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J Lefebvre

Publications and source records attributed to J Lefebvre.

At least 55 records · Page 3Linked to original sources
PubMed1998

Comparative effects of felodipine ER, amlodipine and nifedipine GITS on 24 h blood pressure control and trough to peak ratios in mild to moderate ambulatory hypertension: a forced titration study.

OBJECTIVE: To evaluate the 24 h antihypertensive efficacy and duration of action of felodipine extended release (ER) in comparison with two other long acting dihydropyridine calcium antagonists, amlodipine and nifedipine gastrointestinal therapeutic system (GITS), in patients with mild to moderate essential hypertension substantiated by ambulatory blood pressure (BP) monitoring. DESIGN: Randomized, forced titration, parallel group study. Clinic BP was measured at every patient's visit, and 24 h ambulatory BP was monitored at baseline and at the end of each dose-titration period. SETTING: Single centre: hypertension research unit in Quebec City, Quebec. PATIENTS: There were 89 patients enrolled into the study. Eighty-four eligible patients were randomized, and 83 completed the study and were included in the final efficacy analysis. INTERVENTIONS: Following a two-to four-week washout period (baseline), patients were randomly allocated to receive felodipine ER 5 mg, amlodipine 5 mg or nifedipine GITS 30 mg for four weeks (low dose). All study patients had their daily dose doubled to felodipine ER 10 mg, amlodipine 10 mg or nifedipine GITS 60 mg for a further four weeks (high dose). MAIN RESULTS: Significant (P < 0.001) and similar changes from baseline in clinic BP were observed in all treatment groups for low and high doses. Ambulatory BP profiles showed comparable blood pressure reductions with felodipine ER and amlodipine, and a trend towards a lesser reduction with nifedipine GITS during 24 h, daytime and night-time periods. BP loads were similarly reduced with the three treatments. Trough to peak ratios (T:Ps) were calculated from 24 h ambulatory BP curves according to two different approaches: for diastolic and systolic BP, respectively, the global approach produced T:Ps of 0.49 and 0.50 with felodipine ER 5 mg; 0.50 and 0.34 with felodipine ER 10 mg; 0.70 and 0.60 with amlodipine 5 mg; 0.88 and 0.82 with amlodipine 10 mg; 0.65 and 0.55 with nifedipine GITS 30 mg; 0.68 and 0.53 with nifedipine GITS 60 mg. T:Ps in the individual approach were 0.07 and 0.10 with felodipine ER 5 mg; 0.23 and 0.31 with felodipine ER 10 mg; 0.22 and 0.31 with amlodipine 5 mg; 0.45 and 0.58 with amlodipine 10 mg; 0.27 and 0.31 with nifedipine GITS 30 mg; and 0.24 and 0.40 with nifedipine GITS 60 mg. CONCLUSION: There was no evidence in this study of a difference among felodipine ER, amlodipine and nifedipine GITS in lowering ambulatory or clinic BP. Treatment based on ambulatory BP may be preferable to treatment guided by T:Ps because ambulatory BP is firmly established as a predictor of cardiovascular risk. Furthermore, there is no consensus on how to calculate T:Ps, and different methods of calculation may give divergent results.

Adult↗
PubMed1997

Detection of coxsackie B virus RNA sequences in whole blood samples from adult patients at the onset of type I diabetes mellitus.

Enteroviruses may be linked to insulin-dependent diabetes mellitus (IDDM). The prevalence of enteroviral (EV) infection at onset of adult IDDM was investigated by detection of specific EV sequences in peripheral blood using a reverse transcription and a seminested polymerase chain reaction (seminested RT-PCR). EDTA-treated whole blood samples taken from 12 newly diagnosed IDDM patients with ketosis or ketoacidosis were examined. The comparison groups were 12 adult patients suffering from metabolic decompensation in the course of IDDM, 12 adult patients with decompensated non-IDDM, and 15 healthy adults without any presumed EV infection or metabolic disease. EV genome was detected in five of 12 (42%) newly diagnosed IDDM patients and in one of 12 (8%) patients in the course of IDDM. By contrast, none of the 12 non-IDDM patients and none of the 15 healthy adults had EV sequences in whole blood. Subsequent sequencing of the EV PCR products from the six positive patients showed a significant homology with Coxsackie B3 or B4 viruses, and some common patterns were observed among the sequences. The present study demonstrates that Coxsackie B virus RNA sequences can be detected in peripheral blood from patients at the onset or in the course of IDDM and provides evidence for a role for enteroviruses in adult type I diabetes.

