Abstract:
IMPORTANCE:The effect of strict blood pressure control on clinical outcomes in patients with chronic kidney disease (CKD) is unclear. OBJECTIVE:To compare the outcomes associated with a treated systolic blood pressure (SBP) of less than 120 mm Hg vs those associated with the currently recommended SBP of less than 140 mm Hg in a national CKD database of US veterans. DESIGN, SETTING, AND PARTICIPANTS:Historical cohort study using a nationwide cohort of US veterans with prevalent CKD, estimated glomerular filtration rate less than 60 mL/min/1.73 m(2), and uncontrolled hypertension, who then received 1 or more additional blood pressure medications with evidence of a decrease in SBP. Propensity scores were calculated to reflect each individual's probability for future SBP less than 120 vs 120 to 139 mm Hg. MAIN OUTCOMES AND MEASURES:The effect of SBP on all-cause mortality was evaluated by the log-rank test, and in Cox models adjusted for propensity scores. RESULTS:Using a database of 651,749 patients with CKD, we identified 77,765 individuals meeting the inclusion criteria. A total of 5760 patients experienced follow-up treated SBP of less than 120 mm Hg and 72,005 patients had SBP of 120 to 139 mm Hg. During a median follow-up of 6.0 years, 19,517 patients died, with 2380 deaths in the SBP less than 120 mm Hg group (death rate, 80.9/1000 patient-years [95% CI, 77.7-84.2/1000 patient-years]) and 17,137 deaths in the SBP 120 to 139 mm Hg group (death rate, 41.8/1000 patient-years [95% CI, 41.2-42.4/1000 patient-years]; P < .001). The mortality hazard ratio (95% CI) associated with follow-up SBP less than 120 vs 120 to 139 mm Hg was 1.70 (1.63-1.78) after adjustment for propensity scores. CONCLUSIONS AND RELEVANCE:Our results suggest that stricter SBP control is associated with higher all-cause mortality in patients with CKD. Confirmation of these findings by ongoing clinical trials would suggest that modeling of therapeutic interventions in observational cohorts may offer useful guidance for the treatment of conditions that lack clinical trial data.
journal_name
JAMA Intern Medjournal_title
JAMA internal medicineauthors
Kovesdy CP,Lu JL,Molnar MZ,Ma JZ,Canada RB,Streja E,Kalantar-Zadeh K,Bleyer AJdoi
10.1001/jamainternmed.2014.3279subject
Has Abstractpub_date
2014-09-01 00:00:00pages
1442-9issue
9eissn
2168-6106issn
2168-6114pii
1892181journal_volume
174pub_type
杂志文章abstract:Importance:Providing culturally competent care to the growing number of limited-English proficiency (LEP) Latinos with diabetes in the United States is challenging. Objective:To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care phy...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.8648
更新日期:2017-03-01 00:00:00
abstract:IMPORTANCE:Fostering accountability in the Medicare Accountable Care Organization (ACO) programs may be challenging because traditional Medicare beneficiaries have unrestricted choice of health care providers, are attributed to ACOs based on utilization, and often receive fragmented care. OBJECTIVE:To measure 3 relate...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.1073
更新日期:2014-06-01 00:00:00
abstract:Importance:Clinician communication about goals of care is associated with improved patient outcomes and reduced intensity of end-of-life care, but it is unclear whether interventions can improve this communication. Objective:To evaluate the efficacy of a patient-specific preconversation communication-priming intervent...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamainternmed.2018.2317
更新日期:2018-07-01 00:00:00
abstract:IMPORTANCE:Studies have shown that bisphosphonates may have antitumor and antimetastatic properties. Recently, observational studies have suggested a possible protective effect of bisphosphonates on breast cancer, but the effect of bisphosphonate use on risk of breast cancer has not been tested in randomized trials. O...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamainternmed.2014.3634
更新日期:2014-10-01 00:00:00
abstract:Importance:Manufacturers of US Food and Drug Administration-approved prescription drugs often apply for additional indications based on randomized clinical trials. Real-world database analyses on a medication's use and outcomes in routine settings of care might help to inform decision making regarding such supplemental...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2017.3919
更新日期:2018-01-01 00:00:00
abstract:IMPORTANCE:In type 2 diabetes mellitus (T2DM), team management using protocols with regular feedback improves clinical outcomes, although suboptimal self-management and psychological distress remain significant challenges. OBJECTIVE:To investigate if frequent contacts through a telephone-based peer support program (Pe...
