PubMed Health⌕ Search

Biomedical subjects

A Zanchetti

Publications and source records attributed to A Zanchetti.

At least 163 records · Page 9Linked to original sources
PubMed1995

Cardiac and carotid structure in arterial hypertension and in hypertrophic cardiomyopathy.

The aim of this study was to measure intima-media thickness (IMT) of the common carotid artery (CCA) in patients with hypertrophic cardiomyopathy (HCM) and in hypertensive patients with left ventricular hypertrophy (LVH). We studied 73 subjects: 20 normotensive healthy subjects as control group (I); 20 patients with essential hypertension without LVH (II); 20 hypertensives with LVH (III), and 13 normotensive patients with HCM (IV). Each subject underwent a complete echocardiographic and vascular ultrasonographic study in order to assess left ventricular parameters and the IMT at the level of the CCA. Left ventricular mass index (LVMI) was significantly higher in groups III and IV than in groups I and II (156 +/- 18 and 157 +/- 31 vs. 94 +/- 14 and 98 +/- 10 g/m2, respectively, p < 0.01), while IMT was significantly greater in group III but not in the others [0.88 +/- 0.04 vs. 0.61 +/- 0.03 (I), 0.64 +/- 0.03 (II) and 0.61 +/- 0.04 (IV) mm, p < 0.01]. The correlation between LVMI and IMT was statistically significant within all the hypertensive patients (r = 0.48, p < 0.01) but not in the HCM group (r = 0.17, p = NS). The hypertensive patients with LVH showed structural alterations (related to hemodynamic and humoral factors) both at cardiac and vascular level while in patients with HCM the cardiac alterations (due to a genetic disorder) were not associated with changes at the level of the large arteries.

Adult↗
PubMed1995

Atrial natriuretic peptide and hemodynamic changes during normal human pregnancy.

We compared plasma atrial natriuretic peptide (ANP) and cGMP levels during normal pregnancy--a condition characterized by hypervolemia, high cardiac output, and decreased vascular resistance--with postpartum levels and assessed their relation to pregnancy-induced hemodynamic changes. Humoral and hemodynamic variables were measured in healthy women subjects in the supine and upright postures at each trimester of pregnancy and postpartum. Supine plasma ANP was increased throughout pregnancy (32 +/- 5, 21 +/- 3, and 19 +/- 2 versus 15 +/- 1 pmol.L-1, respectively, at each trimester versus postpartum), as was cGMP (8.6 +/- 1, 7.1 +/- 1, and 6.6 +/- 1 versus 5.6 +/- 1 nmol.L-1), and their increments were directly related (r = .68, P < .01). Both ANP and cGMP levels did not differ from postpartum levels after subjects stood. Supine stroke volume was initially increased but declined below postpartum levels in late pregnancy (69 +/- 4, 60 +/- 3, and 44 +/- 3 versus 58 +/- 4 mL.m-2), whereas after subjects stood it was always higher (56 +/- 3, 58 +/- 3, and 49 +/- 2 versus 44 +/- 2 mL.m-2); thus, stroke volume tended to increase in response to standing in late pregnancy. Supine cardiac index had a similar trend, which was opposite to that of total peripheral resistance (1213 +/- 62, 1265 +/- 79, and 1729 +/- 89 versus 1654 +/- 92 dyne.s-1.cm-5.m-2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

The antiatherosclerotic effect of calcium antagonists in man--what did MIDAS actually show? Multicenter Isradipine Diuretic Atherosclerosis Study.

The Multicenter Isradipine Diuretic Atherosclerosis (MIDAS) Study was a comparison between the dihydropyridine-derived calcium antagonist isradipine and hydrochlorothiazide in 883 hypertensive patients. B-mode ultrasonography of the carotid artery was used in order to evaluate changes in wall thickness and the development of atherosclerotic plaques during a 3-year period. The final publication has yet to appear in a medical journal. However, the study and its main findings have been presented at several international scientific meetings. In brief, isradipine was significantly more effective than hydrochlorothiazide in preventing an increase in intima-media thickness at several points of measurement in the carotid artery in spite of the fact that systolic blood pressure was not as effectively lowered by isradipine as by the diuretic therapy. Since the results and their implications are of great scientific as well as clinical importance we wish to briefly comment on some of the key aspects of the MIDAS Study, as presented at some international meetings.

