Average Blood Pressure Values Research Articles

Rate of blood pressure changes assessed by 24 h ambulatory blood pressure monitoring: another meaningful index of blood pressure variability?

Data collected over the past 60 years, thanks to the introduction of ambulatory blood pressure monitoring (ABPM) techniques, have clearly shown that blood pressure (BP) is a highly variable parameter [1]. Such a solid awareness, however, has not found a suitable translation into clinical practice yet, and the evaluation of BP-related cardiovascular risk is still largely confined, in the best case, to the assessment of average BP values from a series of measurements (obtained by ambulatory or home BPM), while most recommendations related to hypertension management are still based on isolated clinic measurements [2,3]. This despite the availability of growing evidence that BP variability is an independent predictor of organ damage and cardiovascular events [4– 9]. A few reasons may explain the difficulties in introducing BP variability as a routine clinical tool. One, the complex nature of the mechanisms underlying an increase in BP excursions makes the clinical interpretation and practical use of estimates of BP variability difficult. Indeed, an increased amplitude and frequency of BP fluctuations may reflect alterations of different factors involved in cardiovascular control such as impairment of autonomic or hormonal regulation, renal dysfunction, and increased arterial stiffness [10]. Two, the lack of solid evidence supporting the efficacy of any specific treatment in reducing BP variability is associated with the even more important lack of evidence, except for a few animal studies [11], that its reduction may be actually beneficial in reducing cardiovascular risk. Three, the fact that simple conventional estimates of BP variability based on the calculation of 24 h, daytime or night-time standard deviation (SD) of either systolic or diastolic average BP, even if independently related to outcome, appear to have a rather limited predictive power compared to other more traditional risk factors [4–7,12]. Four, the awareness that the SD of BP average values, com-

Efectividad de una intervención terapéutica en hipertensos con mal control por monitorización ambulatoria de la presión arterial

Objective To evaluate the effectiveness of a therapeutic reinforcement in deficiently controlled blood pressure (BP) patients by using ambulatory BP monitoring (ABPM). Design Descriptive, observational and interventional study. Setting Urban primary care center. Subjects Subjects in whom an ABPM was performed from 2004–06. Intervention To intensify antihypertensive treatment in poorly controlled patients in the initial ABPM (average 24 hours BP ≥130/80 mmHg) and performing of a second ABPM later. Main measurements Age, gender, cardiovascular risk factors, antihypertensive treatment, average BP at the office and by ABPM, circadian pattern, intervention type. Statistical analysis of the variables through SPSS-12 program. Results 107 patients were included, with an average of 60±14 years and slight predominance of women (53%). Antihypertensive drugs were taken in 71% of cases, the most frequently prescribed being diuretics (50%). A total of 42 patients were classified as being poorly controlled (39%). Intensification of treatment was performed in 36 of them (86%), addition of drugs being the most common attitude (48%). The post-intervention ABPM was performed in 27 patients (64%), who, starting from averages of 24 hours BP of 142/75±10/9 mmHg in the first monitoring, achieved statistically significant reductions (p≤0.005) in the average values from 24 hours (−11/5 mmHg), daytime (−11/5 mmHg) and systolic nighttime (−10 mmHg) BP values. Conclusion Intensifying antihypertensive treatment is effectiveness to reduce average BP values in poorly controlled patients by ABPM, objectively shown in a subsequent ABPM.

Gender-Related Differences in Adolescent Hypertension and in Target Organ Effects

To assess whether a gender difference exists in adolescent hypertension and its target organ damage and to compare potential confounding factors and target organ damage in hypertensive and normotensive adolescent girls. From the Debrecen Hypertension Study, the anthropometric, blood pressure, and laboratory data as well as intima-media thickness (IMT) and left ventricular mass index (LVMI) of 58 hypertensive boys, 56 hypertensive girls, and 30 normotensive girls were analyzed. Both systolic and mean blood pressure values were higher in adolescent hypertensive boys than in girls. This difference was also present when comparing 24-hour average blood pressure values. Plasma concentrations of nitric oxide (NO) and endothelin-1 were not different in the two gender groups. IMT of the carotid arteries were similar in hypertensive boys and girls, but a significantly higher LVMI was detected in boys. A significant difference was detected in anthropometric data (height, weight, and body mass index [BMI]), plasma concentration of NO (lower levels in hypertensives), and IMT in hypertensive and normotensive girls (higher IMT in hypertensive girls). There is a difference between the severity of hypertension between hypertensive adolescent girls and boys. Hypertensive girls differ from normotensive girls not only in blood pressure values but also in risk factors and subclinical target organ effects. Further studies are needed to explain the gender differences in adolescent hypertension. The potential role of sex hormones in hypertensive teenagers also needs to be clarified in future works.

