Long term follow up of radiofrequency catheter ablation of atrial flutter: clinical course and predictors of atrial fibrillation occurrence.

OBJECTIVES: To evaluate the time to onset and the predictors of atrial fibrillation (AF) during long term follow up of patients with typical atrial flutter (AFL) treated with transisthmic ablation. DESIGN: Prospective multicentre study. METHODS AND RESULTS: 383 patients (75.4% men, mean (SD) age 61.7 (11.1) years) who underwent transisthmic ablation for typical AFL were investigated. In 239 patients (62.4%) AF was present before ablation. Ablation proved successful in 367 patients (95.8%). During a mean (SD) follow up of 20.5 (12.4) months, 41.5% of patients reported AF. The cumulative probability of postablation AF increased continuously as time passed: it was 22% at six months, 36% at one year, 50% at two years, 58% at three years, and 63% at four years. CONCLUSIONS: AF occurred in a large proportion of patients after transisthmic catheter ablation of typical AFL. The occurrence of AF was progressive during follow up. Preablation AF, age < 65 years, and left atrial size > 50 mm are associated with postablation AF occurrence.

Success of serial external electrical cardioversion of persistent atrial fibrillation in maintaining sinus rhythm; a randomized study.

AIMS: The aim of this prospective, randomized study was to determine the efficacy of a serial external electrical cardioversion strategy in maintaining sinus rhythm after 12 months in patients with recurrent persistent atrial fibrillation. METHODS AND RESULTS: Ninety patients with persistent atrial fibrillation lasting more than 72 h but less than 1 year were randomized in a one to one fashion to repetition of up to two electrical cardioversions in the event of relapse of atrial fibrillation detected within 1 month of the previous electrical cardioversion (Group AGG), or to non-treatment of atrial fibrillation relapse (Group CTL). ECGs were scheduled at 6 h, 7 days, and 1 month. Clinical examination and ECGs were repeated during the 6-month and 12-month follow-up examinations. Echocardiography was repeated during the 6-month follow-up examination. Clinical and echocardiographic characteristics were similar in the two groups. All patients were treated with antiarrhythmic drugs before electrical cardioversion and throughout follow-up. After 12 months, sinus rhythm was maintained in 53% of Group AGG patients and in 29% of Group CTL patients (P<0.03). After 6 months, left ventricular ejection fraction had recovered significantly only in Group AGG (56.8 +/- 9.0% at enrollment vs 60.4 +/- 9.4% at 6 months,P <0.001). CONCLUSION: These results demonstrate that an aggressive policy towards persistent atrial fibrillation by means of repetition of electrical cardioversion after early atrial fibrillation recurrence is useful in maintaining sinus rhythm after 12 months.

Transient complete atrioventricular block during transcatheter ablation of a left inferoparaseptal anomalous pathway in a patient with a history of previous surgical repair of ventricular septal defect.

This case describes a young woman with a manifest left inferoparaseptal accessory pathway and previous history of surgical repair of a defect of the ventricular inlet septum in whom a transient complete AV block occurred during radiofrequency ablation performed from the coronary sinus. The presence of a preexisting surgery related AV block unmasked by anomalous pathway ablation is the more reliable explanation for this case.

Cerebral protection with filter devices during carotid artery stenting.

BACKGROUND: Distal embolization of debris during percutaneous carotid artery stenting may result in neurological deficit. Filter devices for cerebral protection potentially reduce the risk of embolization. METHODS AND RESULTS: Elective carotid stent implantation using 3 different types of distal filter protection devices was attempted in 88 consecutive lesions (84 patients) in the internal carotid artery that had >70% diameter stenosis (mean, 78.7+/-10.7%). Procedures were performed in 3 different centers. The mean age of the patients was 69+/-8 years, 75% were men, and 35.7% had neurological symptoms. In 86 lesions, a stent was successfully implanted (97.7%). In 83 of these 86 procedures (96.5%), it was possible to position a filter device. In 53% of filters, there was macroscopic evidence of debris. Collected material consisted of lipid-rich macrophages, fibrin material, and cholesterol clefts. Neurological complications during the procedure, in the hospital, and at 30 days of clinical follow-up occurred in only one patient (1.2%). This patient suffered a minor stroke that resolved within 1 week. Two major adverse cardiac events (2.3%) occurred during the 30 days of follow-up. CONCLUSIONS: Filter protection during carotid artery stenting seems feasible and safe. In the present series, the incidence of neurological complications was low.

