Borderline Hypertensive Patients Research Articles

A study of post exercise hypotension in normotensive offspring of hypertensives after acute exercise.

Post exercise hypotension (PEH) is a well-known entity in hypertensive and borderline hypertensive patients. Since the results are inconsistent in normotensives and there is a genetic predisposition of the individuals to hypertension, we hypothesized that PEH is expected to occur in those normotensives who are offspring of hypertensive parents. In this study, we therefore aimed to compare the magnitude of PEH after an acute bout of moderate intensity continuous exercise (MICE) in the offspring of hypertensives vs. offspring of normotensives. Sixty normotensive participants of both genders (male and female in equal proportion), aged 18-40 yr, were divided into two groups based on their family history of hypertension. The cases (Group 1, n=30) consisted of the normotensives who were offspring of hypertensive parents while the normotensives who were offspring of normotensive parents were taken as the controls (Group 2, n=30). The hypertensive patients were excluded from the study. The individuals underwent a control session (sitting at rest for 5-10 min), followed by a single acute bout of MICE based on the target heart rate (60-70% of maximum heart rate) on a treadmill at the same time of the day (in the morning). The pre- and post-exercise measurements (after 10 min post exercise) of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) were taken in all the participants using mercury sphygmomanometer in sitting position on the left arm. The intergroup and intragroup net effects of exercise on BP were compared with P<0.05 considered significant. The mean SBP was reduced by 5 mmHg than the baseline in the offspring of hypertensives (cases) as compared to the controls after exercise (P=0.01). The fall in mean DBP and MAP was insignificant across both the groups, but the magnitude of PEH measured as delta changes (BP before and after exercise) in SBP (~5 mmHg) and MAP (~4 mmHg) were significantly higher for the cases as compared to the controls (P=0.01). PEH occurs in higher magnitude in normotensives who are genetically predisposed to hypertension, such as offspring of hypertensive parents, and may find regular exercise-induced PEH as an important primary preventive tool to prevent or delay the development of hypertension.

Does Hypertension affect Saliva Properties?

Statement of the Problem: Systemic conditions can affect the salivary glands and oral health. Hypertension induces xerostomia. Because the function of saliva is related to its quality and quantity, therefore, any changes in saliva can lead to diminished quality of patient’s life.Purpose: The aim of this study was to determine the relationship between pH and viscosity of cumulative unstimulated saliva and hypertension in adults with sustained hypertension.Materials and Method: This cross sectional study took place on patients referred to oral medicine faculty of Shahid Sadoughi University of Medical Science. The patients’ blood pressure was measured and the 135 patients fitting the inclusion criteria participated in the study. Their unstimulated cumulative saliva was collected by spitting method and pH of the samples was measured by digital pH-meter set. The viscosity of the samples was measured by comparing the amount of saliva displacement in the thistle tube with control fluids at mm/10 seconds. The data was analyzed by SPSS version 20 software and ANOVA tests and Tukey multiple comparison and their nonparametric equivalent (p≤ 0.005).Results: The results of this study showed that there was a significant relationship between pH and viscosity of unstimulated saliva of normotensive and borderline hypertensive patients (p<.0001and p< .005, respectively) and between normotensive and stage I hypertensive patients (p<.0001, p<0.000). Therefore, hypertension had a direct and significant relationship with saliva viscosity but a reverse relationship with saliva pH.Conclusion: Hypertension can reduce the pH and increase the salivary viscosity in hypertensive patients, which subsequently lead to changes in quality and quantity of secreted saliva and influence the oral health and quality of the patient’s life.

