Objetivo: Avaliar a associação entre a atividade física usual e o perfil de pressão arterial (PA) de 24-h em pacientes com diabetes tipo 2. Métodos: Foi realizado estudo transversal com 151 pacientes com diabetes tipo 2. A atividade física usual foi avaliada por contagem de passos (pedômetro) e pelo nível de atividade física auto-relatada (Questionário Internacional de Atividade Física, IPAQ versão longa). A PA foi medida no consultório e em 24-h pela monitorização ambulatorial de PA (MAPA). Resultados: A idade média foi de 61,1 ± 8,4 anos; 64% eram mulheres (n=97) e 77% eram brancos (n=116). A duração média do diabetes foi de 14,3 ± 8,5 anos. Noventa e dois por cento dos pacientes tinham hipertensão (n = 138), e a PA média no consultório foi de 138 ± 18/78 ± 10 mmHg. Correlações inversas foram observadas entre a contagem de passos diária e a PA de 24-h (sistólica, r = - 0,186, p = 0,022; de pulso, r = - 0,210, p = 0,010; carga pressórica sistólica, r = - 0,177, p = 0,030), do dia (sistólica, r = - 0,198, p = 0,015; de pulso, r = - 0,225, p = 0,005; carga pressórica sistólica, r = - 0,195, p = 0,017), e da noite (de pulso, r = - 0,181, p = 0,026). Os pacientes foram categorizados em tercis da contagem de passos diária e os do 1° tercil (<4873 passos/dia) apresentaram maior PA sistólica de 24-h, PA sistólica do dia, PA média do dia, e carga pressórica do dia do que aqueles do 2° e 3° tercis (Tabela 1), mesmo após ajustes para idade e HbA1c. Conclusões: Pacientes com diabetes tipo 2 e baixos níveis de atividade física usual apresentam maiores níveis de PA sistólica de 24-h e do dia em comparação com aqueles que se exercitam mais espontaneamente, mesmo após ajustes para possíveis fatores de confusão.

A doença arterial periférica (DAP) causa oclusão aterosclerótica que gera redução no aporte de oxigênio para as extremidades inferiores afetando a capacidade funcional dos pacientes. Logo, a caminhada é criticamente importante na DAP. Por isso, o objetivo do Estudo 1 foi avaliar a velocidade auto-selecionada de caminhada (VAS), velocidade ótima de caminhada (VO) e custo de transporte da caminhada em pacientes DAP. Adicionalmente, nós descrevemos o Índice de Reabilitação (IR) . O objetivo do Estudo 2 foi comparar o comportamento metabólico e muscular durante a caminhada de pacientes DAP e sujeitos saudáveis. Observamos que pacientes DAP são menos econômicos na VAS e tem pior economia de caminhada do que os controles nas velocidades testadas. Os dados de co-contrações musculares parecem não explicar essa escolha. Porém, o comportamento muscular ao longo das velocidades indica que os pacientes DAP podem apresentar maiores percentuais de co-contrações musculares do que os indivíduos saudáveis. Esses resultados podem contribuir para uma melhor compreensão do cenário fisiopatológico responsável pelo comprometimento funcional precoce dessa população.

Delayed control of haemorrhage or blood loss has been recognised as a major contributor to preventable trauma deaths, but early detection of internal bleeding is difficult due to unreliability of heart rate (HR) and blood pressure (BP) as markers of volume status. This thesis explores a novel method of early blood loss detection using a noninvasive finger photoplethysmographic (PPG) pulse oximetry waveform that is normally utilised in pulse oximeters for estimating arterial oxygen saturation. Graded head-up tilt (n = 13) and blood donation (n = 43) in human volunteers were selected as experimental models of mild to moderate blood loss. From the tilt study, a novel method for automatically detecting left ventricular ejection time (LVET) from the finger PPG waveform has been developed and verified by comparison with the LVET measured from aortic flow velocity. PPG waveform derived LVET (LVETp) and pulse transit time (PTT) were strongly correlated with aortic LVET and pre-ejection period respectively (median r = 0.954 and 0.964) and with the decrease in central blood volume indicated by the sine of the tilt angle (median r = -0.985 and 0.938), outperforming R-R interval (RRI) and BP in detecting mild central hypovolaemia. In the blood donation study, progressive blood loss was characterised by falling LVETp and rising PTT (p < 0.01). A new way of identifying haemorrhagic phases by monitoring changes and trends in LVETp, PTT and RRI has been proposed based on the results from the two studies. The utility of frequency spectrum analysis of PPG waveform variability (PPGV) in characterising blood loss has also been examined. A new technique of PPGV analysis by computing the coherence-weighted cross-spectrum has been proposed. It has been shown that the spectral measures of finger PPGV exhibited significant changes (p < 0.01) with blood donation and were mildly correlated with systemic vascular resistance in intensive care unit patients (r from 0.53 to 0.59, p < 0.0001), therefore may be useful for identification of different haemorrhagic phases. In conclusion, this thesis has established finger PPG waveform as a potentially useful noninvasive tool for early detection of blood loss.

