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The aim of the present study was to evaluate the effects of 12 weeks of muscle power training (MPT) on casual blood pressure (BP) (before and after each training session) and resting BP (pre- and post-training program) in type 2 diabetes mellitus (T2DM) elderly. Methods: Twelve T2DM elderly individuals (68.75 ± 7.83 years), non-insulin-dependents participated in the present study and performed the MPT program twice a week. Casual BP was measured before and after training sessions, and resting BP was measured 48 h before the first and 48 h after the last training session. Results: Significant decrease in casual systolic (SBP) (−7.08 ± 4.12 mm Hg [effect size [ES]: −1.42 to −0.11]; p < 0.01) and diastolic (DBP) BP (−3.14 ± 1.24 mm Hg [ES: −1.24 to −0.18]; p > 0.01) was found after training sessions, without significant effect (p > 0.05) of the week along time or casual BP × week interaction. No significant change in resting SBP (−5.08 ± 8.93 mm Hg [ES: −0.41]; p = 0.07) and DBP (0.47 ± 6.06 mm Hg [ES: +0.11]; p = 0.79) was found. Conclusion: MPT was able to reduce casual BP after training sessions. However, there was no significant reduction in resting BP after MPT. Nevertheless, although not statistically significant, there were important clinical reductions in resting SBP in T2DM elderly patients.

Oh dear. Another article from academic medicine[1][1] telling us how badly we are doing. Are the authors really telling us that an asymptomatic woman in her late 80s with a casual blood pressure of 160/60 mm Hg has to reduce her systolic blood pressure to 140 mm Hg? Why is there no mention of

Background Hypertension (HT) is a common and serious complication following renal transplantation in children, and an important risk factor for cardiovascular morbidity and mortality. This study evaluated the clinical characteristics of HT in children after renal transplantation. Methods Twenty-four children who were followed up at least 6 months after renal transplantation were enrolled in the study. From the clinical records, demographic and laboratory data, casual blood pressure (BP) measurement, ambulatory BP monitoring (ABPM), medication, and left ventricular mass index (LVMI) at echocardiogram were documented. Results Mean age at time of transplantation was 12.6 ± 3.0 years and mean follow-up period was 19.6 ± 15.8 months. HT was detected in 21 children (87.5%) after renal transplantation. Twelve patients (50%) had HT both before and after transplantation and nine (38%) had HT only after transplantation. HT developed in 67% within the first week and in 95% within the first month. All hypertensive children had night-time HT and no child had isolated daytime HT. The efficacy of HT control was 42%. Median LVMI in patients with HT after renal transplantation was 42.3 g/m(2.7). Conclusions Severe HT, an important complication, was frequently seen in the early period after renal transplantation. Predominance of nocturnal HT and the lack of isolated daytime HT after transplantation underline the importance of ABPM. ABPM should be performed regularly in the first year after transplantation, not only for diagnosis but also for evaluation of HT control.

Ambulatory blood pressure measurement (ABPM) gives better prediction of cardiovascular morbidity and mortality, and endorgan damage associated with hypertension (HTN) than clinic or casual blood pressure measurements, since the diurnal blood pressure profile and nocturnal blood pressure levels are not ascertained by the later. 1 Although the technology has been available for more than three decades, its role in the evaluation and management of hypertension has been well established only in the past decade. Ambulatory blood pressure measurement is indicated to identify ‘white coat’ effect/hypertension, masked hypertension, to evaluate drug-resistant hypertension, and to assess adequacy of control in patients at high-risk of cardiovascular disease. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure and prevention of cardiovascular events. This review summarizes the utility of ambulatory blood pressure monitoring in the manage ment of hypertension and its practical importance.

Background: In practice there is no definite clinical value of grading by casual blood pressure(CBP) and it is need to put forward new Suggestions. Methods: According to the method of three grades by CBP, blood pressure of 270 hypertensives without treatment were graded by three patterns: 4 times of CBP per day(pattern A), 2 times of CBP that not on the same day(pattern B) and 4 times from randomized daily ambulatory blood pressure(pattern C), and then repeatability were compared. Results: (1), In pattern A: BP gradings on the same level in total of 4 times of CBP were 18.50% (50/270 cases), BP gradings between two levels were 38.20% (103/270 cases), BP gradings between three levels were 43.30% (117/270 cases), total of BP gradings between two to three levels were 81.50% (220/270 cases); (2), In pattern B: BP gradings were respectively 25.19% (68/270 cases), 41.48% (112/270 cases), 33.33% (90/270 cases), 74.81% (202/270 cases); (3), In pattern C: BP gradings were respectively 23.70% (64/270 cases), 38.89% (105/270 cases), 37.41% (101/270 cases), 76.30% (206/270 cases). Conclusion: The repeatability of blood pressure gradings judgment are very poor all of above three patterns, and were no clinical value. New recommendations are: (1) It is necessary to classified into stages by target organ damage in hypertensives without ABPM, and not necessary to do grading of CBP; The stages include the phase of pure high blood pressure, the phase of high blood pressure with compensatory target organ damage, the phase of high blood pressure with decompensated target-organ damage; (2) It is necessary not only to classified into stages by target organ damage in hypertensives with ABPM but also necessary to do grading by average ambulatory blood pressure in daytime and nighttime respectively. Key words: hypertension; casual blood pressure; Ambulatory blood pressure; grading; Stage; proposals.

Background: Despite of the recommendations to use population specific blood pressure (BP) references which consider time, ethnicity and environmental factors, there is limited information regarding BP profile among Tanzanians. This cross sectional study was done to determine casual BP profile among healthy volunteer students of the Catholic University of Health and Allied Sciences in Mwanza, Tanzania. Methods: Socio-demographic and lifestyle data were collected using questionnaires. Systolic BP (SBP) and diastolic BP (DBP) were measured using aneroid sphygmomanometer. Results: A total of 299 students (males=204; females=95) were involved in the study. Their mean age was 23.4 ± 0.2 years. SBP ranged from 82-150mmHg (mean= 115.7 ± 0.7mmHg) and DBP ranged from 44–100mmHg (mean= 71.9±0.6mmHg). Mean arterial pressure (MAP) was 86.5±0.5mmHg. Males had significantly higher BP than females; and BP was noticed to increase with increased age and body weight. Upper limits of the normal SBP and DBP calculated as mean + 2SDs and 95 th percentiles were 140.5mmHg and 138mmHg, respectively and for DBP were 91.8 mmHg and 90 mmHg, respectively. Conclusion : The observed upper limits of the distribution of normal BP for the age of the participants are higher than the World Health Organization recommended values. We recommend a larger study to determine BP among healthy Tanzanians to establish the normal values.

