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Background and objectives: Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In this study we tried to know the role of office and ambulatory BP in treated hypertensive patients. Methods and patients: Prospective cohort of 561 treated hypertensive patients were enrolled in the study. Hypertension definitions were according to JNC 8 classification. Office BP and ambulatory BP monitoring was done according to defined protocol. Results: From a subgroup of 158 treated hypertensive patients, 91(16.2%) patients were having white coat hypertension (p value 0.00 by Pearson chi square test). In a subset of 403 patients who were having controlled BP on the day of enrolment as well as on the day of attaching ambulatory BP monitor; 98 (17.4%) patients were having masked uncontrolled hypertension (MUCH). In addition there was very significant percentage of non-dippers and reverse dippers. In our study we found that office BP has a moderate to low specificity and sensitivity and low negative predictive value for overall control in treated hypertensive patients. Conclusion: Ambulatory BP monitoring should be included in the management protocol of treated hypertensive patients, for the optimal BP control.
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A anormalidade da pressão arterial durante o período de sono identificada como médias ≥ 120 x 70 mm Hg, por meio de registros da Monitorização Ambulatorial da Pressão Arterial de 24 horas (MAPA), está relacionada a pior prognóstico e maior risco de eventos. Essa alteração pode ser decorrência de vários fatores, mas, geralmente, independentemente da causa está fortemente relacionada a maior probabilidade de eventos e mortalidade cardiovasculares. Ainda restam dúvidas, embora evidências começam a ser oferecidas, se o tratamento medicamentoso desse estado de comportamento peculiar da pressão arterial nas 24 horas deva ser instituído. Nessa revisão esses aspectos são amplamente discutidos com base nas melhores evidências disponíveis
The abnormality of blood pressure during the sleep period identified as means ≥ 120 x 70 mm Hg, through 24-hour Ambulatory Blood Pressure Monitoring (ABPM) records, is related to a worse prognosis and greater risk of events. This change can be due to several factors, but, generally, regardless of the cause, it is strongly related to a higher probability of cardiovascular events and mortality. Doubts remain, although evidence is beginning to be offered, whether drug treatment of this peculiar behavioral state of blood pressure within 24 hours should be instituted. In this review, these aspects are widely discussed based on the best available evidence
Subject(s)
Humans , Sleep , Blood Pressure Monitoring, Ambulatory , Arterial Pressure/physiology , Hypertension/physiopathologyABSTRACT
Resumen: La monitorización ambulatoria de la presión arterial (MAPA) es una herramienta clínica útil para el diagnóstico y confirmación de hipertensión arterial en pediatría y permite igualmente el diagnóstico de condiciones especiales como la hipertensión de delantal blanco e hipertensión enmascarada. Exis ten recomendaciones internacionales para su realización e interpretación, sin embargo, aún quedan interrogantes por resolver. En esta guía se resume la bibliografía disponible y se intenta estandarizar, a través de consenso de especialistas nacionales, la aplicación de esta técnica. Se necesitan más estudios de investigación en niños que aporten nuevos valores de referencia y que determinen la relación de alteraciones en MAPA con resultados clínicos a largo plazo.
Abstract: Ambulatory blood pressure monitoring (ABPM) is a useful clinical tool for the diagnosis and confir mation of arterial hypertension in pediatrics, and also allows the diagnosis of special conditions such as white coat hypertension and masked hypertension. There are international recommendations for its implementation and interpretation, however, there are still unresolved questions. This guide summarizes the available literature and attempts to standardize, through consensus of national specia lists, the application of this technique. More research studies are needed that provide new reference values and determine the relationship of alterations in ABPM with long-term clinical results.
