We compared urinary albumin excretion in normotensive subjects and patients with white coat and established hypertension. The study involved prospective comparison of office blood pressure, daytime ambulatory blood pressure, and urinary albumin excretion in consecutive patients (n=284) who were selected from general practice with newly diagnosed mild to moderate hypertension before the institution of pharmacologic antihypertensive therapy. All patients had a diastolic office blood pressure above 90 mm Hg; 173 had a consistently elevated diastolic blood pressure (established hypertension), and 111 had an average daytime ambulatory blood pressure below 90 mm Hg (white coat hypertension). A sample of 127 subjects drawn from the Danish national register served as a normotensive control group. The main outcome measure was the ratio of early morning urinary albumin to creatinine. This ratio differed significantly among the three groups, being (on a molar basis) T he white coat phenomenon -ie, a pressor effect related to office examination compared with blood pressure measurement in a patient's usual surroundings 1 -can, if sufficiently pronounced, cause misclassification of some normotensive individuals as hypertensive (white coat hypertension). Among patients with mild to moderate hypertension, the proportion of white coat hypertensive patients has been estimated to be between a quarter and a third.2 -3 As data on the risk associated with a diagnosis of white coat hypertension are still not available, the condition cannot be claimed to be benign. Until prospective studies on morbidity and mortality are available, studies using surrogate end points must be our guide when deciding whether or not to treat these patients. Some studies indicate that white coat hypertensive patients have less cardiac involvement than patients with established hypertension, 4 -5 but studies evaluating the hypertensive effect on other end organs are still needed.Increased urinary albumin excretion is found more frequently in hypertensive patients, 6 -7 and proteinuria is associated with an excess morbidity 8 and mortality. Correspondence to Dr A. Hoegholm, Medicinsk afdeling, Centralsygehuset, DK-4700 Naestved, Denmark.© 1994 American Heart Association, Inc.21±69xlO~6 in the normotensive subjects, 22±39xlO" 6 in the white coat hypertensive patients, and 51±177xlO" 6 in patients with established hypertension. The difference remained significant after correction for covariables. The ratio of early morning urinary albumin to creatinine was weakly but significantly correlated to blood pressure, was more pronounced for ambulatory than for office measurements, was more pronounced for systolic than for diastolic pressure, and was more pronounced for hypertensive than for normotensive individuals. The ratio was as reproducible a measure as 24-hour albumin excretion. We conclude that white coat hypertensive patients have less renal involvement than patients with established hypertension but more than a normotensive control group. (Hypertensi...

This study was designed to compare the cardiac mass and geometry in white coat hypertensive patients and established hypertensive patients through the prospective comparison of office blood pressure, daytime ambulatory blood pressure, and echocardiographically determined left ventricular mass and cardiac geometry in consecutive patients. We studied 143 patients from general practice in an outpatient hypertension unit. The patients had newly diagnosed mild-to-moderate hypertension prior to the institution of pharmacological anti-hypertensive therapy. All patients had a diastolic office blood pressure above 90 mm Hg; 90 had a consistently elevated diastolic blood pressure (established hypertension), whereas 53 had an average daytime ambulatory blood pressure below 90 mm Hg (white coat hypertension). Left ventricular mass index was significantly higher in the group with established hypertension, 102.4 +/- 26.6 g/m2 (mean +/- SD) v 93.6 +/- 23.5 (P = .045). Relative wall thickness was likewise significantly higher, 0.36 +/- 0.07 v 0.33 +/- 0.06 (P = .004). There was no significant difference in left atrial dimension. In a multiple regression model the ambulatory measurements and not the office measurements were statistically significantly associated with the extent of cardiac hypertrophy. Further, 44/53 (83%) of the patients with white coat hypertension had normal left ventricular dimensions, versus only 55/90 (61%) of the patients with established hypertension (P = .033). Thus, white coat hypertensive patients display less cardiac involvement than patients with established hypertension, indicating that they should rather be treated as normotensives than as hypertensives, ie, not with pharmacological antihypertensive therapy.

Hooded-Lister rats were inoculated with 6, 25, 50 or 100 metacercariae of the intestinal trematode Echinostoma caproni. Worm establishment and the pattern of egg excretion were followed during the course of primary infections with 6, 25 and 50 metacercariae. Peripheral blood eosinophilia was followed at all infection levels. After 1 month, worm recovery and faecal egg output showed a gradual decline with increasing duration of infection. High worm burdens were expelled later than smaller worm burdens, and egg output persisted longer in animals exhibiting a high initial egg output. The level of blood eosinophilia increased with increasing degree of infection and with the level of egg output. A marked concomitant resistance to superimposed infection was observed on the challenge of rats harbouring 21- and 49-day-old infections with 50 metacercariae. In addition, rats were partially resistant to secondary infection at challenge day 14 following anthelmintic removal of primary 7-day-old infections with 50 metacercariae and were completely resistant at challenge day 7 following elimination of a primary 14-day-old primary infection.

In combination with propofol, alfentanil was compared with fentanyl for total i.v. anaesthesia in 29 women (ASA classes I, II) admitted for elective hysterectomy. Infusion rates of propofol and fentanyl were determined from the literature and from pilot studies, while alfentanil was given according to a computer program. Dosage was: propofol, bolus 1.5 mg kg-1, infusion 9 mg kg-1 h-1 for 10 min and thereafter 6 mg kg-1 h-1; fentanyl, bolus 7.5 micrograms kg-1, infusion 15 micrograms kg-1 h-1 reduced successively to 1.8 micrograms kg-1 h-1; alfentanil, bolus 60 micrograms kg-1, infusion 240 micrograms kg-1 h-1 reduced successively to 100 micrograms min-1. Induction was smooth and maintenance easy to manage in both groups. Plasma concentrations were stable with a ratio of alfentanil to fentanyl of 100:1. Recovery times were equal and short, but recovery tests performed 3 h after operation showed that alfentanil produced a greater effect on ability to concentrate and fine co-ordination.

Seizures in patients with no history of epilepsy has been associated with administration of remifentanil in two previous case reports. We present a case where a bolus dose of remifentanil (50 micrograms/kg) was followed by a self terminating generalised tonic-clonic seizure in a patient admitted for acute hip surgery, and no previous history of epilepsy.