Electrophysiological properties of the atrioventricular node and ageing: evidence of a lower incidence of dual nodal pathways in the elderly.

AIMS: The purpose of this study was to investigate the relationship between the incidence of dual atrioventricular (AV) nodal pathways and age. Age-related changes in the AV node electrophysiological properties have rarely been investigated. AV nodal re-entrant tachycardia is more frequent in the young than in the elderly. METHODS AND RESULTS: From 1988 to 1998, premature atrial stimulation was performed in 1,435 patients referred to our institution for transoesophageal electrophysiological study. 1,276 patients (89%) with a diagnosis of ventricular pre-excitation, supraventricular arrhythmia or AV block were excluded. The study cohort consisted of the remaining 159 patients (11%) of the whole group) referred for syncope (8.2% of the subgroup), suspected ventricular pre-excitation (10.7%), suspected sinus node dysfunction (52.8%) or undetermined palpitations (28.3%). The 159 study patients were divided into 3 groups according to age: group A (11-30 years, 50 patients), group B (30-60 years, 35 patients) and group C (>60 years, 74 patients). A dual AV nodal pathway was found in 16 patients of group A (32.0%), 6 patients of group B (17.1%) and 8 patients of group C (10.8%), the difference between group A and group C being significant (P<0.05). CONCLUSION: The incidence of dual AV nodal pathways decreases with ageing, suggesting that the AV node undergoes age-related electrophysiological changes. This finding could explain the uncommon onset of AV nodal re-entrant tachycardia in the elderly.

The duration of atrial fibrillation influences the long-term efficacy of low-energy internal cardioversion.

BACKGROUND: It is commonly held that long-lasting atrial fibrillation (AF), especially if associated with marked enlargement of the left atrium, is a negative predictive factor for both the recovery and the maintenance of sinus rhythm. The aim of the present study was to identify the clinical features of patients who have a greater likelihood of success both in the acute phase and, especially, in the medium-long term. METHODS: Since June 1997, we have performed low-energy internal cardioversion to 93 patients (66 males, 27 females, mean age 62 +/- 9 years, range 26-80 years) with a mean duration of AF of 922 +/- 1032 days. Seventy-four patients had heart disease and 19 isolated AF. External cardioversion had been previously performed in 79 patients to no avail. All patients underwent antiarrhythmic therapy and were followed for a period of 13 +/- 7 months. RESULTS: Low-energy internal cardioversion proved efficacious, restoring sinus rhythm, in 92% of patients (86/93) and inefficacious in 8% (7/93). In 24% (21/86) the procedure, although efficacious, was followed by early recurrence of AF which proved to be intractable in 52% (11/21). At the end of the session, 81% (75/93) of the patients maintained sinus rhythm. At the end of follow-up, 40% (38/93) maintained sinus rhythm. Of all the parameters considered in the two groups, the duration of AF was the only one which differed significantly between the group in sinus rhythm and that in AF, with regard to both the efficacy of the procedure in the acute phase (755 +/- 868 vs 1618 +/- 1359 days, p < 0.001) and the long-term outcome (655 +/- 5.8 vs 1107 +/- 1098 days, p < 0.05). CONCLUSIONS: AF lasting more than 2 years constitutes a negative predictive factor for both the recovery and the long-term maintenance of sinus rhythm.

Cardioversion of persistent atrial flutter in non-anticoagulated patients at low risk for thromboembolism.

