Predicting blood pressure outcomes using single-item physician-administered measures: a retrospective pooled analysis of observational studies in Belgium

BackgroundPatient adherence is often not monitored because existing methods of evaluating adherence are either burdensome or do not accurately predict treatment outcomes.AimTo examine whether two simple, single-item physician-administered measures of patient adherence to antihypertensive medication are predictive of blood pressure outcomes.MethodUsing pooled data from five observational studies, a sample was identified of 9725 patients who were assessed using two single-item physician-administered measures of adherence to antihypertensive medication: the first item of the Basel Assessment of Adherence Scale (BAAS) and the Visual Analogue Scale (VAS). These two assessment tools were administered by GPs during regular appointments with patients. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and combined SBP/DBP were measured at baseline and at 90 days.ResultsBAAS-identified adherent patients achieved lower mean SBP and DBP compared with non-adherent patients at 90 days (P<0.001), and had odds ratios of achieving blood pressure control of 0.66 (95% confidence intervals (CI) = 0.61 to 0.73, P<0.001) for SBP, 0.69 (95% CI = 0.62 to 0.76, P<0.001) for DBP, and 0.65 (95% CI = 0.59 to 0.72, P<0.001) for combined SBP/DBP. For VAS-identified adherent patients, the odds ratios of achieving blood pressure control were 0.93 (95% CI = 0.86 to 1.00, P<0.001) for SBP, 0.79 (95% CI = 0.73 to 0.85, P<0.001) for DBP, and 0.91 (95% CI = 0.84 to 0.99, P<0.001) for combined SBP/DBP.ConclusionsThe first item of the BAAS and the VAS are independent predictors of blood pressure control. These methods can be integrated seamlessly into routine clinical practice by allowing GPs to quickly evaluate a patient’s adherence and tailor treatment recommendations accordingly.     

Provision of information and advice in cardiovascular care: clinical performance of general practitioners

The aim of this study was to assess the provision of information and advice by general practitioners (GPs) with respect to patients with hypertension, hypercholesterolaemia, or cardiovascular disease. The study relied on the prospective recording of patient encounters by GPs. Performance indicators were selected from the Dutch national guidelines for general practice. The GPs (n=195) completed 5330 encounter forms. High levels of performance were found with regard to advice on smoking cessation and the provision of information (e.g. information about alarm symptoms or the aim of treatment). Low levels of performance were found with regard to advice on salt consumption, alcohol consumption, weight reduction and physical exercise for patients with hypertension. Discussion of compliance with the therapy in case of hypercholesterolaemia, advice on physical exercise in case of angina pectoris and advice on foot care in case of peripheral arterial disease also showed a substantial gap between recommended and actual care. Performance rates varied considerably across GPs. The patient and GP characteristics examined in this study contributed very little to the clinical performance.     

Effect of satisfaction with social support on blood pressure in normotensive and borderline hypertensive men and women

The relation between blood pressure (BP) and two aspects of social support, perceived satisfaction and structural social support network characteristics, were examined in adults classified as having normal BP or borderline hypertension. Casual BP_s were taken by a trained technician on 3 separate visits, each approximately 1 week apart. Participants were categorized as borderline hypertensive if screening systolic blood pressure (SBP) fell in the range 130-160 mmHg and/ordiastolic blood pressure (DBP) fell in the range 85-100 mmHg; BP_s below these ranges were considered normotensive. Participants underwent ambulatory BP monitoring, Individuals classified as normotensive reported significantly greater support satisfaction than individuals with borderline hypertension. Social network characteristics were not associated with BP. During 24 hr of ambulatory BP monitoring, high perceived support satisfaction was associated with lower SBP and DBP at work, home, and during sleep. These data suggest that perceived satisfaction with social support is associated with lower BP. The presence of social support also may reduce BP levels during daily life. This study was supported by National Institutes of Health (NIH) Grants HL49427, HL49572. HL53724, and MOI-RR-30, National Center far Research Resources, Clinical Research Centers Program, National Institutes of Health.     

The management of hypertension in the elderly by general practitioners in Merseyside: the rule of halves revisited.

