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With the numbers of cases rising worldwide and consistently high mortality, sepsis is one of the world's most significant health issues. The Jena Symposium was dedicated to the challenges in research and development, new approaches to treatment, internationally successful strategies, and a potentially successful new initiative for improving the quality of prophylaxis, early diagnosis, and therapy. The importance of intensifying efforts in the fight against sepsis is becoming increasingly recognized by health care policy. Knowledge of lay people/the public about sepsis is lacking and the standards of quality are in need of improvement.

Hintergrund Nach der gesetzlichen Regelung des Stellenwerts einer Patientenverfugung (PV) besteht das Problem fort, dass eine Vielzahl von Vordrucken unbrauchbar sind. Ziel unserer Untersuchung war herauszufinden, ob eine wertebasierte PV im Textbausteinsystem geeignet ist, den Patientenwillen auszudrucken.

In a randomized, placebo-controlled double-blind trial 22 healthy normotensive young men (mean age 25 +/- 1.7 years) were given a single oral dose of 50 mg captopril or a placebo (11 subjects each). To test their concentration and proficiency, as well as spatial perception and reaction capacity four tests were administered: attention, concentration, hose-pattern perception and "Bonn Determination Device". Captopril had no negative effects on any test performances either one or five hours after its administration, or after a single daily dose for seven days. There was only a small, statistically not significant, difference in the effect on blood pressure between captopril and the placebo.

Einleitung: Für Patienten mit chronischen Schmerzen wird eine interdisziplinäre Versorgung gefordert. In der Praxis arbeiten Spezialdisziplinen jedoch häufig nebeneinander, ohne dass es zu fallbezogener Zusammenarbeit kommt. Unsere Studie zeigt, wie sich der Übergang vom psychosomatischen Konsil- zum Liaisonsystem und die Vernetzung mit einer Psychosomatischen Fachklinik sowie krankengymnastischen Praxen auf Diagnostik und Therapie in einer interdisziplinären Schmerzambulanz auswirkt. Patienten und Methoden: In einer retrospektiven Erhebung wurden alle innerhalb von 6 Monaten vor (N = 165) und nach (N = 277) dem Übergang vom Konsil- zum Liaisonsystem in der Schmerzambulanz gesehenen Patienten erfasst. Aus den Krankenakten wurden medizinische Diagnosen, anästhesistische Therapie, Indikation zum psychotherapeutischen Erstgespräch (Depressivität, somatische Beschwerden) und dessen Ergebnis erhoben. Patienten, bei denen ein psychotherapeutisches Erstgespräch vorgesehen war (N = 94), wurden schriftlich und telefonisch nachbefragt. Ergebnisse: Im Liaisonsystem wurde signifikant häufiger als im Konsildienst psychotherapeutische Diagnostik angefordert (25,6% vs. 13,9%) und durchgeführt (63,3% vs. 30,4%). Der Anteil interdisziplinär betreuter Patienten stieg von 4,2% auf 16,2%. Der Anteil an Patienten, die eine empfohlene Psychotherapie durchführten, blieb mit über 80% konstant hoch. Häufigste indizierte Therapieform war die Verhaltenstherapie (72,7%), häufig kombiniert mit einem körpertherapeutischen Verfahren (32,7%). Von den Therapien wurden 66,8% ambulant, 16,6% stationär und 16,6% als ambulant/ stationäre Kombination durchgeführt. Schlussfolgerung: Im Liaisonsystem wurden signifikant mehr Patienten interdisziplinär betreut als im Konsilsystem. Die gleichbleibend hohe Akzeptanz der vorgeschlagenen Psychotherapie zeigt, dass Patienten die einer Psychotherapie zunächst ambivalent oder ablehnend gegenüberstehen, dazu motiviert werden können. Die enge Kooperation verschiedener Versorgungsstrukturen führte zu einem hohen Anteil interdisziplinär und methodenübergreifend durchgeführter Behandlungen. Introduction: The effectiveness of multidisciplinary treatment of chronic pain with an emphasis on a cognitive behavioural approach is clearly shown by randomised controlled trials. However, it is difficult to motivate patients with chronic pain for this type of treatment. We compared the effectiveness of a consultation model and a liaison model of co-operation between an outpatient pain clinic and a psychosomatic department in creating motivation for psychotherapy. Patients and Methods: In a retrospective design we collected data of all patients seen in the pain clinic during 6 months before (N = 165) and 6 months after (N = 277) changing from a consultation to a liaison model. Clinical data were documented by the Multiaxial Pain Classification (MPC). Level of depression was assessed by Depression-Scale (DS), somatic complaints by list of complaints (BL). Results: In the liaison model diagnostic sessions with the consulting psychotherapist were significantly more often recommended by physicians in the pain clinic (25,6% vs. 13,9%) and accepted by patients (63,3% vs. 30,4%) compared to the consultation model. In either system 80% of the patients accepted the recommended psychotherapy. After changing to the liaison type of co-operation, there was a significant decrease in prescription of opioid and benzodiazepine drugs. Conclusion: The liaison model of co-operation was significantly more effective in enhancing physician’s and patient’s motivation for a psychosomatic approach in the management of chronic pain. Psychotherapy is better accepted by patients suffering from chronic pain if it is offered in a multidisciplinary context and in the familiar surroundings of the pain clinic. Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