Generally, the evaluation of the blood pressure response to resistance exercise has been limited to the evaluation of discontinuous casual blood pressure monitoring, often measured at the end of the exercise.To continuously evaluate the blood pressure response at different intensities of leg press exercise with the same duration and number of repetitions.Seven normotensive healthy men performed an incremental test on the leg press machine at relative intensities of one repetition maximum (1RM). The blood pressure and heart rate were measured simultaneously to the incremental exercise by a photoplethysmographic method.The mean ± SD peak values of the heart rate, diastolic blood pressure (DBP) and systolic blood pressure (SBP) were obtained on 70% of 1RM and were 145 ± 20 bpm, 113.1 ± 15.4 mmHg, and 192.4 ± 20.0 mmHg, respectively. The SBP was characterized by a decrease followed by an increase during the sets of exercise. The decrease in the SBP was 12-22 mmHg and took approximately 25 seconds to reach the minimum value before the increase. It was observed for all participants in most of the intensities. The rate of increase in the SBP was not statistically different between the intensities.Both duration and intensity of exercise have an impact on the blood pressure response. Above 30% of 1RM, the SBP decreases in approximately 20 seconds and starts to increase until the end of the set of leg press exercise.

The GDR-MONICA project comprises 25 administratively defined areas with a population of nearly two million people aged 25–64. Data from the first random sample survey are reported here. The survey gathered information regarding risk factors, dietary behaviour, physical activity and psychosocial factors from 11,281 persons aged 25–64. The average risk factor levels were high in the population: The mean casual blood pressure was 140/88 mmHg and 138/86 mmHg for men and women respectively. In both sexes the mean total cholesterol level exceeded 6.1 mmol/L, and the mean body mass index (BMI) was just over 26.0. The study population consumed, on average, excessive amounts of energy, fat, alcohol, and sodium, and too few carbohydrates. Preliminary conclusions regarding unfavourable trends in risk factor levels have been drawn by comparing the present data with other recent reliable epidemiological studies.

Malignant hypertension seems to be the consequence of very high blood pressure. Furthermore, an increase in sympathetic andrenin-angiotensin system activity is considered to be the main mechanisms producing malignant hypertension. In the presentstudy, 10 offspring of malignant hypertensive (OMH) parents (age 28 ± 5 years, 7 males, 3 females, 2 white and 8 non-white) and10 offspring of normotensive (ONT) parents (age 28 ± 6 years, 2 males, 8 females, 3 white and 7 non-white) were evaluated. TheOMH group had significantly higher (P < 0.05) casual blood pressure (125 ± 10/81 ± 5 mmHg) compared with ONT (99 ± 13/67± 5 mmHg). The increase in blood pressure was greater in OMH (∆ SBP = 17 ± 2 vs ∆ SBP = 9 ± 1 mmHg in ONT) during coldpressor testing, but they had a lower increase in heart rate ( ∆ HR = 13 ± 2 vs ∆ HR = 20 ± 3 bpm in ONT) during isometric exercise(handgrip test). Sympathetic activity, measured by microneurography, was significantly higher (P < 0.05) before exercise inOMH (17 ± 6 vs 11 ± 4 burst/min in ONT) and exhibited a greater increase (∆ = 18 ± 10 vs ∆ = 8 ± 3 burst/min in ONT) duringisometric exercise. This study showed increased sympathetic activity in OMH before exercise and a greater response duringisometric exercise, suggesting an autonomic abnormality before exercise and a greater sympathetic response to physical stressin OMH compared to ONT.Key words: Malignant hypertension; Offspring of malignant hypertensive parents; Sympathetic activity; MicroneurographyPublication supported by FAPESP.Received September 17, 2007. Accepted August 19, 2008

BACKGROUND The objective of the Snapshot Hypertension Registry (SHR) was to assess the quality of antihypertensive drug treatment in hypertensive patients seen by cardiologists on three consecutive days in December 2005. METHODS Full data sets were obtained for 7302 patients (89.9% of total returned) seen by 268 cardiologists. Mean age of hypertensive patients was 65.4 +/- 11.2 years, 62 % were male, and 93 % were referred to the cardiologist by a general practitioner. RESULTS Judging from their casual ("snapshot") blood pressure, 35.3 % were well treated (< 140/90 mm Hg). According to the 24-hour ambulatory blood pressure even a lower rate of hypertensive patients, namely 27.6 %, had their blood pressure well controlled (< 130/80 mm Hg). Of all patients, 24 % were on monotherapy. Only 33.7 % of the patients on monotherapy were normotensive. Of all patients on a combination of drugs 36.9 % were normotensive according to the casual blood pressure measurements. Private patients were prescribed angiotensin receptor blockers more frequently than patients who only had statutory health insurance. CONCLUSIONS The Snapshot Registry analysis revealed that the casual blood pressure in the majority of hypertensive patients who were reviewing antihypertensive medication was not in the normotensive range. In addition, our data demonstrate that evidence-based antihypertensive medication was often not adequately used in Germany.

Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review. Resumo Nas últimas cinco décadas muito têm sido questionadas as medidas casuais da pressão arterial (PA). Significativa porcentagem de pacientes apresenta PA muito diversa quando examinados na clínica ou fora dela. Por isso, é hoje observada uma mudança de paradigma com relação ao melhor modo de se avaliar a PA. O método que mais se consolidou é a Monitorização Ambulatorial da Pressão Arterial - MAPA. É possível obter-se o registro de medidas de PA durante 24 horas avaliando-se vários parâmetros como: médias de PA, cargas de pressão, áreas sob as curvas, variações entre vigília e sono, variabilidade de pressão de pulso etc. As medidas de PA obtidas pela MAPA são mais bem correlacionadas, por exemplo, com os riscos da hipertensão arterial. As principais indicações para a MAPA são: suspeita de hipertensão do avental branco e da hipertensão mascarada, avaliação da eficácia terapêutica nas 24 horas e avaliação de sintomas. Crescem as evidências de que o emprego da MAPA contribui para avaliar os comportamentos da PA, estabelecer diagnósticos, prognóstico e avaliar a eficácia terapêutica anti-hipertensiva. Sem dúvidas, o estudo do comportamento da PA e suas variações durante as 24 horas pela MAPA nos deixaram com menos sombras e mais luzes, e justifica o título desta revisão.

