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The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index ( P =0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P =0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777., (© 2017 American Heart Association, Inc.)

To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information based on the strongest scientific rationale and that is easily applicable to daily clinical practice. Resistant hypertension is defined as uncontrolled blood pressure on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least 4 weeks, at optimal doses. Treatment compliance must be closely monitored, as must factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression, drug interactions and vasopressor drugs). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5-25 mg per day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a β-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.

Background: The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure-lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control., Methods: One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients., Results: The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively (P=0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was -6.7 mm Hg (P=0.0461) in fully adherent and -7.8 mm Hg (P=0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients., Conclusions: In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone., Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777., (© 2016 American Heart Association, Inc.)

Inadequate blood pressure (BP) control may be linked with poor adherence to guidelines by the treating physician. This study aimed at assessing the rates of controlled hypertension as per the 2009 Reappraisal of the 2007 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines in 2185 hypertensive adults across five countries (Algeria, Pakistan, Ukraine, Egypt and Venezuela). The rates of controlled hypertension according to physician perception, type of therapy and risk factors were evaluated. Overall, 40% of patients had controlled hypertension according to the guidelines. A marked divergence in the rates of controlled hypertension as assessed by physicians and guidelines was observed (72% vs 40%). The presence of high/very high risks was linked to poor BP control. High salt intake [29%; odds ratio (OR) 9.94, 95% confidence interval (CI) 6.72;14.69], treatment non-adherence (27%; OR 7.32, 95% CI 4.82;11.13), lack of understanding of the treatment's importance (25%; OR 4.95, 95% CI 3.16;7.75), comorbidity (13%) and depression (9%; OR 10.50, 95% CI 5.37;20.54) were major reasons for not achieving hypertension control. Addition of another drug was the most frequent medication change prescribed. Poor rates of BP control warrant repeated promotion of guidelines while identifying potential contributing factors and implementing strategies that re-establish BP control.

Background: The rate of uncontrolled hypertensives aged >80 years is not well known. The available literature on this topic has used the threshold <140/90 mmHg, whereas there is now a consensus for a different target: systolic blood pressure (SBP)<150 mmHg., Aims: This prospective observational population-based study sought to assess the frequency and management of uncontrolled hypertension in French patients aged ≥80 years., Methods: Nine hundred and seventy-one treated hypertensive outpatients were evaluable (204 recruited by cardiologists, 767 by general practitioners [GPs]; mean age 84.8 ± 3.8 years; 57.8% women)., Results: The frequency of SBP ≥ 150 mmHg was 36.6% (44.6% in cardiologists' patients and 34.4% in GPs' patients). The frequency of satisfaction with SBP ≥ 150 mmHg was 22.0% for cardiologists (32.6% if diastolic blood pressure [DBP] <90 mmHg and 9.5% if ≥90 mmHg; P=0.008) and 30.4% for GPs (51.7% if DBP <90 mmHg and 13.2% if ≥90 mmHg; P<0.0001). Non-diabetic status (for cardiologists) and DBP <90 mmHg (for cardiologists and GPs) were independent determinants of SBP being considered acceptable. Accordingly, in patients with an SBP level ≥ 150 mmHg that was considered too high, treatment was reinforced more often if DBP was ≥90 mmHg (82.3%) than <90 mmHg (68.5%)., Conclusion: In France, hypertension is uncontrolled in more than one in three elderly hypertensives. Physicians are aware that SBP should be lowered to <150 mmHg in patients aged>80 years, but when the target is not reached they are less likely to increase treatment if DBP is <90 mmHg., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

To determine values for home blood pressure (HBP) during pregnancy, nurses taught 45 healthy pregnant women to use a HBP method for 1 week before 15 weeks of gestation, between weeks 15 and 27, and after 28 weeks for the last 3 months of gestation. HBP values were significantly lower during the second trimester and higher during the last trimester (102 +/- 8/59 +/- 7*, 101 +/- 8/57 +/- 8*, 105 +/- 8*/62 +/- 9* mm Hg;*P< 0.05) than during other trimesters. Heart rate increased significantly during the pregnancy. The present study suggests upper limits for HBP: 118/73, 117/73, and 121/80 mm Hg, respectively during the 3-month gestational periods. These findings may be helpful in providing clinicians with comparative values so as begin to establish reference values for HBP during pregnancy.

