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PubMed1987

Left ventricular external constraint: relationship between pericardial, pleural and esophageal pressures during positive end-expiratory pressure and volume loading in dogs.

Left ventricular (LV) diastolic filling is limited by the constraining effects exerted by the pericardium (PE) and the lung/chest wall. The aim of the present study was to assess the validity of various estimates of external cardiac constraint, compared to pericardial surface pressure (Ppe) measured lateral to the LV myocardium. In nine anesthetized dogs we measured Ppe, pleural surface pressure (Ppt) (lateral to the pericardium) and esophageal pressure (Pes) under conditions of volume loading and positive end-expiratory pressure (PEEP). We measured Ppe and Ppl with flat, liquid-containing silastic rubber balloons and Pes with an air-containing cylindrical balloon. After instrumentation, the chest was resealed and continuous suction (-5 mm Hg, 1 mm Hg = 0.133 kPa) was maintained. Volume loading with incremental intravenous infusions of saline was used to increase LV end-diastolic pressure to 20-25 mm Hg. PEEP of 0, 10 and 20 mm Hg were applied at baseline and after each increment of volume loading. At low volume, increases in PEEP caused simultaneous increases in LV end-diastolic pressure (P less than 0.01) and in Ppe (P less than 0.0001) but a reduction in transmural LV pressure (P less than 0.0005). Ppl and Pes both increased with PEEP (P less than 0.001 and P less than 0.01, respectively). However, Ppe always exceeded Ppl, while Pes remained at only approximately 1/3 Ppl throughout. Volume loading caused a significant increase in Ppe (P less than 0.0001) and a smaller, but significant increase in Ppl (P less than 0.05). Pes remained unchanged during volume loading. Thus external cardiac constraint increased markedly during volume loading and PEEP as evidenced by a marked elevation of Ppe. Both Ppl and Pes markedly underestimated this increase. Therefore, calculation of transmural LV pressure by subtracting pleural or esophageal pressure from intracavitary pressure can lead to overestimation of LV preload. The decrease in cardiac output during PEEP occurs secondary to decreased preload, i.e. decreased transmural pressure and end-diastolic dimension. Analysis of performance using cardiac function curves does not suggest a change in contractility with PEEP.

Animals↗
PubMed1983

Noninvasive determination of systolic, diastolic and end-systolic blood pressure in neonates, infants and young children: comparison with central aortic pressure measurements.

Noninvasive determinations of systolic and diastolic blood pressure using the oscillometric method for pressure measurement were combined with externally recorded axillary pulse tracings to estimate end-systolic pressure in 32 neonates, infants and young children. Results were compared with central aortic pressure measurements made at the time of central aortic catheter placement. Studies were performed in patients aged 1 day to 48 months who weighed 0.9 to 18.1 kg. A wide range of systolic (41 to 141 mm Hg), diastolic (22 to 73 mm Hg) and end-systolic (30 to 111 mm Hg) pressure values were found. The mean absolute pressure differences and percent errors (pressure difference divided by central aortic pressure) were 1.8 mm Hg and 2.5% for systolic, 0.8 mm Hg and 0.8% for diastolic and 1.4 mm Hg and 2.1% for end-systolic pressure. No correlation was noted between percent error and age, weight, heart rate, cardiac index or systemic vascular resistance. The ability to perform reliable noninvasive pressure measurements should prove invaluable for clinical and research purposes. In addition, this method of end-systolic blood pressure determination enables sensitive indexes of left ventricular contractility to be measured noninvasively in small children.

Aorta↗
PubMed1996

Polymorphism of angiotensin I converting enzyme gene in the older Chinese: linked to ambulatory blood pressure levels and circadian blood pressure rhythm.

This study was undertaken to evaluate the association of polymorphism of angiotensin I converting enzyme (ACE) gene with causal and ambulatory blood pressure in the Chinese population. Genomic DNA was amplified by polymerase chain reaction (PCR) using primers flanking the polymorphic region in intron 16 of the ACE gene. Alleles were detected on agarose gels stained with ethidium bromide. Causal blood pressure was measured in the 133 normotensive and 122 essential hypertensive subjects; of the essential hypertensive subjects, 65 patients underwent non-invasive ambulatory blood pressure. There was no significant difference of ACE genotype and allele frequencies between the hypertensive and normotensive subjects. Non-significant differences were demonstrated in gender, age, causal blood pressure according to the ACE gene genotypes in the 65 patients who underwent non-invasive ambulatory blood pressure; however, effects of the ACE gene genotypes were observed on the derivatives of ambulatory blood pressure, including sleeping blood pressure levels and circadian blood pressure rhythm (p < 0.05). We suggest that insertion/deletion polymorphism of the ACE gene should be associated with blood pressure and ambulatory blood pressure might be superior to causal blood pressure at the molecular level.

