Use of physician-specific data and flow sheets to improve compliance with preventive and screening health care measures.

Background: The benefits of preventive and screening health-care measures have been well documented, but physician compliance with these measures has been imperfect. This investigation sought to measure and improve compliance of seven internists with a range of health-care measures.

Methods: This study had two parts.

The African American Study of Kidney Disease: do these results indicate that 140/90 mm hg is good enough?

Current national guidelines recommend aggressive lowering of blood pressure (< 130/80 mm Hg) in patients with chronic kidney disease (CKD). In this paper, we summarize recent clinical trial data evaluating the effect of lower blood pressure goals on renal outcomes. The epidemiologic data relating blood pressure to progression of kidney disease, the Modification of Diet in Renal Disease (MDRD) study (in patients with > 1 g proteinuria/d), and meta-analyses of angiotensin-converting enzyme (ACE) inhibitor clinical trials all support lower blood pressure goals in CKD patients, particularly those with proteinuria.