This, and the simple consideration that events cannot occur in a healthy cardiovascular system, but must always be preceded by alterations in organ structure or function, makes this approach a valuable one, and thus information from trials using organ damage as end points has been considered. Similarly, a valuable approach to extend evidence of the benefit of treatment over a longer time scale, is to use as endpoint the incidence or worsening of diseases with an adverse prognostic impact such as diabetes, metabolic disorders and end stage renal disease.
End stage renal disease is associated with a striking increase in cardiovascular risk , and has indeed been used as endpoint in several therapeutic trials. New onset diabetes is also being used as intermediate endpoint, and its predictive value is discussed in depth in Section 4.
Finally, whenever useful, information provided by meta-analyses has been given due attention, but meta-analyses have not been considered to necessarily represent the top level of evidence. Indeed, although meta-analyses have a greater statistical power than individual trials, and may provide useful average measurements of treatment effects, they also have limitations. By definition, they are post-hoc analyses, the choice of the trials to be included is often arbitrary, the trials included are not homogeneous, with differences not always susceptible to being assessed by statistical tests.
Therefore, meta-analysis data have been reviewed critically, as have all other sources of information. Randomized placebo controlled trials investigating the benefits of blood pressure lowering have been numerous and have given unequivocal results. Finally, treatment appears to cause a large reduction in the incidence of heart failure. Meta-analyses of placebo controlled trials have also separately addressed the effect of treatment initiated with different drugs, though comparisons are difficult because of variable blood pressure differences between active and placebo treatments in the various trials.
Beneficial effects, however, have also been found when treatment was initiated with a calcium channel blocker or an ACE inhibitor. The demonstration of the beneficial effects of blood pressure lowering has made it ethically unacceptable to perform placebo controlled trials according to the previous design, i. For this reason in more recent trials the drug under investigation was compared with placebo in groups of patients already treated with other antihypertensive agents. This has provided additional evidence on the beneficial effect of various antihypertensive drugs also documenting that the benefit may be substantial even when blood pressure reductions are small and the initial blood pressure is below the traditional cutoff defining hypertension.
In the ACTION trial in patients with angina pectoris, a modest blood pressure lowering obtained by slow-release nifedipine on the top of other agents also reduced the incidence of cardiovascular events compared to placebo, although only in the subgroup with baseline hypertension. A similar approach has been used to study newer drugs such as angiotensin receptor antagonists. In the RENAAL and IDNT studies on hypertensive patients with type 2 diabetes and nephropathy, addition of the angiotensin receptor antagonists losartan and irbesartan on top of multiple antihypertensive therapies slowed down the progression of renal disease the primary end-point , while showing no significant beneficial effect on most secondary cardiovascular endpoints, for the evaluation of which, however, the studies were not sufficiently powered.
Yet, when these two studies were combined in a meta-analysis a significant reduction of cardiovascular morbidity was found in the angiotensin receptor antagonist treatment group. Most of the available information still relies on the largest trial of this type, the HOT study, but additional data from smaller trials, mostly in diabetic patients, are also available. Data from five trials on about 22, patients have been included in the Blood Pressure Lowering Treatment Trialists' BPLTT collaboration meta-analyses, , the results showing significant benefits from a more intense blood pressure reduction as far as stroke and major cardiovascular events are concerned, particularly in diabetics.
Further information can also be derived from recent placebo-controlled trials see above , in which the placebo group often received a somewhat less intensive antihypertensive therapy. Finally, some indirect evidence may be provided by trials such as the HDFP which compared active treatment regimens of different intensity and did not achieve equal blood pressures in the treatment arms. Almost invariably, a lower blood pressure was accompanied by at least a trend towards less strokes see Section 4.
However, we have also discussed results of more recent trials not included in the BPLTT meta-analysis and critically addressed some of the problems inherent in many of these trials as well as in the various types of analyses. Indeed, these studies provide important information on the relative efficacy of the various classes of antihypertensive agents, but their straightforward interpretation is often made difficult by the failure to achieve comparable blood pressure values with the different treatments. Admittedly, differences are commonly small, but even small blood pressure differences may be accompanied by large differences in outcome, , and statistical adjustment is an imperfect way to cope with failure of achieving a protocol requirement.
Meta-regression analyses can provide information that takes into account differences in blood pressure effects, if it is understood that homogeneity of the trials included in a meta-regression is even lower than homogeneity in classical meta-analyses. Finally, trials comparing different agents actually compare regimens only initiated on different agents, since the majority of randomized subjects ends up with combination therapy including agents similarly distributed in the comparison groups.
A recent meta-analysis of 9 trials comparing calcium antagonists with conventional drugs made use of data on more than patients. Calcium antagonists provided a slightly better protection against stroke, but they showed a reduced ability, as compared with conventional therapy, to protect against the incidence of heart failure. Results were similar when diabetic and non-diabetic patients were separately analysed.
The BPLTT collaboration analysis includes 6 trials with a total of about randomized patients comparing ACE inhibitors with diuretics and beta-blockers. However, there were non-significant trends towards less effective protection of ACE inhibitors as far as stroke and congestive heart failure were concerned. Non-significant differences in odds ratio for total and cause specific cardiovascular events have also been reported by the meta-analysis that has separately examined diabetic and non-diabetic patients.
It should be mentioned that trials comparing ACE inhibitors with diuretics have not always given entirely consistent results. In the second Australian blood pressure study hypertensive patients randomized to an ACE inhibitor had a reduced number of cardiovascular events compared with those randomized to thiazide diuretics, although the difference was small, only evident in men, and significant only if recurrent events were included.
In the ALLHAT trial, on the contrary, hypertensive patients on the diuretic chlorthalidone showed a similar incidence of coronary heart disease the primary end point as compared to those randomized to the ACE inhibitor lisinopril, but heart failure and stroke were significantly lower in the diuretic treated group which also showed a greater blood pressure reduction.
Comparisons of these two drug classes as performed in the BPLTT meta-analysis are based on a total of almost patients from 6 studies. Protection against stroke was, on the other hand, significantly more effective for calcium antagonists, whilst protection against heart failure was better for ACE inhibitors. Five trials have compared angiotensin receptor antagonists with other antihypertensive agents.
The different comparators used make meta-analysis of these studies difficult. A significant reduction in non-fatal stroke although not in the primary end-point was also reported in the elderly patients of the SCOPE trial, in whom candesartan lowered blood pressure slightly more than placebo and usual treatment. During a mean follow-up of 2. Finally, in the VALUE trial more than hypertensive patients at high risk were randomized to treatment with either valsartan or the calcium antagonist amlodipine. Over the 5 year follow-up amlodipine-treated patients showed a slightly lower blood pressure value than valsartan-treated patients.
The incidence of cardiac events and death the primary outcome was not significantly different between the two groups, but there was a significant reduction in myocardial infarction and a non-significant trend towards a lower incidence of stroke in the amlodipine group; on the other hand, the risk of heart failure showed a trend in favour of valsartan. Pooled data have shown that the benefits of angiotensin receptor antagonists for heart failure prevention are particularly large in diabetic patients, but the number of observations is small.
The claim has recently been made that angiotensin receptor antagonists would provide less protection against myocardial infarction than other antihypertensive agents. A similar combination was often used in the chlorthalidone treatment group of the ALLHAT trial, which failed to find inferiority of this combination even concerning stroke prevention. Comparative randomized trials show that for similar blood pressure reductions, differences in the incidence of cardiovascular morbidity and mortality between different drug classes are small, thus strengthening the conclusion that their benefit largely depends on blood pressure lowering per se.
