Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo.

BACKGROUND: Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from population-based studies or secondary healthcare. OBJECTIVE: The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo. METHODS: A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥ 18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥ 140/90 or ≥ 130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension. RESULTS: Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p = 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01-5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension. CONCLUSION: Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control.

Blood pressure in the Congolese adult population of South Kivu, Democratic Republic of Congo: Preliminary results from the Bukavu Observ Cohort Study.

BACKGROUND: Providing factual data about non-communicable diseases (NCDs) is of utmost importance in the sub-Saharan African countries where NCDs and arterial hypertension data remain scattered, scarce, and less representative given the region's heterogeneous population. Within this context, the interuniversity cooperation VLIR-UOS/Catholic University of Bukavu (Democratic Republic of Congo) has established an integrated project for monitoring hypertension and cardiovascular risk factors in the population of South Kivu. The aim of the study was to present the basic results of the determinants of blood pressure in the cohort studied. METHODS: In 2013 and 2014, trained interviewers collected the anthropometric parameters, blood pressure, and medical history of 7405 adults (3060 in urban areas and 4345 in rural areas) including 3162 males and 4243 females; the cohort is expected to be followed for 9 years. RESULTS: The average age of the entire group was 33.0±16.7 years. Compared to men, women had significantly higher obesity indices (P<0.0001), lower blood pressure between 20 and 39 years of age (P<0.0001) but higher blood pressure at 60 years of age and older (P<0.0001). Blood pressure was positively correlated with body mass index, waist circumference, and paradoxically with consumption of vegetables, but negatively correlated with the consumption of fruit, intense physical activity, and relaxation at home. CONCLUSIONS: These results show that a cohort study is feasible in the Democratic Republic of Congo. The factual data analysis can contribute to health policy orientation and setting up of preventive measures. Since most correlated risk factors are preventable, recommendations can already be made in the fight against high blood pressure in this population.

Efficacy of newer versus older antihypertensive drugs in black patients living in sub-Saharan Africa.

To address the epidemic of hypertension in blacks born and living in sub-Saharan Africa, we compared in a randomised clinical trial (NCT01030458) single-pill combinations of old and new antihypertensive drugs in patients (30-69 years) with uncomplicated hypertension (140-179/90-109 mm Hg). After ≥4 weeks off treatment, 183 of 294 screened patients were assigned to once daily bisoprolol/hydrochlorothiazide 5/6.25 mg (n=89; R) or amlodipine/valsartan 5/160 mg (n=94; E) and followed up for 6 months. To control blood pressure (<140/<90 mm Hg), bisoprolol and amlodipine could be doubled (10 mg per day) and α-methyldopa (0.5-2 g per day) added. Sitting blood pressure fell by 19.5/12.0 mm Hg in R patients and by 24.8/13.2 mm Hg in E patients and heart rate decreased by 9.7 beats per minute in R patients with no change in E patients (-0.2 beats per minute). The between-group differences (R minus E) were 5.2 mm Hg (P<0.0001) systolic, 1.3 mm Hg (P=0.12) diastolic, and 9.6 beats per minute (P<0.0001). In 57 R and 67 E patients with data available at all visits, these estimates were 5.5 mm Hg (P<0.0001) systolic, 1.8 mm Hg (P=0.07) diastolic and 9.8 beats per minute (P<0.0001). In R compared with E patients, 45 vs 37% (P=0.13) proceeded to the higher dose of randomised treatment and 33 vs 9% (P<0.0001) had α-methyldopa added. There were no between-group differences in symptoms except for ankle oedema in E patients (P=0.012). In conclusion, new compared with old drugs lowered systolic blood pressure more and therefore controlled hypertension better in native African black patients.

Age and living in an urban environment are major determinants of diabetes among South Kivu Congolese adults.