Introduction: Subjects with insulin resistance (IR) and diabetes are at increased risk of cardiovascular disease (CVD) than those without diabetes, however the mechanistic basis remains elusive. Despite LDL-cholesterol lowering by statin therapy, two-thirds of all CVD events remain, constituting a significant 'residual risk' for CVD. This ‘residual risk’ has been found to be greater for patients with diabetes than those without diabetes. This suggests the role for alternative sources of lipoprotein-derived cholesterol in CVD during diabetes. Both type-1 diabetic as well as IR subjects have been found to have increased plasma concentrations of fasting intestinal derived apoB48 containing remnants (CM-r). However it is not known if the diabetic metabolic milieu indeed increases the susceptibility of the arteries to CM-r and if these indeed bind to arterial proteoglycans (PGs). Objectives: To determine arterial retention of CM-r in type-1 diabetes and IR using ex vivo perfusion methodology in a streptozotocin rat model of type 1 diabetes and JCR-LA-cp rat model of IR. To determine the direct binding affinity and capacity of CM-r to biglycan using an in vitro approach. Methods and Results: We observed increased arterial CM-R retention in type 1 diabetic vessels as well as in IR vessels when compared to control vessels. The retained CM-r colocalized with arterial biglycan in type 1 diabetic vessels and a direct correlation was observed between the CM-r and the presence of glycated proteins in type I diabetic arteries. The increased arterial CM-r retention in the IR rats was associated with increased arterial biglycan protein content. We have conclusively demonstrated for the first time that CM-r indeed bind to human biglycan. Conclusion: Tight glycemic control in patients with type 1 diabetes can alleviate CVD by reducing hyperglycemia and subsequent retention of CM-r. A significant increase in biglycan protein core content during IR is suggestive of early vascular remodeling and may help to explain how CM-r accumulate more readily during diabetes induced CVD. Based on the results from this study, individuals with IR may be at increased risk for atherogenesis due to increased atherogenicity of the post-prandial CM-r when compared to normal population. / Nutrition and Metabolism

Sildenafil increases oxygen delivery and maximal exercise capacity at very high altitudes (greater than or equal to 4300 m) and has been shown to improve short-duration exercise performance in some individuals at simulated high altitude (3900 m). It is unknown whether sildenafil improves maximal exercise capacity and longer duration exercise performance at moderate and high altitudes where competitions are more common. Additionally, the effects of sildenafil on women exercising at altitude have not been examined. The purpose of this study was to determine the effects of sildenafil on cardiovascular hemodynamics, arterial oxygen saturation (SaO2), peak exercise capacity (Wpeak), and 15-km time trial performance, in endurance-trained men and women at simulated moderate (MA; 2100 m, 16.2 % FIO2) and high (HA; 3900 m, 12.8% FIO2) altitudes. Eleven male and 10 female subjects completed two HA Wpeak trials following the ingestion of placebo or 50 mg sildenafil in randomized, counterbalanced, and double blind fashion. Subjects then completed four exercise trials (30 min at 55% of Wpeak + 15-km time trial) at MA and HA following the ingestion of placebo or 50 mg sildenafil in randomized, counterbalanced, and double blind fashion. Sildenafil had little influence on cardiovascular hemodynamics for either gender at MA or HA, but did result in higher SaO2 values compared to placebo during steady state and time trial exercise in men at HA only. Sildenafil did not affect Wpeak or 15-km time trial performance in either gender at MA or HA. We conclude that sildenafil is unlikely to exert beneficial effects at altitudes < 4000 m for a majority of the population.