Because of the unfortunate failure of several comparative trials to lower blood pressure to the same extent in the two active treatment arms, recourse has been made to meta-regression analysis in which differences in achieved blood pressures are taken into account. Despite some limitations in this approach, as previously outlined, all recent meta-regression analyses , , underline the important role of blood pressure lowering for all cause-specific events, with the exception of heart failure: whenever systolic blood pressure is reduced by 10 mmHg, independent of the agent used, both stroke and coronary events are markedly reduced.
It has been remarked that new onset heart failure is often a difficult diagnosis and, when calcium antagonists are administered, diagnosis may be confounded by ankle oedema dependent on vasodilatation. Furthermore, drugs such as diuretics may not prevent new onset heart failure but just mask its symptoms. It is reasonable to suppose that in prevention of heart failure humoral effects, differently influenced by different antihypertensive agents, may play a relevant direct role. Even under this circumstance, however, blood pressure lowering probably remains of paramount importance because in the hypertensive coronary patients of the ACTION trial a blood pressure reduction of The possibility of clinically relevant differences in the beneficial effects of various classes of antihypertensive agents should not be explored by event based trials only.
Subclinical organ damage occurs much earlier than events in the continuum of cardiovascular disease and may be more susceptible to specific, differential actions of the various antihypertensive compounds. Many studies have continued to test the effects of various antihypertensive agents on hypertension associated left ventricular hypertrophy, mostly evaluated by measuring left ventricular mass on the echocardiogram, but only a few of them have followed strict enough criteria to provide reliable information.
As studies in hypertensive patients with left ventricular hypertrophy cannot be placebo controlled but must compare active treatments, 1 a large number of patients must be included in order to have sufficient power to detect presumably small between-treatment differences, 2 treatment duration must be of at least 9—12 months, 3 blood pressure must be equally reduced by the compared treatments, and 4 special precautions must be taken in order to avoid regression to the mean and reading bias if the sequence of scans is not blinded.
More reliable information is provided by a number of large and adequately designed studies. In a relatively large-size study the aldosterone blocker, eplerenone, and the ACE inhibitor, enalapril, were found equally effective, and their combination more effective than either agent but with a greater blood pressure reduction. As to diuretics, the only adequately powered study shows a significant efficacy of indapamide; the same study also showed a superiority of indapamide over the ACE inhibitor, enalapril.
As this is the only study in which an ACE inhibitor was found not to induce left ventricular mass reduction, no conclusion can be drawn on the comparative efficacy of diuretics versus ACE inhibitors in regressing left ventricular hypertrophy. Recent studies have provided further clinically useful information: two long-term trials , have shown that regression of left ventricular hypertrophy is maintained over time but achieves a maximum by 2—3 years.
A large-sized study such as LIFE has been able to show that a treatment-induced reduction in left ventricular mass is significantly and independently associated with a reduction of major cardiovascular events, stroke and cardiovascular and all-cause mortality 57 thus substantiating findings from other long-term observational studies. Some evidence for different effects of various antihypertensive agents on left ventricular hypertrophy is also available from electrocardiographic studies. The LIFE trial showed that losartan was significantly more effective than atenolol in inducing regression of electrocardiographic indices of left ventricular hypertrophy, in parallel with what was shown in the echocardiographic substudy.
Much less information is available on the comparative effects of different antihypertensive treatments on the diastolic abnormalities frequently occurring in hypertensive patients, often but not always concomitant with ventricular hypertrophy. Large trials having left ventricular diastolic dysfunction as primary endpoint are currently ongoing. Attention has recently been concentrated on echocardiographic measurement of left atrial size, as a frequent correlate of left ventricular hypertrophy and a predictor of cardiovascular events, in parallel to growing evidence that antihypertensive agents may exert different effects on development of atrial fibrillation.
A lower incidence of new atrial fibrillation was also observed in three heart failure trials, when the ACE inhibitor, enalapril or the angiotensin receptor antagonists, candesartan and valsartan were compared with placebo as add-on therapy. In the LIFE trial decreased incidence of atrial fibrillation correlated with regression of left ventricular hypertrophy.
They have reported favourable effects of either irbesartan versus placebo and losartan versus amlodipine, the drugs being in both cases added to amiodarone. No comparative data are available between angiotensin receptor blockers and ACE inhibitors. In this area, more information may come from ongoing specific trials.
Comparison of different antihypertensive regimens achieving the same blood pressure levels has also shown consistently greater effects of calcium antagonists than, respectively, hydrochlorothiazide, chlorthalidone and atenolol, , but a recent study has also shown a greater effect of an ACE inhibitor than of a thiazide diuretic. Composition of the carotid wall, investigated by an echoreflectivity approach histologically tested, did not show significantly different changes with both lacidipine and atenolol, however.
Although pulse wave velocity is acknowledged as a valid clinical method for assessing large artery distensibility, there is a paucity of adequate studies investigating the effects of antihypertensive therapy per se and of different antihypertensive regimens on this vascular parameter.
Many of the studies have been small, non-comparative or non-randomized, and it is difficult to conclude whether the described decrease in pulse wave velocity hence in stiffness was due to the blood pressure decrease, to specific properties of the agents employed or to regression to the mean. A number of small, placebo-controlled, relatively short-term only a few weeks studies suggests that several antihypertensive agents can indeed favourably affect pulse wave velocity, but the observed decrease could well be due to blood pressure reduction.
This conclusion is strengthened by a recent study of more or less intense blood pressure lowering, in which a significant reduction in pulse wave velocity was only found in the more intensely treated group. A limited number of randomized trials of antihypertensive therapy have used brain lesions and cognitive dysfunction as endpoints.
Trials using cognitive measurements as endpoints have been the object of a recent meta-analysis. The five studies on subjects that have investigated the effect of blood pressure reduction on logical memory test — found that a reduction in blood pressure of 3.
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On the other hand, the four randomized studies on individuals — , that have analysed perceptual processing and sequential abilities found that a mean blood pressure reduction of Therefore, it appears that lowering blood pressure may improve performance on screening tests for dementia and memory, further supporting the benefits of antihypertensive therapy on cerebrovascular morbidity.
However, performance or perceptual processing and learning capacity may not benefit from blood pressure lowering, suggesting that different cognitive functions may be differently influenced. It should be emphasized that trials showing no benefit in perceptual and learning tests were associated with a much greater blood pressure reduction, and thus a J-shaped effect cannot be excluded. Finally, many of the trials testing cognitive function compared active antihypertensive agents with placebo, and those comparing different antihypertensive regimens are few.
Therefore there is no firm evidence on whether some antihypertensive agents are more beneficial than others in preserving or improving cognition. However, it should be mentioned that the only placebo-controlled study that reported a significant reduction in incident dementia used the calcium antagonist nitrendipine as an active agent.
A very large number of randomized studies has investigated the effects of antihypertensive therapy on a diversity of renal endpoints such as microalbuminuria or proteinuria, glomerular filtration rate and end stage renal disease in a variety of conditions, such as diabetes, diabetic nephropathy, non-diabetic renal disease, or simply hypertension. Because of the diversity of the clinical conditions, of the endpoint used, as well as of the size and statistical power of the studies, the issue is not an ideal one for meta-analyses, as shown by the hot debate raised by a recent meta-analysis.
A major issue is whether in the presence of renal disease renal function is better preserved by a blood pressure goal lower than in uncomplicated hypertension, i. Although this is recommended by all current guidelines, 3 , 30 , it must be recognized that evidence from trials having randomized renal patients to more versus less intensive blood pressure lowering is scanty.
However, in other trials randomization to these goals in patients with non-diabetic renal disease or with diabetes was not accompanied by greater preservation of renal function than randomization to a somewhat higher blood pressure. However, the positive data of the MDRD are strengthened by analyses, admittedly retrospective and observational, of the IDNT trial and of 11 trials in non-diabetic renal patients, showing that systolic blood pressure reduction down to a least mmHg may be beneficial.