Adult↗
PubMed1997

The antihypertensive efficacy of the novel calcium antagonist mibefradil in comparison with nifedipine GITS in moderate to severe hypertensives with ambulatory hypertension.

Mibefradil is a novel calcium antagonist that blocks selectively the T-type calcium channels. In this double-blind forced titration study design we compared the effects of mibefradil 50, 100, and 150 mg and nifedipine GITS 30, 60, and 90 mg monotherapies or combined with lisinopril 20 mg in 71 moderate to severe hypertensives (59 men and 12 women) with confirmed ambulatory hypertension. An incremental dose-response effect was observed both in clinic and ambulatory blood pressure parameters during treatment with mibefradil and nifedipine GITS alone and combined with lisinopril. At maximal dosage, patients treated with mibefradil experienced a greater (P < .05) reduction in clinic and ambulatory diastolic blood pressures as well as a greater response rate (86% v 69%). Trough:peak ratios for systolic and diastolic blood pressures were > 90% at each dose level. Significant decrease in baseline heart rate was observed with mibefradil 150 mg alone or combined with lisinopril, but no patients experienced clinically significant atrioventricular conduction abnormalities. Adverse events related to vasodilation were more prevalent in the nifedipine GITS group. Consequently, the results of the present study demonstrate that the novel calcium channel blocker mibefradil, either alone or in combination with lisinopril, is effective in reducing clinic and 24-h blood pressures while decreasing heart rate and is well tolerated in patients with moderate to severe hypertension.

Adult↗
PubMed1997

[The protein of fibrocystic breast disease--methods of measurement and clinical implications].

The gross cystic disease of the breast has been reported to be associated with a two to fourfold increased breast cancer risk. The cyst fluid contains several hormones and proteins among whom we have isolated and characterized one of these proteins with an estimated molecular weight at 17.4 kilodaltons (Gross Cystic Disease Fluid Protein-17 kDa or GCDFP-17). A specific antiserum against GCDFP-17 was produced and an enzyme-linked immunosorbent assay (ELISA) was perfected to obtain a simple and sensitive method for the study of the GCDFP-17. This protein is also stimulated by androgens in vitro like in vivo and is a potential marker of an androgens' excess. Subsequently, we were able to study 33 ovarian micropolycystic syndromes (OPCS) with a biological hyperandrogenism (Hyperandrogenic Group or GH) compared with 32 control women (GT). The body mass index (BMI) of GH was significantly greater than that of G.T. (29.8 +/- 9.3 vs 21.3 +/- 2.7 kgs/m2--p. < 0.01). The mean plasma value of testosterone (T), delta 4-androstenedione (delta 4-A), dehydroepiandrosterone sulfate (SHDA) and the ratio of T. on sex binding protein (SBP) or free testosterone index (ITL) were significantly greater in GH than in GT (p < 0.01). Despite the circulating excess of androgens in GH, there were no significant differences for GCDFP-17 between the 2 groups (G.H. = 222 +/- 74 vs G.T. = 230 +/- 84 ng/ml) and any correlation between plasma androgens and GCDFP-17 (p < 0.05). Nevertheless, the androgens' excess in G.H. was clearly smaller than that which was seen with the doses of potent androgens used in the treatment of metastatic breast cancer.

Adult↗
PubMed1996

[Congenital diabetes insipidus. Recent advances in molecular genetics].

