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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2001;161:1139.
Association Between Blood Pressure Level and the Risk of Myocardial
Infarction, Stroke, and Total Mortality
In this study, Psaty and colleagues found that
both systolic and diastolic blood pressure were directly associated with the
risk of myocardial infarction and stroke. In older adults, systolic blood
pressure was a better predictor than either pulse pressure or diastolic blood
pressure. The data in this article provide strong support for focusing on
levels of systolic and diastolic blood pressure in diagnosing and establishing
guidelines for the treatment of hypertension in older adults.
(SEE ARTICLE)
Prevalence of High Blood Pressure and Elevated Serum Creatinine Level
in the United States
Mild kidney disease is often undiagnosed and untreated in the United
States. In this cross-sectional study by Coresh et al
of 16 589 adults enrolled in the Third National Health and Nutrition
Examination Survey (NHANES III) from 1988 to 1994, the authors examined the
relationship between elevated serum creatinine levels (an indicator of chronic
renal disease) and treatment for hypertension. Elevated levels of serum creatinine
were directly correlated with inadequate treatment of high blood pressure.
(SEE ARTICLE)
An Evidence-Based Assessment of Federal Guidelines for Overweight and
Obesity as They Apply to Elderly Persons
Federal guidelines indicate that overweight and obesity are major factors
for death and illness in the United States. Individuals with a body mass index
(BMI) of 25 to 29.9 kg/m2 are considered overweight and those with
a BMI of 30 kg/m2or greater are considered obese. Using this criteria,
more than one third of Americans 70 years or older are overweight and 1 in
6 is obese. Heiat and colleagues reviewed published
articles on BMI morbidity and mortality and found that there is no evidence
of greater risk in elderly people who are mildly or moderately overweight
(BMI  27 kg/m2). However, they did find that obesity and near-obesity
(BMI  28 kg/m2) are associated with an increased risk of death.
Federal guidelines for ideal weight in the elderly may be overly restrictive.
(SEE ARTICLE)
Pattern of Primary Resistance of Helicobacter pylori to Metronidazole or Clarithromycin in the United States
Therapy for Helicobacter pylori, the causative
agent in more than 90% of peptic ulcer disease, is becoming more difficult
because of increased resistance to antibiotics commonly used for treatment. Osato et al analyzed data from 17 US-based clinical trials
to establish the rate of resistance to metronidazole, clarithromycin, and
amoxicillin, and to assess whether there is an increase in resistance in certain
demographic areas. Based on agar dilution procedures, resistance to clarithromycin
and metronidazole increased modestly between 1993 and 1999. Amoxicillin resistance
was rare, occurring in only 2 patients. Women were more apt to have metronidazole-
or clarithromycin-resistant H pylori than men. Subjects
who were older than 70 years of age had a significantly lower prevalence of
resistant isolates than other subjects. No demographic differences were detected.
Test method affected the results of susceptibility testing for metronidazole
resistance rates but not for clarithromycin resistance rates.
(SEE ARTICLE)
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