Nephroprotective properties of antihypertensive agents, mostly ACE inhibitors or angiotensin receptor antagonists, have been investigated in a large number of randomized trials. Several placebo controlled studies have shown angiotensin receptor antagonists, ACE inhibitors or a low dose ACE inhibitor-diuretic combination to delay end stage renal disease or a significant increase in serum creatinine, and to reduce or prevent microalbuminuria or proteinuria, in patients with both diabetic and non-diabetic nephropathy.
Comparison of different active regimens has provided less clear results. Two trials, one in patients with proteinuric diabetic nephropathy the other in non-diabetic nephropathy have shown superiority of an angiotensin receptor antagonist or an ACE inhibitor over a calcium antagonist in delaying end stage renal disease and significant increases in serum creatinine, but a post-hoc subanalysis of the ALLHAT trial on those hypertensive patients who had reduced renal function at baseline but proteinuria was unknown showed equal incidence of these endpoints in patients treated with a diuretic, a calcium antagonist or an ACE inhibitor.
More clear results were obtained when the effects of different antihypertensive regimens on microalbuminuria or proteinuria were compared. Of interest are several recent studies that have investigated the combination of an angiotensin receptor antagonist with an ACE inhibitor compared with monotherapies. The COOPERATE study has reported a reduced progression of non-diabetic nephropathy by the combination versus the combination components in monotherapy without a blood pressure difference between treatment groups.
On the other hand, two small studies suggest that very high doses of angiotensin receptor antagonists may exert a significantly greater antiproteinuric action than a standard dose without any increment of the antihypertensive effect. Diabetes and hypertension are often associated, and their combination is known to have ominous consequences. The same confounding factor makes interpretation of the recent negative finding of the DREAM trial difficult: in this trial administration of ramipril to subjects with impaired glucose tolerance was not associated with a lower subsequent incidence of diabetes than administration of placebo.
However, almost half of DREAM subjects had hypertension and one third dyslipidaemia, and a large number of them received various types of antihypertensive agents and lipid lowering drugs. This claim is based on the observation that during controlled trials patients developing diabetes have not had a greater morbidity than patients without new onset diabetes.
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A limitation of the above long-term follow-up studies is that microvascular endpoints, i. Furthermore, in long-term studies follow-up cannot be done under controlled conditions and confounding factors may be frequent and unknown. In the absence of more compelling evidence of an innocuous nature, the increased diabetes incidence with some antihypertensive agents currently raises concerns that would be imprudent to disregard.
The decision to start antihypertensive treatment should be based on two criteria, i. In all grade 1 to 3 hypertensives, lifestyle instructions should be given as soon as hypertension is diagnosed or suspected, while promptness in the initiation of pharmacological therapy depends on the level of total cardiovascular risk. In the high risk hypertensives of the VALUE study the treatment arm in which blood pressure control was somewhat delayed was associated with a trend towards more cardiovascular events.
In grade 1 or 2 hypertensives with moderate total cardiovascular risk drug treatment may be delayed for several weeks and in grade 1 hypertensives without any other risk factor low added risk for several months. However, even in these patients lack of blood pressure control after a suitable period of non-pharmacological interventions should lead to the institution of drug treatment in addition to lifestyle changes.
In case of diabetes, history of cerebrovascular, coronary or peripheral artery disease, randomized trials , , , , have shown that antihypertensive treatment is associated with a reduction in cardiovascular fatal and non-fatal events, although in two other trials on coronary patients no benefit of blood pressure lowering was reported or a reduction of cardiovascular events was only seen when initial blood pressure was in the hypertensive range. Whether a similar therapeutic approach i. It should be emphasized that prospective observational studies have demonstrated that subjects with high normal blood pressure have a greater incidence of cardiovascular disease compared to people with normal or optimal blood pressure.
Unfortunately, the DREAM study was not powered for assessing effects on cardiovascular events, and sufficiently powered trials are necessary to clarify this important issue. For the time being, subjects with a high cardiovascular risk due to factors other than diabetes but a blood pressure still in the high normal range should be advised to implement intense lifestyle measures including smoking cessation and blood pressure should be closely monitored because of the relatively high chance these individuals have to progress to hypertension, 31 , 32 which will then require drug treatment.
However, physicians and patients may sometimes consider antihypertensive drugs, particularly those more effective in protecting against organ damage, new onset hypertension and new onset diabetes. Lifestyle measures and close blood pressure monitoring should be the intervention procedures in subjects with a normal blood pressure who are at low or moderate added risk. In hypertensive patients, the primary goal of treatment is to achieve maximum reduction in the long-term total risk of cardiovascular disease. This requires treatment of the raised BP per se as well as of all associated reversible risk factors.
Additional difficulties should be expected in elderly and diabetic patients, and, in general, in patients with cardiovascular damage. In order to more easily achieve goal BP, antihypertensive treatment should be initiated before significant cardiovascular damage develops. The primary goal of treatment of the hypertensive patient is to achieve the maximum reduction in the long-term total risk of cardiovascular morbidity and mortality.
This requires treatment of all the reversible risk factors identified, including smoking, dyslipidaemia, abdominal obesity or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se. There are also arguments in favour of trying to achieve values below 90 mmHg diastolic and mmHg systolic, i. There is very solid evidence of a beneficial effect reduction in macro and microvascular complications of a greater versus a smaller blood pressure reduction in type 2 diabetic patients as demonstrated by the HOT and UKPDS trials, , and confirmed by the ABCD studies.
Data favouring lower blood pressure targets in patients in whom a high risk condition is due to factors other than diabetes are of variable strength. Furthermore, in a recent post-hoc analysis of the PROGRESS data a progressive reduction in the incidence of stroke recurrence particularly haemorrhagic stroke has been reported until achieved systolic blood pressure values of about mmHg. However, because of the assumption of a protective effect of these drugs per se , blood pressure was seldom considered as a possible mechanism and often unreported, although when mentioned it was lower in the actively treated than in the placebo groups.
Yet, it has been noted in section 5. The growing evidence of the prognostic importance of home and ambulatory blood pressure makes these measurements more and more commonly employed to evaluate efficacy of treatment. For ambulatory blood pressure this approach is supported by the evidence that for similar achieved office blood pressure values, lower achieved ambulatory blood pressures are associated with a lower rate of cardiovascular outcomes.
Similar targets should be adopted in individuals with a history of cerebrovascular disease and can at least be considered in patients with coronary disease. Although differences between individual patients may exist, the risk of underperfusion of vital organs is very low, except in episodes of postural hypotension that should be avoided, particularly in the elderly and diabetic. The existence of a J-shaped curve relating outcomes to achieved blood pressure has so far been suspected as a result of post-hoc analyses — which have reported, however, the rate of events to increase at quite low diastolic pressures.
Trial evidence also shows that for the same or even a greater use of combination treatment achieved systolic blood pressure remains usually somewhat higher in diabetics than in non-diabetics. Several studies have shown that in high or very high risk patients, treatment of hypertension is largely cost effective, that is that the reduction in the incidence of cardiovascular disease and death largely offsets the cost of treatment despite its lifetime duration.
Several trials of antihypertensive therapy, foremost the HDFP and HOT studies, have shown that despite intense blood pressure lowering the incidence of cardiovascular events remains much higher in high risk hypertensives or hypertensives with complications than in hypertensives with initial low or moderate risk. This suggests that some of the major cardiovascular risk changes may be difficult to reverse, and that restricting antihypertensive therapy to patients at high or very high risk may be far from an optimal strategy.
Finally, the cost of drug treatment of hypertension is often contrasted to lifestyle measures, which are considered cost-free. However, real implementation, and therefore effectiveness, of lifestyle changes requires behavioural support, counselling and reinforcement, the cost of which may not be negligible.