Comparative evaluation of dexmedetomidine and labetalol for attenuating hemodynamic stress responses during laparoscopic cholecystectomy in borderline hypertensive patients

Abstract Objective Various pharmacological agents have been tried to attenuate the pressor response in laparoscopic cholecystectomy patients. We have compared single pre-induction intravenous injection of dexmedetomidine with labetalol for attenuation of hemodynamic stress response. Methods A total of 160 patients were considered for this prospective, randomised, double blind clinical study done in a single tertiary care institution. Patients were either included in group D, to receive 1.0 μg kg−1 i.v. dexmedetomidine or group L, to receive 0.3 mg kg−1 i.v. labetalol in 100 ml of normal saline before induction of anaesthesia. Patient's hemodynamic parameters were noted pre-operatively before starting infusion and at fixed intervals afterwards till extrubation. Results After intubation, mean systolic blood pressure (SBP) was higher in patients of group L (128.0 ± 13.866) as compared to group D (123.2 ± 10.672). Afterwards the SBP was comparable until extrubation. Similarly, after intubation patients in group D tended to have lower diastolic pressure (73.1 ± 9.683 vs. 79.2 ± 14.153, p value 0.0017) compared to patients in group L. Also, the relative incidence of bradycardia and hypotension was higher in patients who had received inj. labetalol. Conclusion In patients predisposed to significant fluctuations in blood pressure or heart rate dexmedetomidine may be more suitable than labetalol due to better preservation of normal hemodynamics especially during periods of stress showing a relatively lower incidence of side effects.

Sleep Association With Borderline Diabetes Hypertension: A Cross-sectional Analysis

Abstract Short and long sleep ( 9 hours) are associated with increased odds ratio for diabetes and hypertension and depend on race. However, less is known about the relationships when diabetes and hypertension are in their borderline states. A cross-sectional study using the 2013-2014 National Health Interview Survey and NHANES datasets showed associations between non-midrange sleep duration and borderline disease status that differ from the full-disease associations. Advanced practice providers may use these results to include sleep duration assessment and possible sleep disorder screening in care plans for borderline diabetic and hypertensive patients.

OP.6A.04] HIGH PREVALENCE OF MASKED UNCONTROLLED HYPERTENSENSION AMONG TREATED PATIENTS FOLLOWED UNDER ROUTINE CANADIAN CLINICAL CARE

Objective: Masked hypertension (MH), defined as elevated ambulatory blood pressure (BP) among patients with seemingly well controlled office blood pressure measurements (OBPM), has been associated with high cardiovascular risk. Previous studies have reported a MH prevalence between 10% to 30%, mostly among untreated individuals. The main objective of this study was to describe the prevalence of MH in borderline controlled hypertensive patients treated with short-acting antihypertensives in Canadian routine clinical care. Furthermore, differences between OBPM and home BP measurements (HBPM) taken 24-hours after last medication dose were assessed in treated hypertensive patients with borderline and almost controlled BP. Design and method: Real-life, prospective Canadian study conducted in general practitioners’ offices. Enrolled patients had borderline (SBP 130–139 and/or DBP 80–89 mmHg) or almost controlled (SBP 140–149 and/or DBP 90–99 mmHg) BP based on OBPM and were treated with short-acting antihypertensives. Patients collected HBPMs for 7 consecutive days. MH was defined as HBPM SBP > = 135 and/or DBP > = 85 mmHg among borderline controlled patients. Results: 983 patients were included; 370 (37.6%) were borderline controlled and 613 (62.4%) were almost controlled. Mean (SD) age was 60.5 (11.0) years, 50.1% were male and 65.7% were Caucasian without any remarkable differences between groups. OBPM and HBPM values are summarized in Table 1. Among patients with borderline controlled OBPM hypertension, 187 (50.5%) had MH.Conclusions: A higher rate of MH than what was previously reported in the literature was observed in this study, which confirms previous studies suggesting that the use of short-acting antihypertensives may be a risk factor for MH, probably due to suboptimal coverage over 24 hours. These results support the latest Canadian Hypertension Education Program recommendations that OBPM alone is inadequate for BP control optimization.

Blood pressure-associated polymorphism controls ARHGAP42 expression via serum response factor DNA binding.

