Identifying borderline hypertensives: comparative value of various blood pressure measurements.

Ambulant male military aircrew patients (n = 299) were divided into two groups based on historic evidence of normotension (N) or of untreated borderline essential hypertension (BH). All patients had their blood pressure (BP) measured under various conditions and body positions. Results were analyzed to assess the capability of each BP measurement condition to assign patients correctly to their appropriate group. Clinical BP (physician-recorded with patient seated) and orthostatic stand BP (technician-recorded) showed best sensitivity and acceptable specificity. By incorporating the results of both these measurement conditions, a predictor approximating 90% for most BH and N patients was obtained. Use of these two measurements should enable recognition of most BH patients at a single evaluation.

Blood pressure variability of the individual in orthostatic testing.

Within-subject blood pressure (BP) variability was studied in the context of orthostatic testing. Nineteen healthy men volunteered for biweekly orthostatic testing. BP's were taken on alternate minutes during 5 min of supine rest and a subsequent 5 min of quiet standing. Within-subject variance was computed for systole and diastole by protocol condition; respective variances were than pooled (i.e. averaged) across subjects. The within-subject estimate of variance for a single BP reading in either position was approximately 6 torr (i.e. 1 S.D.). This variance estimate was reduced by averaging additional BP readings from the same visit, and more so by averaging BP readings from multiple visits. These findings have use in the design of orthostatic protocols and in the interpretation of BP data derived therefrom.

Treatment of hypertension in aviators: a clinical trial with Aldactazide.

Thirty-two USAF aircrewmen with mild or moderate, uncomplicated essential hypertension were treated with Aldactazide (spironolactone and hydrochlorothiazide). The study was designed to determine the efficacy and safety of this drug combination in aircrew subject to the stress of flying high-performance aircraft. All patients were investigated in detail before, and again 6 weeks after, beginning Aldactazide treatment. Adequate blood pressure control was achieved in 94% of patients; 84% were able to return to flying duties. Treatment was associated with a moderate loss of weight and plasma volume, and a slight reduction in renal function. Tolerance to multiple stress tests was unimpaired after treatment. Symptoms attributable to treatment were minimal. We conclude that in the dose used, four tablets or less daily, Aldactazide is a safe and fairly effective secondline treatment for hypertensive aircrewmen.