In a randomized trial that enrolled 555 patients with hypertension and a history of cardiovascular disease, diabetes, or chronic kidney disease, McManus and colleagues compared the effect on systolic blood pressure of 12 months of usual care vs self-monitoring of blood pressure combined with an individualized self-titration antihypertensive medication algorithm (self-management). The authors report that compared with usual care, patients randomly assigned to self-management had lower systolic blood pressure readings at the 1-year follow-up. In an Editorial, Nilsson and Nystrom discuss the efficacy and safety of hypertension self-management in high-risk patients.
Up to 20% of adolescents experience an episode of major depression by age 18 years; however, few receive evidence-based treatment. In a randomized trial involving 101 adolescents who screened positive for depression in primary care visits, Richardson and colleagues found that a collaborative care intervention, which included patient and parent engagement and education; brief cognitive behavioral therapy delivered by master’s-level clinicians, antidepressant medication, or both; and regular follow-up, resulted in greater improvement in depressive symptoms at 12 months compared with usual care. In an Editorial, Reeves and Riddle discuss treatment of adolescent depression in primary care settings.
Author Video Interview
Preterm infants are at risk of developing encephalopathy of prematurity, which is associated with neurodevelopmental delay. Experimental and retrospective clinical data suggest that erythropoietin may have neuroprotective effects. Leuchter and colleagues assessed this association in a randomized, placebo-controlled study involving 495 preterm infants, 165 of whom underwent brain magnetic imaging (MRI) at term-equivalent age. The authors found that compared with infants who received placebo, infants who received high-dose erythropoietin within 42 hours of birth had a reduced risk of brain MRI abnormalities.
Persistent pain is prevalent, costly, and often disabling in later life. Makris and colleagues summarize results of a systematic review that identified 92 studies evaluating pharmacologic interventions and nonpharmacologic modalities to manage persistent pain among older adults. The authors discuss the case of Mrs L, a 90-year-old woman with a more than 30-year history of pain, and highlight the importance of combined pharmacologic, nonpharmacologic, and rehabilitative approaches to persistent pain management in older patients.
Continuing Medical Education
This JAMA Diagnostic Test Interpretation article by Polonsky and colleagues presents the case of a 58-year-old woman with concerns about her cardiovascular disease risk. She is asymptomatic, has never smoked, and swims 4 times a week. However, she has a family history of myocardial infarction and elevated total and low-density lipoprotein cholesterol levels. She underwent a cardiac computed tomography scan to measure her coronary artery calcium score—reported as 88 Agatston units. How would you interpret these findings?
JAMA Patient Page
The US Food and Drug Administration has approved 2 products containing omega-3 polyunsaturated fatty acids for treatment of patients with severe hypertriglyceridemia, and many over-the-counter dietary supplements containing omega-3 polyunsaturated fatty acids or fish oils are readily available for purchase. This Medical Letter article briefly reviews results of clinical studies of omega-3 polyunsaturated fatty acids for primary and secondary prevention of cardiovascular disease and for treatment of hypertriglyceridemia.
Highlights. JAMA. 2014;312(8):765-767. doi:10.1001/jama.2013.279683