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PURPOSE: This study was undertaken to investigate whether there is a relationship between the white-coat effect and the cardiovascular complications of hypertension. PATIENTS AND METHODS: In 1,013 consecutive borderline to severe hypertensive outpatients (889 men) with a mean age ([+ or -] SE) of 33.6 [+ or -] 0.5 years and a mean office blood pressure of 152.3 [+ or-] 0.6/95.5 [+ or -] 0.4 mm Hg, blood pressure was measured by noninvasive 24-hour ambulatory monitoring. Target organ damage was assessed by electrocardiogram, chest X-ray, echocardiography, and ophthalmoscopy. The degree of target organ damage and of left ventricular hypertrophy was assessed in the subjects divided according to the levels of their daytime blood pressure and the extent of their white-coat effect. RESULTS: The subjects with a high white-coat effect showed a greater degree of hypertensive complications than those with intermediate or a low white-coat effect. The significant association between the white-coat phenomenon and the hypertensive complications was confirmed by the results of stepwise regression analyses, where sex, age, duration of hypertension, and ambulatory blood pressure were added to the model. A two-way ANOVA showed that both ambulatory blood pressure and the white-coat effect were related to the degree of target organ damage and to left ventricular hypertrophy. Moreover, daytime blood pressure and the white-coat effect showed an interactive effect on hypertensive complications, as the influence of the white-coat effect on end organs increased with increasing levels of ambulatory blood pressure. CONCLUSIONS: The present results show that the white-coat effect is related to the degree of hypertensive complications and that this association is stronger in the subject with more severe hypertension. Am J Med. 1997; 103:208-216. [C] 1997 by Excerpta Medica, Inc.

We reported a case of inappropriate implantable cardioverter defibrillator shocks, due to atrial far‐field on the tip‐to‐ring channel of the fast electrical activity during atrial fibrillation, caused by lead dislocation in the right ventricle outflow tract. During these episodes the can‐to‐right ventricle coil signal correctly recorded the ventricular activity. The shock storm stopped when an antitachycardia pacing restored sinus rhythm.

1. To assess the clinical significance of supernormal left ventricular systolic function in the initial phase of hypertension, 635 never-treated 18–45-year-old borderline to mild hypertensive subjects (477 males, 158 females) were studied. All subjects underwent echocardiography, 24 h ambulatory blood pressure monitoring and 24 h urine collection for catecholamine dosage. 2. Subjects whose left ventricular shortening-stress relationship was above the 95% confidence intervals of 50 normotensive subjects of similar age and sex distribution were defined as having supernormal function. 3. Age, duration of hypertension and left ventricular mass were similar in the hypertensive subjects with normal (85%) and supernormal (15%) ejective performance. Subjects with supernormal function showed higher office systolic blood pressure (P < 0001), office heart rate (P = 0.03) and cardiac index (P < 0001). Conversely, 24 h systolic blood pressure, 24 h heart rate and 24 h catecholamine output did not differ according to left ventricular function. 4. In conclusion, the greater white-coat effect and the normal baseline sympathetic tone exhibited by the patients with increased performance suggest that supernormal left ventricular pump function is only a marker of the alerting reaction elicited by the echocardiographic examination.

To study the relationship of urinary albumin excretion to ambulatory blood pressure and other cardiovascular risk factors in borderline to mild hypertension.

To study the relationship between plasma renin activity (PRA) and coffee consumption, cigarette smoking, alcohol intake and physical activity habits. Setting: The multicentre HARVEST trial, involving 17 Hospital Centres in Northeast Italy. Subjects: 351 borderline to mild hypertensive men (mean age ± SEM 22.7 ± 0.47 years), never treated for hypertension. Interventions: Office and 24-hour blood pressure measurement, supine and standing PRA levels, and urinary catecholamines output. Main outcome measures: PRA levels according to coffee intake and physical activity status. Results: Coffee intake showed a major effect on PRA. Supine PRA levels were 40% higher in the subjects abstaining from coffee (n = 94) than in the coffee drinkers and was similar in the moderate (n = 223) and heavy (n = 34) drinkers. A weaker negative association was found between coffee use and PRA on standing. Office and whole-day blood pressure and heart rate, and urinary catecholamines did not differ according to coffee intake. Supine PRA was lower in the subjects performing regular physical activity than in the inactive subjects. Office and whole-day diastolic blood pressure and heart rate, and urinary norepinephrine were lower in the active than in the sedentary men. No relationship was found between PRA measured either in the supine or the upright posture and tobacco or alcohol use. In a multiple linear regression model supine PRA was negatively correlated with age, coffee consumption and physical activity habits. Conclusions: Chronic coffee intake and physical training showed an inverse relationship with PRA in mild hypertensive men, while tobacco and alcohol use were unrelated to PRA.