SummaryGiven the high rates of both traumatic events and of resulting posttraumatic stress disorder (PTSD) it is imperative to develop and to evaluate efficacious and cost-effective treat

Zur Messung des mehrdimensionalen Konstruktes Psychotherapiemotivation liegen bisher nur wenige standardisierte Selbsteinschat-zungsverfahren vor, welche einerseits okonomisch im Rahmen eines Routineeinsatzes in Kliniken zu erheben sind und deren Dimensionalitat andererseits faktorenanalytisch ausreichend abgesichert ist. Nubling legte 1992 einen an zwei umfangreichen klinischen Stich-proben uberpruften Fragebogen vor, der mit 120 vierstufig zu beant-wortenden Items 7 Faktoren der Psychotherapiemotivation erfaβt. Zur Entwicklung einer Kurzform dieses Bogens wurden von 5 Skalen die jeweils ladungsstarksten Items ausgewahlt und 225 konsekutiven Patienten einer Psychosomatischen Fachklinik vorgelegt. Es zeigte sich, daβ mit einer 40 Items umfassenden Kurzform die ursprungliche Dimensionalitat (Psychischer Leidensdruck und Selbstreflexions-wunsch, Hoffnung, Verleugnung psychischer Hilfsbedurftigkeit, symptombezogene Zuwendung durch andere) sehr gut repliziert, der Faktor «lnitiative und Wissen» der Originalanalysen daruber hinaus in seine beiden Komponenten getrennt werden konnte und die Skalen insgesamt eine ausreichend hohe interne Konsistenz (α > 0,70) aufweisen. Die Skala Leidensdruck korreliert erwartungsgemaβ mit anderen konstruktnahen Variablen wie Emotionalitat, Beschwerden, Depressivitat und Angst.

As publications from the domain of psychosomatic rehabilitation pertaining to the conceptual approaches and effects of partial-hospitalization rehabilitation have so far relied on very small case numbers, the effectiveness of partial-hospitalization rehabilitation was analysed in 318 patients in comparison to a large sample of rehabilitants who had participated in fully inpatient rehabilitation. No relevant differences were found among the groups studied in sociodemographic respects or range of diagnoses. The same was true concerning the level of complaints present at the onset of rehabilitation. Good rehabilitation outcomes were achieved in both groups, however, the effect sizes found for changes in depressiveness and indulgence to complaining ("Klagsamkeit") (GSI from the SCL-90) were lower in the partial-hospitalization group than in the patients in fully inpatient rehabilitation. Also, the relatively high share of partial-hospitalization patients discharged unable to return to work might be clinically significant. While our findings confirm the good results reported from other disciplines, they nevertheless are a reminder of the need for very careful selection of patients for partial-hospitalization rehabilitation, in order not to withhold "better" rehabilitation than could be provided on a partial-hospitalization basis from patients with special sociomedical problems. The best rehabilitation outcomes seem to be achieved by those patients who, towards the end of fully inpatient rehabilitation, were granted transition to the partial-hospitalization programme.