OBJECTIVES: This study aimed to determine the risk factors for diabetes mellitus (DM) in the eastern part of the Democratic Republic of Congo. METHODOLOGY: Multilevel sampling identified 200 households (444 adults aged ≥ 20 years) from 20 neighbourhoods in the city of Bukavu, and 90 households (255 adults aged ≥ 20 years) from 10 villages in the Kaziba (South Kivu) chiefdom (the South Kivu VITARAA study). DM was defined as a personal history of the disorder or a casual glycaemia greater or equal to 200 mg/dL. Standardization according to age and sample readjustment based on the urban-rural distribution of the population was applied accordance with the typical Congolese population. The probability of DM was assessed by multiple logistic regressions. RESULTS: Total prevalence of DM was 3.5%. DM was significantly more prevalent in urban areas (age-standardized prevalence: 4.0%) than in rural areas (1.7%). City-dwelling DM patients were characterized by higher rates of indices of abdominal obesity (P < 0.05) whereas, in rural areas, no patients were obese. In the study group as a whole, only 25.0% of diabetic patients were obese. On multivariate analyses, only age [adjusted OR (95% CI): 4.79 (1.60-14.25); P = 0.004] was independently associated with the prevalence of DM, while the effect of obesity was not significant [2.64 (0.99-7.02); P = 0.051]. CONCLUSION: Age and living in an urban environment appeared to be major determinants of DM in South Kivu. Also, obesity prevalence was relatively low in these diabetic patients, confirming the peculiar, relatively lean, phenotype of type 2 DM in indigenous sub-Saharan Africans.

Left ventricular hypertrophy and geometry in type 2 diabetes patients with chronic kidney disease. An echocardiographic study.

OBJECTIVE: We assessed left ventricular structural alterations associated with chronic kidney disease (CKD) in Congolese patients with type 2 diabetes. METHODS: This was a cross-sectional study of a case series. We obtained anthropometric, clinical, biological and echocardiographic measurements in 60 consecutive type 2 diabetes patients (37 females, 62% ) aged 20 years or older from the diabetes outpatient clinic, University of Kinshasa Hospital, DRC. We computed creatinine clearance rate according to the MDRD equation and categorised patients into mild (CrCl > 60 ml/min per 1.73 m(2)), moderate (CrCl 30-60 ml/min per 1.73 m(2)) and severe CKD (< 30 ml/min per 1.73 m(2)). Left ventricular hypertrophy (LVH) was indicated by a LV mass index (LVMI) > 51 g/m(2.7) and LV geometry was defined as normal, or with concentric remodelling, eccentric or concentric hypertrophy, using relative wall thickness (RWT) and LVMI. RESULTS: Compared to patients with normal kidney function, CKD patients had higher uric acid levels (450 ± 166 vs 306 ± 107 µmol/l; p ≤ 0.001), a greater proportion of LVH (37 vs 14%; p ≤ 0.05) and longstanding diabetes (13 ± 8 vs 8 ± 6 years; p ≤ 0.001). Their left ventricular internal diameter, diastolic (LVIDD) was (47.00 ± 6.00 vs 43.00 ± 7.00 mm; p ≤ 0.001), LVMI was (47 ± 19 vs 36.00 ± 15 g/m2.7; p ≤ 0.05) and proportions of concentric (22 vs 11%; p ≤ 0.05) or eccentric (15 vs 3%; p ≤ 0.05) LVH were also greater. Severe CKD was associated with increased interventricular septum, diastolic (IVSD) (12.30 ± 3.08 vs 9.45 ± 1.94 mm; p ≤ 0.05), posterior wall thickness, diastolic (PWTD) (11.61 ± 2.78 vs 9.52 ± 1.77 mm; p ≤ 0.01), relative wall thickness (RWT) (0.52 ± 0.17 vs 0.40 ± 0.07; p ≤ 0.01) rate of LVH (50 vs 30%; p ≤ 0.05), and elevated proportions of concentric remodelling (25 vs 15%; p ≤ 0.05) and concentric LVH (42 vs 10%; p ≤ 0.05) in comparison with patients with moderate CKD. In multivariable adjusted analysis, hyperuricaemia emerged as the only predictor of the presence of LVH in patients with CKD (adjusted OR 9.10; 95% CI: 2.40-33.73). CONCLUSION: In keeping with a higher rate of cardiovascular events usually reported in patients with impaired renal function, CKD patients exhibited LVH and abnormal LV geometry.