Comparison of the Anti-Hypertensive Effects of the L/N-Type Calcium Channel Antagonist Cilnidipine, and the L-Type Calcium Channel Antagonist Amlodipine in Hypertensive Patients with Cerebrovascular Disease

It is known that the risk of cerebral stroke recurrence in post-stroke patients is comparatively higher than in normal subjects, and it is suggested that autonomic nervous system dysfunctions elevate this risk. We investigated the anti-hypertensive effects of cilnidipine, a Ca antagonist which suppresses sympathetic nerve activation, in hypertensives with chronic-stage cerebrovascular disease in a comparison with amlodipine. Amlodipine 5-7.5 mg/day, or cilnidipine 5-10 mg/day was administered to 78 hypertensive subjects (greater than 140 mmHg systolic, or 90 mmHg diastolic) undergoing outpatient treatment. Amlodipine or cilnidipine was also administered similarly, to 30 subjects having hypertension associated with a cerebral infarct which occurred more than one month earlier due to cerebral thrombosis or embolism. After 3 months administration, the subjects' blood pressures and pulse rates were recorded with an ambulatory blood pressure monitor over 24 hours. No difference was recognized in patient age, gender, and systolic and diastolic blood pressure before treatment between the groups. In the cilnidipine groups, no difference in average 24-hour or waking systolic blood pressure values was seen between cerebrovascular disease (CVD) subjects and non-CVD subjects, although in the amlodipine groups, CVD subjects had significantly higher blood pressure values than non-CVD subjects. In the cilnidipine group, the coefficient of variation values of pulse rate were significantly higher in CVD subjects than in non-CVD subjects (p<0.05). In patients with recent stroke, a Ca antagonist with no sympathetic nerve suppression had weaker blood pressure-lowering effects. Significantly increased pulse rate variability, shown in the CVD subjects administered cilnidipine, suggests that cilnidipine enhanced the parasympathetic function in hypertensive patients with CVD.

Anthropometric and dietary determinants of blood pressure in over 7000 Mediterranean women: the European Prospective Investigation into Cancer and Nutrition-Florence cohort

Anthropometric characteristics and dietary habits are widely recognized to influence blood pressure. We evaluated their role in a large series of Mediterranean adult women. In Florence, in the European Prospective Investigation into Cancer and Nutrition, we recruited 10 083 women, aged 35-64 years. Detailed information on diet, lifestyle, physical activity, and medical history were collected. Anthropometric indices and systolic and diastolic blood pressures were measured at recruitment using standardized procedures. Overall, after excluding those women who reported a clinical diagnosis of hypertension and/or an antihypertensive treatment and those without measurements, 7601 women were available for analyses with an average systolic and diastolic blood pressure value of 123.2+/-16.0 and 78.7+/-9.4 mmHg, respectively. Multivariate regression models showed that body mass index (P<0.0001) and waist circumference (>or=88 cm, P<0.0001), as well as processed meat, potatoes, and wine consumption, were directly associated with both systolic and diastolic values. In contrast, a high consumption of selected foods resulted inversely associated with systolic (total vegetables, yoghurt, and eggs), diastolic (olive oil) or both systolic and diastolic values (leafy vegetables, milk, coffee). Analyses performed on nutrients showed a positive association with alcohol and sodium intake, and an inverse one with potassium and micronutrients derived from fruits and vegetables. In this large series of women from Tuscany, Central Italy, we confirm the independent influence of anthropometric characteristics on blood pressure. The role of specific foods and nutrients in modulating blood pressure also emerged, suggesting a central role for lifestyle modifications in blood pressure control.

