Genetic and Adverse Health Outcome Associations with Treatment Resistant Hypertension in GenHAT

Treatment resistant hypertension (TRH) is defined as uncontrolled hypertension (HTN) despite the use of ≥3 antihypertensive medication classes or controlled HTN while treated with ≥4 antihypertensive medication classes. Risk factors for TRH include increasing age, diminished kidney function, higher body mass index, diabetes, and African American (AA) race. Importantly, previous studies suggest a genetic role in TRH, although the genetics of TRH are largely understudied. With 2203 treatment resistant cases and 2354 treatment responsive controls (36% AA) from the Genetics of Hypertension Associated Treatment Study (GenHAT), we assessed the association of 78 candidate gene polymorphisms with TRH status using logistic regression. After stratifying by race and adjusting for potential confounders, there were 2 genetic variants in the AGT gene (rs699, rs5051) statistically significantly associated with TRH among white participants. The Met allele of rs699 and the G allele of rs5051 were positively associated with TRH:OR=1.27 (1.12–1.44),P=0.0001, andOR=1.36 (1.20–1.53),P<0.0001, respectively. There was no similar association among AA participants (race interactionP=0.0004for rs699 andP=0.0001for rs5051). This research contributes to our understanding of the genetic basis of TRH, and further genetic studies of TRH may help reach the goal of better clinical outcomes for hypertensive patients.

Adverse Outcomes Associated with Inappropriate Drug Use in Nursing Homes

BACKGROUND: Little empirical evidence exists regarding the influence and outcomes of inappropriate medication use among elderly nursing home residents. OBJECTIVE: To identify the prevalence of inappropriate medication use among elderly patients in Georgia nursing homes using the Beers criteria and identify the relationship between inappropriate drug use and the likelihood of an adverse health outcome. METHODS: A cohort design was used to review 1117 patient medical records in 15 Georgia nursing homes with a high risk of polypharmacy. Prevalence of inappropriate medication use among elderly patients, as defined by the Beers criteria, was estimated. The adverse health outcomes of hospitalizations, emergency department visits, or deaths were identified from Medicaid claims data. RESULTS: A total of 519 (46.5%) patients received at least one inappropriate medication and 143 (12.8%) patients experienced at least one adverse health outcome. Logistic regression revealed that the total number of medications taken (OR 1.139, 95% CI 1.105 to 1.173) significantly increased the likelihood of receiving an inappropriate drug, while having a diagnosis of “dementia” (OR 0.748, 95% CI 0.565 to 0.991) decreased the likelihood. Inappropriate medication use increased the likelihood of experiencing at least one adverse health outcome more than twofold (OR 2.34, 95% CI 1.61 to 3.40). Propoxyphene use alone was significantly associated with the occurrence of an adverse health outcome (OR 2.39, 95% CI 1.54 to 3.71). CONCLUSIONS: Inappropriate drug use was common in our study cohort. Inappropriate use of medication in the elderly, particularly propoxyphene, is associated with a higher risk of adverse health outcomes.

Do health benefits explain the price premiums for organic foods?

This paper examines whether the dollar value of health benefits that consumers derive from organic food could account for the price premiums they pay. Price and sales data from realized transactions are inadequate to reveal consumer preferences for health benefits. Our exploratory alternative method estimates the value of health benefits to a hypothetical consumer who assesses risks as risk assessors do and values a unit reduction in all fatal risks equally, regardless of the source of any risk. Under these assumptions, our estimates of the value of health benefits derived from substituting an organic diet for a conventionally produced diet approach zero. For a common organic product, apple juice, we estimated the cost of reducing risks by buying the organic characteristic. The cost of averting each adverse health outcome is 27 to 461 times as large as the value of benefits. If the characteristics of our hypothetical consumer match those of the typical consumer, two inferences follow from our estimates of benefits and costs. First, the typical consumer is unlikely to purchase organic food for health reasons. Second, consumers who choose organic food could differ from typical consumers in several dimensions: perceptions of the level of risk from dietary intake of pesticides, perceptions of the nature of adverse health outcomes from pesticides, or in the importance attached to other attributes of organic food. Our analysis is exploratory partially because there are several behavioral assumptions implicit in the values we calculate. Also, we focus on risks that can be quantitatively estimated, measuring the probability of an adverse health outcome with readily accessible data. Currently, only cancer risks can be measured in terms of probabilities from readily accessible data.