Diakonissehusets sykelius (Lorisenberg), Oslo, Norway S U M M A R YI . The treatment of high blood pressure with modern drugs seems to improve the prospect of life for all grades of essential hypertension.2. The fatal complications are more seldom cerebral and more often cardiovascular. Especially in men coronary artery disease seems difficult to prevent.3. Most remarkable is the great percentage of surviving and symptom-free men and women, especially patients belonging to stage 2 and 3 at registration.4. Blood pressure reduction therapy seems to reduce the frequency of death directly related to hypertension. The grade of arteriosclerosis does not seem to be influenced to the same degree.Until recently there have been conflicting opinions regarding the value of antihypertensive therapy in improving the prognosis of hypertension and its complications (Goldring, 1969). P A T I E N T S A N D M E T H O D SSince 1955 we have registered patients suffering from essential hypertension. The first part of our material consists of 225 men and 208 women registered from 1955 to 1966, and treated medically since registration.The initial assessment was made by one of us (H.S.-M.) who has also undertaken most of the follow-up examinations.The usual clinical investigations were done, including ophthalmoscopy, electrocardiogram, X-ray of chest and urography, estimations of serum potassium, serum cholesterol, serum creatinine, serum uric acid, blood sugar, and urinalysis. Blood pressure was always measured several times in the sitting and standing positions and after five kneebendings. The treatment Correspondence: Dr H. Storm-Mathisen, Diakonissehusets sykehus (Lovisenberg), Lovisenberggt 17, Oslo 4, Norway.
There are many different ways of evaluating a doctor-patient relationship and compliance with a therapeutic regimen. One obvious way is to measure the serum level of the prescribed drug or the urine excretion of the metabolites (1). These methods can only be used in a limited number of patients and for a relatively short observation time. The tablet counting is more convenient in the long-term treatment.Also, an interview might lead to better doctor-patient relationship and seems to be a fairly adequate method for evaluating patient compliance (2,3).An indicator of the compliance to therapy over the years in treatment of a chronic disorder like hypertension is probably to study the number of drop-outs from follow-up (4,s).In the Deaconess Hospital (Lovisenberg sykehus), Oslo, we have in collaboration with several general practitioners treated and checked-up thousands of hypertensive patients. In the period 1955-1975 we have registered 745 patients under our own treatment for a minimum of one year and in the mean more than 10 years.After 1965 this method has been followed: 1. The patient is called with a letter to a policlinic interview and investigation at a given date and time. The waiting time is not more than a few minutes. The laboratory study is done at the same time. The patients are examined about twice ayear or more if necessary. The examination by the physician lasts for about half an hour. The patient's use of tablets is checked on these occasions and side effects are discussed. Also the other parts of the regimen, smoking, diet, etc. are discussed. Blood pressure is measured in sitting and standing position, and standing after five knee bendings. 3. Reports and results concerning laboratory findings are given in a letter to the patient together with a written message about the new dosage of tablets and the new appointment day and hour. The most convenient time for this has already been discussed during the consultation. 4. Blood pressures are plotted on millimetre paper size 21 x 29 cm (A4). The notes for many years are collected in a loose leaf book after a system with cues: Methyldopa, beta-blocker, spironolactone etc. according to the leading drug treatment. 5. Address-cards with cues are collected in special boxes. The main register has signals for cross reference given to this special hypertension register.
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