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INTRODUCTION: We hypothesize that in essential hypertension sympathetic nervous activity is related to the development of left ventricular hypertrophy, which can be regarded as a measure of the severity of hypertension. METHODS: Using spectral analysis, we studied the short-term variability in resting blood pressure and heart rate in essential hypertensive subjects. We measured blood over 10 min using a Finapres in 88 subjects after 20 min rest. We performed echocardiography to evaluate left ventricular hypertrophy and thereby identified three groups: 23 control subjects (group I), 29 hypertensive subjects (World Health Organization criteria) without left ventricular hypertrophy (group II) and 36 hypertensive subjects with left ventricular hypertrophy (group III). None had been treated for hypertension before the study. RESULTS: The variability in blood pressure over a low-frequency period considered to be a marker of sympathetic activity was significantly increased in group II compared with groups I and III (analysis of covariance taking into account blood pressure and age). The variability in heart rate was similar in groups II and III, but both groups had a significantly reduced variability in heart rate compared with group I. CONCLUSION: These data, which examine globally, using a non-invasive method, all neurohormonal factors associated with the development of left ventricular hypertrophy, demonstrate that, in the time course of hypertension, low-frequency oscillations in blood pressure and heart rate are shifted to a lower level, presumably reflecting altered function of the sympathetic nervous system. We suggest that spectral analysis of blood pressure at rest in hypertensive patients can lead to complementary information to single measures of blood pressure and detect differences in the cardiovascular regulatory system.

Purpose A multicentre study was performed on 390 healthy subjects (210 male, 180 female) to evaluate home blood pressure versus office blood pressure. Methods The patients, aged 20-59 years, not on antihypertensive treatment, were not preselected by blood pressure levels. Blood pressure was measured in the doctor's office, using a mercury manometer at the fifth, sixth and seventh minute of rest, and at home by self-measurement using a validated electronic oscillometric device at the fifth, sixth and seventh minute of rest, in the morning and evening, on three consecutive days. Results The analysis of office and home measurements at the fifth, sixth and seventh minute of rest showed a significant decrease in blood pressure, mostly between the fifth and sixth minute. There was no significant variation in home pressure over the three consecutive days of measurement. Blood pressures were significantly higher in the evening than in the morning; the mean differences were 3 mmHg for systolic and 1.5 mmHg for diastolic blood pressure. Compared with office blood pressure measurement, home measurement provided significantly lower systolic and diastolic blood pressure means. Of the subjects, 78% showed a higher systolic and 69.9% a higher diastolic blood pressure with office measurement than with home measurement. Systolic and diastolic blood pressure differences were non-significantly higher for females than for males and did not differ with age. Conclusions The comparison of the office and home measurement distributions allowed us to propose reference values for home blood pressure measurement. These were established by choosing blood pressure at the identical percentile for home measurement as we found for office measurement using the World Health Organization criteria (140/90 and 160/95 mmHg). Using this approach, the upper limit for normotension by home measurement would be 127/83 mmHg and for hypertension 147/86 mmHg. Although this approach has no prognostic value, it could be useful for the interpretation of home blood pressure.

AIM To study spontaneous variations in radial artery compliance. METHODS Compliance was evaluated non-invasively by an echo-tracking system, and variations in sympathovagal tone were analysed by a spectral analysis of continuous blood pressure recordings using a Fast Fourier algorithm. We studied 23 healthy volunteers, aged 25 +/- 4 years (mean +/- SD), at rest, on two occasions at least one day apart (5 +/- 3 days). RESULTS There were no significant differences between the means of the arterial compliance measurements and those of the corresponding spectral analysis. However, the magnitude of change in the low-frequency periods (4-66 mHz) was significantly related (P less than 0.01) to a significant and inverse change in compliance for the same level of blood pressure. CONCLUSIONS While it is possible to use spectral analysis to measure the effect of autonomic nervous regulation on radial artery properties, low-frequency periods cannot be safely ascribed to sympathetic effects alone. Other effects must also be taken into account in measurements of radial artery distensibility.

Blood pressure and heart rate of 15 male shift workers were measured every 15 minutes for 24 hours during three work shifts: morning, 4:00 AM to noon; afternoon, noon to 8:00 PM; and night, 8:00 PM to 4:00 AM. For each shift, 24-hour systolic and diastolic blood pressure showed a large "trough" (the low pressure span) and a continuous range of elevated pressure (the high pressure span). Fourier series were used to model the 24-hour blood pressure profiles. A careful examination of the residuals (measured minus predicted pressures) showed that four harmonics were necessary to describe the data accurately. The model enabled localization in each blood pressure profile of the high and low pressure spans that did not coincide with the subject's work and rest periods. The time and slope of blood pressure entering and leaving these spans could also be individually determined. Mean blood pressure during the high pressure span was the same for the three shifts, but mean blood pressure during the low pressure span was lower when the subject worked in the afternoon. During that shift, the systolic blood pressure slopes entering and leaving the low pressure span were steeper than during the two other shifts. The high pressure span was longest during the night shift and shortest during the afternoon shift. Therefore, a change in the working time profoundly perturbed the 24-hour blood pressure profile.(ABSTRACT TRUNCATED AT 250 WORDS)

Extensive non-invasive evaluation of cardiac function and blood pressure was performed in 26 subjects with borderline hypertension. The degree of cardiac hypertrophy was assessed in these subjects using echocardiographic techniques. Blood pressure and its variability were measured using a 24-hour ambulatory monitoring technique and blood pressure measurements obtained during exercise testing.

