Recombinant human erythropoietin stimulates tubular reabsorption of sodium in anesthetized rabbits

To determine whether recombinant human erythropoietin (rHuEPO) exerts a direct vasoconstrictive effect on renal arteries or affects renal function, we measured renal hemodynamics and renal function during a 30-min intrarenal infusion of rHuEPO in anesthetized rabbits without renal failure. Intrarenal infusion of rHuEPO at a rate of 100 U/min did not alter mean arterial pressure, renal blood flow, or renal vascular resistance, as compared with controls treated with vehicle. There were no significant rHuEPO-associated changes in glomerular filtration rate, filtration fraction, or arterial hematocrit. However, urine volume, urinary excretion of sodium and potassium, and fractional sodium excretion were significantly reduced by intrarenal infusion of rHuEPO. These observations indicate that rHuEPO has no direct effects on mean arterial pressure or renal hemodynamics, but that it stimulates net tubular sodium reabsorption, and reduces urine volume and urinary excretion of sodium and potassium in anesthetized rabbits without renal failure.

Pressor effect of recombinant human erythropoietin: results of ambulatory blood pressure monitoring and home blood pressure measurements

We investigated whether treatment of anemic hemodialysis patients with a low dose of recombinant human erythropoietin (erythropoietin) for a short period would increase their blood pressure. Ambulatory blood pressure monitoring and home blood pressure measurements were used to detect minute increase in blood pressure. Thirty-two patients with a hematocrit of 25% or less received erythropoietin at the dose of 4500 IU/week, by the intravenous route for 8 weeks. Erythropoietin increased the hematocrit from 20.9 +/- 2.1 to 26.2 +/- 2.1%. Erythropoietin elevated mean ambulatory blood pressure by 5 mmHg or more in two-thirds of patients (n = 20; pressor group), while it elevated home mean blood pressure by 5 mmHg or more in one-third of patients (n = 11). An increase in clinic mean blood pressure by more than 5 mmHg was observed only in one-fourth of patients (n = 7). Circadian variation of blood pressure (nocturnal fall and diurnal rise) had been attenuated in the patients of the pressor group before erythropoietin treatment and erythropoietin decreased the nocturnal fall of blood pressure further more. Erythropoietin elevated nocturnal blood pressure more than diurnal blood pressure. Therefore, the increase in blood pressure induced by erythropoietin was detected more reliably by ambulatory blood pressure monitoring. There was no relation between the change in hemoglobin concentration and the increase in ambulatory blood pressure induced by erythropoietin. Erythropoietin tended to decrease cardiac output and plasma volume while it increased total peripheral resistance. It also decreased plasma norepinephrine and vasopressin levels but did not affect other humoral factors. Although the pressor effect of erythropoietin treatment for 8 weeks at the dose of 4500 IU/week was not evident on clinic blood pressure measurements, any increase in blood pressure determined by ambulatory blood pressure should be treated carefully to reduce the risk of a cardiovascular complication in patients receiving hemodialysis.

Muscle cramps and elevated serum creatine phosphokinase levels induced by beta-adrenoceptor blockers

We have assessed the propensity of beta-adrenoceptor blockers to cause muscle cramps and to raise the serum creatine phosphokinase (CPK) level in 78 patients with essential hypertension. After a control period, a beta-adrenoceptor blocker without intrinsic sympathomimetic activity (ISA; propranolol, metoprolol or arotinolol) was administered for three months. Thereafter, the patients were randomised to receive a beta-adrenoceptor blocker with ISA (pindolol or carteolol) for three months or a beta-adrenoceptor blocker without ISA for a further three months. This pattern was continued until all beta-adrenoceptor blockers had been given. At the end of each period, CPK and CPK-MB levels were measured. Of the 78 subjects, muscle cramps occurred in 27 during treatment with pindolol and 32 during treatment with carteolol. No complaints were made by subjects treated with propranolol and arotinolol, but muscle cramps were reported in 2 treated with metoprolol. While muscle cramps were caused both by pindolol and carteolol in 16 subjects, they were caused by either of these drugs in the remainder of the subjects. Muscle cramp occurred mainly in the calves when the patients were in bed at night. Serum CPK and CPK-MB levels increased significantly during treatment with pindolol (control period vs pindolol, CPK = 96 vs 133 IU.ml-1, CPK-MB = 14 vs 18 IU.ml-1) or carteolol (CPK = 117 IU.ml-1, CPK-MB = 18 IU.ml-1) while the levels during treatment with propranolol, arotinolol and metoprolol did not change from those in the control period.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of graded calcium infusions on rhythmic blood pressure oscillations in normal man