BACKGROUND: Treatment of hypertension in the elderly significantly reduces cardiovascular events and confers greater absolute benefit compared with treating younger adults. However, this group has been undertreated in the past. AIM: To perform a reliable and valid multipractice audit of the current management of elderly hypertensive patients. METHOD: An observational study conducted as multiple standardized audits in general practices. The notes of 6139 patients aged 65 years or over from 76 general practices in Merseyside were examined to determine the percentage of elderly patients who had their blood pressure recorded. The percentages of hypertensive patients who were diagnosed, treated, and controlled was also recorded. RESULTS: Eighty-one per cent of the sample had their blood pressure recorded. Fifty-three per cent of patients over the age of 65 were identified as hypertensive; 64% of hypertensive patients are receiving antihypertensive medication and 54% of treated hypertensive patients can be considered controlled. However, very small changes in the criteria used to define blood pressure control have dramatic effects on the results. Digit preference and the number of available blood pressure recordings also significantly affect the results. CONCLUSION: The management of hypertension in the elderly by Merseyside general practitioners (GPs) gives better results than predicted by the 'rule of halves'. Elderly hypertensive patients are more likely to be detected and treated, but only half achieve control to 160/90. The results are particularly sensitive to the degree of digit preference, the number of available recordings, and to the precise definition used for control.     

The influence of oral potassium chloride on blood pressure in hypertensive men on a low-sodium diet

Clinical and epidemiologic studies suggest that the intake of potassium chloride lowers blood pressure. To investigate whether supplemental potassium chloride (96 mmol of microcrystalline potassium chloride a day) reduced the need for antihypertensive medication in hypertensive men on a restricted-sodium diet, we conducted a randomized, placebo-controlled, double-blind clinical trial. A total of 287 men 45 to 68 years of age, 142 given potassium chloride and 145 given placebo, were followed for an average of 2.2 years after the withdrawal of their antihypertensive medication. Men in both groups received instructions on following a low-sodium diet. Overnight urinary sodium excretion fell from 63 mmol per eight hours at base line to an average of 45 mmol per eight hours during follow-up. Participants given supplemental potassium chloride had significantly higher (P less than 0.001) serum potassium levels and urinary potassium excretion (averaging 4.5 mmol per liter and 42.5 mmol per eight hours, respectively) during follow-up than participants given placebo (4.2 mmol per liter and 20.0 mmol per eight hours). Seventy-nine participants in each group required reinstitution of antihypertensive medication according to strict indications defined by the protocol. No significant differences in systolic or diastolic blood pressure were observed between the two groups. During follow-up, systolic and diastolic blood pressure averaged 130.6 and 82.5 mm Hg, respectively, for participants given supplemental potassium, and 132.5 and 83.1 mm Hg for participants given placebo. We conclude that supplemental potassium chloride does not reduce the need for antihypertensive medication in hypertensive men on a restricted-sodium diet.     

Organisational factors in relation to control of blood pressure: an observational study

BACKGROUND: Studies show that 60-75% of treated patients with hypertension in general practice, still do not reach the recommended blood pressure targets of <150/90 mmHg. AIM: To investigate aspects of hypertension management in relation to sociodemographic variables, antihypertensive drug treatment, and organisational factors in primary care. DESIGN OF STUDY: Observational study over 3 years. SETTING: Eight general practices in Tayside, UK. METHOD: Participants were 560 randomly selected patients aged 40-79 years receiving treatment for hypertension. The outcome measurement was blood pressure control, expressed in binary form based on the British Hypertension Society audit standard of <150/90 mmHg. RESULTS: Of 536 eligible patients, 261 (49%) were defined as having inadequate blood pressure control at the end of the study period. No significant associations were discovered with sex, age, deprivation score and comorbidity. In those patients with inadequate control, 30% had no modifications to their drug treatment during the study period. Blood pressure control at the end of the study period was not associated with number of antihypertensive drugs taken or number of antihypertensive drug modifications. The mean number of clinician contacts was 11 (standard deviation = 8), and mean continuity in primary care was high, although this was not associated with improved blood pressure control. A higher proportion of hypertension-related consultations were associated with increased odds of having inadequate blood pressure control. CONCLUSION: Achieving adequate blood pressure control continues to represent a substantial health problem in a significant proportion of the hypertensive population. Patient, physician and organisational elements play a role in ensuring effective delivery of hypertension care in the community.     

