This study compares the relative efficacy of systolic and diastolic biofeedback in lowering the systolic and diastolic blood pressures of normotensives. The importance of testing these biofeedback procedures lies in assessment of their potential as blood pressure self-control techniques for the treatment of essential hypertension.

Thesis (MCur)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Hypertension is on the increase among patients as found on the Routine Monthly Report (RMR) at Kayamandi Clinic. The staggering figures showed that the number of patients with hypertension between January 2009 until December 2009 was 5 754. It was further identified on the Routine Monthly Report (RMR) statistics that, more and more young adults between 18 and 40 years who are visiting the clinic for other health problems are diagnosed with hypertension and its complications. The incident rate of these young adults ranges between 151 and 340 per month. It is very alarming that some of them who are diagnosed with hypertension never return for further follow-up visits and are at risk of debilitating complications which are preventable in later life. The objectives of this study were to determine the knowledge young adult patients have of: • hypertension • the management of hypertension • the complications of hypertension. The study adopted a descriptive, exploratory design with a quantitative approach. The research question determines the research design or approach. In this case a broad overview is necessary of the knowledge young adults at Kayamandi Clinic have on the topic of hypertension. This then serves as a platform for further in-depth studies on this phenomenon. A yes/no scale was used to collect data. The questionnaire was designed in such a way that the participants could understand all the questions. The layout of the questionnaire was easy and the questions were straightforward. The questionnaires were written in English, Xhosa and Afrikaans. After the translation of the questionnaires, a second person scrutinized it for the correctness of the Xhosa translation. An interpreter assisted with the questionnaire in the Xhosa speaking community at the time of data collection, where a language barrier was anticipated. The Cronbach’s alpha test was used to test the reliability of the questionnaire. Informed consent was obtained from each participant. Permission was obtained from the University of Stellenbosch via the Health Research Ethical Committee ((HREC). Permission was also obtained from the Director: Department of Health, Western Cape Province and the authorities of the Cape Wine lands district. A statistician from the University of Stellenbosch was consulted regarding the data analysis and the interpretation of the data. Data was articulated in the form of frequency tables and histograms. The Spearman test was used to determine the correlation between variables. 10% of the participants used in the pilot study were from Cloetesville Clinic and 21% of the participants used for the main study were from Kayamandi Clinic, that is n=210 participants. The results of the study showed that for the n=172 participants that partook in the study, there was a correlation between complications and hypertension but no correlation on lifestyle management. Statistical associations were determined by using the Spearman test on a 95% confidence interval between various variables. The normal descriptive statistical analysis was completed. The implication of the results of this study is that high blood pressure can affect young and old people. Recommendations consist of on going health promotion and continuous education that include both old and young people. / AFRIKAANSE OPSOMMING: Hipertensie is aan die toeneem onder die pasiënte soos gevind in die maandelikse roetine-verslag.Die skokkende syfers soos gerapporteer in die maandelikse roetine-verslag,wys dat die aantal pasiënte met hipertensie by Kayamandi-kliniek van Januarie 2009 tot Desember 2009 was 5 754. Dit is verder geidentifiseer in die maandelikse roetine-verslag dat al hoe meer jong mense tussen die ouderdomsgroep van 18 to 40 jaar oud wat die kliniek vir ander siektetoestande besoek, met hipertensie en verwante komplikasies gediagnoseer word. Die voorkomssyfer van jongmense met hipertensie wissel tussen 151 tot 340 per maand. Dit is sorgwekkend dat sommige van die pasiënte nadat hulle met hipertensie gediagnoseer is, nie terugkeer na die kliniek vir verdere opvolgbesoeke nie en daardeur blootgestel word aan uitmêrgelende komplikasies in hul latere leeftyd wat voorkombaar is. Die doelwitte van die studie is om jong volwasse pasiënte se kennis vas te stel ten opsigte van: • hipertensie • die behandeling van hipertensie • die komplikasies van hipertensie. Die studie neem die vorm van ʼn beskrywende, verkennende ontwerp met ʼn kwantitatiewe benadering aan. Die navorsingsvraag bepaal die navorsingsontwerp of benaderring. In