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Objective: To determine the incidence and risk factors for developing proliferative diabetic retinopathy (PDR), tractional retinal detachment (TRD), and neovascular glaucoma (NVG) at 5 years after the initial diagnosis of type 2 diabetes.Research Design and Methods: Insured patients aged ≥18 years with newly diagnosed type 2 diabetes and 5 years of continuous enrollment were identified from a nationwide commercial claims database containing data from 2007 to 2015. The incidences of PDR, TRD, and NVG were computed at 5 years following the index diagnosis of type 2 diabetes. Associations between these outcomes and demographic, socioeconomic, and medical factors were tested with multivariable logistic regression.Results: At 5 years following the initial diagnosis of type 2 diabetes, 1.74% (1,249 of 71,817) of patients had developed PDR, 0.25% of patients had developed TRD, and 0.14% of patients had developed NVG. Insulin use (odds ratio [OR] 3.59, 95% CI 3.16-4.08), maximum HbA1c >9% or >75 mmol/mol (OR 2.10, 95% CI 1.54-2.69), renal disease (OR 2.68, 95% CI 2.09-3.42), peripheral circulatory disorders (OR 1.88, 95% CI 1.25-2.83), neurological disease (OR 1.62, 95% CI 1.24-2.11), and older age (age 65-74 years) at diagnosis (OR 1.62, 95% CI 1.28-2.03) were identified as risk factors for development of PDR at 5 years. Young age (age 18-23 years) at diagnosis (OR 0.46, 95% CI 0.29-0.74), Medicare insurance (OR 0.60, 95% CI 0.70-0.76), morbid obesity (OR 0.72, 95% CI 0.59-0.87), and smoking (OR 0.84, 95% CI 0.70-1.00) were identified as protective factors.Conclusions: A subset of patients with type 2 diabetes develop PDR and other neovascular sequelae within the first 5 years following the diagnosis with type 2 diabetes. These patients may benefit from increased efforts for screening and early intervention. [ABSTRACT FROM AUTHOR]

Heart failure hospitalizations are a major financial cost to healthcare systems. This study aimed to evaluate the costs associated with inpatient hospitalization. Patients with a primary diagnosis of heart failure during a hospital admission between 2010 and 2014 in the U.S. Nationwide Readmission Database were included. The primary outcome was total cost defined by direct cost of index admission and first readmission within 30-days. A total of 2,645,336 patients with primary heart failure were included in the analysis. The mean ± SD total cost overall was $13,807 ± 24,145; with mean total costs of $15,618 ± 25,264 for patients with 30-day readmission and $11,845 ± 22,710 for patients without a readmission. The comorbidities strongly associated with increased cost were pulmonary circulatory disorder (OR 26.24 95% CI 20.06–34.33), valvular heart disease (OR 25.42 95% CI 20.65–31.28) and bleeding (OR 5.96 95% CI 5.47–6.50). Among hospitalized patients, 12.6% underwent an invasive diagnostic procedure or treatment. The mean cost for patients without invasive care was $10,995. This increased by $129,547, $119,769, $251,110 and $293,575 for receipt of circulatory support, intra-aortic balloon pump, LV assist device and heart transplant. The greatest mean additional cost annually was associated with receipt of coronary angiogram ($26,282 per person for a total of ($728.5 million) and mechanical ventilation ($54,529 per person for a total of $501.7 million). In conclusion, the costs associated with inpatient heart failure care are significant, and the major contributors to inpatient costs are comorbidities, invasive procedures and readmissions. • Costs associated with heart failure hospitalizations in the United States vary greatly among hospitalized patients • Biggest comorbidity contributors to increased inpatient costs are pulmonary disorders, valvular heart disease, and bleeding • Invasive procedures are common in patients hospitalized with heart failure and significantly increase hospitalization costs • Heart Failure readmissions are frequent, and readmissions also significantly contribute to total hospitalization costs [ABSTRACT FROM AUTHOR]

The rates of readmission for serious cardiovascular events among patients admitted with a diagnosis of non-specific chest pain are unknown. A national retrospective cohort study in the United States was undertaken to evaluate the rates, trends and predictors of readmission for serious cardiovascular events (acute coronary syndrome (ACS), pulmonary embolism (PE) and aortic dissection (AD)) after an inpatient episode with a primary diagnosis of non-specific chest pain. Among 1,172,430 patients with an index diagnosis of non-specific chest pain between 2010 and 2014, 2.4% were readmitted with an ACS, 0.4% with a PE and 0.06% with an AD within 6 months of discharge. Predictors of ACS readmissions were diabetes (OR 1.49 95% CI 1.17–1.32), coronary artery disease (OR 2.29 95% CI 2.15–2.44), previous percutaneous coronary intervention (OR 1.65 95% CI 1.56–1.75), previous CABG (OR 1.52 95% CI 1.43–1.61) and discharge against medical advice (OR 1.94 95% CI 1.78–2.12). Female patients (OR 0.82 95% CI 0.78–0.86) and patients in whom a coronary angiogram was undertaken (OR 0.48 95% CI 0.45–0.52) were less likely to be readmitted for ACS. For PE, predictors of readmission were pulmonary circulatory disorder (OR 2.20 95% CI 1.09–4.43), anemia (OR 1.62 95% CI 1.40–1.86) and cancer (OR 4.15 95% CI 3.43–5.02). Peripheral vascular disease (OR 8.63 95% CI 5.47–13.60), renal failure (OR 2.08 95% CI 1.34–3.24) were predictors of AD. Non-specific chest pain may not be a benign condition as readmissions for serious cardiovascular events occur in 3% of patients within 180 days. Research is needed to define measures that may mitigate readmissions among these patients. • Cardiovascular (CV) readmissions after admissions for chest pain are unknown. • 3% of patients with nonspecific chest pain have CV readmission within 6 months. • The daily readmissions for CV events appear to peak within a week of discharge. • Predictors of readmissions include diabetes and existing coronary artery disease. • The cost of these readmissions is ~$120 million dollars between 2010 and 2014. [ABSTRACT FROM AUTHOR]

The article offers information about the global impact of the 2017 American Heart Association and American College of Cardiology (AHA/ACC) guidelines for the prevention, detection, examination, and management of high blood pressure (BP) in adult patients. Issues are presented about strict BP control with a new definition and universal target goal for hypertension.

