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In year 1995 the European Society of Cardiology started an epidemiological study EUROASPIRE to evaluate the results of secondary prevention in some European countries. The first study period was in 1995, the second in 1999-2000 and the third in 2007. From Hungary the same study centers participated in EUROASPIRE I-II-III investigation. Authors present the Hungarian data and changes occurring the last ten years. During the three studies, 1627 coronary patients- younger than 70 years - were evaluated, using standardized methods. In the two Hungarian study centers, the proportion of women and patients older than 60 years increased. The hospital documentation of risk factors improved, at the time of EUROASPIRE III necessary data were found in 89%-99% of patient's records. Mean systolic and diastolic blood pressure continuously decreased between the first and second study period, but at the time of the third study 44% of the patients had elevated blood pressure (>140/90 mmHg). Prevalence of smoking decreased by 8% between second and third study period, however, at the time of the last study, 18% of coronary patients were smokers. The mean of total cholesterol was lower in the last study period comparing to the first investigation (5.6 vs. 5.2 mmol/l). HDL cholesterol level was unchanged and increasing triglyceride values were observed. During the study period the prevalence of obesity continuously increased from 23% to 49%. Prevalence of patients with total cholesterol level 5.5 mmol/l or higher has decreased from 60% to 24%, however 57% of patients did not reach the target level (4.5 mmol/l) although 80% of patients were treated with lipid lowering drugs: 76% of them received statins. Authors say that some part of secondary prevention improved during the last ten years, but many patients did not reach the target blood pressure and cholesterol level and it is embarrassing the prevalence of obesity and diabetes. The published data are not representative for whole Hungary; most probably the general situation is worse. Authors emphasize the importance of secondary prevention in the graduate and postgraduate education. For improving the secondary prevention, better cooperation is needed between hospital staff and patients and general practitioners as well.

Unlabelled: Relevant national societies attribute special importance to the secondary prevention of coronary patients. This is well formulated in their recommendations (9, 11). Actual clinical practice was studied in 1995-1996 by the EUROASPIRE I study. Its Hungarian data were published in 1999 (8). The scope of EUROASPIRE II in 1999-2000 was to study changes occurred in these 5 years. In this paper the authors intend to answer the question whether the clinical practice of secondary prevention of coronary patients showed any changes at the turn of the millennium. Participating centres, the criteria of patient selection and the applied methods were identical in the two studies. Hospital data of 516 patients below the age of 70 were analysed. There was no difference between the two studies neither in the distribution according to gender and age, nor in the number of death. Documentation of the relevant data in the hospital records improved substantially: blood pressure was registered in every patient chart, lipid values in 91%. Information on smoking however is still missing in 1/3 of the patients, while on weight and height in half of them. The response rate at the follow up investigation on was 75%. The prevalence of obesity increased by 60%, that of smoking by 13% since the first investigation 5 years ago. This rate of increase is the largest among the 9 participating centres. The prevalence of hypertension decreased by 24.5% and the proportion of hypertensive patients receiving treatment increased by 7%. In spite of these blood pressure values over 140/90 mmHg were found in 37% of the patients. The mean triglyceride value increased by 53% and the prevalence of severe hypercholesterolaemia by 43%. Lipid lowering drugs are given to 51% of the patients in contrast to 22% 5 years earlier. In spite of this cholesterol values above 5.5 mmol/l were found in 42%. In respect of prophylactic drugs the proportion of patients receiving beta blockers increased from 58 to 84%., Interpretation: The evaluation of complex risk of patients and their long-term care is still deficient. Drug treatment improved quantitatively but not qualitatively. This and the lack of lifestyle-improving medical efforts is reflected by the increase of the proportion of obese and smoking patients and the persistently high prevalence of hypercholesterolaemia and hypertension.

The European Society of Cardiology, the European Atherosclerosis Society and the European Society of Hypertension published in 1994 a joint statement and recommendation on prevention of coronary heart disease in clinical practice. The EUROASPIRE study intended to investigate the present clinical practice in this respect in 9 European countries. The present paper deals with the Hungarian leg of the collaborative study. Hospital data of 546 patients below the age of 70 were reviewed of whom 29% were women. Consecutive patients were identified retrospectively with the following discharge-diagnoses: coronary bypass grafting, PTCA, acute myocardial infarction and angina pectoris. Minimum 6, in the average 18 month after the index event, patients were interviewed and examined. The participation rate was 77%. During the index hospitalisation an incomplete documentation of the main risk factors was found: blood pressure values were missing in 12%, lipid values in 48%, smoking status in 34%, body weight in 22% and family history in 46% of the cases, with wide variation between diagnostic categories. At follow-up 23% of the patients were obese (BMI > or = 30 kg/m2), 49% had elevated blood pressure (140/90 > or = Hgmm), 46% had total cholesterol above 5.5 mmol/l, 23% smoked and 27% were diabetic. 75% of the patients were on antiplatelet, 14% on anticoagulant, 58% on beta-blocking, 22% on lipid lowering, 32% on ACE-inhibitor and 44% on calcium channel blocking medication. The screening of first degree relatives was recommended in only 18% of the patients. The results speak for a substantial neglect of secondary prevention of coronary patients in the Hungarian clinical practice. However without complex detection, evaluation and management of risk factors it is impossible to reduce the recurrence and high mortality of coronary heart disease.

