Sexual activity in hypertensive men.

Erectile dysfunction is one of the major obstacles for noncompliance in the antihypertensive treatment. It has been shown that various antihypertensive drugs have a negative influence on sexual activity such as diuretics and beta-blockers. Thus, the purpose of the present study was to evaluate the effect of valsartan, an AT1-receptor antagonist, or its combination with hydrochlorothiazide on sexual activity in hypertensive patients. A total of 2202 patients (mean age 54+/-8 years) with hypertension systolic blood pressure (SBP)> or =140 mmHg, diastolic blood pressure (DBP)> or =95 mmHg), or with pretreated hypertension, were included in the present analysis. Blood pressure was measured at baseline, after 8 and 16 weeks, respectively. Sexual activity was assessed with a questionnaire at each of the three visits. Sexual activity (intercourse per week) was determined in three groups: controls (n=27; conventional therapy); valsartan group (n=1899); valsartan in combination with hydrochlorothiazide (n=276). There were 26 drop outs. SBP (-18.6 mmHg) and DBP (-11.6 mmHg) decreased significantly in all three groups. Sexual activity decreased slightly in controls from 1.3 to 0.9 times per week (NS), whereas it increased in the valsartan group from 1.0 to 1.6 times during follow-up (P<0.0001). Similarly, sexual activity increased in the combination group from 0.9 to 1.3 times per week during follow-up (P<0.0001). No sexual activity was reported by 467 (21%) of the 2202 patients at baseline and 154 (7%) at 16 weeks follow-up (P<0.05). Impaired sexual activity is common in hypertensive patients (app. 20%). Valsartan increases the rate of sexual intercourses per week, whereas conventional therapy affects sexual activity adversely.

[Patient self-monitoring of oral anticoagulation with CoaguChek]. / Patienten-Selbstkontrolle der oralen Antikoagulation mit CoaguChek.

We investigated the feasibility, quality and safety of patient self-control of oral anticoagulation. The patients were selected by their physicians on the basis of criteria such as compliance, skills and motivation. After theoretical and practical training they self-monitored and self-adjusted their anticoagulant dosage for 6 months by weekly self-measurement of their INR values using a capillary whole blood prothrombin time monitor (CoaguChek). Venous INR measurements once a month served as quality control. There were 51 study participants, who performed a median 5 INR measurements per month. 75.8% of all registered INR values were within the recommended individual INR target ranges. The coefficient of correlation between capillary (y) and venous (x) INR values was r = 0.87 (regression analysis y = 1.0 x -0.2). The concordance of capillary and venous INR values was 80% with respect to the individual INR target ranges. There were 5 minor bleeding episodes and no overt thromboembolic recurrences during the study period. In conclusion, the study demonstrated that patient self-control of oral anticoagulation is feasible and achieves a high percentage of INR values within the recommended target ranges. Therefore, self-control of oral anticoagulation can be offered to skilled and motivated patients as an alternative to physician-guided antiocogulation. However, specific training of these selected patients is necessary.

Psychosocial factors predict medical outcome following a first myocardial infarction. Working Group on Cardiac Rehabilitation of the Swiss Society of Cardiology.

BACKGROUND: The aim of this study was to identify psychosocial variables that, in addition to known medical factors, predict the long-term outcome after a first myocardial infarction. PATIENTS AND METHODS: The study population consisted of 222 men aged 30-60 years who entered an inpatient rehabilitation program a mean of 7 weeks after a first myocardial infarction. Medical data and completed questionnaires for psychosocial variables were obtained from the patients and their family physicians at entry to the rehabilitation center and 1 year later. Further data, including answers to a detailed questionnaire, were collected at the beginning of rehabilitation and after one year; this follow-up was 99% complete. RESULTS: The 1-year mortality was 2.2%, the reinfarction rate 1.8%, hospital readmissions for cardiac reasons occurred in 25%, and 13% of the patients underwent a subsequent revascularization procedure. At baseline and after 1 year, respectively, 84 and 83% of the patients were asymptomatic. A poor medical outcome, defined as death, reinfarction, severe symptoms or poor exercise capacity, was seen in 9% of the patients. The most important physiological predictors for an unfavourable medical outcome, found in bivariate and multivariate analyses, were age, severity of infarction, and major coronary risk factors. In addition, some of the psychosocial variables were significantly related to a poor medical outcome: lack of a stable partnership, high work load, poor general well-being with multiple chronic non-specific health complaints, and a low external locus of control (failure to identify disease-promoting factors within own surroundings or lifestyle). CONCLUSIONS: The medical course of coronary artery disease was predicted not only by medical variables but also by psychological and social variables. As well as being addressed directly, these factors may help to identify patients who need to be followed more closely, so that medical complications can be reduced by treating early signs of disease progression more aggressively.

[Ambulatory rehabilitation of cardiac patients in Switzerland]. / Ambulante Rehabilitation von Herzpatienten in der Schweiz.