Unlabelled: The aim of this multicentre, prospective, randomised, open study was to compare the trough effect of telmisartan (T) and perindopril (P) on diastolic blood pressure (DBP) after a 12-week treatment, using self blood pressure measurement (SBPM)., Methods: To enter the study, patients had to be 18 years of age or older and were required to suffer from mild to moderate hypertension (90 < or = PAD < 110 mmHg and/or PAS < 180 mmHg). At the end of a 3-week run-in placebo period, patients were allocated to receive either T (40 mg) or P (4 mg) once daily for a period of 12 weeks. Patients whose clinic DBP remained higher than or equal to 90 mmHg at the end of the sixth week, were given a double dose regimen. SBPM was performed over 7 consecutive days at 3 different times: at the end of the washout period (W0), at week 6 (W6) and week 12 (W12). A clinic determination of blood pressure (BP) was also performed at each visit, using the same automatic device as that used for SBPM., Results: 671 patients were selected and 441 were randomised (age: 55 +/- 12 years: 240 men and 201 women). Study populations were the following: the safety population (n = 441, T = 220; P = 221), the intent-to-treat (ITT) population (n = 435, T = 217 and P = 218), and the per protocol population (n = 368, T = 188; P = 180). ITT analysis showed a greater diminution of trough DBP from W0 to W12 with T than with P (T: -6.6 +/- 6.7 mmHg and P: -5.1 +/- 7.0 mmHg; p = 0.018 according to ANOVA for repeated measures). Regarding clinic BP, the same results were observed. Likewise, the per-protocol analysis provided similar findings. Doubling dose was significantly less frequent with T (41%; n = 85) than with P (55%; n = 115; p = 0.005). The overall frequency of adverse events was similar in both treatment groups: T = 34% (n = 74) vs p = 32% (n = 70). Most of them were of mild to moderate intensity and transient. As expected, the occurrence of cough was more frequent with P [5% (n = 12), T < 1% (n = 2), p = 0.007]., Conclusion: The trough effect on DBP was statistically higher with T (40 mg) than with P (4 mg), using SBPM as well as automatic clinic BP measurement.

The authors reviewed some of the most relevant studies dedicated to the assessment of the effects of the antihypertensive drugs on the stress-induced cardiovascular changes. The rises in both blood pressure and heart rate turned out not to be significantly altered by calcium channel blockers, ACE inhibitors, moxonidine, nor beta-blockers, whereas they seemed to be slightly blunted by alpha-blocking drugs. However, since baseline blood pressure was significantly lower in treated hypertensives than in placebo-given patients, all antihypertensive drugs eventually resulted in a lower blood pressure level during stress, as compared with untreated patients. Regarding white coat effect, which has to be considered as a very particular stress, it appeared to be lowered to the same extent by placebo and antihypertensive drugs; moreover, its changes were not associated with any clinical beneficial effect.

This study was designed to analyse the relationship between the different blood pressure (BP) variabilities obtained in a non-invasive way and to determine the potential contribution of aging, severity of hypertension and increased ventricular mass to these different BP variabilities. Two hundred and six hypertensive patients underwent a 24-h ambulatory BP measurement (ABPM) as well as a photoplethysmographic BP recording and a standard echocardiography. Nocturnal BP fall and standard deviations of hourly mean BP levels as well as post-prandial fall in BP were calculated from the 24-h ABPM and were considered as indexes of long-term variability. Baroreflex sensitivity (BRS) and spectral powers of systolic BP, diastolic BP and heart rate (HR) over the low frequency band (LF: 0.05--0.14 Hz) were obtained from photoplethysmographic recording and were used as indexes of short-term variability. Short-term variability indexes were shown to be significantly related to those of long-term variability. A decrease in LF spectral powers was associated with a particular profile characterised by an attenuation of nocturnal BP fall, an increase of daytime BP standard deviations, an increase in post-prandial BP fall, a decrease in BRS and to a lesser extent, a diminution in night-time HR standard deviation. Moreover, a negative significant relationship was found between standard deviation of daytime systolic BP and both night systolic BP fall and BRS. Age and nocturnal BP level were associated with all BP variability disorders, whereas left ventricular hypertrophy was associated only with a decrease in LF spectral powers and in night BP fall, and an increase in standard deviation of daytime BP. Finally, LF spectral power of SBP was identified as independently predicted by age and night SBP fall. Journal of Human Hypertension (2001) 15, 41-48

