Subject: Hypertension in Kids / Diabetic Retinopathy / Once-Yearly Osteoporosis Drug / Yesterday

From: Physician's First Watch <[email-masked]>
Date: Wed, 22 Aug 2007 07:52:02 -0400 (EDT)

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Physician's First Watch is editorially independent and does not endorse any company, publication, product, or service.

PHYSICIAN'S FIRST WATCH for August 22, 2007
David G. Fairchild, MD, MPH, Editor-in-Chief

- Hypertension Typically Undiagnosed in Kids
- Blood Pressure and Glycemic Control Key to Preventing Diabetic Retinopathy 
- Once-a-Year Osteoporosis Drug Approved
- Production Trouble Yesterday

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Hypertension Typically Undiagnosed in Kids

Pediatric hypertension may go undiagnosed almost 85% of the time, reports a study in JAMA.

Researchers evaluated data, extracted from electronic medical records, on some 14,000 children and teenagers who had at least three well visits at a large urban health system over a 7-year period.

About 500 children met criteria for hypertension, defined as elevated blood pressure readings during three or more visits. However, true hypertension diagnoses were documented in the EMR for only 16% of these children. Nearly 500 additional children met criteria for prehypertension, of whom 11% were documented as having hypertension or elevated BP.

The authors say that "because normal blood pressure in children is a function of age, sex, and height percentile, clinicians typically cannot remember normal blood pressures for the wide range of children" seen in primary care. They stress the importance of early diagnosis, noting that "evaluation guidelines and effective treatment" do exist.

Link(s):
JAMA article (Free abstract; full text requires subscription) http://click2.nejm.org/cts/click?q=227%3B297020%3BSl8jknT8kCJzus%2B5yOiTqkF7InCTKGRitnN2Gm5P1ss%3D

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Blood Pressure and Glycemic Control Key to Preventing Diabetic Retinopathy 

Strict blood pressure and glycemic control are effective in reducing vision loss from diabetic retinopathy and remain "the cornerstone in the primary prevention" of the disorder, according to a review published in JAMA.

Researchers examined 41 studies with a minimum follow-up of 12 months and 3 meta-analyses.

The 10-year Diabetes Control and Complications Trial found that, over 6.5 years of follow-up, intensive glycemic control in patients with type 1 diabetes reduced the incidence of diabetic retinopathy by 76% and progression by 54%, compared with conventional treatment. Tight blood pressure control had a similar effect, with one U.K. study reporting a 34% reduction in progression after 9 years' follow-up.

Link(s):
JAMA article (Free abstract; full text requires subscription) http://click2.nejm.org/cts/click?q=227%3B297020%3BSl8jknT8kCJzus%2B5yOiTqtnH1kyxcWqTtnN2Gm5P1ss%3D

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Once-a-Year Osteoporosis Drug Approved

The FDA has approved the first once-yearly treatment for postmenopausal osteoporosis, according to Novartis, its maker.

The drug, zoledronic acid (Reclast) is already on the market for treatment of Paget disease. For osteoporosis, it will be administered annually as a single, 15-minute intravenous infusion. 

An industry-sponsored clinical trial showed that compared with placebo over a 3-year period, the treatment reduced the risk for vertebral fractures by 70% and hip fractures by 41% and significantly improved bone mineral density. Serious atrial fibrillation was more common in those taking the drug.

"Given the complex instructions for oral administration of bisphosphonates, the idea of a single yearly intravenous dose of bisphosphonate is attractive," Allan S. Brett wrote in Journal Watch General Medicine when the study was published. However, the occurrence of "serious atrial fibrillation (defined elsewhere as life threatening or resulting in hospitalization or disability) requires further investigation."

Link(s):
Manufacturer press release (Free) http://click2.nejm.org/cts/click?q=227%3B297020%3BSl8jknT8kCJzus%2B5yOiTqnJe0cmBIBFgtnN2Gm5P1ss%3D
NEJM article on clinical trial (Free abstract; full text requires subscription) http://click2.nejm.org/cts/click?q=227%3B297020%3BSl8jknT8kCJzus%2B5yOiTquFUgn%2BnjZNetnN2Gm5P1ss%3D

Related Journal Watch link(s):
Journal Watch General Medicine summary of clinical trial (Free) http://click2.nejm.org/cts/click?q=227%3B297020%3BSl8jknT8kCJzus%2B5yOiTqoCh3qMnxoWHtnN2Gm5P1ss%3D

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Production Trouble Yesterday

We apologize for yesterday's late delivery. We encountered problems that defied solution until we rubbed our heads really hard. We trust you'll forgive us, and we'll try not to let this recur.

Link(s):
First Watch web site (Free) http://click2.nejm.org/cts/click?q=227%3B297020%3BSl8jknT8kCJzus%2B5yOiTqsL90IU4PYD2tnN2Gm5P1ss%3D

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