Cardiovascular diseases are the leading cause of death in the USA. Moreover, hypertension affects approximately 78 million people in the USA and is a major modifiable risk factor. Therefore, elevated blood pressure is listed as the primary contributory cause of death in 15 % of the 2.4 million deaths in 2009. Nonetheless, 44 % of the hypertensive population in the USA did not have it under control in 2014. Hypertension cost was averaged to be 40-50 billion dollars yearly including medications and services and currently rising. New hypertension guidelines recommend treating individuals between ages 35 and 74 with different stages of hypertension. Furthermore, individuals with existing co-morbidities such as chronic kidney disease and diabetes should have increased medication adherence and different blood pressure goal compared to those without co-morbidities. Studies utilizing quality-adjusted life-years (QUALYs) were conducted to asses the cost-effectiveness of treating previously untreated adults with hypertension. On average, treating adults between ages 35 to 74 years could prevent about 50,000 and 13,000 cardiovascular events and deaths, respectively. Overall, treating stage 1 and 2 hypertension adults including emphasis on medication adherence could be effective and cost saving. The purpose of this article is to review different methods and assess cost-effectiveness for hypertension therapy based on the 2014 guidelines.
To evaluate the expression of MDR-proteins in the response to lung cancer chemotherapy. Methods: 147 tumor samples were collected from 143 patients, 35 of which were obtained by bronchoscopy and 112 from surgery; 101 samples belonging to 99 patients were considered valid for the study. The samples were cryopreserved and immunochemistry with monoclonal murine antibodies used to determine the MDR-proteins Pgp, Mrp1 and Lrp. Results: No MDR-proteins were expressed in 16 cases. One MDR-protein was present in 32 cases: Pgp in 3, Mrp1 in 11 and Lrp in 18. Two MDR-proteins were expressed in 34 cases: Pgp and Lrp in 24, Mrp1 and Pgp in 5, and Mrp and Lrp in 5. All the three MDR-proteins were present in 17 cases. No differences were observed considering age (Pgp, p = 0.74; Mrp1, p = 0.95; Lrp, p = 0.26). Neither sex produced changes when considering either number of MDR-proteins (p = 0.55) or types of them (p = 0.21). Significant differences of MRD-proteins were also lacking for number (p = 0.59) and type (p = 0.51) in relation to the tumor histologic grade. The tendency to the simultaneous expression of Pgp and Lrp was very significant (p < 0.01), while the simultaneous expression of Mrp1 and Lrp showed to be no significant (p = 0.26). Conclussions: Pgp and Lrp are frequently expressed simultaneously. Only the expression of Pgp and the number of MDR-proteins expressed simultaneously seem to be related to response to chemotherapy.
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