Confirming the diagnosis of mild hypertension.

Patients with newly found raised blood pressure are known to have lower pressures at subsequent measurements even when not treated. A study was undertaken to determine the extent to which (a) the number of follow-up measurements and (b) the duration of the intervals between them contributed to this fall in pressure. In 42 general practices 110 patients were identified as having for the first time a diastolic pressure (phase V) greater than 90 and less than 110 mm Hg. Both diastolic and systolic pressures were appreciably lower when measured at return visits when compared with the first measurement. The systolic pressure dropped appreciably in the intervals between the first and the second visits and again between the second and third visits. The diastolic pressure fell appreciably only between the first and second visits. The duration of the interval between visits was not associated with a fall in either systolic or diastolic pressure, but the number of measurements was. This pattern of fall in pressure was not affected by the patient''s age or sex. From these results we conclude that patients with newly identified blood pressures that are mildly raised should be seen at two further visits before a decision about treatment is made. The timing of these follow-up visits is not crucial.     

Reye's syndrome: assessment of intracranial monitoring.

Direct measurements of arterial blood pressure and intracranial pressure were recorded in 39 patients aged 3.6 months to 5 years 11 months with Reye''s syndrome judged to be stage 2 or beyond. Of 33 patients who survived, 27 made a full recovery and six were severely handicapped. Measurement of cerebral perfusion pressure, which is greatly reduced in the more severe forms of Reye''s syndrome, was a better guide to prognosis and management than intracranial pressure alone. The findings emphasise that maintenance of cerebral perfusion pressure is essential if mortality and morbidity are to be reduced. Intracranial monitoring is mandatory in all but the mildest cases of Reye''s syndrome.     

Intravenous methylprednisolone in the treatment of Graves' ophthalmopathy.

Eleven euthyroid patients with severe Graves'' eye disease were treated with intravenous methylprednisolone and followed up for six months or more by ophthalmological assessment, orbital computed tomography (CT), photographs, and antibody measurements. Papilloedema resolved in the single patient in whom it was present; visual acuity was abnormal in seven eyes initially and in only one eye after treatment; the intraocular pressure differential, which reflects muscle dysfunction, was initially abnormal in 18 eyes but showed a progressive and distinct improvement; nine patients showed substantial improvement in inflammatory signs. Exophthalmos improved early after treatment, but this improvement was not maintained. Orbital CT showed a pronounced reduction in the bulk of eye muscles after treatment in eight of nine patients. Autoantibodies to the thyroid stimulating hormone receptor declined. Adverse effects were trivial. Thus eight patients showed a clear response to intravenous methylprednisolone as judged by ophthalmic assessment and CT scan. The two patients who showed little response and one who had none all had a long history (more than a year) of ophthalmopathy. Results were better than those with oral steroids and adverse effects less. Treatment of Graves'' eye disease is more likely to be effective if given early; patients should be referred promptly to specialist centres, where treatment with intravenous methylprednisolone should be considered.     

Randomised controlled comparative study of methyldopa and oxprenolol in treatment of hypertension in pregnancy.

One hundred pregnant women with hypertension (defined as diastolic blood pressure at or above 95 mm Hg) were allocated at random to treatment with methyldopa or oxprenolol and were compared with nonhypertensive controls matched according to parity and gestation at delivery. The patients were also stratified into those entering the study early (before 32 weeks'' gestation) and those entering late (after 32 weeks'' gestation). Although there were no differences in diastolic blood pressure between the hypertensive groups before or during treatment, in the early entry group the systolic blood pressure at entry of those allocated to oxprenolol was significantly higher than that of those receiving methyldopa; this difference remained throughout the treatment period. Also in the early entry group further increments of drug treatment were required to control blood pressure of patients receiving oxprenolol than in those receiving methyldopa. The eventual fetal outcome for all patients treated with methyldopa was the same as that for those treated with oxprenolol; birth weight, placental weight, head circumference, and Apgar score were not significantly different and there were no stillbirths in either group.     