Subject(s)
Humans , Child , Practice Guidelines as Topic , Blood Pressure Monitoring, Ambulatory/methods , Hypertension/diagnosis , Pediatrics , Reference Values , Blood Pressure/physiology , ChileABSTRACT
Background: Obesity is widely described as a leading cause of morbidity and mortality and is a known risk factor of many cardiovascular and non-cardiovascular diseases including hypertension. The aim of this study was to analyze the pattern of ambulatory blood pressure in overweight and obese subjects.Methods: This was a prospective, cross-sectional study performed over a period of 1 year in 95 subjects attending the Department of Medicine of tertiary care teaching institute. Anthropometric measures such as weight, height, body mass index (BMI), and waist circumference (WC) were recorded. Ambulatory blood pressure monitoring over a period of 24-hrs was performed in each individual and values were recorded. Comparison between normal subjects and overweight and/or obese subjects was done in terms of various ambulatory BP parameters.Results: Based on BMI, significantly higher proportion of females were obese (p-value = 0.020), as compared to males. Based on both BMI and WC, significant proportion of overweight and obese subjects had higher 24-hr SBP (p-value < 0.001) and 24-hr DBP (p-value = 0.001); higher day-time SBP (p-value < 0.001); higher night-time SBP (p-value < 0.001); and widening of 24-hr pulse pressure (> 50 mmHg) (p-value < 0.001) as compared to normal subjects. However, among various abnormal ABPM parameters, majority of the parameters revealed more incidence of BP abnormalities with increased BMI than with increased WC. Thus, BMI appeared to be a better anthropometric parameter than WC.Conclusions: The findings of the present study confirm that obesity in apparently non-hypertensive subjects leads to rise in both SBP and DBP. Moreover, it is the systolic part of ABPM which probably predicts the cardiovascular morbidity in overweight and obese subjects.
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Resumen: La hipertensión arterial (HTA) en niños y adolescentes es una patología importante, asociada a fac tores modificables y no modificables. En la edad pediátrica, la prevalencia de la HTA es de alrededor de un 3,5%, y va aumentando progresivamente con la edad. El método ideal para su diagnóstico es la medición de la presión arterial (PA) con instrumentos auscultatorios. Según lo publicado por la Academia Americana de Pediatría (AAP) la PA debe ser medida en niños mayores de 3 años una vez al año, y en niños menores de 3 años, si presenta factores de riesgo. Una vez confirmada la HTA, la evaluación debe dirigirse hacia la detección de una enfermedad causal y a la búsqueda de factores de riesgo asociados a una HTA primaria. El objetivo del tratamiento de la HTA primaria y secundaria en pediatría es lograr un nivel de PA que disminuya el riesgo de daño de órgano blanco. Las opcio nes terapéuticas incluyen: tratamiento según etiología específica, no farmacológico y farmacológico. Este documento es producto de un esfuerzo colaborativo de la Rama de Nefrología de la Sociedad Chilena de Pediatría con el objetivo de ayudar a los pediatras y nefrólogos infantiles en el diagnóstico y tratamiento de la HTA en la infancia. En esta primera parte, se presentan las recomendaciones del diagnóstico y estudio.
Abstract: Hypertension (HT) in children and adolescents is an important pathology, associated with modi fiable and non-modifiable factors. In the pediatric, the prevalence of HT is around 3.5%, and it in creases progressively with age. The ideal method for diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. As published by the American Academy of Pediatrics (AAP), BP should be measured in children over 3 years of age once a year, and in children under 3 years of age, if it presents risk factors. Once HT has been confirmed, the evaluation should be directed towards the detection of a causative disease and the search for risk factors associated with primary HTN. The goal of treating primary and secondary HTN in pediatrics is to achieve a level of BP that decreases the risk of target organ damage. The therapeutic options include: treatment according to specific etiology, non-pharmacological and pharmacological. This document is the product of a collaborative effort of the Nephrology Branch of the Chilean Society of Pediatrics with the aim of helping pediatricians and pediatric nephrologists in the diagnosis and treatment of hypertension in childhood. In this first part, the recommendations of the diagnosis and study are presented.
Subject(s)
Humans , Child , Adolescent , Hypertension/diagnosis , Hypertension/therapy , Physical Examination , Blood Pressure Determination/methods , Risk Factors , Combined Modality Therapy , Hypertension/etiology , Medical History Taking , Antihypertensive Agents/therapeutic useABSTRACT
Parkinson’s disease (PD) manifests with motor symptoms of tremor, bradykinesia, muscle rigidity and postural instability. However, various nonmotor symptoms (NMS) have recently been recognized, among which autonomic dysfunction is observed long before the advent of motor symptoms and is aggravated through the course of the disease. Blood pressure (BP) abnormalities also result from autonomic dysfunction which induces orthostatic hypotension (OH), postprandial hypotension (PPH), nocturnal hypertension (NH) and, in particular, great fluctuation of BP over the range of 100 mmHg in a day that is often monitored by 24-hour ambulatory blood pressure monitoring (ABPM). A number of investigations on autonomic dysfunction in PD using 123I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy, neuropathology and immunohistochemistry indicate the centripetal degeneration of the cardiac sympathetic nerves and other autonomic pathology in other organs. Since PD patients have lost neural control of BP, their BP should depend on humoral factors that cannot respond to changes in and out of the body as promptly as autonomic nerves. This may be one of the reasons for irregularly fluctuating and unpredictable BP. Hypertensive fluctuation is much riskier than OH and PPH for vascular events of cerebrovascular disease, cardiovascular disease and other organopathies. Non-medical and medical treatments such as calcium channel blocking may be effective to stabilize BP in patients.
