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The most important cardiovascular risk factors (hypercholesterolemia , hypertension, diabetes, chronic stress, physical inactivity, smoking, adipositas) were evaluated in the second half of the last century using placebo controlled trials. The mechanismen of action was not fully understood or remained unclear. In some studies not only the risk of atherosclerosis was reduced but life expectancy was improved. The length of telomeres is influenced by many of the cardiovascular risk factors and is a biomarker of age. Reduced telomere length are found in higher age, atherosclerosis, hypertension, adipositas, diabetes, smoking, physical inactivity, heart failure, maltreatment in childhood, exposure to traffic pollution, chronic infection, single life and dementia. A positive effect on telomerase and telomere length is found with increased physical activity, statins for treatment of hypercholesterolemia, and higher blood levels of omega-3 fatty acids. The probable mechanismen for this is an activation of telomerase activity. Many of the cardiovascular risk factors influence the cellular DNA by telomere shortening. These effects could be reduced by life style measures with prudent diet and drugs for good somatic fitness and healthy aging. By this mechanism cardiovascular prevention not only reduces the risk of atherosclerosis but also improves life exspectancy by anti-aging effects.

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Life style measures (weight reduction and control, reduction of total fat calories to < 30% of total calories, modification of fat intake to increased monounsaturated vegetable fat, increased intake of dietary fibers, increased physical activity, controlled stress relaxation) are the basis of longterm therapy of coronary heart disease. For transformation to daily life both patient and doctor need motivation, information, patience, and realistic aims. For realization the 10 rules of medical information should be followed. The patient must be informed that the "new lifestyle" is not punishing but means a new quality of life. With respect to the most important metabolic syndrome with hyperinsulinemia due to insulin resistance, weight reduction is the most important measure for preventing complications of atherosclerosis. The patient should use a diary for weight control and blood pressure self-measurement. Secondary prevention of CHD has been shown useful and effective; however, most patients need additionally drug therapy to avoid or retard progression of the coronary heart disease. The targets for cholesterol and blood pressure control are low; the responsibility of the patient remains high. Besides weight reduction, stopping smoking, lowering lipids, controlling hypertension, and aspirin are the most important.

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Fully-automated blood pressure measurement has become increasingly widespread over the last few years, especially in the field of blood pressure self-measurement. The high prevalence of arterial hypertension among the aged (over 30%) means that, frequently, the users additionally suffer from cardiac irregularity and valvular heart disease. Using comparative, invasive blood pressure measurements, we investigated the reliability and accuracy of the currently authorized blood pressure measuring devices, both in patients with the most common cardiac irregularity, atrial fibrillation, and in patients with aortic regurgitation, as an example of blood pressure measurement in connection with hypercirculation. Certain things must be taken into account when carrying out auscultatory blood pressure measurement according to Riva-Rocci and Korotkoff if blood pressure levels are to be determined accurately. Firstly, considering the individual variability of blood pressure levels in connection with atrial fibrillation, the mean value from three consecutive blood pressure measurements is more accurate than a single measurement. Secondly, the diastolic blood pressure of patients with significant aortic regurgitation should always be determined with Phase 4 according to Korotkoff. In patients with atrial fibrillation, the accuracy of the blood pressure devices being considered should be investigated individually. In comparison, devices employing the oscillometric measuring technique for blood pressure self-measurement in the upper arm determine blood pressure levels more accurately and reliably than devices for measurement in the wrist or auscultatory devices. In patients with significant aortic regurgitation, diastolic blood pressure levels determined with currently authorized, fully-automated blood pressure measuring devices are reliable and accurate. Systolic blood pressure levels determined in the upper arm are, however, too high.

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Automatic 24 h Ambulatory Blood Pressure Monitoring (ABPM) has become an established method in the diagnosis and treatment control of arterial hypertension. Fully automatic blood pressure devices for blood pressure self-measurement (BPSM) in the upper arm and in the wrist using the oscillometric measuring technique have been available in Germany for several years. After evaluating the blood pressure devices boso Oscillomat (upper arm) and Omron HEM-601 (wrist) by means of simultaneous invasive measurements, we studied the suitability of this new method for the control of treated hypertension. Using the device Space Labs 90207, we had ABPM carried out in 100 men (aged 58 +/- 8 years) with mild to moderate hypertension. They recorded hourly blood pressure measurements in the wrist between 6 a.m. and 6 p.m., in the same arm as the blood pressure monitoring using the device Omron HEM-601, or in the other arm using the device boso Oscillomat. The values of systolic and diastolic blood pressure were measured using both methods. Since the random samples probably consisted of non-standard distribution differences, we applied the Wilcoxon matched pairs signed rank test for statistical analysis. No significant differences were recorded between the daily mean systolic (p < .07) and diastolic (p < .97) blood pressure values determined by ABPM and by frequent blood pressure self-measurement. Multiple blood pressure readings obtained using blood pressure self-measurement in the upper arm as well as in the wrist are an alternative to the established, automatic 24-h, ambulatory blood pressure measurement for the treatment control of arterial hypertension, that nightly blood pressure measurement can be omitted. It has advantage of unrestricted and desired frequent use under standardized conditions.

