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Unlabelled: The ineluctable fade out of mercury sphingomanometer pressure device involve the necessity in using automatic blood pressure systems. In parallel the recent PHARE II study witness of a lack in the control of hypertension in general practice. In the basis of an automatic blood pressure device measure, we had try to know the efficiency of blood pressure contrôl (BPC) in a specialised consultation., Method: 100 patients with essential systolo-diastolic hypertension (HTA) were screened. An independent physician measured the blood pressure level with an OMRON 705 CP device 3 times. The acceptable BPC was considered less than 160/95 mmHg and the optimal BPC less than 140/90 mmHg. There was 70 man, 30 female (mean age = 67 year old). The initial mean blood pressure was 169/104 mmHg., Results: The final blood pressure measured was 137/80 mmHg. The percentage of patients who have an acceptable contrôl (< 160/95) was 91% and an optimal contrôl (< 140/90) 66%. 12% of these 66 maintain a height cardio-vascular risk. The mean number of medication used was 2 and it's paradoxally not differ between the optimal blood pressure control group and the other patients who need probably an intensive medication. In conclusion these study shows us the importance in understanding our patients particularity in order to increase the treatment efficiency.

The management of hypertension in the elderly requires careful diagnosis, which is not always easy in this population because of the increased variability of blood pressure. The practitioner is faced with three questions in this diagnostic approach: how to evaluate the patient's real blood pressure level, how to assess the degree of cardiovascular impairment and concomitant disease and finally how to evaluate the subject's global cardiovascular risk. Self-monitoring of blood pressure, which allows measurement of blood pressure by the patient himself in his usual environment, provides a better assessment of the elderly patient's real blood pressure level.

The aim of this study was to analyse the respective values of clinic and ambulatory blood pressure measurements in patients with treated hypertension. Twenty-eight patients with mild to moderate hypertension were studied (clinic blood pressure > or = 160/95 mmHg), treated with benazepril alone (n = 7) or combined with hydrochlorothiazide (n = 21). A 24 h ambulatory blood pressure measurement was performed before (d0) and after 8 weeks of treatment (d56). The treatment was effective on the ambulatory blood pressure in 19 patients (Staessen criteria) and effective on clinic measurements in 20 patients (WHO criteria). The results were concordant in 25 of the 28 patients. The decrease of the ambulatory blood pressure values during the day between d0 and d56 was not significantly related to the decrease of the clinic values. The comparison of the ambulatory blood pressure values at each hour between d0 and d56 showed that the treatment was effective during 24 h. The 'white coat' effect has been evaluated at d0 and d56 by the difference between mean daytime ambulatory blood pressure and clinic values. Clinic values were higher than mean daytime ambulatory values in benazepril (14 +/- 12 mmHg and 7 +/- 7 mmHg for the systolic and diastolic pressure) and benazepril-hydrochlorothiazide group (12 +/- 12 mmHg and 0.2 +/- 9 mmHg for the systolic and diastolic pressure). This 'white coat' effect was not modified during the treatment. Previous studies have emphasized a better assessment of the cardiovascular risk with ambulatory than with clinic measurements. The differences in the assessment of the efficiency of the treatment between clinic and ambulatory measurements shown in our study prompt us to use ambulatory measurements in patients with apparently uncontrolled hypertension.

Clinical and 24-hour ambulatory measurements were made in 46 patients with mild to moderate essential hypertension in order to confirm that the efficacy and safety of sustained-release diltiazem LP 300 mg were the same regardless of the time of day at which it was taken. After two weeks of placebo, patients were randomly assigned double-blind to take diltiazem LP 300 mg either morning or evening for four weeks. Diltiazem LP 300 mg significantly lowered diastolic and systolic blood pressure in both groups by clinical or 24-hour ambulatory measurement, and without any difference according to whether diltiazem LP 300 mg was administered morning or evening. A lesser fall in blood pressure during the night in both groups led to study of the effect of diltiazem LP 300 mg according to initial ambulatory diastolic blood pressure level. Diltiazem brought about a greater fall in blood pressure when patients had an ambulatory diastolic pressure of 90 mmHg or more. Clinical, laboratory and electrocardiographic parameters were all satisfactory, regardless of the time at which the drug was taken.