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Objective: To evaluate the anamnestic prevalence of hypertension and the number of subjects with high blood pressure independently by clinical history; quantify how many subjects are in our population with masked hypertension. Design: Descriptive observational study with simple random sampling of residents in Santarcangelo di Romagna. Setting and Participants: From February 2011 to February 2013 we carried out the prospective evaluation of 127 participants: 59 females and 68 males, whose average age was 64 years (range 51 - 80). We performed office blood pressure, ambulatory blood pressure monitoring (ABPM) and recorded clinical history. Results and Conclusion: Our population was made of 62 cases with anamnesis of high blood pressure (the anti-hypertensive treatment works only in 79% cases) and of 65 persons without anamnestic hypertension. In this sub-population in 9 cases the office measurement performed before ABPM was normal, but ABPM found high values of blood pressure night time, and an increased average value, condition compatible with a MH diagnosis. The implications are that there is a substantial number of people in the general population who has untreated hypertension and an increased risk of cardiovascular disease that requires serious consideration. The results obtained in this work, in our opinion, suggest a more intensive use of ABPM in the management of patients with high blood pressure or without hypertension but with organ damage difficult to explain, particularly in diabetics and smokers.
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Hipertensão permanece não controlada na maioria dos pacientes que utilizam tratamento antihipertensivo. Pacientes tratados com hipertensão não controlada freqüentemente têm múltiplos fatores de risco cardiovascular. Além disso, vários estudos observacionais têm demonstrado que a maioria dos pacientes com hipertensão não controlada não recebem terapia tríplice incluindo um diurético. A hipertensão resistente tem sido diferenciada em hipertensão verdadeiramente resistente e hipertensão do avental branco através do uso da monitorização ambulatorial da pressão arterial (MAPA). A MAPA, dessa forma, apresenta um papel importante no diagnóstico preciso de hipertensão resistentes auxiliando na utilização racional do tratamento medicamentoso.
Hypertension remains uncontrolled in most of the patients treated with antihypertensive drugs. Treated patients with uncontrolled hypertension often have multiple risk factors of cardiovascular risk. Moreover, many observational studies have shown that most of the patients with uncontrolled hypertension do not receive triple therapy including an antidiuretic. Resistant hypertension has been distinguished from truly resistant hypertension and white coat hypertension through ambulatory blood pressure monitoring (ABPM). Thus, ABMP has an important role in the accurate diagnosis of resistant hypertension and in supporting the rational use of drug therapy.
Subject(s)
Humans , Adult , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/psychology , Blood Pressure Monitoring, Ambulatory , Blood Pressure Monitoring, Ambulatory/psychology , Blood Pressure Monitoring, Ambulatory , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/pathology , Cardiovascular Diseases/therapy , Risk FactorsABSTRACT
We report the case of a 46-year-old man with hypertension whose blood pressure decreased due to saiko-karyukotsuboreito consumption.The patient also presented with some symptoms that suggested autonomic imbalance. After consuming 7.5g/day of a spray-dried powder of saikokaryukotsuboreito (Tsumura & Co.) for 3 months, his blood pressure measured at office was considerably lower. Twenty-four hour ambulatory blood pressure monitoring revealed that the surge in morning blood pressure, which is considered to be a risk factor for cerebrovascular disease, diminished in addition to the 24-hour mean blood pressure. A postural test revealed that his autonomic balance, which had been in a sympathetic dominant state, was inversely inclined to a parasympathetic dominant state.Our case report suggests that saikokaryukotsuboreito acts on the autonomic nervous system, which in turn exerts an antihypertensive effect, and that this effect is helpful in lowering the blood pressure in hypertensive patients whose autonomic balance is impaired due to stress.
