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To evaluate the possible role of prostaglandins in exercise-induced changes in blood pressure and limb blood flow we have compared the effects of aspirin and indomethacin in a double-blind placebo controlled study in a group of normal volunteers. Nine men undertook treadmill exercise after pretreatment with placebo, aspirin and indomethacin. Indomethacin caused a greater increase in systolic blood pressure during exercise than aspirin (p less than 0.05) and a smaller fall in diastolic pressure than either placebo or aspirin (p less than 0.02 and p less than 0.01). Compared with placebo both aspirin and indomethacin attenuated to a similar degree the increase in calf blood flow (p less than 0.05 and p less than 0.03) and the changes in forearm blood flow following exercise. These results suggest that although aspirin and indomethacin both inhibit prostaglandin production they have different effects on exercise-induced changes in blood pressure. They have, however, similar effects on limb blood flow.

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Many deaths from myocardial infarction occur before medical help is sought. A campaign was mounted in Nottingham ("Nottingham Heartwatch") to encourage early reporting. A total of 13 828 men and women aged 40 and over registered with three general practices were asked to telephone a hospital-based number if they developed chest pain lasting for more than 10 minutes. Patients from study practices reported chest pain earlier after our invitation than they had before and also earlier than patients from control practices. While accepting the advice to call early some patients from the study practices ignored our special number and telephoned their general practitioner. The calls received on the Heartwatch line yielded a lower percentage of definite and probable infarcts than the calls received by the patients' own doctors.The way in which the characteristics of the study practices might have influenced this difference is discussed since it has considerable implications for largerscale attempts to bring patients with suspected myocardial infarction under medical care at the earliest opportunity.

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