The American journal of medicine
-
Gram-negative bacterial pneumonia is the leading cause of fatal nosocomial infection in this country. Predisposing factors include altered upper respiratory tract flora and altered barriers that normally protect the sterile lower respiratory tract from invasion by pharyngeal bacteria. Aztreonam, which is highly active against most gram-negative pathogens and which does not cause nephrotoxicity, has been evaluated in the treatment of nosocomial pneumonia. ⋯ Data further suggest that aztreonam may interact synergistically with aminoglycosides against gram-negative pathogens. Clinical study supports the usefulness of aztreonam against gram-negative nosocomial pneumonia. Since aztreonam is inactive against gram-positive and anaerobic bacteria, it must be used in combination with other antibiotics when these pathogens are suspected.
-
The limited data available from the long-term clinical trials on the treatment of hypertension, as well as several short-term studies, indicate that the lowering of blood pressure in minority patients is feasible over the long term with a marked decrease in morbidity and mortality. The presence of left ventricular hypertrophy and diabetes in a higher number of black compared with white patients does not appear to be a major determining factor in the choice of initial monotherapy. ⋯ When these latter agents are added to a diuretic, however, a good blood pressure response is achieved. There are few data available on the results of long-term treatment in Asian or Hispanic persons.
-
Despite recent advances in both prevention and treatment, cardiovascular disease remains the leading cause of mortality in the United States. One of the major modifiable risk factors for cardiovascular disease, hypertension, is a leading cause of stroke, kidney disease, and diseases of the heart and coronary circulation. Essential hypertension is the most common cause of systemic blood pressure elevation and it responds readily to both pharmacologic and non-pharmacologic treatment. ⋯ For both blacks and Hispanics, however, the decreases in cardiovascular mortality have been less striking. Many factors could account for this disparity, among them the availability of health care facilities in minority neighborhoods, and the health-care-seeking behavior of the patients themselves. Understanding epidemiologic and pathophysiologic data regarding differences between blacks, Hispanics, and non-Hispanic whites will help reduce hypertension-related morbidity and mortality.
-
Data from multiple sources confirm the greater risk of morbidity and mortality from cardiovascular disease that is seen in some minority segments of the population of the United States, when those segments are compared with the population as a whole. In most studies, blacks are shown to have the highest overall mortality rate from cardiovascular disease--higher than the rate for Hispanics, and substantially higher than the rate for whites and Asians. In some of these studies, blacks also have higher rates of both hypertension-related stroke and coronary artery disease. ⋯ Asians, by contrast, have significantly lower death rates from cardiovascular disease, irrespective of national origin, and they also have correspondingly lower mortality from stroke and other hypertension-related diseases. As in coronary artery disease, issues related to access to care may be implicated in the disproportionate morbidity and mortality rates noted in black and Hispanic patients, as well as among some lower-class segments of the non-Hispanic white population. Access to care may depend upon a number of factors, among them cultural isolation, public awareness, individual and group attitudes, perception of resource availability, actual resources, socioeconomic status, educational level, and peer behavior.
-
The treatment of high blood pressure in black people is often complicated by a variety of factors. These include the tendency of black hypertensive patients to have three to five times the cardiovascular mortality of white hypertensive patients, black hypertensives' more frequent progression to end-organ damage and stroke, and socioeconomic conditions that impede access to proper health care. In addition, blacks have a unique hemodynamic profile, one that alters the efficacy of many antihypertensive drugs. ⋯ First, they present a better profile in terms of overall cost and compliance, thanks to their lower relative cost and once-a-day dosing. Second, when diuretics are combined with another antihypertensive therapy, such as an ACE inhibitor or a calcium-entry blocker, responsiveness may be further improved. This combination therapy may be especially important in black hypertensives, who exhibit a higher incidence of concurrent diseases such as left ventricular hypertrophy and congestive heart failure.