Use of shopping centres in screening for hypertension

In two Edmonton shopping centres 9591 people were screened for hypertension: 3.3% were found to be normotensive but taking antihypertensive medication and another 8.8% were found to have elevated blood pressure. Systolic hypertension alone accounted for 45.3% of the hypertensive cases and diastolic hypertension, with or without systolic, for 54%. Of the group with elevated blood pressure 34.5% had been previously unaware of their condition, 18.7% had never received medication for it, 18.2% had received medication in the past but had discontinued it, 26.1% were still on medication and 2.5% were not taking antihypertensive medication and were uncertain if they had ever done so in the past. Eighty-eight percent of the hypertensives who were receiving no medication went to their physician; 41% were prescribed antihypertensive medication, and 87% were still on treatment three months later and 74% one year after detection. Eighteen percent of those started on treatment had their medication discontinued by their doctor over the next year and 8% stopped treatment on their own. Of those hypertensives already receiving medication 88% went to their doctor and 33% had their medication altered.Physician measurements of blood pressure tended to be lower than those recorded at the screening. At least part of the explanation for this discrepancy is that physicians often used blood pressure cuffs that were too wide for the patient''s arm; 25% of the people screened required cuffs narrower than the standard cuff used by most physicians.The prevalence of hypertension was similar among women taking oral contraceptives and women not taking these agents.     

Verapamil versus hydrochlorothiazide in the treatment of hypertension: results of long term double blind comparative trial. Verapamil versus Diuretic (VERDI) Trial Research Group.

OBJECTIVE--To compare the efficacy and tolerability of hydrochlorothiazide, sustained release verapamil, and their combination in patients with mild to moderate hypertension. DESIGN--Randomised multicentre trial of 48 weeks'' duration with a double blind comparison of hydrochlorothiazide and verapamil followed by an open trial of combined treatment for patients not achieving the target diastolic blood pressure (less than 90 mm Hg) during treatment with a single drug. SETTING--Outpatient departments in 10 clinics and 10 private practices of general practitioners or internists. PATIENTS--369 Hypertensive patients with a diastolic blood pressure of 95-120 mm Hg during a placebo run in period of two weeks. INTERVENTIONS--Initial treatment consisted of 12.5 mg hydrochlorothiazide (n = 187) or 120 mg sustained release verapamil (n = 182) once daily (regimen I). If the target diastolic blood pressure of less than 90 mm Hg was not achieved within four weeks doses were increased to 25 mg hydrochlorothiazide or 240 mg verapamil once (regimen II) and twice daily (regimen III). Patients not achieving target blood pressure were given the combination of hydrochlorothiazide and verapamil--that is, 25 and 240 mg once (regimen IV) and twice daily (regimen V). MAIN OUTCOME MEASURE--Blood pressure determined with a device permitting automatic repeated measurements with printouts. RESULTS--After eight weeks of treatment with a single drug 76 out of 178 (43%) and 101 out of 175 (58%) patients achieved the target blood pressure with hydrochlorothiazide and verapamil, respectively. During follow up until 48 weeks patients treated with verapamil reached the target blood pressure more often and at lower doses and were less likely to switch to combination treatment than patients randomised to hydrochlorothiazide treatment. Adding verapamil to hydrochlorothiazide was more effective than the addition of hydrochlorothiazide to verapamil. At the end of the study 42 out of 169 (25%) and 73 out of 163 (45%) patients initially randomised to hydrochlorothiazide and verapamil, respectively, were at target blood pressure without combination treatment. After adding verapamil to hydrochlorothiazide or hydrochlorothiazide to verapamil an additional 58 (34%) and 29 (18%) patients reached the target blood pressure, respectively. Altogether 92 out of 332 (28%) patients failed to achieve target blood pressure with regimen V. There were four, 10, seven, and seven withdrawals due to possible adverse effects to treatment with hydrochlorothiazide, verapamil, combining verapamil with hydrochlorothiazide, and combining hydrochlorothiazide with verapamil, respectively. CONCLUSIONS--In doses currently used in antihypertensive treatment verapamil was more effective than hydrochlorothiazide as a single agent and in combination in mild to moderate hypertension, whereas withdrawal rates caused by side effects possibly related to treatment were similar.     