hierdie geval is ʼn breë oorsig nodig van die kennis van jong volwassenes by Kayamandi-kliniek oor die onderwerp aangaande hipertensie. Dit dien dan as basis vir verdere indringende studies rakende hierdie fenomeen. ʼn Ja/nee skaal is gebruik om data te versamel. Die vraelys is ontwerp op ʼn manier sodat die deelnemers dit kan verstaan. Die uitleg van die vraelys is eenvoudig en die vrae maklik. Die vraelys is geskryf in Engels,Xhosa en Afrikaans.Na die vertaling van die vraelys,is dit deur ʼn tweede person wat ook Xhosa magtig is nagegaan om die korrektheid van die vraelys te verseker. ʼn Tolk het gehelp met die vraelys ten tye van data-insamelling in die Xhosa- sprekende gemeenskap, waar taal ʼn moontlike probleem kon wees. Die Cronbach alpha- toets was gedoen om die betroubaarheid van die vraelys te toets. Ingeligte toestemming was verkry van elke deelnemer. Toestemming was verkry van die Universiteit deur middel van die Gesondheids Navorsings Etiese Kommitee (GNEK). Toestemming was ook verkry van die Direkteur: Departement van Gesondheid, Wes Kaap Provinsie en die owerhede van die Kaap Wynland streek. ʼn Statistiekus van die Universiteit van Stellenbosch was geraadpleeg aangaande die data analise. Data was geartikuleer in die vorm van frekwensies in tabelle en histogramme. Die Spearman-toets is gebruik om die korrelasie tussen variante vas te stel .10% van die deelnemers wat vir die loodprojek gebruik is, is van Cloetesville-kliniek. 21% van die deelnemers wat vir die hoofstudie gebruik is, is van die Kayamandi-kliniek , dus ʼn total van n=210 deelnemers. Die studie het bewys dat vir n=172 deelnemers wat aan die studie deelgeneem het, daar ʼn korrelasie tussen die komplikasies en die hipertensie toestand is, maar geen korrelasie met leefstylgewoontes is gevind nie. Statistiese assosiasies is bepaal deur gebruik te maak van die Spearman-toets op ʼn 95%-interval tussen verskeie variante. Die normale, beskrywende statistiese analise is voltooi. Die implikasie van die resultate van die studie, is dat hoë bloeddruk jonk en ouer mense affekteer. Aanbevelings dui op aanhoudende gesondheids promosies en voortdurende opvoeding wat jonk en ouer persone insluit.

Objectives. To investigate diabetes prevalence, incidence, mortality trends, the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment, and the effect of screening detection on total and cardiovascular disease (CVD), myocardial infarction (MI) and stroke incidence. Study population and methods. Between 1972 and 2001 all patients with diabetes, some detected clinically and some by case-finding procedures (screening), were entered in a diabetes register at Laxå Primary Health Care Center in Sweden. The register included information on medical treatment and laboratory data as well as information on mortality and morbidity from National Registers. The register was supplemented with five non-diabetic subjects, matched to each diabetes patients by age, sex, and year of detection. Results. During the study period 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. Age standardised incidence and prevalence rates for type 1 and type 2 diabetes did not increase over time. Diabetic patients had 17% higher mortality rate than non-diabetic persons, 22% in women and 13% in men. The corresponding over-mortality in CVD was 33%, 41% in women and 27% in men. CVD mortality decreased across time in non-diabetic subjects and in diabetic men but not in diabetic women. Results regarding coronary heart disease (CHD) were similar. CVD incidence increased with fasting blood glucose (FBG), body mass index (BMI), mean arterial blood pressure (MABP), and decreased with metformin treatment and sulfonylurea. Myocardial infarction incidence increased with FBG, BMI and MABP, and decreased with metformin treatment. Stroke incidence increased with MABP. There was no difference in prognoses between those detected by screening or clinically. Conclusions. Diabetes prevalence and incidence did not change over time. The over-mortality according to diabetes was moderate. CVD and MI during follow up were negatively affected by hypertension and hyperglycaemia, and positively by pharmacological diabetic treatment. For stroke no pharmacological protective effect was seen. Screening did not improve prognosis.

M.A. (Psychology) / Please refer to full text to view abstract

M.A. (Psychology) / Against the background of increasing costs of treatment of hypertension amongst the South African Black population, a non-pharmacological treatment model in the form of relaxation and aerobic fitness training was developed. The relaxation and aerobic fitness training model was then evaluated in a pretest-post test experimental and control group design. The findings indicated that the relaxation training as well as the aerobic fitness training showed statistical and clinical significant decreases in both systolic and diastolic blood pressure levels...