The impact of hyperacute blood pressure lowering on the early clinical outcome following intracerebral hemorrhage

Blood pressure lowering in acute intracerebral hemorrhage patients may prevent hematoma growth and neurological deterioration. The optimal goal of hyperacute antihypertensive therapy for intracerebral hemorrhage patients to obtain a favorable early clinical outcome was investigated. Of 688 consecutive patients who were admitted to our stroke care units within 24 h after intracerebral hemorrhage onset, 244 patients who emergently received intravenous antihypertensive therapy due to admission blood pressure at least 180/105 mmHg were assessed. The average systolic and diastolic blood pressure values 6, 12, and 24 h after admission and the percentage reduction of the blood pressure value with respect to the admission blood pressure value were used for analysis. At 3 weeks, 66 patients (27%) had a completely independent activity level corresponding to a modified Rankin Scale score of 1 or less. After adjustment for baseline characteristics, a favorable functional outcome was more common in patients with the lowest quartile of average systolic blood pressure in the initial 24 h (<138 mmHg, odds ratio 4.36, 95% confidence interval 1.10-17.22), and was similarly common in those with the middle two quartiles (138-148 mmHg, 148-158 mmHg) than in those with the highest quartile of systolic blood pressure (> or = 158 mmHg). Analyses using patient quartiles on the basis of the average diastolic blood pressure or the reduction of systolic or diastolic blood pressure did not show an association with early outcome. Lowering the systolic blood pressure to less than 138 mmHg during the initial 24 h appears to be predictive of favorable early outcome in intracerebral hemorrhage patients. Randomized controlled trials to answer this question are needed.

Ambulatory arterial blood pressure monitoring in patients before and after thyroidectomy

[corrected] Increased values of thyroid hormones in the clinical syndrome of hyperthyreosis affect blood pres sure values and its circadial variation. The aim of this study was to define the influence of hyperthyreosis on the values and circadial variations of arterial blood pressure, as well as to investigate the effect of thyroid surgery on blood pressure values. We compared the 24-hour averages of systolic and diastolic blood pressure, their variations and their reduction during the night between 20 female patients with hyperthyroidism and hypertension de novo and 20 healthy females. We compared the values of 24-hour ambulatory monitoring performed before the surgery with the values gathered two weeks after the surgery. The 24-hour average systolic and diastolic blood pressure values were higher in the patients with hyperthyroidism than in the control group (p < 0.001). In the group of patients, the variations in blood pressure were significantly higher than they were in the group of healthy people (p < 0.001). The amplitude of the nocturnal reduction of blood pressure was also significantly lower in the patients with hyperthyroid status and hypertension, in comparison to the healthy persons (p < 0.001). Two weeks after the surgery, a significant reduction of blood pressure values (both for systolic and diastolic) appeared. The patients with hyperthyroidism caused hypertension had higher systolic and dia stolic blood pressure, higher variations in blood pressure and lower nocturnal reduction of blood pressure than healthy subjects. Thyroid surgery, as a control of thyroid function, optimised blood pressure very rapidly.

Normal blood pressure values and percentile curves measured by oscillometric method in children under 6 years of age

for gender, age, and height on ≥three occasions. Knowing that blood pressure values increase in children as they grow older, the purposes of this study were to measure blood pressure by an oscillometric device and to determine normal values and percentile curves for children. Methods :Systolic and diastolic blood pressures were measured twice with an oscillometric device in 3,545 boys and 3,145 girls under six years of age, in Seoul. Using this data, we determined average blood pressure values and percentile curves based on gender and age; we subdivided these values into blood pressures of 50 th , 90 th , 95 th , and 99 th percentiles, by percentile of height. The regression coefficients and standard deviations of the systolic and diastolic blood pressure values were obtained from linear regression models. Results :Older boys and girls had higher systolic and diastolic blood pressure values. Older boys and girls in the same percentile of height for age had higher systolic and diastolic blood pressure values. Taller boys and girls within the same age group had higher systolic and diastolic blood pressure values. Conclusion :Blood pressure standards based on gender, age, and height were obtained via an oscillometric method. Llimitation of this study is that the study population was not from the whole country, but exclusively from Seoul. Nonetheless, the data from this study will be helpful in diagnosing and managing hypertension in Korean children. (Korean J Pediatr 2008;51:998-1006)

BLOOD PRESSURE MEASUREMENT

Blood pressure measurement is the basis for the diagnosis, management, treatment, epidemiology and research of hypertension and the decisions affecting these aspects of hypertension will be influenced by the accuracy of measurement. Although blood pressure measurement is one of the most common clinical techniques, there are some factors affecting it, such as blood pressure variability or blood pressure measuring devices. Blood pressure can be measured in different ways: Clinic blood pressure measurement is taken in physician's office. The accurate measurement of blood pressure in clinical practice is dependent on the individual, the equipment used and the observer; this is the most common when considering therapeutic decisions. Self blood pressure measurement provides us with values on different days, in settings as close to daily life conditions as possible, having no white-coat effect. Ambulatory blood pressure measurement. With this method, using devices that permit the automatic monitoring of blood pressure in a patients normal life, health professionals are able to have blood pressure values over 24 hours, as well as the possibility of average blood pressure values over a requested period, such as the day or the night.