生物反馈联合电刺激在女性盆底功能障碍性疾病治疗中的临床应用

目的:分析生物反馈联合电刺激对女性盆底功能障碍性疾病(PFD)的治疗效果。方法:选择2011年1月至2016年3月我院收治的1000例PFD患者为研究对象,按随机数字表法分为实验组和对照组,每组各500例。实验组给予生物反馈联合电刺激,对照组给予功能性电刺激治疗。比较两组治疗前后盆底肌肉肌力分级的变化,测定盆底功能相关指标的改善及患者治疗前后排尿情况。结果:治疗后2组盆底肌力分级均呈明显上升趋势(Z=52.587,37.581;P0.001),且观察组改善效果优于对照组(Z=27.588,P0.001);治疗后实验组盆底肌肉肌力正常率高于对照组,差异有统计学意义(x~2=68.323,P0.05);治疗后实验组最大收缩压、持续收缩压提升幅度较大,膀胱颈移动度明显减小,与对照组各项指标对比差异有统计学意义(P0.05),且治疗后两组排尿情况均有所好转,实验组效果优于对照组(P0.05)。结论:生物反馈联合电刺激对女性PFD具有较好的效果,能提高患者盆底最大收缩压、持续收缩压,减小膀胱颈移动度,改善患者排尿功能。     

Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study.

OBJECTIVE--To determine the long term effects of relaxation therapy on 24 hour ambulatory intra-arterial blood pressure in patients with mild untreated and uncomplicated hypertension. DESIGN--Four week screening period followed by randomisation to receive either relaxation therapy or non-specific counselling for one year. Ambulatory intra-arterial blood pressure was measured before and after treatment. SETTING--Outpatient clinic in Amsterdam''s university hospital. SUBJECTS--35 Subjects aged 20-60 who were being treated by general practitioners for hypertension but were referred to take part in the study. At three consecutive screening visits all subjects had a diastolic blood pressure without treatment of 95-110 mm Hg. Subjects were excluded if they had damaged target organs, secondary hypertension, diabetes mellitus, a cholesterol concentration greater than 8 mmol/l, or a history of malignant hypertension. INTERVENTIONS--The group allocated to relaxation therapy was trained for eight weeks (one hour a week) in muscle relaxation, yoga exercises, and stress management and continued exercising twice daily for one year with monthly visits to the clinic. The control group had the same attendance schedule but had no training and were requested just to sit and relax twice a day. All subjects were asked not to change their diet or physical activity. MAIN OUTCOME MEASURE--Changes in ambulatory intra-arterial blood pressure after one year of relaxation therapy or non-specific counselling. RESULTS--Mean urinary sodium excretion, serum concentration of cholesterol, and body weight did not change in either group. Diastolic pressures measured by sphygmomanometry were 2 and 3 mm Hg lower in subjects in the relaxation group and control group respectively at the one year follow up compared with initial readings. The mean diastolic ambulatory intra-arterial pressure during the daytime had not changed after one year in either group, but small treatment effects could not be excluded: the mean change for the relaxation group was -1 mm Hg (95% confidence interval -6 to 3.9 mm Hg) and for the control group -0.4 mm Hg (-5.3 to 4.6 mm Hg). Mean ambulatory pressure in the evening also had not changed over the year, and in both groups nighttime pressure was 5 mm Hg higher. The variability in blood pressure was the same at both measurements. CONCLUSIONS--Relaxation therapy was an ineffective method of lowering 24 hour blood pressure, being no more beneficial than non-specific advice, support, and reassurance--themselves ineffective as a treatment for hypertension.     

Beneficial effects of angiotensin converting enzyme inhibition on renal function in patients with diabetic nephropathy.

The effects of angiotensin converting enzyme inhibition with captopril were investigated in patients with diabetic nephropathy and hypertension. After nine days'' treatment with captopril glomerular filtration rate was unchanged in 13 patients, whereas renal plasma flow had increased from 265 to 302 ml/min/1.73 m2 body surface area (p less than 0.05) and the filtration fraction had decreased from 14.3 to 12.8% (p less than 0.025). During two years'' treatment with captopril in 14 patients the mean arterial blood pressure had fallen by 5 mm Hg (p less than 0.005) and the deterioration in glomerular filtration rate had decreased from 10.3 to 2.4 ml/min/year (p less than 0.005). There was no correlation between the fall in blood pressure and the reduction in the deterioration of glomerular filtration rate. These findings suggest that the effects of angiotensin converting enzyme inhibition on renal haemodynamics protect renal function. Inhibitors of angiotensin converting enzyme should be considered for lowering blood pressure in patients with diabetic nephropathy.     