The article offers information about the global impact of the change in the 2017 American College of Cardiology and American Heart Association hypertension guidelines regarding the definition of hypertension from 140/90 mm Hg to 130/80 mm Hg for systolic/diastolic blood pressure. It discusses the usefulness and appropriateness of the new threshold based on its influence in both short- and long-term perspectives.

Background and objective. In the USA, the prevalence of hypertension has been high and increasing in recent decades. Even so, little is known about the changes over time in hospitalizations and the economic burden associated with this epidemic. We examined hypertension-associated hospitalizations and costs from 1979 to 2006. Methods. Using the National Hospital Discharge Survey and the costs of community hospitals in the USA, we analyzed the changes in hypertension-associated hospitalizations and costs over time. We included those hospitalizations with a primary or secondary diagnosis of hypertension among patients aged 25 years and above. We examined changes in costs by adjusting them into year 2008 dollars. The costs included hospital expenses of payroll, employee benefits, professional fees and supplies. Results. From 1979-1982 to 2003-2006, the proportion of hospitalizations that were associated with hypertension (primary or secondary diagnosis) increased from 1.9% to 5.4%. Among all hypertension-associated hospitalizations, the proportion with a secondary diagnosis of hypertension increased from 81.8% to 95.1%. In 2008 dollars, annual costs for hypertension-related hospitalizations increased from US$40 billion (5.1% of total hospital costs) during 1979-1982 to US$113 billion (15.1% of total hospital costs) during 2003-2006. Conclusions. Both the proportions of hospitalizations that were associated with hypertension and the adjusted annual costs of such hospitalizations nearly tripled over the past 28 years. The increases were in substantial measure due to the greatly increasing proportion of hospitalizations in which hypertension was listed as a secondary diagnosis. Interventions for the management of hypertension as a secondary diagnosis might be potentially cost-effective. [ABSTRACT FROM AUTHOR]

Description: New U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for chronic kidney disease (CKD). Methods: The USPSTF reviewed evidence on screening for CKD, including evidence on screening, accuracy of screening, early treatment, and harms of screening and early treatment. Population: This recommendation applies to asymptomatic adults without diagnosed CKD. Testing for and monitoring CKD for the purpose of chronic disease management (including testing and monitoring patients with diabetes or hypertension) are not covered by this recommendation. Recommendation: The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of routine screening for CKD in asymptomatic adults (I statement). [ABSTRACT FROM AUTHOR]

Essential hypertension affects 75% of post-menopausal women in the United States causing greater cardiovascular complications compared with age-matched men and pre-menopausal women. Hormone replacement and current antihypertensive therapies do not correct this post-menopausal increased risk suggesting a distinct pathogenic framework. We investigated the hypothesis that distinct genetic determinants might underlie susceptibility to salt sensitive hypertension in pre-menopausal and post-menopausal states. To determine whether distinct genetic loci contribute to post-menopausal salt-sensitive hypertension, we performed a genome-wide scan for quantitative trait loci (QTLs) affecting blood pressure (BP) in 16-month old post-menopausal F2 (Dahl SxR)-intercross female rats characterized for blood pressure by radiotelemetry. Given identical environments and high salt challenge, post-menopausal BP levels were significantly higher than observed in pre-menopausal (post-menopausal versus pre-menopausal SBP, P<0.0001) and ovariectomized (postmenopausal versus ovariectomized SBP, P<0.001) F2-intercross female rats. We detected four significant to highly significant BP-QTLs (BP-pm1 on chromosome 13, LOD 3.78; BP-pm2 on chromosome 11, LOD 2.76; BP-pm3 on chromosome 2, LOD 2.61; BP-pm4 on chromosome 4, LOD 2.50) and two suggestive BP-QTLs (BP-pm5 on chromosome 15, LOD 2.37; BP-f1 on chromosome 5, LOD 1.65), four of which (BP-pm2, BP-pm3, BP-pm4, BP-pm5) were unique to this post-menopausal cohort. These data demonstrate distinct polygenic susceptibility underlying post-menopausal salt-sensitive hypertension providing a pathway towards the identification of mechanism-based therapy for post-menopausal hypertension and ensuing target-organ complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite mounting evidence that peer coaches can make significant contributions to patient health, little is known about factors that must be addressed to engage and retain them in their role. OBJECTIVE: To identify motivators and barriers to serving as a peer coach. DESIGN: Open ended semi-structured interviews. PARTICIPANTS AND SETTING: In a randomized trial of peer support, patients with well controlled hypertension and good interpersonal skills were recruited and trained to serve as peer coaches for African-American patients from the same practices who had poorly controlled hypertension. Peer coaches spoke by telephone at least three times with their same sex patient-clients on alternate months during the 6-month intervention and counseled about medication adherence as well as other healthy lifestyles. KEY RESULTS: Of 15 trained peer coaches, ten were contacted and agreed to participate in the qualitative interview. Peer coaches had a mean age of 66 years, 50% were women, and 80% were African-American. Themes regarding favorable aspects of the peer coach experience included: meaning and satisfaction derived from contributing to community health and the personal emotional and physical benefits derived from serving as a peer coach. Negative aspects centered on: challenges in establishing the initial telephone contact and wanting more information about their patient-clients' personal health conditions and status. Peer coaches endorsed gender matching but were less clear about race-matching. CONCLUSIONS: Programs that utilize peer support to enhance positive health behaviors should recognize that a spirit of volunteerism motivates many successful peer coaches. Program planners should acknowledge the special characteristics required of successful peer coaches when selecting, motivating and training individuals for this role. [ABSTRACT FROM AUTHOR]