German Legislation has defined the legal significance of advance directives (AD). Nevertheless, many precast ADs are of limited help in clinical decision making. Empirical results are rare and controversial. The SUPPORT study showed that precast ADs had a tendency to being ignored. Value-based AD proved to be of help in the interpretation of patients' wills by physicians. We therefore investigated whether a value-based AD that can be individualized with the help of a check-box-system is a valid instrument of communicating the patient's preferences. This is the first validation of an AD.In our study we evaluated the acceptance and practicability of an AD. Questionnaires and the AD itself were handed out to patients, relatives, and members of the nursing and medical staff. All were asked to fill out the AD, mark all unclear passages, make amendments to the AD if wanted and finally were asked to answer a questionnaire regarding the AD. The level of significance was defined at 5%, meaning that every "unwanted" answer exceeding 5% or passages with more than 5% of the total remarks were analyzed and it was checked whether changes to the AD should be made.The return rate was 64.8% (201 of 310). The results were highly positive for the items "understandable" (81,6%), "clarifying" (65,7%), "helpful" (76,1%), and "sensible" (75,1%). 70% of patients and relatives stated that they were able to express personal wishes and values with this AD, as well as a majority of the medical staff (44% vs. 30%). The discrepancy between the groups was significant (ChiSq=13.11, p.001). All paragraphs of the check-box-system were validated as understandable and clear in intention. Major concerns were the inability of expressing own wishes and values (by 16,4% of all participants) and the fear of later alterations (15,4%). According to the findings and the evaluations the AD was modified.The value-based AD which is routinely used in a university hospital and which can be individualized by a check-box-system was broadly accepted by the test subjects and showed highly positive results with respect to the analyzed items. Only minor changes were derived from our study to hopefully raise its acceptance even more. The discrepancy between patients, relatives and the medical staff concerning the possibility to express one's wishes and values was surprising and in contradiction to former findings. However, our study cannot answer whether the higher level of distrust among medical staff can be explained by negative professional experiences.The investigated AD with a check box system seems to be an adequate instrument to communicate patient's wishes and directives.

As publications from the domain of psychosomatic rehabilitation pertaining to the conceptual approaches and effects of partial-hospitalization rehabilitation have so far relied on very small case numbers, the effectiveness of partial-hospitalization rehabilitation was analysed in 318 patients in comparison to a large sample of rehabilitants who had participated in fully inpatient rehabilitation. No relevant differences were found among the groups studied in sociodemographic respects or range of diagnoses. The same was true concerning the level of complaints present at the onset of rehabilitation. Good rehabilitation outcomes were achieved in both groups, however, the effect sizes found for changes in depressiveness and indulgence to complaining ("Klagsamkeit") (GSI from the SCL-90) were lower in the partial-hospitalization group than in the patients in fully inpatient rehabilitation. Also, the relatively high share of partial-hospitalization patients discharged unable to return to work might be clinically significant. While our findings confirm the good results reported from other disciplines, they nevertheless are a reminder of the need for very careful selection of patients for partial-hospitalization rehabilitation, in order not to withhold "better" rehabilitation than could be provided on a partial-hospitalization basis from patients with special sociomedical problems. The best rehabilitation outcomes seem to be achieved by those patients who, towards the end of fully inpatient rehabilitation, were granted transition to the partial-hospitalization programme.