The authors report the data of a systematic electrocardiographic study of 307 subjects suffering from hypertension. They analyse the EKG anomalies at rest and after exercise and study the relationships likely to exist between these anomalies and other parameters such as age, blood pressure, etc. They stress the diagnostic but also discriminatory value of this type of investigation in hypertension.

Systolic, diastolic BP and heart rate were measured in 106 boys aged between 11 and 16 years old, at rest and during exercise on a bicycle ergometer. The results show: -- at rest: an increase in systolic and diastolic BP with age, and a decrease in heart rate; -- during exercise: an increase in systolic BP without an increase, or with a decrease in diastolic BP. The blood pressure readings were higher in overweight and post pubertal subjects. The value of this study lies in the high number of reproducible readings obtained and in the suppression of the effects of emotivity. It completes the observations made at rest in subjects suspected of having hypertension.

to search in which situation the PWV is the most reproducible.PWV is measured with a continuous doppler technique along the subclavial radial arterial segment on the right forearm. 30 normotensive subjects (20-30 years) are studied twice running at 24-hour interval at rest and during stress (ergometric bicycle, stress levels: 50, 75, 100 watts/mn).Student test and correlation when the data are normally distributed.mean PWV increases progressively with blood pressure during stress. REST: 10.0, 50W: 11.3, 75W: 12.33, 100W: 13.32, 4 mn rest: 10.6. Mean differences (MD) with standard deviations (SD) and correlation (COR) are as following: (Table: see text). If we take into consideration MD, SD and COR between the 2 stress tests, 75W level appears to be the most reproducible.these data must be taken into account when using PWV to appreciate the vascular effect of some medications especially in hypertension.

The reproducibility and reliability of measurements performed with an automatic blood pressure measuring device based on the oscillometric method were assessed by comparison with the results obtained by the indirect auscultation using a mercury manometer. The results of the mean values, of the correlation between successive values and of the variation of the values of systolic and diastolic blood pressure show that the readings obtained by the automatic method are very reproducible.

Comparative study is performed between echocardiographic measurements (TM), exercise test blood pressure profile (ETP) and ambulatory blood pressure load (BPL) in 26 borderline hypertensive subjects (19 males, 7 females). An abnormal ETP is found for 15 subjects (57 p. 100), an abnormal BPL for 10 subjects (38 p. 100). The diastolic interventricular septum thickness (IVS) and the diastolic posterior wall thickness (PWT) are abnormal (greater than 11 mm) for 6 and 3 subjects. Patient with pathologic ETP or/and BPL have greater IVS and PWT than other subjects (p less than 0,001). A good correlation is found between individual activity systolic blood pressure or 24 hours systolic blood pressure means values and PWT, IVS or left ventricular mass. These 3 examinations lead to a better assessment of cardiovascular strain and allow a better diagnosis and therapeutic approach in borderline hypertensive patients.

Several studies published during the last fifteen years seem to demonstrate that major risks, i.e. congenital malformations in the offspring and increased rate of spontaneous abortions, are associated with occupational exposure to anesthetic gases (halothane and nitrous oxide) in operating rooms. In view of the severity of the potential risk, we have: 1) analyzed risk factors in the light of epidermiologic and experimental studies; 2) determined the threshold levels of air pollution for these risk factors; 3) analyzed the situation in the Grenoble Hospital and the means of dealing with it.

Stress tests have been performed for a long time in patients with coronary disease. The study of blood pressure variations, under these circumstances, is also interesting in hypertension. Several types of stress tests, dynamic and static, may be performed. Dynamic tests on ergometric bicycles are the most frequently performed. The evolution of the BP during stress increases regularly and there is a linear correlation between the BP values and the level of work as well as the heart rate (HR). It is therefore possible to individualize a reference blood pressure profile, according to age and sex. The stress may find applications from a diagnostic, prognostic and therapeutic standpoint. First of all, in borderline HT, the stress test enables to confirm the HT and better differentiate between hyperemotional and hyperkinetic patients. In severe hypertension, the stress test permits to better define the magnitude of the haemodynamic disorder. In true hypertensive patients, undergoing major physical stress (work, sports...) the stress test permits to evaluate the tolerance to stress and the faculties of myocardial adaptation. From a prognostic standpoint, the incidence of permanent hypertension is 2 to 3 times higher in patients presenting an abnormal blood pressure profile. There is a significant correlation between the BP at maximum stress and the left ventricular mass index at all stages of the HT. The stress test makes it possible to better define the mode of action of antihypertensive medications, prescribe a personalized treatment according to these patients reactivity to stress and guarantee the correction of blood pressure abnormalities, since normalisation at rest does not necessarily imply a normalisation during stress.