Home blood pressure monitoring in general practice: expectations and concerns

Home blood pressure monitoring in general practice: expectations and concerns

Response to Diurnal Blood Pressure Changes in Stroke Subtypes

We appreciate the comments by Tsivgoulis et al1 regarding our article.2 They pointed out the differences among our results,2 their own results,3 and the results by Kario et al.4 In the study by Kario et al,4 the subjects were older, high-risk hypertensive subjects; the risk of intracerebral hemorrhage (ICH) was not adjusted by the average ambulatory blood pressure (BP) value, which is the most important confounding factor for ICH. In their cross-sectional study, Tsivgoulis et al reported that an inverted dipper–type of circadian BP variation was associated with ICH.3 Although they did adjust for baseline characteristics and …

Lactobacillus helveticus Fermented Milk Lowers Blood Pressure in Hypertensive Subjects in 24-h Ambulatory Blood Pressure Measurement

The present study was carried out to evaluate the blood pressure (BP)-lowering effect and the safety aspects of Lactobacillus helveticus LBK-16H fermented milk with high tripeptide doses on hypertensive subjects using 24-h ambulatory measurements (ABPM). In a randomized, double blinded placebo-controlled parallel group study, 94 hypertensive patients not receiving any drug treatment were given 150 mL twice daily of either L. helveticus LBK-16H fermented milk with a high concentration of tripeptides (Ile-Pro-Pro 7.5 mg/100 g and Val-Pro-Pro 10 mg/100 g) or a control product, for 10 weeks after a 4-week run-in period. Twenty-four-hour ABPM were taken at the beginning and at the end of the intervention period. The average baseline systolic and diastolic BP values were 132.6 +/- 9.9/83.0 +/- 8.0 mm Hg in the L. helveticus group and 130.3 +/- 9.6 /80.2 +/- 7.0 mm Hg in the control group. There was a mean difference of -4.1 +/- 0.9 mm Hg in systolic (P = .001) and a -1.8 +/- 0.7 mm Hg in diastolic BP (P = .048) between the L. helveticus group and the control group. There was no difference in the sum of the adverse events (P = .820). Lactobacillus helveticus LBK-16H fermented milk containing bioactive peptides, in daily use, does have a BP-lowering effect in hypertensive subjects and is thus a potential for the dietary treatment of hypertension.

How to improve the assessment of 24-h blood pressure variability

An increased 24-h blood pressure variability, expressed as SD of 24-h average ambulatory blood pressure values, is associated with target organ damage and cardiovascular risk in hypertension, while a physiological nocturnal blood pressure fall has been associated with reduced cardiovascular risk. Nocturnal blood pressure fall, however, may contribute markedly to the overall blood pressure variability. The aim of our study was to quantitatively assess the contribution of nocturnal blood pressure fall to 24-h blood pressure variability, and to propose a new method for computing 24-h blood pressure variability correcting for nocturnal blood pressure fall. From a large database of ambulatory blood pressure recordings obtained in two hypertension centres (Milan, Italy and Krakow, Poland), we selected 1995 recordings of a sufficiently high quality (> or =70% valid readings, > or =1 measure/h). We calculated (1) blood pressure variability, as SD of 24-h mean blood pressure, both directly from all 24-h individual readings and as a weighted mean of separately computed daytime and night-time blood pressure SD; and (2) the size of nocturnal blood pressure fall. The weighted mean SD of 24-h blood pressure was significantly lower than the corresponding direct 24-h SD of blood pressure. The size of the difference between direct SD and weighted mean SD was strongly correlated with the absolute size of nocturnal blood pressure fall (SD: r=0.89 and 0.86 for systolic and diastolic blood pressures, respectively, P<0.001 for all). The 24-h SD of blood pressure is markedly influenced by the size of nocturnal blood pressure fall, while the weighted mean SD is not. The inclusion of nocturnal blood pressure fall in the calculation of 24-h blood pressure variability may thus lead to the overestimating of this phenomenon. Given that blood pressure variability and fall at night may have opposite prognostic significance, it may be advisable to calculate 24-h SD as the weighted mean of daytime and night-time values, which excludes the interference of night-time blood pressure fall on overall blood pressure variability and allows a more precise assessment of the clinical value of 24-h blood pressure variability. The actual clinical relevance of this new parameter has to be assessed by longitudinal outcome studies.

