Clinical Briefs

Am Fam Physician. 2000 Apr 15;61(8):2545-2548.

New Antihypertension Medication Survey Results

Approximately 38 percent of patients who are being treated for high blood pressure may stop taking their medication because of problems with tolerance, according to results of a recent survey, which was sponsored by the Association of Black Cardiologists. Ninety-five percent of patients think that their blood pressure is under control, although 35 percent of these patients reported elevated or uncontrolled systolic blood pressure higher than 140 mm Hg, according to the survey.

The telephone survey of 314 patients and 101 physicians (primarily cardiologists and family physicians) showed that 36 percent of patients who are being treated for hypertension have changed medications at least once because of severe side effects. The dosage of their current medication had to be adjusted at least once because of side effects, reported 13 percent of respondents. The most commonly reported side effects were fatigue (22 percent) and dizziness (21 percent). Black respondents were significantly more likely to have headache, potassium loss and weakness, compared with white respondents.

“This survey highlights the extent of the tolerability problem in hypertension, which is widespread among all patient populations, and underscores the need for the medical community to continue searching for pharmacologic alternatives,” said Frank James, M.D., president of the Association of Black Cardiologists. “Surprisingly, the survey also presents some new challenges in treating high blood pressure, because the findings show that elevated systolic blood pressure is not being controlled to the recommended levels.”

For more information on the Association of Black Cardiologists, call 678-302-4ABC (4222) or write to 6849-B2 Peachtree Dunwoody Rd., N.E., Atlanta, GA 30328. You may also visit the association's Web site at http://www.abcardio.org.

Incidence of Legal Induced Abortions

In 1997, 1,184,758 legal induced abortions were reported to the Centers for Disease Control and Prevention (CDC), according to a report published in the January 7, 2000 issue of Morbidity and Mortality Weekly Report (MMWR). Data were compiled about legal induced abortions from the 50 states, New York City and the District of Columbia. While the total number of legal induced abortions was available from all reporting areas, not all of the areas collected information about the characteristics of women who obtained abortions. Therefore, this report presents only preliminary data for 1997. The final 1997 abortion data will be published during summer 2000.

In the United States from 1980 through 1990, the number of legal induced abortions increased overall by 10 percent. The highest number of legal abortions was reported in 1990. Since that time, the number of abortions has decreased each year by 2 to 5 percent, except in 1995 and 1996, when the number of abortions increased by 0.9 percent. The number of abortions reported to the CDC for 1997 declined from the year before and is the lowest recorded number since 1978.

In 1997, the number of live births decreased by 0.3 percent from 1996. The number of reported abortions decreased in 34 of the 52 reporting areas. The number of legal abortions per 1,000 live births reported by all reporting areas decreased from 314 in 1996 to 305 in 1997. About 20 per 1,000 women between 15 and 44 years of age had abortions in 1997.

The majority of women who obtained legal abortions in 1997 were white and unmarried. In 98 percent of abortions, curettage was used to end the pregnancy; 18 reporting areas submitted information about nonsurgical medical abortions.

In 1997, the total numbers of legal induced abortions were available for all 52 reporting areas. However, about 32 percent of abortions were reported from states that did not have annual centralized reporting of abortions or from states whose health departments could not provide information about characteristics of women who obtained legal abortions. According to the CDC, to track changes in abortion practice, each state needs an accurate and ongoing assessment of abortion (including the number and characteristics of women who obtain legal abortions).

Previously published MMWRs that include statistical and epidemiologic information about abortion are available on the CDC Web site (http://www.cdc.gov/mmwr).

FDA Approval of New Epilepsy Medication

The U.S. Food and Drug Administration (FDA) recently approved levetiracetam (Keppra), a new medication, as an add-on treatment for partial seizures with or without secondary generalization in adult patients with epilepsy.

The Epilepsy Foundation issued a statement welcoming the approval of the new medication. According to the Epilepsy Foundation, 2.3 million Americans have epilepsy. Of these, 500,000 receive medical care that successfully controls their seizures. About 1 million have incomplete relief and nearly 600,000 still have seizures that are unresponsive to available therapies. Partial seizures are brief involuntary sensations, movements or behaviors that occur in clear or impaired consciousness. The seizures may involve distortions of feeling, perception, mood, vision, hearing or touch. They may also cause loss of awareness, repetitive movements and verbalizations, confused walking about and other behaviors that are not consciously controlled.

According to Steven C. Schachter, M.D., chairman of the advisory board of the Epilepsy Foundation, partial seizures are the most common and treatment-resistant type of seizures in adults. “The approval of Keppra as add-on therapy for partial seizures gives doctors a new treatment option for adults who have seizures or intolerable side effects from their current medications.”

“A medication like Keppra that can be started at an effective daily dose could rapidly make a significant difference for patients whose quality of life is compromised by uncontrolled partial seizures,” said Dr. Schachter.

For more information on epilepsy, call 301-459-3700 or write the Epilepsy Foundation at 4351 Garden City Dr., Landover, MD 20785-2267.