Educational and organisational interventions used to improve the management of hypertension in primary care: a systematic review

BACKGROUND: The optimal way in which to organise and deliver care to patients with hypertension has not been clearly identified. AIM: To determine the effectiveness of educational and organisational strategies used to improve control of blood pressure. DESIGN OF STUDY: Systematic review of randomised controlled trials (RCTs). METHOD: Quantitative pooling of RCT data on patients with hypertension that evaluated the following interventions: (1) self monitoring, (2) educational interventions directed to the patient, (3) educational interventions directed to the health professional, (4) health professional (nurse or pharmacist) led care, (5) organizational interventions that aimed to improve the delivery of care, (6) appointment reminder systems. RESULTS: Fifty-six RCTs met our inclusion criteria. The methodological quality of included studies was variable. An organised system of regular review allied to vigorous antihypertensive drug therapy was shown to reduce blood pressure (weighted mean difference -8.2/-4.2mmHg, -11.7/-6.5mmHg, -10.6/-7.6mmHg for three strata of entry blood pressure) and all-cause mortality at 5 years follow-up (6.4% versus 7.8%, difference 1.4%) in a single large RCT (the Hypertension Detection and Follow-up study). Other interventions had variable effects. Self-monitoring was associated with moderate net reduction in diastolic blood pressure, weighted mean difference (WMD): -2.03 mmHg, 95% confidence interval (CI) = -2.7 to -1.4 mmHg. Educational interventions directed towards physicians were associated with small reductions in systolic blood pressure (WMD) -2.0mmHg, 95% CI = -3.5 to -0.6mmHg and diastolic blood pressure (WMD) -0.4mmHg, 95% CI -1.1 to 0.3mmHg. CONCLUSIONS: General practices and community-based clinics need to have an organised system of regular follow-up and review of their hypertensive patients. Antihypertensive drug therapy should be implemented by means of a vigorous stepped care approach when patients do not reach target blood pressure levels. These findings have important implications for recommendations concerning implementation of structured delivery of care in hypertension guidelines.     

A cluster randomised controlled trial of the effect of a treatment algorithm for hypertension in patients with type 2 diabetes

BACKGROUND: Good blood pressure (BP) control reduces the risk of complications in people with type 2 diabetes, yet many do not achieve this. Guidelines for managing hypertension recommend increasing antihypertensive medications until control is achieved, but the effect of such recommendations in routine primary care is unknown. AIM: To evaluate the effectiveness of a BP treatment algorithm in primary care patients with type 2 diabetes. DESIGN OF STUDY: A cluster randomised controlled trial of 1534 patients with type 2 diabetes. SETTING: Forty-two practices in Nottingham, UK. METHOD: Practices were randomised to continue usual care or to use a treatment algorithm designed so that practice nurses and GPs would increase antihypertensive treatment in steps until the target of 140/80 mmHg was reached. Participants were assessed by a clinical interview and case note review at recruitment and at 1 year. The primary outcome measure was the proportion of participants achieving target BP at 1 year. RESULTS: At 1 year there was no difference between the proportions of participants with well controlled BP in the intervention and control arms (36.6% versus 34.3%; P = 0.27). Mean systolic and diastolic blood pressures were identical in the two arms (143/78 mmHg). There was some evidence that participants in the intervention arm were more likely to be receiving higher doses of their antihypertensive drugs, although there was no significant difference in the number of different antihypertensive drugs prescribed. Participants in the intervention arm had a higher rate of primary care BP-related consultations over 12 months than those receiving usual care (rate ratio = 1.55, 95% confidence interval [CI] = 1.26 to 1.88, P<0.001). CONCLUSION: Despite increased monitoring and possibly higher doses of medication there was no improvement in blood pressure control. Improvements achieved by specialist nurse-led clinics in secondary care may not translate to people with type 2 diabetes in primary care settings.     

Lose weight and win: a church-based weight loss program for blood pressure control among black women.