Aged↗
PubMed2004

The relationship of intraocular pressure to intracranial pressure.

STUDY OBJECTIVE: The early detection of intracranial hypertension can lead to timely medical and neurosurgical intervention, preventing brain herniation and death. In this investigation, we hypothesize that an increase in intracranial pressure can be detected by an increase in intraocular pressure using noninvasive existing technology, the handheld tonometer. METHODS: This was a prospective observational pilot study conducted at a community hospital. Admitted patients with an invasive intracranial pressure monitor were solicited for participation. Patients were excluded if they had known glaucoma or had sufficient ocular or facial trauma that precluded intraocular pressure determination. Simultaneous measurements of intracranial and intraocular pressure were recorded. RESULTS: Twenty-seven patients were enrolled, and 76 individual measurements were performed. All patients with an abnormal intracranial pressure had an abnormal intraocular pressure; similarly, all patients with a normal intracranial pressure had a normal intraocular pressure (sensitivity 1.00, 95% confidence interval 0.86 to 1.0; specificity 1.0, 95% confidence interval 0.93 to 1.0) CONCLUSION: Abnormal intraocular pressure as measured with the handheld tonometer is an excellent indicator of abnormal intracranial pressure in patients with known intracranial pathology.

Female↗
PubMed1997

Left ventricular mass is better correlated with arising blood pressure than with office or occasional blood pressure.

The peak incidence of cardiovascular complications in the morning points to a possible role of the abrupt increase in blood pressure on arising. However, there is as yet no firm evidence linking the extent of the elevation in blood pressure on arising and the risk of cardiovascular complications. We sought a correlation between blood pressure on arising and left ventricular mass in a population of 181 previously untreated hypertensive patients. Ambulatory blood pressure was measured over a 24-h period, and each patient was requested to trigger a blood pressure determination immediately after standing on arising in the morning. Left ventricular mass was measured with M-mode echocardiography and indexed for height, height(2.7), and body surface area. The systolic blood pressure on arising was significantly (P <.01) better correlated than office blood pressure with left ventricular mass index and wall thickness. On multivariate analysis, the values of systolic blood pressure on arising and mean 24-h systolic blood pressure contributed significantly and independently to the correlation with left ventricular mass and wall thickness. These observations point to the significance of the arising blood pressure. A marked abrupt daily elevation in blood pressure on arising, then maintained for a certain time, could contribute to the development of left ventricular hypertrophy and may constitute a trigger for cardiovascular complications.

Adolescent↗
PubMed2002

Reliability and validity of a multi-pad pressure evaluator for pressure ulcer management.

It is often helpful to assess the pressures exerted upon the bony prominences when monitoring the likely outcome of pressure ulcer prevention or treatment. However, in the clinical setting, hard pressure sensors may damage the skin and operational difficulties may influence their reliability and validity. The authors have developed a multi-pad pressure sensor and tested its clinical reliability and validity. The inter-rater and intra-rater reliability were calculated using the coefficient of variation data from 10 patients. After a comparison analysis, the multi-pad was more reliable than a single-pad type pressure sensor. A validation test was conducted in 79 elderly patients. The mean interface pressures recorded among patients who had erythema or stage I pressure ulcers at the sacrum were significantly higher than were the contact pressures measured in patients with no pressure damage. The pressure sensor exhibited satisfactory clinical reliability and validity. Furthermore, it may be that for Japanese elderly patients the maximum pressure that can be tolerated by the tissues around the sacrum may be 40-50 mmHg.

Aged↗
PubMed1998

Use of a neonatal blood pressure cuff to monitor blood pressure in the adult finger--comparison with a standard adult arm cuff.