Introduction Although evidence exists that adolescents’ hypertension could lead to adults’ hypertension, it is a general belief that measures for early detection and treatment of this condition is seldom undertaken especially in medically underserved communities such as Maiduguri, Northeastern Nigeria. This study investigated the prevalence of undiagnosed hypertension among adolescents in Maiduguri, Nigeria, and explored the association between undiagnosed hypertension and adolescents’ physical characteristics and parental socio-demographic factors. Methods Participants’ physical characteristics were assessed, and information on their socio-demographics including parental socioeconomic status were obtained. Blood pressures and heart rates of the participants were also measured three times at 5–10-min period. Results The prevalence of undiagnosed hypertension among the students was 13.2 %, and overwhelming majority (82.4 %) of the hypertensive students were in the prehypertensive stage, while 17.6 % were in the stage 1 classification of hypertension. Higher prevalence of undiagnosed hypertension was observed for the females compared to the male adolescents (X2 = 15.49, p = 0.001), and presence of undiagnosed hypertension is positively but tenuously linked to age (r = 0.11, p = 0.01), body mass index (r = 0.10, p = 0.01), and parental income (r = 0.26, p = 0.02) of the students. Discussion This study suggests that any effective programs designed to mitigate undiagnosed hypertension among adolescents in this city should include strategies that address possible barriers to physical activity and exercise among female adolescents in the society.

To assess home blood pressure status in a Japanese urban population, we analyzed home blood pressure values in normotensive subjects determined by casual blood pressure (140/90 mmHg), hypertensive subjects without medication (or = 140/90 mmHg) and treated hypertensive patients. The subjects (468 male, 232 female; mean age 41 years old) were recruited from a company located in Tokyo. Home blood pressure was measured with a semi-automatic device (Omron HEM-759P). Subjects were instructed to perform triplicate morning and evening measurements on 7 consecutive days. In the treated hypertensive group (n = 70), there was a significant difference between morning (139 +/- 12/88 +/- 9 mmHg) and evening (130 +/- 12/79 +/- 8 mmHg) home blood pressure. In the normotensive group (n = 558), however, only the diastolic blood pressure (DBP) component of the home blood pressure was significantly different between morning (115 +/- 13/72 +/- 9 mmHg) and evening (114 +/- 12/68 +/- 8 mmHg). In the nontreated hypertensive group (n = 72), casual blood pressure (145 +/- 14/92 +/- 9 mmHg) was higher than morning (138 +/- 16/89 +/- 11 mmHg) and evening (134 +/- 16/83 +/- 11 mmHg) home blood pressure, but no difference was seen between morning and evening systolic blood pressure (SBP). According to the reference value of the Japanese Society of Hypertension 2004 (SBPor = 135 mmHg and/or DBPor = 85 mmHg), 7.2% (systolic) and 8.7% (diastolic) of subjects in the normotensive group were classified as hypertensive by home blood pressure. Casual blood pressure in the treated hypertensive group was normal in 64.3% for SBP and 70.0% for DBP. However, their morning SBP (32.9%), morning DBP (40.0%), evening SBP (10.0%), and evening DBP (17.1%) were classified as hypertensive by home blood pressure. Furthermore, patients who were taking antihypertensive drug(s) only in the morning (n = 52) showed higher morning SBP (6 mmHg, p = 0.086) and morning DBP (6 mmHg, p = 0.005) than patients taking drug(s) by other administration schedules (n = 18), but no difference in evening home blood pressure was observed. In conclusion, a proportion of the subjects defined as normotensive by casual blood pressure were classified as hypertensive by home blood pressure in the present urban population. Furthermore, morning home blood pressure control in the treated hypertensive group classified as under control by casual blood pressure was insufficient, especially in patients who were taking medication only in the morning.

Background This study assessed 5-year changes in ambulatory blood pressure (ABP) in healthy, older individuals and determined the extent to which it could be predicted from earlier BP measures and other cardiovascular risk factors. Methods A total of 162 men and women, aged 55 to 79 years, with no prior medical disorders, completed a medical examination and two 24-h ABP sessions. The procedures were repeated 5 years later in 80% (130) of these subjects. A modified hierarchical regression analysis was used to determine whether initial ABP and casual blood pressure (CBP) measures and demographic and physical examination data could predict ABP in 5 years. Results The CBP and most ABP levels during waking and sleep increased after 5 years. However, CBP remained in the normotensive range for 73% of the subjects. The ABP variability tended to decrease over time. The ABP and CBP measures accounted for at least 50% of the variance in the prediction of ABP level after 5 years. In comparison, the predictability of ABP variability was quite low, particularly during sleep ( Conclusions The ABP and CBP were good predictors of future ABP level in healthy older subjects, but ABP variability was more difficult to predict. Except for age, none of the standard cardiovascular risk factors contributed significantly to the prediction of ABP level or variability.

INTRODUCTION The aim of this study was to compare the 24-h ambulatory blood pressure (ABP) profile in never-treated black hypertensive patients living in Africa, Mozambique (20-80 years), versus never-treated white hypertensive patients living in Europe. PATIENTS AND METHODS ABP recordings of untreated black hypertensive patients and white hypertensive patients with 24-h ABP of 130/80 mmHg or more were retrospectively selected from two computerized database records of ABP and matched for age by decades, sex, and BMI. RESULTS Black hypertensive patients were n=548, 47 ± 12 years, 52% women, BMI=28.0 ± 8.2 kg/m(2), 7% smokers, 7% diabetics; white hypertensive patients were n=604, 47 ± 15 years, 52% women, BMI=27.4 ± 5.1 kg/m(2), 8.4% diabetics, and 18% smokers (P

OBJECTIVE Tracking of blood pressure begins in childhood but the relationship between casual blood pressure in childhood and adult levels is not strong enough to predict adult hypertension. The variability of blood pressure in children might suggest that 24 recordings would have less consistency than casual readings when repeated even a relatively short time later. This study compares the short-term tracking ability of casual versus 24-h blood pressure. DESIGN An ambulatory blood pressure device was placed on 50 teenagers. Readings were taken at rest and the device was then worn for approximately 24 h, which included the schoolday. The protocol was repeated 1 year later. RESULTS The correlation coefficient for systolic readings taken 1 year later were: 0.4 for casual, 0.6 for school, 0.6 for home, 0.5 for night-time and 0.8 for 24-h mean systolic blood pressures. When divided into upper and lower tertiles of systolic blood pressure the relationship between tertile ranking 1 year later was stronger for 24-h blood pressure than the casual readings. Casual diastolic pressure was more consistent than the 24-h mean diastolic measurement. CONCLUSIONS In adolescents, in whom tracking of casual blood pressure has been shown to be poor, 24-h mean systolic blood pressure tracks better than any other time period and significantly better than the casual systolic readings. This study needs to be extended and the ability of 24-h blood pressure to track from childhood to adult life investigated.