Lifestyle measures should be instituted, whenever appropriate, in all patients, including those who require drug treatment. The purpose is to lower BP, to control other risk factors and to reduce the number of doses of antihypertensive drugs to be subsequently administered. Lifestyle measures are also advisable in subjects with high normal BP and additional risk factors to reduce the risk of developing hypertension. The lifestyle measures that are widely recognized to lower BP or cardiovascular risk, and that should be considered are:.
Lifestyle recommendations should not be given as lip service but instituted with adequate behavioural and expert support, and reinforced periodically. Because long-term compliance with lifestyle measures is low and the BP response highly variable, patients under non-pharmacological treatment should be followed-up closely to start drug treatment when needed and in a timely fashion.
Lifestyle measures should be instituted, whenever appropriate, in all patients, including subjects with high normal blood pressure and patients who require drug treatment. The purpose is to lower blood pressure, to control other risk factors and clinical conditions, and to reduce the number and doses of antihypertensive agents which might have to be subsequently used. However, lifestyle measures are unproved in preventing cardiovascular complications in hypertensive patients, and long-term compliance with their implementation is notoriously low.
Smoking causes an acute increase in blood pressure and heart rate, persisting for more than 15 minutes after smoking one cigarette. Smoking is a powerful cardiovascular risk factor and smoking cessation is probably the single most effective lifestyle measure for the prevention of a large number of cardiovascular diseases including stroke and myocardial infarction. Where necessary, nicotine replacement or bupropion therapy should be considered since they appear to facilitate smoking cessation.
It is desirable that this become commonplace all over Europe. Many studies have shown a U or J shaped association of mortality with alcohol consumption, in which light and moderate drinking results in a reduced mortality compared with non-drinkers, while heavy drinkers have a rising death rate, but this relationship has recently been challenged by a meta-analysis of available data.
Trials of alcohol reduction have shown a significant reduction in systolic and diastolic blood pressures. They should be warned against the increased risk of stroke associated with binge drinking. Epidemiological studies suggest that dietary salt intake is a contributor to blood pressure elevation and to the prevalence of hypertension. Sodium restriction may have a greater antihypertensive effect if combined with other dietary counselling and may allow reduction of doses and number of antihypertensive drugs employed to control blood pressure.
The effect of sodium restriction on blood pressure is greater in blacks, middle-aged and older people as well as in individuals with hypertension, diabetes, or chronic kidney disease, i. In a restricted salt diet, patients should be advised to avoid added salt, and obviously oversalted food particularly processed food and to eat more meals cooked directly from natural ingredients containing more potassium.
Over the past decade, increased potassium intake and dietary patterns based on the DASH diet a diet rich in fruits, vegetables, and low-fat dairy products, with a reduced content of dietary cholesterol as well as saturated and total fat have emerged as also having blood pressure lowering effects. Supplemental calcium or magnesium , , has been proposed as a means to lower blood pressure, but data are not entirely consistent and additional research is warranted before recommendations on other specific diets can be made, including diets with a modified content in carbohydrates.
Counselling by trained dieticians may be useful. A substantial body of evidence from observational studies documents that body weight is directly associated with blood pressure and that excess body fat predisposes to increased blood pressure and hypertension. In a meta-analysis of available studies, the mean systolic and diastolic blood pressure reductions associated with an average weight loss of 5.
Within trial dose-response analyses , and prospective observational studies also document that greater weight loss leads to a greater blood pressure reduction. Modest weight loss, with or without sodium reduction, can prevent hypertension in overweight individuals with high normal blood pressure, and can facilitate medication step-down and drug withdrawal.
Lack of physical fitness is a strong predictor of cardiovascular mortality independent of blood pressure and other risk factors. Even moderate levels of exercise lowered blood pressure, and this type of training also reduced body weight, body fat and waist circumference, and increased insulin sensitivity and HDL-cholesterol levels. Dynamic resistance training decreased resting blood pressure by 3. However, intensive isometric exercise such as heavy weight lifting can have a marked pressor effect and should be avoided.
If hypertension is poorly controlled, heavy physical exercise as well as maximal exercise testing should be discouraged or postponed until appropriate drug treatment has been instituted and blood pressure lowered. Because in many patients more than one drug is needed, emphasis on identification of the first class of drugs to be used is often futile.
Nevertheless, there are many conditions for which there is evidence in favour of some drugs versus others either as initial treatment or as part of a combination. The choice of a specific drug or a drug combination, and the avoidance of others, should take into account the following: The previous favourable or unfavourable experience of the individual patient with a given class of compounds.
The effect of drugs on cardiovascular risk factors in relation to the cardiovascular risk profile of the individual patient. When an episode runs long, only the first sequence the falling apple is kept. From the episode " Now You Know " onwards, a shortened synthesized version of the theme arranged and performed by frequent series composer Steve Jablonsky is heard, which underscores the falling apple scene, and the photograph of the four lead actresses, crediting Marc Cherry as creator.
The score is electronic-based, but every scoring session incorporates a live string ensemble. Jablonsky incorporates recurring themes for events and characters into the score. Several of those songs have been used in subsequent seasons. Desperate Housewives ' s unique style combined with the heavy dialogue and a quick-fire writing style limits the amount of popular music used within the series.
The series' music supervisor , David Sibley , works closely with the producers to integrate these musical needs into the show. In addition to featured performances by central characters such as Susan Mayer singing along with Rose Royce 's " Car Wash " and Lynette's rendition of " Boogie Shoes ", several characters have been accomplished musicians, such as Betty Applewhite a concert pianist and Dylan Mayfair a prodigy cellist. In August , Marc Cherry said that Desperate Housewives would be on television for a few more years, stating that the series still "has a lot of life left in it.
Steve McPherson ABC Entertainment president and I agree that we shouldn't keep the show going for more than a couple [of] years past my seven-year initial contract. We don't want it to just fade away. We've been in negotiations. I expect to sign my new deal soon to set up a future scenario for the show. Someone else will run the show after season seven and I will serve as executive producer from a distance. He went on to explain that he felt the program had been revitalized by the five-year leap forward for season five, saying: "Yes, I think it worked well.
It was a way to start fresh and let everyone start from scratch in a way". Originally, Cherry hinted that Desperate Housewives would end in ,  and in April , Eva Longoria confirmed that there would definitely be an eighth season and expressed hopes for a ninth.
In August , it was confirmed that the eighth season of Desperate Housewives would be the final season. It's confirmed! We are filming our last season of Desperate Housewives! I am so grateful for what the show has given me! We always knew we wanted to end on top and I thank ABC for giving us our victory lap! And a special thanks to Marc Cherry who forever changed my life! The show was the biggest success of the — television season, being well received by both critics and viewers. The pilot episode had Following the initial success of the show, the term "desperate housewives" became a cultural phenomenon.
This warranted "real-life desperate housewives" features in TV shows, including The Dr. Phil Show ,  and in magazines. For its second year, the show still maintained its ratings — with However, several critics started to notice a declining quality of the show's script,   and USA Today ' s Robert Bianco suggested that the part of the series getting "less good" was that showrunner Cherry had left much of the series writing in the hands of others.
He now stated that he was back full-time, claiming that both he and the writing staff had learned from their mistakes. The critics generally agreed on the improved quality for the third year,    but the overall ratings fell notably from previous seasons. Due to complications from her pregnancy, Marcia Cross was put on bed rest.
After filming one episode from her own personal bedroom she was forced to take maternity leave with eight episodes of season three still remaining. Stories such as Lynette's emotional affair with restaurant manager Rick, proved unpopular. Furthermore, Susan's contrived triangle with Ian and Mike seemed tiresome to many viewers, particularly in an episode where Susan is lost in the woods. Notable, however, was that the show's rating among viewers age 18—24 increased from the previous season.