Arteriosclerosis↗
PubMed1995

Ambulatory blood pressure monitoring in the evaluation of antihypertensive treatment: additional information from a large data base.

Aims of our study were i) to compare in a large number of hypertensive subjects the relative effect of antihypertensive treatment on clinic (C) blood pressure (BP) and various ambulatory (A) BP components, and ii) to determine whether antihypertensive treatment affects BP variability. In 266 mild essential hypertensive outpatients (age: 18-78 years) CBP (trough measurements) and ABP (Spacelabs 90202 or 90207) were measured after 3 to 4 weeks of wash-out and after 4 to 8 weeks of treatment with an ACE-inhibitor (n = 135) or a calcium-antagonist (n = 131). ABP recordings were analyzed to obtain average 24 h, day-time (6 a.m. to midnight) and night-time (midnight to 6 a.m.) systolic and diastolic BP values and standard deviations (BP variabilities). Treatment reduced both CBP and ABP. Treatment-induced changes in CBP showed a poor correlation with those in 24h, day- and night-time BP (r never > 0.23) and the correlation was poor also when trough ABP (mean of last 2 h) was considered. Twenty-four hour, day- and night-time BP were similarly reduced by treatment with a direct relationship between the initial BP values and the subsequent BP falls. BP standard deviations were also reduced by treatment in relation to the pretreatment values but the overall reduction was small, limited to the day-time and proportional or less than proportional to the reduction in mean values, with no changes or an increase in variation coefficients. The effects of ACE-inhibitor and calcium-antagonist treatments were superimposable. Our results from a large data base show that antihypertensive treatment effectively reduces all ABP components. The reduction cannot be predicted by the concomitant fall in CBP but it relates to the initial ABP values. Treatment has a limited effect on BP variability, this being the case both for ACE-inhibitors and calcium-antagonists.

Adolescent↗
PubMed1995

The Hypertension Optimal Treatment (HOT) Study: 12-month data on blood pressure and tolerability. With special reference to age and gender.

The Hypertension Optimal Treatment (HOT) Study is an ongoing prospective, randomized, multicenter trial conducted in 26 countries. Its two main aims are to evaluate the relationship between three levels of target diastolic blood pressure (< or = 90, < or = 85 or < or = 80 mmHg) and the incidence of cardiovascular morbidity and mortality in hypertensive patients and the effects on morbidity and mortality of a low dose, 75 mg daily, of acetylsalicylic acid (ASA, aspirin) compared with placebo. Altogether 19,193 patients have been recruited and randomized and one-year data are now available for all patients. This is a report on the blood pressures achieved, the tolerability and other available data after 12 months of follow-up of all patients. Special reference will be given to the subgroup of elderly patients (> or = 65 years, n = 6,113) as compared to younger patients (< 65 years, n = 13,080). On average, the target group < or = 90 mmHg in diastolic blood pressure has reached 86 mmHg, the target group < or = 85 mmHg has reached 83 mmHg and the target group < or = 80 mmHg has reached 81 mmHg. The percentage of patients that has obtained their target blood pressures is 84% in the target group < or = 90 mmHg, 72% in the target group < or = 85 mmHg and 57% in the target group < or = 80 mmHg at 12 months of follow-up. In the elderly subgroup (> or = 65 years of age) the percentage of patients at target is higher for all target groups, being 86, 76 and 61%, respectively, at 12 months. Antihypertensive treatment is initiated with a calcium antagonist, felodipine, at a dose of 5 mg once daily. If target blood pressure is not reached, additional antihypertensive therapy, with either an angiotensin converting enzyme (ACE) inhibitor or a beta-adrenoceptor blocking agent, is given. Further dose adjustments are made in accordance with a set protocol. As a fifth and final step a diuretic may be added. Side effects have been relatively few in this large multinational series of intensively treated hypertensive patients. Only ankle edema, 2.6% and 3.0%, and coughing, 1.3% and 0.8%, in young and elderly patients, respectively, exceed a frequency of 1%, and 88% of all patients are still taking their baseline therapy felodipine after one year. The one-year data presented here indicate that it should be possible to fulfill the primary aims of the HOT Study.