The Baltimore Church High Blood Pressure Program (CHBPP) offers a behaviorally oriented weight control program consisting of eight weekly 2-h diet counseling/exercise sessions. Pre- and post-program weight and blood pressure measurements were analyzed for 184 black and 3 white women aged 18-81 years (mean 51) who participated in the program in 1984-1986: 88 were taking antihypertensive medication (Rx) and 99 were not (no Rx). Mean weight loss was 6 lb in both groups: -18 to +7 lb in the Rx group and -31 to +3 lb in the no Rx group. The mean systolic/diastolic blood pressure (SBP/DBP) decrease was 10/6 mmHg in the Rx group and 5/3 mmHg in the no Rx group (P < 0.001 for all pre/post comparisons). Final SBP was < 140 mmHg for 74% of participants, versus 52% initially. Final DBP was < 90 mmHg in 92% versus 65% initially. Supporting the inference that BP decreases among weight control program participants reflect program effects, percent changes in SBP and DBP (week 2 to week 8) were significantly correlated with percent change in weight (rs = 0.23-0.36; P < 0.05). Comparison data for 25 women from the CHBPP population showed a mean SBP/DBP increase of 8/2 mmHg over an 8-week interval. Based on follow up measurements 6 months after the end of the 8-week program for 74 of the 187 women, weight lost during the 8-week program was maintained or exceeded by 65%. Net weight change at 8 months from baseline for women in the follow up subsample ranged from -28 to +4 lb; mean (SD) -6 (7) lb. Weight loss and related dietary or behavioral changes resulting from participation in a weight control program can enhance blood pressure control among black women.     

Reversibility of cerebral symptoms in severe hypertension in relation to acute antihypertensive therapy. Danish Multicenter Study

Cerebral symptoms were registered in a multicenter study including 64 patients with severe hypertension, diastolic blood pressure (DBP) greater than or equal to 135 mmHg, and more or less pronounced hypertensive encephalopathy. The symptoms were: headache (70%), dizziness (35%), consciousness disturbances (28%), nausea (27%), paresis (23%), blurred vision (22%), paraesthesia (21%) and vomiting (14%). None had convulsions or coma. Initial treatment was furosemide i.v., and if DBP was greater than or equal to 125 mmHg after one hour, patients were randomized to treatment with either i.v. diazoxide (bolus injections of 75-150 mg) or i.m. dihydralazine (bolus injections of 6-12.5 mg). A gradual fall in blood pressure (BP) was obtained in all three groups. Along with BP reduction a substantial regression of neurological symptoms was registered. After 5 hours only minor cerebral symptoms were present without significant difference between diazoxide and dihydralazine. None developed cerebral complications. The study failed to show a significant correlation between BP reduction and regression of neurological symptoms graded semiquantitatively. Reduction of BP by titration using small repeated bolus injections is recommended, but oral treatment should be considered in the patients who are able to ingest peroral medication in spite of neurological symptoms.     

Is ambulatory blood pressure monitoring cost-effective in the routine surveillance of treated hypertensive patients in primary care?

Achieving target levels of office and/or ambulatory blood pressure readings among treated hypertensive patients is an important aspect of cardiovascular disease prevention. Although office blood pressure measurement is simple and convenient, ambulatory blood pressure monitoring is especially useful for identifying patients with 'white coat' hypertension, in whom falsely raised office blood pressure recordings often lead to unnecessary return visits and additional treatment. Office and ambulatory blood pressure control was compared in 374 treated hypertensive patients in a single general practice, and the costs of performing annual ambulatory blood pressure measurements were compared with potential clinical savings. Ambulatory blood pressure monitoring detected 115 (31%) patients who fulfilled the British Hypertension Society target for ambulatory but not office blood pressure, i.e. white coat hypertension, and 21 patients apparently controlled by office but not ambulatory blood pressure criteria. In economic modelling, the capital, maintenance and user costs of ambulatory blood pressure monitoring (13,790 Pounds per year) were partly offset by fewer follow-up visits and second-line treatments in the group with white coat hypertension (there were modelled savings of 10,178 Pounds). Thus, ambulatory blood pressure monitoring identified a much larger number of treated hypertensive patients with adequate blood pressure control at an extra net cost of 3612 Pounds per year.     