BACKGROUND: The true risk of thromboembolic events after cardioversion of atrial flutter was not addressed carefully. Nevertheless, thromboembolic events were thought to be rare and less likely to occur after cardioversion of atrial fibrillation. The aim of this study was to prospectively evaluate if the interruption of persistent typical atrial flutter could be safely performed without anticoagulation in a group of patients at low risk for thromboembolic events. METHODS: We studied 64 subjects selected among 138 consecutive patients with persistent typical atrial flutter (minimal duration 72 hours) in whom a transesophageal atrial pacing was performed in our electrophysiology laboratory from October 1994 to May 1999. Exclusion criteria included: anticoagulation therapy during the previous 4 weeks; previous history of atrial fibrillation; recent (< 1 month) myocardial infarction; history of thromboembolic events; left ventricular ejection fraction < 40%; presence of moderate or severe mitral regurgitation or stenosis; induction of sustained (> 6 hours) atrial fibrillation during transesophageal atrial pacing. Patients in whom atrial flutter persisted in spite of transesophageal atrial pacing underwent external direct current cardioversion or right atrial overdrive pacing within 24 hours. Thromboembolic events were checked for 4 weeks after the restoration of sinus rhythm. RESULTS: Sinus rhythm was restored in 54 patients by transesophageal atrial pacing, in 8 patients by electrical cardioversion, and in 2 by right atrial pacing. The mean duration of atrial flutter was 18 +/- 19 days, the mean left atrial size 41.3 +/- 6.2 mm, and the mean left ventricular ejection fraction 54.8 +/- 7.3%. During the study period no episodes of thromboembolism were recorded. CONCLUSIONS: Cardioversion of persistent typical atrial flutter in non-anticoagulated patients at low risk for thromboembolic events appears safe.

Diagnostic value of stored electrograms in single-lead VDD systems.

UNLABELLED: Evaluation of the quality of atrial sensing is indispensable to monitor the performance of VDD single-lead systems. In addition to counters, a new VDD system offers storage of intracardiac electrograms (EGMs). The clinical contribution of stored EGMs in a VDD pacemaker was prospectively examined in a multicenter study, and the reliability of its counters was evaluated on the basis of EGM information. METHODS: A VDD system (Pulsar 870, Guidant Co.) was implanted in 46 patients with atrioventricular block. EGM storage was activated upon detection of ventricular tachycardia (VT), recurrent premature ventricular complexes (PVCs), and mode switch ("atrial tachy reaction," ATR). Stored EGMs were retrieved before discharge of the patients from the hospital, and at 6-week, 3-month, and 6-month follow-up. RESULTS: A total of 440 stored EGMs were retrieved and analyzed. Of 30 VT episodes detected, 2 (7%) were confirmed, and all others were attributable to ventricular oversensing. One postmortem interrogation documented VT as the cause of sudden death. Of 175 EGMs stored upon detection of PVCs, 43 episodes (25%) were confirmed and 124 (70%) showed intermittent atrial undersensing with spontaneous AV conduction; in 8 episodes (5%) no abnormality was observed. Of 235 episodes stored upon ATR, 82 (35%) were confirmed and 153 were due to atrial oversensing. CONCLUSIONS: (1). Stored EGMs indicated a high percentage (69%) of event misdiagnosis by the pacemaker. Thus, pacemaker counter information without the availability of stored EGMs should be interpreted with caution. (2). Misclassified events are of high clinical importance since they unmask otherwise unsuspected intermittent under- or oversensing.

Right bundle branch block, intermittent ST segment elevation and inducible ventricular tachycardia in an asymptomatic patient: an unusual presentation of the Brugada syndrome?

We describe the case of an asymptomatic 54-year-old female who underwent a routine electrocardiogram (ECG) in July 1997, which showed incomplete right bundle branch block and an important ST segment elevation with a coved fashion and the inversion of T waves in leads V1-V2. Her family and personal history was free of any cardiovascular pathology. She previously underwent a routine ECG in 1991 and 1995, showing an incomplete right bundle branch block with a moderate ST segment elevation in leads V1-V2. Exercise test, 24-hour Holter ECG, echocardiogram and QT dispersion analysis were all normal. The heart-rate variability in the frequency domain revealed low vagal tone. The signal-averaged ECG was positive due to the presence of three criteria. The patient underwent an electrophysiologic study. The baseline ECG resembled the ones performed in 1991 and 1995. Sinoatrial node and atrioventricular node were normal. The HV interval resulted of 62 ms. A syncopal polymorphic ventricular tachycardia (cycle length 220 ms) interrupted by electrical defibrillation (200 J) was induced with double extrastimulus during pacing at a cycle length of 600 ms from the apex of the right ventricle. At the end of the study, one minute after a bolus of ajmaline 1 mg/kg, an important ST segment elevation in lead V1 and a left axis deviation appeared. The patient began therapy with sotalol 80 mg t.i.d. and the electrophysiologic study was repeated three days later. A non-sustained polymorphic ventricular tachycardia (cycle length 200 ms) was induced with triple extrastimulus during pacing at a cycle length of 370 ms from the outflow tract of the right ventricle. On the basis of these results and as also suggested by recent reports, we decided to implant an Automatic Implantable Cardioverter Defibrillator.

