Clinical Briefs
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim.
Hypertension Treatment in "Real Life"
Data in the United States from the NHANES (National Health and Nutrition Examination Survey) have shown that rates of awareness, treatment, and control of blood pressure remain remarkably suboptimal, despite over three decades of periodic NHANES data reporting and diversification of therapeutic choices. Because most hypertension is treated in the primary care sector, specifically Family Medicine, a perspective on prevalence, treatment, and control in this population is valuable.
The burden of hypertension (HTN) in Canada appears similar to the USA. Petrella utilized a database of 150,000 patients from family practice clinics in Ontario to derive prevalence, treatment, and control assessments. HTN was defined as > 140/90 for the general population, >130/80 for diabetics, and >160 systolic for Isolated Systolic Hypertension.
Based upon these definitions, the majority of persons with hypertension were untreated (68.6%), and only 15.8% had blood pressure treated and controlled. When viewed in concert with US population data, the challenge of blood pressure control in North America remains daunting.
Petrella RJ, et al. J Clin Hypertension. 2007;9(1):28-35
Prevent Recurring Diabetic Foot Ulcers?
Diabetes remains the number one cause of atraumatic limb loss, the majority of which is secondary to diabetic neuropathy, subsequent infection, and tissue loss. Standard management for diabetic patients, including those with a history of foot ulcer, includes periodic clinician examination, education on maintenance of foot skin integrity, examination, prevention of injury, and daily foot self-inspection.
Lavery, et al assessed the comparative efficacy of standard management with what they termed Structured Foot Examination (SFM) and Enhanced Therapy (ENH) in a population of diabetics who would well be considered high risk because they had already sustained a diabetic foot ulcer. SFM included standard management plus training to perform a twice daily mirror-assisted foot examination seeking redness, discoloration, swelling, and local warmth. Results of the SFM were recorded in a logbook. ENH consisted of standard management plus personal instruction on use of a digital infrared thermometer. Foot temperature was measured with the digital infrared thermometer at six sites, and recorded in a logbook. Subjects in each group were advised to make clinician contact for any changes detected.
The primary outcome of the trial was foot ulceration during 15 months of followup. ENH was significantly superior to both standard management and SFM. Overall, there was a four-fold decrease in risk of developing a foot ulcer in the ENH group compared to other groups.
Once a patient has suffered a diabetic foot ulcer, recurrences may be as common as 25% annually or more. A patient-administered temperature monitoring device may substantially reduce this risk.
Lavery LA, Higgins KR, Lanctot DR, et al Diabetes Care 2007;30(1):14-20
Contact Sensitizers in Chronic Urticaria
Up to half of all persons who suffer chronic urticaria (URT) never learn the causative factor. Recently, dermatologists have noted that contact sensitizers are culprits in URT even though patients may NOT evidence irritation at the site of contact in daily life. To better ascertain the percentage of persons who might be suffering sensitivity to contact allergens, Guerra et al performed evaluations on 121 patients with URT who had already undergone "traditional" diagnostic tests including ESR, blood chemistry, urinalysis, food scratch testing, total IgE levels (as well as IgE specific to Anisakis and Echinococcus), HIV and hepatitis testing, thyroid testing, ANA, stool parasite analysis, Helicobacter testing, autologous serum skin testing, CXR, hereditary angioedema screening, urine electrophoresis, lymphocyte subpopulation analysis, and extractable nuclear antigens (Whew!). In addition, study subjects underwent an Italian made specialty Patch Testing system which includes metals, chemicals, cleaning agents, and cosmetics.
Fifty subjects (41%) had positive tests using the novel patch testing panel. None of these individuals had manifested signs of contact dermatitis at the actual sight of exposure in day-to-day activity. In addition to a positive patch test result, application of the culprit allergen to the skin resulted in a worsening of urticaria in approximately half of them. Of the 50 patch test positive patients, everyone who practiced avoidance of the demonstrated allergen enjoyed remission of URT! Contact sensitization is an underappreciated etiology of URT, but specialized testing panels may be required to detect it and intervene appropriately.
Guerra L, Rogkakou, et al J Am Acad Dermatol 2007;56:88-90.
Data in the United States from the NHANES (National Health and Nutrition Examination Survey) have shown that rates of awareness, treatment, and control of blood pressure remain remarkably suboptimal, despite over three decades of periodic NHANES data reporting and diversification of therapeutic choices.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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