Revised Booklet on the Marfan Syndrome

The National Marfan Foundation has recently released the fifth revised edition of “The Marfan Syndrome,” a complete resource on this genetic disorder of the connective tissue. The Marfan syndrome and related connective tissue disorders affect about 200,000 persons in the United States. Often, the heart, blood vessels, eyes and bones are affected. With early diagnosis, proper treatment and a modified lifestyle, most persons with this disorder can live a normal life.

This edition of the booklet contains revised sections about the physical signs and potential symptoms of the disorder, the roles of heredity and family history, the cause of Marfan syndrome, and how to diagnose and treat the disorder. Information on the psychologic and social aspects of the syndrome, insurance issues and research that is currently underway are also included in the booklet.

“Continued advances in the understanding of the genetic cause, revision of the diagnostic criteria and improved approaches to managing all clinical aspects have changed the management and outlook for people with Marfan syndrome and their families. It is more essential than ever that people who have the disorder and their health care providers are familiar with the latest findings and recommendations,” said Reed E. Pyeritz, M.D., the author of the revision.

To order a single copy of the booklet free of charge, call 800-8-MARFAN (800-862-7326) or e-mail the foundation at staff@marfan.org. The booklet is also available on the National Marfan Foundation Web site (http://www.marfan.org). In addition to the booklet, the foundation offers other resources about the Marfan syndrome, including a list of local chapters and support groups. For more information, call the number above or write to the National Marfan Foundation, 382 Main St., Port Washington, NY 11050.

Fitness in Persons with Cerebral Palsy

The American College of Sports Medicine (ACSM) has released an official statement on health-related fitness in children and adults with cerebral palsy. The statement appears in ACSM's Current Comments, August 1999.

According to the ACSM, children with cerebral palsy have lifelong difficulties with movement, function and mobility. While the disorder is not progressive, the levels of independent function often deteriorate once a child enters adolescence and adulthood. To decrease the losses in function and mobility, health-related physical fitness should be incorporated early in the rehabilitation programs of these persons. The following elements should be included in an exercise program for persons with cerebral palsy: cardiorespiratory endurance, muscular endurance, muscular strength, balance/agility, body composition and flexibility.

The ACSM has issued guidelines on exercise training for persons with chronic disease and disabilities, such as cerebral palsy. They include the following:

  • Aerobic capacity and endurance can be enhanced in persons with cerebral palsy through exercise performed at 40 to 85 percent peak VO2 or HR reserve for 20 to 40 minutes per session, three to five days per week.

  • A stationary bicycle may be used if the person is ambulatory; an arm ergometer is recommended if the person is in a wheelchair.

  • For endurance training, six- to 15-minute walks or wheelchair pushes at least two times per week are recommended.

  • Strength enhancement can be accomplished through the use of free weights or weight machines doing one to three sets of eight to 12 repetitions of each exercise two times per week.

  • Flexibility exercise should be done for all involved and uninvolved joints before and after all types of exercise.

Current Comments are official statements by the ACSM concerning topics of interest to the public at large. More information may be obtained by calling 317-637-9200 or by writing the ACSM at P.O. Box 1440, Indianapolis, IN 46206-1440.

Use of PET in the Diagnosis of Cancer

The Health Technology Advisory Committee (HTAC) has published a report on positron emission tomography (PET) for oncologic applications. HTAC was established in 1992 by the Minnesota state legislature. It is an independent, nonpartisan advisory body that evaluates new and emerging health care technologies based on existing scientific research and technology assessments.

PET is a three-dimensional imaging technique designed to measure the level of metabolic activity within the cell. According to the HTAC report, PET is being evaluated for its oncologic applications. Early studies have shown that PET may be a valuable tool in viewing the region of the tumor; detecting, staging, grading, monitoring response to anticancer therapy; and differentiating recurrent or residual disease from post-treatment changes.

The HTAC report addresses the following questions:

  • Is PET an effective tool in diagnosing and/or monitoring patients with cancer?

  • How does PET compare with alternative techniques (such as computed tomography, biopsy and magnetic resonance imaging) that are used for diagnosing cancer and/or monitoring different cancers?

  • What impact does PET have on clinical disease management and health outcomes?

  • Is PET scanning cost-effective when used in cancer treatment?

  • What effect will modified PET technologies have on cancer?

Evidence has not yet shown PET to have a clear clinical benefit over other imaging devices when used for certain cancers. Nearly all studies that have assessed PET for oncologic applications are hampered by small study samples, lack of comparison groups and inconsistent methodology. Research on the use of PET for tumors of the brain, head and neck, and lung has been extensive. This research has shown that PET can provide information not given by other available techniques.

This report (document no. 990318) and others published by HTAC may be obtained free of charge by calling 651-282-6374 or by e-mail: htac@health.state.mn.us. All HTAC reports are also available on the Web at http://www.health.state.mn.us/htac/index.htm.


Copyright © 2000 by the American Academy of Family Physicians.
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