Whether raised blood pressure precedes, follows or develops in parallel with the onset of microalbuminuria, remains unclear. Previous studies, using conventional blood pressure recordings, have yielded discrepant results. Ambulatory blood pressure (ABP) monitoring detects borderline hypertension more reliably, and correlates more closely with end-organ damage. We have therefore compared ABP and left ventricular dimensions in normotensive insulin-dependent diabetic patients with or without microalbuminuria, and matched nondiabetic control subjects. Those diabetic patients with microalbuminuria, and to a lesser extent those without, had higher 24 h mean arterial blood pressure than matched non-diabetic control subjects, with corresponding increases of left ventricular mass, interventricular septal width and posterior wall thickness. These observations suggest that raised arterial blood pressure is present at an early stage of 'incipient' microalbuminuria.

SUMMARY. The performance and clinical utility of a 'C-terminal' parathyroid hormone (PTH) radioimmunoassay (Dac-Cel, Wellcome Diagnostics) is described. Parathyroid hormone, as measured by the Dac-Cel method, is stable in whole blood samples for at least 24 h. 84% of patients with hypercalcaemia due to primary hyperparathyroidism have values above the upper limit seen in normocalcaemic subjects (0,5 ug/L), with detectable serum PTH demonstrable in the remaining 16%. In patients with hypocalcaemia due to hypoparathyroidism serum PTH was undetectable in 73% and 'inappropriately' low in the remainder. In 50% of patients with malignancy-associated hypercalcaemia serum PTH was undetectable, but was above 0·5 ug/L in 13%. Increased PTH concentrations were invariably found in patients with renal failure.The Dac-Cel method is a reliable and robust technique for measurement of PTH and in conjunction with determination of calcium facilitates the diagnosis of primary parathyroid disorders. Caution is required in the interpretation of PTH measurements in patients with renal failure; the significance of detectable PTH in some patients with malignancy-associated hypercalcaemia is not clear.Determination of serum immunoassayable parathyroid hormone (PTH) concentrations forms an important part of the investigation of disorders of calcium metabolism. However, measurement of circulating PTH by radioimmunoassay (RIA) has been bedevilled by the heterogenous nature of circulating PTH and its peripheral metabolism. In recent years, improved understanding of the physiology of PTH secretion and its metabolism, together with the use of well-characterised antisera, has facilitated interpretation of results of PTH in serum. In this report we have evaluated the use of a recently available commercial 'C-terminal' PTH assay (Dac-Cel, Wellcome Diagnostics, Temple Hill, Dartford DA1 5AH, UK) in the investigation of patients with disorders of calcium metabolism. MethodsDac-Cel PTH RIA kits were supplied by

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