A new approach to blood pressure measurement in the primary care setting.

In this study, a method of taking one blood pressure reading using a sphygmomanometer was compared with a method of taking multiple successive readings using an automatic device. With multiple readings the blood pressure tended to be lower and fewer patients were classified as hypertensive. Using an automatic blood pressure recording device seems to be a practical way of achieving multiple readings in a busy clinic setting.

Treatment of hypertension during pregnancy with hydralazine monotherapy or with combined therapy with hydralazine and pindolol.

Forty-four consecutive patients referred for treatment because of hypertension (greater than 150/90 mmHg) occurring during pregnancy were randomly allocated to one of two treatment groups, hydralazine alone (n = 21) or hydralazine combined with pindolol (n = 23). Satisfactory blood pressure control (diastolic pressure less than 90 mmHg) was achieved in 86% of patients receiving hydralazine alone and 91% of those on combined therapy. Although the treatment did not lower the overall incidence of hypertensive complications it appeared to delay the onset of such complications until successful surgical intervention was possible. Fetal outcome was similar in both groups and there was no perinatal mortality in this high-risk population. Although blood pressure control was similar in both groups of patients, combined therapy with hydralazine and pindolol can be considered to be superior to hydralazine monotherapy, since in patients treated with the combination the incidence and intensity of troublesome side-effects was markedly lower.

[The effect of omega-3 fatty acids on risk factors for cardiovascular diseases].

UNLABELLED: Cardiovascular disease (CVD) is associated with dyslipidemia and frequently with insulin resistance, both of which are in general no alleviated by antilipidemic drugs. Our objective was to examine whether a dietary supplement containing omega-3 fatty acids (n-3 FA) can reduce the levels of serum lipids, fasting insulin and glucose in documented CVD patients treated by statins or bezafibrates. In a double-blind placebo-controlled trial of parallel design, 52 patients, age 69.2 years +/- 3.6 treated by antilipidemic drugs, were randomly assigned to receive daily 7 gr of a dietary concentrated supplement containing 67% n-3 FA (185 mg EPA and 465 mg/g DHA) in a form of spread (Yamega Ltd, Israel) or olive oil spread (placebo) and recommended to reduce the consumption of omega-6 fatty acids for 12 weeks. The average values +/- SD before and after dietary supplementations were compared. RESULTS: 44 patients (23 in the n-3 FA group) completed the study. In the n-3FA group we observed a significant decrease (p < 0.05) of total cholesterol (12.2%). LDL-cholesterol (16.8%), triglycerides (36.1%), insulin in hyperinsulinemic subjects (> 20 microunits/ml) (34.9%), and no significant changes in HDL-cholesterol and glucose. No hyperglycemia was detected. In the olive oil group we observed a significant decrease (p < 0.05) in the LDL-cholesterol values of 15.5% and no significant changes in the other parameters. No side effects were reported during the study in any of the participants. Our findings demonstrate that the incorporation of the dietary supplement containing EPA and DHA omega-3 fatty acids reduces significantly the above risk factors for CVD.

Treatment with propranolol and hydralazine throughout pregnancy in a hypertensive patient. A case report.

A chronic hypertensive patient was treated with alpha-methyldopa and diuretics throughout the 30 weeks of her second unsuccessful pregnancy. Treatment with propranolol and hydralazine was effective in controlling her blood pressure and was continued throughout her next two pregnancies, both of which were successful. No adverse reactions were observed in either the mother or the infants. The possibility that this combined treatment is beneficial to both mother and child in such cases should be further explored.

An epidemiologic study of renal failure. I. The need for maintenance hemodialysis.

A nationwide morbidity study of end-stage kidney disease in Israel revealed a mean annual incidence rate, in the two-year period 1965-1966, of 70 cases per million per year requiring maintenance hemodialysis in the age 15-59 Jewish population. Chronic glomerulonephritis (38%) chronic pyelonephritis (24.9%) and polycystic disease (8.1%) represented the three most common diagnostic entities. It is suggested that the load of new cases on available dialysis units will not increase indefinitely but that an equilibrium will be established between the intake of new candidates and the outflow due to deaths and transplantation.

An epidemiologic study of renal failure. II. Acute renal failure.

A total community study of acute renal failure (ARF) was carried out in Israel. The mean annual incidence was 4.8/100,000, the risk being 50% higher in males than in females. It was found that ARF is due primarily to a multiplicity of factors and rarely to a single cause; the high mortality associated with ARF is related to the patient's basic underlying condition. The epidemiology of ARF results from a compilation of the various conditions leading to it, and would, therefore, vary according to the differential distributions of these conditions in the population.

Propranolol and hydrallazine in the management of essential hypertension in pregnancy.

A combination of propranolol and hydrallazine was administered to 13 patients with longstanding hypertension during 15 pregnancies. Hydrallazine was continued through labour and delivery in all patients, while in eight patients propranolol was discontinued 2 to 15 days before delivery. Blood pressure control was uniformly good and superimposed pre-eclampsia did not occur during combined therapy. There were 14 livebirths and one unexplained stillbirth. Except for two cases of milk hypoglycemia, there were no neonatal complications.

Massive proteinuria in patients with chronic pyelonephritis.

Massive proteinuria associated with chronic pyelonephritis is reported in five patients. Two of them were known to have vesicoureteral reflux, whereas three had minor predisposing factors only. None of the patients were in severe renal failure or suffered from severe hypertension at the time of massive proteinuria. Results of histological examinations were compatible with a diagnosis of chronic pyelonephritis. Electron microscopy and immunological studies did not show any primary glomerular lesions.