Diagnostik und Therapie von Bluthochdruck durch kontinuierliche Messung und Rückmeldung

Die Entwicklung einer Aufzeichnungs- und Feedbacksoftware mit Koppelung an einen PC ermöglicht die permanente Online-Darstellung des aktuellen Blutdrucks und der Herzfrequenz. Zur Messung verwendet wird die Finapres-2300 Anlage von Ohmeda Medizintechnik, die nach dem Penaz-Verfahren mit stationärer Messung durch Fingermanschette arbeitet. Das ursprünglich für die Intensivmedizin entwickelte Messgerät wurde so eingerichtet, daß neben der Datenaufzeichnung und -speicherung eine Feedback-Kommunikation mit den Patienten hergestellt werden kann. Realisiert wird dies in grafisch animativer, analoger Form nach jedem zweiten Herzschlag über den PC-Monitor. Ein Belohnungssystem, in Form eines Kontostandfensters auf dem Bildschirm, verteilt Pluspunkte für fallende Tendenz und Minuspunkte für steigende Tendenz des diastolischen Drucks. Die Patienten machen hierbei oft erstmalig die Erfahrung, daß sie die Möglichkeit der Einflussnahme auf ihren Blutdruck haben. Darüber hinaus kann das Programm in einigen Fällen von primärer Hypertonie als "Detektor" für eine zugrunde liegende psychische Kernproblematik eingesetzt werden. Es besteht damit die Möglichkeit, diejenigen Situationen oder Lebensbereiche zu entdecken, bei deren geistiger Repräsentation Blutdruck und/oder Puls außergewöhnlich stark ansteigen oder abfallen. Die statistische Auswertung erfolgt automatisch durch Schnittstellen zu den Programmsystemen SPSS/PC+ und Harvard Graphics. Hieraus ergeben sich weitreichende Perspektiven für die Diagnostik der Hypertonie wie auch im gesamten Bereich der Prävention, Therapie und Rehabilitation von kardiovaskulären Erkrankungen.The development of a new screening and feedback software enables continuous representation of blood pressure and heart rate. To this end, the Ohmeda Finapres-2300 equipment working with the Penaz technique and a finger cuff is used. This con-figuration allows simultaneous data recording and analogous feedback communication with the patient. This is realized after every two heart beats graphically on the monitor. A kind of banking account located in an additional window on the screen is used as a token system, increasing with falling tendency of the diastolic pressure and decreasing with rising tendency. With this method patients often discover for the first time that they are able to influence their blood pressure. Furthermore the program can be used for detection of psychological causes for some cases of essential hypertension. Statistical calculations are performed automatically by the software packages SPSS/PC+ and Harvard Graphics. Thus a variety of applications for diagnosis, therapy, prevention, and rehabilitation of cardiovascular diseases is emerging

Coda: theory matters

Zweitveröffentlichun

Online feedback of the blood pressure by means of noninvasive, continuous measurement

Die Entwicklung einer Aufzeichnungs- und Feedbacksoftware mit Koppelung an einen PC ermöglicht die permanente Online-Darstellung des aktuellen Blutdrucks und der Herzfrequenz. Zur Messung verwendet wird die Finapres-2300 Anlage von Ohmeda Medizintechnik, die nach dem Penaz-Verfahren mit stationärer Messung durch Fingermanschette arbeitet. Das ursprünglich für die Intensivmedizin entwickelte Meßgerät wurde so eingerichtet, dass neben der Datenaufzeichnung und -speicherung eine Feedback-Kommunikation mit den Patienten hergestellt werden kann. Realisiert wird dies in grafisch animativer, analoger Form nach jedem zweiten Herzschlag über den PC-Monitor. Ein Belohnungssystem, in Form eines Kontostandfensters auf dem Bildschirm, verteilt Pluspunkte für fallende Tendenz und Minuspunkte für steigende Tendenz des diastolischen Drucks. Die Patienten machen hierbei oft erstmalig die Erfahrung, daß sie die Möglichkeit der Einflussnahme auf ihren Blutdruck haben. Die statistische Auswertung erfolgt automatisch durch Schnittstellen zu den Programmsystemen SPSS/PC+ und Harvard Graphics. Hieraus ergeben sich weitreichende Perspektiven sowohl für Diagnostik (Blutdruckvariabilität) und Therapie der Hypertonie wie auch im gesamten Bereich der Prävention und Rehabilitation kardiovaskulärer Erkrankungen. Kontrollierte Studien zum therapeutischen Nutzen des Verfahrens wurden von den Autoren bereits begonnen.The new screening and feedback software is used to provide a continuous on-line representation of the patient's blood pressure and heart rate. Measurements are taken with Ohmeda Medizintechnik's Finapres 2300 which operates in accordance with the Penaz technique with stationary measurement taken by a finger cuff. The equipment, originally developed for intensive care departments not only records and stores data but also provides concurrent feedback of the information to the patient. Data is displayed graphically on a screen after every 2 heartbeats. The software also incorporates at type of reward system in the shape of an account status window located on the screen. This system awards plus points when the patient's diastolic pressure falls, and minus points when the pressure rises. These figures are logged in the account, allowing patients to see that they can actually influence their own blood pressure. Statistical calculations are performed automatically by the SPSS/PC+ and Harvard Graphics software packages. A variety of applications are emerging, not only with regard to diagnosis (variability of blood pressure) and treatment of hypertension, but also in terms of prevention of and rehabilitation after cardiovascular diseases. The authors are currently carrying out controlled studies of the therapeutic aspects of the technique