[Knowledge of the general population about hypertension and diabetes mellitus in South Kivu, Democratic Republic of Congo]. / Connaissances de la population générale sur l'hypertension artérielle et le diabète sucré au Sud-Kivu, République démocratique du Congo.

BACKGROUND: In the Democratic Republic of Congo (DRC), a country in a post-conflict period, high priority cannot be given to non-communicable diseases other than to emergencies. This certainly involves inadequacy in raising awareness for prevention of these diseases. OBJECTIVE: To evaluate the level of knowledge of the Congolese general population on hypertension and diabetes mellitus. METHODS: Responses to a questionnaire from 3% of the general population aged 15 and older in the city of Bukavu and two rural areas: Hombo and Walungu (South Kivu, eastern DRC), recruited after stratification by ward in the city of Bukavu and a group of prone villages were expected. The questions focused on identification, testing, causes, complications and treatment of hypertension and diabetes mellitus. RESULTS: Of the 7770 respondents, screening for hypertension and diabetes mellitus affected only 14.9% and 7.3% of subjects respectively. Knowledge of these two conditions was generally low in the general population, although better in the subgroups of patients and those with higher socioeconomic level (P<0.05). Use of the medias was also associated with better knowledge (P<0.05). CONCLUSIONS: This study shows that knowledge about hypertension and diabetes mellitus and their testing in South Kivu is low. It is imperative that the Congolese government includes non-communicable diseases in its priorities of the millennium. Similarly, the WHO should actively contribute to screening for them in low-income countries.

Metabolic syndrome using national cholesterol education program criteria in black patients with arterial hypertension

Objective: to assess the prevalence and correlates of the metabolic syndrome (MS) in black patients with essential hypertension. Methods: A total of 100 consecutive essential hypertensives (53 men and 47 women, mean age 49 ± 10 years, BMI 27 ± 5 Kg/m², SBP 155 ± 19 mmHg, DBP 101 ± 11 mmHg) attending the University of Kinshasa outpatient hypertension clinic and included in a case-control study of lipids and lipoproteins were considered for the present cross sectional analysis. All patients underwent clinical, laboratory and electrocardiographic investigations searching for lipid and lipid cardiovascular risk factors. NCEP-ATP III criteria were used to define the MS. Between group comparisons were made with the Student t test, Mann Whitney U test or Chi square as appropriate. Results: 31 hypertensive patients (33%), 23 men and 8 women, fulfilled the NCEP-ATP III criteria of the MS. In univariate analysis, aside the variables defining the MS, patients with the MS had a significantly higher TC/HDL-c ratio (4.44 ± 2.40 vs 3.79 ± 1.82; p ≤ 0.05) and proportion (13% vs 3%, p ≤ 0.05) of smokers; they paradoxically showed lower proportion (39% vs 52%, p ≤ 0.05) of left ventricular hypertrophy (LVH) in comparison to those without the MS. The two groups were similar for age, sex distribution, duration of hypertension, physical activity, treatment status, BP and other biological variables. Multivariate logistic regression analysis was used to determine the independent contribution of risk factors to the risk of MS. Conclusion: MS is common among Congolese patients with essential hypertension and seems to be paradoxically associated with less pronounced cardiac damage probably due to the phenomenon of reverse epidemiology of traditional cardiovascular risk factors

Nutritional status, socio-economic status, heart rate, and blood pressure in African school children and adolescents.