Subject(s)
Blood Pressure , Postural BalanceABSTRACT
PURPOSE: Obesity in children and adolescence is highly correlated with adult obesity, which can provoke hypertension. Therefore, it is important to evaluate the blood pressure of obese children regularly. In this study, the results of ambulatory blood pressure monitoring (ABPM) in obese children and adolescents were evaluated. METHODS: ABPM was conducted for selected patients who visited Handong University Sunlin Hospital from Feb. 1, 2006 to Dec. 1, 2007. The patients were classified into 3 groups: group 1 was normal, group 2 had normal casual blood pressure and a body mass index over the 95th percentile, and group 3 had high casual blood pressure over 120/80 mm Hg and a body mass index over the 95th percentile. Systolic and diastolic 24-hour blood pressure was measured, including both day and night. RESULTS: There were 49 patients in the study. The results showed a significant difference for average systolic blood pressure between the three groups (105.1+/-4.7, 111.0+/-7.1, 117.8+/-6.6 mmHg, P<0.001), but for average diastolic blood pressure only between groups 1 and 3 (69.1+/-5.3, 77.9+/-6.3 mmHg, P=0.001). In the daytime, only groups 1 and 3 showed a statistically significant difference for systolic and diastolic blood pressure. During the night the systolic pressure of group 3 was significantly higher than the other groups, but the diastolic pressure of group 3 was only higher than that group 1. No statistical difference was found in night dips among the groups. CONCLUSION: Ambulatory blood pressure monitoring in children and adolescents showed statistically higher blood pressure in obese patients with high casual blood pressure.
Subject(s)
Adolescent , Adult , Child , Humans , Blood Pressure , Blood Pressure Monitoring, Ambulatory , Body Mass Index , Hypertension , Obesity , SalicylatesABSTRACT
<b>Objective</b>:<br>This study evaluated the effect of acupuncture treatment on the blood pressure in the elderly based on measurements using the ambulatory blood pressure monitoring method (ABPM). The relationships between the psychological health status and the status evaluated by an oriental medical questionnaire were also examined.<br><b>Methods</b>:<br>The subjects consisted of 15 elderly females aged 75[±6]. A model TM-2421 (A & D Co., Tokyo, Japan) was used for ABPM. Blood pressure was measured before the acupuncture treatment, at the end of the treatment, and one month after the treatment.<br>The average systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PUL) were measured over 24 hours, daytime and nighttime; the hyperbaric index (HBI); and the circadian rhythm were measured by the cosinor method. Subjects were divided into two groups, hypertensive and normal groups, using JNC7 (daytime 135/85mmHg, nighttime 120/75mmHg) as the reference. Subjects were also asked to answer the questions in the Cornell Medical Index (CMI) and Meiji Oriental Medical Score (MOS).<br>Acupuncture treatment was applied twice a week over two months, a total of 18 times, with the aim of improving the blood pressure, psychological status, and chronic pain syndromes.<br><b>Results</b>:<br>Of the 15 subjects who participated in the recent study, six were in the normal blood pressure group and nine, in the hypertensive group.<br>Averages of both SBP and DBP measured over 24 hours, daytime and nighttime exhibited a uniform decreasing trend at the end of the treatment. In the hypertensive group, the average nighttime DBP showed a statistically significant difference. A significant decrease in the HBI was detected in the hypertensive group at the end of the treatment. CMI results indicated that the subjects who were rated abnormal tended to be more normal at the end of the treatment. The oriental medical status evaluated with MOS also indicated an improvement as a result of treatment.<br><b>Conclusion</b>:<br>Acupuncture treatment was considered to effectively decrease blood pressure and improve the psychological status and chronic pain of the elderly.
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Objective: To study 24-hour blood pressure variability (BPV) in essential hypertensives(EH) and to observe the effects of enalapril on BPV in the patients. Methods: BPV were evaluated in 132 EH patients (EH Ⅰ-Ⅱ group 90, EH Ⅲ group 42) using ambulatory blood pressure monitoring, and compared with 60 normal controls.45 EH Ⅰ-Ⅱ patients were treated with enalapril for 4 weeks by randomized single-blind study.The BPV were measured before and after treatment. Results: The SBPV and MAPV during 24-hour period, daytime or nighttime were significantly higher both EH Ⅰ-Ⅱ and EH Ⅲ than control group ( P 0.05).Conclusion:There was a significant increase in BPV(especially in SBPV) and in particular EH Ⅲ group than control group There was no effect in BPV with EH Ⅰ-Ⅱ group by enalapril treatment for 4 weeks.