Effects of Olanzapine–Fluoxetine Combination Treatment of Major Depressive Disorders on the Quality of Life During Acute Treatment Period

The objective of the study was to explore the effects of olanzapine–fluoxetine combination (OFC) treatment of major depressive disorders on the quality of life in the acute treatment period. Methods were prospective and observational design. One hundred and three patients of major depressive disorders were observed. One group of 53 patients received OFC treatment (OFC group); the other group of 50 patients received the treatment of duloxetine (duloxetine group). Two groups were needed to be observed 8 weeks. Observed indicators were Hamilton Depression Rating Scale for Depression (HAMD-24) and four factor scores: the slow, sleep disorders, anxiety/somatization, and hopelessness, Clinical Global Impression-Severity of Illness (CGI-S), WHO quality of life scale (WHOQOL-BREF), and sub-rate measurements. HAMD-24 and four factor scores observation time were assessed before and after treatment; 1, 2, 4, 8 weeks, WHOQOL-BREF score, and sub-time measurements were assessed before treatment and 8 weeks after treatment. HAMD-24 scores of OFC patients in the first week were significantly lower than those of the duloxetine group. The sleep factor scores of OFC patients were significantly lower than those of the duloxetine group in 4 and 8 weeks. By the end of 8 weeks, OFC group was rated significantly lower than the duloxetine group in the physical area. In the acute treatment period, OFC treatment effected faster than the single duloxetine in patients with major depressive disorders. OFC effected within 1 week and was better than the single duloxetine in improving the sleep and physical conditions.     

心包剥离术对老年慢性缩窄性心包炎患者ANF与ET的影响

目的:探讨心包剥离术对老年慢性缩窄性心包炎心钠素(ANF)与内皮素(ET)变化的影响。方法:收集我院收治的慢性缩窄性心包炎患者66例,随机分为对照组和实验组,每组各33例,患者均给予相应治疗,对照组给予相应强心、扩血管药物,实验组患者行心包剥离术,治疗结束后,对所有患者的ANF、ET、血压以及临床治疗效果进行检测并比较。结果:与治疗前相比,治疗后两组患者ANF、ET、舒张压以及脉压水平均下降,收缩压水平升高(P0.05);与对照组相比,实验组患者ANF、ET、舒张压以及脉压水平较低,收缩压水平较高(P0.05);实验组患者治疗总有效率较高(P0.05)。结论:心包剥离术能够降低慢性缩窄性心包炎患者ANF、ET、舒张压以及脉压水平,升高收缩压水平,临床疗效较好,对临床有指导意义。     

Influence of maternal obesity on subcutaneous fat in the newborn.

Skinfold thickness measurements were made at biceps, triceps, subscapular, and suprailiac sites on both sides on 265 full-term newborn infants. The mothers were classified as thin (25), normal (179), or obese (61) on the basis of their triceps skinfold thicknesses. At all skinfold sites the babies of the obese mothers were significantly fatter than the babies of normal mothers, and the babies of the normal mothers were significantly fatter than those of the thin mothers. There was a highly significant positive correlation between maternal triceps thickness and the baby''s sum of skinfold thicknesses. Hypertension was common during the pregnancies of the obese mothers and was associated with a significant reduction in the babies'' skinfold thicknesses. When each of the 61 obese mothers were matched for parity, blood pressure, and smoking habit with 61 non-obese mothers the babies of the obese mothers still had significantly greater skinfold thicknesses than the babies of non-obese mothers.     

Long-term follow-up of a hypertension screening program.

Of 185 people found to be hypertensive in a shopping centre screening program who went to their physician and had medication prescribed, then were contacted 18 months later, 33 had discontinued the medication at their physician''s request. But of 152 who were to continue taking medication 139 (91.4%) had complied. Blood pressure had decreased to less than 160 mm Hg systolic or less than 95 mm Hg diastolic, or both, in 65.1% of the 152; was 160 to 169 mm Hg systolic or 95 to 99 mm Hg diastolic, or both, in 13.8%; was mildly or moderately decreased but still above 169 mm Hg systolic or 99 mmHg diastolic, or both, in 8.6%; and was higher than before the onset of treatment in 3.9%. Adequacy of blood pressure control was not related to age, sex, initial blood pressure values, awareness before the screening of having hypertension, or treatment for hypertension before the screening. Diuretics had been prescribed for 93.5% of the 139 patients, most often as single-pill combinations with other antihypertensive agents.     