Background: White-coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee-VI (JNC-VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time. Hypothesis: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC-VI classification, and the prevalence of white-coat hypertension diagnosed by using JNC-VI normal ABP criteria. Methods: Ambulatory blood pressure was monitored noninvasively in 232 patients with essential hypertension whose casual BP was ≥ 140/90 mmHg. The patients were classified according to JNC-VI classification, and their casual BP was compared with ABP. The criterion of white-coat hypertension was defined as casual BP ≥ 140/90 mmHg with normal ABP according to JNC-VI criteria (< 135/85 during daytime and < 120/75 during nighttime). Results: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased. There were considerable overlaps in the distribution of ABP among stages. The prevalence of white-coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1,10% in stage 2, and 4% in stage 3. Conclusions: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC-VI is very useful for the evaluation of hypertension to differentiate white-coat hypertension from true hypertension.

The relation between blood pressure (BP) and two aspects of social support, perceived satisfaction and structural social support network characteristics, were examined in adults classified as having normal BP or borderline hypertension. Causal BPs were taken by a trained technician on 3 separate visits, each approximately 1 week apart. Participants were categorized as borderline hypertensive if screening systolic blood pressure (SBP) fell in the range 130-160 mmHG and/or diastolic blood pressure (DBP) fell in the range 85-100 mmHg; BPs below these ranges were considered normotensive. Participants underwent ambulatory BP monitoring. Individuals classified as normotensive reported significantly greater support satisfaction than individuals with borderline hypertension. Social network characteristics were not associated with BP. During 24 hr of ambulatory BP monitoring, high perceived support satisfaction was associated with lower SBP and DBP at work, home, and during sleep. These data suggest that perceived satisfaction with social support is associated with lower BP. The presence of social support also may reduce BP levels during daily life.

Ambulatory blood pressure monitoring (ABPM) is an important tool in the diagnosis and management of childhood hypertension. Normal ambulatory blood pressure (ABP) values in children with body heights between 100 and 120 cm have not been reported. The aim of the study was to establish the normal range of values for ABPM in these children. 24-hour ABPM was performed in 40 normotensive (auscultatory casual blood pressure was obtained before ABPM) subjects, aged from 4 to 6 years (26 males, 14 females) with body heights between 95 and 125 cm. ABPM was carried out on non-dominant arm using the oscillometric device (SpaceLab 90207) with appropriate cuff size. The monitor was programmed to measure BP every 15 min. during the day (6 a.m. to 10 p.m.) and every 30 min. during the night (10 p.m. to 6 a.m.). The mean daytime SBP/DBP in boys and girls was 108+/-6/67+/-5 and 105+/-5/66+/-1, respectively. The mean nighttime SBP/DBP in boys and girls was 98+/-6/56+/-5 and 97+/-7/56+/-4, respectively. There was a significant difference between day and night readings of SBP, DBP and heart rate (nocturnal fall was observed). The distribution of ABP noted in this study could serve as preliminary reference. A multicenter study should be performed to provide normal ranges of ABP.

The diagnosis of hypertension in children or adults is predicated on the accurate measurement of the blood pressure and the proper interpretation of that measurement. Outside of the hospital setting, blood pressure is measured noninvasively, that is, not using indwelling arterial lines. The generally agreed-upon term for noninvasive BP measurement outside of a strict study setting and while the patient is at rest is the “casual blood pressure.” This chapter will review currently available methods of casual BP measurement and identify the advantages, disadvantages, and pitfalls of these methods.

Casual blood pressure measurement has provided the basis for the present knowledge of the potential risk associated with hypertension and has guided patient management for many years. The possibility of carrying out repeated ambulatory blood pressure measurements using automatic or semiautomatic devices allows for the gathering of more representative values of blood pressure and for observing the behavior of blood pressure during both moments of activity as well as rest. Ambulatory blood pressure measurement is now increasingly recognized as being indispensable to the diagnosis and management of hypertension, and it has contributed significantly to our understanding of hypertension. Likewise, the better relationship of ambulatory blood pressure measurements with the presence of organ damage and the prognosis to develop it have provided additional support to ambulatory blood pressure as a clinical valuable tool in the research, evaluation, and management of high blood pressure in children and adolescents.

Abstract Apparently healthy men (n=1999, 40 to 59 years old) were investigated from 1972 through 1975 to determine whether systolic blood pressure during bicycle ergometer exercise predicts morbidity and mortality from myocardial infarction beyond that of casual blood pressure taken after 5 minutes of supine rest. During a follow-up of 31 984 patient-years (average, 16 years), 235 subjects had myocardial infarctions, of which 143 were nonfatal and 92 were fatal. Exercise blood pressure was more strongly related than casual blood pressure to both morbidity and mortality from myocardial infarction. Among 520 men with casual systolic blood pressure ≥140 mm Hg, 304 increased their systolic blood pressure to ≥200 mm Hg during 6 minutes of exercise at an initial workload of 600 kpm/min. These 304 men had an excessive risk of myocardial infarction (18.8% versus 9.5% among the 1294 men with casual blood pressure P P =.0011), including those with casual blood pressure ≥140 mm Hg and exercise blood pressure

We investigated the long-term reproducibility of noninvasive 24-hour ambulatory blood pressure monitoring (ABPM) compared with casual blood pressure measurements in 54 individuals (47 +/- 11 years) with borderline hypertension. ABPM and casual blood pressure measurements were obtained 3 times over 2 year period. ABPM data were analyzed to determine the average 24-hour blood pressure (24-BP), the average blood pressure during the waking hours (Day-BP), and the average blood pressure from the time the subject went to bed until he awoke (Night-BP). ABPM measurements were similar for Year 1, 2, and 3 (24-BP: Year 1; 130 +/- 10/79 +/- 6 mmHg; Year 2; 130 +/- 10/79 +/- 7 mmHg; and Year 3; 130 +/- 10/78 +/- 7 mmHg). Bland-Altman analysis and standard deviation of the difference also indicated the reproducibility of 24-BP was better than casual pressure. The 24-BP was significantly correlated with both Day-BP and Night-BP for each year. Day-BP showed the stronger correlation. Our results suggest that Day-BP provides reproducible estimation in subjects with borderline hypertension.

