The accuracy of blood pressure values obtained by continuous noninvasive finger blood pressure recording via the FINAPRES device was evaluated by comparison with simultaneous intraarterial monitoring both at rest and during performance of tests known to induce fast and often marked changes in blood pressure. The comparison was performed in 24 normotensive or essential hypertensive subjects. The average discrepancy between finger and intra-arterial blood pressure recorded over a 30-minute rest period was 6.5±2.6 mm Hg and 5.4±2.9 mm Hg for systolic and diastoiic blood pressure, respectively; a close between-method correspondence was also demonstrated by linear regression analysis. The beat-to-beat changes in finger systolic and diastoiic blood pressure were on average similar to those measured intra-arterially during tests that induced a pressor or depressor response (hand-grip, cold pressor test, diving test, Valsalva maneuver, intravenous injections of phenylephrine and trinitroglycerine) as well as during tests that caused vasomotor changes without major variations in blood pressure (application of lower body negative pressure, passive leg raising). The average between-method discrepancy in the evaluation of blood pressure changes was never greater than 4.3 and 2.0 mm Hg for systolic and diastoiic blood pressure, respectively; the corresponding standard deviations ranged between 4.6 and 1.6 mm Hg. Beat-to-beat computer analysis of blood pressure variability over the 30-minute rest period provided standard deviations almost identical when calculated by separate consideration of intra-arterial and finger blood pressure tracings (3.7 and 3.8 mm Hg, respectively). The two methods of blood pressure recording also allowed similar assessments of the sensitivity of baroreceptor control of heart rate (vasoactive drug injections) and blood pressure (neck chamber technique) to be obtained. Thus, beat-to-beat blood pressure recording via FINAPRES provides an accurate estimate of means and variability of radial blood pressure in groups of subjects and represents in most cases an acceptable alternative to invasive blood pressure monitoring during laboratory studies. (Hypertension 1989; 13:647-655) I n the early 1970s a Czech physiologist, Ian Penaz, described a new approach to continuous noninvasive recording of blood pressure at the finger level, 1 based on a volume-clamp method. This device was improved in its technical aspects (finger plethysmograph of reduced dimension, feedback system for finger volume control, and automatic calibration) by Wesseling and coworkers, Address for correspondence: Prof. Giuseppe Mancia, Centro di Fisiologia e Ipertensione, via F. Sforza 35, 20122 Milano, Italy. Received September 28, 1988; accepted January 19, 1989. studies performed in patients undergoing surgery, FINAPRES was shown to provide blood pressure values close to those simultaneously recorded intra-arterially. 3 -3 Our study was undertaken to evaluate the accuracy of FINAPRES in reproducing intra-arterial blood pressure v...

SUMMARYThe baroreceptor control of the sinus node was evaluated in 10 normotensive and 10 age-matched essential hypertensive subjects in whom ambulatory blood pressure was recorded intraarterially for 24 hours and scanned by a computer to identify the sequences of three or more consecutive beats hi which systolic blood pressure (SBP) and pulse interval (PI) progressively rose (+ PI/ + SBP) or fell ( -PI/ -SBP) in a linear fashion, according to a method validated in cats. In normotensive subjects, several hundred +PI/+SBP and -P I / -S B P sequences of 3 beats were found whereas the number of sequences of 4,5, and more than 5 beats showed a progressive drastic reduction. The mean slopes of + PI/ + SBP (7.6 ± 2.0 msec/mm Hg) and -P I / -SBP (6.4 ± 1.5 msec/mm Hg) sequences were similar, but in both instances there was a large scattering of the values around the mean (variation coefficients: 64.2 ± 4.7 and 62.6 ± 2.4%). The slopes decreased as a function of the sequence length and baseline heart rate and increased to a marked extent during the night as compared with daytime values. All sequences were more rare (-33.2% for +PI/ + SBP and -31.7% for -P I / -S B P ) and less steep in hypertensive subjects ( -4 0 . 3 and -3 6 . 2 % , respectively), who failed to show the marked nighttime increase in slope observed in normotensive subjects. To our knowledge, these observations provide the first description in humans of the baroreceptor-heart rate reflex in daily life. This reflex is characterized by marked within-subject variations hi sensitivity due in part to hemodynamic, temporal, and behavioral factors. All features of the baroreceptor-heart rate reflex are unpaired hi essential hypertension. (Hypertension 12: 214-222, 1988) KEY WORDS • baroreceptor reflexes • ambulatory blood pressure monitoring • hypertension sleep • humans • heart rate W E have previously reported 1 -2 that blood pressure in unanesthetized cats exhibits spontaneous rises or falls that are accompanied by linearly related increases or reductions in pulse interval (PI). We have also reported 12 that sinoaortic denervation abolishes these events, which therefore reflect baroreceptor modulation of the sinus node. We have concluded that evaluation of these events by computer analysis of intra-arterial blood pressure tracings represents a powerful tool for studying the baroreceptor-heart rate reflex in daily life.

With an aggressive neoadjuvant chemotherapy, it is possible to cure more than 60% of patients with nonmetastatic osteosarcoma of the extremity and amputation may be avoided in more than 80% of them. Because local or systemic relapses, myocardiopathies, and second malignancies are possible even 5 years or more after the beginning of treatment, a long-term follow-up is recommended for these patients.

SUMMARY Blood pressure was monitored by a continuous intra-arterial recording in 46 subjects to investigate whether the alarm reaction and the blood pressure and heart rate increases that occur during cuff blood pressure measurement made by a physician 1) attenuate when the physician's visit is repeated several times and 2) are less pronounced if a nurse measures the blood pressure. In 16 subjects the peak mean blood pressure and heart rate rises that occurred in the early part of the physician's first visit (22.6 ± 1.8 mm Hg and 17.7 ± 1.7 beats/min) were virtually identical to those occurring during three subsequent visits by the same physician throughout a 2-day intra-arterial blood pressure monitoring. The less pronounced pressor and tachycardie responses observed in the last part of the physician's visit also were virtually identical among the four visits. In contrast, in 30 other subjects the blood pressure and heart rate rises that occurred during the nurse's visit were 46.7% and 42.1% less (p<0.01) than those occurring during the physician's visit. The late and less pronounced pressor and tachy cardie responses to the visit were also significantly less (p<0.01) in the former than in the latter condition. These results indicate that the error of overestimation of blood pressure inherent in cuff blood pressure measurement by a physician cannot be avoided by repeated visits by the physician over a short time span. It clearly can be reduced, however, if blood pressure measurements are performed by a nurse. (Hypertension 9: 209-215, 1987) KEY WORDS * alerting reaction • invasive blood pressure monitoring measurements • hypertension • blood pressure • stress cuff blood pressure W E have previously shown that blood pressure measurements made by a physician may trigger an alerting reaction that is responsible for a rise in blood pressure that lasts several minutes.1 As hypertension usually is defined in terms of the blood pressure level measured by the physician, this rise can lead to a misdiagnosis of hypertension, particularly of so-called mild hypertension, and to incorrect decisions about when and how much to treat. It is therefore clinically important to investigate the conditions in which the alerting reaction and the accompanying blood pressure rise can be reduced or abolished.In the present study we directed our attention to two possibilities that have been widely discussed but not

The proposed histopathologic grading, to evaluate the effect of chemotherapy on the primary tumor, had the strongest correlation to clinical outcome. This method could therefore be used to identify patients with a high risk of recurrent disease. These patients could be randomized to receive alternative postoperative treatments to investigate whether more aggressive therapies will improve outcome.