[Hypertension short message service]. / Blutdrucksms.

Hypertension Short Message Service is a new tool for disease management aimed at improving the success of the doctor's daily routine in hypertension treatment both in terms of the quality of hypertension assessment and concerning the efficacy of treatment. At present there is a wide and disappointing difference between the results of treatment in routine work [1] and in clinical trials [2, 3] even when the same cohort of patients is treated by the same therapists. The efficacy rate in daily routine is about 20-35% as compared to 70-85% during trials. Assuming this gap is due to differences in disease management we integrated short message service and Internet applications into a new hypertension management tool (Blutdrucksms). According to our registry data "Blutdrucksms" is very successful: More than 80% of our hypertensive patients were treated to target. In June 2008, we implemented the SMS-Blood Pressure Protocol, and in October 2010, we analyzed the data of all "Blutdrucksms" users available in our registry. By then a total of 568 patients - 44% female and 56% male - had sent their self-recorded blood pressure readings as short messages to the SMS-Center; 75% of these patients had had at least one organ damage (left ventricular hypertrophy, increase in intima media thickening or carotid plaque). Mean casual blood pressure, recorded before enrolment into the SMS-program, was 152/83. It had improved to 136/80 mmHg by October 2010. The mean of the self-recorded blood pressures of the last month of participation was 128/76 mmHg and a heart rate of 69 beats per minute; 85% of all hypertensive patients had their pressures at treatment goal. Thus, we assume that "Blutdrucksms" is an excellent tool to improve the efficacy of antihypertensive disease management in routine work. We assume that the success is due to the enhanced communication between patient and doctor via SMS. As we are aware of the weakness of registry analysis we try to set up a controlled prospective study to compare "Blutdrucksms" users to non-users.

Influence of artificial sweetener on human blood glucose concentration.

Artificial sweeteners, such as saccharin or cyclamic acid are synthetically manufactured sweetenings. Known for their low energetic value they serve especially diabetic and adipose patients as sugar substitutes. It has been hypothesized that the substitution of sugar with artificial sweeteners may induce a decrease of the blood glucose. The aim of this study was to determine the reliability of this hypothesis by comparing the influence of regular table sugar and artificial sweeteners on the blood glucose concentration. In this pilot-study 16 patients were included suffering from adiposity, pre-diabetes and hypertension. In the sense of a cross-over design, three test trials were performed at intervals of several weeks. Each trial was followed by a test free interval. Within one test trial each patient consumed 150 ml test solution (water) that contained either 6 g of table sugar ("Kandisin") with sweetener free serving as control group. Tests were performed within 1 hr after lunch to ensure conditions comparable to patients having a desert. Every participant had to determine their blood glucose concentration immediately before and 5, 15, 30 and 60 minutes after the intake of the test solution. For statistics an analysis of variance was performed. The data showed no significant changes in the blood glucose concentration. Neither the application of sugar (F(4;60) = 1.645; p = .175) nor the consumption of an artificial sweetener (F(2.068;31.023) = 1.551; p > .05) caused significant fluctuations in the blood sugar levels. Over a time frame of 60 minutes in the control group a significant decrease of the blood sugar concentration was found (F(2.457;36.849) = 4.005; p = .020) as a physiological reaction during lunch digestion.

Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study.

OBJECTIVE: Few data are available comparing the effects of monotherapy and combination therapy on target organ damage. The PICXEL study compared the efficacy of a strategy based on first-line combination with perindopril/indapamide versus monotherapy with enalapril in reducing left ventricular hypertrophy (LVH) in hypertensive patients. METHODS: In this 1-year multicentre randomized double-blind study, patients received an increasing dosage of perindopril/indapamide (n = 284) or enalapril (n = 272). Changes in blood pressure and echocardiographic measures of LVH were assessed from baseline to the end of treatment. Reading of the echocardiograms was central and blinded for therapy, patient and sequence. RESULTS: Systolic and diastolic blood pressure decreased significantly more in the perindopril/indapamide than in the enalapril group (P < 0.0001 and P = 0.003). The left ventricular mass index decreased by 13.6 +/- 23.9 g/m(2) (mean +/- SD) with perindopril/indapamide (P < 0.0001) and 3.9 +/- 23.9 g/m(2) with enalapril (P < 0.005); these decreases were significantly different (P < 0.0001). The left ventricular internal diameter, posterior and interventricular septal wall thickness decreased significantly with perindopril/indapamide (P < or = 0.0001); the interventricular septal wall thickness decreased significantly with enalapril (P < 0.001). Both treatments were well tolerated. CONCLUSION: A strategy based on first-line combination with perindopril/indapamide achieved better blood pressure decrease with a significantly greater degree of LVH reduction than a strategy based on monotherapy with enalapril in hypertensive patients with LVH.

