Identification of the zebrafish homologues of IMPG2, a retinal proteoglycan.

Photoreceptor outer segments are surrounded by a carbohydrate-rich matrix, the interphotoreceptor matrix, necessary for physiological retinal function. Few roles for molecules characterizing the interphotoreceptor matrix have been clearly defined. Recent studies have found the presence of nonsense mutations in the interphotoreceptor matrix proteoglycan 2 (IMPG2) gene in patients affected by retinal dystrophies. IMPG2 encodes for a proteoglycan synthesized by photoreceptors and secreted in the interphotoreceptor matrix. Little is known about the structure and function of this protein, we thus decided to characterize zebrafish impg2. In zebrafish there are two Impg2 proteins, Impg2a and Impg2b. We generated a phylogenetic tree based on IMPG2 protein sequence similarity among vertebrates, showing a significant similarity between humans and teleosts. The human and zebrafish proteins share conserved domains, as also shown by homology models. Expression analyses of impg2a and impg2b show a continued expression in the photoreceptor layer starting from developmental stages and continuing through adulthood. Between 1 and 6 months post-fertilization, there is a significant shift of Impg2 expression toward the outer segment region, suggesting an increase in secretion. This raises intriguing hypotheses about its possible role(s) during retinal maturation, laying the groundwork for the generation of most needed models for the study of IMPG2-related inherited retinal dystrophies.

Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience.

PURPOSE: Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment. METHODS: Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12-24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D. RESULTS: Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism. CONCLUSIONS: Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.

Health promotion in Local Health Unit 4 Chiavarese--Liguria Region, Italy. "Unplugged" project: needs, methodology and implementation.

AIM: The aim of this paper was to use and evaluate the unplugged project, a school-based program of proven effectiveness aimed at the prevention of substance abuse based on social influence. METHODS: This project was conducted during the school-year 2011/2012; it involved the Local Health Unit (LHU)'s personnel specifically and adequately formed and was addressed to teachers working in the three districts of the LHU4 Chiavarese. The courses involved teachers in three consecutive days and provided both theoretical inputs and practical exercises designed to enpower skills and to make the same effective. As a whole, 25 teachers of the secondary schools (public and private) of first and second level were trained. Following the training, 14 curricular courses have been launched and 286 students have been involved. RESULTS: The teachers have mainly worked on personal and social components of their students, stimulating their critical assessment of standards and skills potentially transferable in everyday life. The benefits for students have been: establishment of the classroom, positive relationship with the teacher, empathy, decrease of conflicts, increased self-awareness and self-esteem, better school results. Besides, teachers benefit from increased respect, self-reliance and confidence, as well as acquisition of new skills. CONCLUSION: Both the interest shown by teachers and the results achieved in classrooms have stimulated school leadership and personnel belonging to LHU4 Chiavarese to plan a new edition of the program the next autumn.

Being Overweight Is Related to Faster Decline in Annual Glomerular Filtration Rate in Kidney Transplant.

Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR. METHODS: A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> -1 mL/min/1.73 m2), slow progressors (> -1 and < -5 mL/min/1.73 m2), and fast progressors (< -5 mL/min/1.73 m2). Percentage of achievement of KDIGO target was also analyzed. RESULTS: The mean GFR was 62.5 mL/min/1.73 m2. Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age-patients were younger (40 ± 12.3 vs 45 ± 13.1 years)-post-transplant body mass index (27.4 ± 5.6 vs 25.2 x ± 5.9 kg/m2), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]). CONCLUSIONS: High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases.

Esophageal motility disorders in the morbidly obese population.