Our objective was to compare three different methods of blood pressure measurement through the results of a controlled study aimed at comparing the antihypertensive effects of trandolapril and losartan. Two hundred and twenty-nine hypertensive patients were randomized in a double-blind parallel group study. After a 3-week placebo period, they received either 2 mg trandolapril or 50 mg losartan once daily for 6 weeks. At the end of both placebo and active treatment periods, three methods of blood pressure measurement were used: a) office blood pressure (three consecutive measurements); b) home self blood pressure measurements (SBPM), consisting of three consecutive measurements performed at home in the morning and in the evening for 7 consecutive days; and c) ambulatory blood pressure measurements (ABPM), 24-h BP recordings with three measurements per hour. Of the 229 patients, 199 (87%) performed at least 12 valid SBPM measurements during both placebo and treatment periods, whereas only 160 (70%) performed good quality 24-h ABPM recordings during both periods (P < .0001). One hundred-forty patients performed the three methods of measurement well. At baseline and with treatment, agreement between office measurements and ABPM or SBPM was weak. Conversely, there was a good agreement between ABPM and SBPM. The mean difference (SBP/DBP) between ABPM and SBPM was 4.6 +/- 10.4/3.5 +/- 7.1 at baseline and 3.5 +/- 10.0/4.0 +/- 7.0 at the end of the treatment period. The correlation between SBPM and ABPM expressed by the r coefficient and the P values were the following: at baseline 0.79/0.70 (< 0.001/< .0001), with active treatment 0.74/0.69 (0.0001/.0001). Hourly and 24-h reproducibility of blood pressure response was quantified by the standard deviation of BP response. Compared with office blood pressure, both global and hourly SBPM responses exhibited a lower standard deviation. Hourly reproducibility of SBPM response (10.8 mm Hg/6.9 mm Hg) was lower than hourly reproducibility of ABPM response (15.6 mm Hg/11.9 mm Hg). In conclusion, SBPM was easier to perform than ABPM. There was a good agreement between these two methods whereas concordance between SBPM or ABPM and office measurements was weak. As hourly reproducibility of SBPM response is better than reproducibility of both hourly ABPM and office BP response, SBPM seems to be the most appropriate method for evaluating residual antihypertensive effect.

Aim of the Study: to assess the reproducibility of blood pressure and heart rate variability measurements in time and frequency domain, by using a Finapres device in healthy volunteers., Methods: 16 normotensive subjects aged 22 to 51 years underwent within a 5-day interval two non-invasive blood pressure recordings by a Finapres device over 15 minutes both in supine and standing positions, at the same time of the day., Statistical Analysis: non parametric tests, relative errors, and intraclass correlation coefficient., Results: [table: see text], Conclusion: the data provided by the FINAPRES device, especially the baroreflex sensitivity measured in standing position, show a good day to day reproducibility.

Aim of the Study: To compare heart rate (HR) and blood pressure (BP) variability in hypertensive patients with or without a fall in BP during the night., Methods: 33 mild to moderato hypertensive patients, mean age 45 +/- 15 years, underwent an echocardiogram, a 24-hr ambultory BP monitoring (ABPM), and a 24-hr ECG monitoring. In addition, a continuous BP recording over 15 minutes was performed between 9 and 11 a.m. both in supine and standing positions, by using digital plethysmography (Finapres device)., Statistical Analysis: non parametric tests., Results: [table: see text], Conclusion: In non dippers, morning BP and HR low-frequency oscillations are shifted to a lower level, as compared to dippers. This characteristic is associated with a reversed circadian pattern of sympathetic activity.