Some epidemiologic and experimental studies have raised the possibility that pulse pressure may be a determinant of vascular structure. In addition, 24-h blood pressure variability has been reported to be more closely related to the severity of target-organ damage than to casual blood pressure in hypertensive patients. These data suggest that when the effects of mechanical stress on the arterial wall are evaluated, it is necessary not only to take into account steady (i.e., mean) parameters but also to consider pulsatile parameters and the variability of steady and pulsatile parameters. Pharmacologic data suggest that reduction of pulse pressure during antihypertensive treatment may be a factor in prevention of altered vascular structure during chronic hypertension. Improving arterial compliance by specific antihypertensive treatment is a way to reduce pulse pressure and therefore to contribute to this prevention. Whether normalization of blood pressure variability by antihypertensive treatment is also a means of preventing altered vascular structure remains to be determined.

Emerging data suggest that essential or primary hypertension occurs in the young. Parental socioeconomic status may play a role but the exact mechanisms still remain unclear.This study was aimed at determining the relationship between parental socioeconomic status and casual blood pressure in adolescents.One thousand and eight adolescents attending two secondary schools in Calabar, Nigeria were selected by stratified random sampling. Their blood pressure, weights and heights were taken using standard methods and sociodemographic data were obtained using a pretested semistructured questionnaire.Blood pressure was increased with age with males having higher values. The other major determinants of blood pressure were weight, height, body mass index, level of physical activity and parental socioeconomic status (p0.05). No relationship was established between these determinants as well as dietary habits with parental socioeconomic status (p0.05). Female adolescents with parents in the lower socioeconomic classes had significantly higher systolic and diastolic blood pressure (p0.05). In contrast, parental socioeconomic status showed no significant relationship with systolic blood pressure and diastolic blood pressure in males (p0.05).The prevalence of elevated blood pressure was higher in females than in males.Low parental socioeconomic status appear to be associated with higher casual blood pressure especially in female coastal Nigerian adolescents. Traditional determinants did not appear to play a significant role. Psychological stress arising from environmental and economic stressors may be responsible.

The concept of measuring blood pressure (BP) has significantly evolved over the past two centuries, overcoming the challenge posed by the well-established, but clearly subjective, art of palpation of the pulse for ‘measures’ other than simply determining heart rate. In the United States, the BP cuff was introduced by Cushing in Baltimore in 1901 and in Boston in 1903 (1,2) when he returned from a trip to Italy with a version of a Riva-Rocci mercury sphygmomanometer. Recognizing the obstacles to be overcome, Cushing noted, “The belief is more or less prevalent that the powers of observation so markedly developed in our predecessors have, to a large extent, become blunted in us, owing to the employment of instrumental aids to exactness, and the art of medicine consequently has always adopted them with considerable reluctance” (2).

For many decades, the casual blood pressure (BP) has been the standard for assessing BP response to antihypertensive agents in clinical trials. Noninvasive ambulatory BP technology has improved vastly in the last 15 years and has been increasingly used in dose-response studies as well as efficacy trials. Through these studies we have learned that casual BP may not be representative of the average daily blood pressure, that it may be quite susceptible to observer bias, and that it may result in inaccurate calculation of the trough-to-peak ratio of an antihypertensive drug. Perhaps more importantly is that a large body of data now supports the superiority of average daily BP over that of the casual or clinic BP in predicting several indexes of hypertensive target organ damage. Thus, use of the ambulatory BP technique in antihypertensive trials yields BP data that are far less susceptible to improper diagnosis and are representative of the hypertensive burden that causes vascular disease.

An elevated casual blood pressure (BP) in children and a positive family history for hypertension are risk indicators for adult hypertension. The risk of future hypertension is higher when BP levels in children or their parents are higher. Using multiple BP readings in children and their parents, groups of children can be discriminated with contrasting risks as a basis for studying the early phase of primary hypertension. Yet, as a means of detecting groups of children eligible for intervention, family history and BP level lack sensitivity for adequate selection. Before screening for future hypertension may be initiated successfully in prepubertal children, more should be known about the determinants and etiology of future BP rise.

Many decisions in pregnancy are based on one or two casual blood pressure estimations made in the antenatal clinic. No previous study has challenged the validity of this practice or attempted to discover whether there are significant differences between the blood pressures of pregnant women when they are measured in the clinic and when they are measured in their home environment. We measured the blood pressures of 35 healthy pregnant women both at the antenatal clinic and in their own homes. All the women were at between 28 and 32 weeks gestation. At both locations, ten consecutive blood pressure and pulse measurements were made at one minute intervals using a Dinamap 1846P automated blood pressure monitor. The readings taken in the clinic were supervised, whilst at home the patients used our blood pressure telemetry system without direct supervision, the results being transmitted automatically to the hospital computer via the public telephone network. The Dinamap results were analysed in detail. Each ten minute recording session was summarised in terms of the first, last, highest, lowest and mean of the systolic, diastolic and mean arterial blood pressure, and pulse measurements in that session. Also, two measures of the variability within a ten measurement series were considered, the average change in pressure or pulse from one reading to the next, and the difference between the highest and lowest readings of pressure and pulse in the series. All descriptors of the clinic and the home measurements were compared using the paired Student's t-test. Clinic and home blood pressure measurements were not significantly different from each other in any respect.(ABSTRACT TRUNCATED AT 250 WORDS)

