Intensive versus conventional blood pressure monitoring in a general practice population. The Blood Pressure Reduction in Danish General Practice trial: a randomized controlled parallel group trial.

Objective: To compare the effect of a conventional to an intensive blood pressure monitoring regimen on blood pressure in hypertensive patients in the general practice setting. Design: Randomized controlled parallel group trial with 12-month follow-up. Setting: One hundred and ten general practices in all regions of Denmark. Participants: One thousand forty-eight patients with essential hypertension. Intervention: Conventional blood pressure monitoring ('usual group') continued usual ad hoc blood pressure monitoring by office blood pressure measurements, while intensive blood pressure monitoring ('intensive group') supplemented this with frequent home blood pressure monitoring and 24-hour ambulatory blood pressure monitoring. Primary outcome measures: Mean day- and night-time systolic and diastolic 24-hour ambulatory blood pressure. Secondary outcome measures: Change in systolic and diastolic office blood pressure and change in cardiovascular risk profile. Results: Of the patients, 515 (49%) were allocated to the usual group, and 533 (51%) to the intensive group. The reductions in day- and night-time 24-hour ambulatory blood pressure were similar (usual group: 4.6 ± 13.5/2.8 ± 82 mmHg; intensive group: 5.6 ± 13.0/3.5 ± 8.2 mmHg; P = 0.27/P = 0.20). Cardiovascular risk scores were reduced in both groups at follow-up, but more so in the intensive than in the usual group (P = 0.02). Conclusion: An intensive blood pressure monitoring strategy led to a similar blood pressure reduction to conventional monitoring. However, the intensive strategy appeared to improve patients' cardiovascular risk profile through other effects than a reduction of blood pressure. Trial registration: Clinical Trials NCT00244660.

Is a targeted intensive intervention effective for improvements in hypertension control? A randomized controlled trial.

BACKGROUND: High blood pressure (BP) is one of the most important risk factors for stroke, and antihypertensive therapy significantly reduces the risk of cardiovascular morbidity and mortality. However, achieving a regulated BP in hypertensive patients is still a challenge. OBJECTIVE: To evaluate the impact of an intervention targeting GPs' management of hypertension. METHODS: A cluster randomized trial comprising 124 practices and 2646 patients with hypertension. In the Capital Region of Denmark, the participating GPs were randomized to an intensive or to a moderately intensive intervention group or to a control group and in Region Zealand and Region of Southern Denmark, practices were randomized into a moderately intensive intervention and to a control group. The main outcome measures were change in proportion of patients with high BP and change in systolic BP (SBP) and diastolic BP (DBP) from the first to the second registration. RESULTS: The proportion of patients with high BP in 2007 was reduced in 2009 by ~9% points. The mean SBP was reduced significantly from 2007 to 2009 by 3.61 mmHg [95% confidence interval (CI): -4.26 to -2.96], and the DBP was reduced significantly by 1.99 mmHg (95% CI: -2.37 to -1.61). There was no additional impact in either of the intervention groups. CONCLUSION: There was no impact of the moderate intervention and no additional impact of the intensive intervention on BP.

High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event.

AIM: The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention of cardiovascular events should be addressed aggressively. The present study was aimed at providing a valid estimate on the prevalence of PAD in patients attending their general practitioner and having previously suffered a cardio- or cerebrovascular event. PATIENTS AND METHODS: 1000 patients with a previous cardiovascular event were screened and PAD was considered present when the ankle-brachial index (ABI) of systolic blood pressure was less than 0.90 using the current recommended technique. RESULTS: 965 (659 men) patients met the inclusion criteria and had detectable systolic blood pressures on the arms and ankles. Mean age was 70±8 years, 77% were current or previous smokers, and 188 patients were diabetics. The medical history included stroke in 392, transitory ischemic attacks in 77, acute coronary syndrome in 298, and ST-elevation myocardial infarction in 253. Brachial systolic and diastolic blood pressures were 139±18 mmHg and 79±12 mmHg, respectively. Total and LDL-cholesterols were 4.5±1.0 mmol/l and 2.4±0.8 mmol/l, respectively. 625 patients were without PAD, 322 had mild to moderate PAD and 18 had severe PAD. The overall prevalence of PAD was 35.3%. CONCLUSION: In patients with previous coronary or cerebrovascular events, PAD occurs with a much higher prevalence than previously estimated. It is suggested that screening for PAD is justified and that it should be carried out in these patients in order to regulate the possible lifestyle and medical intervention.

[Can emergency admissions to departments of internal medicine be replaced by planned admissions?]. / Kan akutte indlaeggelser konverteres til planlagte indlaeggelser på medicinske afdelinger?

INTRODUCTION: The aim of the study was to describe the pattern of admissions to a medical department and to analyse how far acute admissions can be replaced by planned subacute admissions to an outpatient department. MATERIALS AND METHODS: All acute admissions to the medical department during two six-day periods were registered. The department's registrars filled in a structured questionnaire and the senior registrars evaluated the admissions. In addition, a local general practitioner evaluated one-third of the admissions. RESULTS: Altogether, 214 consecutive patients were entered in the study. One-third of the patients had consulted their GP in the week before the admission. Admissions from the casualty department and from GPs were assessed as appropriate in 92% and 71% of the cases, respectively. The senior registrars assessed that 17-20% of the acute admissions could have been replaced by a subacute, planned admission. Only 5% of the patients shared this conclusion. The ability to predict the total length of stay was limited, and greatest accuracy was achieved in prediction of short-term stays. DISCUSSION: In a medical department with many acute admissions, it is possible to replace acute admissions with planned subacute admissions for a large group of patients.

[Pharmacological hypertension therapy]. / Farmakologisk hypertensionsbehandling.

Drug therapy in uncomplicated hypertension can be initiated with either ACE-inhibitors, angiotensin II receptor antagonists, calcium channel blockers or thiazides. In younger patients, the first three classes are preferable. Beta-blockers are first-line drugs for hypertension in patients with cardiac comorbidity. Initial combination therapy is indicated in high-risk patients where blood pressure reduction of > 20/10 mmHg is desired. Resistant hypertension generally calls for an increment in diuretic dosage and/or addition of a potassium-sparing diuretic.