Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Adenosina/análogos & derivados , Piperazinas/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Tiofenos/uso terapêutico , Ticlopidina/análogos & derivados , Síndrome Coronariana Aguda/economia , Adenosina/uso terapêutico , Ensaios Clínicos como Assunto , Clopidogrel , Custos e Análise de Custo , Uso de Medicamentos , Medicina Baseada em Evidências , Humanos , Cooperação Internacional , Marketing , Satisfação do Paciente , Guias de Prática Clínica como Assunto , Cloridrato de Prasugrel , Ticagrelor , Ticlopidina/uso terapêuticoRESUMO
BACKGROUND: Thickness measurement of the outermost layer of the skin, the stratum corneum (SC), is essential for in-vivo measurement of the cutaneous bioavailability of topically applied drugs and cosmetics. Our aim was to compare SC thickness calculated from confocal Raman spectroscopy (CRS) data with results of SC thickness based on confocal laser scanning microscopy (CLSM) measurements and with literature data, to validate CRS data with CLSM data and vice versa. METHODS: SC thickness was measured with two non-invasive devices, confocal Raman spectroscopy and confocal laser scanning microscopy, on four different areas of the body: volar forearm, leg, face and palm in 18 healthy adult subjects. RESULTS: Comparable results of SC thickness were obtained with both methods, structure analysis of CLSM images, and computation of Fick's first law on water gradients measured with CRS: 20 µm and 19 µm (volar forearm), 21 µm and 22 µm (lower leg), and 13 µm with both methods (cheek), respectively. DISCUSSION: For the first time it was possible to accurately determine the thickness of SC with CRS and CLSM and to validate both systems against each other and with results of literature data. CONCLUSION: Both methods, CRS and CLSM, were found to be suitable to measure SC thickness correctly. Therefore, when using CRS, for example to obtain detailed information about the molecular composition of the skin, it is additionally possible to accurately measure SC thickness with the same device to have an orientation in which skin layer molecules are found.
Assuntos
Dermoscopia/métodos , Células Epidérmicas , Epiderme/fisiologia , Microscopia Confocal/métodos , Análise Espectral Raman/métodos , Adulto , Humanos , Pessoa de Meia-Idade , Tamanho do Órgão , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
AIM: Inhibition of diacylglycerol acyltransferase 1 (DGAT1) is a potential treatment modality for patients with type 2 diabetes mellitus and obesity, based on preclinical data suggesting it is associated with insulin sensitization and weight loss. This randomized, placebo-controlled, phase 1 study in 62 overweight or obese men explored the effects and tolerability of AZD7687, a reversible and selective DGAT1 inhibitor. METHODS: Multiple doses of AZD7687 (1, 2.5, 5, 10 and 20 mg/day, n = 6 or n = 12 for each) or placebo (n = 20) were administered for 1 week. Postprandial serum triacylglycerol (TAG) was measured for 8 h after a standardized 45% fat meal. Glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) were measured and a paracetamol challenge was performed to assess gastric emptying. RESULTS: Dose-dependent reductions in postprandial serum TAG were demonstrated with AZD7687 doses ≥5 mg compared with placebo (p < 0.01). Significant (p < 0.001) increases in plasma GLP-1 and PYY levels were seen at these doses, but no clear effect on gastric emptying was demonstrated at the end of treatment. With AZD7687 doses >5 mg/day, gastrointestinal (GI) side effects increased; 11/18 of these participants discontinued treatment owing to diarrhoea. CONCLUSIONS: Altered lipid handling and hormone secretion in the gut were demonstrated during 1-week treatment with the DGAT1 inhibitor AZD7687. However, the apparent lack of therapeutic window owing to GI side effects of AZD7687, particularly diarrhoea, makes the utility of DGAT1 inhibition as a novel treatment for diabetes and obesity questionable.
