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The purpose of this study was to evaluate over a 24 h period the antihypertensive effect of captopril 50 mg + hydrochlorothiazide (HCTZ) 25 mg once a day in mild to moderate hypertension. Ambulatory recordings over 24 h of the blood pressure using the Spacelabs system were performed, at the end of a 15-day placebo period and after giving captopril + HCTZ for 45 days. Captopril + HCTZ significantly decreased (P less than 0.001) systolic and diastolic blood pressures for both the diurnal period (8 h to 22 h) and the nocturnal period (22 h to 8 h). No change in heart rate was observed. For further analysis, the mean hour values of blood pressure and heart rate were calculated. A constant decrease of the systolic and diastolic blood pressure throughout the 24 h was obtained after captopril + HCTZ without any change in heart rate and in nyctohemeral variations. The study provided evidence that, in patients with mild to moderate essential hypertension, captopril + HCTZ once a day decreased systolic and diastolic blood pressure all day long without any change in the heart rate and the blood pressure nyctohemeral cycle. [ABSTRACT FROM AUTHOR]

Introduction: Infection with and antifungal resistance of Candida species have been on the rise globally. Relevant data on these pathogens are relatively few in our region, including Lebanon, thus warranting this study., Methodology: This retrospective study of Candida spp. profiles and their in vitro antifungal susceptibility was based on analysis requests for 186 Candida non-albicans and 61 C. albicans during three periods (2005-2007, 2009-2011, and 2012-2014) over the span of the last 10 years at the American University of Beirut Medical Center (AUBMC), a major tertiary care center in Lebanon. Identification of Candida was done using the API 20C AUX system, and the E-test was used to determine the minimum inhibitory concentrations (MICs) of antifungal agents., Results: Among the 1,300-1,500 Candida isolates recovered yearly, C. albicans rates decreased from 86% in 2005 to around 60% in 2014. Simultaneously, the non-albicans rates increased from 14% in 2005 to around 40% in 2014, revealing 11 species, the most frequent of which were C. tropicalis, C. glabrata, and C. parapsilosis. All these demonstrated high resistance (35%-79%) against itraconazole, but remained uniformly susceptible (100%) to amphotericin B. Though C. albicans and the other species maintained high susceptibility against fluconazole and voriconazole, their MIC90 showed an elevated trend over time, and C. glabrata had the highest resistance rates., Conclusions: The observed rise in resistance among Candida spp. in Lebanon mandates the need for close surveillance and monitoring of antifungal drug resistance for both epidemiologic and treatment purposes.

Background: Antimicrobial resistance has been inflecting deleterious health and economic consequences locally and globally. This study addresses the patterns and trends of bacterial resistance to antimicrobial agents over a decade, at a major tertiary care center in Beirut., Methods: Data on bacterial susceptibility patterns at the CAP accredited Clinical Microbiology Laboratory is analyzed from January 2000 to November 2011, along with related different studies conducted during this period., Results: Increasing rates of ESBL-producing isolates were noted for Escherichia coli, Klebsiella pneumoniae, Salmonella spp. and Shigella spp. Resistance to carbapenems remains problematic in Acinetobacter spp, and Pseudomonas aeruginosa, and started emerging in E. coli and K. pneumoniae. Tigecycline and colistin maintained excellent activity against most ESBL and carbapenem resistant bacteria relevant to the treatment by these agents. Resistance to quinolones is being encountered in Streptococcus pneumoniae, Haemophilus influenzae, Salmonella spp. and Shigella spp. Methicillin resistant Staphylococcus aureus (MRSA), though remaining relatively high, showed decreasing trends of resistance, while vancomycin maintain uniform activity. Rare and sporadic vancomycin resistant strains in enterococci are encountered. Macrolide and clindamycin increasing rates of resistance is noted in S. pneumoniae, group A streptococci, S. aureus, viridans streptococci and some others., Conclusion: Physicians should be aware of the local epidemiology of antimicrobial resistance to properly guide the initial therapy. These resistance problems can be attributed to uncontrolled use of antimicrobial agents, thus, highlighting the need for antimicrobial stewardship to curb this threat.

Background: A high percentage of hypertensive patients present an arm circumference of over 32 cm; the use of a large cuff is therefore recommended. Validation studies are usually performed in the general population using a standard-size cuff. The aim of this study was to assess the accuracy of the Omron M7 device in a population with an arm circumference ranging from 32 to 42 cm., Design: A validation study was performed according to the International Protocol of the European Society of Hypertension. This protocol is divided into two phases: the first phase is performed on 15 selected participants (45 pairs of blood-pressure measurements); if the device passes this phase, 18 supplementary participants are included (54 pairs of blood-pressure measurements), making a total number of 33 participants (99 pairs of blood-pressure measurements), on whom the analysis is performed., Methods: For each participant, four blood-pressure measurements were performed simultaneously by two trained observers, using mercury sphygmomanometers fitted with a Y tube; the measurements alternated with three by the test device. The difference between the blood-pressure value given by the device and that obtained by the two observers (mean of the two observations) was calculated for each measure. The 99 pairs of blood-pressure differences were classified into three categories (

Background: Four electronic devices for self-measurement of brachial blood pressure (BP): the Omron M1 Plus, the Omron M6 Comfort, the Spengler KP7500 D, and the Microlife BP A100 Plus, were evaluated in four separate studies according to the International Protocol of the European Society of Hypertension (ESH)., Design: The International Validation Protocol is divided into 2 phases: the first phase is performed on 15 selected subjects (45 pairs of BP measurements); if the device passes this phase, 18 supplementary subjects are included (54 pairs of BP measurements) making a total number of 33 subjects (99 pairs of BP measurements) on which the final validation is performed., Methods: The same methodology recommended by the ESH protocol was applied for the 4 studies. In each study and for each subject, 4 BP measurements were performed simultaneously by 2 trained observers using mercury sphygmomanometers alternately with 3 measurements by the tested device. The difference between the BP value given by the device and that obtained by the two observers (mean of the two observers) was calculated for each measure. The 99 pairs of BP differences were classified into 3 categories (< or =5, 10, < or =15 mmHg). The number of differences in each category was compared with the number required by the International Protocol. An individual analysis was then done to determine for each subject the number of comparisons < or =5 mmHg. At least 22 of the 33 subjects should have 2 of their 3 comparisons < or =5 mmHg., Results: All 4 tested devices passed the first and the second phase of the validation process. The average differences between the device and mercury sphygmomanometer readings were -1.4 +/- 5.5 and -0.4 +/- 4.8 mmHg for SBP and DBP respectively for the Omron M1 Plus device, -2.1 +/- 7.4 and 0.1 +/- 4.9 mmHg for SBP and DBP respectively for the Omron M6 Comfort device, -1.4 +/- 8.6 and -0.1 +/- 3.5 mmHg for SBP and DBP respectively for the Spengler KP7500 D device, and 1.6 +/- 4.2 mmHg and 0.54 +/- 2.8 mmHg for SBP and DBP respectively for the Microlife BP A100 Plus device. For all devices, readings differing by less than 5, 10, and 15 mmHg for SBP and DBP values fulfill the recommendation criteria of the International Protocol as well as the individual analysis., Conclusions: Omron M1 Plus (HEM-401 1C-E), Omron M6 Comfort (HEM 7000-E), Spengler KP7500 D, and Microlife BP A100 Plus devices fulfilled the validation recommendations of the International Protocol.

