Blood pressure outcomes of dental patients screened chronobiologically: a seven-year follow-up.

BACKGROUND: This article is a follow-up on a 1998 article in JADA. The blood pressure, or BP, of 23 of 24 normotensive patients was monitored at 15-minute intervals for a total of nine days, in three consecutive sessions of four, two and three days, respectively, separated by a few weeks. METHODS: Twelve patients were reached by phone seven years after the prior chronobiologically interpreted monitoring to ascertain their cardiovascular status since the initial monitoring. RESULTS: Only two of the 12 patients reached in follow-up had abnormalities in all three sessions, and only these two patients reported having experienced an adverse vascular event (one a myocardial infarction, the other coronary artery bypass graft surgery). The difference in outcome between the patients with chronobiological abnormality in all three sessions vs. the pool of those with abnormality in only two, one or none of the sessions is statistically significant. CONCLUSIONS: Even a five-day (and sometimes a longer) profile, while greatly preferred to single measurements, may not suffice for a definitive diagnosis of certain patients. Retrospectively, the 864 measurements, on the average, on each person in our study could have served for a recommendation to each person. Chronobiologically interpreted BP and heart rate monitoring for a week or longer as a start detects high-risk states that may be missed by conventional casual measurements that are rarely accompanied by one-day profiles. CLINICAL IMPLICATIONS: The dentist has an important opportunity for conveying the importance of monitoring BP and heart rate for a week to detect an abnormal variability, and for implementing this monitoring. Dentists can educate patients regarding the need for screening and for interpreting the results for variability, and contribute to their overall health by referring them to their physicians when treatment is indicated.

[Organization of cardiologic rehabilitation in central Europe: retrospect, present, future outlook]. / Die Entwicklung der kardiologischen Rehabilitation in Mitteleuropa Rückschau, Umschau, Ausschau.

Cardiological rehabilitation, the comprehensive efficient treatment of chronic cardiac patients, is presented with regard to its difficult theoretical and practical development from the viewpoint of a senior specialist in this field practising in Central Europe. The accompanying WHO lifestyle concept is now considered to be scientifically well-founded, but has not yet been practically implemented on a large scale nor incorporated in the teaching schedule. A requirement for the future is a special medical philosophy for chronic heart patients, i.e., further development of the theoretical basis of rehabilitation, practical application of the scientific recommendations on the importance of life-style alterations, a greatly improved network of all doctors treating chronic heart patients, updating of the training of general medical specialists as well as cardiologists in Public Health, and intensified objective assessment of research on the cardiological rehabilitation of in- and outpatients.

[Do patients with acute and chronic diseases need different management structures today?]. / Brauchen akut und chronisch Kranke heute verschiedene Versorgungsstrukturen?

Arguments are proposed, why the psychosocial situation of the acute and chronic ill are fundamentally different. Some consequences for the medical practice, education and research are discussed.

[Ventricular arrhythmias and left ventricular function in coronary artery disease. A study by M-mode echocardiography and 24-hour Holter-monitoring (author's transl)]. / Ventrikuläre Arrhythmien und linksventrikuläre Funktion bei koronarer Herzerkrankung. Eine Untersuchung mittels M-Mode-Echokardiographie und 24-Stunden-Bandspeicher-Ekg.

In 82 patients with coronary artery disease, most of them having had transmural myocardial infarction, left ventricular function was studied with M-mode echocardiography. Furthermore 24-hour Holter-monitoring was done to determine the maximal degree of ventricular premature contractions (VPC's) according to the classification of Lown. The degree of VPC's was then plotted against echocardiographic parameters of left ventricular function. Confronting the subgroup of patients with Lown grade 0--II with those of grades III and IV, for all parameters significant differences of the mean values could be demonstrated. Parameter "distance E-point of the anterior mitral leaflet--left ventricular septal wall" shows 84% sensitivity; fractional shortening gives 88% specificity. Combination of all four parameters shows 90% specificity, which makes M-mode echocardiography a valuable diagnostic method in identifying those patients with coronary artery disease and malignant arrhythmias who have an increased risk of sudden death.