Age Factors↗
PubMed1995

Addition of urapidil or metoprolol to the treatment of hypertensive non-responders to nifedipine monotherapy: efficacy and metabolic effects. Italian Urapidil Study Group.

This study compared the effects on blood pressure and some metabolic variables of a 3-month period addition therapy of urapidil or metoprolol in 273 hypertensive non-responders to nifedipine sustained release (SR) monotherapy. This was a randomised, open-label, controlled, parallel-group comparative study, followed by another 3-month period during which all patients received the combination nifedipine SR-urapidil independently of the treatment they were previously randomized to. Both treatments caused significant falls in systolic (SBP) and diastolic blood pressure (DBP) when compared with the nifedipine SR monotherapy phase. The addition of urapidil to nifedipine SR caused a significant blood pressure reduction of 16.6/13.6 mmHg (p < 0.001), whereas after metoprolol the decrease was of 15.1/14 mmHg (p < 0.001). While in the overall population there was no statistically significant difference between the reduction caused by the two antihypertensive agents added to nifedipine SR, significant differences (DBP, p < 0.05; SBP, p < 0.01) were observed in the group of 51 patients aged at least 60 years. Total cholesterol and LDL-cholesterol were significantly reduced (p < 0.001) after the addition of urapidil to nifedipine SR, while, on the contrary, the addition of metoprolol to nifedipine SR was followed by a significant rise (p = 0.001). The changes caused by the two agents were statistically different among them (p < 0.01). The non-atherogenic HDL-cholesterol did not change during the addition of urapidil or metoprolol to nifedipine SR, while, the HDL/total cholesterol ratio was significantly increased after the addition of urapidil (p < 0.01) and unmodified after the addition of metoprolol. Between-group analysis showed a significant difference (p = 0.005). Serum triglycerides did not change in the urapidil plus nifedipine SR group but significantly increased in the metoprolol plus nifedipine SR group (p < 0.001); between-group difference was not statistically significant. Plasma glucose was unchanged after the addition of urapidil whereas it was significantly (p < 0.001) increased in the metoprolol-added group with a between-group difference statistically significant (p < 0.05). When metoprolol was substituted by urapidil during the second 3-month period, the negative effects on glucose, total cholesterol, LDL cholesterol and triglycerides were abolished while in the group already treated with urapidil plus nifedipine SR the favourable effects of urapidil plus nifedipine SR on total cholesterol, LDL-cholesterol and HDL/total cholesterol ratio were significantly increased compared with the end of the first 3-month treatment. The results of this study show that when urapidil and metoprolol are added to non-responders to nifedipine SR therapy there is a clinically and statistically relevant blood pressure reduction with both agents, with a therapeutic advantage for the combination urapidil + nifedipine SR in patients more than 60 years old. Moreover, the addition of urapidil was associated with a more favourable effect on serum lipids and glucose than that produced by the addition of metoprolol.

Adult↗
PubMed1995

Characteristics of an ideal antihypertensive therapy for elderly hypertensives.

Treatment of hypertension in the elderly has become not only accepted but also a highly ethical, effective and compelling procedure following the many clearly positive reports on the benefits of lowering elevated arterial pressure in elderly patients. So far most intervention studies in elderly hypertensive patients have used diuretics or beta-blockers or the two in combination as the moiety by which blood pressure has been lowered. However, from a theoretical point of view, more novel therapies could offer advantages that would translate into an even better reduction of cardiovascular morbidity and mortality than has been obtained with the traditional antihypertensive therapies used so far. Some of the studies in elderly hypertensives that are in progress using angiotensin converting enzyme inhibitors or calcium antagonists as the main therapies, e.g. the STOP-Hypertension-2 Study and the Syst-Eur Study, will be briefly reviewed here as will the large data base on urapidil, a dual action antihypertensive drug used in the treatment of elderly hypertensives. By careful evaluation of the effects of novel antihypertensive drugs, and the already existing data base on urapidil in elderly hypertensive patients, it is likely that still better reduction of risk can be obtained in the elderly hypertensives by the use of more novel therapies than diuretics and beta-blockers.

Adult↗
PubMed1995

Guidelines for the management of hypertension: the World Health Organization/International Society of Hypertension view. World Health Organization. International Society of Hypertension.