Felodipine-metoprolol combination tablet: maintained health-related quality of life in the presence of substantial blood pressure reduction.

BACKGROUND: Most treated hypertensive patients do not achieve adequate blood pressure (BP) control. Initiating therapy with two drugs has been suggested when BP is >20/10 mm Hg above goal. To ensure patients' compliance, such treatment needs to be well tolerated and must not compromise health-related quality of life (HRQL). The primary objective of this study was to compare the effects on HRQL of initiating treatment with felodipine + metoprolol (F+M) fixed combination tablets, or enalapril (E), or placebo (P). METHODS: A total of 947 patients of both sexes with primary hypertension (diastolic BP 95 to 110 mm Hg), aged 20 to 70 years, participated in this randomized, double-blind, parallel group, 12-week, multicenter trial. Treatment was initiated with F+M 5 + 50 mg, or E 10 mg, or P. Doses were doubled after 4 or 8 weeks if diastolic BP was >90 mm Hg. The HRQL was measured at baseline and at the last visit using two validated questionnaires: the Psychological General Well-being Index (PGWB) and the Subjective Symptom Assessment Profile (SSA-P). Office BP was measured at trough, that is, 24 h after the previous dose. RESULTS: The HRQL was high at baseline and generally well maintained during the study. For example, the mean (SD) PGWB total score was 104 (16) at baseline and 105 (16) at 12 weeks in all three treatment groups. The BP reductions after F+M (18/14 mm Hg) and E (12/9 mm Hg) were significantly greater than after P (7/7 mm Hg), and the reduction after F+M was significantly greater than after E. CONCLUSIONS: The HRQL is maintained in the presence of substantial BP reduction during antihypertensive treatment with F+M fixed combination tablets.

Blood pressure responses after carotid surgery: relationship to postoperative baroreceptor sensitivity.

BACKGROUND AND PURPOSE: Among hypertensive patients after carotid surgery, a group of patients with increased baroreflex sensitivity was identified. In the other group of hypertensive patients, blood pressure and reflex sensitivity were unchanged postoperatively. We hypothesized that a partial readjustment of baroreceptor sensitivity would produce more stable blood pressure profiles. METHODS: In order to test this hypothesis, a prospective, long-term follow-up study was designed. Blood pressure was monitored in 18 hypertensive and 6 normotensive patients during 6 months using a self-measurement technique. In addition, continuous 24-hour blood pressure monitoring was performed 6 months after surgery. The mean values and the ranges (amplitudes) of systolic and diastolic blood pressure were calculated as indicators for the stability of the circulatory system. RESULTS: Hypertensive patients with unchanged postoperative baroreceptor sensitivity showed significantly more pronounced instabilities of their blood pressure profiles (amplitudes of systolic and diastolic blood pressure p < 0.05 to p < 0.001). A relationship between baroreceptor function and antihypertensive therapy could also be demonstrated, with adequate therapy being much more difficult in patients with reduced or unchanged baroreceptor sensitivity. CONCLUSIONS: In contrast to vascular surgery on the aorta or in the region of the lower limbs, carotid surgery is frequently associated with blood pressure changes, demonstrating the essential role of the baroreceptors in the carotid sinus for the regulation of postoperative blood pressure. Since it seems to be the variability of blood pressure, and not the blood pressure level alone, that is critical, close blood pressure monitoring--allowing for an assessment of blood pressure variability--appears to be of particular importance in such patients.

Impact of mental and physical stress on blood pressure and pulse pressure under normobaric versus hypoxic conditions.

OBJECTIVE: Hypobaric hypoxia, physical and psychosocial stress may influence key cardiovascular parameters including blood pressure (BP) and pulse pressure (PP). We investigated the effects of mild hypobaric hypoxia exposure on BP and PP reactivity to mental and physical stress and to passive elevation by cable car. METHODS: 36 healthy volunteers participated in a defined test procedure consisting of a period of rest 1, mental stress task (KLT-R), period of rest 2, combined mental (KLT-R) and physical task (bicycle ergometry) and a last period of rest both at Graz, Austria (353 m asl) and at the top station Dachstein (2700 m asl). Beat-to-beat heart rate and BP were analysed both during the test procedures at Graz and at Dachstein and during passive 1000 m elevation by cable car (from 1702 m to 2700 m). RESULTS: A significant interaction of kind of stress (mental vs. combined mental and physical) and study location (Graz vs. Dachstein) was found in the systolic BP (p = .007) and PP (p = .002) changes indicating that during the combined mental and physical stress task sBP was significantly higher under hypoxic conditions whereas sBP and PP were similar during mental stress both under normobaric normoxia (Graz) and under hypobaric hypoxia (Dachstein). During the passive ascent in cable car less trivialization (psychological coping strategy) was associated with an increase in PP (p = .004). CONCLUSION: Our data show that combined mental and physical stress causes a significant higher raise in sBP and PP under hypoxic conditions whereas isolated mental stress did not affect sBP and PP under hypoxic conditions. PP-reaction to ascent in healthy subjects is not uniform. BP reactions to ascent that represents an accumulation of physical (mild hypobaric hypoxia) and psychological stressors depend on predetermined psychological traits (stress coping strategies). Thus divergent cardiovascular reactions can be explained by applying the multidimensional aspects of the biopsychosocial concept.

The Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) trial: outcomes in patients receiving monotherapy.

In the main Valsartan Antihypertensive Long-Term Use Evaluation (VALUE) report, we investigated outcomes in 15 245 high-risk hypertensive subjects treated with valsartan- or amlodipine-based regimens. In this report, we analyzed outcomes in 7080 patients (46.4%) who, at the end of the initial drug adjustment period (6 months), remained on monotherapy. Baseline characteristics were similar in the valsartan (N=3263) and amlodipine (N=3817) groups. Time on monotherapy was 3.2 years (78% of treatment exposure time). The average in-trial blood pressure was similar in both groups. Event rates in the monotherapy group were 16% to 39% lower than in the main VALUE trial. In the first analysis, we censored patients when they discontinued monotherapy ("censored"); in the second, we counted events regardless of subsequent therapy (intention-to-treat principle). We also assessed the impact of duration of monotherapy on outcomes. No difference was found in primary composite cardiac end points, strokes, myocardial infarctions, and all-cause deaths with both analyses. Heart failure in the valsartan group was lower both in the censored and intention-to-treat analyses (hazard ratios: 0.63, P=0.004 and 0.78, P=0.045, respectively). Longer duration of monotherapy amplified between-group differences in heart failure. New-onset diabetes was lower in the valsartan group with both analyses (odds ratios: 0.78, P=0.012 and 0.82, P=0.034). Thus, despite lower absolute event rates in monotherapy patients, the relative risks of heart failure and new-onset diabetes favored valsartan. Moreover, these findings support the feasibility of comparative prospective trials in lower-risk hypertensive patients.

[Blood pressure and arterial stiffness. A comparison of two devices for measuring augmentationindex and pulse wave velocity]. / Arterieller Blutdruck und die Elastizität der Arterienwand Augmentationsindex (AIx) und Pulswellengeschwindigkeit (PWV): Ein Vergleich von zwei Messgeräten.

Augmentationindex (AIx) and Pulse Wave Velocity (PWV) give much more information on the function of the arterial tree than that obtained by blood pressure recordings. The rediscovered value of arterial stiffness measured by means of AIx or PWV is now proven as an independent cardiovascular risk factor and helps to differentiate patients at risk and their cardiovascular treatment offer. In the last decade, the methods to measure and to calculate AIx and PWV have become increasingly simple. But as the different methods use different strategies for measuring and calculating these parameters, the results concerning the same term vary, depending on the device used. We undertook nearly simultaneous recordings of AIx in 400 and of PWV in 100 treated hypertensive patients with the very new TensioClinic device developed by M. Illyés, and compared those data with measurements obtained by the SphygmoCor device. The absolute values of m (mean) and SD (standard deviation) of AIx were when TensioClinic was used m: -6.2 % +/- SD:37.9 % and by SphygmoCor m: 26,2 % +/- SD: 11,8 %. The differences were caused by the different methods. As both devices measure the same quality of vascular function, the results correlate closely with a correlation coefficient r = 0.77. In PWV the results of Aortic PWV measured by TensioClinic were m: 9.1 +/- SD: 1.8m/sec and of brachial PWV measured by SphygmoCor: 8.4 +/- SD: 1.5 m/sec. As in AIx, these results were also different, but in contrast to AIx they did not correlate (r = -0.04) because PWV depend on the artery and its physical characteristics, and we

[The theory-practice problem of blood pressure assessment]. / Das Theorie-Praxisproblem bei der Blutdruckbeurteilung.

The theoretical basis for assessment of blood pressure described in the guidelines of the ISH-ESC and in JNC 7 ignores the variability of blood pressure and is therefore not applicable in general practice. Although the guidelines do not meet the daily requirements, they are not questioned by the physician, and are therefore confusing both physicians and millions of patients taking self-recordings. The unsolved problems are: The confidence interval for the single readings and the mean values are ignored. For this reason, the assignment of the patient to the different categories of hypertension is variable and dependent on pure chance. The effects of therapy cannot be detected in a reliable way. Judging the quality of self-recorded data, the blood pressure variability is interpreted as an error of measurement. The problem can be avoided if, instead of single values, mean values out of a sufficient number of measurements and their confidence intervals are assessed.