The objective of this study was to evaluate the efficacy, particularly in terms of the 24-hour cover, and the safety of lisinopril 20 mg + hydrochlorothiazide 12.5 mg 5L/HCTZ) and captopril 50 mg + hydrochlorothiazide 25 mg (C/HCTZ) in patients with essential HT requiring two-agent therapy. Twenty patients with a diastolic blood pressure (DBP) between 95 and 120 mmHg after 2 weeks of placebo were randomised to receive, under double-blind conditions, either L/HCTZ or C/HCTZ as a single daily dose for 4 weeks. Clinical examination, laboratory tests and 24-hour ambulatory blood pressure monitoring (ABPM) were performed at the end of the placebo and active treatment periods. L/HCTZ and C/HCTZ significantly lowered SBP and DBP on occasional recordings and on ABPM. The mean fall in blood pressure on ABPM (SBP, DBP, mean of 24-hour recording, diurnal and nocturnal) at 4 weeks was greater with L/HCTZ than with C/HCTZ. Both treatments were effective for 24 hours and did not alter the circadian cycle. The clinical and laboratory safety was good. The blood pressure figures obtained by ABPM were lower than on occasional recordings, emphasising the value of this technique in the evaluation of a patient's poor response to antihypertensive treatment.

The position of the arm in relation to the heart is one of the factors responsible for variations in arterial blood pressure. The purpose of this study was to confirm these variations and their diagnostic and therapeutic consequences. The blood pressure of 59 subjects was measured in supine position with or without support, this support being a device, recently developed by Swedish physicians, that brings the radial notch of the ulna at heart level. The results obtained confirmed the existence of variations in blood pressure values according to the position of the arm in relation to the heart. When measured with the support, blood pressure fell by 5 mmHg for systolic pressure and 4.6 mmHg for diastolic pressure. These results prove the need for standardization of blood pressure measurement in supine position. It is permissible to believe that at this moment a non-negligible proportion of patients (12 percent in our series) is either wrongly regarded as hypertensive or overtreated. In addition, the blood pressure variations induced by the brachial support should be taken into account in the analysis of future epidemiological studies. We conclude that using the brachial support can be recommended for a better evaluation of supine blood pressure measurements.

Forty-one patients with mild to moderate hypertension were included in a multicentre trial. The objective was to assess the influence of the time at which nitrendipine (Nidrel 20 mg) is taken on its efficacy and tolerance. The drug was administered once daily either in the morning or in the evening during 2 consecutive periods of 28 days. Efficacy was assessed on an ambulatory recording of blood pressure over 24 hours. Globally, nitrendipine results in a statistically significant drop in blood pressure which is not influenced by the time of administration. Treatment response varies greatly according to the initial value of ambulatory diastolic blood pressure. There is a clear antihypertensive effect if ADBP is greater than or equal to 90 mmHg and no hypotensive effect if ADBP is less than 90 mmHg. The incidence of adverse effects did not vary according to the time the drug was taken. Biological tolerance was excellent. Nitrendipine, administered once daily alone appears to be an efficient antihypertensive agent, well tolerated both clinically and biologically. Its efficacy is maintained over a 24-hour period regardless of the time at which the drug is taken.