We recently demonstrated that selective expression of the Rho GTPase-activating protein ARHGAP42 in smooth muscle cells (SMCs) controls blood pressure by inhibiting RhoA-dependent contractility, providing a mechanism for the blood pressure-associated locus within the ARHGAP42 gene. The goals of the current study were to identify polymorphisms that affect ARHGAP42 expression and to better assess ARHGAP42's role in the development of hypertension. Using DNase I hypersensitivity methods and ENCODE data, we have identified a regulatory element encompassing the ARHGAP42 SNP rs604723 that exhibits strong SMC-selective, allele-specific activity. Importantly, CRISPR/Cas9-mediated deletion of this element in cultured human SMCs markedly reduced endogenous ARHGAP42 expression. DNA binding and transcription assays demonstrated that the minor T allele variation at rs604723 increased the activity of this fragment by promoting serum response transcription factor binding to a cryptic cis-element. ARHGAP42 expression was increased by cell stretch and sphingosine 1-phosphate in a RhoA-dependent manner, and deletion of ARHGAP42 enhanced the progression of hypertension in mice treated with DOCA-salt. Our analysis of a well-characterized cohort of untreated borderline hypertensive patients suggested that ARHGAP42 genotype has important implications in regard to hypertension risk. Taken together, our data add insight into the genetic mechanisms that control blood pressure and provide a potential target for individualized antihypertensive therapies.

Plasma concentrations of adrenomedullin and atrial and brain natriuretic peptides in patients with adrenal pheochromocytoma.

The present study aimed to evaluate any changes in the plasma concentrations of adrenomedullin (ADM), atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with adrenal pheochromocytoma (PC). The plasma concentrations of the three peptides were measured in 45 healthy control individuals and 90 untreated patients with PC, who consisted of 20 normotensive patients, 30 borderline hypertensive patients and 40 hypertensive patients. After 4 weeks of effective antihypertensive therapy for hypertensive PC patients, the concentrations of ADM, ANP and BNP were measured again, and laparoscopic adrenalectomy was then performed for all PC patients with values that were measured 2 weeks later. The plasma concentrations of the three peptides were significantly increased in the borderline hypertensive and hypertensive patients compared with the concentrations in control individuals and normotensive patients. In addition, there were significant differences between the levels of ADM, ANP and BNP in the borderline and hypertensive groups. The plasma ADM concentration was not associated with the blood urea nitrogen levels, serum creatinine levels or glomerular filtration rate, but was correlated with the serum epinephrine, serum norepinephrine and urine vanillylmandelic acid levels. In addition, the ADM concentration was associated with the systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction, left ventricular mass index and plasma concentrations of ANP and BNP in the hypertensive patients with PC. After 4 weeks of antihypertensive treatment, the values of the three peptides in the hypertensive patients with PC were not significantly changed. As expected, the values in borderline and hypertensive groups were significantly decreased 2 weeks subsequent to surgery, whereas there were no significant changes in the normotensive group. ADM may participate, along with ANP and BNP, in the mechanisms that counteract further elevation of blood pressure in patients with PC, and there may be an ADM/catecholamine local regulatory mechanism that is important for the control of adrenal medulla functions.

Effectiveness of Acu-Transcutaneous Electrical Nerve Stimulation in Middle Aged Borderline Hypertensive Patients - a Randomised Controlled Trial

Effectiveness of Acu-Transcutaneous Electrical Nerve Stimulation in Middle Aged Borderline Hypertensive Patients - a Randomised Controlled Trial

Celiprolol reduces oxidative stress and attenuates left ventricular remodeling induced by hypoxic stress in mice

