An algorithm has been proposed for the detection of white coat hypertension among subjects with elevated blood pressure (BP) on at least three clinic visits using home BP monitoring (screening test) and, if this is low, ambulatory BP monitoring (diagnostic test). This study aims to test this strategy in practice. The proposed algorithm was applied in 133 untreated subjects with elevated BP assessed in a previous prospective study using repeated clinic, home and ambulatory BP measurements. The proportions of detected and missed cases of white coat hypertension and the diagnostic value of the algorithm were calculated. By applying the algorithm, 99 subjects (74%) were found eligible for home measurements and 35 (26%) for ambulatory monitoring. There were 38 subjects with white coat hypertension (38%), of whom 15 (39%) were not detected by the proposed strategy. The sensitivity, specificity, and the positive and negative predictive value of the algorithm to diagnose white coat hypertension were 61, 81, 66 and 77%, respectively. Of the 34 subjects with normal BP on the third clinic visit, 15 (42%) had elevated home and/or ambulatory BP. These data suggest that, using the proposed strategy, many white coat hypertensives may remain undetected and may receive unnecessary long-term drug treatment. Therefore, more research is needed on the optimal strategy for detecting white coat hypertension in clinical practice.

Based on outcome trials, guidelines for hypertension management recommend lower blood pressure (BP) goals using an individualized treatment strategy (IND) and referral to a specialist of patients uncontrolled after 6 months of treatment. This study aimed to evaluate the performance of General Practitioners (GPs) in reaching the recommended BP goals using the IND, or a stepwise treatment strategy (STEP) as used in the outcome trials. Trained GPs were randomized to reach the BP goals within 6 months using the IND or a STEP strategy in untreated or treated uncontrolled hypertensives. In all, 24 GPs recruited 528 patients of whom 443 were analysed (mean age 65+/-9 years, 42% men, 70% treated, STEP/IND 12/12 GPs, 231/211 patients). After 6 months, 83% of the patients had reached the diastolic BP goal, whereas only 51% the systolic (P<0.0001 for difference). Factors associated with uncontrolled systolic BP were diabetes, age >60 years and triple antihypertensive therapy at baseline. A faster BP reduction was achieved during the first 3 months using the STEP strategy, but at the cost of using more drugs (combination therapy in 68/59% for STEP/IND, P=0.06). At 6 months similar rates of control were achieved with the two strategies. In conclusion, in primary care the diastolic BP goal can be reached within 6 months in the majority of patients, whereas systolic BP remains uncontrolled in 50% of the cases. The IND should be the recommended treatment strategy, but further investigation is required on the reasons for treatment failure and the optimal strategy for its improvement.

The terms 'self-blood pressure' and 'home blood pressure' are being used to describe measurements of blood pressure taken by the patients at home. However, home measurements are not always self-measurements, because these are often taken by the patients' relatives. There is little evidence on the effect of self-measurement on the level of blood pressure taken using automated electronic devices. In regard to clinic blood pressure, two studies using automated devices found no difference between measurements taken by physicians or patients themselves, irrespective of whether self-measurements were taken in the presence or the absence of the physician. In regard to home blood pressure, one randomized crossover trial showed no difference between home measurements taken by the patients themselves or their relatives using fully automated devices. On the other hand, many studies have consistently shown home blood pressure to be lower than clinic pressure. Taken together these data suggest that self-measurement has no effect on the level of blood pressure, either in the clinic, or at home. The lower level of home in comparison to clinic blood pressure seems to be exclusively attributed to the effect of the different setting, rather than the person who is taking measurements. Therefore the term 'self blood pressure' seems to be a misnomer, whereas the term 'home blood pressure' represents a more appropriate term for home measurements taken by patients or their relatives.

The Ty1- copia-like retrotransposon is one of the commonest class of transposable elements in the plant kingdom, often comprising several percent of the total DNA content. We aimed to study the evolutionary relationships of Olea retroelements, using part of the reverse transcriptase domain, as well as the genomic and chromosomal organization of these sequences in Olea europaea chromosomes and their transcription activity and copy number. Fourteen clones, that were isolated from four different species, were sequenced and a phylogenetic tree was constructed based on their predicted amino acids. Five clones derived from O. europaea were clustered together with a 87% nucleotide sequence homology and two Olea oleaster clones showed 98% sequence homology. The rest of the clones showed heterogeneity among them, leading to a common ancestral transposon that existed before the genus arose. The Ty1- copia-like sequences have a dispersed genomic organization, physically distributed on all chromosomes, showing minor clustering in some cases and low copy numbers in the smallest chromosome pair. The total copy number in the O. europaea genome was estimated by dot blotting to be 40,000 in a haploid nucleus, but a number of these are non-functional since the sequenced clones contained stop codons and frame-shifts. Some Ty1- copia-like copies, present in O. europaea, were found to be methylated, while no differences in methylation were observed between DNA isolated from young leaves and callus-suspension cultures.

