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Context: A Maintenance of Certification Part IV project was created on the basis of an existing, multifaceted hypertension improvement program. Objective: To evaluate the impact of the Maintenance of Certification project, the effects of the improvement options on blood pressure control in hypertensive patients, and the participants' perception of the workload related to participation in the project. Design: Nonexperimental retrospective analysis. Setting: Kaiser Permanente hospitals and medical office buildings in Northern California. Intervention: Participants used one or more options from a defined menu of strategies to attempt to increase the percentage of hypertensive patients on their patient panels who had controlled blood pressure. Main Outcome Measure: Proportion of hypertensive patients with blood pressure ≤ 139/89 mm Hg. Results: Fifty-two American Board of Family Medicine and 19 American Board of Internal Medicine certified physicians completed projects. Mean panel blood pressure control improved from 79.49% (standard deviation [SD] = 11.32) to 84.64% (SD = 7.80). The choice of improvement option was not associated with the level of improvement or with the participants' perception of the workload related to completing the project. Conclusion: Project participants improved the care of their patients without an increased perceived burden to their practice. We found no association between the choice of improvement option and either the level of improvement or the perception of workload. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of effective hypertension, hyperlipidemia, and hyperglycemia therapies, target levels of systolic blood pressure (SBP), LDL-cholesterol (LDL-c), and hemoglobin A1c control are often not achieved.Objective: To examine the relative importance of patient medication nonadherence versus clinician lack of therapy intensification in explaining above target cardiovascular disease (CVD) risk factor levels.Design: Cross-sectional assessment.Participants: In 2005, 161,697 Kaiser Permanente Northern California adult diabetes patients were included in the study.Measurement: "Above target" was defined as most recent A1c >/=7.0% for hyperglycemia, LDL-c >/=100 mg/dL for hyperlipidemia, and SBP >/=130 mmHg for hypertension. Poor adherence was defined as medication gaps for >/=20% of days covered for all medications for each condition separately. Treatment intensification was defined as an increase in the number of drug classes, increased dosage of a class, or a switch to a different class within the 3 months before or after notation of above target levels.Results: Poor adherence was found in 20-23% of patients across the 3 conditions. No evidence of poor adherence with no treatment intensification was found in 30% of hyperglycemia patients, 47% of hyperlipidemia patients, and 36% of hypertension patients. Poor adherence or lack of therapy intensification was evident in 53-68% of patients above target levels across conditions.Conclusions: Both nonadherence and lack of treatment intensification occur frequently in patients above target for CVD risk factor levels; however, lack of therapy intensification was somewhat more common. Quality improvement efforts should focus on these modifiable barriers to CVD risk factor control. [ABSTRACT FROM AUTHOR]

Purpose: To assess the association of cardiovascular risk factors and ocular perfusion pressure with early and advanced age-related macular degeneration (AMD) in Latinos.Design: Population-based, cross-sectional study.Methods: Data were collected from a population-based sample of self-identified adult Latinos using standardized protocols for assessing blood pressure and intraocular pressure (IOP) measurement and stereoscopic macular photography. Hypertension was defined as either a history of hypertension or systolic blood pressure (SBP) > 140 mm Hg +/- diastolic blood pressure (DBP) > or = 85 mm Hg. Ocular perfusion pressure (OPP) was defined as the difference between mean arterial blood pressure and IOP. AMD was diagnosed from photographic grading by masked trained graders. Logistic regression was used to assess associations.Results: Gradable retinal photographs were available in 5,875 participants. After adjusting for age, gender, and cigarette smoking, higher DBP and uncontrolled diastolic hypertension were associated with exudative AMD (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1 to 2.8; and OR, 3.3; CI, 1.2 to 9.3, respectively). Higher OPP was associated with a decreased risk of geographic atrophy (GA) (OR, 0.4 per 10 mm Hg; CI, 0.3 to 0.5). Low pulse pressure was associated with a lower risk of exudative AMD (OR, 0.2; CI, 0.1 to 0.6). Obesity was associated with increased retinal pigment (OR, 1.6; CI, 1.0 to 2.3).Conclusions: These data suggest that in Latinos cardiovascular risk factors may play a role in advanced AMD. Given that Latinos have a high prevalence of cardiovascular risk factors, an intervention aimed at reducing these risk factors may also have a beneficial impact on the risk of having early and advanced AMD. [ABSTRACT FROM AUTHOR]

Presents abstracts of studies on gender and the cardiovascular system, presented at the Experimental Biology/International Union of Physiological Sciences 2005 congress held in San Diego, California. "Roles of Sex and Age in the Regulation of Skeletal Muscle Venule Permeability to Rat Serum Albumin (P sRSA by Adenosine (ADO)," by Virginia H. Huxley and JianJie Wang; "Progesterone Effects on Extracellular Fluid Distribution," by Nina Stachenfeld and Hugh S. Taylor; "Indications of an Age-Related Susceptibility to Hypovolemic Circulatory Stress in Females," by Marcus Lindenberger, Henrik Olsen and Toste Länne.

The article elaborates on the study conducted by Daria Mochly-Rosen and colleagues from the Stanford University regarding the significance of protein in reducing heart damage in Stanford, California. Researchers undertake the experiment on mice and they found that proteins reduces heart damage and could hold the key to protecting humans against a potentially life-threatening condition, reduction of blood flow to the heart or cardiac ischaemia. They found that increased activity of a protein called aldehyde dehydrogenase 2 (ALDH2) is correlated with reduced damage following cardiac ischaemia. The researchers then isolated a compound called Alda-1 that activates ALDH2, also reducing heart damage by ischaemia.