Background: About 6 million Americans suffer from heart failure and 70% of heart failure cases are caused by myocardial infarction (MI). Following myocardial infarction, increased cytokines induce two major types of macrophages: classically activated macrophages which contribute to extracellular matrix destruction and alternatively activated macrophages which contribute to extracellular matrix construction. Though experimental results have shown the transitions between these two types of macrophages, little is known about the dynamic progression of macrophages activation. Therefore, the objective of this study is to analyze macrophage activation patterns post-MI. Results: We have collected experimental data from adult C57 mice and built a framework to represent the regulatory relationships among cytokines and macrophages. A set of differential equations were established to characterize the regulatory relationships for macrophage activation in the left ventricle post-MI based on the physical chemistry laws. We further validated the mathematical model by comparing our computational results with experimental results reported in the literature. By applying Lyaponuv stability analysis, the established mathematical model demonstrated global stability in homeostasis situation and bounded response to myocardial infarction. Conclusions: We have established and validated a mathematical model for macrophage activation post-MI. The stability analysis provided a possible strategy to intervene the balance of classically and alternatively activated macrophages in this study. The results will lay a strong foundation to understand the mechanisms of left ventricular remodelling post-MI [ABSTRACT FROM AUTHOR]

Background: Perfusion-cardiovascular magnetic resonance (CMR) is generally accepted as an alternative to SPECT to assess myocardial ischemia non-invasively. However its performance vs gated-SPECT and in sub-populations is not fully established. The goal was to compare in a multicenter setting the diagnostic performance of perfusion-CMR and gated-SPECT for the detection of CAD in various populations using conventional x-ray coronary angiography (CXA) as the standard of reference. Methods: In 33 centers (in US and Europe) 533 patients, eligible for CXA or SPECT, were enrolled in this multivendor trial. SPECT and CXA were performed within 4 weeks before or after CMR in all patients. Prevalence of CAD in the sample was 49% and 515 patients received MR contrast medium. Drop-out rates for CMR and SPECT were 5.6% and 3.7%, respectively (ns). The study was powered for the primary endpoint of non-inferiority of CMR vs SPECT for both, sensitivity and specificity for the detection of CAD (using a single-threshold reading), the results for the primary endpoint were reported elsewhere. In this article secondary endpoints are presented, i.e. the diagnostic performance of CMR versus SPECT in subpopulations such as multi-vessel disease (MVD), in men, in women, and in patients without prior myocardial infarction (MI). For diagnostic performance assessment the area under the receiver-operator-characteristics-curve (AUC) was calculated. Readers were blinded versus clinical data, CXA, and imaging results. Results: The diagnostic performance (= area under ROC = AUC) of CMR was superior to SPECT (p = 0.0004, n = 425) and to gated-SPECT (p = 0.018, n = 253). CMR performed better than SPECT in MVD (p = 0.003 vs all SPECT, p = 0.04 vs gated-SPECT), in men (p = 0.004, n = 313) and in women (p = 0.03, n = 112) as well as in the non-infarct patients (p = 0.005, n = 186 in 1-3 vessel disease and p = 0.015, n = 140 in MVD). [ABSTRACT FROM AUTHOR]

Background: Several guidelines to reduce cardiovascular risk in diabetes patients exist in North America, Europe, and Australia. Their ability to achieve this goal efficiently is unclear. Methods and Findings: Decision analysis was used to compare the efficiency and effectiveness of international contemporary guidelines for the management of hypertension and hyperlipidemia for patients aged 40-80 with type 2 diabetes. Measures of comparative effectiveness included the expected probability of a coronary or stroke event, incremental medication costs per event, and number-needed-to-treat (NNT) to prevent an event. All guidelines are equally effective, but they differ significantly in their medication costs. The range of NNT to prevent an event was small across guidelines (6.5-7.6 for males and 6.5-7.5 for females); a larger range of differences were observed for expected cost per event avoided (ranges, $117,269-$157,186 for males and $115,999-$163,775 for females). Australian and U.S. guidelines result in the highest and lowest expected costs, respectively. Conclusions: International guidelines based on the same evidence and seeking the same goal are similar in their effectiveness; however, there are large differences in expected medication costs. [ABSTRACT FROM AUTHOR]

Background: Patients with acute myocardial infarction (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability, yet we know little about the basis for how such revascularization hospitals are selected.Methods and Results: We examined interhospital transfer patterns in 71 336 AMI patients admitted to hospitals without revascularization capabilities in the 2006 Medicare claims using network analysis and regression models. A total of 31 607 (44.3%) AMI patients were transferred from 1684 nonrevascularization hospitals to 1104 revascularization hospitals. Median time to transfer was 2 days. Median transfer distance was 26.7 miles, with 96.1% within 100 miles. In 45.8% of cases, patients bypassed a closer hospital to go to a farther hospital that had a better 30-day risk standardized mortality rates. However, in 36.8% of cases, another revascularization hospital with lower 30-day risk-standardized mortality was actually closer to the original admitting nonrevascularization hospital than the observed transfer destination. Adjusted regression models demonstrated that shorter transfer distances were more common than transfers to the hospitals with lowest 30-day mortality rates. Simulations suggest that an optimized system that prioritized the transfer of AMI patients to a nearby hospital with the lowest 30-day mortality rate might produce clinically meaningful reductions in mortality.Conclusions: More than 40% of AMI patients admitted to nonrevascularization hospitals are transferred to revascularization hospitals. Many patients are not directed to nearby hospitals with the lowest 30-day risk-standardized mortality, and this may represent an opportunity for improvement. [ABSTRACT FROM AUTHOR]

The article calls for joined national and international efforts to improve understanding of pulmonary arterial hypertension (PAH). It cites the NIH registry, the first comprehensive examination of the epidemiology of primary pulmonary hypertension in the U.S. and which provided data from a period lacking specific PH therapies. The article also discusses whether a global database is necessary and whether it is possible.