Hereditary diabetes insipidus can occur in two forms: the first, referred to as central diabetes insipidus, is responsive to vasopressin whereas the second, termed nephrogenic diabetes insipidus, is resistant to treatment. Recent advances in molecular genetics have contributed to elucidate the pathogenesis of these affections. Familial central diabetes insipidus depicts two unsimilar illnesses. The first, characterized by an autosomal dominant transmission, is of delayed onset and worsens progressively all through life. It is related to a heterozygous mutation of the vasopressin precursor gene mainly involving either the sequence encoding for the signal peptide or the one encoding for neurophysin II, the hormone carrier protein. Mutations described to date are responsible for impairment of vasopressin precursor transportation and processing. Therefore mutant protein accumulates in the posterior pituitary which is involved in the persistant bright spot seen on magnetic resonance imaging. The second illness or Wolfram syndrome, autosomal recessive, associates obligatory features: insulin-dependant diabetes, bilateral optic atrophy and more inconstantly: diabetes insipidus, deafness, genito-urinary and neuropsychiatric disturbances. The cause of this syndrome, still unknown, may involve mitochondrial ADN mutations. Familial nephrogenic diabetes insipidus, of neonatal onset, are mainly X-linked and associated to mutations in the V2 receptor gene. About 60 mutations have been described until now. Some rare cases, transmission of which is autosomal recessive, result from homozygous mutations of aquaporin 2 gene, a water channel involved in the water reabsorption in the renal collecting duct. Other mutations will be probably discovered in future. In conclusion, familial diabetes insipidus constitutes an interesting pathogenic model because it may be explained by impairment of vasopressin gene precursor as well as by abnormalities of renal receptor or post receptor mechanisms of the hormone.

Animals↗
PubMed1996

Relations between aggregative, viscoelastic and molecular properties in gluten from genetic variants of bread wheat.

Glutens differing in their low- and high-molecular-weight glutenin subunits (LMW-GS and HMW-GS) were extracted from genetic variants of bread wheat. Their composition was analysed by electrophoresis, the glutenin size distribution was determined by size-exclusion chromatography. Rheological measurements in the dynamic regime and electron spin resonance spin-labelling experiments gave data on the viscoelasticity and the protein flexibility of the glutens, respectively. In glutens differing in their HMW-GS, a relation is observed between the composition, aggregative properties, segmental flexibility and viscoelastic behaviour. This is not found in glutens with different LMW-GS. However, the proportion of rigid polypeptide segment is related to the height of the elastic plateau in all cases. The organisation of the protein network in gluten is discussed in reference to this data.

Electron Spin Resonance Spectroscopy↗
PubMed1996

Ductal cyst formation in collagen-embedded adult human islet preparations. A means to the reproduction of nesidioblastosis in vitro.

Neogenesis of endocrine islets from ductal epithelium termed nesidioblastosis has been described in vivo after various experimental conditions (90% pancreatectomy or pancreas wrapping in the rodent) and in clinical pathologies. In the adult regenerating pancreas, a proliferation and organization of ductal epithelium into tubular structures precedes its differentiation into endocrine cells. Reproduction of nesidioblastosis in vitro may provide a novel approach to human islet propagation in vitro. With this aim, adult human islet preparations were cultured in diverse three-dimensional (3D) gels in the presence of serum. After 3-5 days in rat tail collagen gels, proliferating (bromodeoxyuridine-positive) cystic structures appeared associated with islets and as isolated spheres. Percentage labeling indexes of the cysts were 4.1, 18.7, 15.4, and 13.3% after 3, 5, 7, and 10 days of culture, respectively. Immunohistochemistry confirmed the ductal (carbohydrate antigen 19-9) and epithelial (keratin-1) nature of the cysts. No cysts were formed in agarose gels or Vitrogen 100, whereas the cyst number was increased by the quantity of serum (20% > 10%) and gels rich in extracellular matrix components and growth factors (Matrigel). The latter lead to tubular networks. Single endocrine islet cells were observed in the ductal cysts after 7 (2.8%) to 10 (5.6%) days in rat tail collagen. Our observations paralleled the changes characteristic of the regenerating pancreas in vivo. 3D culture may permit the identification of matrix and media constituents promoting the neogenesis of islets and may be the means to increase the mass of endocrine tissue obtained from adult cadaveric pancreases for transplantation.

Adult↗
PubMed1996

Usefulness of ambulatory blood pressure monitoring in detecting the additional antihypertensive effect of non-pharmacologic treatment.

