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Biomedical subjects

M Middeke

Publications and source records attributed to M Middeke.

At least 19 recordsLinked to original sources
PubMed1999

Integration of generic indicators for quality management in hospital information systems.

Hospital information systems may contribute in different ways to quality management activities such as monitoring of quality indicators. Most existing quality management activities in hospitals are adjusted to a special medical field or particular disease. These activities often run simultaneously with other procedures and the documentation of patient care. To determine an interdisciplinary integrated quality management procedure, a pilot study was carried out at the Neurosurgery Department and Neonatology Division of the Medical Center of the University of Heidelberg. Predefined generic indicators that may be integrated in an existing information system and used in hospital routine were the basis of this project. The aim of the study was to support the quality management with periodic reports of these indicators. The pilot study showed that there were barriers along the path to an integrated generic quality management. To meet the requirements of routine monitoring, using predefined generic indicators of hospital care, much integration effort, directed at organizational aspects of information processing and information systems architecture, is still needed.

Germany↗
PubMed1997

The effects of antihypertensive combination therapy on lipid and glucose metabolism: hydrochlorothiazide plus sotalol vs. hydrochlorothiazide plus captopril.

Metabolic side-effects of antihypertensive drugs may increase the risk of coronary heart disease despite an adequate blood pressure reduction. Since combinations of different antihypertensive drugs are often necessary and frequently used, we performed a randomized study comparing the effects of a fixed combination of hydrochlorothiazide and sotalol (group A), or hydrochlorothiazide and captopril (group B) on blood pressure and on lipid and glucose metabolism in 40 men with essential hypertension over 1 year. Significant blood pressure reductions (p < 0.001) were achieved in both treatment groups: from 160/105 to 128/88 mmHg in group A (mean doses: hydrochlorothiazide 33 and sotalol 197 mg) and from 162/106 to 135/89 mmHg in group B (hydrochlorothiazide 33 and captopril 64 mg) after 12 months, respectively. No significant changes in body weight were observed in either treatment group. Triglycerides increased (p < 0.05) in both treatment groups (from 183 to 262 mg/dl in A, and from 160 to 196 mg/dl in B) and HDL cholesterol decreased (p < 0.001 and < 0.05) in both groups (from 45.1 to 35.7 mg/dl in A, and from 49.3 to 46.3 mg/dl in B), whereas LDL cholesterol increased significantly (p < 0.05) only in group A from 153 to 164 mg/dl. No significant changes were observed in total cholesterol nor in lipoprotein(a) concentrations in either treatment group. Fasting plasma glucose and hemoglobin A1 increased significantly (p < 0.05) only in group A after 1 year of treatment (from 91.6 to 98.0 mg/dl, and from 6.3 to 6.9%, respectively). Serum levels of creatinine and potassium decreased, and uric acid increased significantly under either combination. Our data show that the diuretic/beta-blocker combination has adverse effects on lipid and glucose metabolism after long-term therapy. The effects of the diuretic/ACE inhibitor combination on lipid metabolism are less pronounced and there are no adverse effects on glucose metabolism. However, the ACE inhibitor component could not completely counteract the metabolic effects of the diuretic. Both combinations have no effects on Lp(a). We conclude that the combination of hydrochlorothiazide with an ACE inhibitor has a better metabolic profile for the treatment of essential hypertension than the combination with a beta-blocker.

Adrenergic beta-Antagonists↗
PubMed1996

Drug effects on BP rhythm in secondary hypertension.

Antihypertensive drug treatment is necessary in most patients with secondary hypertension. Only a small percentage of cases can be cured by operation or angioplasty. Because blunted or reversed nocturnal blood pressure fall is frequently found in patients with secondary hypertension, time of day of drug application is of special interest in these patients. The time structure of blood pressure over 24 hours or even longer can be obtained using ambulatory blood pressure monitoring. This is a prerequisite for individualization of antihypertensive therapy and for achievement of optimal drug effects. Chronopharmacologic aspects are playing an increasingly important role in the treatment of secondary hypertension, especially in renal forms. Recently, the first studies in this field were completed, isradipine and doxazosin in chronic renal failure and trandolapril in hypertensive diabetic subjects. Results show that restoration of normal nocturnal blood pressure fall and constitution of normal circadian rhythm are possible in patients with mild to moderate renal hypertension after evening dosing as compared to morning dosing with monotherapy. In more severe hypertension combination therapy including multiple dosing with special attention to evening application is necessary. In conclusion, optimal drug effects and individualization of antihypertensive treatment in patients with secondary forms of hypertension can be achieved using a stepped care program including chronopharmacologic regimens to restore normal circadian rhythm on a normotensive level.

Antihypertensive Agents↗
PubMed1996

Office hypertension: abnormal blood pressure regulation and increased sympathetic activity compared with normotension.

