CHICAGO—Nearly one-third of the U.S. adult population, an estimated 58 million people, have hypertension, an increase from previous reports, and reversing a three decade decline in the prevalence rate, according to a study in the July 9 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, prior analyses of National Health and Nutrition Examination Survey (NHANES, conducted by the National Center for Health Statistics; provides periodic information on the health of the U.S. population) data through 1991 have suggested that hypertension prevalence is declining, but more recent self-reported rates of hypertension suggest that the rate is increasing.

Hypertension is a major risk factor for cardiovascular disease illness and death.

Ihab Hajjar, M.D., M.S., of the University of South Carolina, Columbia, and Theodore A. Kotchen, M.D., of the Medical College of Wisconsin, Milwaukee, analyzed the most recent NHANES survey, which was conducted in 1999-2000 (n=5,448). They compared this with the two phases of NHANES III conducted in 1988-1991 (n=9,901) and 1991-1994 (n=9,717).

Hypertension was defined as a measured blood pressure (BP) of 140/90 mm Hg or greater or reported use of antihypertensive medications.

The researchers found that in 1999-2000, 28.7 percent of NHANES participants had hypertension, an increase of 3.7 percent from 1988-1991. Hypertension prevalence was highest in non-Hispanic blacks (33.5 percent), increased with age (65.4 percent among those age 60 or older), and tended to be higher in women (30.1 percent).

Many of these individuals were not aware they had hypertension or did not have their hypertension adequately controlled. "In 1999-2000, almost 30 percent of all hypertensive individuals were unaware of their illness, 42 percent were not being treated, and, at the time that their BP was measured, 69 percent did not have their hypertension controlled," the authors write. "Women, older participants, and Mexican Americans tended to have the lowest rates of control."

CHICAGO—Red clover extracts that contain isoflavones (plant derived compounds with estrogen-like structure) are no more effective than placebo for most women seeking relief from hot flashes and other menopausal symptoms, according to a study in the July 9 issue of The Journal of the American Medical Association (JAMA).

"Hot flashes are the primary reason that women seek medical attention for menopausal symptoms," the authors provide as background information in the article. "The recent results from the Women's Health Initiative and long-term follow-up from the Heart and Estrogen/progestin Replacement Study demonstrating an increased risk of cardiovascular disease and breast cancer among women randomized to hormone therapy are likely to reduce the use of hormones for relief of menopausal symptoms. Dietary supplements containing isoflavones derived from soy or red clover are heavily marketed as alternative treatments for menopausal symptoms. In Asia, only 10 percent to 20 percent of women experience hot flashes compared with 70 percent to 80 percent of women in Western countries." The authors say one hypothesis explaining the difference is "that the isoflavones found in soy, a staple in the Asian diet, influence the body's response to the changing hormone levels of menopause."

Jeffrey A. Tice, M.D., from the University of California, San Francisco, and colleagues initiated the Isoflavone Clover Extract (ICE) study to investigate whether two dietary supplements derived from red clover (Promensil and Rimostil) were safe and more effective than placebo (inactive pills) at reducing hot flashes and improving quality of life in symptomatic menopausal women. According to the authors, this study is the largest randomized clinical trial of red clover extracts in postmenopausal women.

The study's 252 participants were menopausal women, ages 45 to 60 years, who were experiencing at least 5 hot flashes per day. The study was conducted between November 1999 and March 2001 at three U.S. medical centers. The participants were randomly assigned to Promensil (82 mg of total isoflavones a day), Rimostil (57 mg of total isoflavones a day), or an identical placebo, and followed-up for 12-weeks.

"The reductions in mean (average) daily hot flash count at 12 weeks were similar for the Promensil (3.4), Rimostil (2.7), and placebo (2.8) groups," the authors report. The percentage reduction from baseline in hot flash counts are Promensil (41 percent), Rimostil (34 percent), and Placebo (36 percent). The authors state that Promensil reduced hot flashes more rapidly than placebo; Rimostil did not. "Quality-of-life improvements and adverse events were comparable in the three groups." The authors note that "heavier women appeared to receive more benefit from the isoflavone supplements …"

CHICAGO—Depressive symptoms are strongly associated with how patients with coronary disease perceive their overall health, according to a study in the July 9 issue of The Journal of the American Medical Association (JAMA).

According to background information provided by the authors, "in patients with coronary disease, cardiovascular interventions are known to improve health status, but the extent to which such benefits result from changes in cardiac vs. noncardiac factors is unclear… Depressive symptoms are known to be associated with worse health status among patients with coronary artery disease, but their relative contributions compared with physiologic measures of disease severity are unknown."

