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.
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.
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/m2 or 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.
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.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2001;161(9):1139. doi:10.1001/archinte.161.9.1139