[Acute myocardial infarct in Switzerland: results from the PIMICS Heart Infarct Register. PIMICS Project (Prospective Ischemia Myocardial Infarction Captopril Survey)]. / Der akute Myokardinfarkt in der Schweiz: Resultate aus dem PIMICS-Herzinfarkt-Register. PIMICS-Projekt (Prospective Ischemia Myocardial Infarction Captopril Survey).

The aim of the PIMICS project was to create, for the first time in Switzerland, a registry of data concerning epidemiology and therapy in patients hospitalised for acute myocardial infarction covering all regions of the country. During 1995/96 73 Swiss hospitals of all categories took part in the PIMICS project. The ratio between males and females in the 3877 registered patients was 2.6:1 (2791 men vs. 1086 women). Female patients were significantly older than males (70.4 +/- 12.0 years vs. 63.4 +/- 12.6 years; p < 0.0001). The prevalence of risk factors differed between men and women: significantly more women had hypertension or diabetes, whereas smoking was more prevalent in males. The median delay between onset of symptoms and arrival at the hospital was 5.5 hours. Thrombolysis and primary angioplasty were more frequently performed in men (40.4% vs. 31.2% in women, p < 0.0001, and 5.7% in men vs. 3.5% in women, p = 0.005 respectively). During the acute phase males were treated more frequently with betablockers. The overall in-hospital mortality was 9.1%. It was significantly higher in female patients (13.5% vs. 7.4% in men; p < 0.0001) and in patients with reinfarction (14.5% vs. 7.1%; p < 0.0001). The mean hospital stay was 12.6 +/- 5.3 days. Only 7.7% of all patients with acute myocardial infarction were discharged within 6 days. At discharge, 51.7% were treated with betablockers and 69.3% with aspirin; 44.8% received ACE-inhibitors and only 13.8% lipid-lowering drugs. Follow-up measures such as coronary angiography and/or angioplasty or bypass surgery were performed significantly more often in males (45.0% vs. 32.9%; p < 0.0001). Likewise, men were more frequently assigned to a rehabilitation program than women (38.2% vs. 32.9%; p = 0.0004). The pre-hospital delay in patients with acute myocardial infarction remains too long. Primary and secondary prevention should be intensified in high risk groups, particularly in females. Thrombolysis and primary angioplasty as mainstays of treatment in acute myocardial infarction are generally used too sparingly, especially in women. With such measures the hospital stay could be shortened further.

[Therapy of hypertension in the elderly: Fosinopril in Old Patients Study (FOPS)]. / Therapie der Altershypertonie: Fosinopril in Old Patients Study (FOPS).

The necessity for a persistent antihypertensive treatment in elderly persons has not been proven until the beginning nineties. An adequate reduction of blood pressure is required also in high age for prevention of cardiovascular accidents. A study is presented which investigates efficacy and tolerance of the ACE-inhibitor fosinopril in an unselected cohort of hypertensive outpatients older than 60 years over 12 weeks. Diastolic hypertension (DBP > or = 96-110 mm Hg) and isolated systolic hypertension (SBP > or = 160-219 mm Hg, DBP 80-94 mm Hg) were analyzed separately. Blood pressure values in both groups were normalized in more than 80% of the patients. In the case of insufficient response an additional dose of 12.5 mg hydrochlorochiazide was somewhat more effective than doubling the dose of the ACE-inhibitor. Efficacy and side effects of the antihypertensive treatment with fosinopril in this study were not dependent on the degree of impaired renal function.

Combined treatment with captopril, hydrochlorothiazide and pravastatin in dyslipidemic hypertensive patients.

OBJECTIVES: Hypertension and hypercholesterolemia frequently coexist, necessitating concurrent treatments for both disorders. The present study aimed at evaluating the efficacy, the safety, and the toleration of captopril, an ACE inhibitor, hydrochlorothiazide, a diuretic, and pravastatin, a HMG-CoA reductase inhibitor co-administered in hypertensive patients in general practice. DESIGN: The patients were followed for 16 weeks and asked to comply with a lipid lowering diet for the whole period. Captopril, 50 mg/once daily, was administered alone for the first 4 weeks. Hydrochlorothiazide, 25 mg/day, was added after 4 weeks if required. Pravastatin treatment (20 mg/day) was started at the 8th week of the study and its dose was doubled 4 weeks later if needed. PATIENTS: A total of 603 patients with hypertension (diastolic blood pressure > or = 95 mmHg) and dyslipidemia (total cholesterol > 6.5 mmol/l) were included. SETTING: The study was performed in general practice by 230 physicians. MAIN OUTCOME MEASURE: Determination of blood pressure, circulating levels of total cholesterol, HDL-cholesterol and triglycerides, and blood chemistry for safety monitoring. RESULTS: At the end of the trial 75.1% of patients had their diastolic blood pressure < or = 90 mmHg and 43.5% a total cholesterol level < 6.5 mmol/l. The overall incidence of adverse events was 21.7%, leading to withdrawal in 10.9% of the total number of patients. The combined treatments had no deleterious effect on safety variables. CONCLUSIONS: Captopril, hydrochlorothiazide and pravastatin are effective and well tolerated medications to treat dyslipidemic hypertensive patients.