The best return visit interval to achieve blood pressure control is currently unknown. This study investigates the relationship between return visit interval and percent change in blood pressure. We reviewed a cohort of hypertensive patient charts from two large, urban family practice offices. Four hundred twenty‐nine patients with 7910 intervals showed a mean return visit interval of 79.5 days. Blood pressure control occurred during 34.5% of office visits. Pearson's r correlation coefficients between return visit interval and percent change in systolic and diastolic blood pressure demonstrated a small but statistically significant correlation. Shorter return visit intervals were associated with better percent changes in blood pressure. The return visit interval may be a simple and useful tool to improve management of hypertension.

BackgroundStarting with one drug and starting with a combination of two drugs are strategies suggested in clinical guidelines as initial treatment of hypertension. The recommendations are not based on evidence about clinically relevant outcomes. Some antihypertensive combinations have been shown to be harmful. The actual harm-to-benefit balance of each strategy is unknown. ObjectivesTo determine if there are differences in clinical outcomes between monotherapy and combination therapy as initial treatment for primary hypertension. Search methodsWe searched the Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 2), Ovid MEDLINE, Ovid Embase, LILACS, ClinicalTrials.gov, Current Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to February 2016. We searched in clinical studies repositories of pharmaceutical companies, reviews of combination drugs in Food and Drug Administration and European Medicines Agency, and lists of references in reviews and clinical practice guidelines. Selection criteriaRandomized, double-blind trials with at least 12 months' follow-up in adults with primary hypertension (systolic blood pressure/diastolic blood pressure 140/90 mmHg or higher, or 130/80 mmHg or higher if participants had diabetes), which compared combination of two first-line antihypertensive drug with monotherapy as initial treatment. Trials had to include at least 50 participants per group and report mortality, cardiovascular mortality, cardiovascular events or serious adverse events. Data collection and analysisTwo authors independently selected trials for inclusion, evaluated the risk of bias and entered the data. Primary outcomes were mortality, serious adverse events, cardiovascular events and cardiovascular mortality. Secondary outcomes were withdrawals due to drug-related adverse effects, reaching blood pressure control (as defined in each trial) and blood pressure change from baseline. Analyses were based on the intention-to-treat principle. We summarized data on dichotomous outcomes as risk ratios with 95% confidence intervals.

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To determine the efficacy and safety of cimetidine in the treatment of duodenal ulcer, forty-five patients with this diagnosis were selected for a double-blind study. Diagnosis was confirmed by endoscopy and photography of the lesion. Cimetidine in the form of 200 mg tablets was administered to twenty-four patients at the rate of 1 tablet t.i.d.p.c. and 2 tablets h.s. The same dosage of an identically appearing placebo tablet was given to twenty-one patients. The only other medication permitted was an aluminum + magnesium gel antacid p.r.n. Patients and medication were randomized, the same patients being seen by the same physician throughout the six-week observation period. Laboratory monitoring of patients (complete blood counts, blood chemistry, urinalysis, gastric acidity) took place at one, two, four and six weeks as did clinical observation. Three placebo patients withdrew from the study. The patients on cimetidine showed a statistically significant greater number of healed ulcers, early and late in the treatment; earlier and more persistent pain relief in a greater number; and considerably fewer requiring antacid than those patients on placebo. No side-effects were noted.

Background Romiplostim is a new second-generation thrombopoietic agent that stimulates thrombopoietin receptors and platelet production. Purpose To evaluate the efficacy and safety of romiplostim in a splenectomised man with idiopathic thrombocytopenic purpura (ITP) who had not responded to other treatments. Materials and methods Follow-up over 2 years of treatment with romiplostim in a 64-year-old patient diagnosed with ITP in 2005. Previously high doses of steroids and non-specific intravenous immunoglobulins (IVIG) had been tried with a bad response; the patient was splenectomised in 2007. In spite of treatment with IVIG 2 g/kg and rituximab 375 mg/m2/week the platelet count did not rise. In September 2009 he started romiplostim 1 mcg/kg/week (dose=75 mcg), increasing gradually as indicated in the SPC. The authors evaluated the efficacy through the platelet count (noted in the clinical history), aim: 50–200 109/litre without bleeds. The adverse effects evaluated the safety. Results Splenectomy, treatment with IVIG and rituximab increased the platelet count in a short time to over 50×109/litre; but this count reduced drastically. After the first dose of romiplostim the platelet count rose from 12 to 99×109/litre. The right platelet count was achieved with a dose of 3 mcg/kg (225 mcg) reduced to 150 mcg when the count was over 200×109/litre. During this period the dose was: 19 weeks of 225 mcg, 30 weeks of 150 mcg and 4 weeks of 75 mcg, aligned with the blood test results. During the 2-year follow-up the average platelet count has been 147×109/litre (between 30 and 323×109/litre). There were no episodes of bleeding (hematomas or epistaxis). The only adverse effect has been colds when the dose was administered. Conclusions Romiplostim has proved as an effective option for maintaining the platelet count in this splenectomised patient with ITP who was resistant to other treatments. Romiplostim is well tolerated with no need to reduce the dose because of adverse effects. Although this drug does not cure the disease it improves the quality of life of the patients without causing bleeds.