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Doctors, Nurses and Patients Journal of Human Hypertension (1998) 12, 767–775 1998 Stockton Press. All rights reserved 0950-9240/98 $12.00 http://www.stockton-press.co.uk/jhh ABSTRACTS Doctors, Nurses and Patients: 2nd International Satellite Meeting of the 17th Scientific Meeting of the International Society of Hypertension Glasgow, 5 June 1998 (Convenor; Dr J Curzio) Journal of Human Hypertension, 1998, Volume 12 1998 Stockton Press ISSN 0950–9240 Recent developments in hypertension DG Beevers University Department of Medicine, City Hospital, Birmingham, UK There have been many important developments in however, remain some anxiety on the use of short- hypertension since the last multidisciplinary confer- acting calcium channel blockers in patients with ence in 1996. We now know more about the value existing coronary heart disease. of antihypertensive treatment and have increasing The angiotensin receptor antagonists have proved evidence in favour of both the calcium channel immensely successful and in March 1997 the first blockers and the ACE inhibitors. long term trial of losartan was published (the ELITE In September 1997 the final results of the SYST- study). This showed that losartan was as good as or EUR trial were published. These showed that blood slightly better than captopril in the management of pressure lowering with the calcium channel blocker, elderly patients with heart failure. It is significant nitrendipine, was associated with a significant that a great many other drugs in this class are being reduction of strokes and an impressive but non-sig- developed by other drug companies. There is nificant reduction in coronary heart disease. There increasing evidence that blocking the renin-angio- was no excess mortality in the treated patients from tensin system has added benefits over other drug cancer or haemorrhagic events. therapies in delaying the progression of renal failure The SYST-EUR trial is almost the last of the pla- in both diabetics and non-diabetics with nephro- cebo controlled trials and the next generation of pathy and also in reducing left ventricular hypertro- trials will be comparing different treatment regimes. phy. There is also one interesting study which sug- Since 1995 there have been considerable anxieties gests that the ACE inhibitors delay the development on the safety of calcium channel blockers in the light of retinopathy in diabetic patients. of a series of papers from the United States. Most of A great many trials are now being established to these studies were relatively weak case-controlled investigate the benefits of the ‘new’ versus the ‘old’ studies and many commentators thought that the drugs in hypertension. In particular the Anglo-Scan- results were improbable. The results of the SYST- dinavian Cardiac Outcome Trial (ASCOT) is ending EUR trial largely reassured us that calcium channel its pilot phase. There will however be relatively blockers are not associated with any excessive mor- little new information on the treatment of hyperten- tality from non-cardiovascular disease. There must, sion until well into the next century. Mercury poisoning RE Ferner West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham, UK A ruling by the European Union heralds the demise such as dimethylmercury, which are very fat sol- of those useful clinical instruments, the mercury uble; and metallic mercury, which is only absorbed thermometer and the mercury sphygmomanometer. into the body as the vapour. The new laws have been passed because of worries Inorganic mercury salts are water soluble, irritate about mercury poisoning. Yet you can drink met- the gut, and can cause severe kidney damage. allic mercury and come to no harm. What does it Organic mercury compounds, which are fat soluble, all mean? cross from the blood into the brain, and cause intel- There are three forms of mercury from the toxico- lectual impairment, damage to the optic nerves, and logical point of view: inorganic mercury salts such ataxia. There can also be peripheral nerve damage. as mercuric chloride; organic mercury compounds, Mercury metal poses two dangers. It can be vapor- Doctors, nurses and patients — Abstracts 768 ised: the vapour pressure (the amount of vapour is turned into organic mercury, for example by bac- ‘given off’) at room temperature is about 100 times teria in the sludge at the bottom of lakes. The bac- the safe amount. As mercury metal is heated, it teria concentrate the organic mercury, and are eaten evaporates more readily, and the vapour pressure by marine creatures that are themselves eaten by fish doubles for every 10°C rise in temperature. This higher up the chain, until the fish are eaten by makes heating mercury, especially in a confined humans. Environmental contamination by metallic