Diabetic nephropathy represents the most common etiology for stage 5 chronic kidney disease in the United States, resulting in the need for dialysis and transplantation. It is estimated that about one-third of U.S. patients who need renal replacement therapy are diabetics. Chronic kidney disease (CKD) of any etiology is associated with cardiovascular disease and is more predictable in patients with diabetic nephropathy.[1] Such individuals have an increased incidence of coronary artery disease and hypertension but also can have diabetic cardiomyopathy due to microvascular complications of diabetes.[2] Optimal blood pressure, blood sugar, and blood lipid control as well as cessation of smoking are of utmost importance in preventing progression of cardiovascular, renal, and end-organ damage. Similarly, early recognition and treatment of microalbuminuria (a manifestation of systemic endothelial dysfunction) is extremely important in improving cardiovascular and renal outcomes.[3] [ABSTRACT FROM AUTHOR]

Background: Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage. Methods: We prospectively registered all trauma patients in Eastern Denmark over 12 consecutive months. We analysed the flow of trauma patients through the system, the time spent at different locations, and we assessed the risk factors of mortality. Results: We included 2875 trauma patients, of whom 158 (5.5%) died before arrival at the hospital. Most patients (75.3%) were brought to local hospitals and patients primarily ( n=82) or secondarily triaged ( n=203) to the level I trauma centre were the most severely injured. Secondarily transferred patients spent a median of 150 min in the local hospital before transfer to the level I trauma centre and 48 min on transportation. Severe injury with an injury severity score >15 was seen in 345 patients, of whom 118 stayed at the local hospital. They had a significantly higher mortality than 116 of those secondarily transferred [45/118, 38.1% vs. 11/116, 9.7% ( P<0.0001)]. Mortality within 30 days was 4.3% in admitted patients, and significant risk factors of death were violence [odds ratio (OR)=5.72], unconsciousness (OR=4.87), hypotension (OR=4.96), injury severity score >15 (OR=27.42), and age. Conclusions: Around 50% of all trauma deaths occurred at the scene. Increased survival of severely injured patients may be achieved by early transfer to highly specialised care. [ABSTRACT FROM AUTHOR]

The article discusses the study which evaluates the effects of adult human epicardium-derived cells (EPDCs) transplanted together with cardiomyocyte progenetor cells to generate mature cardiomyocytes in vitro in the U.S. It explains that the EPDCs are known to improve cardiac function through paracrine protection of the surrounding issue. In this regard, it concludes that the transplanted EPDCs and cardiomyocyte improve cardiac functions after myocardial infarction.

Researchers have established the role of heredity and lifestyle in the occurrence of hypertension, but the potential role of psychosocial factors, especially religiosity, is less understood. This paper analyzes the relationship between multiple dimensions of religiosity and systolic blood pressure, diastolic blood pressure, and hypertension using data taken from the Chicago Community Adult Health Study, a probability sample of adults (N =3105) aged 18 and over living in the city of Chicago, USA. Of the primary religiosity variables examined here, attendance and public participation were not significantly related to the outcomes. Prayer was associated with an increased likelihood of hypertension, and spirituality was associated with increased diastolic blood pressure. The addition of several other religiosity variables to the models did not appear to affect these findings. However, variables for meaning and forgiveness were associated with lower diastolic blood pressure and a decreased likelihood of hypertension outcomes. These findings emphasize the importance of analyzing religiosity as a multidimensional phenomenon. This study should be regarded as a first step toward systematically analyzing a complex relationship. [Copyright &y& Elsevier]

Inpatient rehabilitation has been traditionally employed in developed countries, while in developing countries, outpatient rehabilitation is the rule. The purpose of this study was to compare the patterns of recovery of upper extremity (UE) function, global impairment and independence in activities of daily living (ADL) during the first month after ischemic stroke in inpatient (United States) and outpatient (Brazil) rehabilitation settings. This is a prospective cohort comparison study. Twenty patients from each country were selected using identical inclusion criteria. The study measures employed were the UE portion of the Fugl-Meyer scale, the Action Research Arm test, the National Institutes of Health Stroke Scale and Barthel Index. Changes from baseline to the end of treatment, efficiency and effectiveness of each treatment were compared. Both populations exhibited significant improvement between the first and second evaluations in the four outcome scales (p<0.0001). There were no differences between the two rehabilitation settings on any of the four dependent measures (p>0.05). Substantially different treatment approaches after ischemic stroke led to similar results in UE function, global impairment and ADL. Further studies in larger populations should be performed in order to confirm the present results. [ABSTRACT FROM AUTHOR]

Hypertension afflicts up to 65 million adults in the USA. Although most cases of hypertension are without an underlying cause (i.e., primary hypertension), secondary causes of hypertension should be investigated due to the potential for cure. This article discusses the common causes of secondary hypertension. Furthermore, the etiology, mechanism of blood pressure elevation and treatment are discussed. Through an understanding of the mechanism, diagnosis and treatment of secondary hypertension, physicians can positively influence the associated long-term morbidity and mortality. [ABSTRACT FROM AUTHOR]

Objective: To determine whether local nutritional or ischemic factors are involved in cataract pathogenesis, we aimed to assess whether narrowed retinal vessel caliber predicted the long-term incidence of age-related cataract, as shown in 1 previous report. Design: Population-based cohort study. Participants: The Blue Mountains Eye Study examined 3654 baseline participants (1992–1994), 2335 (75.1% of survivors) after 5 years, and 1952 (75.6% of survivors) after 10 years. Methods: Retinal vessel caliber was measured from baseline retinal photographs using computer-assisted techniques. Mean arteriolar and venular diameters of each eye were summarized as central retinal arterial (CRAE) and venular (CRVE) equivalents. Cataract was assessed from lens photographs of both eyes using the Wisconsin grading system. Main Outcome Measures: Nuclear cataract was defined as opacity > Wisconsin standard photograph 3, cortical cataract defined as opacity ≥5% of the lens area, and posterior subcapsular (PSC) cataract as any present. Eye-specific data were analyzed using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: After adjusting for age, gender, smoking, hypertension, diabetes, body mass index, and inhaled steroid use, reduced incidence of nuclear cataract was associated with the narrowest compared with the widest quintile of CRAE and CRVE (for CRAE: OR, 0.62; 95% CI 0.42–0.92; for CRVE: OR, 0.70; 95% CI, 0.47–1.05) but a higher incidence of PSC cataract (for CRAE: OR, 2.40; 95% CI, 1.34–4.29; for CRVE: OR, 3.17; 95% CI, 1.62–6.20) and cataract surgery (for CRAE: OR, 1.52; 95% CI, 1.06–2.17; for CRVE: OR, 1.58; 95% CI, 1.08–2.32). These associations were not maintained when both CRAE and CRVE were included simultaneously in the same models. Path analysis suggested that age was the most important contributor to nuclear cataract incidence, and CRAE and CRVE, as markers of a latent age-related variable, were only indirectly associated with its incidence (for CRAE: OR, 0.61; 95% CI, 0.41–0.91; for CRVE: OR, 0.62; 95% CI, 0.41–0.94). Conclusions: Retinal vessel narrowing predicted greater risk of long-term incidence of PSC cataract and cataract surgery, and was indirectly linked to a lower incidence of nuclear cataract. Retinal vessel narrowing could be a marker of age-related factors associated with risk of PSC and nuclear cataract. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