We have previously reported that intermittent hypoxic stress, which is relevant to sleep apnea syndrome (SAS), increases oxidative stress and induces left ventricular (LV) remodeling. Celiprolol, a β1-selective adrenoreceptor blocker, is known to have not only an antihypertensive effect but also an antioxidant effect through releasing nitric oxide. The aim of this study was to examine the hypothesis that celiprolol might ameliorate the LV remodeling induced by intermittent hypoxia through its antioxidant effect. Male C57BL/6J mice (8 weeks old) were exposed to intermittent hypoxia (30 s of 5% oxygen followed by 30 s of 21% oxygen) for 8 h day(-1) during the daytime for 10 consecutive days or were maintained under normoxic conditions. Animals were treated with either celiprolol (100 mg kg(-1) day(-1) by gavage) or vehicle. Hypoxic stress caused fluctuations in blood pressure (BP), an increase in the mean cardiomyocyte diameter, perivascular fibrosis and a decrease in endothelial nitric oxide synthase (eNOS) expression. These changes were associated with increased levels of 4-hydroxy-2-nonenal protein, superoxide, tumor necrosis factor-α mRNA and brain natriuretic peptide mRNA in the LV myocardium. Celiprolol significantly suppressed BP fluctuation, restored eNOS expression and reduced oxidative stress and superoxide production, thus ameliorating hypoxia-induced LV remodeling in mice. These findings suggest that treatment with celiprolol might prevent cardiovascular events in borderline hypertensive patients with SAS.

160 DIFFUSE FIBROSIS IN ALSTRöM SYNDROME: A MARKER OF DISEASE PROGRESSION

Background Alstrom syndrome (ALMS) is a rare autosomal recessive genetic disorder with progressive multi-system involvement including; endocrine disarray, sensorineural deficit, cardiac, renal, and hepatic abnormalities. Idiopathic dilated cardiomyopathy (CM) is a major cause of morbidity and mortality. It is observed acutely in infancy in approximately 45% of individuals with high rates of recurrence and new cases in adulthood. Myocardial fibrosis has been demonstrated at post-mortem and on MRI with patchy diffuse late gadolinium enhancement (LE) in an older cohort of ALMS patients. We hypothesise that subclinical diffuse fibrosis in young patients with ALMS precedes any change in conventional parameters of ventricular function or overt scarring on LE. Methods Ten patients with ALMS (mean age 30±11 years, 70% male, 24 h ABPM 135±13/84±9 mm Hg) were compared to 10 newly diagnosed borderline hypertensive patients (mean age 42 years, 70% male, 24 h ABPM 134±8/84±8 mm Hg) and 10 gender matched healthy volunteers. All subjects underwent cardiac MRI (1.5T). Myocardial extracellular volume (ECV) was assessed using T1-mapping pre and 15 min post gadolinium (0.1 mmol/kg) using a modified look-locker inversion recovery sequence (MOLLI). Late gadolinium images were acquired 5–7 min after contrast. Myocardial T1 was assessed by manual contouring of the basal and mid interventricular septum, avoiding areas of LE from a four chamber view. Results Females in all three groups had significantly increased septal myocardial ECV compared with males (0.29±0.03 vs 0.25±0.03, p Conclusions Patients with ALMS have increased septal myocardial fibrosis and reduced longitudinal systolic function which appears independent of blood pressure and left ventricular hypertrophy. Monitoring left ventricular ECV as an imaging biomarker may be a target for early modification of pharmacological therapy in this cohort at high cardiovascular risk. Funding National Commissioning Group.

