Determination of ambulatory blood pressure control in treated patients with controlled office blood pressures.

Office blood pressure measurement is the standard for assessing blood pressure control. Many patients, however, take their antihypertensive medication in the morning, so they are likely to have their office blood pressure measured during the maximal antihypertensive effect. It is therefore unknown whether patients deemed by office blood pressure to be controlled do in fact have 24h blood pressure control. The objectives of this study were to determine blood pressure control, including blood pressure control while the patients were awake and during the first 6 hours after awakening, by ambulatory blood pressure monitoring (ABPM) in treated hypertensive patients deemed by office blood pressure measurements to be controlled. A total of 103 patients on a stable antihypertensive regimen and deemed to be controlled in terms of office blood pressure values (mean office blood pressure <140/90mmHg) were enrolled. Patients were stratified by cardiovascular risk status and the number of antihypertensive medications that they were taking. Seventy-eight out of 103 participants successfully completed ABPM. The mean ambulatory blood pressure was greater than 135/85mmHg and 140/90mmHg while awake for 37% (95% confidence interval [CI] 26-48%) and 23% (95% CI 14-32%) of all patients respectively. Forty-eight per cent (95% CI 33-63%) of patients taking monotherapy versus 25% (95% CI 11-39%) of patients on multiple antihypertensive medications were uncontrolled (P=0.039) using 135/85mmHg as the reference value. Thirty-one per cent (95% CI, 17-44%) of patients on monotherapy versus 14% (95% CI 3-25%) of patients on multiple antihypertensive medication were uncontrolled (P=0.064) using 140/90mmHg instead. These results demonstrate that a high number of patients deemed by office blood pressure to be under control do not have adequate blood pressure control based on ABPM.

Health-related quality of life in the treatment of angina.

The objectives of this study were to review the literature on health-related quality of life (HRQOL) in patients with angina pectoris (AP), provide suggestions for future research, and propose practical considerations for the selection and use of HRQOL instruments in AP clinical trials. A MEDLINE search was conducted of literature published between January 1980 and April 1999 using MeSH terms "quality of life" and "heart disease." Sixty articles were eligible for inclusion. General and disease-specific instruments were used in 55% and 57%, respectively. Findings were inconsistent with respect to which disease-specific or generic aspects of HRQOL were affected by treatment or which measures were sensitive to treatment changes. Disease-specific measures were more sensitive to treatment than general measures. Evidence suggests that HRQOL effects of surgical and medical treatments are similar over the long term. HRQOL is an important outcome measure to consider. Both disease-specific and generic measures should be used, and a variety of dimensions should be addressed when evaluating HRQOL of patients with AP. Further research is needed to assess the long-term effect of various treatments on HRQOL and the predictive power of HRQOL in clinical outcomes.