In previous research it was found that patients with diabetes mellitus suffer from multiple physical symptoms even early in their disease course. Such complaints may relate to blood glucose levels or can be understood as a sign of distress in respect to the diagnosis of a chronic disease.This study was performed to evaluate in a cross-sectional analysis all the symptoms that patients may complain of and to relate these symptoms to a possible dysfunction of the autonomic nervous system.We assessed the complaints of 66 patients with diabetes mellitus and compared these variables with those of patients with psychological disturbances (n = 794) or somatic disease (n = 162). The symptoms were recorded by means of several questionnaires such as the "Giessener Beschwerdebogen" (GBB), "the Freiburger Persönlichkeitsinventar" (FPI), the German version of the State Trait Anxiety Inventory (STAI) and the German version of the State Trait Anger Expression Inventory (STAXI). The autonomic nervous system was assessed using resting and mental stress conditions in a subset of patients with diabetes mellitus (n = 29) and psychological disturbances (n = 44).Patients suffering from diabetes mellitus and psychological disturbances showed a tendency to higher scores in GBB, STAI and STAXI. As far as psychological disturbances are concerned, the complaints experienced by patients with diabetes mellitus were found to be similar to those with somatic diseases. Both groups, however, rate clearly below those with psychological disturbances. The results of autonomic testing showed a significant disturbance in patients with diabetes mellitus with reduced sensitivity of the baroreceptor indicating autonomic neuropathy.Some of the physical complaints of patients with diabetes mellitus can be understood in connection with autonomic dysfunction. Moreover, an explicitly psychological view of these complaints may not be correct.

In a naturalistic setting, we studied the long-term effects of an inpatient treatment program at a psychosomatic rehabilitation clinic, where patients were assigned to a department with either a psychoanalytic or behavior therapeutic orientated treatment after one week of comprehensive diagnosis. The study is based on a self-developed questionnaire which gathers retrospective information in a broad spectrum of problem areas at the point of admittance and release (t0 and t1) as well as current assessments one year following treatment (t2). Additionally, a symptom checklist (Giessener Beschwerdebogen) and a questionnaire assessing depression (Allgemeine Depressionsskala) were prospectively employed at t0 and t2. We asked a consecutive sample of 376 patients to participate, of which 56% answered at t2. Despite limitations of the internal and external validity of the study, we were able to show that substantial improvements are maintained following treatment for both therapies at one-year follow-up, whereas only small difference are found between the outcomes of the two different schools implemented in the clinic.

Patients with diabetes mellitus (DM) often have alterations of the autonomic nervous system (ANS), even early in their disease course. Previous research has not evaluated whether these changes may have consequences on adaptation mechanisms in DM, e.g. to mental stress. We therefore evaluated whether patients with DM who already had early alterations of the ANS reacted with an abnormal regulatory pattern to mental stress. We used the spectral analysis technique, known to be valuable and reliable in the investigation of disturbances of the ANS. We investigated 34 patients with DM without clinical evidence of ANS dysfunction (e.g. orthostatic hypotension) and 44 normal control subjects (NC group). No patients on medication known to alter ANS responses were accepted. The investigation consisted of a resting state evaluation and a mental stress task (BonnDet). In basal values, only the 21 patients with type 2 DM were different in respect to body mass index and systolic blood pressure. In the study parameters we found significantly lower values in resting and mental stress spectral power of mid-frequency band (known to represent predominantly sympathetic influences) and of high-frequency and respiration bands (known to represent parasympathetic influences) in patients with DM (types 1 and 2) compared with NC group (5.3 +/- 1.2 ms2 vs. 6.1 +/- 1.3 ms2, and 5.5 +/- 1.6 ms2 vs. 6.2 +/- 1.5 ms2, and 4.6 +/- 1.7 ms2 vs. 6.2 +/- 1.5 ms2, for resting values respectively; 4.7 +/- 1.4 ms2 vs. 5.9 +/- 1.2 ms2, and 4.6 +/- 1.9 ms2 vs. 5.6 +/- 1.7 ms2, and 3.7 +/- 2.1 ms2 vs. 5.6 +/- 1.7 ms2, for stress values respectively; M/F ratio 6/26 vs. 30/14). These differences remained significant even when controlled for age, sex, and body weight. However, patients with DM type 2 (and significantly higher body weight) showed only significant values in mental stress modulus values. There were no specific group effects in the patients with DM in adaptation mechanisms to mental stress compared with the NC group. These findings demonstrate that power spectral examinations at rest are sufficiently reliable to diagnose early alterations in ANS in patients with DM. The spectral analysis technique is sensitive and reliable in investigation of ANS in patients with DM without clinically symptomatic autonomic dysfunction.