164 MAGNESIUM STATUS AND THERAPY IN BORDERLINE HYPERTENSION

Background, Design and Methods: The electrolyte magnesium plays an important role in the development of primary hypertension. Therefore we have measured plasma and intracdellular Mg++ levels in erythrocytes in 18 untreated borderline hypertensive patients and in 35 untreated normotensive healthy subjects as controls. Results: In patients intracellular Mg++ content was significantly lower (1.61+/−0.09 mmmol/l, mean +/− SD), than in controls (1.84+/−0.14 mmol, p < 0.05). After 12 − 15 weeks of an oral supplementation with 240 − 480 mg Mg++/day, the erythrocyte Mg++ content had increased significantly in the borderline hypertensive group (1.78+/−0.11 mmol/l) (p < 0.05). There was no significant difference between the normotensive and borderline hypertensive group in plasma Mg++ concentrations (0.87+/−0.13 versus 0.83+/−0.17 mmol/l). Systolic and diastolic blood pressure values of the borderline hypertensive group also normalized after oral Mg++ administration (before therapy: 147.6+/−8.5 / 87.2+/−4.4 mmHg, after therapy: 137.2+/−4.6 / 83.8+/−3.4 mmHg) (p < 0.05). After 18 − 21 weeks of magnesium-therapy in the hypertensives, blood pressure was 135.8+/−4.8 / 82.9+/−3.6 mmHg (p < 0.05) and plasma magnesium was 0.91+/−0.29 mmol/l. Conclusions: The clinical study presented here shows a positive effect of oral magnesium therapy in borderline hypertensives. This effect is time-dependent. Long-lasting magnesium therapy should be preferrend since the effects of magnesium supplementation in hypertension occur mainly after long-term treatment.

RAISINS AND BLOOD PRESSURE: A RANDOMIZED, CONTROLLED TRIAL

The CAMELOT study supported the cardiovascular benefits of mildly reducing blood pressure (BP) in borderline hypertensive patients. Raisins are high in potassium content, and have fiber, polyphenols, phenolic acid, tannins, and antioxidants which may help account for their often-cited, yet unproven

Autonomic-Immune-Vascular Interaction

Hypertension is the single most important risk factor for cardiovascular disease and, thus, remains a global public health challenge. Significant progress has been made during the last several decades in the treatment of hypertension through the use of inhibitors of the renin-angiotensin (Ang) system, with either Ang-converting enzyme inhibitors or Ang receptor type 1 blockers, diuretics, α-adrenoreceptor antagonists, and calcium channel blockers. Despite these advances, it has been extremely difficult to manage hypertension in ≈40% of hypertensive patients.1 A majority of these unresponsive patients exhibit increased sympathetic drive and display neurogenic components.2,–,4 The role of elevated sympathetic nervous system in drug-resistant hypertension is corroborated by the recent successes in its treatment by renal sympathetic denervation in humans.3,5,6 These observations have led to the realization that elucidation and understanding of cellular, molecular, and physiological mechanisms involved in the development and establishment of neurogenic hypertension are pivotal in advancing new therapeutic strategies that would be effective in a majority of patients. The objectives of this article are to summarize recent advances in this field, underscoring the importance of coordinated neural-peripheral signaling in neural control of blood pressure (BP) and contribution of inflammatory molecules, and to introduce novel and emerging concepts in the pathogenesis of neurogenic hypertension. It is advised to consult other reviewers for details on fundamental studies related to neural pathways, the renin-Ang system, and involvement of other hormonal systems in neurogenic hypertension.7,–,13 ### Neurogenic Hypertension An alteration in neural cardiovascular (vagal/sympathetic) control mechanism is the principal characteristic of neurogenic hypertension. Studies demonstrating a significant enhancement of the vasomotor and cardiac sympathetic drive, as well as a reduction in the parasympathetic drive in borderline hypertensive patients, support this premise.14,–,16 In addition, hypertensive patients …

HEART RATE VARIABILITY AND LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH BORDERLINE HYPERTENSION WITH AND WITHOUT LEFT VENTRICULAR HYPERTROPHY