The article outlines the research conducted on the medications used in effectively treating diabetic dyslipidemia patients in the U.S. Figures reveal that among 7000 patients with diabetes, 72% were treated with hyperglycemia and 64% for hypertension, but only 28% were treated for dyslipidemia. Researchers found that low-density lipoprotein (LDL) should be the primary target of lipid-lowering therapy for patient with diabetes because their robust reduction of LDL and statins are considered the agents of choice for such patients. Discussed are the details of the issue.

The first evidence of the existence of renin was presented over 100 years ago. However, the importance of renin and the renin–angiotensin system in the pathogenesis of cardiovascular disease was only fully realized in the 1970s. It was another 20 years before the first inhibitors of renin were available for clinical research. Here, we describe the discovery and development of aliskiren, an orally active renin inhibitor, which became the first drug in its class to receive regulatory approval. In 2007, it was approved for the treatment of hypertension by the US Food and Drug Administration and the European Medicines Agency. [ABSTRACT FROM AUTHOR]

The article outlines the research conducted on the implication of thiazide-type diuretics to hypertension patients in the U.S. It reveals that until now there is no simple approach in treating hypertension patients with metabolic syndrome. Researchers based their clinical findings on Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) wherein it employs the use of thiazide-type diuretics in black patients despite the more favorable metabolic profile of calcium channel blockers, alpha-blockers and angiotensin-converting enzyme (ACE) inhibitors.

Objective: The objective of the study was to identify potential explanatory factors for racial differences in blood pressure (BP) control.Design: The design of the study was a cross-sectional studyPatients/participants: The study included 608 patients with hypertension who were either African American (50%) or white (50%) and who received primary care in Durham, NC.Measurements and Main Results: Baseline data were obtained from the Take Control of Your Blood pressure study and included clinical, demographic, and psychosocial variables potentially related to clinic BP measures. African Americans were more likely than whites to have inadequate baseline clinic BP control as defined as greater than or equal to 140/90 mmHg (49% versus 34%; unadjusted odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3-2.5). Among factors that may explain this disparity, being older, reporting hypertension medication nonadherence, reporting a hypertension diagnosis for more than 5 years, reporting high levels of stress, being worried about hypertension, and reporting an increased number of medication side effects were related to inadequate BP control. In adjusted analyses, African Americans continue to have poor BP control relative to whites; the magnitude of the association was reduced (OR = 1.5; 95% CI 1.0-2.1). Medication nonadherence, worries about hypertension, and older age (>70) continued to be related to poor BP control.Conclusions: In this sample of hypertensive patients, there were a number of factors associated with poor BP control that partially explained the observed racial disparity in hypertension control including age, medication nonadherence, and worry about BP. Medication nonadherence is of particular interest because it is a potentially modifiable factor that might be used to reduce the racial disparity in BP control. [ABSTRACT FROM AUTHOR]

The article focuses on the research on the significance of hypertension management and health promotion program in improving the health condition of commercial drivers in the U.S. Hypertension cases continues to rise especially on the increase of obesity cases in the country. Because of its negative impact, it ranked second to heart disease among chronic physical conditions presenting a cost burden to employees. To help prevent the occurrence of such illness, federal regulations restrict commercial driver's licenses (CDL's) among employees who fail to control hypertension. Such scheme help CDL employees maintain normal blood pressure (BP).

Enoxaparin (enoxaparin sodium; Lovenox) is a low-molecular-weight heparin (LMWH) that has recently been approved by the US FDA for use in patients with medically managed ST-segment myocardial infarction (STEMI), or STEMI with subsequent percutaneous coronary intervention (PCI). It binds to and potentiates the action of antithrombin, and inhibits coagulation factors XIa, IXa, Xa and IIa (thrombin), thereby preventing formation of blood clots. Unfractionated heparin (UFH) has long been regarded as the antithrombotic agent of choice in the adjunctive treatment of patients with STEMI. However, compared with UFH, enoxaparin has many advantages in terms of its pharmacodynamic profile and, potentially, also its efficacy.Enoxaparin was significantly more effective than UFH in patients presenting with STEMI who underwent fibrinolytic therapy in terms of the 30-day combined incidence of all-cause mortality plus recurrent nonfatal myocardial infarction (MI) [primary endpoint], and all-cause mortality plus recurrent nonfatal MI plus urgent revascularization (secondary endpoint) in the ExTRACT-TIMI 25 trial. The significant difference in the incidence of the composite primary endpoint between these two groups was maintained at the 1-year follow-up. Although bleeding was reported more frequently with enoxaparin than with UFH in the ExTRACT-TIMI 25 trial, enoxaparin was associated with a net clinical benefit relative to UFH. Patients in this trial received enoxaparin as an initial 30 mg intravenous bolus, followed by 1 mg/kg subcutaneously within 15 minutes and then every 12 hours for up to 8 days; the first two subcutaneous dosages were not to exceed 100 mg. Patients ≥75 years of age did not receive the initial bolus of enoxaparin and the 12-hourly dosages were reduced to 0.75 mg/kg; the dose was also reduced to 1 mg/kg every 24 hours in patients of any age who had an estimated creatinine clearance (CLCR) of <30 mL/min. Data from several earlier randomized, multicentre, phase III trials support these results. [ABSTRACT FROM AUTHOR]

The article evaluates accordance with the Dietary Approaches to Stop Hypertension (DASH) diet among individuals with diagnosed hypertension (HTN) in the United States. It assesses whether the diet of Americans with HTN has improved since the publication and dissemination of the DASH results. The article shows that the dietary profile of adults with HTN in the United States has a low accordance with the DASH dietary pattern. It also reveals that the dietary quality of adults with HTN has deteriorated since the introduction of the DASH diet.