This study investigated the differences in the effect of an angiotensin converting enzyme inhibitor (ACEI) compared with an angiotensin receptor blocker (ARB) on blood pressure (BP) and pulse pressure (PP) measured in the clinic (CBP and CPP, respectively), at home (HBP, HPP) and with ambulatory monitoring (ABP, APP). Twenty-seven hypertensive patients were randomised to receive lisinopril (20 mg) or losartan (50 mg) for 5 weeks, and were subsequently crossed-over to the alternative treatment for a second 5-week period. Measurements of CBP, 24-h ABP and 5-days HBP were performed before randomisation and at the end of each treatment period. All measurement methods showed that lisinopril was more effective than losartan in reducing BP. However, the difference between the two drugs was demonstrated with greater precision using HBP (P<0.001) than 24-h ABP (P<0.01), whereas the poorest precision for demonstrating this difference was provided by CBP (P<0.05). Lisinopril was also found more effective than losartan in reducing HPP (P=0.01) and 24-h APP (P=0.03) whereas no such a difference was detected using measurements of CPP. It was concluded that the antihypertensive drugs may differ in their effects not only on BP, but also on PP. HBP monitoring appears to be as reliable as 24-h ABP monitoring in detecting differences in the effect of drugs on both BP and PP. Clinic measurements seem to be the least reliable method, particularly in the detection of differences in PP.

The aim of the present study was to assess the main determinants of arterial stiffness in Greek and French middle-aged, hypertensive men, by using pulse wave velocity (PWV) measurements, which is an established method of quantification of arterial stiffness. The study was performed in 83 consecutive Greek and 79 consecutive French untreated male hypertensive outpatients aged 45-65 years. French subjects were examined in Paris at the "Centre d'Investigations Préventives et Cliniques" (the IPC Center). Greek patients were examined in Athens at the hypertension outpatient clinic in Sotiria Hospital (University of Athens). In both Greek and French hypertensive subjects, aortic stiffness was determined by the same parameters: age, blood pressure and heart rate (HR) explained approximately 40% of the aortic PWV variations, whereas lipids, triglycerides and tobacco smoking were not significant associated with aortic stiffness. After multivariate adjustments, Greek hypertensives had higher aortic stiffness as compared to the French patients by 1.2 m/s (approximately 10%); p < 0.001. Greek hypertensive subjects had also a higher body weight, waist, HR and prevalence of smoking. However, among all these factors only HR had a significant effect on PWV. Also after adjustment for HR, the difference in PWV between the two populations persisted. In conclusion, in two different populations, stiffness seems to be regulated by the same major factors. The higher aortic stiffness found in Greek hypertensives may be explained by the presence of other non-evaluated risk factors and/or patient selection differences.

To test the hypothesis that the antihypertensive response to angiotensin converting enzyme (ACE) inhibition can predict the response to angiotensin II type I receptor (AT1R) antagonism, 33 hypertensive patients were randomized to receive lisinopril (20 mg) or losartan (50 mg) for 5 weeks. Patients were then crossed-over to the alternative treatment for a second 5-week period. Twenty-four-hour ambulatory BP (ABP) was measured before randomization and on the final day of each period. The agreement in ABP response between the two drugs was assessed using the following approaches: Subjects were classified as responders and nonresponders using as a threshold an arbitrary level of response (ABP fall > or = 10 mm Hg systolic or > or = 5 mm Hg diastolic) or the median ABP response achieved by each of the drugs. Disagreement between the two drugs in the responders-nonresponders classification was expressed as the proportion of subjects whose ABP responded to one of the drugs only. Lisinopril was more effective than losartan in reducing ABP (mean difference 4.7+/-8.1/3.3+/-5.7 mm Hg, systolic/diastolic, P < .05). Disagreement in the antihypertensive response between the two drugs was found in 39%/33% of subjects for systolic/diastolic ABP using the arbitrary response criterion (33%/39% using the median response criterion). Significant correlations were found between the responses to lisinopril and losartan (r = 0.47/0.59, systolic/diastolic, P < .01). We conclude that in more than one third of hypertensive subjects, the BP response to ACE inhibition fails to predict the response to AT1R antagonism and vice versa. These data suggest that there are differences between these two drug classes that are not only of theoretical but also of practical significance.