OBJECTIVE: The present study was designed to investigate whether a non-pharmacologic intervention program (NPIP) consisting of a weight-lowering diet, a reduction in alcohol consumption and physical training at 50% peak aerobic capacity could enhance the blood-pressure-lowering effect of calcium antagonists in obese sedentary, hypertensive patients. METHODS: Fifty-nine subjects were treatred with 5-10 mg isradipine once daily for 8 weeks and were then randomly allocated to either isradipine monotherapy or isradipine plus NPIP for 20 weeks. Clinic and ambulatory blood pressure were used for assessing the antihypertensive effect obtained in both treatment groups. RESULTS: Clinic and ambulatory systolic and diastolic blood pressures decreased significantly after 8 weeks of isradipine monotherapy. At week 28, the group treated with isradipine combined with NPIP and in which significant modifications in body weight (P < 0.0001), alcohol intake (P < 0.0001) and peak oxygen uptake (P <0.01) were observed, had significant (P < 0.05) additional decrements in ambulatory but not clinic blood pressure. CONCLUSIONS: These results demonstrate that the addition of lifestyle modifications in obese sedentary hypertensive patients already receiving pharmacological therapy can induce further blood pressure decrements. Because significant decrements were noticed only with ambulatory blood pressure monitoring, the results of the present study advocate this technique for assessing the magnitude of blood pressure reduction with non-pharmacological therapy.

Journal Article↗
PubMed1996

Incidence of overestimation and underestimation of hypertension in a large sample of Canadians with mild-to-moderate hypertension.

OBJECTIVE: To determine the prevalence of overestimated and underestimated hypertension in a large sample of Canadians with mild-to-moderate hypertension before and after antihypertensive treatment. DESIGN: Data were retrieved from files of 1019 patients in whom clinic and ambulatory blood pressures had been measured both at the start and at the end of several studies involving various pharmacological antihypertensive agents. METHODS: Overestimation and underestimation of hypertension were calculated from the difference between office and awake ambulatory blood pressure both for systolic and for diastolic values (standard criteria) and also from the difference between observed ambulatory blood pressure and the predicted level estimated from individual office blood pressure by means of a regression equation derived for the group (criteria of Perloff et al.). RESULTS: Approximately 20% of the patients satisfied both sets of criteria for overestimation of systolic and diastolic hypertension before treatment. A significantly greater proportion of women showed overestimation of diastolic hypertension compared with men (approximately 27 and 17%, respectively, P < 0.05) on the basis of either set of criteria. Treatment did not affect the prevalence of overestimation of hypertension for the group as a whole, but the proportion of women in whom diastolic hypertension was overestimated decreased to above 17% after treatment (P < 0.001). The same proportion of patients satisfied the criteria of Perloff et al. for underestimation of hypertension, but only about 10% satisfied the standard criteria for this condition, both before and after treatment. The reproducibility of overestimation or underestimation of hypertension was 30-40%, independently from the criteria used. CONCLUSIONS: About one-fifth of patients display overestimated hypertension and, according to the criteria of Perloff et al., as great a proportion show underestimated hypertension. Thus, as many hypertensive patients may be overmedicated and undermedicated on the basis of clinic blood pressure compared with ambulatory blood pressure measurement.

Journal Article↗
PubMed1996

[Thyreotropic adenoma: review of the literature. Apropos of 2 cases].

TSH-secreting adenoma is a rare entity; a series of 69 cases has been collected by Faglia in 1989 and 78 new cases were published from 1987 to 1994. We report two new cases which have been explored by octreotide scintigraphy before treatment with the SRIH analogue. An in vitro SRIH receptor study was also performed in the first patient. This patient, a young man, suffered from hyperthyroidism with enhanced FT3 and FT4 concentrations without decreased TSH values. Plasma alpha subunit level was slightly increased. He had a pituitary tumor, positive in Octreoscan but responded partially to treatment by SRIH analogue. The tumor was in part surgically removed and the SRIH receptors revealed a homogeneous density; their number was equal to those of GH-secreting tumor but their affinity was lower. The second patient, an elderly woman was not surgically treated because the octreotide treatment dramatically improved both tumor volume and thyroid hormone or alpha subunit levels. The tumor, associated to a probable meningioma, was also positive in Octreoscan and was characterized by a highly increased alpha subunit plasma level. These results are discussed by comparison with those of the literature.

Adenoma↗
PubMed1996

[Gonadotropi adenoma linking labeled somatostatin analogs. Lack of relationship with therapeutic effect].