BACKGROUND: Most studies investigating esophageal motility among the morbidly obese have focused on the relationship between lower esophageal sphincter (LES) pressure and gastroesophageal reflux disease (GERD). Very few studies in the literature have examined motility disorders among the morbidly obese population in general outside the context of GERD. This study aimed to determine the prevalence of esophageal motility disorders in obese patients selected for bariatric surgery. METHODS: A total of 116 obese patients (81 women and 35 men) selected for laparoscopic gastric banding underwent manometric evaluation of their esophagus from January to March 2003. Tracings were retrospectively reviewed for the end points of LES resting pressure, LES relaxation, and esophageal peristalsis. RESULTS: The study patients had a body mass index (BMI) of 42.9 kg/m2, and a mean age of 48.6 years. The following abnormal manometric findings were demonstrated in 41% of the patients: nonspecific esophageal motility disorders (23%), nutcracker esophagus (peristaltic amplitude >180 mmHg) (11%), isolated hypertensive LES pressure (>35 mmHg) (3%), isolated hypotensive LES pressure (<12 mmHg) (3%), diffuse esophageal spasm (1%), and achalasia (1%). Only one patient with abnormal esophageal motility reported noncardiac chest pain. CONCLUSIONS: Despite a high prevalence of esophageal dysmotility in our morbidly obese study population, there was a conspicuous absence of symptoms. Although the patients in this study were not directly questioned with regard to esophageal symptoms, several studies in the literature support our conclusion.

Morbidity of laparoscopic surgery for complicated appendicitis: an international study.

BACKGROUND: Although laparoscopic appendectomy has some advantages over open appendectomy, some reports do show more postoperative intraabdominal abscesses. METHODS: A retrospective review of complicated appendicitis managed surgically by eight surgical groups from six countries was undertaken. Among 3,433 patients with appendicitis, 1,017 (29.5%) had complicated appendicitis, which included perforated or gangrenous appendicitis with or without localized or disseminated peritonitis. There were 74 preoperative abscesses (7.4%) and 5 small bowel obstructions. RESULTS: One patient died. There were 29 postoperative intraabdominal abscesses (2.8%) and 112 mostly minor complications. Conversion to laparotomy was necessary for 28 patients (2.7%). The surgical time ranged from 32 to 132 min (mean, 62 min), and the hospital stay ranged from 1 to 18 days (mean, 3.5 days). CONCLUSIONS: The morbidity rates, particularly for intraabdominal abscesses, were less for laparoscopic appendectomy in complicated appendicitis than those reported in the literature for open appendectomy, whereas operating times and hospital stays were similar.

A novel integrated approach for the hazardous radioactive dust source terms estimation in future nuclear fusion power plants.

An open issue still under investigation by several international entities working on the safety and security field for the foreseen nuclear fusion reactors is the estimation of source terms that are a hazard for the operators and public, and for the machine itself in terms of efficiency and integrity in case of severe accident scenarios. Source term estimation is a crucial key safety issue to be addressed in the future reactors safety assessments, and the estimates available at the time are not sufficiently satisfactory. The lack of neutronic data along with the insufficiently accurate methodologies used until now, calls for an integrated methodology for source term estimation that can provide predictions with an adequate accuracy. This work proposes a complete methodology to estimate dust source terms starting from a broad information gathering. The wide number of parameters that can influence dust source term production is reduced with statistical tools using a combination of screening, sensitivity analysis, and uncertainty analysis. Finally, a preliminary and simplified methodology for dust source term production prediction for future devices is presented.

Image computing techniques to extrapolate data for dust tracking in case of an experimental accident simulation in a nuclear fusion plant.

In this paper, a preliminary shadowgraph-based analysis of dust particles re-suspension due to loss of vacuum accident (LOVA) in ITER-like nuclear fusion reactors has been presented. Dust particles are produced through different mechanisms in nuclear fusion devices, one of the main issues is that dust particles are capable of being re-suspended in case of events such as LOVA. Shadowgraph is based on an expanded collimated beam of light emitted by a laser or a lamp that emits light transversely compared to the flow field direction. In the STARDUST facility, the dust moves in the flow, and it causes variations of refractive index that can be detected by using a CCD camera. The STARDUST fast camera setup allows to detect and to track dust particles moving in the vessel and then to obtain information about the velocity field of dust mobilized. In particular, the acquired images are processed such that per each frame the moving dust particles are detected by applying a background subtraction technique based on the mixture of Gaussian algorithm. The obtained foreground masks are eventually filtered with morphological operations. Finally, a multi-object tracking algorithm is used to track the detected particles along the experiment. For each particle, a Kalman filter-based tracker is applied; the particles dynamic is described by taking into account position, velocity, and acceleration as state variable. The results demonstrate that it is possible to obtain dust particles' velocity field during LOVA by automatically processing the data obtained with the shadowgraph approach.