坎地沙坦治疗轻中度原发性高血压的临床疗效和安全性研究

目的 评价坎地沙坦酯治疗原发性轻中度高血压的临床疗效和安全性。方法 选择48例轻中度原发性高血压病人通过2周导入期后随机分入试验组和对照组各24例,按双盲、平行临床药理试验方法分别给予坎地沙坦酯和氯沙坦治疗。治疗4周后如不能有效控制血压,则将用药剂量加倍并维持到第8周末。检测患者治疗前和治疗后不同时间的血压、心率以及血常规、尿常规、肝、肾功能。记录用药期间可能发生的不良事件。结果 试验组和对照组降压显效率均为100%,治疗后2周末收缩压(SBP)和舒张压(DBP)均已明显降低。此后血压继续下降,与用药治疗前相比,用药8周末,试验组和对照组SBP分别下降20.3mmHg和16.4mmHg,DBP分别下降16.8 mmHg和16.1 mmHg。试验组1例病人服药期间出现中度头痛,1例病人感轻度胸闷和腹胀。两组血常规、肝、肾功能均正常。结论 坎地沙坦酯治疗原发性轻中度高血压疗效良好、服用安全。     

Is the humoral renal antihypertensive activity of the spontaneously hypertensive rat (SHR) reset to the high blood pressure?

The kidneys have a humoral antihypertensive system, located in the renal medulla and presumably antagonizing the pro-hypertensive renin-angiotensin system. Medullipin I and II and maybe platelet activating factor (PAF), seem to be the mediators of this system, known to be activated after reversal of renovascular hypertension or when the perfusion pressure to a normotensive kidney is suddenly elevated. The present study was undertaken to investigate whether this system is functioning also in the spontaneously hypertensive rat (SHR), and if it is then reset in proportion to the increased mean arterial pressure (MAP). Isolated kidneys from spontaneously hypertensive rats and from Wistar Kyoto rats (WKY) were cross-perfused in vivo from anaesthetized intact Wistar Kyoto rat 'donors'. After 30 min of perfusion at 100 mmHg the perfusion pressure to the isolated kidneys were, for 60 min, either kept unaltered at 100 mmHg or, for the Wistar Kyoto rat kidneys, increased to 150-200 mmHg and, for the spontaneously hypertensive rat kidneys, raised to 200 or 250 mmHg. The results show that the humoral antihypertensive system is present also in spontaneously hypertensive rat kidneys, but is here reset upwards to or even beyond the elevated MAP level. Furthermore, all mean arterial pressure reductions caused by high-pressure perfusion of Wistar Kyoto and spontaneously hypertensive rat kidneys were accompanied by reductions in heart rate (HR) in the 'donors', in agreement with previous observations after reversing renal hypertension and after i.v. medullipin I injection. In fact, in spontaneously hypertensive rat kidneys, the 'incretory' depressor mechanism appears to be more markedly reset upwards than is the 'excretory' depressor mechanism inherent in pressure diuresis with consequent salt-volume elimination. In conclusion spontaneously hypertensive rats, like Wistar Kyoto rats and Wistar rats, have a humoral antihypertensive system in the kidneys, but it is reset upwards even beyond the elevated mean arterial pressure level in spontaneously hypertensive rats. The combination of a depressor response and reduced heart rate in the 'donors' renders further evidence that the medullipins are the principal, though probably not the only, humoral antihypertensive factors released from the cross-circulated kidneys.     

Blood pressure reactions to acute psychological stress and future blood pressure status: a 10-year follow-up of men in the Whitehall II study

OBJECTIVE: The aim of this study was to examine whether blood pressure reactions to mental stress predicted future blood pressure and hypertension. METHODS: Blood pressure was recorded at an initial medical screening examination after which blood pressure reactions to a mental stress task were determined. A follow-up screening assessment of blood pressure and antihypertensive medication status was undertaken 10 years later. Data were available for 796 male public servants, between 35 and 55 years of age upon entry to the study. RESULTS: Systolic blood pressure reactions to mental stress were positively correlated with follow-up screening systolic blood pressure and to a lesser extent, follow-up diastolic pressure. In multivariate tests, by far the strongest predictors of follow-up blood pressures were initial screening blood pressures. In the case of follow-up systolic blood pressure, systolic reactions to stress emerged as an additional predictor of follow-up systolic blood pressure. With regard to follow-up diastolic blood pressure, reactivity did not enter the analogous equations. The same outcomes emerged when the analyses were adjusted for medication status. When hypertension at 10-year follow-up was the focus, both systolic and diastolic reactions to stress were predictive. However, with correction for age and initial screening blood pressure, these associations were no longer statistically significant. CONCLUSIONS: The results of this study provide modest support for the hypothesis that heightened blood pressure reactions to mental stress contribute to the development of high blood pressure. At the same time, they question the clinical utility of stress testing as a prognostic device.     