For its fourth season, the series proved to have staying power. Ratings rose in the ninth episode " Something's Coming ", where The show once again moved back into the top five highest-rated programs in the — season, being the number-one ABC drama and beating popular medical drama Grey's Anatomy after falling behind it for the first time in the third season.
Although ratings were down for the fifth season, along with every scripted series on television, Desperate Housewives was still the most-watched scripted series on ABC, consistently beating the other ABC flagship shows, Lost and Grey's Anatomy, although the latter is still number one in the 18—49 demographic, followed by Desperate Housewives.
Similar to the fifth season, ratings were down for the sixth season because of heavy competition in many airings, but the show still managed to remain the second most watched scripted show on ABC and the eleventh most watched scripted show of all broadcast television. Nevertheless, the sixth season managed to finish in the top twenty overall, both in total viewers and 18—49 demographic audiences. Among scripted shows, it still ranked in the top ten, in both categories. The seventh season premiered on September 26, and averaged The season saw new lows for the series reaching for the first time below 10 million viewers, and saw lows of 2.
For the first half of the season, ratings started strong averaging However, ratings declined in the second half of the season, after two contiguous episodes had to compete against the 68th Golden Globe Awards and then the 53rd Annual Grammy Awards. The show failed to recover to viewer levels hit in the first half of the season, and continued to receive 9—10 million viewers and 2. This was the first time in its history that Desperate Housewives would not place in the twenty most watched shows of the season, although it would place in the twenty most-watched scripted shows.
The eighth season continued to see declines in the series' ratings. The season premiered to 9. The season began with ratings similar to those of the latter half of season 7, averaging 8—9 million viewers, and between a 2. However, after the mid-season finale the ratings returned lower, hitting the seven million viewer mark and a 2. The season also saw the lowest ratings in the show's eight-year run. Opposite the 54th Annual Grammy Awards , which featured a tribute to the then-recently deceased entertainer Whitney Houston , and the mid-season premiere of The Walking Dead on AMC , the show fell to a 1.
Despite the series lows, the season finale was able to go out on a season high in the ratings and the highest rated episode in over a year and a half, since March with " Searching ". The series finale titled " Finishing the Hat " aired May 13, was viewed by However, the show dropped out of the top thirty most-watched shows in total viewers, coming in at thirty-fifth place.
According to a survey of twenty countries conducted in by Informa Telecoms and Media , Desperate Housewives was the third most-watched television series in the world, after fellow American series CSI: Miami and Lost. In its first public release of online individual television program rankings, Nielsen Media Research announced that the series had , unique online viewers in December In fall , North Korea allegedly executed eighty people for watching banned South Korean soap operas, Desperate Housewives being the most common soap opera.
Desperate Housewives was being secretly watched using mp3 players , hard drives , and DVDs. The nominations of all of the leading actresses except Eva Longoria for both the Golden Globe Award and Primetime Emmy Award received some media interest. While Longoria seemingly wasn't bothered, stating for the press that "I'm new. I just arrived. I didn't expect at all to be in the minds of the Academy", Marc Cherry regarded them being left out as a "horrendous error". In , the show continued to receive several nominations. Primetime Emmy Award nominations at the 58th Primetime Emmy Awards included, among others, guest actress Shirley Knight and supporting actress Alfre Woodard , although none of them resulted in a win.
Joosten won the show's seventh Primetime Emmy Award and first since its debut year. Nominations continued to decline in later years. Notable nominations included nods towards Beau Bridges and Kathryn Joosten in and , respectively. Additionally, Brenda Strong received her first Primetime Emmy Award nomination for Outstanding Voice-Over Performance at the 63rd Primetime Emmy Awards in , a notable feat for a category usually dominated by animated series.
Also in , Vanessa L. There have only been DVD releases of the show. No HD or Blu-Ray version has been released on disc as of Buena Vista Games released the life simulation computer video game Desperate Housewives: The Game on October 5, in North America, featuring an original storyline spanning 12 episodes. A couple of months later, Gameloft released a mobile game based on the series. Play as new neighbor on Wisteria Lane.
In September , Hollywood Records released a soundtrack album distributed by Universal Music Group , Music from and Inspired by Desperate Housewives , featuring music inspired by the series, as well as sound clips taken from the first season of the series. The songs included have been described as promoting " girl power ", and among the artists appearing — all being female — were LeAnn Rimes , Gloria Estefan and Shania Twain.
Two books have been officially released within the Desperate Housewives franchise. Four unauthorized books written from different points of view were released in In conjunction with season six, Marc Cherry was commissioned to write eight "mini-episodes" entitled Another Desperate Housewife. The episodes were written after the previous season's extensive product placement proved unpopular with the fans. The mini-episodes were written to advertise mobile phone company Sprint and involve just three characters.
The third character, Elsa, was Stephanie's friend. It is eventually revealed that Lance and Elsa have been having an affair. Stephanie finds out and tells Lance to break it off. Elsa suggests killing Stephanie, but Lance gets a text message indicating he's seeing another woman and a furious Elsa shoots him. In truth, Stephanie had sent the message herself. The final mini-episode has Elsa being arrested and Stephanie attracted to a handsome policeman at the scene.
Each episode ends with a Mary Alice-like narration saying things such as "This is suspicion on the Now Network" or "This is betrayal on the Now Network. It was presented and sponsored by Sprint , and it was hosted by series creator, Marc Cherry. On February 26, , The Walt Disney Company announced that four South American versions of the show were about to begin production: one for Argentina, one for Colombia, one for Ecuador and one for Brazil.
The Argentine version, titled Amas de Casa Desesperadas , began being broadcast in The first year proved successful enough for a second season to begin production. Just as the two previous Spanish versions, it was titled Amas de Casa Desesperadas , and the production began in July However, it aired its only season during From Wikipedia, the free encyclopedia. American comedy-drama TV series. Comedy-drama Mystery Soap opera. Marc Cherry See full list. Devious Maids List of adaptations. See also: Wisteria Lane and Colonial Street.
See also: List of Desperate Housewives episodes. Main article: List of awards and nominations received by Desperate Housewives. Main article: List of Desperate Housewives home video releases. Retrieved January 1, April 3, Retrieved September 20, BBC News. July 31, The Huffington Post. June 14, March 17, Entertainment Weekly. June 17, Retrieved October 26, TV by the Numbers. Deadline Hollywood.
The Futon Critic. July 25, A malign form of voodoo is being practiced in this country by the priests of Modern Medicine. A man in California went to a clinic, identified himself as gay, and took the HlV-antibody test; results: positive. Then he went to another clinic, identified himself as a heterosexual, and took the same test; results: negative.
Being gay and having been around from the start of the AIDS hysteria, I thought I knew something about the syndrome and treatment. Boy, was I wrong! I was about to reluctantly start the drugs they said I needed due to my initial low CD4 count and high viral load. I am so glad I was fortunate enough to educate myself on this subject.
I now feel totally comfortable in choosing not to use the toxic drugs that are supposed to control HIV. I am completely ignoring the HIV side of things and concentrating on building my immune system back up, naturally. I actually have not had a cold or the flu in 2 years and run 4 miles, times a week. Education is Power! I said no to the doctors and I am alive. I have been black-balled by the press which made a hero out of White. I think that possibility was always a long-shot, but now with further research showing that nearly any psychological or physical stress causes lowered CD4 counts, combined with the difficulty finding a mechanism for HIV to do it, I think the idea is fairly ridiculous.
It went something like this:. A slow, painful, inexorable decline, and an agonizing loss of dignity awaits you, and only with death will the curse be lifted. Virtually every claim ever made about HIV has been repeatedly contradicted. Stress, social isolation, and negative beliefs can create the same type of immunodeficiency that is commonly blamed on HIV. The amount of psychological stress in people diagnosed HIV positive is likely to be much greater than the stress in the people in these studies. Such a high rate of indeterminates on a test that supposedly determines life or death issues is outrageously high.