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PURPOSE: To evaluate the levels of blood pressure when measured by casual and ambulatory blood pressure monitoring. METHODS: We studied 16 sedentary and normotensive subjects (mean 43 +/- 3 years old) showing an exaggerated blood pressure response (SBP > 220 mmHg) during a cycloergometric test, hyperreactive group (HG). This group was compared to 15 others with SBP < or = 220 mmHg during exercise, normoreactive group (NG). Casual blood pressure was obtained by the conventional method and the ambulatory blood pressure monitoring (ABPM) was obtained with SpaceLabs 90207 monitor. This procedure (test 1) was repeated after four months (test 2). RESULTS: Both groups showed statistically higher levels of blood pressure when measured by ABPM device, compared to casual measurements. Systolic blood pressure was significantly higher in HG in casual measurement, in test 1 but not in test 2. Diastolic blood pressure was significantly higher in HG only through the ABPM device. The ambulatory blood pressure average values for two or 24 hours was similar in both groups. No significant differences were observed in left ventricular morphology at the echocardiogram. CONCLUSION: These findings indicate that hyperreactive subjects have an exaggerated stress-induced cardiovascular response during the installation of the device.
Objetivo - Avaliar a pressão arterial de indivíduos normais e hiper-reatores antes e após a colocação do aperelho de monitorização ambulatorial da pressão arterial (MAPA), bem como as médias de 2h, 24h e subperíodos de monitorização. Métodos - Estudaram-se 16 indivíduos (43±3 anos), sedentários, assintomáticos, normotensos e que apresentaram elevação exagerada da pressão sistólica (PAS >220mmHg) durante o teste ergométrico, constituindo o grupo hiper-reator (GH). Este grupo foi comparado com outros 15 indivíduos normotensos em repouso e que apresentaram durante o esforço PAS <220mmHg (GN). A pressão casual foi determinada pelo método auscultatório convencional e os valores de monitorização foram obtidos com o monitor SpaceLabs 90207. Este procedimento (teste 1) foi repetido após período de quatro meses (teste 2). Resultados - Em ambos os grupos observou-se elevação estatisticamente significante das cifras pressóricas após a instalação do monitor, em relação à medida casual. A PAS casual e a pressão diastólica da 1ª medida da MAPA foram maiores (p<0,05) em GH, cujas significâncias desapareceram após quatro meses. A média das duas primeiras horas de monitorização e dos valores da MAPA de 24h foram semelhantes em ambos os grupos. O estudo ecocardiográfico não apresentou diferenças estruturais cardíacas entre GN e GH. Conclusão - Esses dados indicam que indivíduos hiper-reatores podem apresentar resposta cardiovascular exagerada estresse-induzida durante a instalação do monitor
Subject(s)
Humans , Male , Adult , Hypertension/diagnosis , Exercise Test , Time Factors , Follow-Up Studies , Electrocardiography , Manometry , Blood Pressure Monitoring, Ambulatory , Arterial Pressure/physiologyABSTRACT
BACKGROUND: Amlodipine ; 2--4-(2-chlorophenyl)-3-ethoxycarbonyl-5-methoxycarbonyl-6-methyl-1,2, dihydropyridine) is a novel calcium channel antagonist of long half-life and steady state blood levels. However, its blood pressure lowering effect throughout the day has not been well documented especially in Korean patients with essectial hypertension. Therefore, antihypertensive effect of amlodipine in Korean patients with mild to moderate hypertension was evaluated with using 24 hour ambulatory blood pressure measurement(ABPM) as well as office blood pressure measurement. METHODS: Total 25 subjects(M;F=13:12, mean age;53.4+/-7.3 yrs) with mild-to-moderate essectial hypertension had completed the study. After 2 weeks of placebo, amlodipine was mediciated for 12 weeks. Initially, amlodipine was given as 5mg once a day and the daily dose was increased to 10mg/day if diastolic blood pressure in over 90mmHg at the 8th week of medication. The blood pressure level was measured every 4weeks during medication in sitting position('office blood pressure level') and 24 hour ambulatory blood pressure monitoring(ABPM) was done at the placebo run-in phase and at the 8th week of medication. RESULTS: In the view of' office blood pressure lever', the blood pressure lowering effect of amlodipine was already impressive at 4 weeks after medication. The systolic(placebo; 165.3+/-16.9mmHg, arter 4 wk of medication; 136.1+/-16.0mmHg, 8 wk; 136.0+/-12.9mmHg, 12wk; 133.2+/-10.7mmHg) and diastolic blood pressure(placebo; 104.1+/-11.0mmHg,after 4 wk of medication; 87.4+/-6.8mmHg, 8 wk; 86.0+/-6.5mmHg, 12 wk; 84.7+/-5.4mmHg)fell significantly, and most patients had both satisfactory systolic(<160mmHg) and diastolic(<90mmHg) blood pressure levels. And such antihypertensive effects were main tained throughout study period. In contrast, the heart rate did not change significantly. The blood pressure lowering effects assessed by 24 hour AVPM were slightly milder, but absolute systolic and diastolic blood pressures by ABPM after 8 weeks of meddication were as low as those of office measurement. The blood pressure lowering effect was maintained throughout the day including morning periods without either rebound blood pressure elevation or reflex tachycardia. The percent reduction of systolc and diastolic vlood pressure with amlodipine were 17% in office blood pressure measurement and 10% in ABPM. During medication, neither significant side effects nor discomforts that lead to discontinuation of the drug has not been observed. Mild edmatous feeling in 3 subjects, flushing in one and palpitation in one were reported. CONCLUSION: Amlodipine is an effective antihypertensive drug that can control the elevated blood pressure in most patients with mild-to-moderate essential hypertension by monotherapy of once a day regimen without serious side effects.