Background: Two electronic devices for self-measurement of blood pressure - a brachial monitor, the Omron M6, and a wrist monitor, the Omron R7 - were evaluated in two separate studies according to the International Protocol of the European Society of Hypertension., Design: The International Validation Protocol is divided into two phases: the first phase is performed on 15 selected participants (45 pairs of blood pressure measurements); if the device passes this phase, 18 supplementary participants are included (54 pairs of blood pressure measurements) making a total number of 33 participants (99 pairs of blood pressure measurements) on whom the final validation is performed., Methods: The same methodology recommended by the European Society of Hypertension protocol was applied for both studies. In each study and for each participant, four blood pressure measurements were taken simultaneously by two trained observers using mercury sphygmomanometers alternately with three measurements taken by the tested device. The difference between the blood pressure value given by the device and that obtained by the two observers (mean of the two observers) was calculated for each measure. The 99 pairs of blood pressure differences were classified into three categories (

Background: Two electronic devices for self-measurement of blood pressure at the brachial artery -- the Seinex SE-9400 and the Microlife BP 3AC1-1 -- were evaluated in two separate studies according to the International Protocol of the European Society of Hypertension., Design: The international validation protocol is divided into two phases: the first phase is performed on 15 selected participants (45 blood pressure measurements); if the device passes this phase, 18 supplementary participants are included (54 blood pressure measurements) making a total number of 33 participants (99 blood pressure measurements) on whom the final validation is performed., Methods: The same methodology recommended by the European Society of Hypertension protocol was applied for both studies. In each study and for each participant, four blood pressure measurements were taken simultaneously by two trained observers using mercury sphygmomanometers alternately with three measurements by the tested device. The difference between the blood pressure value given by the device and that obtained by the two observers (mean of the two observers) was calculated for each measure. The 99 differences were classified into three categories (< or =5, < or =10, < or =15 mmHg). The number of differences in each category was compared with the number required by the ESH protocol. An individual analysis was then done to determine, for each participant, the number of comparisons < or =5 mmHg. At least 22 of the 33 participants should have two of their three comparisons < or =5 mmHg., Results: In both studies, the two tested devices passed the first phase of the validation process. For the complete analysis (phase 1 and phase 2), the average differences between the device and mercury sphygmomanometer readings were in the first study for the Seinex SE-9400 device 0.9+/-5.2 and -1.7+/-4.7 mmHg for systolic and diastolic blood pressure, respectively, and -0.2+/-4.5 and -2.0+/-4.8 mmHg for the Microlife BP 3AC1-1 device in the second study. For both devices, readings differing by less than 5, 10 and 15 mmHg for systolic and diastolic blood pressure values fulfill the recommendation criteria of the International Protocol as well as the individual analysis., Conclusions: The Seinex SE-9400 and the Microlife BP 3AC1-1 devices fulfilled the validation recommendations of the International Protocol.

Meta-analyses of clinical trials of antihypertensive medications which have measured regression of left ventricular hypertrophy reveal differences between classes of agent, with ACE inhibitors, angiotensin receptor blockers (ARBs), and calcium antagonists being more effective than beta-blockers. The PICXEL study showed that a strategy based on a low-dose combination of the ACE inhibitor perindopril and the diuretic indapamide was significantly more effective than the ACE inhibitor enalapril alone in reducing left ventricular mass. The cardioprotective effect of the combination appears to be independent of its blood pressure lowering effect. A pilot study in patients has shown that perindopril/indapamide improves coronary perfusion which is reduced in hypertension, especially in patients with left ventricular hypertrophy. In a separate study perindopril/indapamide has shown a trend towards reducing cardiovascular events. Animal studies suggest that the combination reverses the changes in arteriolar and capillary densities associated with hypertension. Clinical and experimental studies of the cardioprotective actions of antihypertensive agents are providing a better understanding of how cardiovascular complications in hypertension can be reduced by careful choice of antihypertensive medication.

Objectives: The goal of this study was to determine if a low-dose combination of the angiotensin-converting enzyme inhibitor perindopril (Per) and the diuretic indapamide (Ind) reduces central (thoracic aorta, carotid artery) as well as brachial systolic blood pressure (SBP) more than the beta-blocker atenolol and to determine the hemodynamic factors influencing independently brachial and central SBP: pulse wave velocity (PWV) and pattern of wave reflections., Background: In high cardiovascular risk populations, angiotensin blockade improves survival without affecting brachial SBP and diastolic blood pressure (DBP). Whether central SBP, which is physiologically lower than brachial SBP, is significantly reduced has never been investigated., Methods: This study was a double-blind randomized trial for one year in patients with essential hypertension., Results: For a similar DBP reduction, Per/Ind decreased SBP significantly more than atenolol, with a more pronounced reduction for central than for brachial SBP. After one year, the difference between brachial and central SBP was maintained by Per/Ind (8.28 +/- 1.53 mm Hg) and significantly attenuated by atenolol (0.29 +/- 1.61 mm Hg). Under atenolol, the principal factor modulating SBP reduction was mean blood pressure. Under Per/Ind, this parameter played a minor role, and the central SBP reduction implied a major role for disturbed PWV and wave reflections., Conclusions: Under Per/Ind, but not atenolol, normalization of brachial SBP is achieved with a significantly greater reduction of central SBP. This hemodynamic profile reflects changes of wave reflections issued from distal arterial and arteriolar territory, where Per/Ind, but not atenolol, is known to improve vessel wall structure.