Cardiovascular adaptations to endurance training and detraining in young and older athletes.

In order to evaluate the influence of aging on cardiovascular adaptations to endurance training and detraining, 12 young (range 19-25 years) and 12 older (range 50-65 years) male cyclists were examined during the training and after 2 months of detraining. Twelve young and 12 older healthy sedentary males matched for age and body surface area were used as control groups. Each subject underwent a maximal exercise test using a cycle-ergometer in order to measure maximum oxygen consumption, an M-mode and 2D echocardiography in order to assess left ventricle morphology and systolic function, and a Doppler echocardiography for evaluating the diastolic filling pattern. During the training period both groups of athletes showed higher values of maximum oxygen consumption, left ventricular wall thicknesses, end-diastolic diameter and volume, as well as left ventricular mass, than their control subjects; in the older subjects the adaptation of the heart to aerobic training seems to be obtained mainly through a higher increase in left ventricular diastolic filling. In both groups no significant modifications in the ejection fraction and diastolic function parameters were recorded. After the detraining period the wall thicknesses decreased only in young athletes, while left ventricular mass and end-diastolic diameter and volume reduced only in older athletes. In conclusion, training and detraining induced nearly similar left ventricular morphological modifications in the two age groups, even though greater in the older athletes with respect to the ventricular mass and volume. No relevant differences were observed in the Doppler filling pattern between athletes and sedentary controls.

Efficacy of intravenous propafenone in termination of atrial flutter by overdrive transesophageal pacing previously ineffective.

Fifty patients with symptomatic type I atrial flutter in whom termination of the arrhythmia with transesophageal stimulation was unsuccessful were randomized to undergo a repeat procedure after intravenous propafenone (n = 25) or placebo (n = 25). Immediate sinus rhythm recovery rate was 36% in the propafenone group and 4% in the placebo group (p = 0.005), indicating that intravenous propafenone increases the rate of successful transesophageal stimulation and can be used when a first attempt at conversion is ineffective.

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional reentrant tachycardia. Comparison with patients with ventricular pre-excitation and with normal subjects.

The aim of our work was to evaluate the inducibility of atrial fibrillation in a group of patients with atrioventricular junctional reentrant tachycardia and to compare it with that of patients with a Kent-type ventricular pre-excitation (Wolff-Parkinson-White syndrome) and a control group. One hundred and twenty-five subjects were separated into groups. Group 1 comprised 49 Wolff-Parkinson-White patients, with a mean age of 26.4, range 10-66 years; group 2, 51 patients with atrioventricular junctional reentrant tachycardia inducible by transoesophageal atrial stimulation and/or clinically documented, with a mean age of 43.4, range 16-78 years; group 3, 25 control subjects with a mean age of 26.4, range 13-76 years. Each subject underwent atrial transoesophageal stimulation with the following protocol: programmed atrial stimulation with 1 and 2 stimuli during atrial pacing of 100.min-1 and 150.min-1; atrial stimulation for 10 s at a rate of 200-300-400-500-600.min-1 with intervals of 10 s between stimulations, five successive 'ramp-up' atrial stimulations for 9 s with the rate increasing from 100 to 800.min-1 with intervals of 10 s between stimulations. The end point was the completion of the protocol or induction of sustained atrial fibrillation (> 1 min). The chi-square test was used for statistical analysis. Our results showed that in group 1 atrial fibrillation was induced in 27/49 patients (55.1%); this was sustained in 13/49 (26.5%) and non-sustained in 14/49 (28.5%); in group 2, atrial fibrillation was induced in 22/51 patients (43.0%); it was sustained in 7/51 (13.7%) and non-sustained in 15/51 (29.4%); in group 3, sustained atrial fibrillation was not induced in any subject and in only one subject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant, while group 2 vs group 3 and group 1 vs group 3 were significant (P < 0.003 and P < 0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerability in comparison to the control subjects and a similar vulnerability to group 1 patients. It is possible that the greater atrial vulnerability in the patients of group 2 was due to the double nodal pathway.