ORGANIZATIONS PRODUCING GUIDELINES: Guidelines or recommendations for the management of hypertension have periodically been produced by various organizations or specialized scientific societies, in particular the United States Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure and the World Health Organization/International Society of Hypertension Guidelines Sub-Committee. SIMILARITIES, DIFFERENCES AND EVALUATION OF GUIDELINES: There are many similarities between the different guidelines and any dissimilarities are mainly related to the choice of first-line drugs for treatment and the goal of treatment. In formulating guidelines it is important to avoid placing rigid constraints on practising doctors' decisions while helping them to exert the most careful and informed judgement in individual cases.

Antihypertensive Agents↗
PubMed1995

Ambulatory blood pressure normality: results from the PAMELA study.

OBJECTIVE: To determine ambulatory and home blood pressure means and distributions in relation to clinic blood pressure in a general population. METHODS: We obtained a random sample of 2400 subjects stratified by sex and 10 year age groups to be representative of residents aged 25-64 years of the city of Monza. Participation rate was 69% (1651 subjects). Blood pressure measurements consisted of clinic blood pressure (average of three measurements, sphygmomanometry), home blood pressure (average of morning and evening measurements, semiautomatic device) and ambulatory blood pressure (automatic readings at 20 min intervals, Spacelabs 90207). Clinic blood pressure was obtained both before and after home and ambulatory blood pressures. Data analysis did not include 213 subjects receiving antihypertensive drug treatment and was therefore limited to 1438 participants. RESULTS: In the 1438 subjects, clinic, home and ambulatory blood pressure showed a normal-like distribution, with a taller peak and a narrower base for ambulatory than for home and clinic values. Clinic, home and ambulatory blood pressures were significantly related to each other (P always < 0.001). The means of the two clinic blood pressures obtained on consecutive days were superimposable (127.4 +/- 17.0/82.3 +/- 9.8 and 128.2 +/- 16.5/81.9 +/- 9.9 mmHg) and both were markedly higher than home and 24 h average blood pressures (8.2 mmHg), which were similar to one another. The differences between clinic and home or 24 h average blood pressure were similar in both sexes but increased with increasing age and clinic blood pressure values. The influence of clinic blood pressure values on the clinic-ambulatory or clinic-home blood pressure differences was more important than age. Although higher than the 24 h average value, daytime average blood pressure was also lower than clinic blood pressure. Night-time blood pressure was markedly lower than the daytime value in both sexes and at all ages. CONCLUSION: Data from a large and unbiased sample of a general population show that home and 24 h or daytime average blood pressures are much lower than clinic blood pressure. The relatively close correlation between blood pressure values measured with the different methods used has allowed calculation of home and ambulatory blood pressure values corresponding to the accepted upper limit of normality of clinic blood pressure (140/90 mmHg). The upper limit of normality for the population was for both home and ambulatory blood pressures in the range 120-130 and 75-81 mmHg for systolic and diastolic values, respectively, with slight differences depending on sex and age. Taking 140/90 mmHg as the upper normal limit of the population is therefore an error that leads to individuals whose home or ambulatory blood pressures are high being considered as normotensive.

Adult↗
PubMed1995

Antihypertensive therapy: pride and prejudice.

CLINICAL TRIALS: Investigators of hypertension can be proud of the indisputable successes achieved by antihypertensive therapy and of the correct methodology (randomized controlled trials) by which those successes have been proved. However, hypertension experts should not allow pride to turn into prejudice. Numerous aspects of antihypertensive treatment remain to be clarified. Indeed, that all goals of antihypertensive treatment have been achieved is clear prejudice. Although randomized trials have been essential for establishing the benefits of antihypertensive therapy, claiming that randomized trials are the only valid methodology for providing treatment benefits is another instance in which pride might turn into prejudice. Indeed, there is a large gap between trials and practice, and trials may both overestimate and underestimate the benefits of treatment. Furthermore, event-based trials are not the only valid type of trials, as is often claimed. If the goals of treatment are both to prevent events and avoid or reduce organ damage, then we need both event-based and organ damage-based types of trials. MEASUREMENTS OF SUCCESS: Assessment of the absolute risk and, consequently, calculation of the absolute benefit to be expected from treatment have appropriately been emphasized in recent guidelines for the management of hypertension as instruments to evaluate cost-effectiveness of treatment. However, there is reason for caution against an indiscriminate worship of this concept, because earlier treatment of milder, uncomplicated hypertension is an effective measure by which to prevent development of more severe and complicated hypertension, the treatment of which may be less successful, if success is measured by the residual mortality and morbidity of even well treated patients. BLOOD PRESSURE MEASUREMENTS: Finally, we are still ignorant of the best way to measure blood pressure in order to decide upon initiation and success of treatment. Supporters both of clinic blood pressure measurements and of home or ambulatory blood pressure monitoring have their own prejudices; the problem can only be solved by further research. As in Jane Austen's novel, before the happy end both pride and prejudice must be conquered.