In addition to the requirements of quality management imposed by legislative and in consideration of research projects on the evaluation of psychotherapy the German pension funds introduced a systematic program for quality control in 1994. By the end of this year all the German rehabilitation centers will regularly have to provide information concerning the structure and concepts of the hospital and details of the rehabilitation programs. All therapeutic interventions are listed for every patient. In a subsample of patients detailed information regarding diagnosis and outcome (goal attainment) is required in addition to the final report. A subsample of the final reports is peer-reviewed. Patient's satisfaction and estimation of outcome variables are regularly assessed 3 months after discharge. Within and between institutions quality circles meet regularly. Advantages and limits of these programs are discussed and additional approaches towards total quality management in Bad Kreuznach are described.

Two experiments were conducted to explore the usefulness of the Penaz method for non-invasive, continuous finger blood pressure measurements during mental stress testing. In the first study, blood pressure was measured with the Penaz method, in the second it was measured intra-arterially. Two different subject groups were used. In both experiments the same mental task, a memory search and counting task, was used. Experimental effects, consisting of rest-task differences in heart rate and blood pressure, its (spectral) variability and the coherence between fluctuations in the two signals (e.g. baroreflex sensitivity) are compared for the two measuring methods. Experimental effects on mean pressure values, spectral variability measures and baroreflex sensitivity are similar for the two types of measurement. Effects on mean pressure are smaller in the finger pressure indices. It is concluded that the Penaz instrument can provide us with a useful method for studying cardiovascular reactivity in mental stress research.

Die EPH-Gestose (auch als schwangerschaftsinduzierter Hypertonus oder nur Spatgestose bezeichnet)1 stellt auch heute fur Mutter und Kind ein erhebliches, teils vitales Risiko dar. Mit einer Haufigkeit zwischen 5 und 15% (Kaulhausen 1989) und einer perinatalen Mortalitat von doch bis zu 21% beim ausgepragten Vollbild der Gestose (DFG-Studie, zit. nach Rabe 1990) basiert diese Komplikation zumeist auf einer Vielfalt von Ursachen, die sich — und auch das mus in einem solchen Kreis nicht weiter vertieft werden — in einer Minderdurchblutung verschieden stark betroffener Organe auf dem Boden arterieller Gefasspasmen mit einer konsekutiven Storung der Salz- und Wasserhomoostase niederschlagen. Trotz der anerkannten multifaktoriellen Atiologie konzentrieren sich die wissenschaftlichen Bemuhungen in der Gestoseforschung hauptsachlich darauf, praxisrelevante Parameter zur differentialdiagnostischen Klarung bzw. zur Abschatzung des mutterlichen und kindlichen Risikos zu erstellen (so z.B. Ultraschalluntersuchungen zur Plazentadurchblutung und zur kindlichen Versorgung, Untersuchungen zu Elektrolyt- und Flussigkeitsverschiebungen, zur Balance von vasokonstriktorischen und vasodilatatorischen Systemen, Gerinnungsstorungen usw.).

