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Single-site, intensive, community-based blood pressure (BP) intervention programs have led to BP improvements. The authors examined the American Heart Association's Check. Change.Control: (CCC) program (4069 patients/18 cities) to determine whether BP interventions can effectively be scaled to multiple communities, using a simplified template and local customization. Effectiveness was evaluated at each site via site percent enrollment goals, participant engagement, and BP change from first to last measurement. High-enrolling sites frequently recruited at senior residential institutions and service organizations held hypertension management classes and utilized established and new community partners. High-engagement sites regularly held hypertension education classes and followed up with participants. Top-performing sites commonly distributed BP cuffs, checked BP at engagement activities, and trained volunteers. CCC demonstrated that simplified community-based hypertension intervention programs may lead to BP improvements, but there was high outcomes variability among programs. Several factors were associated with BP improvement that may guide future program development. [ABSTRACT FROM AUTHOR]

BACKGROUND: An increase in endogenous cat-echolamine levels after traumatic brain injury (TBI) is well described. Animal studies suggest that postinjury anemia is exacerbated by a persistent hyperadrenergic state. This study aims to determine if beta-blocker (BB) exposure affects anemia after TBI. STUDY DESIGN AND METHODS: We reviewed a Level I trauma registry for patients with TBI, examining markers of anemia between patients who received BB with those who did not. RESULTS: A total of 174 patients were exposed to BB (BB+) and 245 were not exposed (BB-). The mean age in the BB+ group was 50 years (vs. 36 years in BB-group, p < 0.001). The mean injury severity score was 33.6 for the BB+ group (vs. 30.8 for BB- group, p = 0.01). While BB+ patients were more likely to receive a transfusion (60.9% vs. 35.1%, p < 0.001), BB+ patients reached their nadir hemoglobin (Hb) at a later day of hospitalization and their rate of decrease in Hb was significantly slower (both p < 0.001). Choosing Hb cutoffs for anemia of both 7 and 10 g/dL, Kaplan-Meier demonstrated a significant delay in time to anemia. CONCLUSION: This study suggests beta-blockade delays anemia after TBI. Elaboration of this effect may demonstrate an additional benefit of beta-blockade after head injury. [ABSTRACT FROM AUTHOR]

Purpose Studies of non-steroidal anti-inflammatory drugs (NSAIDs) and cardiovascular events using administrative data require identification of incident acute myocardial infarctions (AMIs) and information on whether confounders differ by NSAID status. Methods We identified patients with a first AMI hospitalization from Tennessee Medicaid files as those with primary ICD-9 discharge diagnosis 410.x and hospitalization stay of > 2 calendar days. Eligible persons were non-institutionalized, aged 50-84 years between 1999-2004, had continuous enrollment and no AMI, stroke, or non-cardiovascular serious medical illness in the prior year. Of 5524 patients with a potential first AMI, a systematic sample ( n = 350) was selected for review. Using defined criteria, we classified events using chest pain history, EKG, and cardiac enzymes, and calculated the positive predictive value (PPV) for definite or probable AMI. Results 337 of 350 (96.3%) charts were abstracted and 307 (91.1%), 6 (1.8%), and 24 (7.1%) events were categorized as definite, probable, and no AMI, respectively. PPV for any definite or probable AMI was 92.8% (95% CI 89.6-95.2); for an AMI without an event in the past year 91.7% (95% CI 88.3-94.2), and for an incident AMI was 72.7% (95% CI 67.7-77.2). Age-adjusted prevalence of current smoking (46.4% vs. 39.1%, p = 0.35) and aspirin use (36.9% vs. 35.9%, p = 0.90) was similar among NSAID users and non-users Conclusions ICD-9 code 410.x had high predictive value for identifying AMI. Among those with AMI, smoking and aspirin use was similar in NSAID exposure groups, suggesting these factors will not confound the relationship between NSAIDs and cardiovascular outcomes. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose To determine if certain non-steroidal anti-inflammatory drugs (NSAIDs) are associated with increased risk of cardiovascular events: acute myocardial infarction (AMI), stroke, and death from coronary heart disease (CHD). Methods We conducted a retrospective cohort study of Tennessee Medicaid enrollees aged 35-94 years between 1 January 1999 and 31 December 2005. Eligible persons were non-institutionalized, had continuous enrollment, and had no serious illness prior to cohort entry. Exposure to celecoxib, rofecoxib, valdecoxib, ibuprofen, naproxen, diclofenac, and indomethacin was studied. The outcome was hospitalization for AMI, stroke, or death from CHD among those with and without a history of cardiovascular disease (CVD). Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) are reported. Results There were 610 001 persons in the final cohort and 14% had a baseline history of CVD. In those without CVD ( N = 525 249) there were 1 566 678 person-years of follow-up and 12 184 events. In this group, non-users had 7.90 events/1000 person-years. Events/1000 person-years were 10.41 for current use of celecoxib (aHR 1.00, 95% CI 0.89-1.13), 10.91 for rofecoxib (aHR 1.21, 95% CI 1.07-1.37), 12.46 for valdecoxib (aHR 1.30 95% CI 1.04-1.61), and 13.25 for indomethacin (aHR 1.36, 95% CI 1.11-1.66) compared to non-users. Among patients with a past history of CVD ( N = 84 752) there were 397 977 person-years of follow-up and 10 248 events. Non-users had 28.30 events/1000 person-years. Among those with CVD, rofecoxib use was associated with increased event rate (30.28 events/1000 person-years [aHR 1.21, 95% CI 1.08-1.37]) and naproxen was associated with a decreased event rate (22.66 events/1000 person-years [aHR 0.88, 95% CI 0.79-0.99]). Among new users, the results were similar except risk among naproxen users was no longer different than non-users. Conclusions We found an increased risk of cardiovascular events among all and new current users of rofecoxib, valdecoxib, and indomethacin in patients with no history of CVD. Among patients with CVD, all and new current rofecoxib use was associated with an increased risk of a cardiovascular event. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study was designed to assess the association between pregnancy-related exposures to antibiotics recommended for use in the event of a bioterrorism attack and major congenital malformations. A retrospective cohort study included 30 049 infants from Tennessee Medicaid born between 1985 and 2000 identified from computerised state databases. Infants with fetal exposures to ciprofloxacin, azithromycin, doxycycline and amoxicillin (antibiotics recommended for potential bioterrorism attacks) (n = 24 521) and erythromycin (included as a positive control) (n = 2128) were compared with infants with no fetal exposure to any antibiotics (n = 3400). Major congenital malformations identified from computerised records were confirmed through medical record review. Overall, 869 (2.9%) of infants in the cohort had a confirmed major congenital malformation, with major malformations ranging from 2.5% to 3.0% among the antibiotic-specific exposure groups. No increased risk was present in multivariable analyses for any malformations and for malformations of specific organ systems. In conclusion, these data suggest that ciprofloxacin, azithromycin, doxycycline or amoxicillin use by pregnant women should not result in a greater incidence of overall major congenital malformations in infants whose mothers take these medications, though a large increase in risk cannot be ruled out. [ABSTRACT FROM AUTHOR]