Aim of the Study: To compare heart rate (HR) and blood pressure (BP) variability in hypertensives with or without left ventricular hypertrophy (LVH)., Methods: Thirty-three mild to moderate hypertensive patients, mean age 45 +/- 15 years, underwent an echocardiogram, a 24 hr ambulatory BP monitoring (ABPM), a 24 hr ECG monitoring and a continuous BP recording over 15 minutes both in supine and standing positions, by using digital plethysmography (Finapres device)., Statistical Analysis: non parametric tests., Results: [table: see text], Conclusion: LVH is associated with a reduction in the markers of sympathetic activity and a decreased baroreflex sensitivity.

We retrospectively studied 216 mild to moderate hypertensive patients receiving either an angiotensin converting enzyme inhibitor (ACEI) or a calcium antagonist (CA), as a once-a-day monotherapy; their blood pressure had been measured using both a sphygmomanometer and an ambulatory blood pressure recorder. Numerous discrepancies were found between the two methods of blood pressure measurement with respect to systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as pulse pressure (PP). Clinic blood pressure measurement did not show any significant differences between the effects of ACEI and those of CA, whereas ambulatory blood pressure measurements (ABPM) showed that in patients with normal ambulatory blood pressure (so-called 'white coat' hypertensive patients), ACEI only (but not CA) significantly lowered SBP, DBP and PP. Accordingly, a threshold of efficacy was sought: it appeared to be lower for ACEI than for CA (120/80 vs 140/85 mmHg). Furthermore, for a given degree of DBP lowering, SBP and PP were more lowered by ACEI than by CA, indicating a greater effect of ACEI on arterial compliance. Likewise, for a given level of mean blood pressure, SBP and PP were lower and DBP slightly higher in patients on ACEI than in those on CA. Our data are consistent with some recent papers, emphasizing a heightened activity of the renin-angiotensin system in 'white coat' hypertensive patients.

The high degree of the intra-individual variability of blood pressure (BP) is related both to biological and technological factors: the biological components of variability are either linked to sympathetic system and respiratory movements or induced by physical and psycho-sensorial stresses; the technological sources of variability are the apparatus and the doctor. The consequences of this high variability can be quantified: the risk for a between-visit change of 35 mmHg for systolic BP (and 17 mmHg for diastolic BP) to be due to the spontaneous BP variability, is as high as 95%. Moreover, according to the regression to the mean, in selected patients with a mean SBP as high as 160 mmHg, a mean spontaneous decrease of 9 mmHg is expected to occur, at the next visit. The physician has then to manage the lack of accuracy of clinic BP measurements. For this purpose, three strategies have to be used: thoroughly examining the patient (if associated with an organ damage, the high BP undoubtedly requires to be treated); rigorously taking into account the published recommendations of BP measurements (the sources of error are now well known and may be easily corrected); finally, using the most sophisticated methods of BP measurements (elf BP measurement), semi-ambulatory or ambulatory BP monitoring, exercise testing), which in some circumstances, may provide useful additional information.

Interest in isolated systolic hypertension in the elderly has increased in the last few years. The definition of this disorder remains controversial: according to most authors, the systolic blood pressure has to be above 160 mm Hg and the diastolic under 90 mm Hg. The prevalence depends on number of visits, as well as on sex, age and race. The elderly is characterized by haemodynamic and neurohormonal features, which have to be pointed out: cardiac output and renal blood flow as well as hepatic blood flow are significantly lower than those of younger adults; great vessels compliance is diminished, baroreflex is impaired and cerebral autoregulation curve is shifted towards the right. From a prognostic point of view, systolic hypertension is now recognized as an independent risk factor for cardio-vascular morbidity and mortality. Recently, the SHEP study has demonstrated that the treatment of isolated systolic hypertension with diuretics alone or associated with beta-blockers resulted in a significant reduction in the incidence of stroke and major cardio-vascular events. The effectiveness of angiotensin-converting enzyme inhibitors and calcium antagonists is still under evaluation.