Antihypertensive Agents↗
PubMed1995

Cardiac and carotid structure in patients with established hypertension and white-coat hypertension.

AIM: The introduction of ambulatory blood pressure monitoring in the clinical practice has defined a new subgroup of hypertensive patients called white-coat hypertensives. It has been reported that white-coat hypertensives have less cardiac involvement than established hypertensive patients. This study was designed to examine the extent of cardiac and vascular involvement in patients with white-coat hypertension and established hypertension. PATIENTS AND METHODS: We studied 82 patients with mild essential hypertension, never previously treated, using 24-h ambulatory blood pressure monitoring and an echocardiographic and vascular ultrasonographic study. Left ventricular dimensions and mass were obtained according to the Penn convention. The intima-media thickness of the posterior wall of both common carotid arteries was measured 5, 10 and 20 mm caudally to the flow-divider and the average value was used for analysis. RESULTS: Of the 82 patients, 31 (mean +/- SD age 35 +/- 10 years) had average 24-h systolic/diastolic blood pressure values of below 132/85 mmHg (white-coat hypertensives) and 51 (aged 42 +/- 2 years) had a consistently elevated diastolic blood pressure. Both groups had similar body surface area (1.82 +/- 0.22 versus 1.81 +/- 0.22 m2), sex distribution (20 males and 11 females versus 32 males and 19 females), duration of hypertension, metabolic parameters and smoking habit. The 24-h ambulatory blood pressure monitoring values were, by definition, significantly higher in established hypertensives than in white-coat hypertensives (142 +/- 10/94 +/- 6 versus 127 +/- 6/79 +/- 4 mmHg, P<0.001). The left ventricular mass index and intima-media thickness were significantly higher in the established hypertensives (112 +/- 17 g/m2, 0.67 +/- 0.11 mm, respectively) than in the white-coat hypertensives (98 +/- 18 g/m2, 0.58 +/- 0.09 mm; P<0.001 for both). CONCLUSIONS: The prevalence of left ventricular hypertrophy and cardiac remodeling was significantly more frequent in established hypertensives (51%) compared to white-coat hypertensives (19%). These confirm that structural changes in the left ventricle in white-coat hypertensives are more limited than in established hypertensives and show that in white-coat hypertensives there is significantly less involvement of the conductance vessels than in established hypertensives.

Adult↗
PubMed1994

Hyperlipidemia in the hypertensive patient.

Hypertension is known to be strongly associated with multiple metabolic abnormalities. A recent population survey carried out in Italy (the Gubbio study) involving 5,376 individuals showed that, up to the age of 64 years, hypertensive men were more markedly overweight (body mass index > or = 30) than normotensive men, whereas in women the prevalence of obesity was higher in hypertensive women at all ages. The prevalence of marked hypercholesterolemia (> or = 250 mg/dL) was uniformly higher in hypertensive compared with normotensive men except in the oldest age group; it was also higher in hypertensive women in the age 45-74 years group. Postabsorptive hyperglycemia and hyperuricemia were also more prevalent in hypertensive men and women, especially in the older age groups. Furthermore, the Tecumseh Blood Pressure Study indicated that not only patients with "sustained" hypertension but also those with so-called "white-coat" hypertension are, as a group, overweight and have elevated levels of cholesterol, insulin, and triglycerides and decreased levels of high-density lipoprotein. The multiple metabolic abnormalities clustered in hypertensives are important in relation to prognosis and therapy. The most recent World Health Organization/International Society of Hypertension guidelines for management of mild hypertension give considerable attention to the global assessment of cardiovascular risk in patients with hypertension and stress that, among individuals with mild hypertension, the risk of serious cardiovascular disease is also determined by a variety of risk factors other than blood pressure. The higher the absolute risk, the greater is the absolute benefit brought about by lowering blood pressure and correcting other risk factors, such as dyslipidemia.

