[Who visits the district nurses in Gothenburg?]. / Vilka besöker distriktssköterskorna i Göteborg?

All visits to or by the district nurses in Gothenburg, Sweden, were registered during one week (daytime Monday to Friday). Altogether 5,250 visits were registered. 77 per cent of all visits concerned subjects 65 years of age or older and 54 per cent subjects 75 years of age or older. It was more common for a woman to visit or be visited by a district nurse than for a man. Of the visits 70 per cent were made by the nurses (59 per cent to the homes of the patients and 11 per cent to homes for the aged), while 30 per cent of all visits were made by the patients to the district nurse's office. Very few visits concerned foreigners living in Sweden. Visits to or by old people were slightly more time-consuming than those to or by younger patients. When planning resources for visits to or by the district nurses it seems that age is by far the most important factor to take into consideration.

Antihypertensive effect of felodipine combined with beta-blockade. A comparison between 2 and 3 daily dosages.

24 hypertensive patients, who were not satisfactorily controlled (diastolic blood pressure greater than 95 mm Hg) with beta-blockers alone were randomised to 2 treatment groups where felodipine was administered for 2 weeks in a total daily dose of 15 mg divided in 2 or 3 doses. Following a 2-week placebo washout period, the patients were switched to the alternative dose regimen in a double-blind crossover manner. Blood pressure was measured with standard techniques and was also non-invasively monitored for 24 hours at the end of each dose regimen period and at the end of the intermediate placebo period. Mean arterial blood pressure at the end of the placebo run-in period was 169/105 mm Hg. Felodipine 5 mg thrice daily reduced blood pressure by 20/9 mm Hg and felodipine 7.5 mg twice daily by 17/9 mm Hg (p less than 0.05). The difference between the 2 dose regimens was not statistically significant. When 24-hour blood pressure measurements for the 2 dose regimens were compared, there were no statistically significant differences. Both regimens reduced the 24-hour blood pressure significantly compared with placebo. Two patients were withdrawn during the study, 1 before felodipine treatment started and the other due to diarrhoea and flushing related to felodipine. Otherwise felodipine was generally well tolerated.

Complaints of cold extremities among patients on antihypertensive treatment.

A total of 758 consecutive patients attending three hypertension clinics answered a questionnaire designed to assess the prevalence and severity of complaints of cold extremities among patients on various antihypertensive drugs. Forty-four per cent claimed to have had complaints of cold extremities and about 50% of these had had symptoms already prior to antihypertensive treatment. Among the newly symptomatic patients the prevalence of symptoms was 18% of those on diuretics and 40% of those on beta-blockers (p less than 0.01). No significant association was found between the prevalence of symptoms and age, sex, use of vibrating tools, smoking or history of various conditions associated with atherosclerosis. No significant difference was found in the prevalence of symptoms among patients on propranolol, alprenolol, pindolol, atenolol and metoprolol. It is concluded that cold hands and feet are common among hypertensive patients and may be aggravated by treatment with not only beta-blockers but also diuretics.

Metoprolol and atenolol administered once daily in primary hypertension. A clinical comparison of the efficacy of two selective beta-adrenoceptor blocking agents.

To compare the antihypertensive effect of two beta-blocking agents, metoprolol (Seloken) and atenolol (Tenormin), a double-blind study was performed in 55 patients. Following a six-week placebo period the patients, who all had mild to moderate essential hypertension (WHO I-II), were randomly allocated to treatment with either metoprolol (n = 28) or atenolol (n = 27). During a six-week period they received 100 mg of either drug once daily. For patients who at the end of that period did not reach a diastolic blood pressure (BP) of less than 95 mmHg the daily dose was increased to 200 mg. Patients who responded (diastolic BP less than 95 mmHg) continued on the initial dosage regimen. When comparing the two groups with regard to the reduction of BP, there was no difference either 24 hours after the last dose or 5-9 hours after drug administration. The decrease in supine systolic/diastolic BP was 18/16 mmHg on metoprolol and 20/16 on atenolol. The decrease in heart rate was comparable in the two groups. Eight patients in the metoprolol and 7 in the atenolol group had their dose increased to 200 mg at the end of the first six-week period. This means that the number of patients not responding to 100 mg daily was comparable in the two groups. We did not observe any differences in side-effects of the two drugs. The results clearly suggest that atenolol and metoprolol are equipotent following once daily administration in patients with mild to moderate hypertension.