The relationships between heart rate variability (HRV), left ventricular mass and diastolic function in borderline hypertensive patients (BHT) were evaluated. 24 h Holter electrocardiogram (ECG) and blood pressure (BP) monitoring, M and 2 D echocardiogram and Doppler analysis in 42 BHT with and without left ventricular hypertrophy (LVH) and in 20 normotensive controls were assessed. From 24-h ECG, time domain indexes of HRV were calculated. Standard Deviation of all Cycles (SDNN) and Standard Deviation of the means of heart periods over five-minute intervals (SDANN) were significantly reduced in BHT with LVH but not in BHT without LVH. No significant differences of short-term variability measures were detectable, although a progressive decrease among control subjects and BHT with and without LVH was observed.Diastolic left ventricular compliance evaluated by early to late transmitral flow velocity ratio (E/A ratio) significantly declined from normotensive subjects to BHT with LVH. There was a significant positive correlation between E/A and SDNN and SDANN throughout all studied groups. This indicates that BHT with LVH has a reduced HRV compared to other groups. This impairment is probably related to left ventricular mass and left ventricular filling abnormalities.

Degree of Arousal Is Most Correlated with Blood Pressure Reactivity During Sleep in Obstructive Sleep Apnea

We investigated blood pressure (BP) reactivity of obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. The influences on BP reactivity of degree of arousal, the lowest O2 saturation (SaO2), and respiratory disturbance (RD) duration were compared. Ten normotensive or borderline hypertensive patients with OSA were studied with one-night polysomnography including non-invasive beat-to-beat BP monitoring (Finapres). We compared baseline BP, pre-apneic BP, and post-apneic BP during both REM and NREM sleep. Also, relationships between delta BP (post-apneic BP minus pre-apneic BP) and degree of arousal, the lowest SaO2, and RD duration were examined. During both REM and NREM sleep, pre-apneic BP was elevated compared with baseline BP. Post-apneic BP elevation was noted compared with pre-apneic BP. The degree of arousal was more significantly correlated with delta BP than the lowest SaO2. RD duration was hardly correlated with delta BP. Pre-apneic BP elevation seems to result from cumulation of sympathetic activation and sympathetic nervous system resetting. The correlation between delta BP and degree of arousal suggests that sympathetic activation causing post-apneic BP elevation may result mainly from an arousal response regardless of hypoxia.

Circulating heat shock protein 60 is associated with early cardiovascular disease.

The phylogenetically conserved nature of heat shock proteins (Hsp) has led to the proposition that they may provide a link between infection and the inflammatory component to vascular disease. Hypertension is associated with atherosclerosis. Here, we measured circulating heat shock protein and heat shock protein antibody levels in association with borderline hypertension. Seventy-two men with borderline hypertension patients and 75 normotensive control subjects (diastolic blood pressure 85 to 94 and <80 mm Hg, respectively) were selected from a population-screening program. The levels of Hsp60; Hsp70; and anti-human Hsp60, anti-human Hsp70, and anti-mycobacterial Hsp65 antibodies were determined with enzyme immunoassay. The presence of carotid atherosclerosis and the intima-media thickness values were determined with ultrasonography. A major novel observation in this report was the detection of circulating Hsp60, which was present at a significantly enhanced level in patients with borderline hypertension. Furthermore, serum Hsp60 was associated with intima-media thicknesses (P<0.01). Anti-Hsp65 antibody levels were higher in borderline hypertension (P<0.001), whereas Hsp70 and anti-Hsp70 antibody levels did not differ. In contrast to anti-Hsp65 antibody, anti-Hsp60 antibody levels were lower in borderline hypertension (P<0.03), although the difference was quantitatively small. None of the parameters evaluated were associated with atherosclerosis, metabolic factors, or smoking. We identified elevated Hsp60 levels in patients with borderline hypertension and an association between early atherosclerosis and Hsp60 levels. The physiological role of Hsp60 release has yet to be defined, but given the proinflammatory properties, these proteins could be involved in the induction/progression of both hypertension and atherosclerosis, as well as being markers for early cardiovascular disease.