OBJECTIVES: To determine the impact of gender, nutritional anomalies, puberty and socio-economic status on the levels of blood pressure, fat distribution and heat rate in African school children and adolescents. This study also identified the risk factors of arterial hypertension in African adolescents. DESIGN: A cross-sectional study carried out between April and July 1996. SETTING: Randomly selected schools of the semi-urban area of Kinshasa Province, capital of the Democratic Republic of Congo. SUBJECTS: 1535 school children and adolescents. OUTCOME MEASURE: Height, weight, waist circumference, hip circumferences, blood pressure and heart rate were measured. Body mass index, and waist-hip ratio, and Z-scores of NCHS/WHO for different levels of malnutrition were calculated for gender and age. RESULTS: High rates of malnutrition forms and overweight/obesity coexisted. Boys with chronic malnutrition had significant higher blood pressure levels. Children with pooled types of malnutrition had higher waist circumference, waist-hip ratio and heart rate values. Children from the low socio-economic status had higher blood pressure and heart rate levels than those from high socio-economic status. Overweight/obesity was more (p<0.05) prevalent among female adolescents (68.5%) than male adolescents (24%). Obese male adolescents had higher blood pressure and heart rate levels than their non-obese male counterparts. 39% of variations of systolic blood pressure of male adolescents were explained only by body mass index, whereas 56% of variations of diastolic blood pressure of male adolescents were explained only by age. Only low socio-economic status was identified as a significant risk factor of arterial hypertension among these African adolescents (OR=1.2; 95% CI 1.1 to 1.3; p<0.01). CONCLUSION: Intervention strategies to combat poverty and high cardiometabolic risk may need to be developed for these African school children and adolescents.

Clinical correlates of left ventricular hypertrophy in black patients with arterial hypertension.

OBJECTIVE: To assess the relationship between the lipid profile, other cardiovascular risk factors and left ventricular hypertrophy (LVH) in black hypertensive patients. MATERIALS AND METHODS: We undertook a cross-sectional study of a case series at the hypertension clinic, University of Kinshasa Hospital. Lipids, lipoproteins and other cardiovascular risk factors were analysed in 100 consecutive hypertensive patients. Left ventricular hypertrophy was assessed by 12-lead electrocardiography (ECG) using Cornell voltage index. RESULTS: Forty-eight hypertensive patients, 26 men and 22 women, had LVH. With univariate analysis, the patients with LVH were older (age 52 +/- 9 vs 45 +/- 9 years; p /= 1.03 mmol/l (adjusted OR 0.19; 95% CI: 0.057-0.651), plasma glucose >/= 6.11 mmol/l (adjusted OR 0.19; 95% CI: 0.046- 0.828), or on treatment for hypertension (adjusted OR 0.23; 95% CI: 0.082-0.645) had a lower risk for cardiac damage compared to their respective control groups. CONCLUSION: LVH is a common complication in Congolese hypertensives. Dyslipidaemia, high plasma glucose levels, the duration of hypertension and being on antihypertensive therapy appear to be the main predictors of hypertensive cardiac damage.

Correlates of serum lipids and lipoproteins in Congolese patients with arterial hypertension.

OBJECTIVE: The purpose of this study was to assess the prevalence of dyslipidaemia and the correlates of serum lipids and lipoproteins among Congolese subjects with and without arterial hypertension. METHODS: One hundred hypertensive patients attending the outpatient clinics at the University of Kinshasa Hospital, and 100 age- and sex-matched controls recruited among hospital personnel or blood donors entered the case-control study. Their blood pressure (BP), heart rate (HR), body mass index (BMI), waist-to-hip ratio (WHR), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), plasma fibrinogen (only in patients) and fasting glucose, serum uric acid, creatinine and creatinine clearance (CrCl) were compared using the Student's t-test or Chi-square test as appropriate. Associations between continuous variables were assessed with Pearson correlation coefficients, and correlates of lipids and lipoproteins were determined using multiple linear-regression analysis. RESULTS: Compared to healthy controls, hypertensive patients had greater BMI (p or= 6.20 mmol/l. In hypertensive patients, TC (r = 0.24; p < 0.01) and LDL-C (r = 0.20; p < 0.05) were positively correlated to plasma fibrinogen. A positive correlation was also observed between TC and LDL-C (r = 0.91; p < 0.001), HDL-C and CrCl (r = 0.28; p < 0.001), and TG and glucose (r = 0.24; p < 0.01), whereas TG were negatively correlated to HDL-C (r = -0.38; p < 0.001). In multiple linear-regression analysis, LDL-C, HDL-C, TG and age accounted for 87% (R2) of variation in TC levels; plasma glucose and HDL-C for 19% (R2) of variation in TG levels; and TG and CrCl for only 17% (R2) of variation in HDL-C levels. CONCLUSIONS: The present data indicate that dyslipidaemia affects a substantial proportion of healthy and hypertensive Congolese subjects. Furthermore, hypertension is associated with a cluster of risk factors characteristic of the metabolic syndrome, of which overweight/central obesity could be the cornerstone. Management of arterial hypertension should therefore focus both on lowering high blood pressure and correcting associated lipid disorders.