journal_title:JAMA internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamainternmed.2014.655
更新日期:2014-06-01 00:00:00
abstract:IMPORTANCE:Better continuity of care is expected to improve patient outcomes and reduce health care costs, but patterns of use, costs, and clinical complications associated with the current patterns of care continuity have not been quantified. OBJECTIVE:To measure the association between care continuity, costs, and ra...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.245
更新日期:2014-05-01 00:00:00
abstract:Importance:Radiation doses for computed tomography (CT) vary substantially across institutions. Objective:To assess the impact of institutional-level audit and collaborative efforts to share best practices on CT radiation doses across 5 University of California (UC) medical centers. Design, Setting, and Participants:...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.0445
更新日期:2017-06-01 00:00:00
abstract:IMPORTANCE:General medicine rounds by attending physicians provide the foundation for patient care and education in teaching hospitals. However, the detailed activities of these rounds in the current era are not well characterized. OBJECTIVE:To describe the characteristics of attending rounds for internal medicine inp...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2013.6041
更新日期:2013-06-24 00:00:00
abstract:IMPORTANCE:Additional information is needed about the role of dietary sodium on health outcomes in older adults. OBJECTIVE:To examine the association between dietary sodium intake and mortality, incident cardiovascular disease (CVD), and incident heart failure (HF) in older adults. DESIGN, SETTING, AND PARTICIPANTS:W...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.6278
更新日期:2015-03-01 00:00:00
abstract:Importance:Facing new financial incentives to reduce unnecessary spending, health care organizations may attempt to reduce wasteful care by influencing physician practices or selecting more cost-effective physicians. However, physicians' role in determining the use of low-value services has not been well described. Ob...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2018.5086
更新日期:2019-01-01 00:00:00
abstract:IMPORTANCE:Feasibility, effectiveness, and sustainability of large-scale readmission reduction efforts are uncertain. The Greater New Haven Coalition for Safe Transitions and Readmission Reductions was funded by the Center for Medicare & Medicaid Services (CMS) to reduce readmissions among all discharged Medicare fee-f...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.0833
更新日期:2016-05-01 00:00:00
abstract:Importance:Every day in the United States, more than 200 people are murdered or assaulted with a firearm. Little research has considered the role of interpersonal ties in the pathways through which gun violence spreads. Objective:To evaluate the extent to which the people who will become subjects of gun violence can b...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2016.8245
更新日期:2017-03-01 00:00:00
abstract:Importance:Lung cancer has become a leading cause of death among people living with human immunodeficiency virus (HIV) (PLWH). Over 40% of PLWH in the United States smoke cigarettes; HIV independently increases the risk of lung cancer. Objective:To project cumulative lung cancer mortality by smoking exposure among PLW...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.4349
更新日期:2017-11-01 00:00:00
abstract:Importance:Initiatives to reduce sodium in packaged foods have been launched in the United States, yet corresponding changes in the amount of sodium that US households obtain from packaged foods have not been evaluated, to our knowledge. Objective:To assess 15-year changes in the amount of sodium that US households ac...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2017.1407
更新日期:2017-07-01 00:00:00
abstract:Importance:Prognostic understanding can shape patients' treatment goals and preferences. Patients undergoing dialysis in the United States have limited life expectancy and may receive end-of-life care directed at life extension. Little is known about their prognostic expectations. Objective:To understand the prognosti...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.2879
更新日期:2019-07-08 00:00:00
abstract:Importance:The American College of Radiology (ACR) has recognized the importance of minimizing radiation doses used for lung cancer screening (LCS) computed tomography (CT). However, without standard protocols, doses could still be unnecessarily high, reducing screening margin of benefit. Objective:To characterize LCS...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.3893
更新日期:2019-09-23 00:00:00