Background: Two devices for self-measurement of blood pressure at the brachial artery-the Omron M5-I and the Omron 705IT-were evaluated according to the international protocol of the European Society of Hypertension., Design: The international validation protocol is divided into two phases: the first phase is performed on 15 selected subjects and if the device passes this phase, 18 supplementary subjects are included making a total number of 33 subjects on which the final validation is performed., Methods: For each subject, four blood pressure (BP) measurements were performed simultaneously by two trained observers using mercury sphygmomanometers alternately with three measurements by the tested device. The difference between the BP value given by the device and that obtained by the two observers (mean of the two observers) was calculated for each measure. The 99 differences were classified into categories (

Background: The aim of this study was to validate the Omron HEM-907 blood pressure (BP) measuring device according to the international validation protocol., Design: The international validation protocol is divided into two phases: the first phase is performed on 15 selected subjects and if the device passes this phase, 18 more subjects are selected making a total number of 33 subjects on which the final validation is performed., Methods: For each subject, BP measurements were performed simultaneously by two trained observers using mercury sphygmomanometers alternately with the Omron HEM-907 device. In all, 99 measurements were obtained for comparison. The difference between the BP value given by the device and that obtained by the two observers (mean of the two observers) was calculated for each measure., Results: The difference between the two observers was -1 +/- 2 mmHg for the systolic BP (SBP) and for the diastolic BP (DBP). The Omron HEM-907 passed the first phase of the validation process. For the second phase, the average differences between the device and mercury sphygmomanometer readings were -1 +/- 7 and -5 +/- 6 mmHg for SBP and DBP respectively. Readings for the HEM-907 device differed by less than 5 mmHg for 61 of the systolic readings and 52 of the diastolic readings; by less than 10 mmHg for 85 of the systolic readings and 85 of the diastolic readings; and by less than 15 mmHg for 94 of the systolic readings and 96 of the diastolic readings., Conclusions: The Omron HEM-907 device passes the two phases of the international validation protocol., (Copyright 2002 Lippincott Williams & Wilkins)

Background: Epidemiological studies have shown that increased arterial stiffness and wave reflections, major determinants of systolic and pulse pressure, are associated with morbidity and mortality. Therapeutic trials based on cardiovascular mortality have recently shown that reduction of systolic blood pressure (SBP) requires normalization of both large-artery stiffness and wave reflections., Aims: To compare the antihypertensive effects of the very-low-dose combination of perindopril (2 mg) and indapamide (0.625 mg) (one or two tablets per day) with the beta-blocking agent atenolol (50 mg; one or two tablets per day) in order to determine whether the combination decreased SBP and pulse pressure more than did atenolol, and whether this decrease occurred in relation to a reduction in arterial stiffness [aortic pulse wave velocity (PWV)] or a decrease in the intensity of, or delay in, wave reflections (augmentation index, measured by applanation tonometry) or a combination of both., Material and Methods: This was a double-blind randomized study in 471 individuals with essential hypertension followed for 12 months. Arterial pressure was measured in the brachial artery (mercury sphygmomanometer) and in the carotid artery (applanation tonometry)., Results: For the same reduction in diastolic blood pressure (DBP), the combination of perindopril and indapamide decreased brachial SBP and pulse pressure significantly more than did atenolol (adjusted differences between groups -6.2 +/- 1.5 and -5.5 +/- 1.0 mmHg, respectively; P < 0.001). This difference was even more pronounced for the carotid than for the brachial artery. Whereas both antihypertensive agents similarly decreased PWV, only the combination significantly attenuated wave reflections., Conclusion: Normalization of SBP, pulse pressure and arterial function--a haemodynamic profile known to improve survival significantly in hypertensive populations at high cardiovascular risk--was achieved to a greater extent with a very-low-dose combination of perindopril and indapamide than with atenolol.

International guidelines recommend that antihypertensive drug therapy should normalize not only diastolic (DBP) but also systolic blood pressure (SBP). Therapeutic trials based on cardiovascular mortality have recently shown that SBP reduction requires normalization of both large artery stiffness and wave reflections. The aim of the present study was to compare the antihypertensive effects of the very-low-dose combination indapamide (0.625 mg) and perindopril (2 mg) (Per/Ind) with the beta-blocking agent atenolol (50 mg) to determine whether Per/Ind decreases SBP and pulse pressure (PP) more than does atenolol and, if so, whether this decrease is predominantly due to reduction of aortic pulse wave velocity (PWV) (automatic measurements) and reduction of wave reflections (pulse wave analysis, applanation tonometry). In a double-blind randomized study, 471 patients with essential hypertension were followed for 12 months. For the same DBP reduction, Per/Ind decreased brachial SBP (-6.02 mm Hg; 95% confidence interval, -8.90 to -3.14) and PP (-5.57; 95% confidence interval, -7.70 to -3.44) significantly more than did atenolol. This difference was significantly more pronounced for the carotid artery than for the brachial artery. Whereas the 2 antihypertensive agents decreased PWV to a similar degree, only Per/Ind significantly attenuated carotid wave reflections, resulting in a selective decrease in SBP and PP. The very-low-dose combination Per/Ind normalizes SBP, PP, and arterial function to a significantly larger extent than does atenolol, a hemodynamic profile that is known to improve survival in hypertensive populations with high cardiovascular risk.

Objectives: We measured the properties of the arterial tree, seeking differences between men and women as they aged., Background: There are many differences between men and women, besides menopause, which might account for such disparities. These include body height, heart rate, stroke volume and smaller arterial diameters. Any gender differences in arterial stiffness could influence pulse pressure (PP), now recognized as a cardiovascular risk factor., Methods: A total of 530 patients (347 men and 183 women) were classified by age into quartiles: < or = 40, 41-47, 48-54 and > or = 55 years. The middle groups represented the menopausal years. Studies included brachial artery blood pressure (BP), aortic pulse wave velocity (PWV), B-mode ultrasonography and wave form analysis of the common carotid artery (CCA), with its conversion to the aortic wave formin. Standard echocardiography provided left ventricular dimensions and flows. Calculated values included CCA compliance and distensibility, systemic compliance, stroke volume and peripheral resistance., Results: At all ages, women had higher heart rates but lower BP than men. Pulse pressure, however, was lower in young women and higher in older women. Measurements influenced by body size, such as CCA diameter, compliance and systemic compliance, were lower in women. Those related to arterial wall properties, such as CCA and aortic distensibility, were the same. Although aortic PWV rose similarly with aging, PWV had more of an influence on PP in women than did mean BP. The reverse was true in men., Conclusions: Despite lower mean BP and similar arterial distensibilitvy, women develop a higher degree of pulsatility with aging, as compared with men. This is mainly due to their smaller physical characteristics, independent of the role of menopause and its related hormonal changes.

