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Whether a change in blood pressure is related to the occurrence of cardiovascular disease, independent of blood pressure level, was investigated using data collected in the Framingham heart study on 5209 subjects. The follow up period of 26 years was divided into a first period of 12 years in which the blood pressure change was computed for each individual and a subsequent period of 14 years in which the risk of cardiovascular disease was determined. Blood pressure change was positively related to risk of cardiovascular disease. This association remained when blood pressure level at the start of the study was taken into account but disappeared when the level attained after the first 12 years was taken into consideration. For the clinician this suggests that the decision to treat high blood pressure is best guided by the actual level of pressure and not by its long term trend in the past.

Two patients with profound dialysis-induced hypotension were seen, in both of whom sequential ultrafiltration and haemodialysis failed to alleviate their symptoms; in one bicarbonate dialysis similarly produced no improvement. The hypotension was frequently severe enough to necessitate premature termination of the dialysis. Haemofiltration was associated with almost total resolution of symptoms, adequate biochemical control of uraemia, and satisfactory removal of weight gain between dialysis sessions. Profound hypotension during dialysis may become more common as older patients enter dialysis programmes; haemofiltration is a valuable technique in such cases.