Knowledge of daily blood pressure profiles is now an important factor in the management of hypertension. We recently analyzed the relationship of casual blood pressure (CBP) to 24-hour blood pressure (24-h BP) in 9 hypertensive patients and 11 normotensive subjects. A 24-hour ambulatory blood pressure monitoring apparatus (24-h ABPM, A & D Co.) was used to monitor 24-h BP. Data were divided into daytime mean blood pressure (daytime mBP), night mean blood pressure (night mBP), and 24-hour mean blood pressure (24-h mBP). In each subject, the 24-h ABP pattern was highly reproducible. Analysis of CBP disclosed that both the systolic blood pressure (SBP) and diastolic blood pressure (DBP) correlated more closely with 24-h mBP than with any other parameter. In view of the high incidence of cerebral infarction during night time or rest, prior knowledge of a blood pressure change pattern from daytime mBP to night mBP in individual patients is important in the prevention of this condition. The degree of decrease from daytime mBP to night mBP varied greatly among individuals, being higher in hypertensive patients than in normotensive subjects. The degree of this change in blood pressure was difficult to predict based on the CBP change pattern following postural change or 5-min rest. In some cases, 24-h ABPM data were within the hypertensive range (systolic > 160 mmHg, diastolic > 95 mmHg) for many hours, even though CBP was within the normal range. On the other hand, the duration of this sustained hypertensive level during 24-h ABPM was sometimes short, even in subjects with elevated CBP. To deal with such discrepancies between CBP and 24-h ABPM, the duration of the sustained hypertensive level during 24-h ABPM should be given high priority in assessing the severity and prognosis of hypertension.

In 1039 subjects ambulatory blood pressure monitoring was performed to define threshold values, which are equivalent to the established limits of the office blood pressure. Mean values and proportions of elevated single readings were correlated to office blood pressure by regression analyses. To avoid impact of varying sleeping periods on 24 h blood pressure, only daytime readings were considered. Correlations between average daytime blood pressure and office blood pressure were linear: Mean daytime values of 135 mmHg (systolic) and of 84 mmHg (diastolic) were equivalent to the casual blood pressure limits of 140 mmHg and 90 mmHg. Correlations between percentages of elevated single readings and office blood pressure were nonlinear: Proportions of 25% systolic readings greater than 140 mmHg and of 17% diastolic readings greater than 90 mmHg were equivalent to casual blood pressure limits of 140 mmHg and 90 mmHg. On the basis of the regression equations, any result of ambulatory blood pressure recording during daytime can now be evaluated in terms of the established standards of office blood pressure.

FUNDAMENTO: O desenvolvimento de hipertensão arterial sustentada é, pelo menos, duas vezes maior em indivíduos hiper-reatores ao esforço. Poucos trabalhos têm avaliado os parâmetros da monitorização ambulatorial da pressão arterial de 24 horas (MAPA) nesses indivíduos. OBJETIVO: Avaliar a relação da pressão arterial (PA) casual com a resposta hiper-reativa ao esforço (RHR) e comparar os padrões da monitorização ambulatorial de pressão arterial (MAPA) de indivíduos hiper-reatores ao esforço a um grupo controle, visando detectar alterações precoces que permitam uma atuação preventiva com implicação prognóstica. MÉTODOS: A PA casual e os dados da MAPA de 26 indivíduos adultos, com idade média de 41,50±11,78 anos, normotensos em repouso, hiper-reatores ao teste ergométrico (TE), foram comparados aos de 16 adultos, com média de idade de 41,38±11,55 anos, também normotensos em repouso, com resposta normal de PA ao esforço. Como normotensão foram considerados valores de PA 220mmHg e/ou incremento >15mmHg de pressão arterial diastólica (PAD) no TE, partindo-se de níveis de PA normais. RESULTADOS: A PAS (p=0,03) e PAD (p=0,002) casuais, a média da PAS (p=0,050) e as cargas pressóricas sistólicas na vigília (p=0,011) e nas 24 horas (p=0,017) à MAPA foram significativamente superiores nos hiper-reatores. CONCLUSÃO: A PA casual se correlacionou positivamente com a RHR. Os hiper-reatores apresentaram características peculiares na PA casual e MAPA, que, embora dentro da normalidade, se diferenciaram das observadas nos normorreatores. BACKGROUND: Developing hypertension is likely to be at least two times greater in individual with exaggerated blood pressure response on exercise testing (ET). Few reports have evaluated the parameters of 24-hour Ambulatory Blood Pressure Monitoring (ABPM) in normotensive individuals with exaggerated blood pressure response to exercise. OBJECTIVE: To evaluate the relationship among the casual blood pressure with hyper-reactive response on ET and to compare Ambulatory Blood Pressure Monitoring (ABPM) data of hyper-reactive individuals with a control group in order to detect early disorders, that allows a preventive action with prognostic implication. METHODS: Casual BP measurement and parameters of ABPM of 26 adult individuals, with mean age of 41.50±11.78 years, normotensive at rest and hyper-reactive on ET was compared to those of 16 adult individuals, with mean age of 41.38±11.55 years, normotensive at rest with normal BP response on exercise. The values 15mmHg diastolic BP on ET for hyper-reactive response diagnosis. RESULTS: Hyper-reactive individuals presented the systolic (p=0.03) and diastolic (p=0.002) casual BP and mean systolic BP (p=0.050), systolic pressure load during the day (p=0.011), and systolic (p=0.017) pressure load higher when compared to the control group. CONCLUSION: Casual high normal BP had a positive correlation with exaggerated BP response. The hyper-reactive individuals showed particular characteristics in casual BP as well as in ABPM parameters, which, although within the range of reference values, differed from those of individuals with normal response to exercise.