Morbidity and mortality in hypertension are mainly determined by arterial lesions which may occur in different regional circulations: kidney, cerebral, coronary ..., causing respectively nephroangiosclerosis, stroke or myocardial infarction... Despite the arteries heterogeneity, structural and functional abnormalities are usually observed at an early stage of hypertension in both large and small arteries. These alterations modify arterial wall physiological and mechanical properties which can be expressed clinically by increasing arterial pulsatility or pulse pressure; they facilitate establishment and progression of atherosclerosis and arteriosclerosis. Since arteries constitute the target, site and common denominator of hypertension cardiovascular complications, several noninvasive techniques may be usefull to assess their haemodynamic: casual and ambulatory blood pressure measurements can evaluate pulse pressure which can be also directly measured in different sites of the arterial tree using the "Tonometer" device; ultrasound techniques can be applied: Doppler signal to assess the arterial flow, video-echo signal to analyse the arterial structure such as intima-media thickness, or echo-tracking systems for direct measurements of arterial wall distension and thickness; pulse wave velocity is widely used as index of arterial distensibility; its assessment, using the Complior device showed that hypertensive patients present a decrease of arterial distensibility and that antihypertensive treatment do not always reverse this abnormality. Since cardiovascular morbidity and mortality are due to arterial lesions, it is important to evaluate the effect of cardiovascular prevention on the arterial wall. Large therapeutical trials, including arterial evaluation, are necessary to assess whether this consideration may particularize patients with high cardiovascular risk and contribute to their treatment and prognostic improvement.

ARTERIAL ABNORMALITIES IN HYPERTENSION: Morbidity and mortality in hypertension are mainly determined by arterial lesions which may occur in different regional circulations (e.g. kidney, cerebral, coronary circulations, causing nephro-angiosclerosis, stroke or myocardial infarction, respectively). Despite arterial heterogeneity, structural and functional abnormalities are usually observed at an early stage of hypertension in both large and small arteries. These alterations modify physiological and mechanical properties of the arterial wall, which may become clinically evident by increasing arterial pulsatility or pulse pressure; the alterations facilitate the establishment and progression of atherosclerosis and arteriosclerosis., Methods of Assessing Arterial Abnormalities: Several non-invasive techniques can be used to assess haemodynamic properties of arteries: (1) casual and ambulatory blood pressure measurements can be used to evaluate pulse pressure; (2) pulse pressure can be measured directly in different sites of the arterial tree using the Tonometer device; (3) ultrasound techniques can be applied, including Doppler signals to assess the arterial flow, video-echo signals to analyse the arterial structure such as the intimal-medial thickness and echo-tracking systems for direct measurements of arterial wall distension and thickness; (4) pulse wave velocity is widely used as index of arterial distensibility; this parameter, assessed by the Complior device, has shown that hypertensive patients have decreased arterial distensibility and that antihypertensive treatment does not always reverse this abnormality., Treatment: It is important to evaluate the effect of cardiovascular risk-reduction measures on the arterial wall. Large therapeutic trials are necessary to show whether an evaluation of arterial abnormalities can identify patients with a high cardiovascular risk and contribute to their treatment and prognostic improvement.

EFFECTS OF HYPERTENSION ON LARGE ARTERIES: The mechanical properties of large arteries make a major contribution to cardiovascular haemodynamics through the buffering of stroke volume and by propagation of the pressure pulse. A sustained increase in blood pressure often leads to stiffness of the large arteries, especially when other risk factors are present. The increased stiffness, in turn, aggravates hypertension by increasing systolic blood pressure and can induce cardiac hypertrophy and arterial lesions. Epidemiological studies strongly suggest that subjects with stiffer arteries have a high pulse pressure, and that stiffening of large arteries is associated with excess morbidity and mortality independently of other cardiovascular risk factors. ENVIRONMENTAL AND GENETIC FACTORS: Apart from high blood pressure and ageing, various environmental and genetic factors that influence the composition of the extracellular matrix of the arterial wall can increase arterial stiffness. Clinical studies suggest that the presence of some genotypes may be a particularly important risk marker for arterial stiffness, and may modulate the effects of hypertension, ageing and lipids on large arteries. EFFECTS OF ANTIHYPERTENSIVE DRUGS: The development of accurate, non-invasive methods has now made it possible to detect alterations of the large arteries. Among antihypertensive drugs, angiotensin converting enzyme inhibitors and calcium channel blockers have proved to be highly effective in improving large artery compliance, and have shown no adverse effects on metabolic factors that can alter arterial structure and function such as lipids, plasma glucose and insulin tolerance. Therefore these drugs may be particularly suitable for treating patients with increased arterial stiffness. Finally, a determination of genotypes may be helpful in the future in choosing antihypertensive therapy.

Aim: The objective of this study was to evaluate the relationship between non-invasive ambulatory blood pressure variability and cardiac baroreflex sensitivity in hypertensive patients., Subjects and Methods: Ambulatory blood pressure measurements (15-min intervals for 24 h) and continuous blood pressure measurements (Finapres, 20 min at rest after a 10-min resting period) were performed in 123 untreated hypertensives (resting diastolic blood pressure > or = 90 mmHg; 80 males, 43 females; mean +/- SD age 49 +/- 12 years, range 19-73). Fourier series were used to model 24-h blood pressure profiles (four harmonics). Ambulatory blood pressure variability was assessed by determination of the residuals in each 24-h blood pressure profile (measured minus predicted pressures). Resting blood pressure variability was defined as the SD of the mean Finapres value. Baroreflex sensitivity was evaluated by automatic detection of blood pressure and pulse interval sequences of > or = 3 beats when systolic blood pressure and pulse interval sequences changed in the same direction (increase or decrease: 1 mmHg for systolic blood pressure and 4 ms for RR interval), and was assessed as the slope of the regression line for each sequence., Results: Ambulatory systolic blood pressure variability increased with age (r = 0.28*) and systolic pressure (r = 0.44**). Baroreflex sensitivity (increasing systolic pressure/pulse interval) decreased significantly with age (r = -0.48**) and systolic pressure (r = -0.23**), and was significantly related to increased ambulatory blood pressure variability (r = -0.33**). In a multivariate stepwise analysis the relationship between ambulatory blood pressure variability and baroreflex sensitivity (increasing systolic pressure/pulse interval) was statistically independent of age and systolic pressure (R = 0.55, P<0.001); this relationship was not observed with the corresponding decreasing sequence., Conclusions: This study shows that in uncomplicated hypertension, ambulatory blood pressure variability is related to baroreflex sensitivity independently of the blood pressure level. This finding has prognostic implications for this non-invasive measurement, which needs to be confirmed by large longitudinal studies.