The EffecTs of Amlodipine and other Blood PREssure Lowering Agents on Microvascular FuncTion in Small Vessel Diseases (TREAT-SVDs) trial: Study protocol for a randomised crossover trial

Background: Hypertension is the leading modifiable risk factor for cerebral small vessel diseases (SVDs). Yet, it is unknown whether antihypertensive drug classes differentially affect microvascular function in SVDs. Aims: To test whether amlodipine has a beneficial effect on microvascular function when compared to either losartan or atenolol, and whether losartan has a beneficial effect when compared to atenolol in patients with symptomatic SVDs. Design: TREAT-SVDs is an investigator-led, prospective, open-label, randomised crossover trial with blinded endpoint assessment (PROBE design) conducted at five study sites across Europe. Patients aged 18 years or older with symptomatic SVD who have an indication for antihypertensive treatment and are suffering from either sporadic SVD and a history of lacunar stroke or vascular cognitive impairment (group A) or CADASIL (group B) are randomly allocated 1:1:1 to one of three sequences of antihypertensive treatment. Patients stop their regular antihypertensive medication for a 2-week run-in period followed by 4-week periods of monotherapy with amlodipine, losartan and atenolol in random order as open-label medication in standard dose. Outcomes: The primary outcome measure is cerebrovascular reactivity (CVR) as determined by blood oxygen level dependent brain MRI signal response to hypercapnic challenge with change in CVR in normal appearing white matter as primary endpoint. Secondary outcome measures are mean systolic blood pressure (BP) and BP variability (BPv). Discussion: TREAT-SVDs will provide insights into the effects of different antihypertensive drugs on CVR, BP, and BPv in patients with symptomatic sporadic and hereditary SVDs. Funding: European Union's Horizon 2020 programme

Prognostic impact of <i>CEBPA </i>mutational subgroups in adult AML

Despite recent refinements in the diagnostic and prognostic assessment of CEBPA mutations in AML, several questions remain open, i.e. implications of different types of basic region leucin zipper (bZIP) mutations, the role of co-mutations and the allelic state. Using pooled primary data analysis on 1010 CEBPA-mutant adult AML patients, a comparison was performed taking into account the type of mutation (bZIP: either typical in-frame insertion/deletion (InDel) mutations (bZIP InDel), frameshift InDel or nonsense mutations inducing translational stop (bZIP STOP) or single base-pair missense alterations (bZIP ms), and transcription activation domain (TAD) mutations) and the allelic state (single (smCEBPA) vs. double mutant (dmCEBPA)). Only bZIP InDel patients had significantly higher rates of complete remission and longer relapse free and overall survival (OS) compared with all other CEBPA-mutant subgroups. Moreover, co-mutations in bZIP InDel patients (e.g. GATA2, FLT3, WT1 as well as ELN2022 adverse risk aberrations) had no independent impact on OS, whereas in non-bZIP InDel patients, grouping according to ELN2022 recommendations added significant prognostic information. In conclusion, these results demonstrate bZIP InDel mutations to be the major independent determinant of outcome in CEBPA-mutant AML, thereby refining current classifications according to WHO (including all dmCEBPA and smCEBPA bZIP) as well as ELN2022 and ICC recommendations (including CEBPA bZIP ms). (Figure presented.)</p

Prognostic impact of CEBPA mutational subgroups in adult AML

Despite recent refinements in the diagnostic and prognostic assessment of CEBPA mutations in AML, several questions remain open, i.e. implications of different types of basic region leucin zipper (bZIP) mutations, the role of co-mutations and the allelic state. Using pooled primary data analysis on 1010 CEBPA-mutant adult AML patients, a comparison was performed taking into account the type of mutation (bZIP: either typical in-frame insertion/deletion (InDel) mutations (bZIPInDel), frameshift InDel or nonsense mutations inducing translational stop (bZIPSTOP) or single base-pair missense alterations (bZIPms), and transcription activation domain (TAD) mutations) and the allelic state (single (smCEBPA) vs. double mutant (dmCEBPA)). Only bZIPInDel patients had significantly higher rates of complete remission and longer relapse free and overall survival (OS) compared with all other CEBPA-mutant subgroups. Moreover, co-mutations in bZIPInDel patients (e.g. GATA2, FLT3, WT1 as well as ELN2022 adverse risk aberrations) had no independent impact on OS, whereas in non-bZIPInDel patients, grouping according to ELN2022 recommendations added significant prognostic information. In conclusion, these results demonstrate bZIPInDel mutations to be the major independent determinant of outcome in CEBPA-mutant AML, thereby refining current classifications according to WHO (including all dmCEBPA and smCEBPA bZIP) as well as ELN2022 and ICC recommendations (including CEBPA bZIPms)