Unlabelled: Nineteen hospitalised, severe and treated parkinsonians (9 males, 10 females), stage IV and V of Hoehn and Yahr's classification, underwent 2 days running ambulatory blood pressure monitoring (ABPM) by ABPM 630 Nippon-Colin device, during a period of therapeutic stability. Hospitalisation allowed reproducibility of daily activity. Diurnal, nocturnal and 24 hours systolic blood pressure (SBP), as well as nocturnal and 24 hours diastolic blood pressure (DBP) were reproducible with a good correlation for each patient. Diurnal diastolic BP was the lone not reproducible value but had a good day 1-day 2 correlation. [table: see text], Conclusion: Parkinsonian ABPM data, except diurnal DBP, are reproducible.

Objective: this retrospective study was aimed: at comparing the effects of angiotensin converting enzyme inhibitors (ACEI) and those of calcium antagonists (CA) on the pulse pressure of mild to moderate hypertensive patients; at assessing whether these effects were associated with some modifications of blood pressure variability or not., Methods: the ambulatory blood pressure (ABP) recordings of 236 patients who previously entered clinical trials with a mean run-in placebo period of 2 weeks and a mean active treatment phase of 6 weeks (ACEI, n = 115; CA, n = 121) were reviewed. Baseline ABP has been analysed both as a continuous variable and as a categorical one (high when > 139/87 mmHg, low otherwise). Pulse pressure was calculated by the difference systolic ABP-diastolic ABP, whereas BP variability was estimated by the standard deviation and the variation coefficient of each recording. The results are given as percentage (mean +/- standard deviation). In the patients with high baseline systolic ABP, ACEI and CA did not significantly differ regarding their effects on pulse pressure (-11.1 +/- 17.2 vs -6.3 +/- 14.0, NS). By contrast, in the other patients, pulse pressure was lowered to a significantly greater degree by ACEI than by CA (-5.5 +/- 18.7 vs +1.8 +/- 18.8, p = 0.04). These differences were not related to baseline diastolic ABP. No difference at all was found with regard to BP variability which was altered by none of the drugs. In conclusion, pulse pressure, a reliable indicator of arterial compliance, seemed to be more decreased by ACEI than by CA, the difference being significant only in patients with apparent hypertension.

Objective: This multicenter study was aimed at determining whether the baseline ambulatory blood pressure (BP) level does influence the efficacy of angiotensin-converting enzyme inhibitors (CEI) and that of calcium antagonists (CA) to the same degree., Methods: The BP recordings of 236 patients with mild to moderate hypertension were reviewed: these subjects previously entered clinical trials comprising a mean 2-week placebo period and a mean 6-week active treatment phase (CEI = 115, CA = 121). The 24-hour baseline ambulatory BP was considered as high when greater than 139/87 mmHg, according to Staessen's meta-analysis., Results: In the patients with an high baseline ambulatory BP, CEI and CA have had roughly a similar effect (reduction in systolic = 9.5 +/- 7.8% vs 7.7 +/- 6.3%, NS; reduction in diastolic = 9.8 +/- 8.6% vs 8.3 +/- 5.8%, NS). Conversely, the patients with a baseline ambulatory BP level lower than or equal to 139/87 mmHg experienced a greater reduction in ambulatory BP with CEI than with CA (systolic = 7.9 +/- 7.0% vs 0.6 +/- 6.7%, p = 0.0001; diastolic: 5.0 +/- 7.4% vs 1.9 +/- 7.6%, p = 0.040). Finally, further analysis found the threshold of drug efficacy to be 120/80 and 135/85 mmHg in CEI and CA patients respectively., Conclusions: 1) CEI are more effective than CA in patients with a low ambulatory BP only. 2) The risk of a visceral hypoperfusion seems however to be limited, since CEI do not reduce diastolic ambulatory BP further, when its baseline level is lower than 80 mmHg.

