Reproducibility and cost of blood pressure self-measurement using the 'Loaned Self-measurement Equipment Model'.

OBJECTIVE: To determine the reproducibility and the cost of the Loaned Self-measurement Equipment Model for blood pressure. SUBJECTS: Seventy-five subjects with non-complicated essential hypertension, having an average age of 56.2 +/- 11 years, were evaluated. METHODS: The Loaned Self-measurement Equipment Model consists of a set of sphygmomanometers belonging to the clinic, loaned to patients for 3-day periods for them to carry out 27 readings, and then returned. Using a mercury sphygmomanometer, a nurse carried out office blood pressure readings during two visits. A month later, the same procedure was repeated under the same clinical conditions. The agreement between studies was assessed by correlation coefficients, coefficients of variation and standard deviation of the differences (SDD). RESULTS: The office blood pressure was 147 +/- 17/89 +/- 12 mmHg during visit A, and 145 +/- 16/88 +/- 11 mmHg during visit B. The self-measurement blood pressure was 139 +/- 16/84 +/- 10 mmHg during the first visit, and 136 +/- 15/84 +/- 11 mmHg during the second visit. In neither of the cases were the differences statistically significant. The correlation coefficients for the office and self-measurement systolic blood pressure were statistically significant (P = 0.018), while those for the diastolic blood pressure were not statistically significant. The SDD for self-measurement systolic blood pressure was 10.7, compared to 15.0 for the office blood pressure (P < 0.01). The comparison in the case of diastolic blood pressure was not significant. The cost of each loan was $5.85 (US dollars). CONCLUSIONS: The Loaned Self-measurement Equipment Model has a good short-term reproducibility, and the cost is reasonable.

Changes in the costs of antihypertensive medications in a developing country: a study in Mexico comparing 1990 and 1996.

In developing countries, the cost of antihypertensive medications is one of the principal limiting factors when trying to treat patients with high blood pressure. To determine the changes in cost (in US dollars) of these medications and in the percentage of the minimum wage needed to purchase them, two cost studies (1990 and 1996) done in Mexico were compared. The yearly cost of a treatment with hydrochlorothiazide was US $13.80 in 1990; in 1996 it was US $10.92. Both figures represent 1.1% of the minimum wage that was in effect at the time. Propranolol hydrochloride cost US $50.52 for a year's treatment in 1990, and US $66.12 for the same in 1996. These figures represented, respectively, 4.2% and 6.7% of the minimum wage of 1990 and 1996. The annual cost for nifedipine was US $176.76 in 1990 (14.7% of the minimum wage) and US $242.16 in 1996 (24.8% of the minimum wage). The yearly cost of enalapril was US $233.04 in 1990 and US $433.20 in 1996; these costs represented, respectively, 19.4% and 44.2% of the minimum wage. The comparison of these two cost studies (1990 and 1996) shows why Mexico's population is finding it more difficult to purchase antihypertensive medications. Higher costs and reduced purchasing power seem to be the two principal factors causing this. This is probably affecting the population's health, as it is more difficult to control high blood pressure without proper treatment.

[A centennial of two great discoveries in the history of medicine: hyperpiesis and the sphygmomanometer (1896-1996)]. / Cien años de dos grandes acontecimientos en la historia de la medicina: hiperpiesis y esfigmomanómetro (1896-1996).

This paper describes two outstanding contributions in the understanding and treatment of primary arterial hypertension and cardiovascular diseases. In 1896, Sir T. Clifford Allbutt reported a series of clinical cases associated with high intensity in the arterial pulse and no renal damage. He named this hyperpiesis to distinguish it from Bright's disease or chronic renal insufficiency. In the same year, Scipione Riva-Rocci invented the Sphygmomanometer which, in principle, is still used today. Also, this paper describes the research work which would lead to the development of the blood pressure measurement device. This development is as significant now as it was then.

Efecto antihipertensivo de la amlodipina 48 a 72 horas después del tratamiento: un estudio con presurometría ambulatoria / Antihypertensive effect of amlodipine 48 a 72 hours after treatment: a study with ambulatory blood pressure monitoring

Se llevó a cabo este estudio abierto, simple ciego, no comparativo y controlado con placebo en 30 pacientes sin evidencia de hipertensión secundaria, para evaluar la eficacia de la amlodipina administrada en una sola dosis al día. Después de un período de placebo de dos semanas, siguió un período de 10 semanas de tratamiento activo; la dosis inicial de amlodipina fue de 5 mg una vez al día, la cual se aumentó a 10 mg a las cuatro semanas, en los pacientes en los que no se controló la hipertensión. La determinación de la presión arterial de manera convencional se efectuó en la semana 0, al final de la primera y segunda semanas y cada dos semanas en la fase de titulación y al fin del estudio; las cifras obtenidas al final de la segunda semana del período de placebo se tomaron como basales. El monitoreo ambulatorio de la presión arterial se llevó a cabo el último día del período placebo, el primer día de tratamiento activo, durante el último día del período de mantenimiento y durante las 48 a 72 horas que siguieron a la última dosis. Los resultados demuestran que la amlodipina es efectiva en el control de la presión arterial a lo largo de las 24 horas del día y que su actividad antihipertensiva perdura aún en el lapso entre las 48 y 72 horas posteriores a la suspensión del tratamiento

Efecto antihipertensivo de la amlodipina 48 a 72 horas después del tratamiento: un estudio con presurometría ambulatoria / Antihypertensive effect of amlodipine 48 a 72 hours after treatment: a study with ambulatory blood pressure monitoring

Se llevó a cabo este estudio abierto, simple ciego, no comparativo y controlado con placebo en 30 pacientes sin evidencia de hipertensión secundaria, para evaluar la eficacia de la amlodipina administrada en una sola dosis al día. Después de un período de placebo de dos semanas, siguió un período de 10 semanas de tratamiento activo; la dosis inicial de amlodipina fue de 5 mg una vez al día, la cual se aumentó a 10 mg a las cuatro semanas, en los pacientes en los que no se controló la hipertensión. La determinación de la presión arterial de manera convencional se efectuó en la semana 0, al final de la primera y segunda semanas y cada dos semanas en la fase de titulación y al fin del estudio; las cifras obtenidas al final de la segunda semana del período de placebo se tomaron como basales. El monitoreo ambulatorio de la presión arterial se llevó a cabo el último día del período placebo, el primer día de tratamiento activo, durante el último día del período de mantenimiento y durante las 48 a 72 horas que siguieron a la última dosis. Los resultados demuestran que la amlodipina es efectiva en el control de la presión arterial a lo largo de las 24 horas del día y que su actividad antihipertensiva perdura aún en el lapso entre las 48 y 72 horas posteriores a la suspensión del tratamiento (AU)