These pediatric hypertension guidelines are an update to the 2004 “Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents.” Significant changes in these guidelines include (1) the replacement of the term “prehypertension” with the term “elevated blood pressure,” (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61380-4.pdf

Global burden of COPD: risk factors, prevalence, and future trends.

/pdf/2021-esc-guidelines-on-cardiovascular-disease-prevention-in-14ygu7kat1.pdf

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including cardiovascular disease, diabetes and hypertension. The present study analysed data from 20,296 subjects aged > or =45 yrs at baseline in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). The sample was stratified based on baseline lung function data, according to modified Global Initiative for Obstructive Lung Disease (GOLD) criteria. Comorbid disease at baseline and death and hospitalisations over a 5-yr follow-up were then searched for. Lung function impairment was found to be associated with more comorbid disease. In logistic regression models adjusting for age, sex, race, smoking, body mass index and education, subjects with GOLD stage 3 or 4 COPD had a higher prevalence of diabetes (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-1.9), hypertension (OR 1.6, 95% CI 1.3-1.9) and cardiovascular disease (OR 2.4, 95% CI 1.9-3.0). Comorbid disease was associated with a higher risk of hospitalisation and mortality that was worse in people with impaired lung function. Lung function impairment is associated with a higher risk of comorbid disease, which contributes to a higher risk of adverse outcomes of mortality and hospitalisations.

https://erj.ersjournals.com/content/erj/32/4/962.full.pdf

Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.

Although total mortality has decreased dramatically over the past 30 years, driven largely by successful reductions in deaths from cardiovascular diseases (CVDs), mortality from chronic obstructive pulmonary disease (COPD) has more than doubled. COPD is currently the 4th leading cause of mortality worldwide, accounting for more than three million deaths per year. Owing to increased prevalence of smoking in developing countries and the aging of the population across Western nations, COPD mortality is expected to more than double over the next 20 years, so that by 2030, it will be responsible for 10% of the world’s total mortality (currently 7%), accounting for seven million deaths annually. Although these figures are truly alarming, they probably underestimate the global impact of COPD on overall mortality, because COPD contributes significantly to other major causes of mortality, such as ischemic heart disease (IHD), stroke, and lung cancer.

https://erj.ersjournals.com/content/erj/28/6/1245.full.pdf

Mortality in COPD: Role of comorbidities.

Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Saskatchewan Canada : Cardiovascular Disease in COPD Patients

Aims
To characterize the patient profile, medication utilization, and healthcare encounters of patients with neurogenic bladder dysfunction related to incontinence.

Methods
Medical and pharmacy claims were retrospectively analyzed from April 1, 2002 to March 31, 2007 to characterize neurogenic bladder patients. There were 46,271 patients in the Neurogenic bladder cohort, and 9,315 and 4,168 patients in Multiple Sclerosis (MS) and Spinal Cord Injury (SCI) subcohorts, respectively. Demographic data, concomitant diseases, use of overactive bladder (OAB) oral drug, and healthcare encounters were summarized using descriptive statistics.

Results
The mean age of neurogenic bladder patients was 62.5 (standard deviation 19.6) years. A high frequency of lower urinary tract infections (UTIs; 29%–36%), obstructive uropathies (6%–11%), and urinary retention (9%–14%), was observed. Overall, 33,100 (71.5%) patients were taking an OAB oral drug; 10,110 (30.5%) patients discontinued and did not restart. During the one-year follow-up period, 39.0% (8,034) of neurogenic bladder patients had a urology visit, 31.7% (14,679) had a neurology visit, 33.3% (15,415) were hospitalized, and 14.4% (6,646) were in a nursing home (highest rates observed in SCI subcohort). UTI diagnoses comprised over 20% of all hospitalizations one-year post-index. Annually, neurogenic bladder patients averaged 16 office and 0.5 emergency room visits.

Conclusions
This is the largest observational study conducted to address the epidemiology of the neurogenic bladder population, including healthcare utilization. These data suggest that patients with neurogenic bladder may have suboptimal management, indicated by high incidences of urinary tract complications and hospitalizations. Neurourol. Urodynam. 30:395–401, 2011. © 2010 Wiley-Liss, Inc.

Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database.