Comparison of angiotensin-converting enzyme inhibitors and calcium antagonists in the treatment of mild to moderate systemic hypertension, according to baseline ambulatory blood pressure level.

This study was aimed at determining whether baseline ambulatory blood pressure (BP) levels influence the efficacy of angiotensin-converting enzyme inhibitors and calcium antagonists in the same manner. Accordingly, the ambulatory BP recordings of 236 mild to moderate hypertensive patients who had previously entered a clinical trial and had received either a calcium antagonist (n = 121) or an angiotensin-converting enzyme inhibitor (n = 115) were reviewed. The inclusion criterion was a clinic diastolic BP between 95 and 115 mm Hg at the end of the placebo period. Patients were classified according to the difference between their observed and predicted ambulatory BP (the latter assessed by regressing the observed ambulatory BP on the clinic BP). Reduction in ambulatory systolic and diastolic BP seemed to be greater (p less than 0.0001, p = 0.01) in patients receiving an angiotensin-converting enzyme inhibitor than in those who were given a calcium antagonist. However, analysis of variance showed (1) there was a significant interaction (F = 6.37 p = 0.01) between the pharmacologic class and the baseline systolic ambulatory BP; and (2) the difference in diastolic ambulatory BP reduction between both classes was no longer significant when adjusted for baseline diastolic ambulatory BP. In patients with higher than predicted ambulatory BP levels, angiotensin-converting enzyme inhibitors and calcium antagonists had roughly a similar effect (reduction in systolic BP, 9 +/- 8% vs 7 +/- 6%, p = not significant; reduction in diastolic BP, 11 +/- 8% vs 8 +/- 6%, p = not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

A population-based survey of drug treatment efficacy by the French National Committee for the Control of Arterial Hypertension.

To assess the adequacy of antihypertensive treatment in the French population, a survey was conducted from October 1990 to April 1991 in five French cities during sales exhibitions. A total of 7107 individuals visited the stand of the French National Committee to have their blood pressure (BP) measured. Among them, 1289 were treated hypertensive subjects fully aware of their treatment. The efficacy of antihypertensive treatment was assessed in this population. Among those hypertensive treated subjects 35 to 65 years old, 60% had a BP < 160/95 mm Hg and 27% < 140/90 mm Hg. Among those > 64 years of age, 44% had a BP < 160/90 mm Hg. In 1992, these results were included in a publication by the World Hypertension League. Data obtained with this new and interesting approach were reviewed 4 years later. The approach is inexpensive (the equivalent of US $28,000) and made it possible to directly inform thousands of people, normotensive and hypertensive, about arterial hypertension and antihypertensive drug therapy, as well as risk factors for cardiovascular disease. This kind of approach may be worth a strict evaluation, to assess whether it is really useful in improving high blood pressure control in the population.

Use of electronic pill boxes to assess risk of poor treatment compliance: results of a large-scale trial.