This study was designed to determine whether calcium contributes to the regulation of rhythmic oscillations in blood pressure. Six normal subjects received sequential 1-h infusions of calcium gluconate (1.5, 3.0 and 4.5 mg calcium/kg/h) during continuous blood pressure (Finapres) monitoring. The plasma ionized calcium ([Ca2+]) concentration increased from 4.6 +/- 0.07 mg/dl to 5.97 +/- 0.20 mg/dl (p < 0.01) with infusion. The mid-frequency (0.07-0.14 Hz, Mayer wave) power spectrum of diastolic blood pressure was depressed slightly following the first dose but increased significantly following the final dose (p < 0.05). The high-frequency (0.15-0.40 Hz) power spectrum of systolic blood pressure decreased following the first dose (p < 0.05) and subsequently remained low. The low-frequency (0.02-0.6 Hz) power spectrum was not affected. These results demonstrate that graded hypercalcaemia affects blood pressure oscillations in man. Our data suggest that the amplitude of the Mayer wave, a clinical marker of sympathetic vascular tone, is modulated in part by calcium.

Compliance with long-term dietary salt restriction in hypertensive outpatients

Eighty hypertensive outpatients were recruited for a dietary salt restriction program to examine long-term compliance. Twenty-four-hour urine samples were collected repeatedly (7.9 +/- 2.6 times, mean +/- s.d.) during a follow-up period of 6.4 +/- 1.7 years. After initial urine collection, nutritional education was carried out by dietitians to reduce dietary salt intake to 8 g/day or less. After every urine collection, the subjects were given advice by doctors on salt restriction, if necessary. The mean 24-hour urinary salt excretion (U-NaCl) and the mean urinary salt/creatinine ratio (U-NaCl/U-Cr) varied considerably both among and within individuals. U-NaCl/U-Cr, but not U-NaCl, in females was significantly higher than that in males, and in middle-aged subjects than in young subjects. U-NaCl and U-NaCl/U-Cr tended to decrease in the summer. In spite of the repeated educational effort, neither U-NaCl nor U-NaCl/U-Cr was different in the first control samples from that in the last samples. When 57 subjects were divided into three groups according to the urinary salt excretion level, U-NaCl was consistently higher during a follow-up period in the high-salt excretion group than in the mid-salt excretion group, while U-NaCl in the low-salt excretion group was initially lower than, but finally similar to, that in the mid-salt excretion group. These results suggest that: (1) multiple 24-hour urine samplings are required to assess urinary salt excretion in individuals; (2) the influence of age and sex should be taken into account in interpreting U-NaCl/U-Cr; and (3) it seems difficult to achieve long-term dietary salt restriction as a non-pharmacologic treatment of hypertension in an outpatient clinic.

Ultrasonic diagnosis of renal cell carcinoma in hemodialysis patients

From April 1985 to December 1992 abdominal ultrasonic examination was performed in 1,603 hemodialysis patients at our hospital. Renal cell carcinoma was found in 41 patients (2.6%), confirmed by nephrectomy as well as histology. This rate was 32 times greater than that of the general population (22 patients with renal cell carcinoma were detected among 27,933 at our health care center). Renal cell carcinoma was found in 18 patients with a contracted kidney, 19 with acquired cystic disease of the kidney and 4 with a native kidney after renal transplantation. Among 19 patients with acquired cystic disease of the kidney 8 had unilateral multiple tumors and 5 bilateral multiple tumors. The detection rate of renal cell carcinoma was 100% by ultrasonography, 67% by computerized tomography and 56% by angiography. Ultrasonography was the most accurate examination for the diagnosis of renal cell carcinoma in hemodialysis patients.

