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And while Barack Obama recently proposed regulations that will allow doctors to prescribe buprenorphine to more patients, he has actually made doing so subject to increased red tape and has not touched the sclerotic bureaucracy that restricts methadone to highly isolated clinics.
It has always been difficult to recruit workers for isolated clinics.
Clinic geography, which in our analysis was widely varied across FP and NPF providers, probably affects patient outcomes, as isolated clinics in either urban or rural locations may be the only available dialysis facility in a given region, and patients have no choice of provider to patronize.
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Only few studies have explored the clinical significance of isolated clinic hypertension in diabetes (14– 17), and in almost all cases, the number of subjects identified as having this condition was limited.
This calls for antihypertensive drug treatment also in diabetic subjects with isolated clinic hypertension.
It has long been shown that subjects with isolated clinic hypertension exhibit metabolic abnormalities of prognostic significance (5).
Because isolated clinic hypertension carries a lower level of risk than sustained hypertension, a lesser benefit in the former than in the latter condition is predictable.
It also suggests that this increased risk may materialize even in individuals in whom isolated clinic hypertension is diagnosed in the absence of metabolic abnormalities or organ damage.
Out of 262 patients with type 2 diabetes, only 56 were found to have an isolated clinic hypertension based on clinic blood pressure values ≥140/90 mmHg and an average daytime blood pressure <135/8 5mmHg.
In 2,052 subjects aged 25 74 years, 356 were diagnosed as having an isolated clinic hypertension, i.e., a high clinic together with a normal 24-h average blood pressure (3, 4).
Similar findings were obtained when isolated clinic hypertension was diagnosed by office versus home blood pressure, which was made possible by the semiautomatic morning and evening self-measurements of blood pressure performed by all subjects of the PAMELA cohort.
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