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JAMA. 2013;310(7):661-663. doi:10.1001/jama.2013.5260.
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Hypertension control remains a major clinical challenge. Jaffe and colleagues describe implementation of a multifaceted hypertension quality improvement program, which in 2001-2009 involved between 349 937 and 652 763 adult members of an integrated health system, and they compare annual health system–level hypertension control rates with statewide and national estimates. The authors found that compared with state and national hypertension control rates implementation of the hypertension quality improvement program was associated with a significant increase in hypertension control rates in the integrated health system. In an Editorial, Goyal and Bornstein discuss effective system-level approaches to improve blood pressure control.

Related Editorial

Excess urinary albumin excretion (an albumin to creatinine ratio [ACR] >30 mg/g) is more common in black than white individuals and is associated with increased risk of incident stroke. To assess whether a similar association extends to coronary heart disease, Gutiérrez and colleagues analyzed data from a prospective cohort of 28 207 adults of both races aged 45 years and older. The authors found that higher urinary ACR was associated with increased risk of incident but not recurrent coronary heart disease in black compared with white individuals. In an Editorial, Weiner and Winkelmayer discuss the interaction of race with kidney disease and cardiovascular risk.

Related Editorial

Infantile hypertrophic pyloric stenosis (IHPS) shows strong familial aggregation and heritability, but knowledge of specific genetic variants associated with IHPS is limited. Feenstra and colleagues report results of a study to identify gene variants associated with IHPS. Among the authors’ findings was the identification of a new genome-wide significant locus on chromosome 11q23.3—in a region harboring the apolipoprotein A-1 (APOA1) gene cluster—suggesting the possibility of an inverse relationship between cholesterol levels in neonates and IPHS risk.

To assess the efficacy of lateral wedge insoles as a conservative treatment for medial knee osteoarthritis pain, Parkes and colleagues performed a systematic literature review and identified 12 randomized trials (885 participants) that compared lateral wedge treatments with neutral or flat insole (control) conditions. The authors report that meta-analysis of the data from the 12 studies showed a favorable effect of lateral wedge insoles on knee pain; however, analysis of 7 trials in which lateral wedges were compared with neutral insoles found no effect—suggesting lateral wedge insoles are not efficacious for the treatment of medial knee osteoarthritis pain.

CLINICAL REVIEW & EDUCATION

Obstructive sleep apnea may be a diagnostic consideration when patients present with a symptom of excessive daytime fatigue. In this article in The Rational Clinical Examination Series, Myers and colleagues report results of a systematic review of 42 studies that examined the accuracy of the clinical examination for predicting obstructive sleep apnea in patients referred to a sleep laboratory. Among the authors’ findings was that obstructive sleep apnea is most likely diagnosed in patients who snore, who have body mass index greater than 30, and who have the composite findings of hypertension, increased neck circumference, and nocturnal gasping or choking.

Economic analyses—including one published in JAMASurgery in February 2013—suggest that during extended patient follow-up, bariatric surgery is cost-effective but not cost-saving compared with usual medical care or intensive life-style interventions. In this From the JAMA Network article, Maciejewski and Arterburn discuss the need to identify patient or procedural factors that may be associated with a potential for health improvement and cost savings to inform insurance coverage decisions for bariatric procedures.

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