Assuntos
Acetatos/uso terapêutico , Fármacos Antiobesidade/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diacilglicerol O-Aciltransferase/antagonistas & inibidores , Diarreia/induzido quimicamente , Obesidade/tratamento farmacológico , Pirazinas/uso terapêutico , Acetatos/efeitos adversos , Adulto , Fármacos Antiobesidade/efeitos adversos , Diacilglicerol O-Aciltransferase/efeitos dos fármacos , Relação Dose-Resposta a Droga , Esvaziamento Gástrico/efeitos dos fármacos , Peptídeo 1 Semelhante ao Glucagon/efeitos dos fármacos , Humanos , Absorção Intestinal/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Peptídeo YY/efeitos dos fármacos , Pirazinas/efeitos adversos , Resultado do Tratamento , Redução de Peso/efeitos dos fármacosRESUMO
OBJECTIVE: This study evaluated the short term efficacy of tongue cleaning with meridol HALITOSIS tooth & tongue gel in comparison to mechanical tongue cleaning alone and untreated after five and 60 minutes in patients with an oral cause of bad breath. METHODS: Fifty-four male and female subjects with an intra-oral cause of halitosis (organoleptic ratings > or = 2 and volatile sulphur compounds > or = 50 ppb) participated in this crossover study and were assigned to six different treatment sequences (ABC, ACB, BAC, BCA, CAB, CBA) with no treatment (A), mechanical tongue cleaning alone (B), and tongue cleaning with tooth & tongue gel applied to the tongue cleaner (C). Efficacy was assessed by organoleptic ratings and volatile sulphur compound measurements five and 60 minutes after treatment RESULTS: Cleaning the tongue with tooth & tongue gel applied onto the tongue cleaner resulted in significantly reduced organoleptic ratings (p < 0.001 for the five-minute assessment; p = 0.001 for the 60-minute assessment) and volatile sulphur compounds (H2S + CH3SH: p = 0.005 for the five-minute assessment; p = 0.003 for the 60-minute assessment) compared to no treatment at the five- and 60-minute assessment time points, while mechanical tongue cleaning alone was less effective in reducing organoleptic ratings (p = 0.008 for the five-minute assessment; p = 0.144 for the 60-minute assessment) and volatile sulphur compounds (H2S + CH3SH: p = 0.261 for the five-minute assessment; p = 0.365 for the 60-minute assessment). CONCLUSIONS: Single tongue cleaning with meridol HALITOSIS tooth & tongue gel had a positive effect on halitosis five and 60 minutes after treatment. Tongue cleaning with tooth & tongue gel in combination with other oral hygiene procedures is a promising approach to control halitosis.
Assuntos
Aminas/uso terapêutico , Halitose/prevenção & controle , Higiene Bucal/instrumentação , Fluoretos de Estanho/uso terapêutico , Língua , Cremes Dentais/uso terapêutico , Cromatografia Gasosa , Estudos Cross-Over , Combinação de Medicamentos , Feminino , Halitose/metabolismo , Humanos , Sulfeto de Hidrogênio/análise , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Compostos de Sulfidrila/análise , Sulfetos/análise , Fatores de Tempo , Língua/efeitos dos fármacos , Resultado do Tratamento , Compostos Orgânicos Voláteis/análiseRESUMO
Anemia is common in the elderly and its impact on various important health outcomes has recently been clearly demonstrated. Although a causal relationship has not yet been demonstrated, adequate diagnosis and treatment are important. Because of ongoing changes in demographics an increasing number of anemic elderly patients is to be expected. Despite this, many issues regarding the aetiology and the management of anemia in older persons remain unresolved. The present review will focus on aspects specific to the causes of anemia in the elderly and suggests an algorithm for the management of this very common condition. Clearly evidence based guidelines on anemia in this highest age group need to be developed. Treatment options for patients with myelodysplastic syndromes are also discussed.