贝那普利联合氨氯地平对高血压患者降压效果、血压变异性及心功能的影响

目的:探讨贝那普利联合氨氯地平对高血压患者降压效果、血压变异性(BPV)及心功能的影响。方法:选取2015年2月～2018年12月期间西安交通大学医学院附属三二〇一医院收治的131例高血压患者,根据随机数字表法分为对照组(n=65)和研究组(n=66),对照组患者给予氨氯地平治疗,研究组在对照组基础上联合贝那普利治疗。比较两组患者治疗后的降压效果、BPV以及心功能指标,记录两组患者治疗期间不良反应情况。结果:两组患者治疗4个月后收缩压(SBP)、舒张压(DBP)均下降,且研究组低于对照组(P0.05)。两组患者治疗4个月后24 h收缩压变异性(24hSBPV)、白天收缩压变异性(dSBPV)、24h舒张压变异性(24hDBPV)、白天舒张压变异性(dDBPV)均下降,且研究组低于对照组(P0.05),而夜间收缩压变异性(nSBPV)、夜间舒张压变异性(nDBPV)比较差异无统计学意义(P0.05)。两组患者治疗4个月后A峰速度、A/E峰值均下降,且研究组低于对照组(P0.05)。两组患者治疗4个月后E峰速度、EF值均升高,且研究组高于对照组(P0.05)。两组不良反应发生率比较无差异(P0.05)。结论:贝那普利联合氨氯地平治疗高血压患者的降压效果确切,可有效改善患者BPV及心功能,且安全性较好。     

Leaf water potentials measured with a pressure chamber

Leaf water potentials were estimated from the sum of the balancing pressure measured with a pressure chamber and the osmotic potential of the xylem sap in leafy shoots or leaves. When leaf water potentials in yew, rhododendron, and sunflower were compared with those measured with a thermocouple psychrometer known to indicate accurate values of leaf water potential, determinations were within ± 2 bars of the psychrometer measurements with sunflower and yew. In rhododendron. water potentials measured with the pressure chamber plus xylem sap were 2.5 bars less negative to 4 bars more negative than psychrometer measurements.

The discrepancies in the rhododendron measurements could be attributed, at least in part, to the filling of tissues other than xylem with xylem sap during measurements with the pressure chamber. It was concluded that, although stem characteristics may affect the measurements, pressure chamber determinations were sufficiently close to psychrometer measurements that the pressure chamber may be used for relative measurements of leaf water potentials, especially in sunflower and yew. For accurate determinations of leaf water potential, however, pressure chamber measurements must be calibrated with a thermocouple psychrometer.

     

Measuring blood pressure in the elderly: does atrial fibrillation increase observer variability?

OBJECTIVE--To compare the interobserver and intraobserver variability of blood pressure measurements in geriatric patients in atrial fibrillation and in sinus rhythm. DESIGN--Prospective assessment of blood pressure measurements carried out in random order in two groups of elderly patients by five doctors unaware of the aims of the study. SETTING--Acute assessment wards for geriatric medicine, Cardiff Royal Infirmary. PATIENTS--50 Elderly patients in sinus rhythm and 50 in atrial fibrillation. MAIN OUTCOME MEASURES--Interobserver and intraobserver variability of blood pressure measurements in the two groups expressed as the coefficient of variability and compared by the Mann-Whitney U test. RESULTS--Interobserver variability was significantly greater in the patients with atrial fibrillation for both systolic and diastolic pressures. Intraobserver variability was significantly greater in the atrial fibrillation group for diastolic pressures but the difference was not significant for systolic pressures. These differences were not related to pulse rate, age, or level of blood pressure. CONCLUSIONS--The findings suggest that in the presence of atrial fibrillation physicians'' interpretations of Korotkoff sounds are less uniform, which may have important clinical implications. Possibly a standardised methodology may overcome this problem.     

Lack of effect of oral magnesium on high blood pressure: a double blind study.

Seventeen unselected patients with mild to moderate essential hypertension and whose average supine blood pressure after two months'' observation with no treatment was 154/100 mm Hg were entered into a double blind randomised crossover study of one month''s treatment with magnesium aspartate (15 mmol magnesium/day) and treatment with placebo for a further month. This preparation of magnesium was well tolerated and did not cause diarrhoea. Despite a significant increase in plasma magnesium concentration and a significant increase in urinary excretion of magnesium while taking magnesium aspartate there was no fall in blood pressure compared with either treatment with placebo or values before treatment. The results provide no evidence for a role of dietary magnesium in the regulation of high blood pressure and are contrary to recent speculations.     