Synthesis of an immunologically active analog of thymic humoral factor-gamma 2 with enhanced enzymatic stability

Acetyl-thymic humoral factor-gamma 2 chloromethyl ketone [Ac-Leu-Glu-Asp-Gly-Pro-Lys-Phe-Leu-CH2Cl], an analog of thymic humoral factor-gamma 2, was synthesized and studied for its immunological effects on the impaired blastogenic response of T-lymphocytes isolated from uremic patients. Synthetic thymic humoral factor-gamma 2 and the synthetic acetyl-thymic humoral factor-gamma 2 chloromethyl ketone both restored the impaired blastogenic response of T-lymphocytes of uremic patients. However, the synthetic thymic humoral factor-gamma 2 is susceptible to proteolytic digestion. On the other hand, the synthetic acetylthymic humoral factor-gamma 2 chloromethyl ketone retained activity and was shown to exhibit a high degree of stability when incubated in human serum, These results indicate that N-terminal acetylation and the introduction of a chloromethyl ketone residue into the C-terminal residue of thymic humoral factor-gamma 2 increase resistance to proteolytic degradation by exopeptidases without loss of immunological activity.

Indoxyl-beta-D-glucuronide, the primary emitter of low-level chemiluminescence in plasma of hemodialysis patients

Characteristic light emission induced by the oxidation of hydroxyl radicals has been found in plasma of hemodialysis patients (Agatsuma et al., Clin Chem 1992;38:48-55). We purified a primary emitter, a chemiluminescent component peaking at 430 nm, by anion-exchange chromatography and reversed-phase HPLC. By using proton nuclear magnetic resonance and authentic indoxyl compounds, we determined the primary emitter to be indoxyl-beta-D-glucuronide. Absorption and fluorescence spectra of the purified sample coincided well with those of authentic indoxyl-beta-D-glucuronide, as did the peak in the chemiluminescence emission spectrum. Retention time of the purified sample on reversed-phase HPLC, measured by fluorescence, was also in accordance with that of indoxyl-beta-D-glucuronide. To our knowledge, this is the first identification of a primary emitter of low-level chemiluminescence from a biological source.

Indoxyl-beta-D-glucuronide, the primary emitter of low-level chemiluminescence in plasma of hemodialysis patients

Characteristic light emission induced by the oxidation of hydroxyl radicals has been found in plasma of hemodialysis patients (Agatsuma et al., Clin Chem 1992;38:48-55). We purified a primary emitter, a chemiluminescent component peaking at 430 nm, by anion-exchange chromatography and reversed-phase HPLC. By using proton nuclear magnetic resonance and authentic indoxyl compounds, we determined the primary emitter to be indoxyl-beta-D-glucuronide. Absorption and fluorescence spectra of the purified sample coincided well with those of authentic indoxyl-beta-D-glucuronide, as did the peak in the chemiluminescence emission spectrum. Retention time of the purified sample on reversed-phase HPLC, measured by fluorescence, was also in accordance with that of indoxyl-beta-D-glucuronide. To our knowledge, this is the first identification of a primary emitter of low-level chemiluminescence from a biological source.

Syntheses and immunological effects of thymic humoral factor-gamma 2 and its Phe7-substituted analogues

Thymic humoral factor-gamma 2 and five analogues modified at position 7 with various phenylalanine derivatives were synthesized by a solid-phase method. The synthetic peptides were tested for their effects on the impaired blastogenic response of phytohaemagglutin-stimulated T-lymphocytes of uraemic patients with infectious diseases. The synthetic thymic humoral factor-gamma 2 enhanced the blastogenic response of T-lymphocytes in the blood of the two patients tested. Of the synthetic peptides, [4-fluoro-Phe7]thymic humoral factor-gamma 2 exhibited the most potent effect.

Accuracy and performance of the Terumo ES-H51, a new portable blood pressure monitor

A high performance portable automatic sphygmomanometer, the Terumo ES-H51 (104 g, 58 x 22 x 92 mm), was newly developed for clinical use as a substitute for auscultation using a mercury sphygmomanometer. This device usually displays blood pressure (BP) values obtained by the Korotkoff sound method (K-method). However, when the device judges that BP values obtained by the K-method are inaccurate or unreliable, it substitutes automatically BP values obtained by the cuffoscillometric method (O-method). The accuracy and reliability of the device was tested by comparing it to the auscultation with the standard mercury sphygmomanometer. The mean difference between BP values obtained by the standard method and those obtained by the K-method were -0.7 +/- 2.9 mm Hg systole (mean +/- SD) and -0.3 +/- 2.6 mm Hg diastole, whereas the difference between the former and those obtained by the O-method were 0.3 +/- 5.7 mm Hg systole and 0.3 +/- 4.3 mm Hg diastole (n = 170). The agreement between the BP values obtained according to each of the two methods using the device and the standard method was within 5 mm Hg for 72% to 93% of both systolic and diastolic readings. Therefore, BP values measured by the ES-H51 are accurate. The ES-H51 is sufficiently small and light to be carried easily anywhere. The objective and reproducible BP information obtained by the present device would be useful in clinical practice.