Subject(s)
Humans , Amlodipine , Blood Pressure , Calcium Channels , Flushing , Half-Life , Heart Rate , Hypertension , Reflex , TachycardiaABSTRACT
PURPOSE--To evaluate clinical efficacy and tolerability of isradipine SRO (I.SRO), 5 mg O.D. in essential hypertensives. METHODS--Eighty-three of 87 selected outpatients with a mean age of 51.3 years (ranging from 25 to 65), 33 male, 48 white, 29 black and others of different races, who had clinical supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg underwent the study. After a three-week wash-out period, patients received I.SRO 5 mg O.D. at 8:00 am for a six-week period (phase I). After this phase, patients received I.SRO 5 mg O.D. at 8:00 pm for a six-week period (phase II). The patients had a follow-up with an interval of three weeks and the ambulatorial blood pressure monitoring (ABPM) for 24 hours was performed with a SpaceLabs 90207 or Del Mar Avionics devices after the wash-out period and at the end of phases I and II. Measurements were performed at 15-min intervals during the day (6 am to 10 pm) and at 30-min intervals during the night (10 pm to 6 am). RESULTS--a) Heart rate did not show significant changes during the treatment period (phases I and II) when compared with the wash-out period; b) causal blood pressure: at the end of both treatment periods (phases I and II) there were statistically significant decreases (p < 0.001) in supine SBP and DBP compared with wash-out values. The mean SBP decreased from 161.6 +/- 14 to 144.3 +/- 13 mmHg (phase I) and to 141.8 +/- 13 mmHg (phase II). The mean DBP decreased from 103.4 +/- 6 to 91.2 +/- 7 (phase I) and to 89.1 +/- 8 (phase II); c) ABPM: the mean systolic 24-h ambulatory blood pressure was significantly reduced (p < 0.001) from 148.8 +/- 17 to 137.2 +/- 15 mmHg (phase I) and to 133.4 +/- 13 mmHg (phase II). The mean diastolic 24-h ambulatory blood pressure was significantly decreased (p < 0.001) from 94.3 +/- 9 to 87.0 +/- 9 (phase I) and to 85.8 +/- 8 mmHg (phase II). The mean daytime and nighttime, systolic and diastolic 24-h ambulatory blood pressure were: wash-out--152.3 +/- 17, 140.2 +/- 21, 97.4 +/- 9, 86.8 +/- 13; phase I--139.9 +/- 15, 130.0 +/- 17, 89.3 +/- 9, 81.3 +/- 10; phase II--136.7 +/- 13, 125.3 +/- 15, 88.5 +/- 8, 79.1 +/- 10, respectively. Blood pressure load (percentage of systolic blood pressure values > 140 mmHg or of diastolic blood pressure values > 90 mmHg) was significantly reduced from 62.2/62 per cent (SBP/DBP), on the was-out, to 37.9/39.9 per cent (SBP/DBP) on phase I and to 32.3/34.3 per cent (SBP/DBP) on phase II; d) side effects: most frequently related were palpitations (2.3 per cent ), headache (1.1 per cent ), flush (1 per cent ) and ankle oedema (1 per cent ). They were in general, mild-to-moderate and disappeared after the first 3 weeks of treatment. Only two patients were withdrawn because of headache (one of them with previous diagnosis of migraine). CONCLUSION--I.SRO, given by oral route, in the dosage of 5 mg O.D. as monotherapy, was effective and well tolerated, promoted significant reduction on 24-h ambulatory blood pressure attenuating the early morning rise and did not interfere with the circadian rhythm of blood pressure. No significant differences were detected in the BP lowering effect when I.SRO was given during the morning or evening. These results may indicate that the drug is as suitable as one of the first choice for treating mild and moderate hypertensive patients