European journal of clinical investigation
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Eur. J. Clin. Invest. · May 2018
ReviewHypertension: New perspective on its definition and clinical management by bedtime therapy substantially reduces cardiovascular disease risk.
Diagnosis of hypertension-elevated blood pressure (BP) associated with increased cardiovascular disease (CVD) risk-and its management for decades have been based primarily on single time-of-day office BP measurements (OBPM) assumed representative of systolic (SBP) and diastolic BP (DBP) during the entire 24-hours span. Around-the-clock ambulatory blood pressure monitoring (ABPM), however, reveals BP undergoes 24-hours patterning characterized in normotensives and uncomplicated hypertensives by striking morning-time rise, 2 daytime peaks-one ~2-3 hours after awakening and the other early evening, small midafternoon nadir and 10-20% decline (BP dipping) in the asleep BP mean relative to the wake-time BP mean. ⋯ Additionally, bedtime hypertension chronotherapy, that is, ingestion of ≥1 conventional hypertension medications at bedtime to achieve efficient attenuation of asleep BP, better reduces total CVD events by 61% and major events (CVD death, myocardial infarction, ischaemic and haemorrhagic stroke) by 67%-even in more vulnerable chronic kidney disease, diabetes and resistant hypertension patients-than customary on-awaking therapy that targets wake-time BP. Such findings of around-the-clock ABPM and bedtime hypertension outcome trials, consistently indicating greater importance of asleep BP than daytime OBPM or ambulatory awake BP, call for a new definition of true arterial hypertension plus modern approaches for its diagnosis and management.
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Eur. J. Clin. Invest. · May 2018
Consequences of relying on statistical significance: Some illustrations.
Despite regular criticisms of null hypothesis significance testing (NHST), a focus on testing persists, sometimes in the belief to get published and sometimes encouraged by journal reviewers. This paper aims to demonstrate known key limitations of NHST using simple nontechnical illustrations. ⋯ Researchers and journals should abandon statistical significance as a pivotal element in most scientific publications. Confidence intervals around effect sizes are more informative, but should not merely be reported to comply with journal requirements.