The aim of this preliminary report is to compare the evaluation of the antihypertensive drug effect, during a controlled trial, using casual measurements and 24 hr B.P. monitoring. 20 patients (16 males, 4 females 55 +/- 10 years old) with primary hypertension (WHO stage I or II) were included with a diastolic blood pressure greater than or equal to 100 mmHg (mean blood pressure from three clinical readings). Casual B.P. and B.P. monitoring (Spacelabs - 4 measurements per hour during a 24 hr period) were established before and after the end of the placebo run in period (one placebo tablet given once daily at 8 h-8 h 30 a.m. for 15 days). Overall sample data: The clinical B.P. decrease (167 +/- 16-109 +/- 7 before and 147 +/- 17-97 +/- 11 after treatment) is higher that the ambulatory B.P. decrease (148 +/- 15-101 +/- 8 before and 138 +/- 21-94 +/- 14 after treatment). Individual patient data: A clinical B.P. decrease (of at least 10 mmHg) was found in 17 patients for systolic B.P. and in 15 patients for diastolic B.P. A significant ambulatory B. P. drop decrease (p less than 0.05) was found in 11 patients for 24 hr systolic and diastolic B.P. The clinical and ambulatory responses to the treatment are in line in 14 patients, but differ in 3 instances. There is a little correlation (for the diastolic B.P.) and no correlation (for the systolic B.P.) between the clinical and the ambulatory B.P. decreases after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study is to evaluate the antihypertensive effect of placebo assessed by 24 hr non invasive blood pressure monitoring. 20 patients (16 males, 4 females, 55 +/- 10 years old) with primary hypertension (WHO stage I or II) were included with a diastolic blood pressure greater than or equal to 100 mmHg (mean blood pressure from three clinical readings). Casual blood pressure and blood pressure monitoring (Spacelabs - 4 measurements per hour during a 24 hr period) were established before and at the end of the placebo run in period (one placebo tablet given once daily at 8 h-8 h 30 a.m. for 15 days). Overall sample data: There was no antihypertensive effect of the placebo with casual BP (167 +/- 16-109 +/- 6 mmHg before and 167 +/- 16-109 +/- 7 mmHg after placebo) and with 24 hr B.P. monitoring (142 +/- 14-96 +/- 8 mmHg before and 141 +/- 14-96 +/- 8 mmHg after placebo). The circadian curves were similar. Individual patient data: A clinical placebo effect (B.P. decrease of at least 10 mmHg) was found in 5 patients for the systolic B.P. and in 2 for diastolic B.P. A significant ambulatory placebo effect (p less than 0.05) was found in 5 patients for the 24 hr systolic B.P. and in 4 patients for the 24 hr diastolic B.P. However, patients with clinical placebo effect were not the same as those with ambulatory placebo effect. There was no correlation between the clinical and the ambulatory response to placebo treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

To gain a better understanding of the therapeutic effect of HTA, the present study reports a new method essentially based on the non invasive non ambulatory monitoring of blood pressure by the Dinamap 845. This apparatus was initially assayed towards the measure of invasive blood pressure and by the auscultatory method, and afterwards towards the analysis of approximately one hundred resulting data. The computer analysis of the data was performed using a microcomputer which gives the results as: time dependent curves over 24 hr; histograms, percentage of the values of HTA (above 140 mmHg for the systolic and 90 mmHg for the diastolic one); numeric data such as: average values, SEM... The method reported here appears to be convenient to follow new therapeutic treatment because the data obtained before and after treatment proved to be more rigorous and less varying upon the physician. This kind of investigation seems also helpful in the case of both hypertensive emergencies and treatment of those HTA which are difficult to stabilize. But it is thought to be not easily applied to all the hypertensions studied in the usual medical practise.

The reproducibility of a novel ambulatory blood pressure (B.P.) monitoring was tested, for clinical trial in hypertension. The spacelabs apparatus is based on standard auscultatory and oscillometric blood pressure measurements. Ten normotensive patients and 15 hypertensive patients were investigated as follows: their blood pressure was monitored twice over a 24 hr period at an interval of 30 and 15 days respectively. The monitoring data were expressed as the mean of the average blood pressure over day-time (7 hr-22 hr) and 24 hr as well as 24 hr. B.P. profiles (means of 4 measurements per hour). The statistical analysis of the two subpopulations of patients showed a satisfaction reproducibility of both the 24 hr B.P. curves (normotensive patients: PAS: r = 0.94; PAD: r = 0.92; Hypertensive patients PAS: r = 0.82; PAD: r = 0.64 p less than 0.001). and blood pressure levels (normotensive patients: J1: 113 +/- 10/70 +/- 6 mmHg; J30: 110 +/- 10/68 +/- 6 mmHg. Hypertensive patients: J1: 150 +/- 10/98 +/- 9 mmHg; J15: 155 +/- 15/96 +/- 8 mmHg). In contrast, analyzing each patient individually exhibited a correct reproducibility of the B.P. levels but the 24 hr--profiles of either the diastolic or systolic blood pressure could not be correlated with sufficient reliability (normotensive patients: 7 times out of 10 for PAS, and 4 times out of 10 for PAD; hypertensive patients: 5 times out of 15 for PAS, and 3 times out of 15 for PAD). In addition, the patient activity, should be carefully controlled during ambulatory blood pressure measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

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.