The objective of the present study was to determine the predictive factors of treatment compliance in hypertensive patients. This was an open large-scale multicenter study where mild to moderate essential hypertensive patients received trandolapril (2 mg) once daily for 30 to 60 days in addition to their usual treatment. Trandolapril was packed in electronic pill boxes that registered date and time of each opening. The main compliance parameters were the percentage of missed doses, the percentage of delayed doses, and the percentage of correct dosing periods. Predictive factors of poor compliance (correct dosing periods < 80%) were determined using a multivariate stepwise logistic regression analysis. Two thousand one hundred seventy-three patients aged 60 +/- 12 years were analyzed. Of the total patients 37% were poor compliers; 29% of patients forgot more than 10% of doses and 36% of patients delayed more than 10% of doses. Ranked predictive factors of poor compliance were: age < 60 years (odds ratio [OR], 1.80 [1.49 to 2.17], P = .0001), the Paris area (OR, 1.70 [1.32 to 2.19], P = .0001), smokers (OR, 1.65 [1.29 to 2.11], P = .0001), monotherapy (OR, 1.40 [1.14 to 1.72], P = .0012), and baseline diastolic blood pressure > or = 100 mm Hg (OR, 1.21 [1.01 to 1.46], P = .044). Therefore, we conclude that young hypertensives, large city dwellers, and smokers are more likely to be poor compliers. The presence of some of these characteristics might incite the physician either to encourage patient compliance or to prescribe antihypertensive drugs that have an effect that persists even beyond 24 h.

An attempt to improve blood pressure control in the French population: information and outcome awareness at the general practitioner level.

To improve blood pressure (BP) control in general practice, 3122 general practitioners agreed to participate in a result awareness program. A survey carried out 6 months after participating physicians had been informed of the outcome of treatments they had given showed that blood pressure control (cut-off point: BP < 140/90 mm Hg) had not improved. However, using less stringent criteria, a slight improvement in blood pressure control could be observed. Although this improvement was marginal, results are sufficiently encouraging to warrant another study after a new awareness campaign among the medical population.

Prevalence, treatment, and control of hypertension in the French population: data from a survey on high blood pressure in general practice, 1994.

A survey was conducted in a cohort of 235 general practitioners (GP) selected by Sofres Medical who were representative of the French medical population, to measure the percentage of patients with hypertension, treated hypertensives and patients with controlled hypertension. Data were collected over 1 week of office consultation. Practitioners were initially instructed to use the same type of mercury sphygmomanometer, equipped with pneumatic cuffs of different sizes. Three consecutive blood pressure (BP) measurements were made and the last two were recorded. Practitioners had to carry out their own survey over a period of 1 week on all patients > 18 years of age who visited their offices. Patients were considered as hypertensive (HP) if the mean of the two recorded BP measurements was > or = 140/90 mm Hg or if they were taking antihypertensive drug treatment. Three cutoff points were used to define controlled hypertension: < 140/90 mm Hg (overall population of HP), < 160/95 mm Hg (HP < 65 years of age), and < 160/90 mm Hg (HP > or = 65 years of age). Among 12,351 patients (mean age, 48.6 years; women, 58%), 5020 were HP, (41%) of whom 2035 were without treatment (41%) and 2985 were receiving antihypertensive drug treatment (59%). Two hundred-thirty patients (4.6%) remained at high risk with moderate or severe hypertension (BP > or = 180 [systolic] or 105 [diastolic] mm Hg), ie, 1 patient/week/GP. The study confirms the high prevalence of hypertension in general practice and shows that 7 of 10 patients have an acceptable control of their BP (< 160/95 or < 160/90 mm Hg according to age) but only 24% of treated HP achieved the target of a BP level < 140/90 mm Hg, representing 28% of the 18 to 64 year old group and 21% of the elderly group. French GP did not choose an optimal control, and the medical community is waiting for answers to crucial questions, ie, does optimal BP control significantly improve the absolute cardiovascular risk? How far should blood pressure be lowered?

Treatment of essential hypertension in general practice: an open-label study of 47,351 French hypertensive patients treated for one year with perindopril.