Bicycle seat interface pressure: reliability, validity, and influence of hand position and workload

Bicycle seat pressure is often examined by researchers exploring solutions for reducing seat injuries as it is thought a critical determinant; however, a reliable and valid methodology for this undertaking has not been reported. The current study was designed to address this shortcoming and to establish baseline interface pressure measurements for females and males. Participants completed two separate identical bicycle ergometer trials at 118 W in the tops and drops and at 300+/-82.4 W in top handlebar positions. Seat pressures were quantified from a pressure-sensing mat and the validity of the pressure system was examined through the relationship between known seat weights and the sum of seat pressures. Within trial intraclass correlation coefficients (ICCs) ranged between 0.90 and 0.99 and the between trial ICC values ranged between 0.02 and 0.96. The relationship (Pearson correlation coefficient) between seat weight and the sum of pressures was 0.97. Significant peak pressures were 39% greater in the 118 W top than 300 W top handlebar condition and 29% greater than the 118 W drop handlebar condition (p < 0.05). The gender comparison revealed that significant male peak pressure values were greater (24%) and that female values were less influenced by the hand position factor. Select within trial pressure measurements were found to be reliable during pedaling and valid statically. Additionally, the results indicated that workrate and hand position were factors influencing seat pressure and that males and females responded differently to adjustments of these factors.     

Effectiveness of a program to improve hypertension screening in primary care.

OBJECTIVE: To evaluate the effectiveness of a program to improve hypertension screening practices in primary care. DESIGN: Retrospective quasi-experimental study. SETTING: Two hospital-based family medicine centres (FMCs). PATIENTS: In the study FMC, two study groups of randomly selected adult patients: 425 who visited the FMC before implementation of the screening improvement program (from Apr. 1, 1983, to Mar. 31, 1984) and 418 who visited it afterward (from Apr. 1, 1986, to Mar. 31, 1987). These patients were matched with 392 and 442 control patients respectively seen during the same time frames at the second FMC. INTERVENTIONS: Educational sessions for physicians to standardize blood pressure measurement and knowledge of the recommendations from the Canadian Hypertension Society on hypertension screening and diagnosis, and specific operational incentives to improve hypertension screening, including a reference guide placed in each physician''s office, a coloured form for recording blood pressure measurements placed in every patient''s chart and a follow-up and recall card file. MAIN OUTCOME MEASURE: Frequency of blood pressure measurements recorded in patient charts. RESULTS: The hypertension screening rate was 60% per year in the study group before program implementation and 79% in the study group afterward; the corresponding rates in the two control groups were 72% and 59% (p < 0.0001). Patients were more likely to be screened if they visited the physician for a periodic health examination than for other problems (e.g., psychosocial or dermatologic) and if they had a scheduled appointment rather than no appointment. Physician characteristics that were positive predictors of screening were low age, female sex and payment on a salary basis. CONCLUSION: Physician education and incentives are effective in improving hypertension screening practices in hospital-based FMCs without incurring additional costs or other use of resources. Further evaluation of such a program should be undertaken in other primary care settings.     

Contrasting effects of enalapril and metoprolol on proteinuria in diabetic nephropathy.

OBJECTIVE--To assess whether angiotensin converting enzyme inhibition reduces proteinuria in diabetic nephropathy more than blood pressure reduction with other antihypertensive treatment. DESIGN--Prospective, open randomised study lasting eight weeks in patients with diabetic nephropathy. SETTING--Outpatient nephrology clinics. PATIENTS--40 Patients with type I diabetes and diabetic nephropathy with reduced renal function. INTERVENTION--Antihypertensive treatment with enalapril or metoprolol, usually combined with frusemide. MAIN OUTCOME MEASURES--Arterial blood pressure and urinary excretion of albumin and protein. RESULTS--Arterial blood pressure after eight weeks was 135/82 (SD 13/7) mm Hg in the group given enalapril and 136/86 (16/12) mm Hg in the group given metoprolol. Proteinuria and albuminuria were similar in both groups before randomisation. After eight weeks'' treatment, the geometric mean albumin excretion was 0.7 (95% confidence interval 0.5 to 1.2) g/24 h in the patients given enalapril and 1.6 (1.1 to 2.5) g/24 h in the patients given metoprolol (p less than 0.02). The proteinuria was 1.1 (0.7 to 1.7) and 2.4 (1.6 to 3.6) g/24 h respectively (p less than 0.02). CONCLUSIONS--Antihypertensive treatment with enalapril reduced proteinuria in patients with diabetic nephropathy more than an equally effective antihypertensive treatment with metoprolol. This points to a specific antiproteinuric effect of the angiotensin converting enzyme inhibitor independent of the effect on systemic blood pressure.