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The objective of the present study was to examine the association between albumin excretion rate (AER) and office and ambulatory blood pressures (BP), and other recognized cardiovascular risk factors in stage I hypertension. The study was carried out in 870 never-treated 18- to 45-year-old hypertensives (628 men, 242 women). Office and ambulatory BP, 24-h urinary collection for AER assessment, and echocardiographic left ventricular mass (n = 587) were obtained. AER was similar in men and women (12.3 v 12.5 mg/24 h) and was unrelated to age and body mass index. In 85.2% of the subjects, AER was < 16 mg/24 h, in 8.3% it was between 16 and 29 mg/24 h (borderline microalbuminuria), and in 6.1% it was >or= 30 mg/24 h (overt microalbuminuria). Office systolic BP was not different in the three groups, whereas 24-h systolic BP was higher in the subjects with microalbuminuria than in those with normal AER (P < .0001) and was similar in the two microalbuminuric groups. Office and 24-h diastolic BPs were higher in the subjects with overt microalbuminuria than in those with normal AER. Left ventricular mass was correlated to systolic (P < .0001) and diastolic (P = .01) 24-h BP, but was unrelated to AER. Family history for hypertension, smoking, coffee and alcohol intake, and physical activity habits did not influence AER. In a logistic regression analysis, 24-h systolic BP emerged as the only determinant of microalbuminuria (P < .0001). In conclusion, these results indicate that borderline levels of microalbuminuria may also be clinically relevant in stage I hypertension. Overweight and lifestyle factors do not appear to influence AER in these patients. Finally, the lack of correlation between AER and left ventricular mass suggests that renal and cardiac involvement do not occur in a parallel fashion in the initial phase of hypertension.

1. The aim of the present study was to evaluate whether postural blood pressure (BP) change could predict office-day-time BP disparity and the nocturnal BP fall in young, mild essential hypertensives. We investigated 411 males aged between 18 and 45 years with never treated borderline to mild hypertension. BP was measured three times after a 5 min rest in the supine position and thereafter three times after 2 min of standing. The mean of six BP measurements obtained during two visits in the lying position was defined as office BP. 2. Twenty-four hour ambulatory BP monitoring was performed with either the A&D TM-2420 model 7 or the ICR Spacelabs 90207. BP values were averaged for day- and night-time periods. The nocturnal BP fall was defined as the difference between the average day- and night-time BP. 3. The standing-lying difference was significantly inversely correlated with the office-daytime difference for both systolic blood pressure (SBP) (r = -0.34, P < 0.001) and diastolic blood pressure (DBP) (r = -0.24, P < 0.001). These correlations did not change when the obese subjects (body mass index > 30 kg/m2) were excluded from the analysis. No significant correlation between standing-lying difference and nocturnal BP fall was found. 4. Our results indicate that white coat hypertension assessed as the office-daytime BP disparity is partially related (in a negative fashion) to the BP reaction to standing. The postural BP change does not predict nocturnal BP fall in young, mild essential hypertensives.

In the present paper the problem of the normalcy limits of whole-day ambulatory blood pressure has been faced by evaluating the difference between casual and ambulatory blood pressure in a population of 522 subjects with blood pressure values covering the whole blood pressure range. On the basis of the casual blood pressure levels, 60 subjects were normotensives, 110 borderline hypertensives, 214 mild, 103 moderate and 35 severe hypertensives. The differences between casual and median 24-hour blood pressure averaged 18.4/9.6 mmHg. The difference between casual and median day-time was 14.2/6.7 mmHg. This difference was independent from the ambulatory blood pressure values and unrelated to the sex or age of subjects. The upper normal limits of ambulatory blood pressure were established by subtracting the above differences from the normal limits established by the WHO for casual blood pressure (140/90 mmHg). For 24-hour blood pressure the upper limits were 121.6/80.4 mmHg and for day-time blood pressure these were 125.8/83.3 mmHg. Contrary to previous studies conducted on normotensive populations with this approach the selection of patients based on casual blood pressure is avoided and the WHO normalcy limits are taken into account.

Purpose of the study was to investigate whether and to what extent blood pressure variability and average night-time blood pressure are related to cardiovascular complications in hypertension. To this aim 60 normotensive and 462 hypertensive subjects were studied by means of non-invasive 24 hour blood pressure monitoring, using either the Avionics, or the ICR Spacelabs, or the Takeda system. Each subject was attributed a target organ damage score on the basis of 12-lead electrocardiogram, chest X-ray and fundoscopy, starting from 0 (no damage) up to 5 (maximum degree of damage). The 522 subjects were subsequently subdivided into 5 classes of increasing average daytime diastolic blood pressure. In each class a higher degree of cardiovascular complications was present in the subjects with the higher blood pressure variability and the higher average night-time blood pressure. From these results it may be inferred that both blood pressure variability and night-time blood pressure are related to the degree of target organ damage in hypertension. This stresses the importance of recording blood pressure throughout the 24 hours.

To answer the question often asked by hypertensive patients whether it is advisable for them to spend a holiday in the mountains for fear of a rise in blood pressure, 12 untreated mild hypertensive and 12 normotensive subjects underwent 24-hour non-invasive blood pressure monitoring, plasma catecholamines assay (HPLC) and plasma renin activity determination at home (sea level) and in a mountain resort (1210 m). The 2 evaluations (at home and in the mountains) were performed in a cross-over fashion. The ICR Spacelabs Pressuromaster and the Del Mar Avionics Pressurometer IV were used: blood pressure was measured every 8 minutes during daytime and every 15 minutes during sleep. Blood pressure was also recorded during a 1.5 to 3 hour excursion by cable-car to a height of 3006 m. Average 24-hour blood pressure at sea level was 134/86.7 mmHg in the hypertensive subjects and 115.8/73.6 mmHg in the normotensive ones. At 1210 m, it rose to 140.6/90.2 mmHg (n.s.) and to 120.8/74.9 mmHg (n.s.) respectively. Twenty-four-hour profiles showed that the blood pressure difference was present only during waking hours, while during sleep blood pressure levels were similar at sea level and in the mountains.(ABSTRACT TRUNCATED AT 250 WORDS)