[Suprasystolic dP/dt max an additional parameter of contractile cardiac function obtained by cuff oscillometric tracings]. / Un paramètre additionnel de fonction ventriculaire gauche dérivé du profil oscillométrique artériel.

Technological evolution allowed to record high fidelity traces that--when analysed by complex mathematical systems--may provide extremely detailed and new information about all the factors involved in the determinism of pulse wave. Suprasystolic waves, i.e. those recorded immediately before systolic pressure, may be regarded as similar to aortic pressure waves evaluated during cardiac catheterization. Suprasystolic dP/dt max was calculated from the profile of pulse wave recorded by the DynaPulse, an automatic portable non-invasive oscillometric method to simultaneously measure BP and analyse arterial waveforms, in 10 normal healthy subjects (age 37 +/- 5) and 5 subjects with ischaemic dilatative cardiomyopathy (age 41 +/- 7) whose ejection fraction--invasively assessed--was < 40%. The 24 h dP/dt max curves were analysed by parametric and non parametric tests. We found a significant difference (p < 0.001) in the average 24-h dP/dt max between healthy subjects (471 +/- 36.7 mmHg/sec) and patients with impaired cardiac function (271 +/- 54.2 mmHg/sec). The average daytime and nighttime dP/dt max values showed significantly higher values in normal subject in comparison to patients with heart failure (daytime 7.23 h: 529 +/- 74 mmHg/s versus 227 +/- 64 mmHg/s, p < 0.001; nighttime: 572 +/- 82 mmHg/s versus 202 +/- 67 mmHg/s, p < 0.001). We also found a difference in the occurrence of acrophases, at similar blood pressure value, i.e. the highest dP/dt values occurred during the night in normal subject, the opposite in ischaemic patients. Furthermore, the dP/dt max correlates only with systolic blood pressure.

Evaluation of the effect-duration of once-daily enalapril compared with once-daily captopril.

The extent and duration of the antihypertensive effect of enalapril and captopril, both given once daily, were evaluated in 12 mild-to-moderate essential hypertensives by 24-hour noninvasive blood pressure (BP) monitoring (Pressurometer IV-mod 1990-1991, Del Mar Avionics). Patients were randomized to a cross-over regimen either with enalapril, 10-20 mg, followed by captopril, 50-100 mg (first group), or with captopril followed by enalapril (second group). The dose was doubled if, at week 3 of each treatment, the diastolic BP remained at 90 mm Hg. Doubling of the 2 drugs was not required in 4 patients; in 7 patients the dose of both drugs was doubled; and in 1 patient the dose of only captopril was doubled. Two of the 7 patients who required doubling of both drugs were considered nonresponders to enalapril and captopril. The circadian rhythm was not altered by the treatments, and the drugs reduced BP mainly during the waking hours. However, the second peak of systolic BP in the late afternoon did not graphically appear to be modified by captopril administration. A periodic asymmetric model with 3 harmonics analysis carried out on 24-hour BP data justifies only the use of enalapril for once-daily administration.

Pressor effects from daily events and laboratory complex stimuli relating personality factors.

Our preliminary research has attempted to establish a series of methods to study the complex interactions occurring between pressor reactivity and personality profile. Ten untreated mild hypertensives (age 42.9 +/- 8) without damaged target organs were recruited from an outpatient hypertension center along with an equal number of normotensive volunteers (age 38.2 +/- 8.1). We performed a sequence of stressor types under laboratory conditions (sensory perceptual activities, psychomotor responses, and cognitive behavior) following an order ranging from inferior levels to superior levels of systemic integration. The subjects also underwent a 24-h automatic noninvasive blood pressure recording which took into account the situational reactivity. They filled in MMPI and STAI questionnaires before and after the stressor batteries. Only the sensory-perceptual test (Stroop color test modified), the arithmetic test, and the psychomotor test provoked a significant increase in blood pressure and, in the latter test, also a significant increase of the heart rate. The test batteries' mean differences were not significant between the two groups. Similarly, the answers to the trait-anxiety questionnaires did not allow us to make a substantial division between normotensive and hypertensive subjects. On the contrary, the situational anxiety questionnaires showed a significant difference in the score reading preceding and following a task performed by the hypertensive subjects. We observed significant differences for both systolic and diastolic 24-h blood pressure data in transition from a working situation to the sleeping period. However, there was not a significant difference in hypertensive blood pressure readings recorded during work and at home.(ABSTRACT TRUNCATED AT 250 WORDS)