Effect of clonidine at steady state on blood pressure in spontaneously hypertensive rats. Interaction of various alpha-adrenoceptor antagonists

The influence of various alpha-adrenoceptor antagonists (phentolamine, yohimbine, R 28935, prazosine, terazosine) on clonidine's blood pressure effects at different steady state plasma concentrations was investigated in awake spontaneous hypertensive rats. Clonidine's threshold (greater than 10 mmHg, less than 20 mmHg) antihypertensive effect was potentiated by phentolamine but opposed by centrally acting antagonists as was the maximal antihypertensive effect. The pressor response on the other hand was blocked by peripherally acting alpha-1- and alpha 2-antagonists. The effect of clonidine on blood pressure thus seems a consequence of both the tissue distribution and the alpha-adrenoceptor affinity. At low steady state plasma concentrations of clonidine a peripheral action could be a part of the antihypertensive mechanism.     

The antihypertensive effect of pinacidil versus prazosin in mild to moderate hypertensive patients seen in general practice

The antihypertensive effect of a new vasodilating drug, pinacidil, was compared with prazosin in a randomized, open study in general practice including 131 patients with a sitting diastolic blood pressure (DBP) between 100-115 mmHg. At inclusion 108 patients were untreated and the remaining patients were on treatment with thiazide diuretics and/or beta-blockers. The aim was to reduce the sitting DBP to less than or equal to 95 mmHg, which was achieved in 85% of the patients treated with pinacidil and in 77% of the patients treated with prazosin (NS). In the responding patients the reductions were (mean +/- SD) 16 +/- 7 mmHg (p less than 0.001) and 13 +/- 6 mmHg (p less than 0.001) in the pinacidil group (n = 60) and the prazosin group (n = 46), respectively (p less than 0.10). During 5 months of maintenance therapy no statistically significant differences in blood pressures between the two treatment groups were present. Side-effects were typical of vasodilator therapy, i.e. headache, dizziness, tachycardia and edema, leading to discontinuation of therapy in 10 patients in each treatment group. Heart rate (HR) was increased with pinacidil and unchanged with prazosin. Edema was frequently seen with pinacidil and dizziness with prazosin. Because of edema a thiazide diuretic was given to nine patients in the pinacidil group and two patients in the prazosin group. No clinically significant changes in ECG and biochemical variables were observed. In conclusion, the study has demonstrated that pinacidil is as effective an antihypertensive agent as prazosin. Pinacidil may be used as monotherapy. However, the study suggests that pinacidil should be used as add-on therapy to thiazide diuretics.     

Treatment of hypertension

Summary In the Munich Blood Pressure Study (MBS), a cross-sectional study (MBS I) with follow-up (MBS II) of a random sample of 3,198 citizens aged 30–69 (response rate, 69.3%), treatment and control of hypertension were examined.Of the actual hypertensives 59% (221) in MBS II (373) were on drug treatment and about two-thirds (150) of those being treated had controlled blood pressure (BP). Women's BP was better controlled than men's.Of the 221 treated hypertensives 85% (188) received types of drugs or drug combinations which were in accordance with the recommendations of the German Hypertension League. However, this did not apply to the prescribed dosages of the various drugs. Of the treated hypertensives 52% were either on a diuretic, on a beta-blocker, or on a combination of both drugs. Rauwolfia alkaloids combined with a diuretic were given to 27%.In 79% of the participants who had received a beta-blocker either alone or in combination with other antihypertensive agents and who still had high BP values, the prescribed beta-blocker dosage was below the recommended daily dose. Fatigue was the most frequently reported symptom, possibly attributable to antihypertensive drug treatment.Electrocardiographic signs of left ventricular hypertrophy were found less frequently in controlled hypertensives, in comparison to treated but uncontrolled hypertensives or untreated hypertensives.Abbreviations AV Atrioventricular - BMI Body mass index - BP Blood pressure - DBP Diastolic blood pressure - GKV Gesetzliche Krankenversicherung - ISH International society for hypertension - LVH Left ventricular hypertrophy - MBS Munich blood pressure study - NHANES National health and nutrition examination survey - SBP Systolic blood pressure     