The impact of clinical parameters on the pathogenesis of myocardial hypertrophy was examined in 75 male patients with mild essential hypertension. Clinical parameters were age, body weight, sodium excretion (as an estimate for dietary salt intake), systolic and diastolic blood pressure at work, casual blood pressure, resting and stress blood pressure during mental stress test and physical exercise. Left ventricular mass as a parameter for the degree of left ventricular hypertrophy was assessed by 2-D guided M-mode echocardiography. Left ventricular mass correlated with body weight (r = 0.47, p less than 0.002), with body mass index (r = 0.48, p less than 0.001), with systolic blood pressure at the worksite (r = 0.28, p less than or equal to 0.05), and systolic blood pressure at rest (r = 0.35, p less than or equal to 0.01), whereas no correlation was found between casual or stress blood pressure readings during physical exercise and mental stress with the degree of left ventricular hypertrophy. Sodium excretion was related to the end-diastolic diameter of the left ventricle (r = 0.33, p less than or equal to 0.01) and to left ventricular mass (r = 0.35, p less than or equal to 0.01). Multiple regression analysis revealed that sodium excretion over 24 hours, systolic blood pressure at the worksite and body mass index were independent determinants of left ventricular mass. Thus, dietary salt intake was found to modulate the degree of left ventricular hypertrophy independently of the pressure load imposed on the myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

We examined whether healthy young swimmers improved performance during emotional and physical stress testing in the laboratory or during competition. Twenty four well trained healthy Caucasian pupils (14 boys and 10 girls, means = 16 years) were randomly treated either with 20 mmol Mg-aspartate-HCl/d or placebo for 3 months. After Mg supplementation serum Mg increased from 0.85 +/- 0.03 to 0.89 +/- 0.06 mmol/litre (P less than 0.05). Mg in red blood cells remained unchanged (4.79 +/- 0.35 mmol/kg dry weight before supplementation and 4.96 +/- 0.27 three months later, P = 0.32) whereas no increase in serum Mg or Mg in red blood cells was found in subjects who received placebo. Student's t test and analyses of variance revealed no significant differences in performance data either in the laboratory or during competition after supplementation with Mg.

To investigate the clinical importance of microproteinuria, we examined the prevalence of microproteinuria and its relation to cardiac structural adaptation in 80 male, middle-aged patients with essential hypertension. Patients with secondary causes of hypertension were ruled out. 14 out of 80 hypertensives (18 percent) were found to have microproteinuria defined as "negative" for urinary protein excretion in the conventional test, but "positive" (above the upper normal limit) in the 24-hour urine samples. Patients with microproteinuria had a similar age and body weight, but a higher systolic and diastolic pressure (161 +/- 14/104 +/- 12 vs 148 +/- 14/97 +/- 9 mmHg, p less than 0.02) and greater creatinine clearance (163 +/- 36 vs 136 +/- 33 ml/min, p less than 0.01) than those with normal protein excretion. Also, hypertensives with microproteinuria had a greater left ventricular mass (241 +/- 57 vs 207 +/- 45 g, p less than 0.05) and greater cross sectional area (22.2 +/- 2.8 vs 20.5 +/- 2.9 cm2, p less than 0.05) evaluated by 2-D guided M-mode echocardiography than the control group. A positive Sokolow-index was more prevalent in patients with microproteinuria than in those without (x2 = 6.2, p less than 0.02). Patients with essential hypertension and microproteinuria (prevalence 21 per cent) were characterized by a higher arterial pressure, by a higher degree of echocardiographic and electrographic evidence of left ventricular hypertrophy. Thus, microproteinuria might serve as a marker for early target organ damage in essential hypertension.

Electrical carotid sinus nerve stimulation was applied in three normotensive anginal patients and one hypertensive patient during upright tilting. Despite a base-line depressor response to continuous stimulation, orthostatic hypotension was not augmented. In individual patients stimulation slightly enhanced the fall of systolic pressure and delayed the increase of diastolic pressure immediately after tilting. Base-line heart rates and cardio-acceleration upon tilting remained almost uninfluenced by stimulation. It is concluded that a moderately enhanced carotid baroreceptor afferent nerve traffic did not interfere with the regular orthostatic response.