Objective: we used initial whole day blood pressure (BP) level to evaluate antihypertensive therapy in different class of agents., Design and Methods: The study was performed with 205 hypertensive patients. All patients had essential mild to moderate hypertension after single-blind placebo run in period. At the end of this period, and after 1 month of active treatment (3 class of agents: angiotensin converting enzyme inhibitors (ACEI) = 117, calcium channel blockers (CCB) = 52, beta-blockers (BB) = 36) casual blood pressure was performed and ambulatory BP was monitored during the whole day. At the start of the study, 91 of 205 patients had an ambulatory diastolic BP less than to 90 mmHg (group I: "normotensive patients") and 114 greater than or = 90 mmHg (group II: "hypertensive patients"). Clinical measurements and whole day BP monitoring are used to assess response to treatment for all patients and for the group I and II., Results: Therapy decreased clinical BP by 19 +/- 15/11 +/- 9 mmHg and average whole day BP by 10 +/- 11/7 +/- 8 mmHg. In the 3 class of agents, there is no difference between group I and II at the start of study. ACEI treatment: In group I, decrease of average whole-day BP by 12/7 and by 11/8 mmHg in group II. In contrast for CCB treatment: 2/2 and 13/7 (p less than 0.001), for BB treatment 10/4 and 13/11. In the 3 class of agents, there is no difference in the clinical BP decreases between group I and II., Conclusion: Our data emphasize a significant discrepancy between clinical and ambulatory BP evaluation among patients displaying low ambulatory BP particularly with CCB treatment in contrast with ACEI treatment. In the low group, CCB decreased ambulatory BP less than ACEI did. These results suggest that there is a lesser chance of overtreating "normotensive" patients with CCB than there is with ACEI.

This prospective study was designed: 1. to determine both the mean level and the intrinsic variability of blood pressure (BP) and heart rate (HR) in normotensive patients with insulin-dependent diabetes mellitus (IDDM), by using a nonambulatory recorder; 2. to look for a relationship between these parameters and the indices of diabetic target-organ damage. The patient group consisted of 21 subjects with IDDM (6 females, 15 males), aged 19 to 70 years, who were normotensive according to WHO criteria. The duration of the diabetics ranged from 1.5 to 32 years. A control group of 17 age and sex-matched normal volunteers was also examined. Each subject underwent a 24 h non ambulatory BP recording, a 2-dimensional echocardiography and a pulsed doppler examination; furthermore, an index of autonomic nervous system dysfunction was established, as well as an index of microangiopathy. Twenty-four hour BP and HR mean levels appeared to be slightly higher in IDDM patients than in control group, but the difference was significant for night SBP and 24 h DBP only. No difference was found with regard to BP and HR absolute variabilities; the relative variability of night DBP was slightly lower in IDDM group (p less than 0.05). A loss of nocturnal decline in BP was noted in 2 control subjects and in 9 IDDM patients: 8 out of these IDDM patients had an autonomic dysfunction. An abnormal HR circadian pattern was seen in 1 control and in 2 IDDM subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

