The Walsall clinic for survivors of myocardial infarction is described. Coronary heart disease is a major health issue in Walsall. The starting point for the project was the publication of the Scandinavian Simvastatin Survival Study (4S) in 1994, which showed the benefit of cholesterol treatment in these patients. Although the new clinic was established primarily to implement a 4S‐based regime, the cholesterol regime has been modified in the light of newer evidence, and the service broadened to encompass cardiological assessment and the use of other forms of secondary prevention. Several factors have contributed to the success of the service, including support from the Health Authority, patient involvement, partnership with Primary Care and the use of information technology. The latter has integrated routine clinical record keeping and correspondence with complete prospective audit data accumulation and measurement of performance against evidence‐based standards. These principles are of potential value in other clinical effectiveness initiatives.
One of the most practical advances in the management of hypertension has been the realization that some drugs may be effective if given once daily. Different beta-blocking drugs given in multiple daily doses are probably equally effective in lowering blood pressure if equivalent doses are used, and this has usually been judged by their ability to reduce an exercise tachycardia. It is therefore important to know if this is true when given in a single daily dose. A small initial study has been carried out to compare the effects on blood pressure control of once daily slowrelease (SR) oxprenolol and once daily atenolol.
Trial DesignSeven patients (4 male and 3 female) who were taking oxprenolol as the only treatment for their hypertension, completed a double-blind crossover trial in which the slow release preparation was compared with the conventional preparation of oxprenolol in a similar dosage. The preliminary results showed that the slow release preparation was as effective as the twice daily conventional preparation. The patients received atenolol for four weeks at the end of the trial period of SRoxprenolol. There was an intervening period of conventional oxprenolol and the blood pressure was taken before the atenolol phase and before the SR-oxprenolol phase. As the variability of blood pressure during the day was to be assessed the patients were taught to measure their own Supine
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