No Relevant Seasonal Influences on Office and Ambulatory Blood Pressure: Data From a Study in Borderline Hypertensive Primary Care Patients

Our objective was to study seasonal influences on office and ambulatory blood pressure. We therefore designed a prospective 7-month study of 47 borderline hypertensive patients in a primary care setting. We used no interventions. Our main outcome measures were the differences between summer and winter office and ambulatory blood pressures and 95% confidence intervals. Results showed that winter minus summer differences ranged from 0 to 3 mm Hg. Only one significant difference was found: ambulatory systolic daytime pressure was significantly higher (3 mm Hg) in winter than in summer. Our results do not confirm the data of earlier studies in hypertensives. In view of the small and clinically irrelevant winter-summer differences, it seems unnecessary to modify antihypertensive treatment of borderline hypertensives according to the season.

The natural history of borderline hypertension in a Chinese population.

One hundred and thirty-one borderline hypertensive patients were followed up for 17 years. A cohort of normotensives strictly matched by age, sex, region and occupation served as controls (1:1). It was found that 64.6% of borderline hypertensive patients developed into established hypertensives after 17 years follow-up, 25.5% restored to normotensives and 13.8% remained unchanged. The total mortality rate of borderline hypertensives was higher than that of normotensives (27.9 vs 13.4/1000 person years), and the relative risk of total death in borderline hypertensives was 2.35. The main cause of death was stroke, accounting for 42.5% of the total death rate. The relative risk rates of occurrence and death associated with stroke were 8.3 and 11.6, respectively. It is concluded that the main complication of borderline hypertension was stroke rather than coronary heart disease, which was similar to that of established hypertension in this area. Part of the borderline hypertensives need to be treated to reduce the risk of cardiovascular complications.

A controlled comparison on the effect of muscle and cognitive relaxation procedures on blood pressure: implications for the behavioural treatment of borderline hypertensives

Outcome studies concerned with the efficacy of muscle versus cognitive relaxation procedures in reducing blood pressure remain inconclusive because of inappropriate controls and confounded relaxation instructions. In order to better compare the potency of these two procedures 30 borderline hypertensive patients were assigned to muscle tense release, muscle stretch release and cognitive relaxation procedures, placebo attention and test only control conditions to form groups orthogonally matched for pre-treatment systolic blood pressure, sex and age. Most importantly, the relaxation procedures were designed to be distinctive for each condition so that cognitive and muscle procedures were not confounded. Both cognitive and muscle relaxation procedures were superior in reducing blood pressure when compared to controls; the muscle tense release procedure proved most effective. These results dispell the common assumption that an amalgam of these two components is most effective and support previous findings that muscularly oriented relaxation methods seem more effective in treating somatic problems. The practical and theoretical significance of emphasizing a muscle relaxation approach in clinical practice and in further outcome studies are discussed.

Arterial distensibility and compliance in hypertension

Under normal circumstances arteries, especially the larger elastic ones, distend during systole, and hence are able to store volume energy during this phase of the cardiac cycle. In this way the increase in blood pressure during systole will be leveled off. The amount of energy that can be stored depends not only on the degree of distension (distensibility), but also on the initial diameter of the vessel—two parameters actually determining the compliance of an artery. In both established and borderline hypertension distensibility and compliance of the larger elastic arteries are reduced, as compared with normotensives, but not of the radial artery, at least in patients with established hypertension. In these patients this artery shows a pronounced increase in intima-media thickness. The elastic modulus of the radial artery is not different in hypertensive and normotensive subjects. In the present state of the art, it cannot be concluded whether the loss of artery wall distensibility is caused solely by the increase in blood pressure or that also structural wall changes are involved. In borderline hypertensive patients distensibility and compliance of the elastic arteries are diminished as compared with normotensive subjects. The loss of distensibility already occurs in the fourth age decade and is not homogeneous along the carotid artery bifurcation. The distensibility is significantly lower at all levels in the carotid artery bulb than in the common carotid artery, the proximal part of the bulb, where the baroreceptors are predominantly located, being most affected. This pattern is similar to that observed in normotensive subjects in the sixth age decade, indicating that the carotid arteries age faster in borderline hypertensive than in normotensive subjects.