BACKGROUND: There are few suitable methods for monitoring blood pressure continuously (or intermittently) for research in adult stroke patients, who are ill but do not justify invasive intensive care monitoring. METHOD: We tested a neonatal arm blood pressure in adults by placing it on the forefinger ("finger cuff"). We compared the repeatability of the finger cuff with blood pressure measured by a standard adult arm cuff using the oscillometric technique in 168 ambulatory outpatients attending a cerebrovascular disease clinic. RESULTS: The mean difference between sequential mean blood pressure readings with the finger cuff was 0.55 mm Hg (95% confidence interval (CI) -14.36 to 15.47 mm Hg), and for the arm cuff was 3.31 mm Hg (95% CI -23.33 to 16.71 mm Hg). Measurements made with the arm cuff were shown to affect subsequent arm cuff readings made within a few minutes of the first. The mean difference between the finger cuff and arm cuff mean blood pressure readings was 0.03 mm Hg (95% CI -26.07 to 26.14 mm Hg) and agreement was better when the blood pressure was measured with the finger cuff first rather than the arm cuff. However, although there was no difference in the mean blood pressure recordings both systolic and diastolic blood pressure measurements differed systematically between arm and finger cuff. CONCLUSION: The reproducibility of sequential blood pressure measurements made with the finger cuff was better than with the arm cuff. The performance of the finger cuff compared with that of the arm cuff was sufficiently good to encourage use of the finger cuff in research involving automatic intermittent monitoring to observe sequential blood pressures over time in stroke patients. However, measurements of systolic and diastolic pressure were not the same with the two cuffs and further work on calibration of the finger cuff would be useful.

Adolescent↗
PubMed2001

Evaluation of digital blood pressure measured with the Omron F3 device as an index of brachial arterial pressure, under different thermal and hormonal conditions.

BACKGROUND: Devices that record from the finger have potential practical advantages for home monitoring of blood pressure. However, digital arterial pressure may vary substantially from that in the brachial artery, due to the influence of peripheral wave reflection. AIMS: (1) To compare digital arterial pressure, as measured with the Omron F3 device, with brachial arterial pressure and (2) to determine the effect on digital pressure of changing local vascular resistance. METHOD: The subjects were normotensive young adult non-smokers (12 males, 14 females). Pressures were recorded simultaneously from arm (using an Omron HEM-705CP) and finger with subjects seated and both recording sites at the level of the xiphisternum. Measurements were made at ambient temperatures of 19 degrees C and 30 degrees C; at rest, during brief contralateral hand cooling and after hand rewarming. RESULTS: In many cases, resting finger values differed substantially from arm values; sometimes by 20 mm Hg or more. The extent of individual variations was not correlated with gender or temperature. However, group pressure differences between the sites were greater in females at ovulation than at menstruation and greater at 30 degrees C than at 19 degrees C. For all groups, pressure differences between sites were attenuated during hand cooling and restored by rewarming. CONCLUSIONS: Finger blood pressure, as measured with the Omron F3, misestimates brachial blood pressure in a high proportion of normal subjects. This error is increased under circumstances associated with cutaneous vasodilation. The Omron F3 does not appear to be suitable for unsupervised home monitoring of blood pressure.

Adult↗
PubMed2004

Automated self-initiated blood pressure or 24-hour ambulatory blood pressure monitoring in pregnancy?

OBJECTIVE: To determine whether self-initiated and recorded automated blood pressure measurement can provide an accurate estimate of ambulatory blood pressure in pregnant women suspected of having 'white coat hypertension'. DESIGN: A prospective observational study. SETTING: Women's and Children's Health Unit, St George Hospital, a teaching hospital of the University of New South Wales. POPULATION: Pregnant women being assessed for possible 'white-coat hypertension'. METHODS: Sixty-six pregnant women who were undergoing 24 hour ambulatory blood pressure monitoring (ABPM) in their home or work environment also measured their blood pressure six times during this interval using a self-initiated automated blood pressure recorder (Omron HEM 705CP). Agreement between awake ABPM and Omron recorded blood pressures was tested by Bland-Altman analysis. MAIN OUTCOME MEASURE: Limits of agreement between blood pressures measured by each device. RESULTS: Average blood pressures obtained by the two devices were identical (125/77 mmHg) but limits of agreement were wide, -20 to +23 mmHg for systolic blood pressure and -9 to +15 mmHg for diastolic blood pressure. CONCLUSION: The Omron HEM 705CP is a useful device for measuring group average blood pressures in pregnant women suspected of having white coat hypertension but cannot reliably replace ABPM for clinical management of individual pregnant women.

Blood Pressure↗
PubMed1993

Response of ambulatory blood pressure to antihypertensive therapy guided by clinic pressure.

