Once hypertensive, always hypertensive? A three year follow-up after stopping medication.

OBJECTIVE: To verify the existence of hypertension in a group of long-term pharmacologically treated hypertensives and to evaluate the possibility of discontinuing their medication. DESIGN: The diagnosis of hypertension was established when after a wash-out period (one month) the blood pressure measured at three consecutive examinations, with at least one week interval between them, was always higher than WHO's reference levels for the diagnosis of hypertension. Those who did not fulfil these criteria would continue, with regular controls, without medication as long as clinically indicated. The final evaluation was done after a three year follow-up. SETTING: The out-patient Hypertensive Unit of the Department of Geriatrics, Skellefteå Hospital, Sweden. PARTICIPANTS: 86 out-patients (33 males and 53 females) aged 68 to 82 years (mean 74) with long-term hypertension sent to our unit by general practitioners in our health district (population 80,000). RESULTS: 34 of the initial 86 patients required medication by the end of the wash-out period. The remaining 52, 16 males and 36 females, continued without medication and after the three year follow up 14 of them were still without it. There was a striking difference between males and females since a significantly higher number of males than females were free of medication at the end of the period (p < 0.001). In those who restarted pharmacological therapy, the period without medication lasted no longer than five months. CONCLUSIONS: Arterial hypertension can easily be over-represented as a diagnosis if not revised when clinically advisable or if established without accurate criteria. The possibility of stopping the antihypertensive medication in old patients is worth considering, particularly in male patients. The dangers of such strategy are practically minimal when regular controls are undertaken during the attempt.

Pharmacokinetics of co-trimazine (sulphadiazine plus trimethoprim) in geriatric patients.

The study was aimed at analyzing the pharmacokinetics of sulphadiazine (SDZ) and trimethoprim (TMP) in geriatric patients and was carried out in two stages. The first stage compared 11 geriatric patients (68-89 years old) and 9 healthy volunteers (21-34 years old). Serum concentration and urine elimination were determined on day 4 after 12-hourly administration of 1 tablet of co-trimazine containing 410 mg sulphadiazine (SDZ) plus 90 mg trimethoprim (TMP). The mean serum concentrations of SDZ were significantly higher in the older subjects than in the volunteers after 1, 8 and 12 h (p less than 0.05, 0.01, 0.01), but were not differentiable after 2 or 4 h. For TMP, the serum levels were higher (p less than 0.05) in the patients only after 8 h. The amounts collected in urine were higher in the normal volunteers for SDZ during the intervals 0-2 h (p less than 0.05), 2-4 h (p less than 0.01), and 4-8 h (p less than 0.01), but not for 8-12 h. The 12-hour recovery was 69% SDZ + acetyl-SDZ recovered in the patients compared to 66.0% in the volunteers. Indistinguishable amounts of TMP were recovered during each interval in the two groups of subjects, 59.2% in the patients compared to 70.0% in the volunteers. The second stage of the study comprised 9 geriatric patients of mean age 83.6 years and creatinine clearance 59.2 ml/min who were followed for 11 days. A steady increase in serum levels was observed. The mean peak serum concentration for SDZ was 16.7 +/- 4.2 mg/l after the first dose and 44.7 +/- 11.3 mg/l on day 10. For acetyl-SDZ, the respective concentrations were 2.1 +/- 0.9 and 7.1 +/- 3.1 mg/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Is maintenance digoxin necessary in geriatric patients?

Digoxin therapy was withdrawn over a four-year period in the geriatric wards of Skellefteå Hospital, if the indications for it were not clear, the medication was of doubtful value and there were no contraindications to withdrawal. Contraindications comprised symptoms of cardiac failure at rest or during light physical activity, X-ray signs of pulmonary congestion, a proven need for digoxin therapy following earlier withdrawal, or atrial fibrillation with a ventricular rate higher than 95 beats/min. A patient, who within two months presented signs of cardiac failure or an arrhythmia requiring digoxin, was considered to be in need of digoxin. Digoxin was withdrawn from a total of 141 patients, of whom 134 were examined after two months. According to our criteria, 108 (81%) of these 134 patients did not require digoxin treatment.

The use of co-trimazine and co-trimoxazole in elderly patients with urinary tract infections.

In a double-blind study geriatric patients received either 410 mg sulphadiazine plus 90 mg trimethoprim (co-trimazine) or 800 mg sulphamethoxazole plus 160 mg trimethoprim (co-trimoxazole) twice daily. The investigation was carried out in order to compare the clinical efficacy and safety of co-trimazine in relation to co-trimoxazole with special emphasis on laboratory data in elderly patients suffering from uncomplicated urinary tract infections. Two to four weeks after start of treatment the original pathogen was eradicated in 80% of the 40 patients that were assessable for the effect of co-trimazine therapy, and in 77.8% of the 39 assessable patients in the co-trimoxazole group. There were no statistically significant differences between the two treatment groups in terms of laboratory data. Both drugs were well tolerated.

[Prosthetic fitting in the geriatric leg amputee (author's transl)]. / Prothetische Versorgung bei geriatrischen Beinamputierten.

This retrospective study regarding prosthetic fitting in geriatric amputees showed that only about 50 per cent of the patients could be fitted with a prosthesis. The time interval from the amputation until the patients walked adequately with the prostheses was very long. This was due to problems with the healing of the stump, as well as insufficiencies in the medical organization. An increased coordination of the care of these patients before and after an amputation would improve the whole course of events. It is suggested that the main responsibility for these patients should be transferred to physicians, specialized in long-term care medicine.