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Characteristics of Patients with Uncontrolled Hypertension in the United States
This large national health survey indicated that approximately 27 percent of the adult population in the United States has hypertension. Of those with hypertension, only 23 percent are taking medication that controls their blood pressure. Most cases of uncontrolled hypertension consist of mild systolic hypertension in persons 65 years of age or older, most of whom have adequate access to health care.
The findings of this health survey are somewhat surprising. The problem of uncontrolled hypertension is not limited to the poor, the uninsured, or minorities. Instead, it is more common among older people who have access to health care and relatively frequent contact with physicians.
Related Editorial
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Failure of Metronidazole to Prevent Preterm Delivery among Pregnant Women with Asymptomatic Trichomonas Infection
Infection with Trichomonas vaginalis during pregnancy has been associated with preterm delivery, but it has not been known whether screening and treatment for infection in asymptomatic women can reduce this risk. In this randomized, double-blind, placebo-controlled trial, metronidazole therapy for asymptomatic vaginal trichomoniasis in pregnancy did not reduce, but instead appeared to increase, the risk of preterm delivery. The increase was due primarily to an increase in the frequency of preterm labor.
Routine screening and treatment of asymptomatic pregnant women for vaginal trichomoniasis cannot be recommended.
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Clopidogrel in Addition to Aspirin in Acute Coronary Syndromes
Patients with acute coronary syndromes usually receive aspirin. This trial focused on whether the addition of clopidogrel, an antiplatelet drug that blocks adenosine diphosphate–induced platelet aggregation, would provide additional benefit. The use of clopidogrel plus aspirin resulted in a rate of the composite end point of death from cardiovascular causes, nonfatal myocardial infarction, or stroke that was 20 percent lower than that with aspirin alone, but there was an increased risk of bleeding.
Although clopidogrel plus aspirin had clinical benefit beyond that of aspirin alone, the benefit was small and was partially offset by an increased risk of bleeding, including bleeding necessitating transfusion. Patients treated with the combined regimen should be monitored closely for bleeding complications.
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Cigarette Advertising in Magazines
Reducing cigarette smoking among adolescents is a public health priority. The 1998 Master Settlement Agreement between 46 states and the four largest U.S. tobacco companies prohibited tobacco advertising that targeted young people. This study examined trends in cigarette advertising in magazines between 1995 and 2000. It found that the Master Settlement Agreement appears to have had little effect on cigarette advertising in magazines and on the exposure of young people to these advertisements.
Although magazine advertising is only a small part of the total marketing expenditures of the tobacco industry, it is an important means by which adolescents are exposed to information about cigarettes. These findings suggest that more stringent restrictions on cigarette advertising in magazines may be necessary.
Related Editorial
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Clinical Practice: Subclinical Hyperthyroidism
Atrial fibrillation develops in a 67-year-old woman. The physical examination is remarkable only for an irregular pulse at a rate of 120 and a long-standing goiter. The serum thyrotropin level is less than 0.05 mU per liter. The thyroxine and triiodothyronine levels are normal. Should the thyroid dysfunction be treated?
This Clinical Practice article discusses the potential risks associated with subclinical hyperthyroidism and approaches to the management of this condition.
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Medical Progress: Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis, which usually comes to attention during the fifth or sixth decade, is a rapidly progressive fibrotic disease that results in respiratory failure in 40 percent of patients. Treatment is largely supportive, but newer investigational therapies hold promise, and lung transplantation is a viable option for some younger patients.
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