The specific competitive alpha 1-postsynaptic blocking action and haemodynamic effects of prazosin (Minipress) have been summarized. Prazosin causes dilatation of arterioles and veins, reduces total peripheral resistance as well as preload and afterload. Cardiac output does not change at rest, stroke volume and subsequent cardiac output increase during exercise. The changes in heart rate have non-significant. It does not cause sympathetic counter-regulation, plasma renin activity does not increase, aldosterone level decreases, salt- and fluid retention may rarely be observed. It does not provoke angina. The authors report on the results of their examinations with the first dose of prazosin in 61 patients (in 33 cases by the double-blind cross-over method by placebo control), and summarize the observations made with the drug in long-term treatment in Hungary. The authors and other teams used prazosin as a long-term treatment (of approximately 3 months) in combination with other drugs in a total of 344 patients, and as monotherapy in 159 patients. In the course of combination treatment side-effects were observed in 15% of the patients (dizziness, headache, weakness, occasionally palpitation). During monotherapy, side-effects occurred in 12% of the patients (tachycardia, headache, weakness, dizziness). Hungarian results confirm the usefulness of prazosin in all stages of hypertension. It is effective in 30-35% of the cases as a monotherapy (this rate is congruent with the efficacy of beta-blockers, calcium antagonists and antihypertensive drugs of central action). Earlier prazosin had been used as a third agent in combination treatment of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

The antihypertensive efficacy of urapidil was compared with that of atenolol in a double-blind randomised parallel-group 10-week study. 44 patients with essential hypertension entered the study, and 43 with a supine DBP of 100 to 125 mm Hg after a 2-week placebo period were randomised either to urapidil (n = 22; 60 to 120 mg/day) or atenolol (n = 21; 50 to 100 mg/day) for 8 weeks. Blood pressure, heart rate, electrocardiogram (supine and standing) and side effects were recorded every week, and medical examinations and laboratory tests were done at the end of the placebo and active treatments. 36 patients completed the trial (17 on urapidil and 19 on atenolol). Patients' characteristics were similar in the two groups, and there were no differences between them in blood pressure and heart rate at the end of placebo period. Both drugs produced a significant fall in supine and standing blood pressure; urapidil decreased supine blood pressure from 164/109 to 150/96 (p less than 0.001), and atenolol decreased it from 167/111 to 146/94 mm Hg by week 8 (p less than 0.001). There were no differences in the blood pressure-reducing effects of the two drugs. There was no change in heart rate in the urapidil group, but a marked reduction occurred in the atenolol group, with significant differences from placebo and urapidil (p less than 0.001). Side effects were reported in 32% of the urapidil group and in 29% of the atenolol group; however, these were mild and transient in all but two patients (urapidil = 1, atenolol = 1) who were withdrawn.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty patients with moderate (4) to severe (16) hypertension, whose blood pressure (BP) could not be controlled on the previous combined antihypertensive therapy, were investigated. In acute studies the first doses of captopril, 25 and 50 mg led to a significant drop in BP 30 min after administration. The maximum fall in BP was recorded at 90-120 min and this effect was maintained throughout the whole observation period (8 hours). The fall in BP was similar in supine and standing positions and there was no change in the heart rate. During long-term (14.5 months) therapy only 2 out of the 20 patients exhibited continuing good BP control with captopril monotherapy of a maximum daily dose of 150 mg. A comparison of the acute and chronic BP lowering effects of captopril showed that the first dose of captopril caused a significantly greater decrease in BP than chronic monotherapy. However, combined captopril with a diuretic or with a diuretic and calcium antagonist or beta blocker provided a sustained BP control, significantly better than the previously used anti-hypertensive combinations (182 +/- 27/115 +/- 11 mmHg vs 164 +/- 20/104 +/- 11 mmHg p less than 0.05). The Hungarian captopril preparation (Tensiomin), similarly to other captopril products, through its angiotensin converting enzyme inhibition, caused an increase in plasma renin activity and in concentration of plasma angiotensin I and a decrease in plasma angiotensin II. Eight out of the 20 patients developed side effects, which disappeared spontaneously in 4 patients within 2-14 days. Captopril was withdrawn in 3 patients for not achieving satisfactory BP control and/or because of side effects. It is concluded that captopril is safe and effective in the long-term treatment of hypertension, however, majority of the patients with severe forms of hypertension required double or multiple combinations.