Finally, studies of brain anatomy show structural differences bet

Finally, studies of brain anatomy show structural differences between the brains of fibromyalgia patients and healthy individuals. The cerebral alterations offer a compelling explanation for the multiple symptoms of fibromyalgia, including widespread pain and affective disturbances. The frequent comorbidity of fibromyalgia with stress-related disorders, such as chronic fatigue, posttraumatic stress disorder, irritable bowel syndrome, and depression, as well as the similarity

of many CNS abnormalities, suggests at least a partial common substrate for these disorders. Despite the numerous cerebral alterations, fibromyalgia might not be a primary PS-341 nmr disorder of the brain but may be a consequence of early life stress or prolonged or severe stress,

affecting AZD9291 chemical structure brain modulatory circuitry of pain and emotions in genetically susceptible individuals. NEUROSCIENTIST 14(5):415-421, 2008. DOI: 10.1177/1073858407312521″
“Background Angiotensin-converting enzyme (ACE) inhibitors reduce major cardiovascular events, but are not tolerated by about 20% of patients. We therefore assessed whether the angiotensin-receptor blocker telmisartan would be effective in patients intolerant to ACE inhibitors with cardiovascular disease or diabetes with end-organ damage.

Methods After a 3-week run-in period, 5926 patients, many of whom were receiving concomitant proven therapies, were randomised

to receive telmisartan 80 mg/day (n=2954) or placebo (n=2972) by use of a central automated randomisation system. Randomisation was stratified by hospital. The primary outcome was the composite of cardiovascular death, myocardial infarction, stroke, or hospitalisation for heart failure. Analyses were done by intention to treat. This trial is registered with, number NCT00153101.

Findings The median duration of follow-up was 56 (IQR 51-64) months. All randomised patients were included in the efficacy analyses. Mean blood pressure was lower in the telmisartan group than in the placebo group throughout the study JNJ-64619178 cell line (weighted mean difference between groups 4 .0/2.2 [SD 19.6/12. 0] mm Hg). 465 (15.7%) patients experienced the primary outcome in the telmisartan group compared with 504 (17 . 0%) in the placebo group (hazard ratio 0 . 92, 95% CI 0 . 81-1 . 05, p=0.216). One of the secondary outcomes-a composite of cardiovascular death, myocardial infarction, or stroke-occurred in 384 (13 . 0%) patients on telmisartan compared with 440 (14.8%) on placebo (0 . 87, 0 . 76-1 . 00, P=0. 048 unadjusted; p=0.068 after adjustment for multiplicity of comparisons and overlap with primary outcome). 894 (30.3%) patients receiving telmisartan were hospitalised for a cardiovascular reason, compared with 980 (33 .0%) on placebo (relative risk 0 . 92, 95% CI 0. 85-0. 99; p=0. 025).

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