In hypertension, the principal components of the mechanical stress acting on the arterial wall may be evaluated not only from the level of peak systolic and end-diastolic blood pressure but also by the level of pulse pressure and variability of blood pressure measured by ambulatory monitoring. The purpose of the present study was, in a population of 51 subjects with essential hypertension, to determine the influence of these parameters and of heart rate on the distension capacity of the common carotid artery, measured noninvasively by high-resolution echo-tracking techniques. The pulsatile change in diameter of the carotid artery diameter, estimated either in absolute or relative values, was shown to be significantly and independently correlated with four mechanical parameters deduced from daytime ambulatory blood pressure measurements: baseline diastolic blood pressure (the lower the diastolic blood pressure, the higher the distension capacity; r = -0.44; P < .001); pulse pressure (the higher the pulse pressure, the higher the distension capacity; r = 0.32; P < .024); variability of diastolic blood pressure (the higher the variability, the higher the distension capacity; r = 0.37; P < .008); and mean heart rate (the higher the heart rate, the more reduced the distension capacity; r = -0.28; P < .05). Multiple regression analysis indicated that mean diastolic blood pressure and its variability, mean heart rate, and pulse pressure acted independently on carotid artery distension, even after adjustment for age. The present study suggests for the first time that, in humans, hypertension may act on the arterial wall not only through the amplitude of peak systolic and end-diastolic blood pressure but also through several other mechanical factors involving the level of pulse pressure and heart rate and also blood pressure variability. Thus, in addition to the level of blood pressure, carotid artery distension is specifically influenced by two factors independently implicated in the epidemiologic cardiovascular risk: pulse pressure and heart rate.

Objective: To assess the circadian blood pressure profile observed 3 months after endarterectomy., Design: Twenty-five patients undergoing unilateral or bilateral carotid endarterectomy were compared with a control population of 20 patients, matched for age, sex, weight and drug therapy. Casual mean blood pressure measured by mercury sphygmomanometry was similar in both groups., Results: Non-invasive ambulatory blood pressure monitoring showed that, whereas mean arterial pressure was identical in both groups, the group undergoing surgery had a significant increase in pulse pressure and its variability over 24 h. Such abnormalities predominated during the nocturnal period, in which the reduction in systolic blood pressure was less pronounced in the operated group than in controls. For all parameters there was no significant difference between subjects with unilateral or bilateral endarterectomy., Conclusion: This study provides evidence that patients with carotid endarterectomy were characterized in the long term by an increase in the pulsatile component of blood pressure and its variability, in association with a disturbance in the physiological circadian rhythm. Such findings were not identified using casual blood pressure measurements.

In a double-blind cross-over study, the arterial changes produced by hydrochlorothiazide were compared with those observed after the calcium antagonist felodipine in 16 patients with mild to moderate systemic hypertension. Diameter changes at the site of the common carotid and brachial arteries were investigated using pulsed Doppler velocimetry, and pulse-wave velocities of the aortic, brachial and femorotibial areas were measured using standard noninvasive techniques. Whereas hydrochlorothiazide and felodipine similarly decreased blood pressure, hydrochlorothiazide did not change pulse-wave velocity, and the diameters of the brachial and common carotid arteries. Felodipine significantly decreased pulse-wave velocity, and increased brachial arterial diameter and compliance, with no change in carotid arterial diameter. Evidence was found that although felodipine had specific effects on the arterial system of hypertensive subjects, hydrochlorothiazide did not produce any sizable arterial change. These differential effects may influence specifically the heart afterload, with important consequences for diuretics that are known to cause minimal changes in cardiac structure and function.

In this study the dose-response curves reflecting the arterial and the antihypertensive effects of converting enzyme inhibition were analysed. The BP measurement (using a random zero sphygmomanometer) and its decrease following converting enzyme inhibition were used as a marker of the arteriolar effect of the drug. The effect on conduit arteries was evaluated through determination of carotid-femoral pulse wave velocity used as an index of arterial distensibility. We compared the dose-response curves of these two parameters in a double-blind study carried out in 24 patients with essential hypertension, who were randomised between placebo and 2, 4 and 8 mg of the converting enzyme inhibitor trandolapril given for 8 days. The antihypertensive effect was observed from 2 mg, at which dose the plateau of BP reduction was already achieved. No significant correlation was found between dose and BP reduction (r = -0.34), whereas the dose was significantly related to the change in pulse wave velocity (r = -0.56, P < 0.01). No significant correlation was found between changes in BP and change of pulse wave velocity. The study provides evidence that the effect on the conduit artery was obtained for higher doses than the BP effect in patients treated for hypertension by the converting enzyme inhibitor trandolapril.

Background: Clinical and experimental data have shown that different antihypertensive drugs do not cause similar changes in arterial compliance for an equipotent blood pressure reduction. There are no clear data on the effects of sodium and diuretics on the visco-elastic properties of the hypertensive arterial wall., Data Analysis: Cross-sectional epidemiological studies suggest that for given values of age and blood pressure, pulse wave velocity is lower in the presence than in the absence of a low sodium intake. Longitudinal studies indicate that in hypertensive subjects, a low sodium intake is associated with a larger brachial artery diameter than that seen with a high sodium intake. In hypertension in the elderly and in severe hypertension with end-stage renal disease, a sodium overload reduces arterial compliance and distensibility independently of blood pressure changes. In animal studies, the diuretic compounds cycletanine and indapamide increase systemic and carotid compliance independently of blood pressure changes. In contrast, in a crossover study in hypertensive subjects, the diuretic agent hydrochlorothiazide did not change arterial compliance and pulse wave velocity while the calcium entry-blocker felodipine did improve these hemodynamic parameters., Conclusion: The studies reviewed indicate that sodium may act on the arterial wall independently of blood pressure changes. the contribution made by counter-regulatory mechanisms, which may be related to the renin-angiotensin and the sympathetic nervous systems, might explain the differences between the clinical and the experimental changes observed with diuretic compounds.