Assuntos
Anemia/etiologia , Idoso , Algoritmos , Anemia/epidemiologia , Anemia/mortalidade , Estudos Transversais , Diagnóstico Diferencial , Humanos , Prognóstico , Fatores de Risco , Taxa de SobrevidaRESUMO
This study aimed to compare a new chlorhexidine (CHX)-free mouthrinse containing amine fluoride/stannous fluoride (ASF) against a benchmark containing CHX with respect to their effect on oral malodour after single use. A total of 42 male and female subjects with an intraoral cause of bad breath, each with an organoleptic rating (OR) of at least 2 and a total volatile sulfur compound (VSC) concentration higher than 130 ppb, participated in the study. Subjects were allocated to one of three treatment groups (i.e. CHX-free ASF mouthrinse, CHX benchmark mouthrinse or water) according to a randomization list. Participants received written instructions on precautions to be taken for optimal breath analysis. Eight trained and qualified odour judges assessed the subjects' malodour by OR at baseline and 30 min and 4 h after single use of the mouthrinses. Additionally, VSC levels were measured at baseline and 4 h after using the mouthrinse. Treatment with water alone led already to some reduction in OR with mean differences to baseline of -1.13 at 30 min and -0.64, 4 h after treatment. Both CHX-free ASF product (-1.51) and CHX (-1.48) provided a significantly stronger OR reduction than water at 30 min (p < 0.05). Only CHX-free ASF treatment showed a sustained benefit in terms of significantly better OR reduction after 4 h (-1.17, p < 0.05), whereas CHX (-0.81) was not significantly different from water (-0.64, p = 0.517). Both ASF (-90.9%) and CHX (-81.6%) reduced VSC levels significantly stronger than water (-53.5%; p < 0.001). OR and VSC readings in the group using the CHX mouthrinse did not differ significantly from those in the group using the CHX-free ASF formulation. The newly developed CHX-free ASF mouthrinse significantly reduced oral malodour after single use, both in terms of OR and VSC levels. Efficacy was comparable to that of the CHX benchmark product.
Assuntos
Halitose/prevenção & controle , Antissépticos Bucais/uso terapêutico , Adulto , Testes Respiratórios , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Statistical methodology has become an increasingly important topic in dermatological research. Adequacy of the statistical procedure depends among others on distributional assumptions. In dermatological articles, the choice between parametric and nonparametric methods is often based on preliminary goodness-of-fit tests. AIM: For the special case of the assumption of normally distributed data, the Kolmogorov-Smirnov test is the most popular choice. We investigated the performance of this test on four types of non-normal data, representing the majority of real data in dermatological research. METHODS: Simulations were run to assess the performance of the Kolmogorov-Smirnov test, depending on sample size and severity of violations of normality. RESULTS: The Kolmogorov-Smirnov test performs badly on data with single outliers, 10% outliers and skewed data at sample sizes < 100, whereas normality is rejected to an acceptable degree for Likert-type data. CONCLUSION: Preliminary testing for normality is not recommended for small-to-moderate sample sizes.
Assuntos
Interpretação Estatística de Dados , Dermatologia , Distribuição Normal , Pesquisa Biomédica/métodos , Humanos , Projetos de Pesquisa , Tamanho da AmostraRESUMO
Pneumocystis carinii pneumonia in patients with chronic lymphocytic leukaemia (CLL) who have not been treated with fludarabin are rare, although clinically relevant CD4 T-cell depletion can occur in longstanding CLL without prior treatment with purine analogues. A 52 year old woman is reported who was on long term treatment with chlorambucil and taking a short course of prednisone for familial CLL before she developed progressive dyspnoea, and P carinii pneumonia was diagnosed in bronchoalveolar lavage fluid. Despite treatment with high dose co-trimoxazole the patient died.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Infecções Oportunistas/complicações , Pneumonia por Pneumocystis/complicações , Anti-Infecciosos/uso terapêutico , Clorambucila/administração & dosagem , Dispneia/etiologia , Evolução Fatal , Feminino , Humanos , Leucemia Linfocítica Crônica de Células B/genética , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Linhagem , Pneumonia por Pneumocystis/tratamento farmacológico , Prednisona/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoAssuntos
Arritmias Cardíacas/complicações , Fibrilação Ventricular/etiologia , Anticoagulantes/uso terapêutico , Cardioversão Elétrica , Eletrocardiografia , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Fibrilação Ventricular/tratamento farmacológicoRESUMO
Granulocyte colony-stimulating factor (G-CSF) is widely used to accelerate neutrophil recovery after allogeneic BMT or PBSC transplantation. The optimal time to start G-CSF treatment is not known. Forty-two patients undergoing allogeneic BMT or PBSC transplantation for hematological malignancies received G-CSF either on day 6 or on day 9 post transplant. The time to hematological recovery was monitored and the two groups were compared with respect to peritransplant morbidity and mortality. Recovery of the neutrophil counts to >0.1 x 10(9)/l, > 0.5 x 10(9)/l and >1.0 x 10(9)/l were not significantly different in either group. There was no difference in recovery of red blood cell and platelet counts and no difference between the two groups with respect to the number of febrile days or number of days on antibiotic treatment. Documented bacterial, viral or fungal infections did not occur more often when G-CSF treatment was started on day 9. Delaying treatment with G-CSF resulted in a significant reduction in the length of treatment from 13 to 10 days (23.1% reduction). Reducing the length of the treatment by 3 days lowered the costs by 395.40 Euro per patient. Delaying G-CSF treatment and starting on day 9 after BMT or PBSC transplantation is safe and results in a clear economic benefit.
Assuntos
Transplante de Medula Óssea/métodos , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Transplante de Células-Tronco de Sangue Periférico/métodos , Adolescente , Adulto , Contagem de Células Sanguíneas , Transplante de Medula Óssea/efeitos adversos , Transplante de Medula Óssea/mortalidade , Feminino , Sobrevivência de Enxerto/efeitos dos fármacos , Fator Estimulador de Colônias de Granulócitos/economia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/mortalidade , Neoplasias Hematológicas/terapia , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Transplante de Células-Tronco de Sangue Periférico/mortalidade , Estudos Prospectivos , Fatores de Tempo , Transplante Homólogo , Transplante IsogênicoRESUMO
Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare disorder of unknown aetiology affecting predominantly young to middle-aged women. It is characterized by a polyclonal expansion of B cells, including typical binucleated lymphocytes, and is associated with the presence of the translocation t(14;18), involving the bcl-2 oncogene. The stage of differentiation of the B cells expanded in PPBL is not known. We analysed the immunophenotype of the expanded B-cell subset in five new patients with PPBL and found a large uniform expansion of a recently defined human memory B-cell population, IgD(+)CD27(+) memory B cells. After in vitro stimulation with interleukin 2 (IL-2) and Staphylococcus aureus Cowan strain I, B cells from PPBL patients produced high levels of IgM immunoglobulins, which is a characteristic feature of IgD(+)CD27(+) memory B cells. Using a quantitative real-time polymerase chain reaction method, we found a high frequency of the translocation t(14;18) in the range of 1000-3000 per 106 B cells in PPBL patients. In contrast, a much smaller number of cells with a t(14;18) was found in B cells from healthy individuals. Our finding that PPBL is an accumulation of memory B cells further suggests that chronic antigeneic stimulation plays an important part in the pathogenesis of this disorder. This IgD(+)CD27(+) memory B-cell population might harbour a certain number of 'physiological' t(14;18) translocations that increases as this population expands in PPBL patients and constitutes the majority of peripheral blood lymphocytes.
