at baseline and every year during treatment, allowing repeated classification of either condition.
RESULTS:After 1 year of treatment 21.1% and 17.8% of the patients were classified as MUCH and WUCH, respectively. For both conditions the prevalence was similar in the following years, although with a large change in patients composition because only about 1/3 of patients classified as MUCH or WUCH at one set of office and ambulatory BP measurements maintained the same classification at a subsequent set of measurements. In only 4.5% and 6.2% MUCH and WUCH persisted throughout the treatment period. MUCH and WUCH reproducibility was worse than that of patients showing control or lack of control of both office and ambulatory BP.
CONCLUSIONS:Both MUCH and WUCH display a poor reproducibility over time. This should be taken into account in studies assessing the long-term prognostic value of these conditions based on only one set of BP measurements.
OBJECTIVEWe sought to perform a comprehensive assessment of long-term changes in left ventricular (LV) mass, focusing on new onset, persistence, regression and severity of LV hypertrophy (LVH), as ...well as independent demographic and clinical variables related to this dynamic process in a population-based sample.
DESIGN AND METHODA total of 1,113 participants with measurable echocardiographic parameters at baseline evaluation and at the end of a ten-year follow-up period were included in the present analysis. Cut-points for LVH were derived from current echocardiographic guidelines
RESULTSLVH prevalence significantly increased from 13% to 33%, as a consequence of new onset LVH in 254 and regression in 31 cases, respectively. Severe LVH increased about 1.8 times as compared to baseline and this trend was mainly related to the transition from mild and moderate to severe LVH in subjects with pre-existing cardiac hypertrophy. A number of baseline variables such as age, female gender, office and out-of-office systolic BP, body mass index, ATP 3 metabolic syndrome, and use of antihypertensive drugs were independently correlated either to new-onset and persistent LVH.
CONCLUSIONSLong-term LV mass changes in the general population are associated to a marked worsening in cardiovascular risk profile related to increased prevalence and severity of LVH. As BP, metabolic variables and BMI emerged as key correlates of a such dynamic process, our findings suggest that early interventions aimed to modify such risk factors at the community level may have a role in preventing new onset and progression LVH.
OBJECTIVE:Limited information is available on the association between serum uric acid (SUA) and metabolic syndrome, diabetes mellitus, renal failure, blood pressure (BP) control and cardiovascular ...(CV) risk profile in treated hypertensives of eastern European countries.
DESIGN AND METHOD:The BP-CARE study examined BP control and CV risk profile in about 8000 treated hypertensive patients followed by non-specialist or specialist physicians in Albania, Belarus, Bosnia, Czech Republic, Latvia, Romania, Serbia, Slovakia and Ukraine. In 3220 of them measurements included, along with clinic BP, 24-hour BP, metabolic and renal function variables, SUA values.
RESULTS:51% were males, while mean age (±SD) was 60.0 ± 10.9 yrs, clinic BP 147.3 ± 18/87.8 ± 10 mmHg, 24 hour BP 137.3 ± 19/81.3 ± 10 mmHg and SUA values 5.68 ± 1.9 mg/dl, with a normal distribution in the population. SUA was significantly higher in males than females (5.99 ± 1.9 vs 5.34 ± 1.9 mg/dl, P < 0.0001) and progressively and significantly greater from the low to the medium, high and very high risk patients (4.87 ± 1.38 vs 5.85 ± 2.00, P < 0.0001, ESH CV risk categories). Significant differences were also found between diabetic and non-diabetic patients (5.92 ± 2.2 vs 5.58 ± 1.8, P < 0.0001), patients with and without metabolic syndrome (5.92 ± 2.1 vs 5.43 ± 1.7, P < 0.0001) and from stage 1 to stage 5 renal insufficiency (from 5.87 ± 2.0 to 10.48 ± 3.4, P < 0.0001). No significant difference in SUA was found between patients treated and non-treated with diuretic or angiotensin II blockers or in those under antihypertensive drug combination vs monotherapy. No difference in SUA was also found when analyzing the data in relation to clinic or 24-hour BP control.
CONCLUSIONS:These data provide evidence that similarly to what described in western Europe, in central and eastern European countries SUA values are closely related to metabolic alterations, including diabetes mellitus, to renal insufficiency and CV risk profile. At variance from other studies, however, no relationship was found with BP control.