Background: In treating hypertension the optimal dose of angiotensin converting enzyme (ACE) inhibitor is derived from dose-response curves that relate the quantity of drug taken to the resulting fall in blood pressure; the blood pressure fall reflects a decrease in vascular resistance and hence, a degree of arteriolar vasodilation. However, ACE inhibition dilates not only the small arteries but also the larger calibre arteries, which increases compliance. Given the differences in structure and function of large and small arteries, the optimal drug dose for a given vessel may differ according to the size and structure of the vessel. DOSE-RESPONSE EFFECTS IN CLINICAL STUDIES: Clinical studies indicate that in the brachial artery territory, larger doses are required to obtain arterial dilation than to produce a decrease in vascular resistance. In the aorta, an improvement in arterial compliance and distensibility is governed both by the fall in blood pressure and the drug dose. Finally, for the femoral artery, the degree of arterial dilation is influenced markedly only by the drug dose., Application to Treatment: An understanding of the drug dose required to produce a given change in the hypertensive arterial system may have important implications for the control of blood pressure. For a given mean arterial pressure, systolic blood pressure is lower and diastolic blood pressure higher when aortic compliance is increased, a haemodynamic change commonly seen following ACE inhibition. Recent double-blind studies have shown that ACE inhibitors produced a more pronounced decrease in systolic than diastolic blood pressure., Conclusion: These findings indicate that the optimum doses required to improve the arterial wall in large arteries must be evaluated by long-term antihypertensive therapy.

Large artery dilation is produced by angiotensin-converting enzyme inhibition in hypertensive subjects despite a significant blood pressure reduction. The resulting increase in arterial compliance may be due both to blood pressure decrease and to arterial smooth muscle relaxation. In healthy volunteers and in hypertensive subjects, dosages causing large artery dilation seem to be higher than those causing pure arteriolar dilation with resulting blood pressure reduction. Similar findings have been noted to obtain compliance enhancement. Such results may be important in considering antihypertensive therapy, particularly when remodeling of the cardiovascular system is considered in long-term treatment.

Objective: Casual (mercury sphygmomanometer) and ambulatory blood pressure measurements were determined in 61 subjects with sustained essential hypertension., Design: Patients were classified into three subgroups: smokers or non-smokers; patients with or without hyperglycemia; and patients with or without plasma lipoprotein abnormality. Mean casual blood pressure were shown to be identical in these three subgroups., Results: When ambulatory blood pressure was analyzed, smokers exhibited a significant increase in pulse pressure exclusively during the activity period, whereas diastolic blood pressure and mean arterial pressure (MAP) were not modified in comparison with controls. Patients with abnormal plasma glucose showed a significant increase in systolic and pulse pressure during both activity and non-activity periods, with a slight increase in MAP during the activity period. Patients with and without plasma lipid abnormality displayed similar ambulatory blood pressure., Conclusion: The study provides evidence that, in spite of similar casual blood pressure levels among smokers and non-smokers, as well as among those with elevated fasting glucose levels, smokers and patients with hyperglycemia have a higher systolic and pulse pressure during 24-h monitoring, pointing to the possible role of cyclic stress in the deterioration in the structure of the hypertensive arterial wall.

Common carotid blood flow and cold pressor test were evaluated in 16 patients with sustained essential hypertension before and after 30 days treatment with the converting enzyme inhibitor Enalapril (20 mg). Enalapril decreased blood pressure and carotid vascular resistance with no significant change in heart rate. After treatment, despite a wide range of the responses, the changes in systolic blood pressure to cold test were significantly attenuated, whereas the heart rate responses were not. Acute random and double blind administration of either Cadralazine or Nitrendipine, two vasodilating drugs which are known to cause an activation of the autonomic nervous system, were performed before and after long term treatment by Enalapril. Whereas the blood pressure and heart rate responses to cold test was unmodified by these compounds before Enalapril treatment, significant changes were observed after converting enzyme inhibition: Cadralazine reduced the heart rate response whereas Nitrendipine increased it significantly. The study provides evidence that converting enzyme inhibition causes sympatho-inhibitory influences which are principally observed in stress conditions, with heterogeneous responses depending on the nature and the type of stimulation.

Cardiac hypertrophy in hypertension is related to increased peripheral vascular resistance and reduced aortic compliance. Non-invasive measurement of pulse wave velocities and systolo-diastolic variations of the diameter of the aortic arch show that an increase in the elastic modulus of the aorta is closely related to the increase in cardiac mass. This relationship holds even after correction for mean arterial pressure. Therefore, it has been suggested that, in hypertension, the decreased aortic compliance leads to a disproportionate increase in systolic blood pressure and end systolic wall stress, predisposing to cardiac hypertrophy. The blood pressure, arterial haemodynamics of the forearm (by pulsed Doppler flow measurement) and echocardiographic parameters were studied in 16 patients with permanent essential hypertension, before and 3 months after treatment with perindopril, an ACE inhibitor. In a simple blinded study versus placebo, perindopril was shown to significantly reduce the blood pressure (p less than 0.01) while brachial blood flow increased (p less than 0.01) because of a simultaneous increase in blood flow velocity and arterial diameter. During 5 minutes' occlusion at the wrist, blood flow velocity decreased more in patients taking perindopril than those on placebo (p less than 0.01) whilst the reduction in arterial diameter was equivalent, indicating that the increase in arterial diameter with perindopril could not be explained by flow-dependent dilatation alone but by a direct effect of the drug on the artery. During the treatment phase, brachial arterial compliance increased (p less than 0.01) and pulse wave velocity decreased (p less than 0.01) and there was no change in arterial shear stress defined as the product of mean blood pressure and arterial diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this study was to validate a two-dimensional (2D) echography coupled range-gated Doppler system for the non-invasive measurement of internal diameter, blood flow velocity, and pulse wave velocity of peripheral arteries, such as the common carotid artery (CCA), femoral artery (FA), and brachial artery (BA) in man. The array of the ultrasonic system and the Doppler probe were attached and formed a fixed angle (38 degrees 30'). The artery was firstly visualized using the echo-graphic array probe in order to position the Doppler beam. Then, the range-gated Doppler system was used to measure both internal diameter and blood flow velocity with the sample volume position covering the internal diameter. Using a hydraulic device, there was an obvious correlation between the calculated and the measured velocities (r = 0.98). Normal values of diameter, blood flow velocity and blood flow were measured in 18 healthy volunteers. The means (+/- 1 standard deviation) was as follows: diameter, CCA = 0.636 +/- 0.027 cm, FA = 0.843 +/- 0.074 cm, BA = 0.302 +/- 0.052 cm; flow velocity, CCA = 19.5 +/- 2.1 cm s-1, FA = 11.4 +/- 1.2 cm s-1, BA = 6.7 +/- 1.0 cm s-1. Blood flows were as follows: CCA, 370.6 +/- 42.5 ml mn-1, FA 387.0 +/- 75.0 ml mn-1 and BA (wrist occlusion) 29.8 +/- 12.5 ml mn-1. The intra-observer reproducibilities for CCA, FA and BA were respectively: for diameter, 4.9%, 4.12% and 14.8%; for velocity, 8.9%, 10.6% and 10.2%. The inter-observer reproducibilities were respectively: for diameter, 5.6%, 5.4% and 11.3% for velocity, 6.5%, 5.7% and 6.3%. Simultaneous determinations of pulse wave velocity from blood flow velocity recording allowed estimations of the distensibility of these arteries. Finally, the coupled echo and range-gated Doppler system permitted non-invasive evaluation of blood flow calculated as the product of the vessel cross-sectional area and measured blood velocity and also of arterial compliance as the ratio of the cross-sectional area and the square of pulse wave velocity. Such estimations of the conduit and buffering functions of peripheral large arteries in man were shown to be more accurate for the common carotid and the femoral arteries than for the brachial artery.