L’asma bronquial es una malaltia freqüent amb una prevalença del 10-13% de la població. Un 27% de la població asmàtica ha estat atesa per agudització en l’últim any. Aquesta darrera constatació és, en part, deguda al deficient control clínic de la població asmàtica. Les aguditzacions asmàtiques (AA) poden ser un epifenomen d’aquest mal control, o bé degudes a l’actuació d’un o diversos desencadenants, com els virus o els al·lèrgens. En l’actualitat, els pacients no reben un tractament correcte i el grau de control de l’asma és deficient. Això comporta un desconfort per al pacient i també un risc, ja que és potencialment mortal, així com una enorme sobrecàrrega econòmica per a la societat, que augmenta considerablement durant l’atenció sanitària per aguditzacions. Aquestes són les raons per les quals varem decidir estudiar la situació en el nostre entorn, i proposar l’aplicació de conductes i mesures clíniques que permetin millorar el nivell de control que actualment tenen els pacients asmàtics. Primer estudi: Monitoring of asthma outpatients after adapting treatment to meet international guidelines (ASMACAP I). Objectiu: Els pacients asmàtics en règim ambulatori tenen un control deficient de la seva malaltia. L’objectiu d’aquest estudi ha estat realitzar una intervenció de curta durada, i factible de repetir en la pràctica diària, per intentar millorar-ne el control. Pacients i mètodes: Es varen citar els pacients asmàtics de 2 centres d’assistència primària per fer-los un qüestionari, adaptar el tractament segons les recomanacions de la GINA (Global Initiative for Asthma) i explicar en 5 minuts en què consisteix la malaltia. Als 4 mesos es va fer una segona visita i es va repetir el protocol. Es varen comparar els paràmetres assistencials dels 4 mesos anteriors a cada visita. Resultats: Les característiques clíniques dels 180 pacients eren les següents: un 70% eren dones, un 17% fumaven, un 8% eren analfabets, un 46% només tenien estudis primaris, un 45% estaven en contacte amb productes de neteja, i en un 63% l’asma era extrínseca. Quant a la gravetat de l’asma, en un 73% era lleu, en un 23% moderada i en un 4% greu. Un 22% havien rebut explicacions sobre la seva malaltia, un 50% tenien el tractament per escrit, un 14% disposaven d’un pla escrit en cas d’exacerbació, i un 54% rebien corticosteroides inhalats. Els 110 pacients (61%) que varen venir a la segona visita mostraven diferències, en els 4 mesos anteriors a cada visita, en el tractament amb corticosteroides inhalats (78%, p<0,001), en el nombre de visites al seu metge (p<0,001), en les visites per agudització al seu metge (p<0,001), i a urgències en el seu ambulatori (p<0,002), i també en l’estadi de la malaltia (p<0,02). Conclusions: Aquesta mínima actuació clínica ha reduït la freqüència dels pacients als centres assistencials i ha millorat el grau de control clínic d’aquests pacients. Segon estudi: Rate and characteristics of asthma exacerbations: the ASMAB I study. Objectiu: Aquest estudi analitza la incidència i les característiques clíniques dels episodis d’agudització asmàtica (AA) atesos en els serveis d’urgències (SU) de la ciutat de Barcelona (estudi ASMAB-I). Pacients i mètodes: Es varen estudiar els episodis d’AA atesos en els SU hospitalaris i en els SU domiciliaris (061) durant 129 dies, corresponents a una població de 1.203.598 habitants majors de 14 anys. Resultats: En total es varen identificar 831 episodis d’AA, 523 dels quals varen ser atesos en 3 hospitals universitaris, 113 en 2 hospitals de segon nivell, i els altres 195 (20 dels quals varen ser remesos més tard a l’hospital) en els SU domiciliaris. La freqüència mitjana va ser de 6,4 episodis/dia, amb una incidència d’AA de 0,53/105 habitants/dia (interval de confiança del 95%, 0,46-0,56) i de 8,2/105 pacients asmàtics (interval de confiança del 95%, 6,89-8.41). Dels 276 episodis atesos de dilluns a dijous en els serveis dels hospitals universitaris, 66 pacients (24%) varen tenir un inici agut i 14 (5%) un inici sobtat. Únicament 85 pacients (31%) prenien de forma regular corticosteroides inhalats, i només 33 (12%) varen afegir corticosteroides orals en les 12 h prèvies a anar a urgències. Un 16% dels episodis es varen qualificar de greus i un 3% de quasi fatals. Finalment, un total de 82 pacients (30%) varen ser hospitalitzats; varen ingressar el 12% de les AA lleus, el 39% de les AA moderades, el 62% de les AA greus i el 100% de les quasi fatals. L’índex de comorbilitat de Charlson va ser més superior en els pacients hospitalitzats (p<0,001). En els 28 pacients readmesos (10%), en el moment de l’alta prèvia se’ls havia prescrit menys antibiòtics (p<0,001) i bromur d’ipratropi (p<0,0001). Conclusions: La taxa d’AA establerta pot ser un indicador útil del grau de control de l’asma i pot servir per confirmar augments d’AA permanents o puntuals en el futur. L’inici ràpid (agut o sobtat) és freqüent. Molts pacients no reben un tractament adequat abans de l’hospitalització. L’agudització greu és freqüent en el nostre medi. L’ingrés està relacionat amb la gravetat i la comorbilitat. Els pacients readmesos han rebut a l’alta menys antibiòtics i bromur d’ipratropi. / Bronchial asthma is a common disease with a prevalence of 10-13% of population. A 27% of the asthmatic population required to be attended in