Cardiovascular neural regulation during and after prolonged high altitude exposure.

Eight young healthy male subjects, members of a Himalayan expedition, underwent 24 h Holter monitoring before departure, after 1 and 4 weeks at high altitude (5000 m) and after return to sea level. At high altitude, the circadian reciprocal changes in low and high frequency (LF, HF) were absent, with no significant reduction in the LF to HF ratio over the 24 h; moreover, the proportion of adjacent R-R intervals that differed by more than 50 ms (pNN50) decreased significantly and remained lower after return to sea level. Urine catecholamines increased at high altitude, but only norepinephrine, after 1 week of exposure, rose significantly. Upon return to sea level the density, but not the affinity, of [alpha]2-adrenergic receptors on platelets decreased significantly compared to pre-expedition values. At high altitude increased sympathetic activity was indicated by elevation of urine norepinephrine and by the loss of circadian rhythm in spectral components. The simultaneous reduction of HF and pNN50 demonstrated decreased vagal tone. The persistence of increased sympathetic activity could explain the downregulation of adrenergic receptors after prolonged high altitude exposure.

[The ST/HR slope and coronary stenoses]. / ST/HR slope e stenosi coronariche.

BACKGROUND: The heart rate adjustment of ST depression (ST/HR Slope) has been shown by some authors to markedly improve the accuracy of treadmill exercise electrocardiogram for identifying and quantifying coronary artery disease. However, other authors have obtained different results. In the present study the results of our exercise electrocardiography laboratory are compared with the data obtained from the literature. METHODS: Fifty patients (46 males and 4 females, age range 60 +/- 7 years) with suspect or certain coronary artery disease were referred for a routine treadmill exercise electrocardiogram, and subsequently underwent cardiac catheterization and selective coronary cineangiography to assess the severity of coronary obstruction. All patients exercised according to a recently reported modification of the standard Bruce protocol, proposed by Kligfield et al, for a more accurate evaluation of the ST/HR Slope, which was calculated in real time by a computerized system. Patients with coexisting valvular heart disease, cardiomyopathy, left bundle-branch block on the resting ECG, myocardial infarction within 8 weeks, diabetes mellitus, hypertensive response during exercise testing (diastolic blood pressure > 95 mm Hg and/or systolic blood pressure > 190 mm Hg), abnormalities or variations of the coronary arteries, were excluded from this study. RESULTS: This method correctly identified 13 of 14 patients with multivessel coronary artery disease and 35 of 36 with less severe disease: one patient was false negative and another one false positive. Thus, in our exercise electrocardiography laboratory this approach shows a sensitivity of 93%, a specificity of 97%, a positive predictive value of 93% and a negative predictive value of 97% for the detection of severe coronary disease. CONCLUSIONS: These findings suggest that, in patients selected as in this study, the ST/HR slope is a good method which improves the clinical usefulness of the treadmill exercise electrocardiogram in coronary artery disease.

[The behavior of the arterial pressure at rest and under exertion in normotensive and hypertensive subjects exposed to acute hypoxia at a median altitude]. / Comportamento della pressione arteriosa a riposo e da sforzo in normotesi e ipertesi sottoposti a ipossia acuta da media quota.

In order to evaluate blood pressure changes at rest and during effort in response to moderate altitude acute hypoxia, we performed noninvasive blood pressure monitoring and maximal bicycle stress testing in 10 normotensive and 13 untreated mild hypertensive subjects at sea-level and in a mountain resort (m. 2572). Blood pressure was measured every 10 minutes by the Spacelabs 5200 pressurometer and bicycle stress test was performed at initial workload of 50 watts and steps of 50 watts every 3 minutes until exhaustion. Mean systolic blood pressure resulted unchanged in the normotensive subjects (120.8 +/- 10.6 vs 121.5 +/- 6.9 NS) while in the hypertensive ones it increased slightly at 2572 m. (131.0 +/- 12.3 vs 137.0 +/- 13.1 NS). Mean diastolic blood pressure did not increase significantly at 2572 m in either group (respectively from 74.5 +/- 90 to 80.1 +/- 7.9 NS and from 88.3 +/- 10.2 to 94.7 +/- 10.7 NS) even if blood pressure increase was relevant in some hypertensive subjects. During the monitoring, heart rate increased at 2752 m in both groups, even if this difference was significant in the hypertensive group only (respectively 82.8 +/- 11.8 vs 94.3 +/- 13.2 in normotensive subjects-NS-and 88.0 +/- 6.3 vs 104.0 +/- 7.8 in hypertensive subjects-p less than 0.001). During the ergometric test submaximal systolic blood pressure (100 and 150 watts) increased slightly in both groups, but this difference was significant in hypertensive subjects at a workload of 150 watts only (208.3 +/- 18.2 vs 219.3 +/- 19.2 p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[The effects of enalapril on basal arterial pressure at rest and during exercise and on cardiac performance in hypertensive athletes]. / Effetti dell'enalapril sulla pressione arteriosa basale e da sforzo e sulla performance cardiaca in atleti ipertesi.

