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To investigate the clinical importance of microproteinuria, we examined the prevalence of microproteinuria and its relation to cardiac structural adaptation in 80 male, middle-aged patients with essential hypertension. Patients with secondary causes of hypertension were ruled out. 14 out of 80 hypertensives (18 percent) were found to have microproteinuria defined as "negative" for urinary protein excretion in the conventional test, but "positive" (above the upper normal limit) in the 24-hour urine samples. Patients with microproteinuria had a similar age and body weight, but a higher systolic and diastolic pressure (161 +/- 14/104 +/- 12 vs 148 +/- 14/97 +/- 9 mmHg, p less than 0.02) and greater creatinine clearance (163 +/- 36 vs 136 +/- 33 ml/min, p less than 0.01) than those with normal protein excretion. Also, hypertensives with microproteinuria had a greater left ventricular mass (241 +/- 57 vs 207 +/- 45 g, p less than 0.05) and greater cross sectional area (22.2 +/- 2.8 vs 20.5 +/- 2.9 cm2, p less than 0.05) evaluated by 2-D guided M-mode echocardiography than the control group. A positive Sokolow-index was more prevalent in patients with microproteinuria than in those without (x2 = 6.2, p less than 0.02). Patients with essential hypertension and microproteinuria (prevalence 21 per cent) were characterized by a higher arterial pressure, by a higher degree of echocardiographic and electrographic evidence of left ventricular hypertrophy. Thus, microproteinuria might serve as a marker for early target organ damage in essential hypertension.

The relationship between blood pressure reactions on an ergometric and an emotional stress test was studied in a population of 62 normotensive subjects. Significant correlations for systolic (r = 0.34, p = 0.004) and diastolic ( r = 0.03, p = 0.01) blood pressure were found. It is concluded that 1) there is a individual-specific blood pressure reactivity, 2) Hypertension is closely related to the individual-specific systolic blood pressure reactivity for it is known that hypertensives exhibit stronger systolic blood pressure reactions on both stressors.

The influence of coronary-prone behaviour on coronary heart disease is well established, but the link between behavioural and pathophysiological processes is still unknown. A beta-adrenergic hyper-reactivity of type-A subjects is assumed. In this investigation the influence of beta-blockers on the type-A behavior pattern was tested in an inter-individual comparison. Sixteen male hypertensive subjects (stage I or II) were divided at random into two therapeutic groups (beta-blockers vs diuretics). Each patient was given a type-A interview before therapy and at a minimum of 4 weeks after the onset of therapy. Subjects in both groups were similar in age and before therapy they had similar blood pressure at rest as well as similar cardiovascular reactivity and type-A behaviour pattern. After therapy, subjects in the group treated with beta-blockers exhibited less type-A behaviour than those in the group treated with diuretics. The possible influence of the attenuation of the type-A behaviour on the risk of coronary heart disease should be investigated in a prospective study.