our established hypertension registry to identify newly diagnosed hypertensive males age 26-60 years old between 2008-2010. Patients had to have had 3 years of KPNC membership prior to enrollment in the hypertension registry. Patients with preexisting ED or significant medical comorbidity were excluded. We then measured the incidence of ED in this population, with varying categorical levels of blood pressure control. ED was defined by at least 2 primary care or urology diagnoses of ED in our electronic health record within 2 years, at least 2 filled prescriptions for ED medications within 2 years, or 1 diagnoses of ED and 2 filled prescription for ED medications.RESULTS: We identified 39,320 newly diagnosed potent hypertensive men. The overall incidence for ED was 13.9% with a mean follow-up of 55.1 AE 28.7 months. Higher average systolic blood pressure > 120 mm Hg was associated with a higher risk of ED in a dose dependent manner (see Figure 1). Wide variation in blood control was associated with a higher incidence of ED (OR: (95% CI); 1.359 (1.258-1.469)) and a shorter time to the development of ED (log rank, p<0.0001).CONCLUSIONS: Among adults diagnosed with hypertension, tighter blood pressure control is associated with a lower incidence and a longer time to the development of ED. We believe this data may serve as a novel motivator for hypertensive men to better adhere to their hypertension treatment regimen.
Introduction: Rectal bleeding (RB) is a symptom of colorectal cancer (CRC) that often prompts endoscopic investigation. The outcomes of RB in the setting of CRC have not been well described. We investigated the outcomes of patients diagnosed with stage IV CRC after presenting with RB. Methods: We retrospectively analyzed patients ages 18 years and older diagnosed with Stage IV CRC from 2011 to 2017 in our academic, safety-net hospital. Patients were excluded if they were not diagnosed via diagnostic colonoscopy. Patients were stratified based on RB at presentation. Location of tumors were categorized as right-sided colorectal cancer (RCRC) and left-sided colorectal cancer (LCRC). RCRC included those located from the cecum to the proximal two-thirds of the transverse colon. LCRC included those located from the distal one-third of the transverse colon to the rectum. Results: Sixty-nine patients met the inclusion criteria. General characteristics are shown in Table . Those without RB had significantly higher Charlson Comorbidity Index (CCI) scores (p , 0.05). The average time from presentation to endoscopy in those with RB compared to those without RB were 0.9 1 1.5 months and 1.2 1 3.3 months, respectively (p 5 0.53). All thirty-five patients with RB had LCRC. For those without RB, eighteen had RCRC and sixteen had LCRC. There were no differences in times to surgery (p 5 0.09), systemic therapy (p 5 0.27), or any treatment (p 5 0.14). Median survival in those with RB was 1377 days and those without RB was 358 days. Using the Cox proportional hazards model with CCI, gender, and race as covariates for multivariate analysis, the average length of survival remained significantly higher in patients with RB (p , 0.01, HR 0.43, 95% CI 0.23-0.80) (Figure). Conclusion: RCRC and LCRC have been documented to have different morphological and molecular characteristics, with RCRC often being described as more aggressive than LCRC. In our study, all patients who presented with RB had LCRC and more than half of the patients without RB had RCRC. The absence of RB was associated with increased mortality after controlling for age, comorbidities, gender, and race. Furthermore, there were no differences in time to either endoscopy or treatment. In conclusion, RB in CRC may be more indicative of left-sided disease which may be associated with a less aggressive disease course. However, more research is required to fully understand the association between RB and clinical outcomes.
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