In 1989, there were 21 rehabilitation clinics and 21 ambulatory cardiac rehabilitation programs in Switzerland. Approximately 3/4 of the cardiac rehabilitation programs are offered within rehabilitation clinics, which cater for 6000 patients. The first ambulatory cardiac rehabilitation program in Switzerland was instituted in 1972. Since then a continuous rise in the number and importance of such programs has been observed. There is a wide variety of program selection and intensity. All programs include physical activity, risk factor interventions and psychosocial support. The mean duration of the programs is 3 months, the range being from 6 weeks to a year. Evaluation after 8 years' existence of the ambulatory cardiac rehabilitation program at the Kantonspital Olten indicates that such a program in an out-patient setting in conjunction with a community hospital is feasible; it can be conducted with a high degree of safety and is followed by similar lifestyle changes to those observed after in patient rehabilitation at specialist clinics. The results with regard to cardiovascular risk factors and ability to return to work are comparable.

[Cognitive and psychological effects on the population of a cardiac emergency campaign]. / Kognitive und psychische Effekte einer Herznotfallkampagne auf die Bevölkerung.

The major part of the delay from onset of symptoms of acute myocardial infarction to arrival in hospital is caused by patients' delayed reporting. Therefore, a media campaign was initiated by the Swiss Heart Foundation with the goal of informing people about the seriousness of chest pain and about the importance of proper action in these situations. An initial 2 months' national campaign was followed by a 3 weeks' intensive local campaign in a mixed urban/suburban area in central Switzerland. The aim of the study was to evaluate the effects of this media campaign on patients information and reaction in case of cardiac emergency, and to study the possible impact of this campaign on anxiety levels and other emotions. Telephone interviews were performed before and after both the national and the local campaign using a cohort of 500 persons in a longitudinal and 4 x 500 persons in a cross-sectional study. The information had reached about 50% of the population by the end of the local campaign. The percentage of persons who would call the emergency medical services immediately in case of chest pain increased from 40% to 57% in the cross-sectional and from 48% to 65% in the longitudinal study (p < 0.001), and the percentage of persons who would call the ambulance team immediately on witnessing a person with a heart attack increased from 25 to 92% in the cross-sectional and to 96% in the longitudinal study (p < 0.001). Anxiety levels and other negative emotions decreased slightly during the campaign (p < 0.05), whereas feelings of personal safety revealed a slight increase (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[The current status of cardiac rehabilitation in Switzerland]. / Aktuelle Situation der kardialen Rehabilitation in der Schweiz.

The aim of this study was to investigate the present situation of institutionalized cardiac rehabilitation in Switzerland. In 1989, there were 21 rehabilitation clinics and 21 ambulatory cardiac rehabilitation programs in Switzerland. All programs include physical activity and risk factor intervention. There is a wide variety of program selection and intensity. The medical care, the physical activity program, the strategy for risk factor intervention, the technical equipment and the emergency concept can be regarded as good in most rehabilitation clinics and in the ambulatory rehabilitation programs. However, a search for quality criteria for further activities in cardiac rehabilitation in Switzerland seems desirable.

Postlunch smoking for pleasure seeking or arousal maintenance?

Interactions between smoking and eating might be expected, since the craving to smoke increases after a meal, since smokers tend to have a lower body weight and since they have also been suggested to differ from nonsmokers with respect to metabolism. Further, both eating and smoking have been reported to affect mental performance. In the first experiment the influences of a heavy meal, a light meal and no meal on smoking behavior and subjective ratings were compared in 15 subjects. Whereas puffing behavior was not affected by the meal conditions, craving and smoking enjoyment increased after the meals. In the second experiment the effects of smoking on postlunch performance and concomitant central and peripheral physiology were investigated. Postlunch smoking (compared to postlunch no smoking) distinctly showed the usual increases in heart rate, peripheral vasoconstriction and electrocortical arousal, but it failed to affect rapid information processing performance and its concomitant event-related EEG potentials as well as several indices of metabolic activity. It appears, thus, that under the conditions of the present experiments, pleasure seeking may be a more important factor in postmeal smoking than the effects on performance, EEG or metabolism.

Psychophysiological reactivity in type A and B women during a rapid information processing task.

Type A and Type B women assessed by a newly developed German questionnaire 'need for control' (NC) were compared with respect to time-pressured information processing performance and to simultaneously recorded psychophysiological reactivity. The task was computer controlled, monetarily reinforced and subject paced. The physiological measurements included the cardiovascular parameters, ECG and finger plethysmographic amplitudes and the noncardiovascular parameters, EMG (frontal muscle), skin conductance reactivity, and respiration. NC-Type A and Type B women did not differ in performance, but the Type As showed stronger vasoconstrictive responses to the task than did the Type Bs. Other physiological intergroup differences were not seen. In addition, the Type As scored significantly higher in nervousness and irritability and marginally higher in depression, reactive aggressivity and neuroticism than did the Type Bs. This particular pattern of NC-Type A/B differences is discussed with regard to relevant differences observed by other studies between SI and JAS Type As and Bs.

[Psychophysiological reactivity in relation to type A behavior]. / Psychophysiologische Reaktivität in Beziehung zum Typ-A-Verhalten.

This relationship was examined in 77 healthy men. Stress reactivity in the 26 Type A was not more increased than in the 12 Type B men for the cardiovascular variables (heart rate, pulse transit time, finger vasoconstriction and blood pressure), but for body movement, EMG, respiration frequency. Body movement and EMG were the best predictable physiological variables for the Type A behavior pattern, and this mainly in the two speech tests.