The efficacy and acceptability of perindopril were assessed over one year by 4800 French general practitioners in an open label study of 47,351 freely consenting adults with mild to moderate hypertension. Perindopril was administered as a single daily dose each morning. The starting dose of 4 mg (or 2 mg in patients over 70 years) was doubled after one month, to a maximum of 8 mg if diastolic blood pressure (DBP) was greater than 95 mmHg. Thereafter a non-potassium sparing diuretic was added to the 8 mg dose if necessary. At 12 months, effective blood pressure control, defined as recumbent DBP below 90 mmHg, was achieved in between 68 and 77% of patients. The majority of patients (80% [n = 37,348]) received perindopril alone throughout the 12-month study period. The final prescription (at six months) revealed that 65% of patients were treated with the once daily 4 mg dose. Throughout the 12 months of the study, 7.6% of patients (n = 3564) discontinued treatment, 5.1% (n = 2401) due to adverse events and 0.4% (n = 187) due to fatal events (principally cardiovascular reasons). Cough was the most frequent adverse symptom, leading to withdrawal of 3.28% of patients; this symptom was spontaneously reported in an additional 6.4% of patients throughout the one-year period but did not lead to discontinuation. All other adverse events leading to withdrawal were present in less than 0.4% of cases. The majority of fatal outcomes was due to cardiovascular events (n = 78), 37 were due to cancer, 19 due to road accidents and 53 due to miscellaneous causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Laparoscopic repair of traumatic diaphragmatic hernia.

Posttraumatic diaphragmatic rupture or eventration is still a challenging problem. Herein five cases of patients with such a diaphragmatic lesion treated successfully by laparoscopy are reported with a discussion of the advantages of this mini-invasive surgical approach.

Pulmonary capillary hemangiomatosis in an asymptomatic elderly patient.

Thoracic hemangiomatosis is an extremely rare condition of the thorax of unknown origin: thin-walled capillary blood vessels infiltrate the lung parenchyma, blood vessels, interlobular septa, bronchiolar walls and pleura. The infiltration of pulmonary veins and venules induces secondary pulmonary veno-occlusive disease and pulmonary hypertension with a slowly progressive clinical course. This condition can be associated with vascular dementia and disseminated intravascular coagulation (DIC).

[Ambulatory blood pressure, reproducibility, variability and change, placebo effect]. / Charge tensionnelle ambulatoire, reproductibilité, variabilité et variation, effet placebo.

Blood pressure assessment by ambulatory recordings is a recent clinical method. What is the reproducibility and variability of the results and what is the circadian variation of blood pressure? How useful is the technique for evaluating therapeutic efficacy? Several groups have reported that the reproducibility is good within a group of patients but that this is not observed in case by case and measurement by measurement analysis; however, when the periods of observation are sufficiently long (several hours) the recordings are comparable. In clinical practice for an individual patient, it would seem better to compare the average daily pressure load, at rest and during activity, which is more reproducible than the hourly average of blood pressure. The circadian variation of blood pressure and short-term (within the hour) or long-term (24 hours) variability have been analysed in depth and although the ambulatory blood pressure shows the same circadian variation as invasive arterial measurement, it does not show instantaneous variability. The placebo effect is not marked when a large group of patients is studied. On the other hand, case by case analysis shows the persistance of this phenomenon in small numbers of cases and, in practice, these results make the maintenance of a placebo period in therapeutic trials a necessity. In conclusion, ambulatory blood pressure recording in daily medical practice enables the study of therapeutic variations in blood pressure over a 24 hour period. However, it does not yet enable satisfactory analysis of the variability of blood pressure.

[Automatic non-ambulatory measurement of arterial pressure. Computer data-analysis of the evaluation of antihypertensive treatment]. / Mesure automatique non ambulatoire de la pression artérielle. Analyse informatique des données pour l'appréciation d'un traitement hypotenseur.

To gain a better understanding of the therapeutic effect of HTA, the present study reports a new method essentially based on the non invasive non ambulatory monitoring of blood pressure by the Dinamap 845. This apparatus was initially assayed towards the measure of invasive blood pressure and by the auscultatory method, and afterwards towards the analysis of approximately one hundred resulting data. The computer analysis of the data was performed using a microcomputer which gives the results as: time dependent curves over 24 hr; histograms, percentage of the values of HTA (above 140 mmHg for the systolic and 90 mmHg for the diastolic one); numeric data such as: average values, SEM... The method reported here appears to be convenient to follow new therapeutic treatment because the data obtained before and after treatment proved to be more rigorous and less varying upon the physician. This kind of investigation seems also helpful in the case of both hypertensive emergencies and treatment of those HTA which are difficult to stabilize. But it is thought to be not easily applied to all the hypertensions studied in the usual medical practise.