The Clinical Utility of Patient-Measured Blood Pressure at Home in the Management of Hypertension

The Clinical Utility of Patient-Measured Blood Pressure at Home in the Management of Hypertension

Assessing the prognostic relevance of blood pressure variability: discrepant information from different indices

Assessing the prognostic relevance of blood pressure variability: discrepant information from different indices

Effect of the Angiotensin-Converting Enzyme Inhibitor Perindopril on 24-Hour Blood Pressure in Patients with Lacunar Infarction: Comparison between Dippers and Non-Dippers

Antihypertensive therapy based on the angiotensin-converting enzyme (ACE) inhibitor perindopril reduced the incidence of recurrent stroke in the Perindopril Protection against Recurrent Stroke Study (PROGRESS). The present study assessed the effect of perindopril on the 24-h blood pressure (BP) in hypertensive patients with lacunar infarction using ambulatory BP monitoring (ABPM). There was a 4-week observation period, a 4-week treatment period 1 (perindopril at 2 mg/day), and a 4-week treatment period 2 (perindopril at 4 mg/day). Twenty-seven hypertensive patients with lacunar infarction (10 dippers and 17 non-dippers) were enrolled. The average 24-h BP values were significantly decreased after both treatment periods. When the patients were divided into dippers and non-dippers, perindopril exhibited a different BP-lowering effect in the groups with these two circadian BP patterns. In dippers, daytime BP was significantly decreased, whereas nighttime BP was not, so an excessive fall of nighttime BP was not observed. In non-dippers, both daytime and nighttime BP were decreased, with a stronger BP-lowering effect at night. There was a significant inverse correlation between the magnitude of the change in nighttime BP and the night/day ratio. These results suggested that perindopril could induce a sustained decrease of the 24-h BP in patients with lacunar infarction. In particular, a more pronounced nighttime BP-lowering effect was observed in non-dippers. As the incidence of non-dippers is reported to be high among patients with cerebrovascular disease, better nighttime BP control by perindopril might have helped to improve the outcome of such patients in PROGRESS.

Lower Fitness Test Scores and Childhood Obesity are Associated with Elevated Blood Pressure Values

0469 Children with low levels of fitness and age- and gender-adjusted body mass index (BMI; kg/m2) greater than 30 may be at high risk for developing cardiovascular disease. PURPOSE: The purpose of this descriptive study was to determine resting blood pressure (BP) values, BMI, baseline muscular strength, endurance and flexibility levels for inner city children aged 5–10 years in Dayton, OH. METHODS: Subjects were a convenience sample of 75 apparently healthy inner-city grade school students. Participation in the study was voluntary. University of Dayton students measured height, weight and BP and recorded scores for shuttle run, push-ups, sit-ups, and sit-and-reach exercises according to the President's Fitness Challenge. Data were grouped according to subject adjusted BMI (1 normal weight; 2 overweight; and 3 obese) and descriptive statistics, correlations and independent T tests completed for all variables. BP and fitness scores were compared to age and gender adjusted norms. RESULTS: Average systolic and diastolic BP values were significantly higher than normative values for all children (p 0.015 and 0.0001, respectively) especially for children with obesity. Average fitness, flexibility and muscular endurance test scores were significantly lower than national standards especially for children with obesity. CONCLUSIONS: The data indicate that obesity and low levels of fitness are associated with higher blood pressure values in children. It is especially alarming that these relationships are evident in children ages 5–10 years. Increased physical activity opportunities need to be made available for grade school children.

Lower Fitness Test Scores and Childhood Obesity are Associated with Elevated Blood Pressure Values

0469 Children with low levels of fitness and age- and gender-adjusted body mass index (BMI; kg/m2) greater than 30 may be at high risk for developing cardiovascular disease. PURPOSE: The purpose of this descriptive study was to determine resting blood pressure (BP) values, BMI, baseline muscular strength, endurance and flexibility levels for inner city children aged 5–10 years in Dayton, OH. METHODS: Subjects were a convenience sample of 75 apparently healthy inner-city grade school students. Participation in the study was voluntary. University of Dayton students measured height, weight and BP and recorded scores for shuttle run, push-ups, sit-ups, and sit-and-reach exercises according to the President's Fitness Challenge. Data were grouped according to subject adjusted BMI (1 normal weight; 2 overweight; and 3 obese) and descriptive statistics, correlations and independent T tests completed for all variables. BP and fitness scores were compared to age and gender adjusted norms. RESULTS: Average systolic and diastolic BP values were significantly higher than normative values for all children (p 0.015 and 0.0001, respectively) especially for children with obesity. Average fitness, flexibility and muscular endurance test scores were significantly lower than national standards especially for children with obesity. CONCLUSIONS: The data indicate that obesity and low levels of fitness are associated with higher blood pressure values in children. It is especially alarming that these relationships are evident in children ages 5–10 years. Increased physical activity opportunities need to be made available for grade school children.