[A case of intracerebral tuberculoma: clinical characteristics and MRI findings]

A case of intracerebral tuberculoma treated surgically was reported. A 47-year-old man was admitted to our hospital because of progressive left hemiaparesis over the previous 5 months. A computerized tomography scan showed a well enhanced mass associated with a marked perifocal edema. T1 weighted magnetic resonance imaging (MRI) revealed an isosignal ring around the heterogenous low intensity mass. A low intensity area just interior to this ring was also visualized both in T1 and T2 weighted images. Although the clinical course was unusually long, this was diagnosed as a metastatic brain tumor. He underwent a right frontal craniotomy and a well circumscribed, yellowish, firm mass was totally extirpated. Pathohistologically, this mass was considered to be a tuberculoma though the tuberculous bacilli could not be identified in Ziehl-Neelsen staining. His hemiplegia improved much and his ambulation was restored. Since tuberclomas are quite rare in developed countries, the diagnosis of intracerebral tuberculomas would be extremely difficult unless tuberculosis was verified in some other organs. The auxiliary examinations even by using MRI have often given little information which would assist diagnosis. However, based on pathological findings, the ring appearance and low intensity area medial to the ring in the outer part of the tuberculoma shown in MRI of our patient seemed to represent a chronic granulomatous inflammation and gave a clue to rule out the suspicion of metastatic brain tumors. To make a correct diagnosis of intracerebral tuberculomas, multidisciplinary consideration is mandatory.

Pressor effect of recombinant human erythropoietin: results of home blood pressure measurements in hemodialysis patients

We investigated whether the treatment of anemic hemodialysis patients with a low dose of recombinant human erythropoietin (rHEpo) for a short period would increase the blood pressure (BP). Home BP measurements were used to detect minute increases in BP. Fifty-one anemic patients on maintenance hemodialysis with a hematocrit of 25% or less received rHEpo at the dose of 4500 IU/week by the intravenous route for 8 weeks. Overall, rHEpo did not increase the BP whether measured at home or in the clinic (causal BP). Hemoglobin concentration increased significantly from 7.1 +/- 0.7 to 8.8 +/- 0.7 g/dl. Patients were classified into two groups according to the change in mean (M) home BP induced by rHEpo: a pressor group (delta MBP > or = 5 mmHg, n = 17) and a non-pressor group (delta MBP < 5 mmHg, n = 34). The hemoglobin concentration rose significantly in both groups, but there was no change in casual BP. Home blood pressure measurements showed a gradual and continuous rise in BP in the pressor group, but not in the non-pressor group. Patients administered antihypertensive medications before rHEpo treatment accounted for 88% of the former and 50% of the latter groups. Two patients with malignant nephrosclerosis were included in the pressor group. The findings indicate that rHEpo, even given at a low dose for a short period, elevates the BP, as determined by home BP measurement, but not by casual measurements obtained in the clinic.

[Ultrasonic diagnosis of renal cell carcinoma in hemodialysis patients]

Abdominal ultrasonic examination (US) was performed in 1556 patients on hemodialysis for 7 years and 6 months from April 1955 to September 1992. Renal cell carcinoma (RCC) proved histologically by operation was found in 36 patients (41 kidneys). Among the 36, RCC developed from the contracted kidney in 15, the individual kidney after renal transplantation in 3, and from ACDK (acquired cystic disease of the kidney) in 18. Among the 18 (ACDK), multiple tumors were found in the unilateral kidney in 8 and in bilateral kidney in 5. RCC was detected at the rate of 2.3% in patients on hemodialysis (1 out of 43). It was 29 time as high as in healthy persons (RCC was found in 22 out of 27933 at our Health Check-up Center, 0.079%). RCC was diagnosed 100% by US, 68% by CT, and 55% by angiography. US is the most excellent examination for the diagnosis of RCC in patients on hemodialysis.

