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Australian Journal of Pharmacy : March 2005
ducation patients progressing to multiple-drug treatment (38.7 per cent versus 45.1 per cent; P =.14). However, the final office and home higher systolic and diastolic measurements were higher in the home blood pressure group than in the office blood pressure group. It was concluded: ‘Adjustment of antihypertensive treatment based on home blood pressure instead of office blood pressure led to less intensive drug treatment and marginally lower costs but also to less blood pressure control, with no differences in general well-being or left ventricular mass. ‘Self-measurement allowed identification of patients with white-coat hypertension. Our findings support a stepwise strategy for the evaluation of blood pressure in which self- measurement and ambulatory monitoring are complementary to conventional office measurement and highlight the need for prospective outcome studies to establish the normal range of home-measured blood pressure.’ Comment It is interesting to note that these two investigations came to conflicting results. In the meta-analysis1 study it was concluded that in patients with hypertension, home blood pressure monitoring was superior to standard blood pressure monitoring in the healthcare system. On the other hand, in the blinded, randomised, controlled trial2 adjustment of antihypertensive treatment based on home blood pressure instead of office blood pressure led to less blood pressure control. In a discussion of these studies it is stated:1 ‘The results of our systematic review and of the latest trial highlight the need for further evidence from prospective studies of outcome to inform potential modifications of treatment guidelines.’ The results...highlight the need for further evidence from prospective studies of outcome to inform potential modifications of treatment guidelines Equipment In an extensive editorial3 concerning the issue of self-monitoring of blood pressure the following comments are made regarding equipment that is available. ‘Few of the devices available on the market are accurate.’ ‘Wrist and finger devices are not recommended. Patients should be warned that devices for self-monitoring are often put on the market without having been independently validated. Up-to-date information about validated devices is provided by the website www.dableducational.org.’ 1. Cappuccio FP, Kerry SM, Forbes L, Donald A. Blood pressure control by home monitoring: meta-analysis of randomised trials. BMJ 2004;329:145. 2. Staessen JA, Hond ED, Celis H, et al, for the Treatment of Hypertension based on home or office Blood Pressure (THOP) trial investigators. Antihypertensive treatment based on blood pressure measurement at home or in the physician’s office: a randomised controlled trial. JAMA 2004;291:955–964. 3. Stergiou G, Mengden T, Padfield PL, Parati G, O’Brien E. Self monitoring of blood pressure at home. BMJ 2004;329:870–871. ¦ Simvastatin found to be of benefit in multiple sclerosis M ULTIPLE sclerosis (MS) is a chronic recurrent inflammatory disorder of the central nervous system. The disease results in injury to the myelin sheaths, the oligo- dendrocytes, and, to a lesser extent, the axons and nerve cells themselves. Four different clinical courses of MS have been defined. The first, relapsing–remitting MS (RRMS) is characterised by self- limited attacks of neurologic dysfunction. These attacks develop acutely, evolving over days to weeks. Over the next several weeks to months, most patients experience a recovery of function that is often (but not always) complete. Between attacks the patient is neurologically and symptomatically stable. During the past decade there has been much progress in the treatment of multiple sclerosis. Immunomodulatory drugs, for example, interferons beta-1a [Avonex, Rebif] and beta-1b [Betaferon], glatiramer acetate [Copaxone Injection] have been approved in Australia for the treatment of MS. However, it is considered that they ‘are only partly effective, are injected, and are expensive’.1 In addition to their cholesterol-lowering effect, statins have been shown to have immunomodulatory effects, and this observation has prompted an investigation of the effect of simvastatin on the treatment of relapsing-remitting multiple sclerosis.1 A multi-centre, open-label, single-arm study to gather information on use of oral simvastatin in the treatment of MS has THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 ? 211