This is Journal Watch, a medical-literature
survey produced by the Massachusetts Medical
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  Contents copyright 1994, Mass. Medical Society.

Journal Watch Summaries for September 30, 1994

NSAIDs MAY INCREASE ANTIHYPERTENSIVE THERAPY IN THE ELDERLY.
  JAMA 1994 Sep 14; 272:781-6.

SCREENING FOR PROSTATE CANCER: A DECISION ANALYSIS.
  JAMA 1994 Sep 14; 272:773-80.

LONGER-LASTING BIOPROSTHETIC HEART VALVES.
  J Am Coll Cardiol 1994 Sep; 24:676-82.

REDUCING COLIC.
  Pediatrics 1994 Sep; 94:322-32.

AN OUTBREAK OF MEASLES.
  MMWR 1994 Sep 2; 43:627-9.

CHILDRENS' ACCESS TO CIGARETTE VENDING MACHINES.
  MMWR 1994 Sep 2; 43:625-7.

NSAIDs MAY INCREASE ANTIHYPERTENSIVE THERAPY IN THE ELDERLY.
   How important is the tendency of nonsteroidal anti- inflammatory {*filter*}
(NSAIDs) to raise {*filter*} pressure? This case-control study compared the use of
NSAIDs among 9411 New Jersey Medicaid patients (65 years or older) who started
antihypertensive medication between 1981 and 1990 with that of randomly
selected controls from the same database.
  Forty-one percent of patients who received antihypertensive medication used
NSAIDs during the year before the index date versus 26 percent of controls.
After adjusting for age, sex, race, nursing home residence, and other factors,
recent NSAID users (those using NSAIDs during the 60 days before the index
date) were at greater risk for initiating antihypertensive therapy (odds
ratio, 1.66) than controls. There was evidence of a dose-response effect;
adjusted odds ratios for starting antihypertensive therapy ranged from 1.55
for patients who received low daily doses of NSAIDs to 1.82 for those who
received high doses.
   Comment: There are several possible explanations for the association
between NSAIDs and antihypertensive therapy found in this study. One
possibility is that NSAIDs users received more intensive medical attention.
Nonetheless, the findings are consistent with our understanding of the
pathophysiology of NSAIDs and support the practice of tapering these {*filter*} in
patients with borderline hypertension. --TH Lee.
   Citation: Gurwitz JH; et al.  Initiation of antihypertensive treatment
during nonsteroidal anti-inflammatory drug therapy.  JAMA 1994 Sep 14;
272:781-6.

SCREENING FOR PROSTATE CANCER: A DECISION ANALYSIS.
   Digital rectal examination (DRE), prostate-specific antigen (PSA), and
transrectal ultrasound (TRUS) are now used to screen for prostate cancer. This
decision analysis compared four screening strategies that combined these tests
with a strategy of not screening.
   The analysis assumed that localized cancer was treated with radical
prostatectomy and estimated the sensitivity and specificity of DRE (0.5 and
0.94), PSA (0.67 and 0.97), and TRUS (0.81 and 0.84). All screening programs
produced a gain in average unadjusted life expectancy of just one to two days
for men aged 50 to 70 years. The gain in life expectancy due to screening
increased with advancing age even though the effects of treatment on life
expectancy were smaller in older men. When quality of life was added to the
analyses, screening produced a loss in quality-adjusted life-years, due to
treatment complications and side effects. Cost-effectiveness analyses
indicated that the screening strategies cost $113,000 to $729,000 per
incremental life-year saved.
   Comment: This analysis supports those clinicians and policy makers who have
questioned the wisdom of widespread screening for prostate cancer. However,
like all decision analyses, it is based on some assumptions that are supported
by relatively few data. --TH Lee.
   Citation: Krahn MD; et al.  Screening for prostate cancer: a decision
analytic view.  JAMA 1994 Sep 14; 272:773-80.