The objective of this prospective study was to define the limits below which ambulatory blood pressure (BP) does not decrease in patients with essential hypertension, when the decision to institute and intensify drug treatment is based on conventional blood pressure measurements. After a 1 month placebo run-in period, 30 patients were treated for 1 year with the converting enzyme inhibitor lisinopril or the calcium antagonist isradipine; dose adjustments and the decision to add hydrochlorothiazide were based on conventional blood pressure measurements in the clinic. Ambulatory blood pressure was recorded during 24 h in the run-in period and after 16, 24, and 52 weeks of active therapy. The baseline ambulatory blood pressure below which pressure does, on average, not decrease during active treatment was defined as the pressure at which the regression line between the on-treatment pressure and blood pressure in the run-in period intersects the line of identity. The systolic/diastolic blood pressure limits were similar for the three assessments during active treatment and averaged 128/88 mm Hg for daytime, 106/73 mm Hg for nighttime pressure, and 119/81 mm Hg for the whole 24 h, with upper 95% confidence limits of 137/93, 115/78, and 127/86 mm Hg, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1978

A comparison of the cardiorespiratory effects of continuous positive airway pressure breathing and continuous positive pressure ventilation in dogs.

Five patterns of ventilation have been compared in dogs: (1) spontaneous ventilation at ambient pressure (SV); (2) intermittent positive pressure ventilation (IPPV); (3) spontaneous ventilation at 0.98 kPa positive airway pressure, delivered from a non-rebreathing circuit incorporating a 5-litre reservoir bag and fresh-gas flow of twice the minute volume (CPAP (bag)); (4) spontaneous ventilation at 0.98 kPa positive airway pressure, with the reservoir bag replaced by a weighted bellows (CPAP (bellows)) and (5) IPPV with 0.98 kPa positive end-expiratory pressure (CPPV). CPAP significantly decreased the rate of respiration compared with SV. CPAP (bellows) resulted in a significant increase in tidal volume. Mean oesophageal pressure, right atrial pressure, pulmonary wedge pressure and pulmonary artery pressure increased during IPPV, CPAP (bag), CPAP (bellows), and CPPV compared with SV. There were no significant changes in mean systemic arterial pressure, cardiac output, PaO2, PaCO2, CaO2, (CaO2-CVO2), PAO2-PAO2) or pulmonary venous admixture. Under the conditions of this study oxygen transport was not altered by positive airway pressure ventilation.

Animals↗
PubMed1999

Cheek and tongue pressures in the molar areas and the atmospheric pressure in the palatal vault in young adults.

The pressures acting on the maxillary and mandibular posterior teeth from the tongue and cheeks were measured in 24 adults aged 22-29 years. In addition, the pressure in the palatal vault was recorded. The pressure at two maxillary (buccal and lingual) and two mandibular (buccal and lingual) measuring points, and in the palatal vault was recorded simultaneously. Repeated recordings of the pressures at rest, and during chewing and swallowing were made. The pressures at rest were of similar magnitude (about 2 g/cm2) at the buccal and lingual sides of the mandibular posterior teeth. The median resting pressure at the maxillary posterior teeth was 2.7 g/cm2 on the buccal side and 1.0 g/cm2 on the lingual side. The difference in the maxilla was significant, but not in the mandible. It was concluded that the equilibrium of tooth position is maintained by the pressure from the cheeks and the tongue. During chewing and swallowing the pressures on the lingual side of the teeth were greater than those on the buccal side. At rest about half of the subjects had a negative pressure at the palatal vault, but no correlations between the resting pressure at the palatal vault and the resting pressures on the teeth were found.

Adult↗
PubMed2001

Ventilatory support by continuous positive airway pressure breathing improves gas exchange as compared with partial ventilatory support with airway pressure release ventilation.

