#150HIPPOCRATES   May  - July  2005  Vol. VII.  No. 3

 

BM

HIPPOCRATES   May - July  2005  Vol. VII.  No. 3  Page:    144

 

  TELEMEDICAL HOME BLOOD PRESSURE MNITORING IN CLINICAL PRACTICE

How  can optimal hypertension control be improved by TensioCare-system?

 

Béla Benczúr1, M. Illyés2

County Hospital, Hypertension Outpatient Clinic, Kecskemét, Hungary1,

  TensioCare Centre, Budapest, Hungary2

It’s well known that office blood pressure doesn’t perfectly represent the real blood pressure pattern of hypertensive patients due to „white-coat” hypertension. Ambulatory blood pressure monitoring (ABPM) is a valuable method for characterizing the patients’ blood pressure (BP) as a „cross-cut picture” according to a lot of measurements during 24 hours. Self blood pressure measurement (SBPM) is able to avoid the limitations of casual, office blood pressure readings and contributes to the ABPM data as a „longitudinal picture” of blood pressure changes. The low rate of well-controlled hypertension (4-25%) is mostly due to the poor compliance of patients.  Aim of the study: To compare the efficacy of two methods of hypertension management: the SBPM-based and the conventional (based on casual, office BP readings). Patients and method: Authors introduced self blood pressure measurement in therapy-resistant and/or high risk hypertensive patients controlled in the Hypertension Office. Internationally validated blood pressure monitors (BHS, AAMI) were used with built-in memories and automated data transmitting capabilities over the telephone network. Special monitoring protocol was developed and used. Office visits at Hypertension Clinic were performed only every third month. Patients regularly measured their BP in the 3-month interval between office visits at the pre-scheduled time points. BP readings were automatically downloaded to the service centre and monthly BP summaries confirmed by a „hypertension specialist” are provided to the patients and to their GPs. The physician can make decisions according to the received BP pattern of the previous period and give therapeutic advice to the patient over the phone performing the so-called „telemedical visits”. A control goup of patients with similar risk status was created in which the BP was measured only with conventional method (casual office readings without using SBPM). Therapeutic decision making was the privilege of the investigator (the treating physician) according to the recent guidelines in both patient groups in order to reach target blood pressure.  Results: SBPM was performed in 24 pts (15 female, and 9 male, mean age was 56.8±11 ys) for a mean duration of 3.3 months. The patients’ compliance to BP measurements was fairly good (58%). Control-group included 24 hypertensive pts with a mean age of 60±11 ys. Target BP was reached in 11 pts (45%) vs 10 (41%) (SBPM vs control group) while the responder rate (improved but not controlled BP) was 50% vs 25% in the two groups, respectively. The mean decrease of blood pressure was 23/13 vs 12/7 mmHg (SBPM- vs control-group) after the first month and 29/16 vs 25/11 mmHg at the end of the 3-month period. Interesting observation was made in the SBPM-group; spontaneously improved blood pressure trend occured in 6 pts during the monitoring period.  Conclusions: - Our data show that a management strategy based on home self blood pressure monitoring (SBPM) allows a significantly higher success rate in term of efficacy (hypertension control and response rate) than the conventional method based on casual office BP measurements. -„Virtual hypertension clinic” can improve the patients’ compliance and become a powerful tool to increase the rate of hypertension control. - Our findings suggest that telemedical blood pressure monitoring may have a beneficial effect on hypertension control without any changes of active treatment. – This method doesn’t need any special skill of physician (despite of ABPM) and the opportunity of continuous bidirectional consultative contact is provided between the treating physician and the „hypertension specialist” of service centre.

   

 

 

HIPPOCRATES   May - July  2005  Vol. VII.  No. 3  Page: 150  

 

 

 

REACH International registry for reduction of atherothrombosis for continued health.

G. Pfliegler, MD, PhD, national coordinator

Division of Rare Diseases, Institute of Medicine, University of Debrecen

H-4012 Debrecen, Hungary

Nagyerdei krt. 98.

Tel/Fax: 36-52-425574

e-mail: pfliegler@unideb.hu

 

Summary

Atherosclerosis and its most severe form, atherothrombosis belong to the leading causes of death int he developed world and especially in our country. Previously venous (e.g. deepl venous thrombosis) and arterial  (e.g. peripheral artery disease, myocardial infarction, stroke) were more or less treated separately from the medical point of view. Recent results reveild that theses syndromes are different manifestations of the same pathophysiological events in an indivisible organ, the vascular system.

Several studies had been carried out on general risk factors, e.g. smoking, obesity, hereditary thrombophilia, etc. The REACH (REduction of Atherothrombosis for Continued Health) study is based ont he recognition that beside the general risk factors for thr first time it focuses on national or even regional differences, characteristics. Data might be good basis for better understanding differences in risk factors and treatment modalities thereby contributing to the only effective, individual therapy. In this paper the structure of REACH study and its early results are presented.

 

 

 

 

 

 

 

 

 

HIPPOCRATES   May - July  2005  Vol. VII.  No. 3  Page 157

To HIPPOCRATES To Abstracts To Content To Article

Summary

In the major part of the large intervention lipid studies patients with diabetes took part as well.

According to retrospective analysis in some part of studies a significant decrease for cardiovascular risk could be found while in the diabetes subgroups of other studies (HPS, 4S, CARE, VA-HIT) only tendencies could be identified (LIPID, AFCAPS/TexCAPS, WOSCOP, Helsinki Heart Study), or unfavourable results were occured (ASCOT-LLA).

However studies conducted only in patients with diabetes (CARDS, DAIS) favourable results were received.

Until now there has been no study conducted to estimate the effect of fibrates in a great number of patients with diabetes.

Into the „Fenofibrate Intervention and Event Lowering in Diabetes” (FIELD) study 9795 patients with type 2 diabetes were included who were randomized for comicronizalt fenofibrate or placebo treatment. Over the planned duration of 5 years until the occurence of approxinately 500 coronary events.

According to on 80% power present prediction a 22% reduction in such events is expected, using the intention – to – treat methods.

The results of the FIELD study can be expected at the end of 2005.

 Key words: fibrate – diabetes – statin – FIELD

 

 

BM

HIPPOCRATES   May - July  2005  Vol. VII.  No. 3  Page    189

To HIPPOCRATES To Abstracts To Content To Article

 Summary

Leukopenia means a reduced number of white blood cells (WBC). Beyond the depression of the total WBC count, reduced number of lymphocytes, eosinophils, basophils is also distinguished. Neutropenia shares the greatest significance in clinical practice, so it will be discussed in detaile in this article.

Susceptibility for infections is increased in neutropenia. Subtypes of neutropenia include some congenital abnormalities, and it can be generated as a consequence of infections and also as a side effect of various drugs. Immunological neutropenia, or bone marrow infiltration in malignant diseases is also frequent. Neutropenia caused by chemotherapeutic agents is the most common cause.

The degree and severity of neutropenia is variable that determines clinical significance and also therapeutical decisions.