space, very dangerous. Even at room temperature, mercury from chemical plants, its subsequent organ- poisoning can occur if mercury metal is spilled into ification, and the concentration of poisonous organic crevices or cracks in the floorboards of a poorly ven- mercury in fish, lead to the Japanese tragedy at Mini- tilated room. Dentists are occasionally poisoned in mata Bay in the late 1950s when over 800 people this way. Mercury vapour, being fat soluble, easily were poisoned. A number were children in utero. crosses into the brain, and causes tremor, It is the need to reduce mercury contamination of depression, and a behavioural disturbance called the environment which should encourage us to cut erethism. In addition, the vapour causes mouth the usage of metallic mercury. However, much more ulcers and salivation. metallic mercury is spilled as waste by the chemical A second danger from metallic mercury is that it industry than is dropped on the floor in the clinic. Validated patient self-measurement of blood pressure verifies hypertension and optimises its management RS Armstrong, JP Taylor, M Stowasser and RD Gordon Hypertension Unit, Greenslopes Private Hospital, Brisbane, Australia Patient self-measurement of blood pressure period of time. Self-measurement verifies hyperten- optimises management through providing compre- sion by excluding white coat hypertension and hensive, accurate information and by promoting quantifying the white coat effect. Patients can take patient compliance and involvement in the manage- frequent measurements at times not normally read- ment of their condition. Self-measurement also ily obtainable and thus contribute more comprehen- enables the progress of geographically remote sive information with regard to 24-h control and patients to be followed. Assessment, education and optimal distribution of medication. continuing follow-up however are essential to pro- Management is optimised by patient self-measure- vide valid, standardised measurements and reason- ment because the measurement is more consistent ably ensure user and device accuracy. and accurate than what is provided by many health Patients view an instructional video either on the professionals. Because the patient feels more in con- hospital video system or at the Hypertension Nur- trol, compliance is improved. By excluding the se’s office. Viewing is followed by demonstration white coat effect, lower doses can be administered and practice with the nurse instructor using a dual with confidence with fewer side effects and a better or three way stethoscope. Accuracy is confirmed quality of life. The chronotherapuetic approach to prior to leaving and patients take home written management using self-measured blood pressures instructions and a simplified checklist. A 2-week can facilitate optimal use of medication and result later follow-up visit to ensure proper technique and in reduced cost for individual and health budgets. promote patient confidence is arranged and further Patient self-measurement, because of its repeat- 6-monthly checks of device and patient technique ability without aid of health professional staff for are encouraged. Aneroid gauges are checked by comparing ran- each period of measurement, is more cost effective domly selected points on the gauge against the mer- than office blood pressure measurement or 24 h cury column. Electronic devices are connected with ambulatory monitoring. a Y piece to the mercury and a series of six simul- In these days of accountability and cost valued taneous same arm measurements are taken on the ahead of outcome by government agencies, the person who uses the device for self-measurement. reduced cost to the patient and the community at Validity is also promoted by obtaining multiple the same time as patient care is improved, must be readings under standardised conditions over a short almost unique. Knowledge-base of blood pressure measurement—do guidelines help? D Wingfield, M Pierce and M Feher Dept of Primary Healthcare and General Practice, Imperial College School of Medicine, London University, London, UK The measurement of blood pressure (BP) is a crucial questionnaire survey was conducted of 831 com- part of clinical assessment and hypertension man- munity-based practitioners (550 general prac- agement and is commonly performed inaccurately titioners and 281 practice nurses) in north west Lon- despite the publication of national and international don. consensus guidelines for its measurement. A postal The response rate was 61%. Overall the nurses (n Doctors, nurses and patients — Abstracts 769 = 196) had a greater knowledge base than the GPs the nearest 2 mm mercury (GP 53%, nurse 67%) and (n = 320) and both community groups had a greater correctly reporting the rate of fall of the
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