[Long-term artificial ventilation by nasal intermittent positive pressure ventilation; 6 cases of domiciliary assisted ventilation]

Six patients with chronic respiratory failure associated with hypercapnia were treated with nasal intermittent positive pressure ventilation (NIPPV) at home. NIPPV was delivered via a custom molded nasal interface described by McDermott. The patients consisted of one patient with kyphoscoliosis, three with Tb-sequela, one with COPD, and one with neuromuscular disease. Each patient had been treated with oxygen therapy until assisted ventilation was initiated because of CO2 retention. NIPPV was administered using a volume cycled flow generator set to deliver a minute volume such that PaCO2 was maintained between 35 and 45 Torr on NIPPV trial performed during wakefulness under the condition of no leakage from the mask. Supplementary oxygen was added so that oxygen saturation was maintained above 90 percent during more than 95% of nighttime NIPPV. Arterial blood gas tensions during daytime spontaneous breathing showed an improvement (PaCO2 68.3 +/- 7.2 Torr, PaO2 70.4 +/- 15.5 Torr, SaO2 91.6 +/- 4.3% before treatment; PaCO2 55.8 +/- 4.7 Torr, PaO2 87.5 +/- 16.5 Torr, SaO2 95.5 +/- 1.7% on treatment, mean +/- SD). The duration of NIPPV at home ranged from 2 to 24 months (11.7 +/- 6.8), and there was no hospitalization due to exacerbation during this period. In conclusion, NIPPV via a custom molded mask is simple, noninvasive, and suitable for the provision of long-term and domiciliary assisted ventilation.

[A case of gliosarcoma associated with large cyst]

A case of gliosarcoma with a large cyst is reported. A 22-year-old female was admitted to our hospital with complaints of blurred vision and headache. Plain skull x-ray films showed a radiolucent area in the right frontal area. Computed tomography (CT) revealed an iso-dense mass in the right frontal lobe with a large cyst. After administration of contrast medium, the solid part and cyst wall were well enhanced and the content of the cyst was slightly enhanced. CT number of the cyst fluid was increased from 64.2 to 83.5 Hounsfield units, after administration of the contrast medium. Axial T1-weighted magnetic resonance image (MRI) revealed an iso-intense mass with marked enhancement by Gd-DTPA in the same area. A large cyst was shown to be located in the dorsal part of the mass. A small round protrusion, 10 mm in diameter, was found on the anterior portion of the mass on this MRI. Right carotid angiogram showed a tumor stain fed by the frontopolar artery. Right frontal lobectomy including the tumor was carried out with a preoperative diagnosis of glioblastoma. The patient received radiation therapy of 60Gy (whole brain 40Gy; focal 20Gy) and chemotherapy postoperatively. Histologically, necrosis, hemorrhage and endothelial hyperplasia were revealed at the tumor lesion. The tumor was composed of proliferation of glial and mesenchymal elements. The glial element appeared as fibrillary astrocytoma and polar spongioblastoma. The mesenchymal element showed sarcoma. As mentioned above, this tumor was diagnosed as gliosarcoma. It was difficult to make a diagnosis of gliosarcoma preoperatively because of the complex findings similar to malignant gliomas in conventional neuroradiological imaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Rhythmic oscillations of blood pressure and R-R interval in patients with chronic renal failure

Rhythmic blood pressure (BP) and R-R interval (R-R) oscillations at low-, mid- and high-frequency bands (LF: 0.02-0.06 Hz; MF: 0.07-0.14 Hz; HF: 0.15-0.40 Hz) were compared between uraemic patients maintained on haemodialysis and control subjects. The LF and MF power spectra of BP were attenuated more in patients than in controls. With subjects standing, the MF power spectrum of BP increased significantly in both groups. With subjects supine, the plasma norepinephrine concentration was higher, and its increment upon standing was greater in patients than in controls. Each R-R frequency power spectrum decreased more in patients than in control subjects. The HF power spectrum of R-R, i.e. a vagal tone index, systematically decreased upon standing in the control subjects but not in the patients. The linear coupling between BP and R-R oscillations was strongest in the HF band, decreasing in the MF and LF bands. Transfer function analysis indicated that, in uraemic patients, linear BP/R-R relationships were altered in the HF band but remained normal in the LF and MF bands. The present results suggest that, first, the decreased amplitude of Mayer waves, i.e. the MF power spectrum of BP, observed in uraemic patients can be attributed to low sensitivity of the vasculature to sympathetic stimuli, and, secondly, autonomic modulation of linear BP/R-R relationships is frequency-dependent.

