Background-Hypertension control is an important and modifiable risk factor for cardiovascular disease. The overall rate of hypertension control among patients followed in cardiology clinics, as well as clinician variability in control rates, is unknown. Methods and Results-We conducted a retrospective cohort study of patients with hypertension (nϭ5979) routinely followed in a cardiology clinic (nϭ47 physicians). Overall, 30.3% of patients with hypertension had suboptimal control (blood pressure [BP] Ն140/90 mm Hg) at the end of a 13-month follow-up period. Patient-level factors associated with control were younger age, male sex, white ethnicity, having a primary care provider at Duke, private insurance, Medicare/Medicaid, and comorbid diagnoses of heart failure or coronary artery disease. Unadjusted rates of suboptimal BP control among clinicians' clinic patient panels ranged from 16% to 44%. Even after adjusting for patient factors, patients' odds of BP control varied 6-fold, depending on their treating clinician. Using a patient's average BP rather than their most recent BP did not result in significant changes in provider performance. In chart reviews (nϭ300), clinicians failed to document a plan to address hypertension in 38% of patients with elevated BP in the clinic. Conclusions-Up to one-third of patients followed routinely by cardiologists in clinic have suboptimally controlled BP, with wide variability in performance across individual clinicians. This variability, alongside evidence that elevated BP is often not acted on during clinic visits, demonstrates a potential opportunity for quality improvement.

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It has long been known that the kidney, in its functioning state, is distended with blood (1-4). Rose-Bradford (1) stressed the "passive" character of this distension, for he noted that the kidney swelled when the blood pressure rose and shrank when it fell. Text- fig. 1 shows how the organ collapses when its circulation is abruptly cut off; in this instance, although drainage was obviously incomplete, it shrank from a volume of 49 cc. to a volume of 39 cc., showing that at least 20 per cent of its normal functioning volume was distending fluid. This fluid drains from the renal vein when the renal artery is occluded; in quantity, when drainage is complete, it averages 26 per cent of the functionally distended kidney (5, 6).This aspect of renal behavior has, however, been overlooked by those investigating the functional vascular morphology of the organ. Led recently by Trueta el al. (7), many studies of blood distribution have been attempted, using particularly the technic of injecting India ink into the vascular system and then, at necropsy, examining the distribution of ink. In such studies, the distribution of ink at necropsy should reflect the distribution while the organ is functioning. But if the kidney's blood were to drain out after removal, the subsequent localization of the dye would give only very rough information about the distribution of blood in the functioning organ. The latter is not thoroughly known and hence the present study was undertaken.Actually, the fluid naturally distending the kidney is not blood alone; rather, it is a fluid containing less red cells and less plasma protein than simultaneously drawn blood, the same amount of Na and Ca, and increased quantities of K, C1, urea, and PO4 (6). Because kidney interstitial fluid (or lymph) has approximately this same composition, we have concluded that the distending fluid is very probably a mixture of blood and interstitial fluid. Furthermore, since the distending fluid contains only about half the red cells that blood contains (6), the volume of its two components, in terms of percentage of the functionally distended kidney, is 13 per cent blood and 13 per cent interstitial fluid.

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Background: To reduce readmissions rates for patients admitted with acute myocardial infarction (AMI) or congestive heart failure (CHF), Duke University Hospital piloted a program in which patients were contacted by telephone within 72 hours of discharge and asked a set of structured questions believed to identify gaps in care to reduce the risk of readmission. Methods: A cohort of 838 patients admitted between December 2012 and May 2013 with a primary diagnosis of AMI (n=374) or CHF (n=464) were identified by DRG for prospective telephone follow-up and analyzed retrospectively. For primary outcome analysis, readmission rates were compared between two groups: one that received the telephone intervention and one that did not. If successfully contacted, patients were asked about filling and complying with their prescriptions, knowledge of their follow-up appointment, and understanding their discharge instructions. A secondary outcome analysis evaluated readmission rates among the telephone-eligible subgroup. Results: Patient characteristics among those contacted vs. not contacted did not differ substantially for either AMI or CHF discharges. Among AMI patients, there was no association between contact attempt and readmission within 30 days (p = 0.719) or 90 days (p=0.803). This finding persisted after adjusting for the effect of age at hospitalization, disease group, race, gender, and payor (OR = 1.28, 95% CI = 0.61 - 2.68, p = 0.512 at 30 days; OR = 1.24, 95% CI = 0.65 - 2.37, p = 0.510 at 90 days). Among CHF patients, there was no association between contact attempt and readmission within 30 days (p = 0.156) or 90 days (p=0.904). This finding persisted after adjusting for the effect of age at hospitalization, disease group, race, gender, and payor (OR = 0.67, 95% CI = 0.35 - 1.25, p = 0.207 at 30 days; OR = 0.94, 95% CI = 0.56 - 1.55, p = 0.797 at 90 days). There was no association between telephone-eligible patients and readmission rates at 30 or 90 days for either condition. Among patients successfully contacted, there was no association between answers pertaining to post-discharge behavior and readmission rates for CHF or AMI. Conclusions: Early telephone follow-up targeting post-discharge behaviors was not observed to impact 30- or 90-day readmission rates for patients admitted to an academic medical center with CHF or AMI.