These results support the importance of duration of ruptured membranes as a risk factor for vertical transmission of HIV and suggest that a diagnosis of AIDS in the mother at the time of delivery may potentiate the effect of duration of ruptured membranes.
most frequently prescribed combination therapy (22%), followed by the combination beta blocker-diuretic (15%) and calcium channel blocker-diuretic (14%). Only 2% of the physicians reported to retain the current antihypertensive medication. The predominant therapeutic strategy chosen by the physicians was to prescribe an additional medication, followed by the substitution of at least one antihypertensive drug and the option to increase the dose of at least one drug. The logistic regression analysis revealed that male hypertensive patients older than 75 years treated by Dutch-speaking physicians older than 60 years were more likely to remain on the same treatment. The most prevalent reasons for the no-change strategy choice were 'the treatment is well tolerated' and 'the clinical situation is acceptable'. Treatment inertia may already have set in prior to the study as all patients were treated for >6 months without achieving blood pressure control.Conclusions: Rather than concluding that therapeutic inertia is an unimportant factor in clinical practice, it seems more likely that being involved in a survey, designed to identify patients' cardiovascular risk and blood pressure goal, can induce a change in clinician behaviour (Hawthorne effect), resulting in better clinical practice.
Background:The difference between clinic and ambulatory BP increases with age. Data, however, are mainly available in subjects aged up to 80-85 years and limited information exists on older ages.
Methods:We studied 11 patients, all females, aged 100 years or more (101.5 years, range 100-104), hospitalized in our Geriatric Institute. 7 patients had a history of hypertension but none was under antihypertensive treatment. Mild cognitive impairment was diagnosed in 10 patients. 5 patients had a history of myocardial infarction but none of stroke. Clinic BP was the mean of two measurements performed in the sitting position after 5 minutes of rest. Ambulatory BP was recorded for 24 hours with automatic readings spaced by 20 minute intervals. The recordings were carried out successfully in all circumstances and no subject reported problems with night sleep.
Results: Clinic BP was 111.8 AE 12.5 /68.2 AE 8.73.mmHg (systolic/diastolic, mean AE SD). Mean 24 h BP was 122.44 AE 13.31/63.22 AE 5.47 mmHg, The day and night BP values were 123.3 AE 11.94/64.8 AE 5.47, 121.77 AE 15.44/ 59.77 AE 5.71 mmHg, respectively.Conclusion: The progressively greater difference between clinic and ambulatory BP associated with aging reverses above a certain age because in centenaries no difference between clinic and ambulatory BP is apparent. Confirming previous reports centenaries appear to loose the day-night BP circadian rhythm.
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