OBJETIVO: Avaliar o monitor OMRON 705-CP de medida de pressão arterial em adolescentes e adultos jovens. MÉTODOS: De acordo com o protocolo da British Hypertension Society e da Association for the Advancement of Medical Instrumentation, realizamos a validação do aparelho em 60 adolescentes. O monitor foi conectado em Y com a coluna de mercúrio e foram realizadas 4 medidas consecutivas e simultâneas, analisadas as independentes e calculadas as diferenças médias entre as pressões e o desvio padrão dessas diferenças. Os resultados foram analisados de acordo com o sistema de grau do protocolo utilizado. RESULTADOS: Foram avaliadas 240 medidas. A idade média dos pacientes foi 16,3 anos. Quando comparada a medida realizada pela coluna de mercúrio com o aparelho houve uma diferença < 15 mmHg em 97,9% das medidas sistólicas e 98,8% das diastólicas; uma diferença < 10 mmHg em 86,3% das medidas sistólicas e 90,4% das diastólicas, classificada como grau A; uma diferença < 5 mmHg em 59,1% das medidas sistólicas e 67% das medidas diastólicas, considerada pela classificação entre A/B. A diferença média e o desvio padrão dessa diferença na pressão sistólica foi de 2,91±6,42 mmHg e para a diastólica de 1,16±5,79 mmHg. CONCLUSÃO: O monitor OMRON 705-CP mostrou-se válido para medidas de pressão arterial de adolescentes segundo o protocolo empregado. OBJECTIVE: To assess the Omron 705-CP monitor for measuring blood pressure in adolescents and young adults. METHODS: According to the protocols of the British Hypertension Society and the Association for the Advancement of Medical Instrumentation, we performed validation of the device in 60 adolescents. The Omron monitor was connected in Y to a mercury column. Four consecutive and simultaneous measurements were taken with the mercury column sphygmomanometer and the test device, were independently analyzed, and the mean differences between the blood pressure measurements and the standard deviations of those differences were calculated. The results were analyzed according to the grading system of the protocol used. RESULTS: Two hundred and forty measurements were evaluated. The mean age of the patients was 16.3 years. When the measurement performed with the mercury column sphygmomanometer was compared with that taken with the device, a difference < 15 mmHg was observed in 97.9% of the systolic and 98.8% of the diastolic blood pressure measurements; a difference < 10 mmHg was observed in 86.3% of the systolic and 90.4% of the diastolic blood pressure measurements, which was classified as grade A; a difference < 5 mmHg was observed in 59.1% of the systolic and 67% of the diastolic blood pressure measurements, and was classified as grade A/B. The mean difference and the standard deviation of that difference for the systolic blood pressure was 2.91±6.42 mmHg, and, for the diastolic blood pressure, it was 1.16±5.79 mmHg. CONCLUSION: The Omron 705-CP monitor proved to be useful for measuring blood pressure in adolescents according to the protocol used.

There is a large amount of information in the literature to state that blood pressure control using ambulatory blood pressure measurement has a better predictive value for future cardiovascular events and target organ damage than casual blood pressure measurements. Clinical studies are currently evaluating if this approach is cost-effective. At the present time, and in the usual clinical practice, the use of ambulatory blood pressure monitoring is recommended for patients with resistant or difficult-to-control hypertension, for hypertensive patients with previous cardiovascular events or significant target organ damage, for the diagnosis of white coat hypertension, when there are symptoms suggesting hypotension or there is large variability in casual blood pressure measurements (Rev Méd Chile 2005; 133: 89-95)

The concept of measuring blood pressure (BP) has significantly evolved over the past two centuries, overcoming the challenge posed by the well-established, but clearly subjective, art of palpation of the pulse for “measures” other than simply determining heart rate (HR). In the US, the BP cuff was introduced by Cushing in Baltimore in 1901, and in Boston in 1903 (1,2), when he returned from a trip to Italy with a version of a Riva-Rocci mercury sphygmomanometer. Recognizing the obstacles to be overcome, Cushing noted, “The belief is more or less prevalent that the powers of observation so markedly developed in our predecessors have, to a large extent, become blunted in us, owing to the employment of instrumental aids to exactness, and the art of medicine consequently has always adopted them with considerable reluctance. (2)”

Casual blood pressure (BP) measurement is the basis of present knowledge about the risks associated with hypertension (1) and has guided patient management for many years (2). Nevertheless, casual BP is characterized by high variability, and the small number of measurements obtained in medical settings may not necessarily reflect the usual BP of an individual (3). The possibility of carrying out repeated measurements with ambulatory BP monitoring (ABPM) using invasive (4) or noninvasive devices (5) provides more representative values of BP, and permits the observation of the behavior of BP during activity and sleep.

Some epidemiological studies on blood pressure among children and adolescents have revealed that blood pressure levels in childhood are the strongest predictors of adult blood pressure levels. In the adult population, hypertension causes a two to threefold increase in an individual's risk of cardiovascular morbidity. Cardiovascular risk depends on blood pressure itself, coexistent risk factors and whether there is hypertensive end-organ damage. Therefore, accuracy in determining blood pressure is essential and a standardized protocol should be considered for blood pressure measurement, which would make the comparison of results obtained by different studies in different countries possible. This article reviews the main determinants of accuracy for casual and ambulatory blood pressure measurements in children. Estudos epidemiológicos envolvendo medida de pressão arterial em crianças e adolescentes têm demonstrado que o valor da medida de pressão arterial na infância constitui-se no maior preditor dos níveis pressóricos do adulto. A hipertensão arterial no adulto eleva em duas a três vezes o risco individual de desenvolvimento de morbidade cardiovascular. O risco cardiovascular depende da pressão arterial propriamente dita, de fatores coexistentes e da presença de lesão instalada de órgãos-alvo. A acurácia na determinação da pressão arterial é, portanto, mandatória e um protocolo estruturado e padronizado para sua obtenção deveria ser estabelecido, possibilitando a comparação de resultados de estudos realizados em diferentes países. Este artigo discute os maiores determinantes da precisão de medida da pressão arterial casual e ambulatorial na criança.

To investigate the association of smoking habits with blood pressure (BP) and intraocular pressure (IOP), and to examine whether the smoking-BP association is related to the IOP level.This study was conducted on the basis of a cross-sectional design using annual health check-up data during one-year between August, 1999 and August, 2000 for 611 middle and old-aged Japanese residents living in Ibaraki prefecture, Japan.After adjustment for age, gender, body mass index and alcohol intake score, the proportion of hypertensives, and the mean systolic and diastolic blood pressure (SBP and DBP) of the subjects without antihypertensive medications were the highest (50.4%, 129.6 mmHg and 75.9 mmHg, respectively) in the "smokers of 25 or more cigarettes per day with intraocular pressure (IOP)≥15 mmHg" of six subgroups crossed by three smoking categories (non-smokers, 1 to 24 cigarettes per day, and 25 or more cigarettes per day) and two IOP categories (less than 15 mmHg, and 15mmHg or greater). On the other hand, the adjusted proportion of hypertensives, and the adjusted mean SBP and DBP decreased with increasing smoking category in the individuals with less than 15 mmHg of the IOP (p for trend=0.028 for proportion of hypertensives 0.008 for the SBP, and 0.001 for the DBP, respectively).Heavy smoking may be specifically related to 'high BP accompanied by high IOP', although the BP may be inversely associated with smoking under the condition without high IOP.