Blood pressure, heart rate, common carotid and brachial arterial hemodynamics using pulsed Doppler flowmetry and pulse wave velocity determinations were evaluated using a double-blind crossover design versus placebo in 14 patients with sustained essential hypertension treated by the selective beta 1 blocking agent bisoprolol. Blood pressure and heart rate significantly decreased after bisoprolol, whereas no significant change occurred in the diameter, the blood flow and in the vascular resistance of the carotid and brachial circulations. Pulse wave velocity significantly decreased in the brachioradial and the carotid femoral areas. The decrease in the latter was -1.6 +/- 0.8 m/s with bisoprolol and -0.06 +/- 0.80 m/s with placebo (p = 0.001). Brachial artery compliance significantly increased from 117 +/- 49 to 205 +/- 84 cm4 x dynes-1 x 10(9) (p = 0.001), indicating that the antihypertensive effect of beta 1 blockade is associated with an improvement in the viscoelastic properties of the brachial artery wall.

The load of the heart in hypertension is related both to increased peripheral vascular resistance and decreased aortic compliance. From noninvasive studies involving determinations of pulse-wave velocity and systolic-diastolic variations of aortic arch diameter, it can be shown that increased aortic elastic modulus is strongly related to increased cardiac mass. The relationship is observed even after adjustment for the level of mean arterial pressure. It is suggested that decreased aortic compliance in hypertension causes a disproportionate increase in systolic pressure and end-systolic stress, thus contributing to promote cardiac hypertrophy. Such a possibility may have consequences for long-term antihypertensive therapy. Following converting enzyme inhibition and calcium blockade, important dissociations may be observed between the antihypertensive effect and the cardiac and arterial changes.

Blood pressure, forearm arterial haemodynamics and echocardiographic parameters were studied in patients with sustained essential hypertension before and after administration of the ACE inhibitor, perindopril. In a single blind study versus placebo, perindopril significantly reduced BP and at the same time increased brachial artery diameter, blood flow and compliance. As part of the haemodynamic investigation, a 5 minute wrist occlusion was performed. During this period, blood flow velocity and arterial diameter decreased but the reduction in diameter was smaller with perindopril after one year's treatment showing an increase in brachial artery diameter. This result indicates that the increase in brachial arterial diameter following perindopril could not be explained solely on the basis of a flow dependent dilation. When perindopril was withdrawn after three months of treatment and replaced by placebo for four weeks, BP and forearm arterial haemodynamics returned towards baseline values. However, cardiac mass which was significantly decreased after perindopril remained decreased four weeks after cessation of treatment. In the seven normalised patients, perindopril was continued for one year; arterial compliance remained increased and cardia mass diminished. The study showed that the arterial changes caused by perindopril involved a drug-related relaxation of arterial smooth muscle and that there was a differential response in cardiac and arterial changes following long term treatment.

The ratio between ankle (ASP) and brachial (BSP) systolic pressure was studied by using Doppler ultrasound in 198 normal subjects aged between twenty and ninety years: 97 males and 101 females. The ASP/BSP ratio decreased significantly with age both in males (r = -0.64; p less than 0.001) and in females (r = -0.72; p less than 0.001). In males, the decrease in the ratio with age was due to a significant decrease in ASP with age (r = -0.52; p less than 0.001), whereas BSP did not increase significantly with age. In females, a different result was observed, since only BSP (and not ASP) was significantly (and positively) correlated with age. In both sexes, the diameter of the terminal abdominal aorta measured by echocardiography was significantly increased with age, and full examination with Doppler ultrasound excluded any significant arterial stenosis of the lower limbs. The study provided evidence that age- and sex-related changes in arterial wave transmission do exist in normal subjects.

Blood pressure, forearm arterial hemodynamics (with a pulsed Doppler flowmeter), and echocardiographic parameters were studied in 16 patients with sustained essential hypertension before and 3 months after administration of the converting enzyme inhibitor perindopril. In a single-blind study versus placebo, it was shown that perindopril significantly reduced blood pressure (p less than 0.01), whereas there was an increase in brachial blood flow (p less than 0.01) because of a simultaneous increase in blood flow velocity (p less than 0.01) and arterial diameter (p less than 0.01). During a 5-minute period of wrist occlusion, blood flow velocity was reduced to a greater extent with perindopril than with placebo (p less than 0.001), whereas corresponding reductions in arterial diameter were equivalent, indicating that the increase in diameter after perindopril could not be explained simply on the basis of flow-dependent dilatation. During active treatment, brachial artery compliance increased (p less than 0.01) and pulse wave velocity decreased (p less than 0.01), whereas there was no change in the tangential tension of the arterial wall, defined as the product of mean arterial pressure and arterial diameter. Four weeks after treatment was stopped, blood pressure and forearm arterial hemodynamics returned toward baseline values. Cardiac mass was significantly decreased after perindopril (p less than 0.01) and remained decreased 4 weeks after cessation of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

1. The ratio between ankle (ASP) and brachial (BSP) systolic pressures was studied using Doppler ultrasound in 66 male subjects, 33 with sustained uncomplicated essential hypertension and 33 age-matched normal controls. 2. Based on covariance analysis, the ASP-BSP relationship was significantly different in the two populations, the ASP/BSP ratio (mean +/- SEM) being significantly lower in hypertensive subjects (106 +/- 1 vs 132 +/- 2; P less than 0.001). 3. While the ASP/BSP ratio was negatively correlated with age in normal subjects, no significant correlation was observed in hypertensive subjects. 4. The diameter of the terminal abdominal aorta measured by echography was significantly greater in hypertensive subjects, while full examination with Doppler ultrasound excluded any significant arterial stenosis of the lower limbs. 5. The study suggested that, in patients with sustained uncomplicated essential hypertension, the lower ASP/BSP ratio is related to changes in arterial wave transmission.