In an epidemiological examination outside specialized laboratories we investigated the test-retest stability of blood pressure (BP) and heart rate (HR) reactions to standardized mental stress in 136 men (mean age 44 +/- 7 years) with complaints of mental and physical fatigue. Repetitive stress testing was performed at 4-week intervals on four occasions. On all four occasions stress levels differed significantly from baseline levels (P less than 0.001). Baseline conditions for BP and HR were significantly correlated at 4-week and 8-week intervals (P less than 0.001). Cardiovascular reactivity to mental stress was also stable over a 4, 8, and 12-week period. We conclude that psychophysiological reactivity can be assessed with good reliability under field conditions.

In der Pathogenese der essentiellen Hypertonie sind seit vielen Jahren vor allem 2 Theorien kontrovers gegenubergestellt worden: 1) Eine erhohte Reaktivitat des Blutdrucks auf eine Vielzahl von Stimuli fuhren uber strukturelle Gefasveranderungen langfristig zu einer chronischen Blutdruckerhohung. 2) Eine Abschwachung negativer Feedbackmechanismen auf akute Blutdruckanstiege fuhrt zu verstarkter Natriumretention und uber Volumenanderungen zur chronischen Hypertonie.

Am Institut fur Experimentelle Hamatologie der Universitat Bonn werden zur Zeit etwa 780 hamophile Patienten betreut. Serum von 637 dieser Patienten konnte auf das Vorhandensein von Antikorpern gegen HIV (Human Immunodeficiency Virus) untersucht werden. 61% der Untersuchten wiesen Antikorper gegen HIV auf, was auf eine Gesamtzahl von etwa 475 HIV-infizierten Hamophilen schliesen last.

To evaluate the role of the sympathetic nervous system in essential hypertension and the influence of clonidine, 28 male subjects with mild to moderate hypertension were either treated with low-dose clonidine (n = 14, mean age: 42.4 +/- 2.1 years) or were randomized to a nontreated control group (n = 14, mean age: 40.2 +/- 2.4 years). Clinical blood pressure and heart rate were assessed, and after 4 weeks of treatment plasma catecholamines and the hemodynamic response to mental arithmetic, cold stimulation, and ergometric exercise were compared between both groups. Under therapy with 0.075 mg of clonidine per day casual blood pressure dropped and diastolic BP was significantly lower than in the control group. Heart rate did not change. After 4 weeks the plasma levels of epinephrine and norepinephrine were the same in both groups. During mental arithmetic total peripheral resistance decreased in the treated group while it did not change in the control group, but both groups did not differ in their percentage changes in the hemodynamic parameters in response to the three stress tests. It has been concluded that clonidine reduces sympathoadrenergic activity, but in a low dosage this effect is obviously restricted to a reduction of arteriolar tone.

Das Verhaltenstyp—A—Muster (V.—A—M.) ist ein Syndrom sehr unterschiedlicher Verhaltensweisen, das aufgrund ihrer Personlichkeitsstruktur disponierte Personen zeigen, sobald sie mit entsprechenden Umgebungsbedingungen konfrontiert werden. Das V.—A—M. ist gemas dieser Konzeption das Resultat einer Interaktion von Personlichkeitsmerkmalen mit bestimmten Anforderungen der Umwelt (Rosenman u. Friedman 1977).