Assuntos
Linfócitos B/imunologia , Imunoglobulina D/imunologia , Memória Imunológica , Linfocitose/imunologia , Membro 7 da Superfamília de Receptores de Fatores de Necrose Tumoral/imunologia , Adulto , Apoptose , Estudos de Casos e Controles , Cromossomos Humanos Par 14 , Cromossomos Humanos Par 18 , Células Clonais , Feminino , Humanos , Immunoblotting , Imunoglobulina M/imunologia , Interleucina-2/farmacologia , Linfocitose/genética , Linfocitose/metabolismo , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Proteínas Proto-Oncogênicas/análise , Proteínas Proto-Oncogênicas c-bcl-2/análise , Staphylococcus aureus , Translocação Genética , Proteína X Associada a bcl-2 , Proteína bcl-XAssuntos
Inibidores da Enzima Conversora de Angiotensina/farmacologia , Captopril/farmacologia , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Captopril/administração & dosagem , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/tratamento farmacológico , Hipertrofia Ventricular Esquerda/etiologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: To examine the efficacy of ACE inhibitors for treatment of nondiabetic renal disease. DATA SOURCES: 11 randomized, controlled trials comparing the efficacy of antihypertensive regimens including ACE inhibitors to the efficacy of regimens without ACE inhibitors in predominantly nondiabetic renal disease. STUDY SELECTION: Studies were identified by searching the MEDLINE database for English-language studies evaluating the effects of ACE inhibitors on renal disease in humans between May 1977 (when ACE inhibitors were approved for trials in humans) and September 1997. DATA EXTRACTION: Data on 1860 nondiabetic patients were analyzed. DATA SYNTHESIS: Mean duration of follow-up was 2.2 years. Patients in the ACE inhibitor group had a greater mean decrease in systolic and diastolic blood pressure (4.5 mm Hg [95% CI, 3.0 to 6.1 mm Hg]) and 2.3 mm Hg [CI, 1.4 to 3.2 mm Hg], respectively) and urinary protein excretion (0.46 g/d [CI, 0.33 to 0.59 g/d]). After adjustment for patient and study characteristics at baseline and changes in systolic blood pressure and urinary protein excretion during follow-up, relative risks in the ACE inhibitor group were 0.69 (CI, 0.51 to 0.94) for end-stage renal disease and 0.70 (CI, 0.55 to 0.88) for the combined outcome of doubling of the baseline serum creatinine concentration or end-stage renal disease. Patients with greater urinary protein excretion at baseline benefited more from ACE inhibitor therapy (P = 0.03 and P = 0.001, respectively), but the data were inconclusive as to whether the benefit extended to patients with baseline urinary protein excretion less than 0.5 g/d. CONCLUSION: Antihypertensive regimens that include ACE inhibitors are more effective than regimens without ACE inhibitors in slowing the progression of nondiabetic renal disease. The beneficial effect of ACE inhibitors is mediated by factors in addition to decreasing blood pressure and urinary protein excretion and is greater in patients with proteinuria. Angiotensin-converting inhibitors are indicated for treatment of nondiabetic patients with chronic renal disease and proteinuria and, possibly, those without proteinuria.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Nefropatias/tratamento farmacológico , Creatinina/sangue , Diabetes Mellitus , Progressão da Doença , Seguimentos , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Nefropatias/complicações , Nefropatias/metabolismo , Falência Renal Crônica/prevenção & controle , Modelos Logísticos , Modelos de Riscos Proporcionais , Proteinúria/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
We report the occurrence of the syndrome of persistent polyclonal B-cell lymphocytosis in a brother and a sister. Both showed the morphological and immunophenotypic features of this rare disorder. In addition both had mild splenomegaly, increase of serum IgM and serological evidence of previous EBV infection. Of interest, two additional brothers had no evidence of PPBL but were indistinguishable in terms of HLA haplotype (HLA-DR7), smoking habits or evidence of EBV infection. These observations provide additional support for a genetic basis of the syndrome but suggest that pathogenic factors other than those known so far may be required for its full expression.