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Today, self-measurement of blood pressure is seen as the optimal goal in improving the compliance of the hypertensive patient, but it can only be reached by using well trained medical staff. In this, the role of nurses is particularly vital. We administered a questionnaire to 77 nurses and 146 doctors to determine their levels of knowledge concerning blood pressure measurement techniques and pitfalls, and definition of hypertension. The general knowledge of both groups was insufficient. Whereas doctors showed greater medical knowledge, nurses were better at the techniques. Both were equally deficient in defining hypertension. We therefore set up a short course (3h) in blood pressure measurement to evaluate knowledge and provide further training. The course consisted of a pretest, a short training programme and a post-training test. Post-training test results showed an average improvement in defining hypertension from 5% to 85%. We conclude that short-term training courses in blood pressure measurement are needed for nurses and doctors, particularly young doctors. We also need more coverage in the medical press to stimulate interest in this vital topic.

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One of the major problems of both pharmacological and non-pharmacological treatment is compliance of the patient. We attempted to reduce compliance problems by using group exercise in hypertensive patients. A group of 29 hypertensive patients (aged 54 +/- 10 years) met weekly for nearly 2 years. Each session (90-120 min) comprised four parts: endurance training, gymnastics and relaxation, education and a discussion of related problems such as nutrition and lifestyle. There was a significant decrease in systolic (9%) and diastolic (6%) blood pressures at rest and during exercise (systolic 12%), and an increased maximal work load (18%). In addition, drug treatment was substantially reduced (reduced in 56% of patients abandoned in 10% of patients). Cholesterol levels were reduced by 18%, although, during a 6-10 day nutritional report, fat made up 40% of the total calorific intake, indicating the need for individualized dietary advice. The major goal was to improve compliance and increase non-pharmacological treatment, exercise being a minor consideration which may have relevance for the treatment of hypertension.

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Out-patient groups of hypertensives were organized in an effort to improve long-term treatment results with greater attention to general measures and to increase compliance. Under supervision of a doctor and a physiotherapist 45 patients (aged 54 +/- 10 years) with mild or moderately severe hypertension were enrolled in a sports training programme after thorough examination. At the same time they were given advice and instructions on self-measurement of blood pressure, diet, medication, general life style and relaxation techniques. In the first 20 patients (observation period of more than one year) a significant reduction in both resting (systolic of -9%) and exercise (systolic of -12%) blood pressures was noted. At the same time exercise tolerance was raised (+18%), while body-weight and total cholesterol concentrations were lowered. It was possible to reduce drug dosage in seven patients, in three more it was discontinued. Left-ventricular wall thickness fell slightly but not significantly. There were no complications. It is concluded that group therapy with sport as a vehicle and advice on general life style are satisfactory means for controlling hypertension and achieve better compliance.

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The recently published intervention studies have shown that effective prevention of coronary artery disease can be done by risk factor modification. Identification and care for patients with higher risk is a challenge for the attending physician. He should focus his attention on the three major risk factors: hypertension, hypercholesterinemia and smoking. Normalisation of eating behaviour is the basis in the treatment of hypertension and hypercholesterinemia. For smoking cessation family members should also be advised to stop smoking, too. An effective reduction in the risk profile by life style changes can only be achieved if a good relation between patient and physician can be established.

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The binding of water to the dimethylphosphate anion (DMP-) was calculated using the PCILO method. We found binding energies of 25.95 kcal-mol-1 in the O1-P-O3 plane bridgeing the anionic oxygen atoms and 19.3 kacl-mol-1 for the one-site association of a water molecule to an anionic oxygen atom of DMP-. In this range on water molecule added to DMP- in the O1...O3 bridged configuration has a significantly higher binding energy to DMP- than water molecules added to other binding sites. The total binding energy of 5 water molecules to DMP- is 92 kcal-mol-1, a quantity which is about 10% less than the sum of the binding energies of the corresponding monohydrates.

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