the outpatient settings in the last year. This last report is, in part, due to the clinical control deficiency of the asthmatic population. Asthmatic exacerbations (AE) could be an epiphenomenon of this bad control, or likely due to the presence of one or many triggering agents, such as viruses or allergens. At present, patients do not always receive an accurate treatment and report that their disease is poorly controlled. This unsatisfactory control gives rise to a greater personal discomfort and it is also a risk for the patient, since asthma is a potentially mortal threat; besides, it is also a greater economic burden on the heath system, which significantly increases health care assistance due to exacerbations. For these reasons, we decided to evaluate this situation in our settings and to outline a few clinical behaviour and measures to be followed so that patients improved their control rate of asthma symptoms. First study: Monitoring of asthma outpatients after adapting treatment to meet international guidelines (ASMACAP I). Objective: Poor control of asthma treated in outpatient settings has been demonstrated. The aim of this study was to perform a short intervention, readily replicable in everyday practice, to try to improve control of asthma symptoms. Patients and Methods: Two primary health care clinics made appointments with asthma patients to administer a questionnaire and adapt their treatment to the guidelines of the GINA (Global Initiative for Asthma). Patients also received an explanation of the disease lasting not more than 5 minutes. The protocol was repeated at a second visit 4 months later. Health care parameters were compared with those from the previous visit. Results: The characteristics of the 180 patients were as follows: 70% were women, 17% were smokers, 8% were illiterate, 46% had only primary education, 45% were in contact with cleaning products, and 63% had extrinsic asthma. The asthma severity was as follows: mild in 73%, moderate in 23%, and severe in 4%. Twenty-two percent had received previous explanations of the disease, 50% had a written treatment plan, 14% had a plan for exacerbations, and 54% were taking inhaled corticosteroids. The second appointment was kept by 110 (61%) of the patients, who showed differences with respect to the previous visit 4 months earlier in the percentage taking inhaled corticosteroids (78%, p<.001), the number of visits to the physician (p<.01), visits to the physician due to exacerbations (p<.001), emergency visits to the outpatient clinic (p<.002), and disease severity (p<.02). Conclusions: This minimal clinical intervention reduced the need for visits to health care centers and improved the clinical control of the disease. Second study: Rate and characteristics of asthma exacerbations: The ASMAB I Study. Objective: The aim of this study was to determine the incidence and clinical characteristics of asthma exacerbations seen by emergency services in Barcelona, Spain (the ASMAB-I study). Patients and methods: The emergency services considered in the study served a population of 1.203.598 inhabitants aged over 14 years. Episodes treated in hospital emergency departments and by emergency services called to patients’ homes over a period of 129 days were included in the study. Results: In total, 831 episodes of exacerbation were identified; 523 were seen in 3 university hospitals, 113 in secondary hospitals, and 195 by emergency services at the patient’s home. Twenty of the patients seen at home were subsequently taken to hospital. The mean frequency was 6.4 episodes per day, corresponding to a daily incidence of 0.53 exacerbations per 100.000 inhabitants (95% confidence interval, 0.46-0.56 exacerbations/100.000 inhabitants) and 8.2 per 100.000 asthmatic patients (95% confidence interval, 6.89-8.41 exacerbations/100.000 asthmatic patients). Of the 276 episodes treated between Monday to Thursday in university hospitals, 66 patients (24%) reported acute onset and 14 (5%) sudden onset. Only 85 patients (31%) regularly used inhaled corticosteroids and only 33 (12%) added oral corticosteroids in the 12 hours prior to consulting emergency services. In 16% of cases the episode was classified as severe and in 3% near fatal. Eighty-two patients (30%) were ultimately admitted to hospital: 12% of mild exacerbations, 39% of moderate exacerbations, 62% of severe episodes, and 100% of near-fatal episodes. The Charlson comorbidity index was higher in patients admitted to hospital (p<.001). In the 28 patients readmitted to hospital (10%), antibiotics (p<.001) and ipratropium bromide (p<.0001) had been prescribed less often at the time of discharge after the first hospital admission. Conclusions: The rate of asthma exacerbation established in this study may be a useful indicator of the degree of control of the disease and may serve as a reference to confirm future short-term or lasting increases in asthma exacerbations. Rapid onset (acute or sudden) is common and many patients are not receiving appropriate treatment prior to hospital admission. Severe exacerbation is common in our practice setting. Hospital admission is related to severity and comorbidity. Patients who are readmitted to hospital had less often received antibiotic treatment and ipratropium bromide when discharged previously.