Bernice Ruo, M.D., from the Veterans Affairs Medical Center, San Francisco, and colleagues conducted "The Heart and Soul Study", a study of 1,024 adults with stable coronary artery disease recruited from outpatient clinics in the San Francisco Bay area between September 2000 and December 2002 to compare the contributions of depressive symptoms and cardiac function to patient-reported health status. Participants completed a daylong baseline study appointment that included a medical history interview, a physical examination, an exercise treadmill test with a stress echocardiogram, and a comprehensive health status questionnaire.

"Of the 1,024 participants, 201 (20 percent) had depressive symptoms," the authors report. "Participants with depressive symptoms were more likely than those without depressive symptoms to report at least mild symptom burden (60 percent vs. 33 percent), mild physical limitation (73 percent vs. 40 percent), mildly diminished quality of life (67 percent vs. 31 percent), and fair or poor overall health (66 percent vs. 30 percent). … Compared with participants who did not have depressive symptoms, those with depressive symptoms were younger, had lower income, and were less likely to be male or married. They were more likely to have a history of myocardial infarction [heart attack], or diabetes mellitus, to smoke, and to report greater stress and worse social support. Participants with depressive symptoms had higher body mass index and lower exercise capacity." The authors add that cardiac function was not affected by depressive symptoms.

CHICAGO—About one in five Medicare patients would exceed a prescription drug benefit cap of $750, and could face paying 2-3 times more in out-of-pocket expenses, according to a study in the July 9 issue of The Journal of the American Medical Association (JAMA).

Annual dollar limits, or "caps," on drug benefits are common in Medicare managed care (Medicare + Choice Plans) and have been part of several proposals as a way to provide a national Medicare drug benefit at reasonable costs, according to background information in the article. Approximately 15 percent or nearly 6 million Medicare beneficiaries are enrolled in Medicare + Choice plans, and in 1999, 1 in 5 Medicare beneficiaries who had drug coverage obtained their benefits through Medicare + Choice.

Chien-Wen Tseng, M.D., M.P.H., of the University of Hawaii, and Pacific Health Research Institute, Honolulu, and colleagues at the David Geffen School of Medicine at University of California, Los Angeles, and RAND Health, Santa Monica, Calif., conducted a study to determine how cap levels affect the percentage of Medicare + Choice patients who exceed their benefit cap. In addition, for patients who exceeded their cap, the researchers examined their out-of-pocket drug expenditures before and after exceeding the cap and the top medications contributing to their total drug expenditures.

The study consisted of a cross-sectional analysis of 2001 pharmacy claims data from a large Medicare + Choice plan in a mature market with caps of $750 to $2000 per year applied to the plan's share of prescription costs. The study included patients who filled at least one prescription in 2001 (n = 438,802).

The researchers found that a total of 22 percent, 14 percent, and 4 percent of Medicare patients exceeded caps of $750, $1000, and $2000, respectively. "Across caps, patients faced a potential 2- to 3-fold increase in median out-of-pocket costs after exceeding caps ($179-$305/mo) to continue the same prescription use as before exceeding caps ($79-$100/mo). For patients who exceeded a cap of $750, yearly out-of-pocket drug costs ranged from $564 to $4,201. Fifteen of the 20 medications with the highest total prescription expenditures for patients who exceeded the cap were for chronic conditions. Seven had lower-cost generic versions or a generic medication available in the same treatment class," the authors write.

On average, patients who exceeded the cap did so 3 months before the end of the year.

"At lower cap levels, up to 1 in 5 of the plan's patients exceeded their cap and faced potentially high increases in out-of-pocket costs to maintain the same prescription use as before," the authors write. "The implication is that many Medicare patients with drug benefits through Medicare + Choice may have coverage for only part of the year because of low benefit caps. … Although a capped drug benefit is better than none, health plans and policymakers who wish to provide a Medicare prescription drug benefit need to consider carefully how generously to set cap levels. Given limited resources to finance drug benefits, lower cap levels can allow insurers to offer some drug benefits to a greater number of people. However, if benefit caps are set too low, such coverage may be inadequate for many beneficiaries with chronic illnesses who are poor and require many expensive and necessary medications."

HIGH BLOOD PRESSURE RATES STARTING TO RISE IN THE U.S., ELDERLY AFRICAN AMERICAN WOMEN MOST AT RISK