Establishing an arterial compliance index by measuring pulse wave velocity (PWV) has proved useful for the early diagnosis of arterial lesions in atherosclerosis and diabetes, but the lack of reproducibility of this measurement when performed at rest has limited its use. Exercise tests, a global method for the dynamic study of blood pressure (BP) level, has been suggested as a means of standardizing the neurosensorial influences on the vasomotor tone. In this paper, we advocate a dynamic evaluation of arterial compliance by measurement of PWV during exercise, and we report the results of our study concerning the reproducibility of PWV during exercise, and we report the results of our study concerning the reproducibility of PWV measurements and the changes observed in arterial compliance during dynamic constraints. Thirty normotensive subjects aged from 20 to 30 years were studied on two occasions separated by more than 24 hours. PWV was measured in the subclavian and radial arteries by doppler shifted ultrasound combined with ECG, both at rest and after 3 levels (50, 75, 100 watts) of a standard triangular exercise test in sitting position. BP levels during exercise were the same in both tests. The reproducibility of PWV measurements in these two tests confirmed the non-reproducibility of these measurements at rest. It also showed that reproducibility is obtained during the first minutes of exercise (r = 0.72 ; p less than 0.001 at 75 watts). Changes in PWV at exercise varied with the subject, with a mean progressive increase of 1 m/s/level (rest = 9.8, 50 w = 11.1, 75 w = 12.2, 100 w = 13.14; 4 min. later: 10.7 m/s).(ABSTRACT TRUNCATED AT 250 WORDS)

Starting from projective situations--thematic apperception test (TAT) we have researched personality characteristics liable to be found in hypertensive subjects. With reference to a control group of 59 subjects we have studied 41 essential hypertensive subjects. They undergo a preliminary interview structured on the questionnaire type, are classically tested with the TAT, have one or several free interviews. These data are exploited on three levels and contents = manifest, latent, adaptive. It emerges that there are permanent biographical elements (elements of reactivation. Difficulty to put up with aggressiveness, object loss anxiety, use of operative thought back of adaptation = absence of solution to conflicts and possibilities of passage ?), personality patterns in between obsessional pole neurosis and limit state (Bergeret's nosography). These data partly overlap other research, they encompass a wider field than hypertension, given the structures involved (limit state, psychosomatic component). The lack of mentalization justifies the use of therapeutic techniques such as relaxation, biofeedback...

The used of a test of prolonged grip and recording the changes in arterial blood-pressure and heart rate is suggested as a way of studing the blood-pressure changes of effort in hypertensives. This test provides a real screen for provoqued hypertension: it allows --to define a normal profile of reference for blood-pressure, --to check the fluctuations at rest of blood-pressure, --to determine the severity of haemodynamic dissorders, --to judge the efficiency of hypotensive therapy.

Blood-pressure (BP) responses to exercise are worth studying to evaluate the cardiovascular adjustment ability of hypertensive subjects whose daily activities include important physical performances. Some authors also consider that they have a predictive value. Changes in exercise BP over a period of more than 3 years (mean: 5.2 +/- 2.26 years) were studied in 225 subjects, some of whom had normal BP while others had untreated borderline or moderate hypertension. Globally, the mean values of diastolic pressure, heart rate, exacerbated response and BP profile remained remarkably stable with time despite significant differences in some groups of subjects. When each subject was considered separately, a normal BP response to exercise had a very high predictive value, since systolic and diastolic pressure which were normal at the first examination remained normal at the second examination in 85 p. 100 and 93 p. 100 respectively of the subjects. The reproducibility with time of response to exercise is an additional incentive to perform this type of examination.

The results of continuous 12-hour electrocardiography in 40 convalescent patients after myocardial infarction undergoing a programme of readaptation on average 4 weeks after the initial infarction are reported. The frequency and alarming nature of the VES observed in 75% patients who had already undergone selection for the coronary readaptation programme, 30% of whom were receiving antiarrhythmic therapy, is emphasized. The observation of a progressive increase in the number of VES during the day prompts the following suggestions: the possibility of limited continuous ECG monitoring at the end of the day, the need to adapt the dosage of antiarrhythmic drugs during this most critical period. The comparison of the results of continuous ECG with those of repeated exercise ECG seems very positive, but some reservations are made and it would seem logical to associate these two complementary methods of investigation.