Type A behavior (TABP) was assessed in 212 German policemen using the structured interview (Si), whereby 10% were classified as A1 (= extreme type A), 48% as A2 (= moderate), 13% as X (= indefinite), and 29% as B (= non type A) by two independent raters. Moreover, traditional risk factors were assessed: serum cholesterol (CHOL) including high density (HDL) and low density cholesterols (LDL), cigarette smoking habits; at rest, during the Si and during a quiz systolic (SBP), and diastolic blood pressure (DBP), as well as heart rate (HR) were measured, and pressure-rate-index (PRi) was calculated. As in this group of policemen TABP and many of the investigated parameters were dependent on age, in a preliminary data analysis 18 type A1 subjects (group A) were compared to 18 age matched type B or X subjects (group B). Between group A and B no differences were found in CHOL as well as HDL and LDL, cigarette smoking, SBP, DBP, HR, and PRi at rest. During the Si group A exhibited a higher rise in SBP, HR, and PRi as well as higher maximal reactions in SBP and PRi. No differences were found during the quiz. This investigation gives some further evidence that the TABP has to be regarded as an independent risk factor; moreover, in specific situations like the Si it is associated with higher cardiovascular reactions independent of language and culture. This cardiovascular hyperreactivity might be regarded as one of the mediators between TABP and CHD.

The hypothetical advantage of ambulatory blood pressure (BP) recordings over clinical casual BP readings is based on the assumption that it reflects the impact of daily life stress. We investigated the relation of ambulatory BP, heart rate (HR), and respiratory frequency (RF) readings to environmental conditions (work vs. home) and to the perceived level of stress (from 1 = completely relaxed to 5 = extremely stressed) in 34 healthy employed subjects. Systolic and diastolic BP (129 vs. 120 mmHg; 89 vs. 82 mmHg), RF (18 vs. 16 resp/min) and perceived stress (2.3 vs. 1.6 a.u.) differed significantly between work and home. ANOVA revealed a significant effect of perceived stress on SBP (F = 7.87; p less than 0.001), DBP (F = 8.73; p less than 0.001), and HR (F = 7.23; p less than 0.001).

Basierend auf den Ergebnissen zweier prospektiver Studien (WCGS und Framingham) ist seit 1982 erstmals ein Verhaltensmuster als medizinischer Risikofaktor fur die koronare Herzerkrankung anerkannt worden (The Review Panel 1981; Rosenman et al. 1976; Haynes et al. 1980). Uber die moglichen Pathomechanismen konnte allerdings bis heute keine Ubeeinstimmung erzielt werden (Matthews 1982; Glass 1982; Myrtek 1983). — Auch fehlen Untersuchungen zur Spezifitat des Typ-A-Verhaltens, d.h. zu der Frage, ob das Typ-A-Verhalten ausschlieslich eine koronarspezifische Bedeutung hat. Ahnve et al. (1979) zeigten, das auch Patienten mit Angina-pectoris-Beschwerden ohne koronare Herzerkrankung im Vergleich zu Gesunden gehsuft Typ-A-Verhaltensweisen aufwiesen. Allerdings wurde das Typ-A-Verhalten mittels eines nicht standardisierten Fragebogens erfast.

Previous studies showed the importance of the response of blood pressure to emotional stress in essential hypertension. However, it is unclear to what extent the response of blood pressure to emotional stress is influenced by antihypertensive treatment, and especially by beta-blockers. In the present study the influence of antihypertensive treatment with either beta-blockers (beta) or diuretics (D) was compared in two series of experiments on male hypertensives, carried out after 2 weeks (beta, n = 11; D, n = 11) and 1 year of treatment (beta, n = 11; D, n = 9). One of the two drugs was randomly allocated to each patient. In the first series of experiments an ergometric exercise test was also performed (workload depending on age and body surface area, 60-100 W). The two medications caused a similar decrease in basal blood pressure. The response of blood pressure to emotional stress was also the same in both groups, and equal to that in untreated hypertensives. However, the reaction of systolic blood pressure to dynamic exercise was lower in the patients treated with beta-blockers (30.2 +/- 9.5 mm Hg) than in those treated with diuretics (42.9 +/- 12.1 mm Hg; p = 0.013). The effect of antihypertensive treatment on the reactivity of blood pressure therefore cannot comprehensively be tested by means of a single stress test. In terms of controlling the response of blood pressure to stress, beta-blockers are not generally more effective than diuretics, but only in certain situations.