Are patients with dementia treated as well as patients without dementia for hypertension,diabetes, and hyperlipidaemia?

Background

Patients suffering from dementia are at risk of being treated differently by GPs from patients without it. Explanations for this could be stigmatisation, treatment with a palliative approach, and the result of the disease process.

Aim

To ascertain whether patients with dementia are treated differently, the index diseases of hypertension, diabetes, and hyperlipidaemia were used to measure care.

Design of study

Retrospective matched control study.

Setting

German general practice.

Method

Sixteen GP practices recruited all their patients with dementia and at least one of the index diseases. Patients without dementia but only the index diseases were matched for age, sex, index disease, and practice, resulting in 216 pairs of patients with and without dementia. From the files, blood pressure, blood sugar/glycated haemoglobin, cholesterol, the dates of measurement, the number of doctor–patient contacts, and the prescribed medication to treat the three conditions under scrutiny were documented. For analysis, t-tests and χ²-tests were used.

Results

No differences were found in treatment outcomes between the two patients groups, except one significant difference: one of the two documented systolic blood pressure values is lower in the dementia group. Furthermore, patients with dementia more often do not receive any medication or are treated with low-priced medications for hypertension (nearly significant).

Conclusion

GPs do not seem to treat patients with dementia differently. The use of lower-priced antihypertensive medication could be the only indication for some kind of difference in approach.     

妊娠期高血压病患者产后降压治疗的效果分析

目的 分析妊娠期高血压疾病患者产后抗高血压治疗的临床效果。方法 回顾性分析2013年6月~2016年6月我院收治的124例妊娠期高血压疾病患者,按照是否进行抗高血压治疗分为观察组和对照组,观察组64例,对照组60例。观察组患者产后采用抗高血压治疗,对照组患者产后未进行治疗或者进行不规范的降压治疗,对两组患者血压水平进行比较。结果 相对于对照组,观察组患者产后血压接近正常的时间更短,尿蛋白转阴更快,高血压遗留率相更低,差异具有统计学意义（P＜0.05）。结论 妊娠期高血压疾病的患者若产后血压和蛋白尿仍未正常,积极抗高血压治疗,能有效降低高血压的遗留率,促进恢复。     

Stopping drug treatment of hypertension: experience in 18 British general practices.

BACKGROUND: Of the many reports published describing the effect of withdrawing antihypertensive medication from patients who have well-controlled blood pressure, none have been major British general practice studies. Studies from other settings have shown that a substantial minority can do so without harm or resulting in the relapse of their hypertension. AIM: To determine the proportion of hypertensive patients who could have their medication withdrawn without relapse, and to seek factors associated with success at withdrawal. METHOD: A longitudinal observational study in 18 general practices in north-east England. Practices selected and managed patients to guidelines suggested by the study protocol. Data were abstracted from records by practice staff over three years of follow-up. RESULTS: A total of 196 out of 224 (88%) patients were followed up. Forty-three (22%) of these 196 remained normotensive off medication for the whole study. A total of 108 (55%) of the 196 had restarted medication by three months. Twenty-six (31%) of the 84 males, but only 17 (15%) of the 112 females, remained off medication. No differences in age, morbidity, symptoms, or biochemical parameters occurred between the group who stayed off medication and those who restarted it. Apart from male sex, no factors were found that enabled the prediction of patients more likely to succeed at stopping medication. CONCLUSIONS: One-fifth of well-controlled hypertensives in British primary health care could have their medication withdrawn without the relapse of their hypertension or any harm. Of those that do relapse, over half are likely to have done so before three months. Life-long observation of all patients is essential.