A typical American diet contains amounts of sodium chloride far above evolutionary norms and potassium far below those norms. It also contains larger amounts of foods that are metabolized to noncarbonic acids than to organic bases. At baseline, in a steady state, diets that contain substantial sodium chloride and diets that are net acid producing each independently induce and sustain increased acidity of body fluid. With increasing age, the kidney's ability to excrete daily net acid loads declines, invoking homeostatically increased utilization of base stores (bone, skeletal muscle) on a daily basis to mitigate the otherwise increasing baseline metabolic acidosis, which results in increased calciuria and net losses of body calcium. Those effects of net acid production and its attendant increased body fluid acidity may contribute to development of osteoporosis and renal stones, loss of muscle mass, and age-related renal insufficiency. The inverted ratio of potassium to sodium in the diet compared with preagricultural diets affects cardiovascular function adversely and contributes to hypertension and stroke. The diet can return to its evolutionary norms of net base production inducing low-grade metabolic alkalosis and a high potassium-to-sodium ratio by 1) greatly reducing content of energy-dense nutrient-poor foods and potassium-poor acid-producing cereal grains, which would entail increasing consumption of potassium-rich net base-producing fruits and vegetables for maintenance of energy balance, and 2) greatly reducing sodium chloride consumption. Increasingly, evidence supports the health benefits of reestablishing evolutionary norms of dietary net base loads and high potassium and low sodium chloride loads. We focus here on the American diet's potential effects on bone through its superphysiologic content of sodium chloride. [ABSTRACT FROM AUTHOR]

Abstract: The spatial segregation of the US population by socioeconomic position and especially race/ethnicity suggests that the social contexts or “neighborhoods” in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial–ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10–15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks’ greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40–50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial/ethnic and, to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension. [Copyright &y& Elsevier]

Background: Cardiovascular structure and function in youth with prehypertension have been incompletely investigated. Methods: Casual and ambulatory blood pressure (BP) measurement, arterial stiffness, noninvasive hemodynamic profiles, and cardiac structure were studied in a twin cohort of American black and white youth (n = 942; mean age, 17.6 ± 3.3 years SD). A family history of essential hypertension was used as a proxy to study genetic susceptibility to prehypertension. Results: The occurrence of prehypertension was approximately 12% in the entire sample. Body mass index and waist circumference were significantly greater in prehypertensive subjects than in normotensive subjects. The 24-h ambulatory systolic BP (SBP), 24-h ambulatory diastolic BP (DBP), nighttime ambulatory SBP, and nighttime ambulatory DBP were significantly elevated in prehypertensive subjects compared with normotensive subjects. In whites, prehypertensive subjects compared with normotensive subjects showed increased radial (6.8 ± 0.1 v 6.2 ± 0.1 m/sec, P < .001) and foot pulse-wave velocity (PWV) (7.4 ± 0.1 v 7.0 ± 0.1 m/sec, P = .001). In whites, the total peripheral resistance index was greater in prehypertensive subjects than in normotensive subjects (P = .005). White prehypertensive subjects had a significantly greater heart rate than white normotensive subjects (69.0 ± 1.4 v 64.0 ± 0.6 bpm). In contrast, in blacks, the cardiac index was higher in prehypertensive subjects than in normotensive subjects (3.3 ± 0.1 v 3.0 ± 0.1 L/min/m2, P = .004). In blacks and whites, there were no statistical differences in the parameters of left-ventricular structure between normotensive subjects and prehypertensive subjects. Finally, prehypertensive subjects were more likely to have a positive family history of essential hypertension, especially in blacks. Conclusions: Prehypertension compared with normotension exhibited unfavorable cardiovascular phenotypes. Cardiovascular characteristics of prehypertension appear to be race-dependent. [Copyright &y& Elsevier]

OBJECTIVES: To describe hypertension trends in U.S. adults aged 60 and older using National Health and Nutrition Examination Survey (NHANES) data. SETTING: NHANES III (1988–1994) and NHANES 1999 to 2004. DESIGN: Cross-sectional nationally representative health examination survey. PARTICIPANTS: Participants in NHANES III (n=5,093) and NHANES 1999 to 2004 (n=4,710). MEASUREMENTS: Blood pressure (BP). RESULTS: In 1999 to 2004, 67% of U.S. adults aged 60 and older years were hypertensive, an increase of 10% from NHANES III. Between 1988 to 1994 and 1999 to 2004, hypertension control increased for men from 39% to 51% ( P<.05) but remained unchanged for women (35% to 37%; P>.05). Non-Hispanic black men and women had higher prevalences of hypertension than non-Hispanic whites (odds ratio (OR)=2.54, 95% confidence interval (CI)=1.90–3.40 and OR=2.07, 95% CI=1.31–3.26, respectively), but men were less likely to have controlled BP (OR=0.60, 95% CI=0.41–0.86). Mexican-American men and women were less likely than non-Hispanic whites to have controlled BP (OR=0.55, 95% CI=0.33–0.91 and OR=0.63, 95% CI=0.40–0.98, respectively). Women and men aged 70 and older were significantly less likely to control their hypertension than those aged 60 to 69. In addition, women aged 70 and older were significantly less aware and treated. Having BP measured within 6 months was significantly associated with greater awareness, greater treatment in men and women, and greater control in women. A history of diabetes mellitus or chronic kidney disease (CKD) was significantly associated with less hypertension control. CONCLUSION: There was a significant increase in hypertension prevalence from 1988 to 2004. Hypertension control continues to be problematic for women, persons aged 70 and older, non-Hispanic blacks and Mexican Americans, and individuals with diabetes mellitus and CKD. [ABSTRACT FROM AUTHOR]

The articled reports on the prevalence of actions to control high blood pressure (HBP) in 20 U.S. states in 2005. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), it was found that U.S. adults take some action to control HBP. These actions include changes in the diet, exercise, and taking prescribed medication. It was also found that self-reported HBP increased by age group.