UNLABELLED: In acute lung injury, airway pressure release ventilation (APRV) with superimposed spontaneous breathing improves gas exchange compared with controlled mechanical ventilation. However, the release of airway pressure below the continuous positive airway pressure (CPAP) level may provoke lung collapse. Therefore, we compared gas exchange and hemodynamics using a crossover design in nine pigs with oleic acid-induced lung injury during CPAP breathing and APRV with a release pressure level of 0 and 5 cm H(2)O. At an identical minute ventilation (V(E) 8 L/min) spontaneous breathing averaged 55%, 67%, and 100% of V(E) during the two APRV modes and CPAP, respectively. Because of the concept of APRV, mean airway pressure was highest during CPAP and lowest during APRV with a release pressure of 0 cm H(2)O. Shunt was reduced to almost half during CPAP (6.6% of Q(t)) compared with both APRV-modes (13.0% of Q(t)). Cardiac output and oxygen consumption, in contrast, were similar during all three ventilatory settings. Thus, in our lung injury model, CPAP was superior to partial ventilatory support using APRV with and without positive end-expiratory pressure. This may be attributable to beneficial effects of spontaneous breathing on gas exchange as well as to rapid lung collapse during the phases of airway pressure release below the CPAP level. These findings may suggest that the amount of mechanical ventilatory support using the APRV mode should be kept at the necessary minimum. IMPLICATIONS: Oxygenation is better with continuous positive airway pressure breathing than with partial mechanical ventilatory support using airway pressure release ventilation. Therefore, mechanical ventilatory support achieved by a cyclic release of airway pressure during APRV should be kept at the minimum level that enables enough ventilatory support for patients to avoid respiratory muscle fatigue.

Anesthesia↗
PubMed1984

Comparison of the effects of positive end-expiratory pressure and jugular venous compression on canine cerebral venous pressure.

The confluent sinus pressure was measured in eight mongrel dogs in the head-up position to compare the effectiveness of positive end-expiratory pressure (PEEP) and jugular venous compression in increasing cerebral venous pressure. When the head was elevated 30 cm above the heart, confluent sinus pressure decreased from 9.6 +/- 1.8 (mean +/- SEM) to -5.3 +/- 0.5 mmHg. At constant arterial carbon dioxide tension (PaCO2 = 28 +/- 2 mmHg), PEEP (20 cmH2O) did not increase cerebral venous pressure. However, when the jugular veins were compressed with a neck tourniquet with pressures of 20-140 mmHg, cerebral venous pressure increased rapidly. When neck tourniquet pressure was maintained at 40 mmHg, confluent sinus pressure in all dogs was increased and sustained at 2.4 +/- 0.8 mmHg. Carotid artery pressure measured distal to the tourniquet was not altered. The efficacy of extrathoracic venous pressure elevation (neck tourniquet) is greater than intrathoracic (PEEP), and this may relate to the Starling resistor effects of neck veins and the presence of jugular venous valves. We conclude that prophylactic use of PEEP in the prevention of air embolism during the sitting position may not be as effective as jugular venous compression.

Animals↗
PubMed2002

Relationship between intracranial pressure and critical closing pressure in patients with neurotrauma.

BACKGROUND: The driving pressure gradient for cerebral perfusion is the difference between mean arterial pressure (MAP) and critical closing pressure (CCP = zero flow pressure). Therefore, determination of the difference between MAP and CCP should provide an appropriate monitoring of the effective cerebral perfusion pressure (CPP(eff)). Based on this concept, the authors compared conventional measurements of cerebral perfusion pressure by MAP and intracranial pressure (CPP(ICP)) with CPP(eff). METHODS: Simultaneous synchronized recordings of pressure waveforms of the radial artery and blood flow velocities of the middle cerebral artery were performed in 70 head trauma patients. CCP was calculated from pressure-flow velocity plots by linear extrapolation to zero flow. RESULTS: Intracranial pressure measured by intraventricular probes and CCP ranged from 3 to 71 and 4 to 70 mmHg, respectively. Linear correlation between ICP and CCP was r = 0.91. CPP(ICP) was 77 +/- 20 mmHg and did not differ from CPP(eff); linear correlation was r = 0.92. However, limits of agreement were only +/- 16.2 mmHg. Therefore, in 51.4% of the patients, CPP(ICP) overestimated CPP(eff) by 19.8 mmHg at most. CONCLUSION: Assuming that CPP(eff) (MAP - CCP) takes into account more determinants of cerebral downstream pressure, in individual cases, the actual gold standard of CPP determination (MAP - ICP) might overestimate the CPP(eff) of therapeutic significance.

Adolescent↗
PubMed1985

Blood pressure response to antihypertensive therapy: ambulatory versus office blood pressure readings.

