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To clarify psychological factors related to white coat hypertension, we examined personality characteristics of patients with mild essential hypertension by psychological testing. Patients with essential hypertension were taught to measure their own blood pressure (BP) with a semi-automatic oscillometric BP measuring device and were asked to measure BP at home in the sitting position before going to sleep. The duration of the study was 8 wk. Patients were defined as "white coat" hypertensive patients (WCHT) (n = 49) if home systolic BP was 135 mmHg or less and home diastolic BP was 85 mmHg or less, and as "sustained" hypertensive patients (SHT) (n = 53) if home systolic BP was 140 mmHg or more or home diastolic BP was 90 mmHg or more. All the patients underwent the following psychometric tests: self-rating questionnaire for depression, MMPI alexithymia scale, type A behavior pattern check list, general health questionnaire (GHQ), and egogram check list. WCHT did not differ from SHT in the scores for depression, alexithymia, type A behavior pattern, or GHQ. However, WCHT showed an abnormal pattern on egograms, as compared with SHT. On egograms, SHT showed a normal hill-shaped pattern with a peak in "nurturing parent (NP)", and "free child (FC)" was higher than "adapted child (AC)" in both genders. In contrast, WCHT showed significantly lower FC and significantly higher AC than SHT, and AC was higher than FC in both genders. These findings suggested that WCHT tend to suppress their own emotions and become over-adaptive to their surroundings, as compared with SHT. (Hypertens Res 1997; 20: 99-104)

SUMMARY An orally active renin inhibitor, ES 6864 (JV-[(2R)-3-morpholinocarbonyl-2-(l-naphthylmethyl)propionyl]-(4-thiazoIyl)-L-alanyl-cyclostatine-(2-morpholinoethyl)amide), was synthesized. ES 6864 was found to be a highly potent inhibitor of human renin with a K\ value of 7.3 x 10~9 M. The compound competitively inhibited human renin. The inhibitor was also potent against monkey renin but was less effective against renins from pig, goat, dog, rabbit, and rat. ES 6864 did not inhibit cathepsin D, pepsin, trypsin, chymotrypsin, angiotensin converting enzyme, and urinary kallikrein at a concentration of 10~5 M. ES 6864 was resistant to proteolytic actions of the enzymes in rat tissue homogenates (liver, kidney, pancreas, and small intestine). Oral administration of ES 6864 at 30 mg/kg to conscious, sodium-depleted marmosets produced a significant blood pressure reduction and almost complete inhibition of plasma renin activity, which persisted for 5 hours. Oral administration of ES 6864 also produced dose-related decreases of blood pressure in hog renin-infused rats, but the duration of action was much shorter than that in conscious marmosets. The parent compound in the blood following oral administration of ES 6864 to marmosets was confirmed directly by measuring the plasma concentration of ES 6864. These results enhance the possibility of developing renin Inhibitors that can be used clinically. (Hypertension 11: 708-712, 1988) KEY WORDS • human renin inhibitor • competitive inhibition • oral administration marmoset • hog renin-infused rat • plasma renin activity • blood pressure

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