OBJECTIVE:The PAMELA is an epidemiological study performed on a population sample, including office, home and 24 h ambulatory blood pressure (BP) measurements. Measurements were made at baseline, ...after 11 years, and repeated in a 3rd survey 26 years later.
DESIGN AND METHOD:3200 subjects were randomly selected to represent the population of Monza (North Italy) aged 25–74 years. In each subject body mass index (BMI), office (sphygmomanometer), home (semiautomatic validated device), 24 h (validated automatic oscillometric device) systolic (S) and diastolic (D) BP measurements, heart rate (HR) and biochemical variables were obtained. All values were measured at baseline (1st survey, 1990–91), 11 years later (2nd survey, 2001–02) and after further 15 years (3rd survey, 2016–17).
RESULTS:562 subjects (279/283 males/females, mean age 41 ± 10 yrs) participated at the 3 surveys. Baseline average office, home and 24 h SBP/DBP were respectively 122/81 ± 14/9, 116/73 ± 15/10, 116/73 ± 9/7 mmHg and increased respectively of 5/1 ± 14/9, 4/1 ± 14/9 and 4/2 ± 10/7 mmHg at the 2nd survey. At the 3rd survey a further increase of 11/2 ± 7/11, 8/3 ± 16/10 and 13/2 ± 15/9 mmHg was observed in office, home and 24 h BP respectively. The baseline-3rd survey office, home and 24 h SBP difference was unrelated to age, while the DBP increase was inversely related to age (r = −0.32, −0.39 and −0.38, respectively, P < 0.0001). The baseline-3rd survey increase in office, home and 24 h DBP was significantly directly related to the concomitant BMI increase (r = 0.23, 0.17 and 0.14, respectively, P < 0.005). Office and home HR was similar in the 3 surveys. A reduction in 24 h HR was detected between the 1st and 3rd survey (−4.0 ± 8.2 b/min). At baseline hypertensive subjects were 22.2% (office BP), 19.3% (home BP) and 20.7% (24 h BP), and increased to 37.7%, 33.8% and 43.5% at the 2nd survey and to 68.7%, 65.8% and 80.8% at the 3rd survey respectively.
CONCLUSIONS:The PAMELA 26-year follow-up represents the longest survey ever done describing the long-term changes of BP measurements in general population. It shows a long-term increase in office, home and 24 h BP only partially accompanied by HR changes, and an increase in the prevalence of hypertension, particularly pronounced when defined with 24 h measurements.
Continuous positive airway pressure (CPAP) is frequently used to treat patients with acute respiratory failure in out-of-hospital settings. Compared to a facemask, the helmet has many advantages for ...the patient but requires a minimum gas flow of 60 L/min to avoid CO2 rebreathing. The aim of the present bench study was to evaluate the performance of four Venturi devices, connected to a single oxygen cylinder, in delivering helmet-CPAP with clinically relevant gas flow, fraction of inspired oxygen (FiO2), and positive end-expiratory pressure (PEEP) values.
Three double-inlet Venturi systems (EasyVent, Ventuplus, Compact-HAR) were connected to full 5-L oxygen cylinders using a double flowmeter, and their oxygen requirements to reach different setups (flow 60-80 L/min; FiO2 0.4-0.5-0.6, PEEP 7.5-10-12.5 cmH2O) were tested. The fourth Venturi system (O2-MAX) was directly attached to the tank, and the flow and FiO2 delivered at preset FiO2 0.3 and 0.6 were recorded. The runtime of the cylinder was assessed.
EasyVent, Ventuplus, and O2-MAX were able to deliver helmet-CPAP with clinically useful setups when connected to a single oxygen cylinder, while Compact-HAR did not. The runtime of the cylinders ranged between 28 and 60 minutes according to the preset flow and FiO2. The delivered gas flow decreased slowly and linearly with the drop in cylinder pressure until its exhaustion.
Helmet-CPAP might be provided using portable Venturi systems connected to an oxygen cylinder, but not all of them are able to deliver it. The use of a double flowmeter allows delivery of both high flow and high FiO2 when double-inlet Venturi systems are used. Due to the flow drop observed during the cylinder consumption, a flow >60 L/min should be set when helmet-CPAP is started. Considering the flow drop phenomenon, the estimated duration of the tank runtime can be used with a margin of safety when planning patient transport.
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