A dose of 10 mg of enalapril was administered once a day to regularly trained hypertensive athletes (mean age 39 +/- 8.9 range 29-51) in order to evaluate the effect of the drug on ambulatory blood pressure and on blood pressure and physical performance during stress testing. STUDY DESIGN. This investigation was a randomized, double blind, cross-over versus placebo trial. At first, subjects whose blood pressure met the entry criteria (casual diastolic blood pressure greater than or equal to 95 mmHg), were subjected to 24-hour ambulatory blood pressure monitoring and maximal upright bicycle stress testing including measurement of O2 uptake. Then they were randomly assigned to treatment with placebo or enalapril. After one month they repeated stress testing and then they were crossed over. Stress testing was repeated in all subjects after two months. The 24-hour ambulatory blood pressure monitoring was repeated in all subjects during enalapril treatment only, by a non-blind investigator. RESULTS. Ambulatory blood pressure decreased significantly during enalapril and no changes in heart rate were observed during the monitoring. The results of bicycle stress testing, both in basal and during the placebo test were comparable as regards blood pressure response, maximal workload, effort duration, maximal heart rate and VO2 max. With enalapril systolic and diastolic blood pressure decreased significantly during stress testing both versus basal test and placebo test at each workload considered including maximal workload. No changes were observed during enalapril as regards maximal workload, effort duration, maximal heart rate and VO2 max. CONCLUSION. Our results suggest that enalapril could be effective in treating hypertensive athletes because it reduces blood pressure during physical effort without affecting physical performance. We conclude that enalapril could be considered a first-choice drug in hypertensive athletes doing aerobic sports.

[Evaluation of the efficacy and tolerability of sustained-release nifedipine in arterial hypertension. Continuous monitoring of arterial pressure]. / Valutazione dell'efficacia e tollerabilità della nifedipina ritardo nell'ipertensione arteriosa. Studio con monitoraggio continuo incruento della pressione arteriosa.

UNLABELLED: The anti-hypertensive efficacy of slow-release nifedipine 20 mg twice a day was investigated in 20 consecutive patients (13 females and 7 males, mean age 50.3 +/- 9.9 years) with mild to moderate hypertension (mean casual BP 162.2 +/- 7.5/103.1 +/- 4.7 mmHg) continuous blood pressure monitoring and routine laboratory tests were performed before and after three months of continuous therapy, whereas casual blood pressure was assessed after one and three months of therapy. RESULTS: In 4 patients, all female, adverse effects (headache) led to discontinuation of therapy. In the other 16 patients casual blood pressure decreased to 149.8 +/- 12.7/95.3 +/- 6.6 after one month and to 148.7 +/- 11.7/91.4 +/- 7.1 after three months (p less than 0.05 and became normal after three months in 11 patients (68%). Continuous blood pressure monitoring showed a significant fall in systolic and diastolic day time blood pressure (from 132.8 +/- 6.0/87.9 +/- 5.1 - p less than 0.02) and in systolic night time blood pressure (from 117.1 +/- 6.6 to 107.1 +/- 5.1 - p less than 0.02) without changing the shape of the circadian profiles. No significant changes in systolic blood pressure variability were observed. There was no correlation between pretreatment blood pressure levels and the extent of blood pressure fall during therapy. Heart rate, body weight and all biochemical parameters remains unchanged. CONCLUSION: Our findings confirm the antihypertensive efficacy of slow release nifedipine. This study does not concord with other reports regarding the tolerability of this drug in women. However the small number of patients does not allow any firm conclusions to be drawn.