This study investigates the influence of age and gender on the relationship between birth weight and blood pressure in childhood, using casual and 24-h blood pressure measurements. Casual and 24-h blood pressure were measured on 976 normal schoolchildren (550 girls) aged 6 to 16 years. There was no significant association between birth weight and casual systolic blood pressure (regression coefficient (s)=-0.30; 95% CI –1.79, 1.19). There was a significant negative correlation between birth weight and mean 24-h systolic blood pressure (s=-2.13; 95% CI –3.35, -0.90). Subgroup analysis by gender revealed a significant relation for girls (s=-2.88; 95% CI –4.44, -1.32) but not boys (s= -1.02; 95% CI –2.99, 0.95). ). Subgroup analysis by age group revealed a significant relation for ≥11 years old (s= -3.17, 95% CI –4.86, -1.48) but not children

The reproducibility of serial measurements of ambulatory blood pressure monitoring (ABPM) has not been well explored in children. We performed 24-h ABPM in 59 subjects (38 boys) aged 8–19 years with repeatedly elevated casual blood pressure (BP). According to the results of ABPM, the individuals were divided into a hypertensive group (mean 24-h systolic or diastolic BP >95th percentile for height, n=28) and a normotensive group (n=31). No antihypertensive agents were given. Both groups were reexamined after 1 year. In the hypertensive group, systolic and diastolic BP dropped significantly by an average of 2.1–4.5 mmHg when measured either during the daytime or over 24 h, but not at nighttime. In the normotensive group, only small BP changes were observed except for a significant increase in systolic BP at night. At the repeat examination after 1 year, 54% of the originally hypertensive subjects were defined as normotensive and 23% of the originally normotensive subjects as hypertensive. The study indicates that a single ABPM measurement is not sufficient for definitive classification of young individuals into hypertensives or normotensives.

To perform ambulatory blood pressure monitoring (ABPM) in high school students and to compare the 24-hour values with casual blood pressure (BP).Ambulatory BP monitoring was carried out in 190 high school students, 15 or 16 years of age, with elevated casual BP during the first examination at school for hypertension; 66 had elevated casual BP at both the first and the second examinations (group H1), and 124 students were normotensive at the second examination (group H2). Sixty-two students who were consistently normotensive served as control subjects (group N). Average BPs for the 24-hour period, the awake period (10 AM to 10 PM), and the sleeping period (1 AM to 6 AM) were calculated.Average BP for each period was significantly higher in group H1 than in group N. Average BP in group H2 for these periods was intermediate between those of group H1 and of group N. The casual BP had a significant positive correlation with the average BP during the awake period (r = 0.55, p0.01 for systolic BP; r = 0.37, p0.01 for diastolic BP). In most subjects the casual BP readings were higher than BP during ABPM.Casual BP measurements correlated with 24-hour BP, but they tended to be higher than the measurements obtained during 24-hour ABPM.

Blood pressure (BP) measurement induces an alerting reaction that causes an increase of BP above the “basal” when it is measured in the clinic. The intensity of this elevation is function of many factors and decreases in subsequent measurements. Thus some individuals who have elevated BP values at a first “casual” determination have normal values at subsequent examinations. The present study was undertaken to investigate left ventricular (LV) function and structure in young individuals with a first elevated “casual” BP. In order to study this we separated two groups of young male individuals (average age 21 ± 0.6) from a previous screening in which BP had been measured at two different examinations separated by 1 week. Group A (n =12) had diastolic blood pressure (DBP)

Ambulatory blood pressure monitoring (ABPM), like casual blood pressure (BP), is imperfectly reproducible between visits. The reproducibility of ABPM is less than the reproducibility predicted from a simple model of random variation of BP. This suggests either increased technical error in the technique, an element of increased biologic variability, or both. In addition, ABP shows a between-day variation (add about 6 to 7 mm Hg diastolic, similar in magnitude to what is observed with casual BP) which cannot be obviated by the average of many within-day measurements. The reliability of ABPM, although conventionally judged excellent at about R I =0.75, is insufficient to avoid misclassification errors and regression to the mean when BP cutpoints are employed

Since the classic study of Ayman and Goldshine [2], it has been recognized that the casual measurement represents a single measurement of blood pressure that reflects this constantly changing parameter to only a limited degree. Frequently altering conditions, especially the presence of a physician or nurse [9], lead to only limited reproducibility [1] of the casual blood pressure measurement, which nevertheless routinely enters into the establishment of the diagnosis and the decision for therapy and has been accepted and recommended by the World Health Organization (WHO) [21]. Apart from repeated measurements, home blood pressure measurement by the patients is particularly considered [8, 13] in order to obtain everyday representative blood pressure values. Continuous invasive intraarterial [10, 12] long-term techniques for blood pressure measurement, particularly the discontinuously measuring noninvasive procedures recently developed, now make it possible for us to analyze the blood pressure variability and the intraindividual circadian blood pressure technique in hypertensive ambulant patients under placebo [7], as well as under conventional [5] and new [15] antihypertensive therapy.

We examined whether long-term antihypertensive monotherapy with enalapril decreased clinical casual blood pressure (BP) as well as BP at work and during stress, and whether this angiotensin-converting enzyme (ACE) inhibitor had an adverse effect on the physiologic hemodynamic pattern during experimental mental stress. Seventeen male patients with hitherto untreated mild-to-moderate essential hypertension (mean age: 47 +/- 8 years) had 24-hour BP monitored noninvasively with the Physioport system before and during treatment with enalapril (5-10 mg/day) for 6 months. They also had a mental stress test, physical exercise test, and the cold pressor test before and after therapy. After the diagnostic observation period, average clinical casual BP was 150 +/- 12/102 +/- 7 mg Hg. Average BP at work, stress BP during all types of stimulation in the laboratory, and clinical casual BP significantly decreased during monotherapy with enalapril. Neither the circadian rhythm nor the hemodynamic pattern during mental stress was significantly altered by enalapril. BP increases during emotional stress were not significantly attenuated by the ACE inhibitor. These results demonstrated that enalapril effectively lowers BP without altering the physiologic hemodynamic pattern during emotional stress.