Abstract The U.S. Food and Drug Administration designed the trough-to-peak ratio as an instrument for the evaluation of long-acting antihypertensive drugs, but the ratios are usually reported without accounting for interindividual variability. This study investigated how the trough-to-peak ratio would be affected by interindividual and intraindividual variability and by smoothing of the diurnal blood pressure profiles. The ambulatory blood pressure was recorded on placebo in 143 hypertensive patients (diastolic pressure on conventional measurement >95 mm Hg). After 2 months, the recordings were repeated on 10 mg (n=66) or 20 mg (n=77) lisinopril given once daily between 7 and 11 pm . The baseline-adjusted trough-to-peak ratios were determined from diurnal blood pressure profiles with 1-hour precision. Lisinopril reduced (±SD) the 24-hour pressure by 16±17 mm Hg for systolic and 10±10 mm Hg for diastolic ( P< .001). According to the usual approach, disregarding interindividual variability, the trough-to-peak ratio was 0.72 for systolic pressure and 0.67 for diastolic pressure. In the 143 patients the ratios were not normally distributed. They were the same on both lisinopril doses. When interindividual variability was accounted for, the median trough-to-peak ratio was 0.34 (P 5 to P 95 interval, −0.46 to 0.87) for systolic pressure and 0.26 (−0.44 to 0.84) for diastolic pressure. In 66 patients examined twice on 10 mg lisinopril at a median interval of 32 days, the trough-to-peak ratios were characterized by large intraindividual variability. The median trough-to-peak ratios increased ( P <.001) when the individual blood pressure profiles were progressively smoothed by substituting 1-hour averages by 2-hour moving averages (systolic/diastolic pressure, 0.41/0.27), 2-hour averages (0.43/0.29), 3-hour moving averages (0.42/0.34), or 3-hour averages (0.47/0.36). In conclusion, the trough-to-peak ratio is idealized by not accounting for interindividual and intraindividual variabilities and by smoothing of the diurnal blood pressure profiles. If after review of its usefulness the trough-to-peak ratio is further instituted as an instrument in the evaluation of long-acting antihypertensive drugs, its determination and presentation must be regulated beyond the presently available recommendations.
Abstract Objectives: Although high volumes of literature have been written on interventions in dementia home care, only a poor efficiency has been proved. Nevertheless, caregivers often express strong feelings of satisfaction about the proposed support. In this meta-analytic review, a quantitative analysis of the effect of the different types of professional dementia home care interventions was made. Method: A systematic literature search, covering the years 1980 until 2007, was performed using Medline, Embase, Cochrane DSR, Dare, CCTR, and ACP Journal Club). Limitations on publication type were determined as randomized controlled trial and controlled trial. Results: Psychosocial intervention in dementia home care was found to be beneficial in a non-significant way on caregivers' burden. An almost negligible decrease in depression was found in the psychosocial intervention arm while multidisciplinary case management contributed to a larger though insignificant decrease of depression in caregivers. Respite care was responsible for an increase in burden. Conclusion: This review demonstrated, in accordance with other qualitative reviews, the weak evidence that supporting family caregivers could be beneficial. Although the rather small benefits of formal support, supporting family caregivers is an indispensable issue in dementia home care. Professional caregivers should keep in mind that family caregivers highly appreciate the intervention and that they feel less burdened or depressed in the short time follow up but that premature home care remains more rule than exception. Keywords: dementiaprimary caregiverinterventionshome caresystematic review Acknowledgements This study took place in the framework of a large population based survey on the needs of community dwelling demented elder and their carers and was funded by the National Social Security Board. The review was performed in the preparation of a randomized controlled trial on caregiver support which will be published soon. The project was by public tender assigned to the Academic Centre of General Practice of the Catholic University of Leuven and the Department of Clinical Psychology in Aging of Liege. The authors and researchers were not involved in any competing interests. The medical Ethical Board of the Medical School of the Catholic University of Leuven approved the study.
Objective. To compare the occurrence of pre-existing and subsequent comorbidity among older cancer patients (≥60 years) with older non-cancer patients. Material and Methods. Each cancer patient (n = 3835, mean age 72) was matched with four non-cancer patients in terms of age, sex, and practice. The occurrence of chronic diseases was assessed cross-sectionally (lifetime prevalence at time of diagnosis) and longitudinally (incidence after diagnosis) for all cancer patients and for breast, prostate, and colorectal cancer patients separately. Cancer and non-cancer patients were compared using logistic and Cox regression analysis. Results. The occurrence of the most common pre-existing and incident chronic diseases was largely similar in cancer and non-cancer patients, except for pre-existing COPD (OR 1.21, 95% CI 1.06-1.37) and subsequent venous thrombosis in the first two years after cancer diagnosis (HR 4.20, 95% CI 2.74-6.44), which were significantly more frequent (P < 0.01) among older cancer compared to non-cancer patients. Conclusion. The frequency of multimorbidity in older cancer patients is high. However, apart from COPD and venous thrombosis, the incidence of chronic diseases in older cancer patients is similar compared to non-cancer patients of the same age, sex, and practice.
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