Hematocrit and stroke in black Africans under tropical climate and meteorological influence.

OBJECTIVES: To assess the relationship between hematocrit and risk of fatal and non-fatal stroke in conjunction with meteorological variations. DESIGN: Prospective study of a series of Africans living in Kinshasa, Congo, followed up for 5 years. SUBJECTS: A total of 1,032 unselected patients consecutively admitted to hospitals for acute stroke. Main outcome measures. Fatal and non-fatal ischemic or hemorrhagic strokes. The association of hematocrit with stroke morbidity and mortality and meteorological variables were evaluated by simple or multiple linear regression and logistic regression. RESULTS: Patients were aged 53.7 +/- 12.1 years. Hematocrit was mostly correlated with mean ambient air temperature (r = 0.124; p < 0.001) and atmospheric pressure at 6 a.m GMT (r = 0.157; p < 0.001). Patients with hematocrit > 40% presented the highest levels of systolic blood pressure, fibrinogen, body temperature, resting heart rate, duration of coma and incidence of all stroke types and ischemic stroke (p < 0.001). Hematocrit > 40% was associated with stroke mortality (Odds ratio, 6.2, 4.5-8.6; p < 0.001). The risk of stroke mortality was multiplied by 21, 18.3 and 4.2 in conditions of a mean ambient air temperature > 28 degrees C, atmospheric pressure 975-977 mm Hg and body temperature > 37 degrees C respectively. CONCLUSIONS: Our study suggests that higher hematocrit is associated with an increased risk of stroke morbidity and mortality, particularly ischemic stroke at noon. This risk is probably mediated by increased susceptibility of African older hypertensive subjects to meteorological variations.

J-shaped relationship between mortality and admission blood pressure in black patients with acute stroke.

AIM: The charts of 388 patients admitted for a recent stroke at the University of Kinshasa Hospital, Department of Medicine, were analysed to assess the case fatality rate and its determinants. RESULTS: During the hospitalization period (average 31 days), 169 deaths (44%) were recorded. Mortality was higher (P<0.05) in women (54%) than in men (42%), in haemorrhagic (61%) than in ischaemic (26%) strokes, and in patients with depressed consciousness, motor deficits, tachycardia or atrial fibrillation on admission. Mortality increased with advancing age, the depth of coma, the severity of motor deficit and the plasma glucose level on admission. Plasma glucose, urea and the leucocyte count were higher in patients who died than in survivors. Patients with and without a history of hypertension, diabetes or stroke recurrence had similar mortality rates. The latter tended to be higher in smokers and alcohol consumers. Using logistic regression analysis, depressed consciousness (P<0.001), tachycardia (P<0.001), plasma urea on admission (P<0.05) and a history of alcohol consumption (P<0.05) emerged as significant predictors of mortality. Admission systolic/diastolic blood pressure was similar in those who died (177 +/- 41/104 +/- 26 mmHg) and in survivors (171 +/- 41/101 +/- 23 mmHg). However, in the whole study population and in subgroups of patients who were comatose or conscious on admission, mortality showed a J-shaped relationship to admission systolic blood pressure with low rates in the range 160-199 mmHg before and after adjustment for age and sex, higher rates being observed for higher or lower blood pressure ranges. CONCLUSIONS: Depressed consciousness, ECG abnormalities, delayed admission and elevated plasma urea predict a high case fatality rate whereas systolic blood pressure within the range 160-199 mmHg appears to be optimal for survival in the patient group studied.

[Initial arterial pressure and prognosis of cerebrovascular accidents]. / Pression artérielle initiale et pronostic de l'accident vasculaire cérébral.

