Risk factors for uncontrolled hypertension in Italy.

To identify factors related to poor control of blood pressure in primary care, we designed a retrospective case-control analysis of clinical and demographic data recorded in the General Practitioners (GP) database. Study data were provided on a voluntary basis by 21 GPs from a practice-based network in primary care. The study included 2519 hypertensive patients enrolled between January 1 and December 31, 2000. The interventions were antihypertensive medication, and the main outcome measures were control of systolic and diastolic blood pressure (BP). The independent variables considered were: age of patient and GP; patient gender, body mass index, history of smoking, diabetes mellitus, or cholesterol tests; family history of hypertension; previous visits for cardiologic, nephrologic, or vascular surgery evaluation; prior hospitalizations for myocardial infarction or heart failure, and number of admissions for surgery; length of patient follow-up, type of antihypertensive medication, mean daily dosage, adherence to the drug regimen, and number of other medications currently being taken by the patient. Blood pressure was uncontrolled (>140/90 mmHg) in 1525 (60%) of the 2519 hypertensive patients enrolled. The presence of diabetes mellitus, increasing patient age, and increasing GP age significantly increased the risk of uncontrolled BP. Factors significantly associated with a reduced risk of uncontrolled BP were the number of other medications currently being taken by the patient and a prior history of MI. We conclude that the failure of antihypertensive medication to adequately control BP is determined by both the patient's characteristics and factors related to the patient-doctor relationship. Successful treatment of hypertension requires patient adherence to the regimen that has been agreed on by the patient and the physician.

[Radiotherapy with 131J and 125J of Basedow's disease. Indications and results relative to the incidence of post-actinic hypothyroidism]. / La terapia radioisotopica con 131J e 125J nel morbo di Basedow.

The indications for radioisotope management in Basedow's disease and the complications involved are explained. Particular reference is made to the possibility of early or late hypothyroidism when 131I and 125I are employed for this purpose. The physiopathogenetic bases for this are examined in relation to dosage and early diagnosis. Results obtained with small doses (fractionated in some cases) of these isotopes in 126 patients with thyrotoxicosis. One-year and later follow-up was directed to the clinical and functional responses to treatment in the light of age, sex, T4, maximum uptake, eff. T/2, thyroid size, and doses administered. Recurrences were rather frequent and further doses were given. However, early hypothyroidism was very rare. This appeared to be related to the dose administered and inversely to gland size. The results are compared with those in the literature.