Arterial distensibility estimated by carotid femoral pulse wave velocity was evaluated in 22 patients with sustained essential hypertension, together with 3 different methods of blood pressure (BP) measurement: mercury sphygmomanometer, semiautomatic BP recording using the Dinamap apparatus and 24-hour ambulatory BP monitoring using a Spacelabs monitor. Although pulse wave velocity did not correlate with BP measured by mercury sphygmomanometer, it strongly and positively correlated with BP measurements using the other 2 procedures. The best correlation was observed with ambulatory BP with respect to systolic BP only (r = 0.685, p less than 0.001). Since cardiovascular morbidity and mortality in hypertensive patients is mainly related to lesions of the large arteries, the determination of pulse wave velocity together with ambulatory BP measurements is proposed for the evaluation of cardiovascular risk.

Brachial artery mean arterial pressure (MAP), blood flow velocity (BFV), blood flow (BF), and arterial compliance (AC) were measured using pulsed Doppler systems in patients with sustained essential hypertension. The hemodynamic investigation was performed before (T0) and after 3 months (T1) of chronic treatment with the converting enzyme inhibitor Perindopril and after a further month with placebo (T2). Following treatment with Perindopril, BFV, BF, and AC significantly increased while MAP significantly decreased. The changes in AC and BFV were negatively and significantly correlated both between T0 and T1 and between T1 and T2. The study showed that the increase in arterial compliance produced by Perindopril was inversely related to the extent of arteriolar dilatation, indicating that factors other than the blood pressure reduction itself were involved in the brachial artery changes.

An indirect approach for the study of the changes in the incremental circumferential modulus (E) of the brachial artery after arteriolar vasodilatation was undertaken in patients with sustained essential hypertension. The product of E and the thickness (h) of the arterial wall was evaluated by means of the Moens-Korteweg equation using determinations of brachioradial pulse wave velocity and brachial artery diameter with pulsed Doppler methods. In three homogeneous groups of patients with hypertension the Eh product was studied after vasodilatation caused either by nitrendipine, a calcium entry blocking agent, or by medroxalol, an alpha and beta blocking agent, or by isosorbid dinitrate. The three drugs caused similar reductions in blood pressure and increases in arterial diameter and hence decreases in wall thickness. Variance analysis for multigroups indicated that the decrease in Eh after vasodilatation was significant for nitrendipine but not for medroxalol and isosorbid dinitrate. Covariance analysis showed that for any level in Eh product the decrease in Eh was higher for nitrendipine than for isosorbid dinitrate and medroxalol. Since the three drugs had comparable mechanical and geometrical effects, the study provided evidence that, in men with essential hypertension, the smooth muscle tone of the brachial artery was significantly more sensitive to calcium inhibition than to autonomic blockade, causing a more important decrease in elastic modulus.

Non-invasive ambulatory blood pressure monitoring (Spacelabs 5200) was carried out before and 3 months after treatment with perindopril, a new angiotensin converting enzyme (ACE) inhibitor given at 4-8 mg once a day in the morning. Twenty-one patients with sustained essential uncomplicated hypertension were analysed. The 24-h mean values for systolic and diastolic blood pressure, their standard deviations (absolute variability) and their coefficients of variation were compared before and after the administration of perindopril, using a two-way analysis of variance. In order to determine whether perindopril could decrease systolic more than diastolic pressure, we evaluated the relationship between systolic and diastolic blood pressure as recorded by the Spacelabs monitor. The correlation coefficient between these two parameters was calculated before (r = 0.82) and after (r = 0.76) treatment. Comparison between the corresponding slopes indicated that, at any given value of diastolic blood pressure, systolic blood pressure was lower after than before the administration of perindopril.

The effects of perindopril on the 24-hour arterial pressure levels were evaluated by ambulatory recording in 21 patients (mean age 48 +/- 2 years) with mild to moderate hypertension. At the end of a 3 months treatment with perindopril (4 to 8 mg per day in one dose), comparison by variance analysis of the mean values of arterial pressure over 24 hours before and after treatment showed a significant decrease of SAP (from 144 +/- 3 to 133 +/- 3 mmHg, p less than 0.01) and DAP (from 95 +/- 2 to 87 +/- 2 mmHg, p less than 0.01). The fall in arterial pressures was more pronounced during day-time (7 a.m. to 10 p.m.) than at night. Particular attention was paid to the reduction of systolic pressure owing to its relation with arterial compliance. There was a significant correlation between ambulatory recordings of SAP and DAP before and after treatment (r = 0.82 and 0.76 respectively, p less than 0.001). Calculation and comparison of the corresponding regression slope showed that for any given level of DAP, SAP was lower after than before treatment. This effect is related to the increase of arterial compliance observed after treatment with perindopril, as already reported by other authors.

Pulse wave velocity was measured in 27 obese and 25 nonobese patients with sustained essential hypertension. Pulse wave velocity was significantly increased in obese patients in comparison with nonobese patients. The result was independent of age, sex, and level of blood pressure. In the overall population, a significant positive correlation (r = 0.85; p less than 0.001) was observed between the degree of obesity and pulse wave velocity. A study of partial correlation coefficients indicated that the levels of glycemia, cholesterolemia, and triglyceridemia did not influence the relationship. After body weight was reduced, blood pressure decreased and arterial compliance increased. The results show that in patients with sustained essential hypertension: pulse wave velocity and obesity are strongly related independent of age, sex, blood pressure, and associated metabolic disorders and body weight reduction is associated with an improvement of arterial distensibility and compliance.

Blood pressure, forearm arterial haemodynamics and echocardiographic parameters were studied in patients with sustained essential hypertension before and after administration of the angiotensin converting enzyme (ACE) inhibitor perindopril for 1 year. Perindopril significantly reduced blood pressure and at the same time increased brachial artery blood flow, diameter and compliance. As part of the haemodynamic investigation, a 5-min period of wrist occlusion was performed. Blood flow velocity decreased significantly to the same extent with perindopril and with placebo, but the corresponding reductions in arterial diameter were smaller with perindopril than with placebo, indicating that the increase in diameter following perindopril could not be explained solely on the basis of a flow-dependent dilation. After 3 months, treatment was stopped for 4 weeks. Blood pressure and forearm arterial haemodynamics returned towards baseline values. However, cardiac mass, which was significantly decreased after perindopril administration, remained decreased 4 weeks after cessation of treatment. In seven responder patients, perindopril was continued as sole therapy for 8 months. Arterial compliance remained elevated and cardiac mass diminished. The study showed that the arterial changes caused by perindopril involved a drug-related relaxation of arterial smooth muscle and that there was a differential response in cardiac and arterial changes following long-term treatment.