OBJETIVO: Estudiar en condiciones de práctica clínica habitual el efecto de la automedición domiciliaria (AMPA) sobre el descenso de presión arterial (PA) en hipertensos.MÉTODO: Estudio experimental, en Atención Primaria. Participaron 109 pacientes con hipertensión (HTA) ligera, mal controlados en consulta, aleatorizados en grupo intervención (GI), que fue instruido para la AMPA facilitándosele un automedidor electrónico validado, y grupo control (GC) que siguió el programa de HTA del Área. Se controlaron sus presiones arteriales (PA) con una monitorización ambulatoria de la presión arterial (MAPA), al inicio, 6, 18 y 30 meses. Se consideró controlada la PA con media por MAPA de 24 horas menor de 130/80 mmHg. Se registró el consumo de fármacos por Dosis Diaria Definida, el Índice de Bienestar Psicológico y las visitas por HTA y totales al Centro de Salud y otras variables demográficas y factores de riesgo cardiovascular. Se implementó un programa de educación sistematizado según el método de los estadíos del cambio, que fue evaluándose también. Se realizó análisis bivariante y multivariante por regresión lineal múltiple y/o regresión logística.RESULTADOS: A los seis meses ambos grupos mejoraron el control de su HTA, empeorando el control de la HTA a los 18 meses y a los 30 meses, aunque sin llegar al mal control inicial. El descenso de la PA fue similar en ambos grupos, con tendencia a ser menor en el GI que en el GC a los 30 meses (Diferencia de 3,6 mmHg para la PA sistólica y 2,3 mmHg la diastólica en el MAPA de 24 horas, "p" respectivamente de 0,036 y 0,052) a expensas de la presión nocturna, no habiendo diferencias significativas en la diurna. No hay diferencias significativas en el control de la PA entre ambos grupos en la presión arterial diurna, pero si la hay a favor del GC en la presión arterial nocturna (p=0,021) y casi en la de 24 horas (p=0,064). El GI consume menos fármacos (1,1 vs. 1,3; p=0,010).CONCLUSIÓN: Constatamos un menor descenso de la PA y un peor control en el grupo de AMPA al final del estudio, en cifras moderadas, y a expensas de la presión nocturna. El impacto sobre el proceso asistencial es favorable con un menor consumo de fármacos. Tras la intervención educativa constatamos una mejora de las conductas relacionadas con el control de la HTA a corto plazo (6 y 18 meses) pero no a los 30.

Atherosclerotic plaques with high probability of rupture show the presence of a hot spot due to the accumulation of inflammatory cells. This study utilizes two and three dimensional (2-D and 3-D) arterial geometries containing an atherosclerotic plaque experiencing different levels of inflammation and uses models of heat transfer analysis to determine the temperature distribution in the plaque region. The 2-D studies consider three different vessel geometries: a stenotic straight artery, a bending artery and an arterial bifurcation which model a human aorta, a coronary artery and a carotid bifurcation, respectively. The 3-D model considers a stenotic straight artery using realistic and simplified geometries. Three different blood flow cases are considered: steady-state, transient state and blood flow reduction. In the 3-D model, thermal stress produced by local inflammation is estimated to determine the effect of inflammation over plaque stability. For fluid flow and heat transfer analysis, Navier-Stokes equations and energy equation are solved; for structural analysis, the governing equations are expressed in terms of equilibrium equation, constitutive equation, and compatibility condition, which are are solved using the multi-physics software COMSOL 3.3 (COMSOL, Inc.). Our results indicate that the best location to measure plaque temperature in the presence of blood flow is recommended between the middle and the far edge of the plaque. The blood flow reduction leads to a non-uniform temperature increase ranged from 0.1 to 0.25 oC in the plaque/lumen interface. In 3-D realistic model, the multiple measuring points must be considered to decrease the potential error in temperature measurement even within 1 or 2 mm at centerline region of plaque. The most highly thermal stressed regions with the value of 1.45 Pa are observed at the corners of lipid core and the plaque/lumen interface. The mathematical model developed provides a tool to analyze the factors affecting heat transfer at the plaque surface. The results may contribute to the understanding of the relationship between plaque temperature and the likelihood of rupture, and also provide a tool to better understand arterial wall temperature measurements obtained with novel catheters.