A hipertensão arterial é uma doença crônica, caracterizada pelo aumento constante da pressão sangüínea acima da normalidade (140 mmHg para a sistólica e 90 mmHg para a diastólica). Tem alta prevalência, em geral assintomática e é determinada por diversos fatores como raça, hereditariedade, idade e hábitos de vida relacionados à alimentação e à prática de exercícios físicos. É um dos maiores fatores de risco de morbidade e mortalidade cardiovasculares no mundo todo, causando além dos sérios problemas relativos à saúde, alto custo social. A falta de adesão às recomendações que são dadas aos pacientes é uma das causas do insucesso no tratamento dos indivíduos hipertensos, tornando-se um problema de saúde pública, encontrado em países do mundo todo. Por ser a hipertensão arterial uma doença assintomática é mais difícil motivar seu tratamento. Para isso, é fundamental a prática de uma sistemática contínua de orientação ao paciente pela equipe de saúde. O presente trabalho teve como objetivo estudar a repercussão de um programa educacional para melhorar a adesão do paciente ao tratamento. Foi aplicado pelo farmacêutico e comparado a um grupo controle, em pacientes atendidos pelo ambulatório de hipertensão do Hospital Universitário da Faculdade de Medicina da Universidade de São Paulo, através de palestras e orientação individualizada. Os resultados foram avaliados por meio de questionário, dosagens de sódio e potássio urinário, controle de pressão arterial, peso corpóreo, medidas de circunferência de cintura e quadris e de exames bioquímicos laboratoriais, entre outras variáveis. Verificou-se que os pacientes do grupo experimental apresentaram maior redução da pressão arterial sistólica e diastólica, do nível sé rico de triacil-gliceróis e da relação entre cintura/quadril, além de apresentarem aumento da excreção urinária de potássio em volume de 24 horas e da porcentagem de acertos em questionários referentes a aspectos gerais sobre hipertensão arterial, em relação aos pacientes do grupo controle. Tais resultados indicam aumento de adesão ao tratamento, mediante o processo educativo oferecido ao grupo experimental. / Hypertension is a chronic disease featured by a continuous rise in blood pressure above normal levels (140mmHg for systolic pressure and 90mmHg for diastolic pressure). A highly prevalent disease, it is not usually accompanied by symptoms and is determined by a number of factors, such as race, heredity, age, and living habits related to food intake and physical exercises. It is one of the highest risk factors for cardiovascular morbidity and mortality, thus leading not only to serious health disorders, but also to high social expenditure. Unsuccessful treatment of individuals who suffer from hypertension is in part a consequence of the fact that patients do not follow recommendations, which ultimately causes hypertension to be a public health issue throughout the world. As patients do not display any symptoms, they turn out to be less easily motivated to undergo treatment. It is therefore utterly important that health professionals provide patients with continuous, systematic guidance. This project analyzes the effects of an educational program aimed at fostering patients adhesion to medical treatment. It was carried out by a pharmacist and compared to a control group comprised by patients who sought medical assistance at the University Hospital hypertension clinic of the Medical School of the University of São Paulo, by means of lectures and private guidance. Results were assessed by means of a questionnaire, urinary potassium and sodium dosages, arterial pressure control, corporeal weight, waist and hip circumference measures, laboratory biochemical tests, among other variables. Results showed that the educational process addressed to the said experimental group was effective as to lower systolic and diastolic blood pressure, serum triacylgycerol levels and waist-hip ratio. An increase in urinary potassium excretion was also observed within a 24-hour volume, along with a greater number of correct answers to general questions about hypertension among patients in the control group. Such results are an evidence that the number of individuals who adhered to medical treatment increased as a consequence of the educational process provided for the experimental group.