The incredible reliance of patients, doctors, and scientists on tests with such obvious inconsistencies is a cause for alarm, and yet it appears that the only people sounding the alarm are not being listened to. Tuberculosis with a positive HIV antibody test is AIDS, but tuberculosis with a negative test is just tuberculosis, even if it is occurring in an IV drug user with multiple opportunistic infections.
This causes a suppression of the immune system, with selective depletion of CD4 T-cells. Rarely are the drug toxicities and complications caused by the treatment held responsible. It can equally be caused by severe malnutrition in poorer and famine stricken societies. I know this view is completely against the current beliefs forced by media presentation of a social problem, but it is the responsibility of dedicated scientists to take into consideration and explore all aspects to this problem.
We are only now beginning to understand what AIDS may be. We know one thing it is not, a virus produced disease! We should not close our eyes to new information just because we are sold the idea that this condition is caused by a class of viruses conveniently called HIV. They are consistently and drastically short of methionine, cystine and cysteine--very important amino acids. They also have a manyfold rise in the levels of arginine and glutamate In a series of other experiments, when IL-6 and another similar substance TNF -tumor necrosis factor are added to a cell culture medium that contains cells with the ability to produce the virus, particles labeled HIV are extruded It is also unfortunate that we do not understand the subordinate metabolic roles of IL-6 to cortisone-releasing mechanism and IL-1 production On this fragment of unconnected information is placed the whole argument that AIDS is a virus-caused disease.
Because a test has been designed that marks and shows the particular fragments produced by IL-6 or TNF. Women, who participate in anal sex to avoid becoming pregnant, should be aware of this immune suppressive property of semen. All we needed to know now is how did these AIDS patients become cysteine-deficient?
We should commence the research of this phenomenon and not sidetrack AIDS research into a dead end by making a jump of faith and assuming it to be virus produced. It could be produced by many other factors, one of them cysteine and zinc deficiency, particularly in underdeveloped and poorer countries. It is also possible that it is caused as a result of persistent and increasingly severe local damage in the rectum, producing a long-term run on the body's protein reserves.
This test by itself is not an accurate indicator of the presence of an agent that causes the disease. The HIV itself produced by a more severe imbalance in the make up of the amino acid pool of the body. It is this devastating amino acid pool imbalance that kills the patients, and not the HIV particle. When morphine or heroin is used, the sensations of hunger and thirst are also suppressed and the body begins to feed off itself. In countries where people used to smoke opium, a great number of these people eventually died of lung infections--exactly what is now blamed on the virus and contaminated needles.
This is what everyone is led to believe. This in my opinion is an erroneous representation of a different truth.
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All this test shows is that the body has come across this antigenic particle and has registered its structure. The question is, do we continue to measure the straw or the inherent structural and physiological limitations? Do we pay attention to the limitations of the body, or do we in carefree abandon blame an ineffective slow virus for the ills that befall some members of our society?
But do you really want to express this opinion? Or merely raise the question? If you do, then the new Gestapo will likely pay you a visit. Forget about that government grant. Forget about the raise. There was a rush to judgment on many fronts, a lot of speculation I smelled a rat from the very beginning, and kept up with it ever since.
A hypothesis is an assumption made by scientists for discussion about their scientific problems. The public in some peculiar way have accepted the hypothesis as a proven theory. Many people are making a good living out of it, writing positive reports, no matter how negative the results are. This is false. The relatively low death rates would not have appeared if the high death rates due to aggressive treatments with AZT had not occurred in the early s. Many HIV-positive people, not treated with the cocktails, have remained healthy for more than fifteen years.
They would feel better when they think something can be done. South Africa refused to pay for those drugs with borrowed money. This makes China an easy target. The take home message from the recent Barcelona AIDS conference is that incompetent AIDS scientists and even more incompetent medical reporters are wasting lives and money while creating sanctions against medical breakthroughs by refusing to listen to anyone who questions their conclusion that HIV is the sole cause of AIDS.
This is medical incompetence at its worst. I consider this to be a violation of scientific ethics. The scientific method is based, at least partially, on debate. To call for the end to a debate is unscientific; to do so with the power of the US government behind you is unethical. This is unethical. Patients taking purified, recombinant factor VIII would have a stronger immune system and would consequently be healthier.
We were neutral, simply eager to contribute to settling this unsettling affair. We are still waiting. More accurately, we have given up. We never were allowed access to taxpayer-funded data. We waited in lunchrooms of prestigious hospitals before realizing that our host was not going to appear with the data and was too embarrassed to join us for lunch. Our phone calls were never answered. The sadly predictable result of questioning these two sacred cows of modern biomedicine was the almost complete destruction of a once lofty professional standing.
The inescapable conclusion: clean data and perceptive, unbiased analyses win every time. Your readers can be as angry as they like, but they should save their anger until after they have evaluated clinical DATA The entire AIDS and cancer areas are a mess. All current hypotheses are plainly incorrect, inadequate or in many cases absolutely falsifiable on the basis of existing data However, there is no detectable infectious Hiv in most patients, only antibodies.
Furthermore, the mortality of Hiv antibody-positive individuals treated with anti-Hiv drugs is greater than that of mostly untreated Hiv-antibody positive individuals, a disturbing finding in regard to current therapies.
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George L. Mental stress provokes production of the hormone cortisol; excessive cortisol causes rapid and dramatic reductions in T cells, a condition known as lymphocytopenia. Walter B. Cannon reported that shamans, tribal medical authorities thought to possess special powers, were able to kill errant tribe members by simply pointing at them with a bone.
The research data tend to be formulated from actuarial models and short trials in pregnant women attending antenatal clinics. The results of such research lead to frightening statistics, giving the impression that the whole of southern Africa will be depopulated within the next 24 months. This is the perfect breeding ground for the rapid spread of HIV. The rate in the prison population should be higher than that in the general population, or at least the same. But the figures for prisons in South Africa are way below those generated by actuarial models and antenatal data, which purportedly reflect the incidence of infection in the general population.
Stuart W. Clinician at U. The greatest danger of severe reactions occurs when latex comes into contact with moist areas of the body or internal surfaces during surgery, because more of the allergen can rapidly be absorbed into the body. The Chemical and Veterinary Investigation Institute in Stuttgart said on Friday it had found the carcinogen N-Nitrosamine in 29 of 32 types of condoms it tested in simulated conditions. The condoms, which were kept in a solution with artificial sweat, exuded huge amounts of cancer-causing N-Nitrosamine from its rubber coating.
Researchers measured amounts of N-Nitrosamine, that were way above the prescribed limits for other rubber products such as baby pacifiers. The true scientist wants to know how it all works. Again a strong and unconditional no! The situation has become so ridiculous that someone who has had an unprotected sexual contact with a total stranger runs to the doctor immediately to have an aids-test.
Why, in the name of Theophrastus Bombastus von Hohenheim, would anybody do that?? To make sure the whole world starts treating you as a leper? To get your health insurance cancelled, never to be renewed again? To run into trouble every time you try to cross a border? Or to end your sex life once and for all?
Just because deep inside you knew your research was a fraud? Yes, there are scientists who would not prostitute themselves, but they have labs in broom closets in the basement Maybe they can get through your thick skull. Plastic sex! If you use those suckers, you might as well go all the way and get yourself one of those inflatable plastic dolls. Their product had already flopped and rightfully so when somebody came up with the master stroke of AIDS.
Congratulations, colleagues at the CDC! You did it! You really succeeded in convincing those simple-minded youths they should forfeit their turn at having the same fun their parents had! With your help, Nixon could even have been successful at selling used cars Sure, the old fogeys have always tried that. In my own adolescent years they told us that every sex act was automatically followed by an unwanted pregnancy.
