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This study compares the blood pressure (BP) levels, the variability and the circadian BP variation recorded in ambulatory (AM) and self measurement (SM) conditions. The BP is recorded every 15 min on the day time with an automatic device (Space-labs) in a population of 16 normotensive patients; the same day, each patient performs with an half automatic device (SEB) 9 self measurements between 8 am and 8 pm. The SM method provides significantly lower mean values: -3.9 mmHg and -3.1 mmHg for the Systolic and the Diastolic blood pressure (SBP and DBP) than the AM. The heart rate (HR) also is lower in SM than in AM (-6.5 cy/min). The BP variability is lower for the SBP and the HR in SM. The correlation between AM and SM hours means is poor. This study shows that the self measurement method provides a lower BP level and variability than the full ambulatory method and the hourly means variation are not assessed.

In order to improve the reproducibility of arterial compliance measurements, normally taken at rest, we performed these measurements during exercise under stable conditions. Our aim was to determine, in both normotensive and hypertensive subjects, those parameters which condition changes in arterial compliance during exercise, and in particular age, systolic/diastolic arterial pressures and heart rate. The study involved 59 normotensive and 31 hypertensive subjects. Compliance was evaluated by measuring pulse wave velocity in the upper limbs at three levels of exercise: 50, 75 and 100 watts. Pulse wave velocity measured in different age-groups gradually increased at each exercise level, but age made no significant difference in values. Only one correlation appeared at recovery, with a significant (p less than 0.05) difference between normotensive and hypertensive subjects. As regards arterial pressures, there was only one correlation with diastolic pressure reflecting an increase in mural tension during exercise. A correlation with heart rate appeared during exercise, probably due to the vasomotor effect of a higher adrenergic tone. The diversity of vascular repercussions and haemodynamic regulation modes during exercise accounts for the variability of arterial compliance measurements taken during exercise, irrespective of age and blood pressure level. However, these measurements remain of interest for their reproducibility and their correlation with the adrenergic tone. This may be useful for the choice of an antihypertensive therapy.

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)

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.

Purpose: to search in which situation the PWV is the most reproducible., Methodology: 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)., Statistics: Student test and correlation when the data are normally distributed., Results: 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., Conclusion: these data must be taken into account when using PWV to appreciate the vascular effect of some medications especially in hypertension.

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.

The invasive and non-invasive techniques now available for automatic monitoring of blood pressure have provided new sets of physiological as well as diagnostic and therapeutic data. Recordings of blood pressure variations over a 24-hour period have shown that it increases during the day and decreases at night, that these physiological changes are more pronounced in the elderly than in young subjects and also that they depend on the degree of physical activity. The clinical applications of these techniques rest on the possibility of recording a blood pressure-activity profile over time, in order to speak, ultimately, in terms of blood pressure load activity. By reference to a normal blood pressure profile, genuinely hypertensive subjects can be differentiated better from those overactive, hyperemotional subjects who are perhaps not suffering from true hypertension. Finally, 24-hour recordings repeated over periods of several days or weeks enable the clinicians to assess therapeutic effectiveness and to envisage an authentic chronotherapy.

The authors report the cases of two men with coronary artery disease by amiodarone for 8 and 24 months respectively. They developed clinical and radiological changes of diffuse interstitial pneumonia, characterised by an inflammatory syndrome, restrictive changes on spirometry, reduced CO transfer and abnormal blood gases. Broncho-alveolar lavage showed a lymphocytosis with a large quantity of iodine in the macrophages and the presence of amiodarone and its metabolite in the supernatant fluid. The responsibility of this drug is imputed and the patients were cured within 3 months of its withdrawal with regression of clinical, radiological, spirometric and control alveolar lavage abnormalities. A favourable outcome without steroid therapy is practically unknown in the literature. These cases illustrate the possible risk of alveolitis or diffuse interstitial pneumonia during long term amiodarone therapy, the pathogenesis of which is discussed: iodine overload, direct drug toxicity or an immunological mechanism.

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.

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.

The reproductibility and reliability of measurements made with an automatic device for measuring blood pressure was assessed with reference to the results obtained by indirect auscultation with a mercury manometer. The results of the study of the average values of the correlation between successive values, and of the variability of the values of the systolic and diastolic blood pressure show that the measurement obtained by this method are very reproducible.

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.

Unlabelled: Technological progress has led to the creation of jobs requiring minimal physical labor, high mental concentration, and rotating shift schedules. This study evaluates the physiological effects of rotating shift work on the cardiovascular system., Methods: blood pressure (BP) and heart rate were recorded automatically (Spacelabs) under ambulatory conditions over a 24 h period in 15 quality control technicians at a chemical factory, during each one of their 3 shifts: morning (4 am-12 noon), afternoon (12 noon to 8 pm) and night (8 pm to 4 am)., Results: mean Bp and HR did not differ significantly between the 3 shifts when the work period was taken into account. (table; see text) Activity appears to prevail over circadian rythm and to determine BP and HR levels. Techniques using chronological series analysis which take BP variability into account (Fourier harmonic transformations) show that night work considerably modifies the modes of BP and HR variation (going to sleep, waking-up, variability at work)., Conclusion: BP and HR measurement provide a pratical approach to the analysis of physiological disturbances induced by rotating shift work in employees with mentally demanding jobs.

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.

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.

Purpose: evaluate, in a Public Health approach, the contribution of ambulatory blood pressure recordings (ABPR) in the diagnostic and therapeutic management of hypertension., Methods: a retrospective study is led among 32 physicians who have addressed 473 patients for ABP: 182 for borderline hypertension (B-H) diagnosis, 94 for treatment decision (NT-H) and 197 for a therapy efficiency assessment (T-H). ABPR is performed with the non invasive Spacelabs device on a 24 hour period. The data interpretation is provided by statistical comparison of patient's data with those of a same age and sex 30 normotensive subjects group., Results: The table presents the action of physician according to the ABPR motive and answer: TT = therapy, NT = no therapy, ADJ = adjustment, NADJ = no adjustment. (Table: see text)., Conclusion: physicians follow drastically ABPR interpretation: a large number of patient avoid a treatment (68 percent of B-H group and 63 percent of NT-H group), the therapy is modified for 40 percent of the T-H patients. Such evidence may have some Public Health implications.