A comparative study of clinical and ambulatory responses to antihypertensive treatment was conducted retrospectively in 69 patients with mild to moderate arterial hypertension. The patients received different drugs, but blood pressure (BP) was measured by the same methods in each of them. (a) Clinical BP was measured with a mercury manometer some time after taking the last dose of antihypertensive drug: 24 hours in patients who took one daily dose, 12 hours in those who took two daily doses. (b) Ambulatory BP was measured with a Spacelabs SPM 5200 instrument over a minimum of 24 hours. The parameters compared were: (1) BP figures recorded. Correlation was very poor as regards both SBP (r = 0.42 before treatment, r = 0.55 after treatment) and DBP (r = 0.40 and r = 0.46 respectively). The mean BP value was lower in the ambulatory group than in the clinical group (-20/-12 mmHg), the difference being slightly less marked after treatment (-12/-6 mmHg). (2) Degree of absolute reduction of BP induced by treatment. Correlation was very poor between the two methods as regards both SBP (r = 0.46) and DBP (r = 0.49). (3) Proportion of responders and non-responders to treatment, the clinical response being defined as normalization and/or more than 10 p. 100 reduction of DBP, and the ambulatory response as a significant decrease of mean diastolic value over 24 hours. Among the 69 patients studied, there were 51 concordant cases (36 responders, 15 non-responders with the two methods) and 18 discordant cases (10 clinical responders but ambulatory non-responders, 8 clinical non-responders but ambulatory responders).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory measurement of the blood pressure may be considered as a reliable technique. Its validity is demonstrated by two types of factors: the first is physiological: the nycthemeral curves obtained with this method are similar to those provided by the first invasive studies, and especially show a definite nocturnal depression in most individuals; the second is epidemiological: the ambulatory blood pressure level is closely correlated with the left ventricular mass, measured on sonograms and has a good predictive value of future cardiovascular accidents. Its superiority over the standard measurement method, lies in the very principle of the method. It is an automatic measurement: the "white coat" artefact is therefore avoided. It is a repetitive and prolonged measurement, permitting therefore to analyze a complete nyctohemeral cycle instead of a single sample. Finally, it is an ambulatory measurement: the patients is therefore in his usual environment and not in the peculiar context of a medical office. However, the limitations of the method must be presented. The most important result from the interpretation of the collected data: the so-called aberrant values are identified from very arbitrary criteria and their elimination may be at the origin of errors; the currently available "norms" are only a indication and do not enable the physician to decide decisively between abstention and therapeutic intervention. An ambulatory blood pressure recording is particularly justified in the following two circumstances: 1) definite dissociation between elevated blood pressure at the consultation and moderate visceral repercussions; 2) hypertension resisting to an apparently well managed treatment that one hesitates to increase.

Twenty patients with mild, untreated arterial hypertension had ambulatory blood pressure recordings and a digitized echocardiographic study of the left ventricle with measurement of its mass (LVM) and of relaxation parameters. A significant correlation was found between LVM and ambulatory systolic pressure during daytime (r = 0.64; p less than 0.01; n = 20) and during 24 hours (r = 0.79; p less than 0.001; n = 16). One of the relaxation parameters studied, the time taken to reach maximal speed of left ventricular enlargement, was closely related to the diurnal diastolic blood pressure (r = 0.58; p less than 0.01; n = 20), whereas in this population with mild arterial blood pressure none of the parameters was related to the amount of increase of LVM. One may therefore consider the abnormalities of left ventricular relaxation as likely to appear at an early stage of arterial hypertension; their discovery may antedate that of LVM and confirm that the hypertensive disease is real. However, the methodological problems encountered with type of exploration ought to be stressed: left ventricular relaxation is a multifactorial phenomenon, and its echocardiographic approach is subject to many hazards.

Effects of Verapamil, 120 mg t.i.d. in twenty-one hypertensive patients were assessed at rest and during dynamic exercise. The selection criterion was a diastolic blood pressure (DBP) found, at least 3 times, between 95 and 115 mmHg, not responding to placebo therapy. After 30 days of treatment with Verapamil, the resting systolic blood pressure (SBP) and DBP respectively decreased from 151.8 to 137.5 mmHg (p less than 0.001) and from 103.2 to 89.8 mmHg (p less than 0.001). The blood pressure (BP) and heart rate (HR) responses to dynamic exercise were also significantly blunted and the BP profile on effort was normalized in about half of the cases. Finally, the automatic recording of BP by a non invasive device showed a fall in the mean blood pressure (MBP) from 100.6 to 90.8 mmHg (p less than 0.001). The best results were obtained in patients with lower pretreatment plasma renin activity index and higher DBP or MBP automatically measured. The degree of response was not significantly related to age nor to plasma homovanillic acid level, which, however, significantly rose in all patients following therapy. This increase in sympathetic tone suggests a vasodilatory effect of Verapamil. The tolerance was good in all patients but four, whose electrocardiogram showed some alteration of atrio-ventricular conduction.