Age is the major risk factor for cardiovascular diseases (CVD) and this is attributable in part to stiffening of large elastic arteries and development of vascular endothelial dysfunction. In contrast, regular aerobic exercise is associated with reduced risk of CVD. Swimming is an attractive form of aerobic exercise and always recommended for health promotion as well as prevention and treatment of risk factors for CVD. However, there is little scientific evidence to date indicating that swimming is equally efficacious to land-based exercise modes in reducing cardiovascular risks. Accordingly, the aim of the research was to determine the role of regular swimming exercise on both CVD traditional risk factors and vascular functions. To comprehensively address this aim, 2 different approaches were used: Study 1 (cross-sectional study) was designed to determine the potential benefit of regular swimming exercise in the primary prevention of age-related decreases in vascular function. Key measurements of vascular function were performed in middle-aged and older swimmers, runners, and sedentary controls. Central arterial compliance was higher in swimmers and runners than in sedentary controls. Study 2 (intervention study) was designed to determine whether regular swimming exercise could reverse the age-associated decline in vascular function. Middle-aged and older subjects completed either a 12-week swim training program or relaxation/ stretching exercise (attention control) program. Short-term swim training improved arterial blood pressure and vascular functions. In summary, regular swimming exercise can attenuate reductions in and partially restore the loss of vascular function including central arterial compliance and endothelial function in middle-aged and older adults. Swimming exercise exhibited typical central arterial compliance and endothelial function phenotypes that are often displayed in land-based exercise. / text

Die Arterielle Hypertonie zählt neben Hypercholesterinämie, Diabetes mellitus, Übergewicht, Rauchen und Bewegungsmangel als Risikofaktor für Erkrankungen des Kreislaufsystems. Die in vielen Leitlinien geforderte Behandlungsqualität bei arterieller Hypertonie soll sowohl in der hausärztlichen und fachärztlichen Praxis als auch in der stationären Behandlung optimal erreicht werden. In der vorliegenden Arbeit wird untersucht, ob der Anteil der stationär behandelten Patienten, die insgesamt einen Zielblutdruck unterhalb von 140 mmHg erreichen, höher ist als der Anteil derselben Patienten in der hausärztlichen Versorgung. Durch die retrospektive Auswertung der Daten von Patienten mit Hypertonie in der Abteilung Nephrologie und Rheumatologie der Medizinischen Fakultät der Georg-August-Universität Göttingen wurden die Informationen für die Analyse erfasst und statistisch ausgewertet. Es wird die Frage erörtert, inwiefern die medikamentöse Behandlung im stationären Aufenthalt zu einer signifikanten Verbesserung der Blutdruckwerte, insbesondere bei Patienten mit manifesten Vorerkrankungen und mit Vormedikation gegen Bluthochdruck, führt. Darüber hinaus wurde dem Problem nachgegangen, inwieweit die medikamentöse Behandlung nach dem Krankenhausaufenthalt fortgesetzt wird. Hierzu wurde zunächst ein Fragebogen entwickelt, um folgende Kategorien aus den Krankenakten der ausgewählten Patienten einheitlich erfassen zu können: persönliche Daten, Vorerkrankungen, Familien¬anamnese, Risikofaktoren, Vormedikation, Anamnese am Tag der Aufnahme, Nachmedi-kation, Diagnostik während des stationären Aufenthalts, Daten am Tag der Entlassung. Diese Informationen wurden im Anschluss statistisch ausgewertet und zur Einschätzung der aufgestellten Hypothesen herangezogen. Die Untersuchungen belegen, dass in der stationären Behandlung insgesamt für mehr Patienten Erfolge bezüglich der medikamentösen Therapie erzielt wurden. Die Ergebnisse dokumentieren eine Gleichberechtigung der von der Deutschen Hochdruckliga empfohlenen Therapieformen, sei es die Monotherapie oder die primäre Kombinationstherapie. Alle durchgeführten Medikationen führen gleichermaßen zu signifikanten Verbesserungen der Blutdruckwerte.