Lim Sze Nee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 165-176). / Abstracts in English and Chinese. / Abstract --- p.i / Abstract (Chinese Version) --- p.iii / Acknowledgements --- p.v / Table of Contents --- p.vi / List of Tables --- p.xi / List of Figures --- p.xiii / List of Abbreviation --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1. --- General Introduction --- p.1 / Chapter 1.1 --- Classification of algae --- p.2 / Chapter 1.2 --- Chemical and mineral composition of marine macroalgae --- p.4 / Chapter 1.3 --- Uses of marine macroalgae --- p.7 / Chapter 1.3.1 --- Food --- p.7 / Chapter 1.3.2 --- Industrial uses --- p.8 / Chapter 1.3.3 --- Agricultural uses --- p.9 / Chapter 1.3.3.1 --- Fertilizer --- p.9 / Chapter 1.3.3.2 --- Fodder --- p.9 / Chapter 1.3.4 --- Medicinal properties --- p.10 / Chapter 1.4 --- Pharmacological effects of marine macroalgae --- p.11 / Chapter 1.4.1 --- Antioxidant activity --- p.11 / Chapter 1.4.2 --- Hypotensive activity --- p.11 / Chapter 1.4.3 --- Antiviral activity --- p.12 / Chapter 1.4.4 --- Antimicrobial activity --- p.12 / Chapter 1.4.5 --- Antitumor activity --- p.13 / Chapter 1.4.6 --- Hypocholesterolemic activity --- p.14 / Chapter 1.5 --- Objectives --- p.14 / Chapter CHAPTER 2 --- Free Radical Scavenging and Antioxidative Activities of Marine Macroalgae --- p.16 / Chapter 2.1 --- Introduction --- p.16 / Chapter 2.1.1 --- Free radicals: definition and sources --- p.16 / Chapter 2.1.2 --- Free radical-induced damage --- p.16 / Chapter 2.1.2.1 --- Biological lipid peroxidation --- p.16 / Chapter 2.1.2.2 --- Lipid oxidation of foods --- p.18 / Chapter 2.1.3 --- Antioxidants --- p.19 / Chapter 2.1.3.1 --- Antioxidants --- p.19 / Chapter 2.1.3.2 --- Antioxidant mechanisms --- p.20 / Chapter 2.1.4 --- Synthetic antioxidants --- p.21 / Chapter 2.1.5 --- Natural antioxidants --- p.24 / Chapter 2.1.6 --- Objectives --- p.27 / Chapter 2.2 --- Methods and Materials --- p.28 / Chapter 2.2.1 --- Preparation of algae extracts --- p.28 / Chapter 2.2.2 --- Determination of free radical scavenging activities --- p.32 / Chapter 2.2.2.1 --- Superoxide anions scavenging activity --- p.32 / Chapter 2.2.3 --- Antioxidative activity using hemolysis assay --- p.33 / Chapter 2.2.3.1 --- Preparation of red blood cell (RBC) --- p.33 / Chapter 2.2.3.2 --- Hemolysis assay --- p.33 / Chapter 2.2.4 --- Lipid peroxidation assay --- p.34 / Chapter 2.2.4.1 --- Preparation of rat brain homogenates --- p.34 / Chapter 2.2.4.2 --- Measurement of lipid peroxidation --- p.34 / Chapter 2.2.5 --- Statistics --- p.35 / Chapter 2.3 --- Results --- p.36 / Chapter 2.3.1 --- Superoxide radical scavenging activity of algal extracts --- p.36 / Chapter 2.3.2 --- Effects of algae extracts on hemolysis assay --- p.41 / Chapter 2.3.3 --- Effects of algae extracts on lipid peroxidation --- p.44 / Chapter 2.4 --- Discussion --- p.50 / Chapter CHAPTER 3 --- Isolation of Antioxidative Phenolic Compounds from Sargassum siliquastrum --- p.60 / Chapter 3.1 --- Introduction --- p.60 / Chapter 3.1.1 --- Phenolic compounds --- p.60 / Chapter 3.1.2 --- Major classes of phenolic compounds --- p.60 / Chapter 3.1.3 --- Functional aspects of phenolic compounds --- p.61 / Chapter 3.1.3.1 --- Functions of phenolic compounds in plants --- p.61 / Chapter 3.1.3.2 --- Biological and pharmacological activities --- p.64 / Chapter 3.1.3.3 --- Food industry --- p.65 / Chapter 3.1.4 --- Polyphenolic compounds in brown algae --- p.66 / Chapter 3.1.5 --- Objectives --- p.68 / Chapter 3.2 --- Methods and Materials --- p.69 / Chapter 3.2.1 --- Extraction and isolation of antioxidant components from S siliquastrum --- p.69 / Chapter 3.2.2 --- Thin-Layer chromatography --- p.70 / Chapter 3.2.3 --- Antioxidant activity --- p.71 / Chapter 3.2.4 --- Determination of total phenolics --- p.71 / Chapter 3.2.5 --- Infrared spectra --- p.72 / Chapter 3.2.6 --- Ultra-violet and visible (UV-vis) spectrophotometry --- p.72 / Chapter 3.2.7 --- Statistics --- p.73 / Chapter 3.3 --- Results --- p.73 / Chapter 3.3.1 --- Identification of phenolic compounds from various solvent extracts of S. siliquastrum --- p.73 / Chapter 3.3.2 --- Isolation of dichloromethane fraction by liquid chromatography --- p.81 / Chapter 3.3.3 --- Phenolic content of isolated compounds --- p.86 / Chapter 3.3.4 --- IR and UV-vis spectra --- p.86 / Chapter 3.4 --- Discussion --- p.92 / Chapter 3.4.1 --- Antioxidative activities --- p.92 / Chapter 3.4.2 --- Relationship between phenolic contents and antioxidant activity --- p.95 / Chapter 3.4.3 --- Identification of antioxidant compounds --- p.97 / Chapter CHAPTER 4 --- Hypotensive Activities of Marine Algae in the Rat --- p.102 / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.1.1 --- Basic principles of cardiovascular system --- p.102 / Chapter 4.1.2 --- Regulation of arterial pressure --- p.105 / Chapter 4.1.2.1 --- Short-term regulation of arterial pressure --- p.105 / Chapter 4.1.2.2 --- Long-term regulation of arterial pressure --- p.107 / Chapter 4.1.3 --- Hypertension --- p.108 / Chapter 4.1.3.1 --- Causes of hypertension --- p.109 / Chapter 4.1.3.2 --- Where do antihypertensive or hypotensive agents act? --- p.114 / Chapter 4.1.3.2.1 --- Sympathetic nervous system inhibitors --- p.115 / Chapter 4.1.3.2.2 --- Diuretics --- p.120 / Chapter 4.1.3.2.3 --- Vasodilators --- p.121 / Chapter 4.1.3.2.4 --- Calcium antagonist (Calcium channel blockers) --- p.121 / Chapter 4.1.3.2.5 --- Angiotensin-converting enzyme (ACE) inhibitors --- p.122 / Chapter 4.1.3.2.6 --- Antihypertensive drug combination --- p.122 / Chapter 4.1.4 --- The relationship between hypertension and free radicals --- p.123 / Chapter 4.1.5 --- Development of new antihypertensive agenrs --- p.124 / Chapter 4.2 --- Materials and methods --- p.125 / Chapter 4.2.1 --- Animal care --- p.125 / Chapter 4.2.2 --- Preparation of the blood pressure measurement in rats --- p.125 / Chapter 4.2.2.1 --- Effects of seaweed extracts on arterial blood pressure of rat --- p.126 / Chapter 4.2.2.1.1 --- Single-dose response curve --- p.126 / Chapter 4.2.2.1.2 --- Cumulative-dose response curve --- p.126 / Chapter 4.2.2.2 --- Pharmacological blocker studies --- p.128 / Chapter 4.2.3 --- Statistics --- p.131 / Chapter 4.3 --- Results --- p.131 / Chapter 4.3.1 --- Hypotensive effects of marine algal extracts --- p.131 / Chapter 4.3.2 --- Effects of pharmacological blockers on MAP --- p.135 / Chapter 4.4 --- Discussion --- p.150 / Chapter 4.4.1 --- Hypotensive effects of the marine algal extracts --- p.150 / Chapter 4.4.2 --- Pharmacological action of marine algal extracts --- p.152 / Chapter CHAPTER 5 --- Conclusion --- p.160 / REFERENCES --- p.165 / RELATED PUBLICATIONS --- p.177

A hipertensão arterial é uma doença crônica, caracterizada pelo aumento constante da pressão sangüínea acima da normalidade (140 mmHg para a sistólica e 90 mmHg para a diastólica). Tem alta prevalência, em geral assintomática e é determinada por diversos fatores como raça, hereditariedade, idade e hábitos de vida relacionados à alimentação e à prática de exercícios físicos. É um dos maiores fatores de risco de morbidade e mortalidade cardiovasculares no mundo todo, causando além dos sérios problemas relativos à saúde, alto custo social. A falta de adesão às recomendações que são dadas aos pacientes é uma das causas do insucesso no tratamento dos indivíduos hipertensos, tornando-se um problema de saúde pública, encontrado em países do mundo todo. Por ser a hipertensão arterial uma doença assintomática é mais difícil motivar seu tratamento. Para isso, é fundamental a prática de uma sistemática contínua de orientação ao paciente pela equipe de saúde. O presente trabalho teve como objetivo estudar a repercussão de um programa educacional para melhorar a adesão do paciente ao tratamento. Foi aplicado pelo farmacêutico e comparado a um grupo controle, em pacientes atendidos pelo ambulatório de hipertensão do Hospital Universitário da Faculdade de Medicina da Universidade de São Paulo, através de palestras e orientação individualizada. Os resultados foram avaliados por meio de questionário, dosagens de sódio e potássio urinário, controle de pressão arterial, peso corpóreo, medidas de circunferência de cintura e quadris e de exames bioquímicos laboratoriais, entre outras variáveis. Verificou-se que os pacientes do grupo experimental apresentaram maior redução da pressão arterial sistólica e diastólica, do nível sé rico de triacil-gliceróis e da relação entre cintura/quadril, além de apresentarem aumento da excreção urinária de potássio em volume de 24 horas e da porcentagem de acertos em questionários referentes a aspectos gerais sobre hipertensão arterial, em relação aos pacientes do grupo controle. Tais resultados indicam aumento de adesão ao tratamento, mediante o processo