[Antihypertensive treatments: drug efficacy effect and initial ambulatory blood pressure]. / Traitements antihypertenseurs: effet médicament et niveau de pression artérielle ambulatoire initial.

OBJECTIVE: we used initial whole day blood pressure (BP) level to evaluate antihypertensive therapy in different class of agents. DESIGN AND METHODS: The study was performed with 205 hypertensive patients. All patients had essential mild to moderate hypertension after single-blind placebo run in period. At the end of this period, and after 1 month of active treatment (3 class of agents: angiotensin converting enzyme inhibitors (ACEI) = 117, calcium channel blockers (CCB) = 52, beta-blockers (BB) = 36) casual blood pressure was performed and ambulatory BP was monitored during the whole day. At the start of the study, 91 of 205 patients had an ambulatory diastolic BP less than to 90 mmHg (group I: "normotensive patients") and 114 greater than or = 90 mmHg (group II: "hypertensive patients"). Clinical measurements and whole day BP monitoring are used to assess response to treatment for all patients and for the group I and II. RESULTS: Therapy decreased clinical BP by 19 +/- 15/11 +/- 9 mmHg and average whole day BP by 10 +/- 11/7 +/- 8 mmHg. In the 3 class of agents, there is no difference between group I and II at the start of study. ACEI treatment: In group I, decrease of average whole-day BP by 12/7 and by 11/8 mmHg in group II. In contrast for CCB treatment: 2/2 and 13/7 (p less than 0.001), for BB treatment 10/4 and 13/11. In the 3 class of agents, there is no difference in the clinical BP decreases between group I and II. CONCLUSION: Our data emphasize a significant discrepancy between clinical and ambulatory BP evaluation among patients displaying low ambulatory BP particularly with CCB treatment in contrast with ACEI treatment. In the low group, CCB decreased ambulatory BP less than ACEI did. These results suggest that there is a lesser chance of overtreating "normotensive" patients with CCB than there is with ACEI.

[Antihypertensive therapeutic effect. Comparison of their evaluation using clinical and ambulatory measurements of arterial pressure. Preliminary study]. / Effet thérapeutique antihypertenseur. Comparaison de l'évaluation par mesure clinique et ambulatoire de la pression artérielle. Etude préliminaire.

The aim of this preliminary report is to compare the evaluation of the antihypertensive drug effect, during a controlled trial, using casual measurements and 24 hr B.P. monitoring. 20 patients (16 males, 4 females 55 +/- 10 years old) with primary hypertension (WHO stage I or II) were included with a diastolic blood pressure greater than or equal to 100 mmHg (mean blood pressure from three clinical readings). Casual B.P. and B.P. monitoring (Spacelabs - 4 measurements per hour during a 24 hr period) were established before and after the end of the placebo run in period (one placebo tablet given once daily at 8 h-8 h 30 a.m. for 15 days). Overall sample data: The clinical B.P. decrease (167 +/- 16-109 +/- 7 before and 147 +/- 17-97 +/- 11 after treatment) is higher that the ambulatory B.P. decrease (148 +/- 15-101 +/- 8 before and 138 +/- 21-94 +/- 14 after treatment). Individual patient data: A clinical B.P. decrease (of at least 10 mmHg) was found in 17 patients for systolic B.P. and in 15 patients for diastolic B.P. A significant ambulatory B. P. drop decrease (p less than 0.05) was found in 11 patients for 24 hr systolic and diastolic B.P. The clinical and ambulatory responses to the treatment are in line in 14 patients, but differ in 3 instances. There is a little correlation (for the diastolic B.P.) and no correlation (for the systolic B.P.) between the clinical and the ambulatory B.P. decreases after treatment.(ABSTRACT TRUNCATED AT 250 WORDS)