Somatotropin- and thyrotropin-secreting adenomas are well known for positive uptake of radio-labeled octreotide in vivo, this fact is not so well assessed for gonadotropin-secreting adenomas (GSA). We report one case of positive somatostatin receptor scintigraphy in a woman suffering from histologically proven GSA. This 63 year old patient has been suffering for two years of akinetic syndrome when the outcome of diplopia led to the discovery of a large hypophyseal tumor spreading till V3 floor and in left cavernous sinus by resonance magnetic imaging (RMI). Clinical examination showed anterior hypopituitarism and bitemporal hemianopsia. Biologically, blood gonadotropins were decreased more on LH (0.6 UI/l, N > 15) than on FSH (10 UI/l; N > 20). A lack of response of gonadotropins to LHRH with low blood estradiol concentration (< 10 pg/ml) was noticed. Basal blood measurement of alpha subunit was at 0.17 microgram/l (N = 0.10-1.6) and increased at 0.39 microgram/l after stimulation by LHRH. Although in low range of normal values, other hypophyseal hormones were normal except prolactinemia (45 mg/L; N < 20), however stimulated by TRH and related to dopaminergic deconnection; Indium 111 labeled octreotide scintigraphy showed an over uptake of the tumor. Three month treatment by octreotide (100 micrograms x 3/day subcutaneously) did not allow to decrease significantly FSH concentration or to reduce the tumoral mass. Incomplete removal of the tumor was performed by transphenoidal route. Immunohistochemical analysis revealed positive immunostaining for alpha subunit and FSH beta on numerous cells while the labeling was slightly less strong for LH beta. These data evoked a GSA. This case record depicts the possibility of detection of GSA by somatostatin receptor imaging. However a positive result does not preclude of somatostatin analog therapeutic efficiency.

Adenoma↗
PubMed1996

[Diabetes insipidus revealing pituitary metastasis of bronchial carcinoma].

Pituitary metastasis are rare but represent an important differential diagnosis of intrasellar tumorous syndromes. We report one case of intrasellar metastasis of a bronchial adenocarcinoma in a 50 year old woman. Clinical syndrome associated a tumorous syndrome (cephalalgia, bitemporal hemianopsia) and an anterior and posterior hypopituitarism biologically proven. A large intra and suprasellar mass which compressed the optic chiasma and highly enhanced after gadolinium injection was found by nuclear magnetic resonance imaging. The surgical biopsy displayed a pituitary metastasis of a right inferior lobar bronchial adenocarcinoma with bone secondary localizations. Cerebral radiotherapy and corticotherapy allowed recovery of visual loss but did not prevent rapid death. The clinical and radiological features which may evoke an intrasellar metastasis were: the tumorous syndrome associated with or revealed by diabetes insipidus, loss of spontaneous hypersignal of the neurohypophysis in nuclear magnetic resonance imaging, bulking pituitary stalk, bilobar character of the mass which is in favour of rapid cell proliferation, postero-superior extension, lowering of the V3 floor and very strong and homogeneous signal after gadolinium injection.

Carcinoma, Bronchogenic↗
PubMed1995

Effects of vitamin D3 derivatives on growth, differentiation and apoptosis in tumoral colonic HT 29 cells: possible implication of intracellular calcium.

In addition to the effects on tumor cell differentiation and growth inhibition, vitamin D3 derivatives may exert other cellular actions such as the inhibition of angiogenesis or the induction of apoptosis. In this study, we demonstrated that vitamin D3 derivatives, 1,25-dihydroxyvitamin D3, the natural derivative and Ro 23-7553, a synthetic derivative, displayed complex effects in tumoral colonic HT 29 cells. Indeed, as a function of the stage of culture, they induced either apoptosis or differentiation along with a constant cell cycle blockade in G1. Intracellular calcium analysis indicated that treatment resulted in disturbance in the distribution of calcium suggesting a possible role for intracellular calcium in the observed effects. The association of 9-cis-retinoic acid, the ligand of RXR, with vitamin D3 derivatives modified the demonstrated effects, indicating in our model, a preferential effect of vitamin D3 derivatives via the heterodimeric form of the receptor.

Antineoplastic Agents↗
PubMed1995

Vitamin-D3 derivatives and breast-tumor cell growth: effect on intracellular calcium and apoptosis.