Twenty patients with hypertensive heart disease have been hospitalised for adjustment of their antihypertensive medication. The new treatment was left unchanged during a period of forty days, the survey consisted in three blood pressure measurements at rest every day during the first ten days of hospitalisation and an ambulatory blood pressure measurement the 10th and 40th day. The 10th day, there is no significant correlation between blood pressures measured at rest and ambulatory, even if the average BP levels are not significantly different. The 40th day, the average BP levels are equivalent with a correlation coefficient of 0.5 for the systolic and 0.64 for the diastolic blood pressure (p less than 0.01). Thus, a measurement of the ambulatory BP at the 10th day of hospitalisation seems to be a good indicator of the expected long term therapeutic effect. However, absence of greater increase of the ambulatory BP at one month probably corresponds with the majored action of certain treatments as time goes by.

Cobalt urinary excretion should be a good way to know the level of exposition of subjects submitted to hard metals. The study is done on 28 workers of 3 different workrooms. Sunday 24 hours diuresis is retained. For 5 workers, the urinary cobalt measurements are done from samples made at the beginning and the end of work during 5 days. Atmospheric dust measurements are realized in different points of the 3 workrooms (individual and general samples). For measures atomic absorption spectrometry is used. The results show a good correlation between cobalt exposure and urinary concentrations. Friday evening urinary cobalt is a good expression of week exposure. The results obtained well correlate with those of others authors. Cobalt urinary measures are proposed for supervision of workers exposed to hard metals.

Report of one case of chronic pericardial effusion combined with pulmonary valve stenosis and atrial septal defect in a man aged 31, hospitalized for congestive heart failure. The relationship between these two diseases were studied, and the diagnostic and therapeutic problems posed were studied.

Study of the blood pressure and cardiac rate changes in the course of an exercise test makes it possible to assess the possibilities of cardiovascular adaptation. This "induced arterial hyperrtensive subjects from those who possibly are not, and to assess correctly the blood pressure changes observed in various circumstances. On effort, an approach of the severity of the haemodynamic disturbance of the consequences of this disturbance, of the efficiency of treatment.

Circadian blood pressure (BP) and heart rate (HR) variations are studied during activities and sleep in a group of nine subjects with shiftwork activities (3 X 8 hours with a short rotation of 2 days). BP and HR values are measured in ambulatory (outside the hospital) with and automatic device (Spacelab system 5,200) during 24 hours at 3 times according to the work periods (morning 7-12 AM, afternoon 3-11 PM, night 1-7 AM) on a month. According to BP hour variations, activities and sleep are the main determining factors. For work periods BP mean values are significantly lower during night than during day. The lower BP values are found during the sleep periods, but the values are higher when subjects sleep during the day. There is an adaptation according to work hour changes, but this adaptation is incomplete and during night activities, the circadian rythm is partly altered. These constatations must be taken in account particularly on a therapeutic point of view for hypertensive subjects for which the treatment must be adjusted.

Variations in blood pressure were investigated by an automatic, non-invasive ambulatory method in 9 subjects with essential hypertension. Recordings were made after 6 week periods during which captopril was taken either once or twice daily, in a double-blind cross-over study. Although the effects of captopril administration either once or twice daily were broadly similar, there was a significant decrease in diastolic blood pressure values on the once-daily regimen. These results suggests that treatment once a day can advantageously replace twice-daily treatment.

Self-measurement of blood pressure has become widespread in recent years. It may be defined as the measurement of arterial pressure by a conscious and free-willed subject. Self-measurement must remain a medical procedure, which means that doctors should be able to advise their patients (a) on the type of apparatus they should purchase and get validated at regular intervals; (b) on the method of using the apparatus in practice, and (c) on the circumstances, conditions and numbers of measurements to be performed. Doctors must remain responsible for the interpretation of the results obtained and for the diagnostic, pronostic an therapeutic applications of the method. Self-measurement of blood pressure naturally has advantages and disadvantages, but it must be noted that it may offer an alternative to hospitalization or to ambulatory arterial pressure measurement, avoid excessive or defective therapies and improve the patient's compliance with his treatment.

The authors studied the reproductibility of the measures of the haemodynamic (HR-SAP-DAP) and hormonal (PRA-plasma catecholamine) parameters at rest and during stress. 11 normotensive male subjects, age 20-26 years, have release 2 stress tests on ergometric bicycle spaced from 8 to 180 days (mean 54.2 days). The measure of haemodynamic parameters is reproducible during stress. The PRA measures is reproducible at stress instead of individual variations of natriuresis between 3-10 g. The measure of plasma norepinephrine levels is reproducible for strict rest and during stress. This express an identical participation of the sympathetic system for the same physical work load. This results express the interest of stress tests for the definition of a normal blood pressure and hormonal profile.