A reduced coronary flow reserve has been reported in patients with ischemialike symptoms and normal coronary arteries. In 13 such patients, both coronary vasomotion and flow reserve were studied. The luminal area of the proximal and distal third of the left anterior descending and left circumflex artery were determined by biplane quantitative coronary arteriography using a computer-assisted system. Patients were studied at rest, during submaximal supine bicycle exercise (4.0 minutes, 116 W), and 5 minutes after sublingual administration of 1.6 mg nitroglycerin. Heart rate, mean pulmonary pressure, and mean aortic pressure as well as the percent change of both proximal and distal luminal area were determined. In 10 of the 13 patients, coronary sinus blood flow was measured by coronary sinus thermodilution technique at rest and after dipyridamole infusion (0.5 mg/kg in 15 minutes) 10±5 days after quantitative coronary arteriography. Coronary flow ratio (dipyridamole/rest) and coronary resistance ratio (rest/dipyridamole) were determined in these patients. Patients were divided into two groups according to the behavior of the coronary vessels during exercise (vasodilation, group 1; vasoconstriction, group 2). Coronary vasodilation of the proximal (luminal area +26%, p <0.001) and distal (+45%, p <0.001) artery was observed in seven patients (group 1) during exercise and after sublingual nitroglycerin (+46%, p<0.001; and + 99%, p<0.001, respectively). In group 2 (n=6), however, there was coronary vasoconstriction of the distal vessel segments (-24%, p<0.001) during exercise, whereas the proximal coronary artery showed vasodilation (+26%, p<0.001) during exercise. After sublingual nitroglycerin, both vessel segments elicited vasodilation (distal coronary, +44%, p<0.001; proximal coronary artery, + 47%, p <0.001). Coronary flow ratio amounted to 2.5 in group 1 and 1.2 in group 2 (p <0.05) and coronary resistance ratio to 2.7 in group 1 and to 1.2 in group 2 (p<0.05), respectively. Thus, among patients with ischemialike symptoms and normal coronary arteries, there is a group of patients (group 2) with an abnormal dilator response of the distal coronary arteries to the physiologic dilator stimulus of exercise and a reduced dilator capacity of the resistance vessels after dipyridamole (abnormal coronary vasodilator syndrome). The nature of this exercise-induced distal coronary vasoconstriction is not clear but might be due to an abnormal neurohumoral tone that may cause or contribute to the blunted vascular response during exercise. (Circulation 1989;79:516-527)

In this study, self-determined, ambulatory and casual blood pressure measurements were studied in patients with mild to moderate essential hypertension. 31 patients were studied during a 7-day period: casual blood pressures were taken on the 1st, 4th and 7th day. Pressure monitoring for 24 h using a noninvasive ambulatory blood pressure recorder was performed on the 1st and 7th day. Patients recorded blood pressure daily at home at least 3 times each day. On the 1st day, the mean casual blood pressure was significantly higher than either mean self-determined blood pressure or mean 24-hour ambulatory blood pressure. There was no significant difference between ambulatory daytime means and self-determined means. Casual blood pressures decreased from day 1 to day 7 significantly, while no significant difference in self-determined or ambulatory readings was observed. On the 7th day casual blood pressures were still significantly higher than self-determined measurements. Our results show that values obtained from daytime ambulatory measurements and self-determined measurements were equivalent. A fall in blood pressure with serial observations was found only in casual blood pressure, while no significant change occurred with either self-determined or ambulatory pressure. Since self-determined blood pressure measurements are easier and more economical to perform than ambulatory measurements, self-determined measurement is an excellent alternative to obtain representative blood pressure values for the diagnosis and treatment of hypertension.