Effective control of hypertension: a project of the Hungarian Society of Hypertension, baseline data.

The aim of the project is to assess the quality and improve the preventive and curative practices at the primary care level in Hungary. A total of 50 general practitionaires were selected on a voluntary basis in Budapest, Hungary, and from them, 30 were randomized to the intervention (I) group and 20 to the reference (R) group. The members in the I group have been trained for the official hypertension guideline and their everyday work is monitored. Those in the R group have only been monitored to measure the efficacy of the training. In all, 10% from the known hypertensive persons (N=10,799) and 5% of the remaining (nonhypertensive) patients (N=60,341) were selected randomly from the GP's computer files and invited for screening investigation performed by trained medical students. They measured the blood pressure of patients, assessed the cardiovascular risk status and the quality of education of patients by standardized questionnaires. In total, 4083 patients were invited, but only 39.2% attended the screening visit. The prevalence of undetected hypertension was 34.6%. This prevalence was significantly higher in the older (>60 years: 46.8%) than in the younger (<50 years: 20.8%, P<0.0001) age group and it was higher in men (41.5%) than in women (30.1%, P<0.001). The proportion of H patients on drug treatment was 85.3% and the frequency of patients under effective blood pressure control (eg<140/90 mmHg) was 27.8%. Counselling to patients for a healthier lifestyle (exercise, smoking, alcohol consumption, diet) was very rare. In conclusion, our data represent the primary care of Budapest and may not be relevant to the whole country. As a consequence of this study, education of primary care physicians and patients is a must for further improvement of hypertension care.

The role of health promotion in prevention policy against cardiovascular diseases in Hungary.

The development of public health has been a high priority in recent years in Hungary. In spite of concentrated efforts to establish a more advanced health service, the health status of the population has not improved and trends in mortality and morbidity are still unfavourable. Risk factors from the environment and from health-damaging behaviour are generally accepted as the main causes of cardiac diseases, yet lay people still think that progress in therapy can compensate for the effects of an unhealthy, overstrained and self-exploiting way of life. We might have well-educated experts and well-equipped institutes but two in three victims of myocardial infarction do not even reach hospital. A reorientation of health policy to a more prevention-focused approach and joint activities of all administrative, economic and social sectors coordinated at government level are necessary to put health in a more favourable position in the pattern of values in our society. The medical and sociological research work and the community level prevention activities began in 1982 in the 17th district of Budapest. The data of 1,611 residents of the district aged 25-64 were analysed. From data on nutrition, leisure-time physical activity, obesity, blood pressure distribution, and smoking habits it was established that socially unfavourable conditions cause a higher risk of cardiovascular diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of indomethacin on transcapillary exchange.

The effect of isosmotic hypervolaemia induced by intravenous saline infusion, on the Evans blue space, haematocrit, plasma protein concentration and urine output in dogs under anaesthesia was investigated. In hypervolemia, the Evans blue space increased by 25--30%, while the haematocrit did not change. The change in the plasma protein level was the same as that observed in control animals. Urine output increased significantly under the effect of hydration. When 4 mg/kg of indomethacin was given before a saline load, the Evans blue space did not change under the effect of hydration, the haematocrit decreased significantly, and the plasma protein level changed in the same way as in the two other groups. Urine output did not exceed the control value (without hydration) in spite of the saline load. It is concluded that indomethacin pretreatment inhibits the transcapillary fluid exchange.

Plasma volume in isosmotic hypervolaemia.

The Evans-blue distribution volume, haematocrit, and plasma protein concentration were investigated in non-hydrated (control), hydrated, and acutely nephrectomized hydrated, anaesthetized dogs. In control anaesthetized dogs a decrease of the plasma protein level was observed as part of the plasma proteins was lost into the extravascular space and did not return into the circulating plasma during the experimental period. Under the effect of hydration, the Evans-blue distribution volume increased significantly, while the haematocrit and plasma volume did not change. The phenomenon was ascribed to an increase in capillary permeability. During hydration following acute nephrectomy, the Evans-blue distribution volume increased but the haematocrit disecreased and the circulating plasma volume increased. It is concluded that a material (or materials) orginating from the kidney may influence capillary permeability.