To define whether a diurnal rhythm of peripheral resistance exists in normotensive and hypertensive subjects, has any relationship with that of blood pressure and differs in dipper and non-dipper hypertensives.

The aim of the study was to assess the clinical significance of the blood pressure (BP) reaction to standing in 1029 stage I hypertensives. Office BP was measured six times in the supine position and six times after 2 min of standing. All subjects underwent 24-h ambulatory BP monitoring, and measurements of 24-h urinary epinephrine and norepinephrine excretion. Echocardiography was performed in 636 patients. With use of mixture analysis we could single out a population with abnormal diastolic BP response to standing (hyperreactors, n = 95). These subjects had a diastolic BP increase from lying to standing of >11 mm Hg. The other subjects were defined as normoreactors (n = 934). Office systolic BP was similar in the two groups. Diastolic BP was lower (91 ± 6 mm Hg v 95 ± 5 mm Hg, P < .0001) and heart rate was higher in the hyperreactors (77 ± 10 beats/min v 75 ± 9 beats/min, P = .004). After adjusting for age, gender, and smoking habits the statistical significance did not change. Adjusted 24-h systolic BP (P = .02) and diastolic BP (P = .02) were higher in the hyperreactors than in the normoreactors. Hyperreactors were characterized by higher cardiac index (3.2 ± 0.8 L/min/m2 v 3.0 ± 0.7 L/min/m2, P = .008 for adjusted values), lower total peripheral resistance (1420 ± 330 dyne/sec/cm-5 v 1600 ± 380 dyne/sec/cm-5, P = .003), and higher urinary norepinephrine output (114.9 ± 80.3 µg/24 h v 90.6 ± 78.5 µg/24 h, P = .03). Dimensional echocardiographic data and albumin excretion rate did not differ between the two groups. In conclusion, mixture analysis allowed us to identify a population of young mild hypertensives with exaggerated BP response to standing. Hyperreactors were characterized by higher whole-day BP and by a hyperkinetic hemodynamic pattern as a result of increased sympathetic tone. Am J Hypertens 1997;10:546–551 © 1997 American Journal of Hypertension, Ltd.

The effect of different editing methods on the reproducibility of ambulatory blood pressure and on its correlation with microalbuminuria was studied in a population of 584 stage I hypertensives participating in the Hypertension and Ambulatory Recording Venetia Study (HARVEST) Group. For systolic blood pressure (SBP), a modified version of the Casadei method showed the best reproducibility indices, followed by the original Casadei and the Kennedy methods. The Staessen, SpaceLabs, and A&D methods showed poorer indices, irrespective of whether calculations were made in recordings with more or less than 10% artifactual readings. For diastolic blood pressure (DBP), reproducibility indices did not substantially vary with the various editing procedures except for the Kennedy method, which showed a slightly better performance. Blood pressure variability (standard deviation) showed a better reproducibility with the original and modified versions of the Casadei and the Kennedy procedures than with the other methods, especially in the subjects with percentage of measurement errors greater than 10%. The correlation coefficients between 24-h SBP and albumin excretion rate ranged from 0.128 for the raw data to 0.154 for the data edited according to the Casadei procedures. For DBP, the correlation coefficients were similar except for DBP edited with the Kennedy method, which did not correlate with albumin excretion rate to a statistically significant level. These data suggest that, to make the results of different laboratories comparable, common ambulatory blood pressure editing criteria should be used. The modified version of the Casadei procedure, which is automatic and can be applied to recordings obtained from any device, should be regarded as the method of choice. © American Journal of Hypertension, Ltd. Am J Hypertens 1997;10:419–427