BACKGROUND: The percentage of patients with office or white-coat hypertension has been reported in international studies to be 20-30% of the hypertensive population. These patients can be identified and distinguished from patients with established hypertension by ambulatory blood pressure monitoring (ABPM) or self-measurement. There is still no satisfactory explanation for the phenomenon of 'office hypertension' and there are no data available to show how the blood pressure behaviour of office hypertensives differs from that of normotensive subjects away from the physician's office or clinic environment. OBJECTIVE: To investigate the blood pressure behaviour of patients with office hypertension away from the clinical setting over a 24 h period and to compare it with that of normotensive subjects. DESIGN AND METHODS: The blood pressure and heart rate of 36 patients with office hyhpertension and 33 normotensive subjects matched for age and sex were measured in a hypertension outpatient clinic and over 24 h using ABPM. The ambulatory data were subjected both to conventional and to modern rhythm analysis. Urinary catecholamine excretion was measured as a marker of sympathetic activity. RESULTS: In the clinic, the patients with office hypertension had significantly (P < 0.01) higher blood pressure values (146/97 mmHg) than did the normotensive controls (128/81 mmHg). The conventional analysis as well as the rhythm analysis of the ABPM data revealed no difference between the two groups with respect to the 24 h, daytime or night-time mean values and SD. However, the rhythm analysis showed a higher maximum and a lower minimum value for systolic and diastolic blood pressures in the patients with office hypertension, resulting in a greater amplitude both of systolic and of diastolic blood pressure due to a significantly (P < 0.005 and P < 0.05) higher maximum minus minimum value (38/32 mmHg) compared with those of normotensive controls (29/28 mmHg). The early morning rise in systolic and diastolic blood pressures was significantly (P < 0.008 and P < 0.03) greater in the patients with office hypertension (11/9 versus 7/7 mmHg) and intersected the curve of the normotensive controls at approximately 0600 h. No significant differences in heart rate at any time were observed between the groups. The urinary excretion of noradrenaline and dopamine was significantly (P < 0.01 and P < 0.05) increased during daytime for the office hypertensives. CONCLUSION: Patients with office hypertension, who by definition do not yet have established hypertension, already exhibit abnormal regulation both of systolic and of diastolic blood pressure during the morning period and daytime, with a significantly greater early morning rise compared with normotensive subjects and a greater blood pressure amplitude (amplitude hypertension) due to lower blood pressure during night-time and higher blood pressure during the day with increased sympathetic activation. Office hypertension seems to be the earliest manifestation of hypertension.

Journal Article↗
PubMed1996

Effect of nocturnal blood pressure measurement on sleep and blood pressure during sleep.

Nocturnal hypertension is of diagnostic interest and has important prognostic and therapeutic implications. Nighttime blood pressure can easily be measured using ambulatory blood pressure monitoring (ABPM). However, during nocturnal ambulatory blood pressure measurement pump noise, tactile stimuli and pressure produced by cuff inflation may alter the quality of sleep and subsequently influence the physiological fall of night time blood pressure. Eight studies were performed to determine whether non-invasive automated blood pressure monitoring during day and/or night provokes alert reaction, arousal, sleep disturbances and changes in blood pressure and/or heart rate. From these studies it can be concluded: 1) Nighttime blood pressure can be evaluated properly using ABPM. 2) Nocturnal blood pressure is not overestimated by ABPM. 3) ABPM does not induce an alarm reaction and a blood pressure rise when monitored with a silently operating recorder. 4) Sleep is often disturbed by blood pressure measurement without provoking a blood pressure increase. 5) In older patients blood pressure measurement and age-related alterations in sleep quality may influence each other. A patient's protocol has to be carried out and sleep quality should be recorded to provide a proper interpretation of nocturnal blood pressure behavior. ABPM is an important and valuable method to record nocturnal blood pressure for diagnostic and therapeutic purposes.

Arousal↗
PubMed1995

Double-blind comparison of antihypertensive treatment with ramipril and piretanide, given alone or in combination.

In a double-blind, randomized, multicenter trial, we compared the efficacy and safety of the fixed combination of 5 mg ramipril and 6 mg piretanide and the respective component monotherapies in hypertensive patients [supine diastolic blood pressure (DBP) 100-114 mm Hg]. After a single-blind run-in period on placebo, 611 patients were randomized to ramipril (n = 209), piretanide (n = 201), or the combination therapy (n = 201). At randomization, the three groups had the same characteristics (51% men, age 55 +/- 10 years, BP 165 +/- 18/104 +/- 6 mm Hg). At 4 weeks, BP decreased more with combined therapy than with monotherapy. As compared with piretanide monotherapy, the gain in the antihypertensive effect in the supine position averaged 2.1 mm Hg [90% confidence interval (CI) -0.8-5.0 mm Hg; p = 0.07] systolic BP (SBP) and 1.9 mm Hg (CI 0.3-3.5 mm Hg, p = 0.02) DBP and, as compared with ramipril monotherapy, these differences were 4.2 mm Hg (CI 1.3-7.0 mm Hg, p = 0.008) and 2.0 mm Hg (CI 0.5-3.6 mm Hg, p = 0.009). The incidence of adverse events (AE) and the changes in biochemical measurements were similar in the three treatment groups with the exception of spontaneously reported polyuria and serum uric acid concentration. Polyuria was reported more frequently (p < 0.001) with piretanide therapy (n = 23) and combined therapy (n = 19) than with ramipril therapy (n = 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