abstract:IMPORTANCE:The American Heart Association recommends routine provocative cardiac testing in accelerated diagnostic protocols for coronary ischemia. The diagnostic and therapeutic yield of this approach are unknown. OBJECTIVE:To assess the yield of routine provocative cardiac testing in an emergency department-based ch...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2013.850
更新日期:2013-06-24 00:00:00
abstract:IMPORTANCE:Older patients with diabetes mellitus receiving medical treatment whose blood pressure (BP) or blood glucose level are potentially dangerously low are rarely deintensified. Given the established risks of low blood pressure and blood glucose, this is a major opportunity to decrease medication harm. OBJECTIVE...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2015.5110
更新日期:2015-12-01 00:00:00
abstract:IMPORTANCE:The RAS/RAF/mitogen-activated protein kinase and extracellular signal-regulated kinase (ERK) kinase/ERK cascade plays a crucial role in melanoma cell proliferation and survival. Sildenafil citrate (Viagra) is a phosphodiesterase (PDE) 5A inhibitor commonly used for erectile dysfunction. Recent studies have s...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.594
更新日期:2014-06-01 00:00:00
abstract:Importance:Among patients who had acute kidney injury (AKI) during hospitalization, there is a need to improve risk prediction such that those at highest risk for subsequent loss of kidney function are identified for appropriate follow-up. Objective:To evaluate the association of post-AKI proteinuria with increased ri...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.6390
更新日期:2020-03-01 00:00:00
abstract:Importance:Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation. Objective:To examine the association between mistreatment and medical student ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2020.0030
更新日期:2020-05-01 00:00:00
abstract:Importance:Accumulating epidemiologic evidence has suggested favorable associations between plant-based dietary patterns and risk of type 2 diabetes, although there is a lack of a quantitative summary of evidence substantiating this important association. Objective:To quantitatively synthesize available prospective ob...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.2195
更新日期:2019-07-22 00:00:00
abstract:Importance:Low-value care is prevalent in the United States, yet little is known about the downstream health care use triggered by low-value services. Measurement of such care cascades is essential to understanding the full consequences of low-value care. Objective:To describe cascades (tests, treatments, visits, hosp...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2019.1739
更新日期:2019-06-03 00:00:00
abstract:Importance:The association between incretin-based drugs, such as dipeptidyl peptidase 4 (DPP-4) inhibitors and glucagon-like peptide 1 (GLP-1) agonists, and acute pancreatitis is controversial. Objective:To determine whether the use of incretin-based drugs, compared with the use of 2 or more other oral antidiabetic dr...
journal_title:JAMA internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1001/jamainternmed.2016.1522
更新日期:2016-10-01 00:00:00
abstract:IMPORTANCE:Self-monitoring of blood glucose is a costly component of care for diabetes mellitus, with unclear benefits for patients not taking insulin. Veterans with dual Department of Veterans Affairs (VA) and Medicare benefits have access to test strips through both systems, raising the potential for overuse. OBJECT...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.5405
更新日期:2015-01-01 00:00:00
abstract:IMPORTANCE:Controversy exists regarding whether the decision to pursue a do-not-resuscitate (DNR) order should be grounded in an ethic of patient autonomy or in the obligation to act in the patient's best interest (beneficence). OBJECTIVE:To explore how physicians' approaches to DNR decision making at the end of life ...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2015.0295
更新日期:2015-05-01 00:00:00
abstract::Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laborator...
journal_title:JAMA internal medicine
pub_type: 杂志文章,评审
doi:10.1001/jamainternmed.2017.5152
更新日期:2017-12-01 00:00:00
abstract:IMPORTANCE:Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown. OBJECTIVE:To determine the use of cardiac biomarker testing overall, as well as stratified b...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2014.5830
更新日期:2015-01-01 00:00:00
abstract:IMPORTANCE:Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated. OBJECTIVE:To examine the risk of incident MI associated with AF. DESIGN, SETTING, AND PARTICIPANTS:A prospective cohort of 23,928 partici...
journal_title:JAMA internal medicine
pub_type: 杂志文章
doi:10.1001/jamainternmed.2013.11912
更新日期:2014-01-01 00:00:00