Blood pressure readings obtained by the physician in his office and ambulatory blood pressures recorded with the semi-automatic Remler device, were compared during a controlled antihypertensive drug trial. Either timolol or methyldopa was administered in in double-blind fashion to 30 patients with uncomplicated essential hypertension. All exhibited a diastolic office blood pressure greater than 95 mmHg at the end of a four-week placebo period. All patients then received a combination of hydrochlorothiazide (25 mg/day) and amiloride (2.5 mg/day). After four weeks of diuretic therapy, timolol (10 mg/day, n = 14) or methyldopa (250 mg/day, n = 16) were added randomly for six weeks. The dose of all antihypertensive agents was doubled after two weeks of therapy with diuretics combined with timolol (n = 7) or methyldopa (n = 16) because of the persistence of diastolic blood pressure levels greater than 90 mmHg at the office. When assessed in the office, the antihypertensive effect of timolol and methyldopa was similar. During ambulatory blood pressure monitoring, however, pressure levels were lower in the patients given timolol (P less than 0.05 for the diastolic). With both regimens, the blood pressure response measured outside the clinic during usual daily activities could not be predicted from that observed with office blood pressure readings. Furthermore the magnitude of the drug induced blood pressure decrease was more reproducible in time when determined outside the clinic. These data suggest that ambulatory blood pressure monitoring is more precise in evaluating the efficacy of antihypertensive therapy than office blood pressure measurement.

Activities of Daily Living↗
PubMed1989

Comparison of Finapres non-invasive beat-to-beat finger blood pressure with intrabrachial artery pressure during and after bicycle ergometry.

To evaluate the accuracy of continuous non-invasive blood pressure measurements in the finger during exercise, Finapres blood pressures of six normotensive healthy males were measured during increasing levels of bicycle exercise, using simultaneously registered ipsilateral intrabrachial artery pressures as a reference. At rest, finger systolic blood pressure was higher and finger diastolic and mean arterial pressures were lower than the corresponding intrabrachial pressures in five of the six subjects. During exercise, average finger diastolic and mean arterial pressures did not differ further from these intrabrachial pressures, but finger systolic pressure increased considerably more than the direct systolic pressure, exceeding it by 26 +/- 20 mmHg (mean +/- s.d.) at maximal exercise. This latter finding potentially limits the use of finger blood pressure measurements during exercise.

Adult↗
PubMed1997

24-hour blood pressure control by once-daily administration of irbesartan assessed by ambulatory blood pressure monitoring. Irbesartan Multicenter Investigators' Group.

OBJECTIVES: To compare 24 h ambulatory blood pressure and trough office blood pressure lowerings after 8 weeks of therapy with 75 mg irbesartan once a day, 150 mg irbesartan once a day , and 75 mg irbesartan twice a day versus placebo; and to assess safety and tolerability of irbesartan therapy. DESIGN: Multicenter, double-blind, randomized, placebo-controlled trial. SETTING: Sixteen centers in Italy. PATIENTS: Caucasian patients (n = 215) aged > or = 18 years with seated diastolic blood pressure 95-110 mmHg and ambulatory diastolic blood pressure (ADBP) > or = 85 mmHg. PRIMARY OUTCOME: Mean 24 h ADBP after 8 weeks of irbesartan therapy. RESULTS: Mean changes (value before treatment minus value after treatment) in ADBP for placebo, 75 mg irbesartan once a day, 150 mg irbesartan once a day, and 75 mg irbesartan twice a day were -0.2, -5.4, -7.2, and -7.2 mmHg, respectively; respective changes in ambulatory systolic blood pressure were +1.6, -8.3, -10.5, and -9.7 mmHg. All irbesartan regimens reduced trough office seated diastolic blood pressure and seated systolic blood pressure after 2 and 8 weeks of treatment (all P < 0.01, versus placebo except for seated systolic blood pressure in patients in the 75 mg irbesartan once a day group). Trough: peak ratios were > or = 55% with 150 mg irbesartan once a day. Percentages of patients whose blood pressures were normalized with 150 mg irbesartan once a day (45%) and 75 mg irbesartan twice a day (47%) were greater than those with placebo (14%, P < 0.01) and with 75 mg irbesartan once a day (19%, NS, versus placebo). Adverse events with irbesartan were similar to those with placebo. CONCLUSIONS: All irbesartan regimens significantly reduced mean 24 h ADBP and ambulatory systolic blood pressure, and were well tolerated. Administration of 150 mg irbesartan once a day provided significant reduction of blood pressure for 24 h, equivalent to that obtained with the same daily dose divided into two separate administrations.

Aged↗