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Effect of CPAP on Blood Pressure in Patients With OSA
Many patients with resistant hypertension have obstructive sleep apnea (OSA). To assess the effect of continuous positive airway pressure (CPAP) treatment on blood pressure in these patients, Martín-García and colleagues randomly assigned 194 patients with resistant hypertension and OSA to receive 12 weeks of CPAP or no CPAP therapy with no changes made in blood pressure medications. The authors report that patients receiving CPAP treatment experienced a decrease in 24-hour mean and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern.
Weight Change and Health 3 Years After Obesity Surgery
Little is known about long-term weight loss and health outcomes after bariatric surgery. In a 3-year follow-up of 2458 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) for severe obesity, Courcoulas and colleagues found that median weight loss was 41 kg for RYGB and 20 kg for LAGB participants, with the majority experiencing maximum weight change during the first year. Improvements in comorbid hyperglycemia, hyperlipidemia, and hypertension were variable but of greater magnitude with RYGB than LAGB. In an Editorial, Ikramuddin and Livingston discuss outcomes of bariatric surgery.
Author Video Interview
Trends and Outcomes of Donor Oocyte Cycles
In an analysis of data from the Centers for Disease Control and Prevention’s National ART Surveillance System—representing 93% of all US fertility centers—Kawwass and colleagues assessed 2000-2010 trends in donor oocyte cycles and predictors of good perinatal outcome, defined as a live-born infant delivered at 37 weeks or later and weighing 2500 g or more. Among the authors’ findings were that the proportion of cycles using frozen embryos and elective single-embryo transfers increased, clinical decisions that were both associated with good perinatal outcomes. In an Editorial, Myers discusses factors that may influence outcomes of assisted reproduction with donor oocytes.
Acid-Suppressing Medication and Vitamin B12 Deficiency
Medications that suppress the production of gastric acid may lead to malabsorption of vitamin B12.In a case-control study involving 25 956 patients with and 184 199 patients without incident vitamin B12 deficiency, Lam and colleagues found that previous and current use of proton pump inhibitors and histamine 2 receptor antagonists for 2 years or more was associated with a subsequent diagnosis of vitamin B12 deficiency.
Clinical Review & Education
Pruritus in the Older Patient
Older patients commonly experience pruritus, which when severe can significantly affect a patient’s function and quality of life. Berger and colleagues discuss the case of Mr A, an 85-year-old man with intractable, widespread pruritus. The authors review the etiology, diagnosis, and treatment of pruritus in the elderly and propose a simple diagnostic and therapeutic algorithm for this challenging clinical problem.
Continuing Medical Education
Statin Therapy for Primary Prevention of CVD
In this JAMA Clinical Evidence Synopsis, Taylor and colleagues report results of a meta-analysis of data from 18 clinical trials (56 934 participants) of statin therapy for primary prevention of cardiovascular disease (CVD). The authors found that compared with placebo, statins were associated with lower rates of all-cause mortality, major vascular events, and revascularization procedures without an increase in rates of life-threatening adverse effects such as cancer. In an Editorial, Robinson discusses the accumulating evidence supporting statins for primary prevention of CVD.
Highlights. JAMA. 2013;310(22):2363–2365. doi:10.1001/jama.2013.5455
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