Evidence from past studies indicates that children with traumatic brain injury experience difficulties with inhibitory control. Less is known about inhibitory control in children with frontal brain injury related to cerebral infarction. We compared the inhibitory performance of children with frontal infarcts related to sickle cell disease with that of a control group of children with sickle cell disease but no history of cerebral infarction. On a stimulus-response reversal task, children with frontal infarcts made significantly more accuracy errors in the inhibitory condition than controls. Findings from this study and from previous research suggest that impairments in inhibitory control are common following frontal injury in a range of pediatric populations. [ABSTRACT FROM AUTHOR]

The article studies the frequency of analgesic use and risk of hypertension among men. The most commonly used drugs in the U.S. are nonnarcotic analgesics. The study showed that the frequency of nonnarcotic analgesic use is independently associated with a moderate increase in the risk of incident hypertension. These results may have important public health implications given the widespread use of these medications and the high prevalence of hypertension.

The article explores international differences in hypertension treatment, treatment intensification, and hypertension control in western Europe and the U.S. The researchers conducted a cross-sectional analysis of the nationally representative CardioMonitor 2004 survey. The results indicate that lower treatment thresholds and more intensive treatment contribute to better hypertension control in the U.S. compared with the western European countries included in the study.

Blood pressure is not controlled in as many as 50%–75% of hypertensive patients, primarily because of inadequate adherence to treatment. This paper examines the efficacy of a Transtheoretical Model (TTM)–based expert system intervention designed to improve adherence with antihypertensives in a sample of 1227 adults. Participants were proactively recruited and randomly assigned to receive usual care or three individualized expert system reports and a stage-matched manual over 6 months. Participants were surveyed at baseline, and 6, 12, and 18 months. Significantly more of the intervention group participants reported being in Action and Maintenance at follow-up time points (ie, 73.1% of the treatment group versus 57.6% of the control group at 12 months and 69.1% of the treatment group versus 59.2% of the control group at 18 months). Scores on a behavioral measure of nonadherence differed significantly at follow-up time points. TTM-based expert system interventions have the potential for a significant impact on entire populations of individuals who fail to adhere, regardless of their readiness to change. [ABSTRACT FROM AUTHOR]

The article discusses the implications of therapeutic inertia (TI), a phenomenon wherein physicians failed to recommend a change in the medication of patients with hypertension in the U.S. The Physician Consortium for Performance Improvement provides prospective data collection forms for hypertension cases. The satisfaction of physicians with blood pressure response is one of the cited reasons for TI. The country's health care system supports physicians for performing procedures rather than discussing them about their lifestyle or need to take medication.

Study design:Cross-sectional analysis of a convenience sample of locally recruited participants, including both patients and volunteers.Objectives:To determine whether there is an association between plasma homocysteine and hypertension in persons with spinal cord injury (SCI).Setting:Spinal Cord Injury Service of the Veterans Affairs Palo Alto Medical Center (California, United States of America).Methods:The incidence of hypertension, dyslipidemia, insulin resistance, and the presence of metabolic syndrome were determined in 168 individuals with SCI (mean age 50.2±12.8 years). Fasting lipids, insulin, glucose, plasma homocysteine, and anthropometric data was gathered for each subject.Results:Blood pressure values (P<0.001) and mean arterial pressure (P<0.05) increased with higher plasma homocysteine levels. Homocysteine values were also significantly greater among individuals with hypertension compared with those who were normotensive or prehypertensive (P<0.0001). There was an inverse relationship between plasma homocysteine levels and glomerular filtration rate and effective renal plasma flow (P<0.05).Conclusions:Plasma homocysteine levels are elevated in persons with SCI who have hypertension and inversely related to renal function, which suggests that renal dysfunction may be a link between homocysteine and hypertension in persons with SCI.Sponsorship:Funded by the VA Rehabilitation Research and Development Service, Merit Review Grant #B2549R.Spinal Cord (2006) 44, 474–479. doi:10.1038/sj.sc.3101873; published online 6 December 2005 [ABSTRACT FROM AUTHOR]

Purpose: The Ocular Hypertension Treatment Study (OHTS) demonstrated that medical treatment of people with intraocular pressure (IOP) of > or =24 mm Hg reduces the risk of the development of primary open-angle glaucoma (POAG) by 60%. There is no consensus on which people with ocular hypertension would benefit from treatment.Design: Cost-utility analysis with the use of a Markov model.Methods: We modeled a hypothetic cohort of people with IOP of > or =24 mm Hg. Four treatment thresholds were considered: (1) Treat no one; (2) treat people with a > or =5% annual risk of the development of POAG; (3) treat people with a > or =2% annual risk of the development of POAG, and (4) treat everyone. The incremental cost-effectiveness ratio was evaluated.Results: The incremental cost-effectiveness ratios for treatment of people with ocular hypertension were 3670 US dollars per quality adjusted life-year (QALY) for the Treat > or =5% threshold and 42,430 US dollars/QALY for the Treat > or =2% threshold. "Treat everyone" cost more and was less effective than other options. Assuming a cost-effectiveness threshold of 50,000 to 100,000 US dollars/QALY, the Treat > or =2% threshold would result in the most net health benefit. The decision was sensitive to the incidence of POAG without treatment, treatment effectiveness, and the utility loss because of POAG.Conclusion: Although the treatment of individual patients is largely dependent on their attitude toward the risk of disease progression and blindness, the treatment of those patients with IOP of > or =24 mm Hg and a > or =2% annual risk of the development of glaucoma is likely to be cost-effective. Delay of treatment for all people with ocular hypertension until glaucoma-related symptoms are present appears to be unnecessarily conservative. [ABSTRACT FROM AUTHOR]

The US population, by percentage, shows a trend toward increased proportions of citizens identified as minorities. Whereas in 2000, according to the US Census Bureau, 71.4% of the population was self-identified as white; this group is expected to decrease to 61.9% by 2025. The proportion of blacks and African Americans from 2000 vs. 2025 is expected to increase from 12.2% to 12.9%. Also, in the smaller population of American-Indian, Eskimo, and Aleutian natives, growth is projected from 0.7% to 0.8%. Asians and Pacific Islanders as a category will become a larger proportion, from 3.9% to 6.2%. The largest increase in proportion will be seen in those identified as Hispanic (of any race), from 11.8% in 2002 to 18.2% in 2025. [ABSTRACT FROM AUTHOR]