Those bogeyman tales were not as sophisticated as the AIDS myth, I admit, but at least they really did bear a relationship to sex. AIDS, I repeat, does not. Immunodeficiency has more to do with things such as recreational drugs, or malnutrition. But, funny enough, those dogmas are exactly the type of hogwash that the religious conservatives happily accept, because the AIDS-swindle takes aim at sex.
And all that to satisfy the egos of some scientists who goofed, and the doom prophets who insist that there ought to be a divine punishment for promiscuity. And how nice for the big pharmaceutical companies! Those antiviral drugs they are putting in the bargain basement now are, by their very nature, so poisonous that they will probably destroy millions of lives instead.
Rich people live longer than poor people; everyone knows that. And the reason is not that they use condoms, or restrict themselves to one sexual partner. No, they simply eat well, and they have access to proper medical care. Or die That would be good advertising too Well, more power to you, sir! AIDS the loss of immune response to infectious diseases can have various causes, but a sexually transmitted virus is not one of them. You are dead right pointing the finger at the real causes of this scourge: Poverty, malnutrition, and lack of medical care.
He refuses to let greedy pharmaceutical companies sell him overpriced antiviral drugs on a payment plan that would make his people become even poorer and more undernourished. How much longer are you going to tolerate this nonsense? Make sure the corrupt scientists never get a research grant again. They cannot isolate anything that can be identified either, because they work with cellular slop that could contain antibodies to whatever and godknowswhat showing enzymatic activity that has also been reported to be associated with known retroviruses.
Formerly Asst. Did research with Dr. Jesse Beams, one of the lead scientists on The Manhattan Project. Nobody should be given a death sentence based on the results of nonspecific and inaccurate tests. Up close, it turns out to be much like any other human enterprise, riven with envy, ambition and the standard jockeying for position. But the firm was barely two months old when the story ran, and two rival entrepreneurs who launched similar products a few years back had gone under. You tell me. This was getting seriously weird. Eric Borman said business was good, but he was a master craftsman who made one or two deluxe caskets a week and seemed to resent the suggestion his customers were the sort of people who died of AIDS.
Borman pointed, and off I went, deeper and deeper into the maze. On the far side of the golf course, Mrs. Smith has just buried her beloved servant. Your cousin Lenny knows someone who owns a factory where all the workers are dying. Your newspapers are regularly predicting that the economy will surely be crippled, and schooling may soon collapse because so many teachers have died.
We had no idea. We were playing a game, driven by hysteria. Here in South Africa, entrepreneurs are piling into the AIDS business at an astonishing rate, setting up consultancies, selling herbal immune boosters and vitamin supplements, devising new insurance products, distributing condoms, staging benefits, forming theater troupes that take the AIDS prevention message into schools. We write exactly in the way that we are told, even knowing that this or that is not true. There is a lack of common sense in understanding subjects and problems. However, journalists do not care about this contradiction.
A similar thing happens with discrepancies between Gallo and Montagnier regarding the origin of AIDS, discrepancies which are published, but nobody says a word. Similarly with information from the CDC; they replied to me that viral load is improper for diagnosing HIV infection, yet nobody calls them on this, most journalists do not question it, they just report that viral load diagnoses HIV infection. We must no longer believe in an AIDS virus that supposedly has magic powers, that mutates, that every time they use a new antiretroviral the virus uses its magic powers to resist.
The causation aspect is a mythical perpetuation which has been advanced to an untouchable status. Sometimes these statements are literal untruths; at other times they merely insinuate untruths in their equivocation between rates of disease and rates-of-change in population-specific disease rates. Estimates of the prevalence of HIV infection are well-known to be unreliable, and have been continually revised downwards. It therefore seems highly likely to us that a substantial number of the reported cases of heterosexual transmission in the partners of injecting drug users, in particular, are themselves injecting drug users.
Women are dying of AIDS, but it is not because of heterosexual or lesbian sex. Rather, AIDS disproportionately affects those women who inject drugs, and thereby largely suffer other diseases, poverty, and malnutrition. People who develop the disease are robbed of hope of recovery. The Koch postulates must be satisified as a unity. This means that one must isolate and purify the supposed cause from every case of the disease. The purified agent must be injected into a suitable animal host and shown to induce the disease.
This has never been done, and in the only animal model, that of the Chimpanzee, HIV causes no disease at all. From the new diseased host, the cause must then be isolated once more and the procedure repeated. Again, this has not been done. There is no way you could make that much virus. Does what Ho and Shaw say actually make any sense? Are their experimental techniques sound? Do their conclusions follow from their results? Is their mathematical analysis sound? My conclusion will be that this new work is about as convincing as a giraffe trying to sneak into a polar bears only picnic by wearing sunglasses.
Is nobody at Nature bothered by the fact that neither paper contains any hard data which can be independently analysed? And Wei, et al. The reader is given absolutely no explanation of how this assay of viral load is supposed to be carried out and no indication of how reliable it is. They seem to have learned like the mad hatter to believe six impossible things before breakfast and so one more makes no difference.
One gets a remarkable sense of being disassociated from the real world when entering the realm of AIDS research. Am I mad or are they? Koch's postulates are failed at every turn. It is well- acknowledged that the HIV virus is cleared quickly out of the body. The mechanism by which it is cleared is through the production of an antibody, which is specific for the virus. How does a virus which is not present do progressive damage to an immune system?
However, this does not mean that HIV is causing the final collapse of the immune system, but vice-versa: the final collapse of the immune system allows large numbers of HIV particles to exist. Nevertheless, if the immune system eventually decompensates from multiple toxic exposures, it is easy to blame a virus which is going along for the ride. It also fits the allopathic paradigm of one disease, one cause. This has changed lives. It has caused depression and lethargy. Many productive citizens have given up and are waiting to die.
Some have committed suicide in despair and anticipation of a future of suffering and certain death from AIDS. This is just not the case. The idea of the inevitability of an AIDS-related death for people with an HIV-positive blood test is a wild guess for which there is no proof. It is a thundering herd of paradigm-dominated, research grant-motivated opinion. Here is a drug for treating autoimmune deficiency which causes autoimmune deficiency.
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When one sees the result of treatment with AZT, the list of possible side effects becomes the list of probable, almost certain, side effects. When AZT hits the scene, T cells are killed by the millions. Loss of appetite, nausea and vomiting of blood , muscle wasting, severe fatigue, bloody diarrhea and slowed growth in children are the results which the doctor can count on seeing in the person taking AZT. In comes a patient, probably with an infection, to see the doctor.
On the next visit to the doctor, weight loss is noted and patient is not feeling so well. T-cells are down. We had better increase the dose of AZT. It happened, for example, to Arthur Ashe, who was informed, but not convinced, of this information, so he continued taking AZT.
AIDS, like cancer and vascular disease, is a disease which selects out those people able to think for themselves and willing to inform themselves. Those who blindly follow the blind will, well, both fall into a ditch. Darwin lives! I keep an open mind for the HIV hypothesis and yet, as it appears now, it would be the strangest thing in science if it should turn out to be true. His opinion was that people were dying of lots of things, but not noticeably more than was ever the case. Mbeki, nobody I talked to in South Africa even cared about AIDS, simply because so few people even knew somebody who knew somebody who supposedly had it.
People are far more concerned about crime. Often, HIV testing is not even performed and people are diagnosed on the basis of unspecific symptoms such as weight loss and diarrhea. Long term use is known to cause immunosuppression and side effects that are actually indistinguishable from AIDS. The pharmaceutical companies do not even attempt to deny this. Millions of people have been encouraged to put all their hope and trust in these drugs. She has never used antiretroviral drugs and she says that she maintains her health by maintaining a strictly healthy diet and lifestyle.
