[Automatic blood pressure monitors. Even with seal of approval they are often inaccurate!]. / Blutdruck-Messautomaten. Selbst mit Prüfsiegel oft ungenau!

Owing to the permissible tolerances, even successfully tested automatic blood pressure devices may deliver quite false values. In the largest hypertension study (HOT study) so far carried out, the use of an oscillometric device cannot be considered to provide the "evidence base" for the tacit abandonment of the nonautomatic Korotkoff method, in particular in view of the contradictions in the published data on the device employed. When automatic devices are used in clinical trials, special regulations in the testing protocols of the devices, and a critical consideration of measuring methods in the discussion of the results, are mandatory.

Clopidogrel and membranous nephropathy.

Membranous nephropathy with nephrotic syndrome occurred in a patient with anterior myocardial infarction 2 months after the start of clopidogrel treatment. Sensitisation by prior treatment with ticlopidine is discussed.

[Practical conducting of blood pressure measuring. Important contributing factors and possibilities of errors]. / Praktische Durchführung der Blutdruckmessung. Die wichtigsten Einflussfaktoren und Fehlermöglichkeiten.

Studies have shown that both laypersons and doctors and medical staff have insufficient knowledge of the proper handling of blood pressure measurement. The resulting deviations in the measured values are of a diagnostically relevant order of magnitude capable of leading, for example, to an erraneous diagnosis of hypertension. Some of the factors frequently receiving too little attention are, for example, the use of an inappropriate cuff size, failure to ensure that the patient is adequately rested, and inappropriate positioning of the arm during measurement. Attention is drawn to the recommendations of the various hypertension societies.

[Primary Sjögren's syndrome and glomerulonephritis]. / Primäres Sjögren-Syndrom und Glomerulonephritis.

HISTORY AND CLINICAL FINDINGS: An 82-year-old woman with hypertension for 20 years developed a nephrotic syndrome with severe oedema followed by acute oliguric renal failure after a bout of bronchitis and a gastrointestinal infection. She also complained of xerostomia and dry eyes of recent onset. INVESTIGATIONS: Biochemical tests showed a serum creatinine level of 6.1 mg/dl, a 1:5120 antinuclear antibody (ANA) titre, and positive values for Ro(SS-A) and La(SS-B) antibodies. HLA-DR typing demonstrated HLA-DR3 (HLA-DRB1*0301) and DR13 (HLA-DRB1*13) antigens. Renal biopsy revealed minimal glomerular lesions with focal and segmental glomerulo-sclerosis as well as (hypertension-induced) benign nephrosclerosis and focal tubular atrophy with interstitial fibrosis. TREATMENT AND COURSE: After two hemofiltrations and concomitant administration of 100 mg prednisone renal function quickly improved and the proteinuria fell to 1 g/dl. At the same time the xerostomia improved. The nephrotic syndrome recurred 7 months later after the prednisone dose had been reduced to 10 mg/d, but after the dose had been raised to 50 mg/d and cyclosporin A (150 mg/d) had been added a lasting remission occurred and renal function became stable though impaired. CONCLUSION: The relatively rare association of glomerular disease (here focal segmental glomerulosclerosis) with Sjögren's syndrome can, as in this case, be triggered by a viral infection. A genetic predisposition for Sjögren's syndrome is suggested by the demonstration of HLA-DR3 alleles. Administration of steroids is indicated for the treatment of the nephrotic syndrome and, in case of recurrence, can be combined with cyclosporin A. Both drugs also influence the symptoms of Sjögren's syndrome.

Devices for blood pressure self measurement: tested in comparison.

OBJECTIVE: Comparative clinical evaluation of instruments designed for the self-measurement of blood pressure. METHOD: The usefulness of 27 different, exclusively oscillometric, automated devices were tested on a single group of 24 test persons without pressure-reducing arterial stenoses in the upper extremity. The cuff was to be put on the upper arm with 20 devices, on the wrist with five devices and on the left index finger with two devices. Per device and test person, six sequential comparative measurements were carried out using automated self-measurement and standard method with a double stethoscope in the same arm. RESULTS: On average, the devices measured the systolic pressure between 13.2 mmHg lower and 3.5 mmHg higher than the standard procedure; the diastolic pressure was measured between 17.4 and 0.2 mmHg lower. Using a scoring system, in which a device only got points for a comparative measurement if the differences to the control in systolic and diastolic measurement both were < or = 10 mmHg, the devices gained between 67 and 259 out of a maximum of 576 points. If each of the test persons had opted to buy just those devices which revealed a mean systolic and diastolic error of < or = 5 mmHg in his or her case, younger test persons would have found zero to five suitable devices older persons three to 13. The site of cuff application had no significant influence on results. CONCLUSIONS: Standard measurements and measurements with automated blood pressure self-measurement devices can differ considerably. In young test persons less suitable instruments are found than for older persons.