Assuntos
Linfócitos B/patologia , Proteínas do Capsídeo , Saúde da Família , Linfocitose/etiologia , Antígenos Virais/sangue , Suscetibilidade a Doenças/etiologia , Antígenos Nucleares do Vírus Epstein-Barr/sangue , Feminino , Antígenos HLA-DR , Humanos , Imunoglobulina M/sangue , Linfocitose/diagnóstico , Linfocitose/genética , Masculino , Pessoa de Meia-Idade , Núcleo Familiar , Fatores de Risco , FumarRESUMO
OBJECTIVE: To determine the antihypertensive efficacy, effect duration and safety of the angiotensin II type 1 receptor blocker candesartan cilexetil and the angiotensin converting enzyme inhibitor enalapril once daily in patients with mild to moderate hypertension. METHODS: A multicenter, randomised, double-blind parallel group study was performed in Finland, France, the Netherlands, Spain and Sweden. Three-hundred-and-ninety-five men and women in the age range 20-80 years with primary hypertension were randomised to an 8-week double-blind treatment period with either candesartan cilexetil 8-16 mg or enalapril 10-20 mg once daily, with forced dose titration after 4 weeks. Non-invasive ambulatory blood pressure was measured for 36 h at baseline and after 8 weeks. The primary efficacy variable was the change in mean diastolic and systolic ambulatory blood pressure 22-24 h post-dose. RESULTS: There was a significant difference in the adjusted mean difference for the change from baseline to week 8 between candesartan cilexetil and enalapril 22-24 h post-dose by -3.5 mmHg (95% confidence interval, CI: -6.8 to -0.3 mmHg; p < 0.032) in ambulatory systolic blood pressure and -3.0 mmHg (95% CI: -5.1 to -0.8 mmHg; p < 0.008) in ambulatory diastolic blood pressure. There was a significant difference in adjusted mean daytime ambulatory blood pressure 24-36 h post-dose by -4.2 mmHg (95% CI: -6.8 to -1.6 mmHg; p < 0.002)/-3.5 mmHg (95% CI: -5.1 to -1.8 mmHg; p < 0.001). Both drugs were generally well tolerated. CONCLUSION: The results of the present study suggest that advantages may be attributed to the use of candesartan cilexetil, as compared to enalapril in the treatment of patients with essential hypertension. In comparison with enalapril 20 mg, candesartan cilexetil 16 mg more effectively lowered blood pressure at trough and in particular on the day following the day after the last dose.
Assuntos
Anti-Hipertensivos/administração & dosagem , Benzimidazóis/administração & dosagem , Compostos de Bifenilo/administração & dosagem , Enalapril/administração & dosagem , Hipertensão/tratamento farmacológico , Tetrazóis , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos/efeitos adversos , Benzimidazóis/efeitos adversos , Compostos de Bifenilo/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Enalapril/efeitos adversos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Pró-Fármacos/administração & dosagem , Pró-Fármacos/efeitos adversos , Equivalência Terapêutica , Fatores de TempoRESUMO
We report the first case of a lethal Amanita phalloides intoxication from stored mushrooms. After picking the mushrooms were kept in a freezer for 7-8 months. This case is in accordance with the well-known stability of the amatoxins and demonstrates the possibility of A. phalloides poisoning at any time of year.
Assuntos
Amanitinas/química , Alimentos Congelados , Intoxicação Alimentar por Cogumelos , Amanita , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , SuíçaRESUMO
OBJECTIVES: Afferent nerve stimulation, such as acupuncture and transcutaneous electric nerve stimulation (TENS), has shown a blood pressure reduction in both animal and man. In the present open and non-controlled study we investigated the effect on 24-h ambulatory blood pressure of low frequency TENS in a group of hypertensive subjects who do not respond properly to pharmacological treatment. METHOD: Twelve patients were investigated. The patients were treated with TENS at two acupoints on both forearms for 30 min twice daily during 4 weeks. 24-hour ambulatory blood pressure monitoring was recorded 1 week before, at start, at the end and finally 1 week after the TENS treatment. RESULTS: The blood pressure did not change significantly during the run-in period. After 4 weeks of TENS, the mean systolic blood pressure decreased by 6.3 mm Hg (P < 0.05) and the mean diastolic blood pressure decreased by 3.7 mm Hg (P < 0.05). The blood pressure reduction remained unchanged 1 week after treatment. There was no change in mean heart rate. CONCLUSION: The present study suggests that continuous TENS may have additional blood pressure-lowering properties in hypertensive patients who do not respond properly to pharmacological treatment. The effect of TENS may also have a prolonged effect. Journal of Human Hypertension (2000) 14, 795-798