The present study analysed the charts of the patients admitted for acute stroke and assessed the relation between stroke mortality and initial blood pressure. Of the 388 patients admitted, 169 (44%) died. Mortality increased with advancing age and was higher in women, in hemorrhagic stroke (61%), and in patients with severe neurological deficit on admission. Average blood pressure on admission did not differ between the patients who died and those who survived. However, mortality was 42, 32, 57 and 62% in patients whose admission systolic blood pressure was, respectively, less than 160 mmHg, 160 to 199 mmHg, 200 to 249 mmHg and 250 mmHg or more. It described a similar curve when four categories of admission diastolic blood pressure were constituted. The data indicate a high case fatality rate in stroke patients. Mortality was higher in women; it increased with age and severe neurological deficit. The relation of stroke mortality to admission blood pressure suggests that it is not the lowest in patients with the lowest blood pressure, but in those with blood pressure level allowing the best brain perfusion after the onset of stroke.

Differences between black and white persons in blood pressure and related biological variables.

In societies with several ethnic groups the prevalence of hypertension is abnormally high in black subjects. In addition, blacks are more susceptible to the consequence of high BP. Compared with whites plasma renin is low in blacks independently of age, the level of BP and dietary sodium consumption. No abnormal mineralocorticoid level has ever been consistently reported in blacks to account for their low renin. However potassium intake, prostaglandin and kallikrein excretions are low in blacks and black/white differences exist in the distribution of the restriction fragment length polymorphism at the gene loci for renin. It is hypothesised that the low renin and the propensity of blacks to hypertension result from elevated free cytosolic calcium. Indeed several factors inducing or associated with an increased cytosolic calcium cluster in blacks, e.g. sodium pump inhibition, high intracellular sodium concentration, low plasma ionised calcium, high parathyroid hormone. Furthermore, intensive calcium mobilisation from intracellular stores in response to circulating serum agonists as observed in skin fibroblasts of blacks might be contributive should it occur in all cells including vascular smooth muscle and juxtaglomerular cells.

[Calcium channel blockers in the elderly with hypertension]. / Inhibiteurs calciques chez le sujet âgé hypertendu.

Administered alone, calcium entry blockers (CEB) are effective antihypertensive agents in the aged, and their blood pressure lowering action is similar to that of other antihypertensive drugs. CEB may be regarded as alternatives to diuretics in the elderly, and they should be used instead of diuretics when these are contraindicated. The effectiveness of CEB might be explained by some characteristics of old age, such as elevated mean blood pressure, reduced plasma renin activity, blunted sympathetic activity, altered drug pharmacokinetics and so forth. CEB appear to have a favourable metabolic profile and to be as safe in the elderly as in younger patients. The beneficial effects of CEB on mortality, morbidity and quality of life in geriatric hypertension still need to be established.

[Hemodynamic effects of urapidil in men]. / Effets hémodynamiques de l'urapidil chez l'homme.

In hypertensive patients as well as in normal subjects, urapidil has a hypotensive action. This is mainly mediated by a peripheral alpha adrenoceptor blockade with a decrease in systemic vascular resistance. In addition, acute animal experiments demonstrated a centrally mediated hypotensive action, possibly by 5-hydroxytryptamine1A-receptor stimulation. Studies in humans showed an increase in cardiac output, which was not always significant; it resulted either from an increased heart rate or an increased stroke volume. Acute changes in pulmonary hemodynamics after administration of urapidil were most pronounced in patients with pulmonary hypertension: pulmonary artery pressure and pulmonary vascular resistance decreased significantly and pulmonary capillary wedge pressure decreased non-significantly. A small reduction in pulmonary artery pressure and capillary wedge pressure was seen in patients with congestive heart failure and in patients in whom acute blood pressure elevation developed after coronary bypass surgery. In patients with essential hypertension, forearm, renal and splanchnic flows were shown to increase and vascular resistance to decrease significantly after an acute intravenous doses of urapidil. The hemodynamic changes that occur during chronic therapy are largely unknown, except for systemic vascular resistance which remains decreased.