Blood pressure in centenarians in Poland.

The objective of the study is assessment of the prevalence and type of hypertension in centenarians in Poland. The investigations included 92 people who had turned 100 years of age, who, within the protocol of the Project of Investigation Polish Centenarians, underwent genetic, anthropometric, psychological and sociological examinations, and whose cardiovascular system was assessed. In the present analysis, we are analysing data concerning their blood pressure (BP) assessed by several measurements (3-6) with the mercury sphygmomanometer on both arms in sitting (if possible) or lying position performed during one visit. Hypertension was diagnosed when average BP value exceeded > or = 160/95 or > or = 140/90 mmHg. The average of age was 101.2 years (range 100-111 years), the respective values for BP were: systolic 146.7 mmHg (99-213 mmHg), diastolic BP--80.3 mmHg (55-114 mmHg) and pulse pressure (PP) 66.4 mmHg (31-129 mmHg). Hypertension diagnosed based on the criterion > or = 160/95 mmHg was found in 29% of subjects, and according to the recent WHO criterion (> or = 140/90 mmHg) in 65% of subjects. PP exceeded 65 mmHg in 44.6%, and was above 50 mmHg in 91% subjects. In conclusion, hypertension occurs less frequently in centenarians, than in the entire population of old people, but it nevertheless cannot be considered a rare condition.

Sedation Without Anesthesiologist in 5250 Endoscopic Procedures: Midazolam vs. Midazolam + Dolantine vs. Propofol

Nowadays, narcotics and benzodiazepines are used in most of the gastrointestinal endoscopies. Propofol has some advantages over the rest of sedatives but its use is generally restricted to the anesthesiologist. Aims: Assess the safety and tolerance of nurse-assisted sedation with no anesthesiologist through the performance of a gastrointestinal endoscopy in a endoscopic unit. Patients and methods: The use of Propofol was initiated during endoscopy in our Unit in 02/02. The age and ASA of the patients, type of procedure, tolerance and type and dose of sedatives were anotated prospectively. Additionally, blood pressure (BP), heart rate (HR), pO2 and any special incidence were also reported in those patients under sedation. Results: 6438 endoscopies.were included. Sedation was administered in 5250 (81,5%) (ASA I: 24%, ASA II: 48%, ASA III: 27%, ASA IV: 1%): Midazolam (Mid): 952 (18,1%), Midazolam+Dolantine (Mid+Dol): 1459 (27,8%) and Propofol (Prop): 2839 (54,1%). In the procedures without sedation (18,5%), tolerance and the average values of the pO2 were lower (p=0.001, p=0.008) and the HR higher (p=0.011) when compared to the groups with sedation.Among those groups under sedation, the Prop group had a better average value of BPs (p=0.000), and pO2 (p=0.000) at the end of the procedure than the group Mid+Dol. The latter had less tachycardia than the other two groups (p=0.000). PO2 declined less in Mid (p=0.000) than the Prop and Mid+Dol. Tolerance, as assessed by the nurse and the patient, respectively, was worse in the group Mid when compared to Mid+Dol and Prop (p=0.000). There were some complications of clinical relevance in 45 cases (0.8%). 24 (0,44%) had low pO2, more frequently detected in the Prop and Mid+Dol groups than in Mid. The endoscopic tube was withdrawn in 4 cases in order to ventilate the patient but no intubation was required. Bradycardia was detected in 17 and reversed by using atropine, with a higher proportion in the group Mid+Dol. Finally, there were also: 2 boncoaspirations, 1 laringospasm, 1 angor and 1 comicial episode. There was no mortality. Conclusion: Sedation improves the tolerance of endoscopy. Propofol shows a better profile of tolerance and safety than the rest of used sedatives. The efficacy and low number of complications of Propofol supports the routinary use of this drug without anesthesiologist in the Endoscopy Unit.