Twenty-one patients with mild or moderate hypertension were randomised to receive either Atenolol 100 mg (N = 10) or Pindolol 15 mg (N = 11) in a once daily dosage over a two month period. The effects of these two betablockers on the blood pressure and plasma lipid profile were studied. Special attention was paid to the methodology: obese patients (30% over theoretical weight derived from the Lorenz formula) and those with pre-treatment triglyceride levels higher than 1.82 mmol/l were excluded because of the well documented biological instability of such patients. The selected patients were given placebo for two weeks. At the end of the placebo period those subjects whose body weight, total cholesterol, apolipoproteins or triglycerides had varied by more than 10%, 15% and 30% respectively, were also excluded from the study. At the end of the 60 days active treatment period, a comparable fall in the blood pressure was observed in both groups and there was no significant difference in the biological parameters as compared with pre-treatment values. In addition, the cardiovascular risk, evaluated by the B/A1 apolipoprotein ratio, increased in only one patient in the group receiving Atenolol and one patient receiving Pindolol.

The objectives of the study were to appraise the knowledge which the patients have about their hypertension, and to assess the knowledge and involvement of pharmacists in the management of the hypertensive patient. All the pharmacies in the Poitou-Charentes area were invited both to participate in a training session about arterial hypertension and asked to fill in a pharmacist's questionnaire. Furthermore, each participant was required to submit a patient's questionnaire to 20 consecutive hypertensives. A total of 104 pharmacies and 1015 hypertensive patients participated in the survey. In all, 88% of the patients (n=893) were aware of their blood pressure (BP) figures, but 68% (349/515) considered themselves wrongly, to be normalized; 39% (n=350) only had BP figures <140/90 mmHg. They said they had been poorly informed about recommended lifestyle changes. In all, 18% (n=185) were equipped with an automatic device. A total of 77% (n=779) were able to give the names of their drugs without the help of the pharmacist. Treatment-related unwanted effects were reported by 8% of the patients (n=79). Only 18% (n=29) of the pharmacists were able to provide a correct definition of hypertension. Most of them thought hypertension was well controlled in the general population and considered that both tolerance of and compliance with antihypertensive treatment were satisfactory. They could most often (80%, n=135) supply a SBPM device, but 58 (36%) only were able to provide relevant advice regarding the recommended procedures. In conclusion, The BP goals and the lifestyle modifications are poorly known by the hypertensives. Pharmacists' knowledge is frequently wrong and should be improved by appropriate training programmes.Journal of Human Hypertension (2005) 19, 577–584. doi:10.1038/sj.jhh.1001859 Published online 14 April 2005 [ABSTRACT FROM AUTHOR]

This multicentre study was aimed at comparing the trough effect of telmisartan and perindopril on diastolic blood pressure (DBP), using self blood pressure measurement (SBPM). A second objective was to compare the data obtained from SBPM with those provided by automatic office BP measurement. A total of 441 mild-to-moderate hypertensive patients were randomised to receive either telmisartan 40 mg or perindopril 4 mg for a period of 12 weeks. Patients whose clinic DBP remained higher than or equal to 90 mmHg at the end of the 6th week (W6) were given a double-dose regimen. Office BP and SBPM were performed at baseline (W0), at W6 and at week 12 (W12), both with the same automatic device. A greater diminution of trough DBP was obtained with telmisartan (-6.6 ± 6.7 mmHg) than with perindopril (-5.1 ± 7.0 mmHg; P = 0.018). Regarding clinic BP, the same results were observed. Doubling dose was significantly less frequent with telmisartan (41%; n = 85) than with perindopril (55%; n = 115, P = 0.005). Mean values of SBPM were lower than office BP values, with a difference of a greater importance at W0 than at W12: 6.6 vs 4.7 mmHg for systolic blood pressure (P < 0.005) and 3.2 vs 1.4 mmHg for DBP (P < 0.0001). At W12, isolated office hypertension was found in 9% of the patients (n = 37), while there were 14% of the patients (n = 55) with isolated home hypertension. In conclusion, the trough effect on DBP was statistically higher with telmisartan than with perindopril. SBPM values were lower than office BP values, with greater differences before than after treatment. About a quarter of the patients were found to be controlled with a method but not with the other one. [ABSTRACT FROM AUTHOR]