Hypertension is more common and more severe in African Americans than in other population groups in the United States, placing them at increased risk of cardiovascular disease, stroke, and end-stage renal disease. Whereas past efforts to reduce blood pressure (BP) via the diet centered on manipulating isolated nutrients, there are now conclusive data demonstrating that it is not single dietary components but the overall dietary pattern that has the greatest influence on BP. A nutritionally complete diet rich in fruits, vegetables, and low-fat dairy foods has been clearly proven to significantly lower BP in all population groups. This diet, commonly referred to as the Dietary Approaches to Stop Hypertension (DASH) diet, has been tested in randomized, controlled trials emphasizing African American populations and documented the greatest beneficial effects in hypertensive African Americans. Improving diet quality has been shown to be simply implemented without adverse effects such as symptoms of lactose maldigestion. It is also known to beneficially affect other cardiovascular risk factors and is in keeping with dietary recommendations for prevention of some cancers and osteoporosis. This paper reviews the current data relating dietary patterns to BP control, and advocates dietary recommendations that can accomplish their intended objective of enhancing the health of Americans by promoting safe, feasible, and proven-effective means of doing so. In the case of hypertension prevention and treatment, and thus the reduction of cardiovascular disease risk, overall diet quality should be the primary focus of nutritional recommendations. [ABSTRACT FROM AUTHOR]

Presents a physical activity recommendation for the hypertensive patient. Prevalence of cardiovascular disease (CVD) in the U.S. from 1991 to 1999; Increase in the prevalence of hypertension, a known risk factor for CVD, in the U.S.; Correlation between body fat mass and hypertension; Physical activity program for hypertensive adults.

Lycopene is a major carotenoid with potent antioxidant properties that may provide protection against the development of type 2 diabetes mellitus (DM). In this study we examined the association between baseline dietary intakes of lycopene, lycopene-containing foods, and the subsequent development of type 2 DM in a large prospective cohort study. We analyzed a total of 35,783 women from the United States, aged > or =45 y and free from self-reported cardiovascular disease, cancer, and DM at baseline. Intakes of lycopene and total and individual tomato-based food products were assessed by a 131-item-validated semiquantitative food-frequency questionnaire. During a median follow-up of 10.2 y, 1544 cases of incident type 2 DM were documented. After adjusting for age, total energy intake, randomized treatment assignment, body mass index, and other known DM risk factors, the multivariate-adjusted relative risks and 95% CI of type 2 DM across increasing quintiles of dietary lycopene, were 1.00 (baseline), 1.10 (0.94-1.29), 1.10 (0.94-1.29), and 1.07 (0.91-1.26) (P linear trend = 0.56). Compared with women who consumed <1.5 servings/wk total tomato-based food products, women who consumed 1.5 to <4, 4 to <7, 7 to <10, and > or =10 servings/wk had multivariate relative risks (95% CI) of 1.03 (0.88-1.20), 1.02 (0.87-1.20), 1.09 (0.89-1.33), and 1.04 (0.80-1.36), respectively (P linear trend = 0.54). The associations for individual tomato-based food products were similar to the results for the combination of all tomato products. Our study found little evidence for an association between dietary intake of lycopene or lycopene-containing foods and the risk of type 2 DM. [ABSTRACT FROM AUTHOR]

Objectives: Menu planning is an important part of personalized lifestyle counseling. The paper describes the results of an automated menu generator (MenuGene) of the web-based lifestyle counseling system Cordelia that provides personalized advice to prevent cardiovascular diseases.Methods: The menu generator uses genetic algorithms to prepare weekly menus for web users. The objectives are derived from personal medical data collected via forms in Cordelia, combined with general nutritional guidelines. The weekly menu is modeled as a multilevel structure.Results: Results show that the genetic algorithm-based method succeeds in planning dietary menus that satisfy strict numerical constraints on every nutritional level (meal, daily basis, weekly basis). The rule-based assessment proved capable of manipulating the mean occurrence of the nutritional components thus providing a method for adjusting the variety and harmony of the menu plans.Conclusions: By splitting the problem into well determined sub-problems, weekly menu plans that satisfy nutritional constraints and have well assorted components can be generated with the same method that is for daily and meal plan generation. [ABSTRACT FROM AUTHOR]

Obesity could have serious consequences for older cohorts. We used a microsimulation to estimate lifetime costs, life expectancy, disease, and disability for seventy-year-olds based on body mass. Obese seventy-year-olds will live about as long as those of normal weight but will spend more than $39,000 more on health care. Moreover, they will enjoy fewer disability-free life years and experience higher rates of diabetes, hypertension, and heart disease. Medicare will spend about 34 percent more on an obese person than on someone of normal weight. Obesity might cost Medicare more than other diseases, because higher costs are not offset by reduced longevity. [ABSTRACT FROM AUTHOR]

Background Effectively reducing cardiovascular disease disparities requires identifying and reducing disparities in risk factors. Improved understanding of hypertension disparities is critical. Methods Cross-sectional analysis of nationally representative samples of black and white adults 20 years and older who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2002 (white, n = 4624; black, n = 1837) and NHANES III conducted in 1988-1994 (white, n = 7121; black, n = 4709). We examined differences in hypertension prevalence, awareness, treatment, and blood pressure (BP) control among both treated and prevalent cases across the 2 periods. Results Hypertension prevalence increased significantly from 35.8% to 41.4% among blacks and from 24.3% to 28.1% among whites and remains significantly higher among blacks. Awareness is higher among blacks (77.7% vs 70.4%; P<.001), as is treatment (68.2% vs 60.4%; P<.001). These results are driven by higher rates in black women. Blood pressure control rates among those treated have increased in both races, primarily as a result of increased BP control in black and white men (27.3% and 44.7%, respectively; P≤.03). Despite the improved BP control rates, disparity in BP control among treated cases increased, with 59.7% of treated whites and 48.9% of treated blacks now reaching BP goal (P<.001). Racial differences in BP control rates among those treated cannot be explained by nonpharmacologic management or health insurance, but educational attainment is associated with BP control. Conclusion The higher prevalence of hypertension in blacks and the growing disparity in BP control among those treated pharmacologically are causes for concern. [ABSTRACT FROM AUTHOR]