There is often no further explanation. This of course makes no sense to people who do not already know the arguments. Hence, people do not understand the real arguments and as a result even those without a vested interest develop strong anti-dissident views without any real knowledge of what it is really about. If an unreliable test and sometimes no testing is being used to diagnose HIV in Africa, how can we be confident that giving toxic anti-retroviral drugs to people under these circumstances is acceptable?
One of them I sent under my own name to get tested for HIV antibodies, the other I sent under the name of one of my HIV positive patients for viral load testing to the same lab. Most HIV-infected people have not advanced to overt disease. Immune host defense systems can be helped or even rebuilt through natural methods and therapies. The longest surviving AIDS patients are those who have rejected synthetic drugs and are on natural therapies. There remain profound questions and an increasingly loud whisper from the margins of the scientific literature that either we did not get it completely right in the early stages of the disease or, even, that we got it completely wrong.
His report concluded that drugs were a factor. The CDC refused to release the report. The great sin that Duesberg committed was to challenge the priesthood of that secular religion. The fact that a virus was being blamed suited them fine since viruses are nothing if not democratic. The multiplication factor, however, increases every year. In this had jumped to In the last one and a half years, the WHO has multiplied the reported cases by The oft-repeated horror scenarios This form of presentation is extremely unusual in medicine as it produces useless results.
The figures automatically rise, even if only a few new cases are still coming in each year. None of the projections have come true but they have been the basis for enormous budgets for the agencies involved. The impact on other health issues is enormous, especially in poorer countries. The major symptoms are weight loss, chronic diarrhea and chronic fever. The minor symptoms include coughing and generalized itching. To begin with, less than 50 percent of Africans have access to safe drinking water. Over 60 percent have no sanitation.
Human and animal excrements mix with the water supply. People drink this water and ingest infectious parasites and bacteria. As a result, dysentery is endemic. It weakens the immune system. The typical symptoms are fever, weight loss and coughing. This is exactly what is required for an AIDS diagnosis. Malaria is the most widespread disease in Africa and tropical countries.
The symptoms include fever, weight loss and fatigue. The idea that there should be a different kind of AIDS for Africans or Europeans or Americans defies the scientific definition of viral infection. So give us free mosquito nets instead of condoms and Aids medicaments. Innumerable western companies, NGOs, international organisations and Aids experts profited from it. These drugs are similar or identical to chemotherapy drugs used in cancer treatment. They work by stopping cell growth. They kill your body from the inside out.
This is exactly how the incidence of TB and other infectious diseases was dramatically reduced in the US and Europe. This is not what these already suffering people need to be healthy and successful. This is exactly how to propagate death, disease and poverty. This postulate veils the real cause of AIDS. Jager in a live interview , one of the leading German AIDS authorities, in the period from to , there has not been a single case of male or female HIV infection in the age group not even in homosexuals!
Yet ignorance and unwillingness to know can no longer be an alibi for the humiliating helplessness and indifference among officials, professional medical associations, and almost all fellow human beings who face this almost unprecedented lack of scientific and medical ethics.
Since he has worked in basic research on cancer and AIDS. It happens all the time. In he held a research fellowship in immunology from the National Institutes of Health. Early in his career he was instrumental in getting the drug AZT released, an act he looked back on with regret. In a BC Supreme Court writ, Lisa Lebed claims when she was admitted to the hospital in late to give birth to a daughter, a blood sample was taken without her consent. It revealed she was HIV positive, so she gave up the baby girl for adoption and decided to have a tubal ligation.
The explanation she was given was a lab error. In spite of voluminous evidence which shows that HIV is not the cause of AIDS, the myth is deliberately kept going so that industries keep prospering. The toxic effects of ARVs include nerve damage, weakened bones, unusual accumulation of fat in the neck and abdomen and drug-induced diabetes. Many people have developed dangerously high levels of cholesterol and other lipids in the blood, raising concern that HIV positive persons might face another epidemic of heart disease.
These are: antibiotic abuse, recreational drug abuse, anal sex which causes toxic shock to the receiving partner and nutritional stress. Realization is also slowly but surely dawning that the damage caused by the stressed immune system could be reversed by good diet, yogic and other exercises, herbs available readily, acupuncture, homeopathy, proper rest, avoidance of alcohol, drugs, tobacco, proper hygiene, etc.
In other words, a person is to be treated as a whole: body, mind and spirit. The principles of healing are very simple: a the body heals itself b there is an inner environment c treatment should not be worse than the disease. Has 30 years of clinical, teaching and research experience. Delivered over 10, lectures in 63 countries, written 33 books, thousands of articles, reports, editorial letters, short stories and other works.
When studied all of these people had received the influenza vaccine four to six weeks prior and this was rapidly covered up by the press. I had been a pharmacist for over 20 years at that time and had many of the same misgivings Dr. He was intelligent, concise, impeccably informed and vastly experienced in his field. We swim in a daily SEA of bugs. We have enough toxic and dangerous bugs within us to kill an army if they put us in a blender and fed us raw to them.
If the drugs kill you, your doctors, family and friends will believe that AIDS killed you. The fact that so many are emotionally attached to this is the major problem A leader with a brain! Thabo Mbeki. How unusual By the billions It may well be that things are worse for B-W given the propensity of all flaks to play down bad times. Regardless, this news is promising and indicates that AZT and similiar toxics may soon be synonymous with snake oil. When the medical establishment is heavily invested in a set of assumptions, it can seem nearly impossible. Yet it is now undeniable that a positive HIV test does not mean you have a fatal disease.
Founder of EarthSave Foundation. Soquel, California. Subsequent studies proved that, in fact, no more people were dying in total, than measured before ! The numbers today show that the 2. Maybe there are those who would wish that that were true? Simply put; no one dies any more of malaria and TB? Research scientists [outside AIDS research] laugh at us. To them a good sample size is 30, people. You cannot draw conclusions from statistically flawed studies and no study with a tiny sample can be trusted It is also unethical to run trials of drugs in places like Malaysia with only 30 people involved and then try to justify these flawed trials because some people got access to drugs who otherwise would have had nothing.
No matter how overblown their previous predictions and assertions prove, no matter how good the news to the contrary, they always find a way to make the end of the world seem just around the corner. Female AIDS cases attributed to heterosexual contact declined from 4, to 3,, down in turn from 6, in It is the ultimate triumph of politics over science. All tests for identifying HIV status have been seriously challenged. Questions have been raised about whether the virus really can be transmitted via breastfeeding.
Then why does it allow smoking? Why does it allow people to eat junk food? Why does the government allow us to put children into cars? This means, for example, that even HIV-positive mothers have a right to breastfeed. CDC , p. Under this definition it appears that HIV can be anything a physician says it is. AIDS is, in essence, a collection of 26 previously known diseases.
AIDS is not a disease, it is a collection of diseases. It may appear to be highly deadly because it counts together what previously had been counted separately. Is this an epidemic, or is this simply innovative accounting? For example, the surveillance reports emphasize cumulative figures. The report CDC , p. Also, once a person is diagnosed as having AIDS, it is retained forever, even if the original basis for the diagnosis disappears.
This does not necessarily mean they died as a result of AIDS. The other deaths tables that are provided in the mid report have no such acknowledgment. The data do not provide any means for distinguishing these deaths. While many different kinds of diseases can result from severe immunosuppression, there is no apparent reason for making distinctions among those diseases depending on what caused the immunosuppression. The discussions on the issue tend to imply that a positive result on any of these tests is a sure sign of impending death, but there is no solid published evidence to support that assumption.
While some take the view that the presence of these antibodies is a cause for alarm, it should perhaps be viewed as just the opposite, a highly desirable finding.