Vitamin-D3 derivatives are now well-recognized growth inhibitors of numerous tumoral cells and in particular breast-cancer cells. However, the mechanisms by which they operate are not well established. Among the wide range of physiological and biological functions of vitamin-D3 derivatives, the best described include their action on calcium homeostasis. In this study, we sought to establish whether the effects of vitamin-D3 derivatives on breast-cancer cell growth may be in part related to intracellular calcium modulation and induction of apoptosis. To address these questions, we used, in addition to 1,25(OH)2D3, the active metabolite of vitamin D3, a non-calcemic 1,25(OH)2D3 derivative: Ro 23-7553 [16-ene-23-yne-1,25(OH)2D3], which in our hands was more potent than the parent compound in inhibiting breast-cancer cell growth. We showed that the efficiency of both compounds in growth inhibition was higher in the estradiol-receptor-positive-breast-tumor MCF-7 cells than in the estradiol-receptor-negative MDA-MB 231 cells. In MCF-7 cells in particular, important modifications of intracellular calcium related to the emptying of intracellular pools were observed. The depletion of Ca++ from intracellular stores was followed by the induction of apoptosis. Such a phenomenon was never observed in MDA-MB 231 cells. Our results suggest that the action of vitamin-D3 derivatives on the depletion of calcium stores, which was more significant in MCF-7 than in MDA-MB 231 cells, may induce apoptosis in the former cells and account for the high efficiency of vitamin-D3 derivatives on growth inhibition of MCF-7 breast-tumor cells.

Apoptosis↗
PubMed1995

Clinical efficacy of force titrated doses of diltiazem extended-release. A placebo controlled study.

Thirty patients with clinical and ambulatory essential hypertension were treated in a double-blind fashion with force titrated doses of placebo or diltiazem once daily (OD) extended-release (ER) 120, 240, 360, and 540 mg to characterize the full-dose range of the new formulation. An incremental dose-response effect was observed both in clinic and ambulatory blood pressure parameters. Doses of > or = 240 mg significantly decreased clinic diastolic blood pressure, whereas systolic blood pressure was significantly lowered by the 540-mg dose. Moreover, compared with placebo, ambulatory blood pressure was significantly decreased by the 360- and 540-mg dose levels. Trough/peak ratios for systolic and diastolic blood pressures were 50% and higher at dose levels of 240 mg and above. Adverse reactions with diltiazem OD ER were generally mild and similar to those observed with placebo. The findings of this study indicate that the most favorable effects of diltiazem OD ER were observed in response to the 360- and 540-mg dose levels. The dose escalation forced titration study design appears to be a valuable tool in obtaining rigorous dose-response data of new antihypertensive agents.

Adolescent↗
PubMed1995

Antihypertensive effects of amlodipine and hydrochlorothiazide in elderly patients with ambulatory hypertension.

Recent studies and authorities have advocated the use of low-dose thiazide diuretics as first-line treatment agents in elderly hypertensives. However, these recommendations were based solely on blood pressure (BP) measured in the clinic. The objective of the present 32-week double-blind study was to compare the effects of hydrochlorothiazide (HCTZ) and amlodipine (AML) in elderly patients with confirmed ambulatory hypertension. After a 4-week placebo washout period, 42 (25 men, 17 women) patients (mean age, 69 years) with clinic sitting diastolic BP of 95 to 114 mm Hg and daytime ambulatory diastolic BP of > or = 90 mm Hg were randomized double-blind to receive AML 5 to 10 mg (n = 21) or HCTZ 12.5 to 25 mg (n = 21) once daily. After 8 weeks of monotherapy, patients in whom clinic diastolic BP remained > or = 90 mm Hg were given combination therapy with the other agent. Amlodipine monotherapy induced significant reductions in clinic, mean 24-h, daytime and sleep systolic/diastolic BPs whereas only clinic BP decreased significantly in patients treated with HCTZ monotherapy. Moreover, 19/21 versus 8/21 patients on AML and HCTZ monotherapies achieved adequate BP control. At the end of the 32-week treatment period, combination therapy in the HCTZ group resulted in statistically significant reductions in clinic as well as in 24-h, daytime and sleep ambulatory BPs that were similar to those observed in the AML monotherapy group. In conclusion, the administration of AML monotherapy induced significant reductions in both clinic and ambulatory BPs in elderly patients whereas only clinic BP was significantly decreased by HCTZ monotherapy. Moreover, the addition of AML to HCTZ in patients inadequately controlled by monotherapy has permitted statistically significant decrements in clinic as well as in ambulatory BP. Consequently, the results of the present study suggest that the use of HCTZ in doses of up to 25 mg daily is inadequate for ambulatory BP control in the elderly despite official recommendations.

Aged↗