To identify predictors of chronic obstructive pulmonary disease (COPD) severity and assess the relation between COPD severity and risk of cardiovascular outcomes 	A␣cohort of patients with diagnosed and treated COPD was compiled from the Saskatchewan Health longitudinal databases We used multivariate modeling to identify predictors of hospitalization for COPD as an indicator of COPD severity, and we used the model to characterize patients according to quintiles of COPD severity These severity levels were used as independent variables in multivariate models of cardiovascular outcomes Determinants of COPD severity included emphysema, recent nebulizer use, home oxygen services, corticosteroid use, frequent bronchodilator use, pneumonia and prior COPD exacerbation The 20% of patients with the highest COPD severity were 127 (CI: 107–150) times more likely to have arrhythmia, 125 (CI: 107–146) times more likely to have ischemic heart disease, 138 (CI: 111–171) times more likely to have angina, 228 (CI: 195–266) times more likely to have congestive heart failure, and 163 (CI: 122–216) times more likely to die of cardiovascular causes than the least severe 20% of patients Patients with more severe COPD, as defined by our model, had higher cardiovascular morbidity and mortality than patients with less severe COPD

Chronic obstructive pulmonary disease severity and cardiovascular outcomes.

ContextCisapride, an oral prokinetic drug indicated for the
symptomatic treatment of nocturnal heartburn due to gastroesophageal
reflux disease, was approved by the US Food and Drug Administration in
July 1993. After reports of serious cardiac arrhythmias and deaths
during administration of cisapride, most involving concomitant exposure
to another drug, a series of label changes and warnings were issued in
February 1995, October 1995, June 1998, and June 1999. Cisapride was
removed from general distribution in July 2000.ObjectiveTo determine the frequency of contraindicted
coprescribing and codispensings, in which cisapride and a
contraindicated drug were prescribed or dispensed to the same patient
for overlapping periods, and the proportion of contraindicated
coprescribing by the same physicians and codispensing by the same
pharmacies.Design and SettingRetrospective study of prescription claims from
a managed care organization database for all patients with cisapride
prescriptions between July 1993 and December 1998.ParticipantsA total of 38 757 adult and pediatric patients
who had a cisapride prescription immediately preceded by at least 60
days of insurance eligibility.Main Outcome MeasureProportion of cisapride prescriptions or
dispensing occurring during the same treatment period as a drug
contraindicated at that time prescribed by the same physicians or
dispensed by the same pharmacies.ResultsOf 131 485 cisapride prescriptions dispensed after
the warnings began, 4414 (3.4%) overlapped with at least 1 drug
contraindicated in the labeling at the time of the prescription. Of all
overlapping prescription pairs, 2190 (50%) were by the same
physicians, 3908 (89%) were by the same pharmacies, and 765 (17%)
were dispensed on the same day.ConclusionPrescriptions dispensed by the same pharmacies
accounted for a far higher proportion of contraindicated medication
pairs than prescriptions from the same physicians. The pharmacy may be
an important and underutilized intervention point to prevent
contraindicated drugs from being used together.

https://jamanetwork.com/journals/jama/articlepdf/194238/jbr10211.pdf

Coprescribing and codispensing of cisapride and contraindicated drugs.

Objective

To quantify the impact of the first three label changes and ‘Dear Doctor’ letters as sole interventions, sent to prescribers and pharmacists, on the prescribing and dispensing of cisapride and contraindicated drugs.



Methods

Using a managed care claims database, a total of 38 757 patients with cisapride prescriptions (July 1993– December 1998) were selected. An interrupted time series analysis and an exponentially weighted moving average analysis (EWMA) were conducted to determine whether there were changes in the proportion of contraindicated codispensings following each intervention.



Results

3.6% of cisapride dispensings overlapped with contraindicated drug dispensings. Beginning in 1994, the overlapped proportions declined slowly from 4.5% ending at 3.2% in 1998. The interrupted time series analysis showed that there was a statistically significant abrupt permanent decrease in the proportion of contraindicated dispensing following the June 1998 label change (coefficient −1.0094, p = 0.045), meaning that the proportion of contraindicated dispensing dropped nearly one percentage point after the third intervention. The 1995 label changes did not have statistically significant effects. The EWMA analysis showed that the proportion of contraindicated dispensings was lower than 3 standard deviations below average during the period after the June 1998 intervention, with no significant effects following the two earlier interventions.



Conclusions

The June 1998 cisapride label change and accompanying ‘Dear Doctor’ letter had a downward impact on the proportion of dispensing of contraindicated drugs with cisapride. The other two label changes did not have independent significant impacts. Copyright © 2003 John Wiley & Sons, Ltd.

Earl L. Goehring

Papers

Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Saskatchewan Canada : Cardiovascular Disease in COPD Patients

Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database.

Chronic obstructive pulmonary disease severity and cardiovascular outcomes.

Coprescribing and codispensing of cisapride and contraindicated drugs.

Impact of cisapride label changes on codispensing of contraindicated medications.