Low adherence to antihypertensive medication remains a public health challenge. Understanding barriers to, and determinants of, adherence to antihypertensive medication adherence may help identify interventions to increase adherence and improve outcomes. The Cohort Study of Medication Adherence in Older Adults (CoSMO) is designed to assess risk factors for low antihypertensive medication adherence, explore differences across age, gender, and race subgroups, and determine the relationship of adherence with blood pressure (BP) control and cardiovascular outcomes over time. Between August 2006 and September 2007, 2194 participants, age 65 years and older, taking antihypertensive medication were recruited and enrolled in CoSMO and completed a baseline telephone survey. Antihypertensive medication adherence was assessed with the Morisky Medication Adherence Scale (MMAS) and the medication possession ratio (MPR). Low adherence was defined as a MMAS score < 6; non-persistent MPR was defined as <0.80. BP data were abstracted from outpatient electronic medical records; uncontrolled BP was defined as systolic or diastolic BP ≥140 or 90 mmHg, respectively. The mean age of participants was 75.0 ± 5.6 years, 58.8% were women, 30.7% were black, and 83.6% were taking 2 or more classes of antihypertensive medication. Overall, 14.1% of participants had low adherence, 27.0% had a non-persistent MPR, and 33.7% had uncontrolled BP. Participants with low MMAS were 2.71 (95% confidence interval (CI) 2.31-3.18) times more likely to have non-persistent MPR and 1.20 (95% CI 1.00-1.43) times more likely to have uncontrolled BP than participants with high MMAS. Low antihypertensive medication adherence and uncontrolled blood pressure are common in older, insured patients. Research identifying barriers to achieving antihypertensive medication adherence may assist in developing tailored interventions to increase medication adherence and improve outcomes.

The recent Kidney Disease: Improving Quality Outcomes (KDIGO) recommendations called for an investigation of the relationship between various radiological methods to assess cardiovascular calcification and measures of arterial stiffness. Accordingly, in 131 adult maintenance hemodialysis patients, we investigated the association of aortic pulse wave velocity (PWV) with calcification of cardiac valves on echocardiography, coronary artery, and thoracic aorta calcium on computed tomography and a calcification score of the abdominal aorta obtained on a plain abdominal X-ray. All tests were performed within a week. Mean PWV increased as the severity of coronary artery, thoracic, and abdominal aorta calcium scores increased (each P<0.05). No trend was present for number of valves with calcification. After multivariable adjustment, abdominal aorta X-ray calcium scores remained associated with PWV (P=0.004), whereas the association of PWV with thoracic aorta and coronary artery calcium scores became marginal (P=0.308 and P=0.083, respectively). No association was found between number of calcified valves and PWV. This study demonstrates a strong association between abdominal aorta calcification on plain X-ray and PWV and a borderline association with thoracic aorta and coronary artery calcification. Sudden death and congestive heart failure, two frequent causes of death in hemodialysis, are likely caused by increased arterial stiffness that can be closely predicted by the presence of aortic calcification on plain X-rays.

This is the first civilian study that analyses the impact of DCR in patients managed with DCL. During the DCL and DCR study period more PRBC, FFP, and platelets with less crystalloid solution was used intraoperatively. DCL and DCR were associated with a survival advantage and shorter trauma intensive care unit length of stay in patients with severe hemorrhage when compared with DCL and CRE.