Effectiveness of medication self-management, self-monitoring and a lifestyle intervention on hypertension in poorly controlled patients: The MEDICHY randomized trial.

Background: Uncontrolled hypertension is a common problem worldwide, despite the availability of many effective antihypertensive drugs and lifestyle interventions. We assessed the efficacy of a multi-component intervention in individuals with uncontrolled hypertension in a primary care setting. Methods: This study was a randomized, multicenter, parallel, two-arm, single-blind controlled trial performed in primary healthcare centers in Mallorca (Spain). All participants were 35 to 75-years-old and had poorly controlled hypertension. Patients were randomly assigned in a 1:1 ratio to a control group (usual care) or an intervention group (self-monitoring of blood pressure, self-titration of hypertensive medications, dietary interventions, and physical activity interventions). The primary outcome was decrease in the mean SBP at 6 months relative to baseline. Results: A total of 153 participants were randomized to an intervention group (77) or a control group (76). After 6 months, the intervention group had a significantly lower systolic blood pressure (135.1 mmHg [±14.8] vs. 142.7 mmHg [±15.0], adjusted mean difference: 8.7 mmHg [95% CI: 3.4, 13.9], p < 0.001) and a significantly lower diastolic blood pressure (83.5 mmHg [±8.8] vs. 87.00 mmHg [±9.0], adjusted mean difference: 5.4 [95% CI: 2.9, 7.8], p < 0.0001). The intervention group also had significantly more patients who achieved successful blood pressure control (<140/90 mmHg; 54.4% vs. 32.9%, p = 0.011). Discussion: Self-monitoring of blood pressure in combination with self-management of hypertensive medications, diet, and physical activity in a primary care setting leads to significantly lower blood pressure in patients with poorly controlled hypertension.Clinical Trial Registration: ClinicalTrials.gov, identifier ISRCTN14433778.

Effectiveness of a multifactorial intervention, consisting of self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise, in patients with uncontrolled hypertension taking 2 or more antihypertensive drugs: The MEDICHY study.

INTRODUCTION: High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure. METHODS/DESIGN: This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales). DISCUSSION: This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).

Simultaneous magnetoencephalography and intracranial EEG registration: technical and clinical aspects.

The purpose of this study was to describe the methodology necessary for simultaneous recording of intracranial EEG (ICEEG) and magnetoencephalography (MEG) and to assess the sensitivity of whole-head MEG versus depth electrode EEG in the detection and localization of epileptic spikes. Interictal MEG and depth electrode activities from the temporal mesial and occipital lobes were simultaneously recorded from four candidates for epilepsy surgery. Implanted depth electrodes identified neocortical and mesial structures of ictal onset. Interictal spikes detected by these same depth electrodes were compared with simultaneous MEG events. MEG detections of ICEEG spikes, ICEEG versus MEG spike amplitudes, number of ICEEG contacts involved in the spike, and anatomic locations of MEG equivalent current dipoles were analyzed. MEG detected and localized 95% of the neocortical spikes, but only 25% to 60% of spikes from mesial structures. Mesial temporal spikes resulted in lower MEG spike amplitudes, when compared with neocortical spikes. Equivalent current dipoles of MEG spikes localized to the ictal onset zones in all four patients. MEG can detect and localize interictal epileptiform spikes that are recorded from depth electrodes in both neocortical and mesial structures, despite the lesser amplitude of spikes of mesial origin.

Bilateral anterior capsulotomy for refractory obsessive-compulsive disorders.

A prospective study on the effects of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder (OCD) is presented. A total of 18 procedures were performed in 15 patients. The mean duration of the OCDs was 18.1 +/- 5.6 years (range 11-26 years). The mean total Yale-Brown Scale (Y-BOCS) score was 29.67 and mean Global Assessment of Functioning was 43.61. The results throughout the follow-up period remained the same as at 1 month postoperatively. The observed mean recovery on the Y-BOCS was 33.2% (p = 0.017). 52.9% of the patients showed a 33% recovery, 29.4% of the cases showed a 50% recovery and 17% showed a 66% recovery. Global Assessment of Functioning recovered by 19% (p = 0.111). No cognitive deficit was disclosed by neuropsychological screening tests. Complications were observed in 3 cases, 1 with transitory hallucinations, 1 with a single epileptic seizure and 1 case who developed a progressive behavior disorder that became permanent. We conclude that bilateral anterior capsulotomy is a safe and effective procedure.

Eficacia de la psicocirugía en el trastorno obsesivo-compulsivo. Resultados preliminares (septiembre, 2002) / Effectiveness of psychosurgery in obsessive-compulsive disorder.

Tras una concisa introducción al trastorno obsesivo-compulsivo (T.O.C.) resistente, a la historia de la psicocirugía y en concreto a la técnica neuroquirúrgica de la capsulotomía bilateral anterior, se describe el Protocolo de Psicocirugía del T.O.C. resistente del Hospital de Mutua de Terrassa. Dicho protocolo se halla en marcha desde 1998, habiéndose valorado 38 solicitudes y dando lugar a 18 intervenciones de psicocirugía mediante capsulotomía bilateral anterior por termocoagulación, hasta Septiembre de 2002 y de su seguimiento durante un año. Se informa de los resultados preliminares valorándose: La Escala de Yale-Brown para Obsesiones-Compulsiones (Y-BOCS) total y las subescalas para obsesiones y compulsiones, los cuestionarios de Hamilton y Beck para depresión y STAI-estado para la ansiedad y la Escala de Evolución de la Actividad Global (E.E.A.G.) del Eje V del DSM-IV. Así como de una batería básica de evolución neuropsicologica compuesta por: los cubos de Kohs, la medida de la memoria visual inmediata y a medio plazo (WMS-R) del test del trazo A y B (TMT). Como medida principal de respuesta la escala Y-BOCS basal de 29,4 paso a 19,1 al mes y al 17,3 al año, con una mejoría media del 332 por ciento al mes. Un 53 por ciento de pacientes mejoraron, tomando como criterio de respuesta la disminución del 33 por ciento de su puntuación basal en la Y-BOCS total. No se objetivó empeoramiento en ninguna de las escalas neuropsicologicas utilizadas. Tan sólo 3 pacientes presentaron complicaciones tras la capsulotomía (AU)