The Medical clinics of North America
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Med. Clin. North Am. · Sep 2005
ReviewUpdate on disparities in the pathophysiology and management of hypertension: focus on African Americans.
Hypertension treatment and control is of paramount importance in the prevention of premature cardiovascular disease. African Americans present a special challenge to the clinician due, in part, to their earlier age of onset,greater prevalence, and increased rates of untoward events. A review of the recent studies of genetic epidemiology has not revealed unique genotypes that explain human hypertension or the disparate impact suffered by African Americans. ⋯ These findings suggest that to have an immediate and substantial impact on the ethnic disparity of hypertension, resources and research should be directed toward social and behavioral factors. Prompt and aggressive control of blood pressure is an effective global strategy for cardiovascular risk reduction. In most cases, this approach requires multiple interventions including lifestyle modification and an antihypertensive regimen that is tailored to the individual under the current guidelines and not stipulated by race.
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African Americans and other ethnic minority groups suffer disproportionately from type 2 diabetes and its complications than do white Americans. Genetic and environmental factors contribute to the ethnic disparities in diabetes and its complications. ⋯ The progressive nature of diabetes requires the use of more than one agent. Drug combinations should be selected for their therapeutic fire power and complementary mechanisms of action, and exogenous insulin need not be delayed unnecessarily if oral agents are ineffective.
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Socioeconomic factors and differences in access to health care systems, perhaps more so than physiologic differences, play a significant role in race-based differences faced by acute care practitioners.
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Med. Clin. North Am. · Sep 2005
ReviewPrognostic impact of race and ethnicity in the treatment of colorectal cancer.
Numerous advances in the treatment of patients who have metastatic disease have improved colorectal cancer management, including new chemotherapeutic agents and combinations and targeted agents that modulate the efficacy of chemotherapy. Recent advances in the administration of irinotecan and oxaliplatin, in combination with 5-FU/LV, plus the addition of targeted agents bevacizumab and cetuximab have afforded steady increases in response rates and survival. Ongoing studies are evaluating the optimal sequencing and combinations of the agents described and the efficacy of new combinations in metastatic and adjuvant settings. Because the number of African-American patients in most clinical trials in colorectal cancer has been low, it is imperative that method increase participation so that new research developments reach all segments of the population.
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Med. Clin. North Am. · Sep 2005
ReviewIs there disparity in the care of minority patients with upper aerodigestive tract malignancy?
The data presently available indicate that there is unequal (disparate) care in patients with head and neck cancer. The reasons for this are likely multifactorial and require further study. ⋯ For example, Hispanics are not a homogeneous ethnic group; hence, differences in social perception, cultural mores, and available medical resources can be demonstrated that can directly impact care and outcome. Appropriate epidemiologic studies are needed with more underserved minority patients to analyze these differences further and to address such differences.