educativo oferecido ao grupo experimental. / Hypertension is a chronic disease featured by a continuous rise in blood pressure above normal levels (140mmHg for systolic pressure and 90mmHg for diastolic pressure). A highly prevalent disease, it is not usually accompanied by symptoms and is determined by a number of factors, such as race, heredity, age, and living habits related to food intake and physical exercises. It is one of the highest risk factors for cardiovascular morbidity and mortality, thus leading not only to serious health disorders, but also to high social expenditure. Unsuccessful treatment of individuals who suffer from hypertension is in part a consequence of the fact that patients do not follow recommendations, which ultimately causes hypertension to be a public health issue throughout the world. As patients do not display any symptoms, they turn out to be less easily motivated to undergo treatment. It is therefore utterly important that health professionals provide patients with continuous, systematic guidance. This project analyzes the effects of an educational program aimed at fostering patients adhesion to medical treatment. It was carried out by a pharmacist and compared to a control group comprised by patients who sought medical assistance at the University Hospital hypertension clinic of the Medical School of the University of São Paulo, by means of lectures and private guidance. Results were assessed by means of a questionnaire, urinary potassium and sodium dosages, arterial pressure control, corporeal weight, waist and hip circumference measures, laboratory biochemical tests, among other variables. Results showed that the educational process addressed to the said experimental group was effective as to lower systolic and diastolic blood pressure, serum triacylgycerol levels and waist-hip ratio. An increase in urinary potassium excretion was also observed within a 24-hour volume, along with a greater number of correct answers to general questions about hypertension among patients in the control group. Such results are an evidence that the number of individuals who adhered to medical treatment increased as a consequence of the educational process provided for the experimental group.

Abstract not available

This thesis explores how decision-making agency roles played by doctors, pharmacists and government affect the social efficiency of choices in the prescription drug market. The primary objective is to contribute to the quality of expenditure decompositions in this sector and, thereby, to draw attention to the real cost of drug consumption in Canada. Expenditure growth in the pharmaceutical sector may occur because Canadians are purchasing more drugs or more in terms of the health outcomes sought through drug consumption. Prices may also be rising for the drugs that patients consume. Furthermore, with new generations of prescription drugs replacing older and often equally effective ones, expenditure inflation may be due, at least in part, to growing inefficiencies in consumption. Deflating nominal expenditures with traditional economic price indexes is a commonly used approach to decomposing expenditure changes into changes in price, changes in productivity or both. This method may be biased because decision-making agency relationships and non-standard financial incentives give rise to possible inefficiencies in the pharmaceutical sector that would not commonly be found in other sectors. This proposition is explored theoretically and empirically. Potential biases stemming from financial incentives are explored in the context of the measurement problem posed by the entry of generic drugs. Traditional techniques of the economic approach to measurement do not capture the full effect of generic competition because decision-making agents do not always have incentive to consider the full price of drugs consumed. Potential information-related problems in pharmaceutical price and productivity measurement are explored within the context of the hypertension market. Health outcomes based indexes are constructed for this treatment category based on recognized national guidelines for the treatment of hypertension. Economic indexes of price and productivity appear to overstate social productivity in this segment because persistent non-compliance with national guidelines has resulted in higher costs without corresponding health improvements.