In order to examine the physiological variation in blood pressure and heart rate that occurs during normal activities in patients with diabetes, 24-h profiles were constructed from continuous ambulatory recordings. Isometric and dynamic tests were also performed. The patients were subdivided into 25 uncomplicated cases, 11 with peripheral neuropathy and 6 with autonomic neuropathy. These were compared with a 'control' group of 22 normal subjects. Abnormal 24-h blood pressure profiles were found particularly in the patients with autonomic neuropathy. This group had attenuation or reversal of the usual diurnal rhythm, blood pressure often rising during the night and falling in the early morning. Diurnal heart rate variation was reduced in all three groups of patients. Blood pressure responses to both forms of exercise were also significantly reduced in the autonomic neuropathy group (maximum change in systolic blood pressure during isometric exercise was 10 +/- 4 mmHg vs 36 +/- 3 mmHg in the control group, p less than 0.003). Patients with peripheral neuropathy also had some impairment of exercise-induced blood pressure changes, but to a lesser degree.

Summary:It is generally believed that there a~ blood pressure differences between the right and left arms, but most of the validation studies have used nonsimultaneous measurements. It is important to know whether there is a difference, as methodological comparisons ax often made using a different technique on each arm. We have measured the blood pressure simultaneously in both arms in 91 patients, using two observers and two cuffs to pmvide eight measurements in a fully balanced design. The mean difference in blood pressure between the m s (left/ right) was -1.3 (SE 0.4)A.l (SE 0.3) mmHg. Mean differences of the same magnitude were found between the two observers, and between the cuffs. Thus, no systematic difference of any consequence was found, although individual patients had mean between-am differences in blood pressure of up to 10 mmHg. These results suggest that no significant bias is introduced in methodological comparisons that use both arms.

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BRL 26921 is a protected plasminogen-streptokinase complex with selective affinity for thrombus. When given intravenously within three hours of the onset of a first acute myocardial infarction angiographic patency of the infarct related vessel was seen in all 16 patients receiving the active drug compared with only two of 16 receiving a placebo. There was relative sparing of left ventricular function in the active treatment group with anterior infarction (mean left ventricular ejection fraction 37% compared with 23% for placebo), but no significant difference in left ventricular function between the active and placebo groups was seen in patients with inferior infarction. Intravenous BRL 26921 is highly effective in causing coronary reperfusion and may help to preserve left ventricular function when given early in the course of anterior infarction.

Intraarterial ambulatory blood pressures were recorded prior to and during therapy with two different calcium ion antagonists, nifedipine and verapamil, in two separate groups of patients. In the first group, nine patients were studied off therapy and following a minimum of 6 weeks of nifedipine treatment (dose range, 20 to 60 mg twice daily). A second group of 16 patients followed the identical protocol but were prescribed verapamil (120 to 160 mg, three times daily). During both studies, patients underwent standardized physiological tests including tilt, isometric handgrip, and dynamic bicycle exercise. Both verapamil and nifedipine caused a reduction in blood pressure over most of the 24 hours studied. Nifedipine did not affect heart rate whereas verapamil caused a reduction of approximately 10 bpm. Nifedipine and verapamil did not induce postural hypotension, and the absolute responses to dynamic and isometric exercise were reduced. These results show the efficacy of slow channel inhibitors in the management of essential hypertension.

Self-recording of the blood pressure by patients away from hospital or office ("home blood pressure") has been advocated as providing a better estimate of "true" blood pressure. The reliability of home blood-pressure recording has been assessed only by standard indirect methods which themselves are subject to considerable error and variability. The accuracy of self-recorded blood pressures was therefore assessed in 57 patients with essential hypertension by comparison with simultaneous measurements of clinic blood pressures and with intra-arterial blood pressures recorded at home and at hospital. Home systolic blood pressures showed good agreement with clinic and intra-arterial pressures, but home diastolic blood pressures overestimated intra-arterial pressures, as did clinic diastolic pressures. The clinic and home diastolic pressures showed good agreement. There was considerable variability in individual differences comparing the indirect and intra-arterial methods, though the two indirect methods showed much closer agreement.This study suggests that home blood pressures are as accurate as clinic readings but may be recorded more frequently and thus provide more useful information. Neither is likely to approximate the intra-arterial blood pressure.