Adult↗
PubMed1994

Goals of antihypertensive treatment and planning of therapeutic trials.

The prevention of both cardiovascular events and organ damage or disease have to be considered to be different, but essential, goals of antihypertensive therapy. As the mechanisms that lead to organ damage and to events are, to a significant extent, different, it must be recognized that the achievement of the two goals has to be evaluated through trials using, separately or conjointly, different criteria. Thus far, randomized trials of antihypertensive therapy have almost exclusively measured mortality and morbidity data, and have provided information relevant to the prevention of cardiovascular events in those hypertensive patients in whom a relatively high rate of events is expected during the relatively short time span (3 to 6 years) of the trial, namely, those who have severe hypertension or who are elderly. However, in young or middle-aged patients with mild-to-moderate hypertension, for whom the goal of therapy would be to prevent or retard the development of vascular lesions to help these patients achieve their full life span, trials should be based on the measurement of organ damage rather than, or in addition to, the monitoring of events. The MIDAS trial has been the first in which two different modes of antihypertensive therapy have been tested for their capacity to influence the development of atherosclerosis in hypertension. It is likely that the results of this study will prompt many more therapeutic trials based on the quantitative assessment of organ damage in hypertension.

Antihypertensive Agents↗
PubMed1994

Hemodynamic and humoral effects of chronic treatment with the neutral endopeptidase inhibitor SCH 42495 in spontaneously hypertensive rats.

Blockade of atrial natriuretic factor (ANF) degradation by specific neutral endopeptidase (NEP) inhibitors may be useful in treatment of hypertension because of the potential diuretic, natriuretic, and arterial pressure (AP)-lowering effects. To test this possibility, we examined the effects of chronic oral treatment with the NEP inhibitor SCH 42495 on BP, diuresis, natriuresis, plasma ANF, cyclic GMP, and the renin-angiotensin system (RAS) in conscious unrestrained spontaneously hypertensive rats (SHR) and compared them with the effects induced by the angiotensin-converting enzyme (ACE) inhibitor spirapril (SPIR). Four groups of adult SHR were treated orally for 4 weeks with placebo, SCH 42495 3 mg/kg twice daily (b.i.d.), SCH 42495 30 mg/kg b.i.d., and spirapril 1 mg/kg b.i.d. Systolic BP (SBP) was measured weekly, and 24-h urine was collected every week for measurement of urinary volume, sodium, potassium, and cyclic GMP excretion. Plasma ANF, cyclic GMP, renin activity (PRA), and aldosterone (ALDO) were determined from blood collected when the rats were killed. After 4-week treatment with SCH 42495, circulating levels of ANF were similar in both SCH 42495- and placebo-treated SHR; plasma cyclic GMP was higher, however, in the treated rats than in controls and urinary cyclic GMP increased only with the higher dose of SCH 42495. PRA and plasma ALDO tended to be lower in both SCH 42495-treated groups than in controls, yet BP, diuresis, and natriuresis throughout the study were not different from controls. In contrast, spirapril decreased BP; this effect was associated with significant increments in renin and decrements in ALDO and ANF, without changes in plasma and urinary cyclic GMP.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1994

Ambulatory and home blood pressure normality: the Pamela Study.

Ambulatory blood pressure monitoring (ABPM) is increasingly used in the clinical evaluation of hypertension. However, a number of limitations restrict its routine use. One of the limitations is a lack of definite conclusions about ambulatory blood pressure normality, because of the shortcomings of previous studies on this issue. In the present study we describe a survey from a large sample of subjects within the age range of 25-64 years. It was found that 24-h average systolic and diastolic blood pressures are markedly lower than clinic blood pressure, and for daytime average and home blood pressure as well. In addition, it was found that the clinic ambulatory or home blood pressure disparity is related to the baseline clinic blood pressure (i.e., it increases with increasing clinic blood pressure values) and that the three pressures (ambulatory, home, clinic) are closely related to each other, thereby allowing the application of correction factors to obtain information on ambulatory or home blood pressure normality. This results in an upper normality limit for 24-h average blood pressure and home blood pressure of around 120 mm Hg systolic and 77 mm Hg diastolic pressure.

Adult↗