Desmoplastic infantile ganglioglioma with extraparenchymatous cyst--case report

A large supratentorial tumor associated with an extraparenchymatous cyst and multiloculated intraparenchymatous cysts occurred in a 14-month-old infant. This case had all the characteristic features of desmoplastic infantile ganglioglioma both clinically and histologically. The notable difference was the extraparenchymatous cyst. The extraparenchymatous cyst was probably caused by entrapment of cerebrospinal fluid in the subarachnoid space by some check-valve mechanism because the leptomeninges were commonly involved in the tumor. A similar mechanism may explain the etiology of the intraparenchymatous, disproportionately large cyst in desmoplastic infantile gangliogliomas.

[The effects of intrarenal infusion of recombinant human erythropoietin on renal hemodynamics and renal function in anesthesized rabbits]

To determine whether recombinant human erythropoietin (rHuEPO) has direct effect on mean arterial pressure or renal function, rHuEPO was infused intrarenally at a rate of 100 U min-1 for 30 min in anesthetized rabbits without renal failure. Intrarenal infusion of rHuEPO resulted in no change in mean arterial pressure, renal blood flow, or renal vascular resistance as compared with vehicle control. rHuEPO also produced no significant change in glomerular filtration rate, filtration fraction, or arterial hematocrit. However, urine volume, urinary excretion of sodium and potassium, and fractional sodium excretion were significantly reduced by intrarenal infusion of rHuEPO. These observations demonstrate that rHuEPO has no direct effects on mean arterial pressure or renal hemodynamics, whereas rHuEPO stimulates net tubular sodium reabsorption possibly by direct tubular action, and reduces urine volume and urinary excretion of sodium and potassium in anesthetized rabbits without renal failure.

Plasma concentrations of immunoreactive-endothelin in patients with chronic renal failure treated with recombinant human erythropoietin

1. Elevation of blood pressure is one of the major side effects of recombinant human erythropoietin therapy in haemodialysis patients. 2. We investigated the possible involvement of endothelin in the pathogenesis of this recombinant human erythropoietin-induced blood pressure elevation in 51 patients undergoing maintenance haemodialysis. 3. Blood haemoglobin level increased from 7.1 +/- 0.1 to 8.8 +/- 0.1 g/dl (means +/- SEM) after 8 weeks of treatment with recombinant human erythropoietin (3000-4500 units/week). An increase in mean blood pressure was found in 19 patients (37%) (n = 9, by 0-10 mmHg; n = 10, by > 10 mmHg). 4. Plasma immunoreactive-endothelin concentration significantly increased from 2.26 +/- 0.18 to 3.14 +/- 0.31 pmol/l in the 10 patients whose mean blood pressure increased by more than 10 mmHg (P < 0.05), but not in the other patients. Moreover, the increase in plasma immunoreactive-endothelin concentration showed a significant positive correlation with the change in mean blood pressure in 19 patients with elevated mean blood pressure (r = 0.47, P < 0.05). 5. There was no significant correlation between the change in plasma immunoreactive-endothelin concentration and the change in blood haemoglobin level or the change in body weight. 6. These results suggest the possibility that endothelin may contribute to the recombinant human erythropoietin-related rise in blood pressure in some haemodialysis patients.

Effect of slow release nifedipine tablets in patients with essential hypertension

The antihypertensive effect of slow release nifedipine (CAS 21829-25-4) tablets (20 mg, Adalat) administered once or twice daily was studied in patients with essential hypertension of WHO stage I or II. Ambulatory blood pressure was monitored by a finger volume oscillometric device every 5 min for 24 h before and during the treatment with nifedipine. Whether administered once or twice daily, nifedipine tablets dit not change the pattern of circadian blood pressure variation; i.e. diurnal rise and nocturnal fall. Twice daily administration induced a significant downward shift in the blood pressure pattern. In other words, further hypotensive effect was observed during the night when the blood pressure was already low. On the other hand, administration once daily in the morning lowered daytime blood pressure without affecting blood pressure during the night. The duration of action of nifedipine tablets administered once daily was 12 h or more. In the acute experiment using 20 mg tablets of nifedipine, plasma concentration of nifedipine was well correlated with the percentage change in mean blood pressure. The minimal effective plasma concentration of nifedipine was estimated to be 13.4 ng/ml. However, in chronic treatment, nifedipine lowered blood pressure at the plasma concentration of 10 ng/ml. The results indicate that nifedipine tablets administered once daily provide an effective antihypertensive regimen for controlling daytime hypertension with minimal antihypertensive effect during the night.