Publications (57) View all
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Article: Assessment and interpretation of blood pressure variability in a clinical setting.
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ABSTRACT: Blood pressure (BP) is characterized by marked fluctuations occurring within the 24 h as a result of complex interactions between behavioral, environmental, humoral, and neural central or reflex influences. Significant BP variations also occur over more prolonged periods of time (i.e. between days, weeks, months, seasons and even years), not as a random phenomenon but as a result of several interacting factors yet not completely identified. Depending on the method and time interval considered for measurement, the clinical significance and prognostic implications of different types of BP variability (BPV) may substantially differ. Either in the short or in the long term, BPV has been associated with development, progression and severity of cardiac, vascular and renal organ damage and with an increased risk of cardiovascular events and mortality, independently adding to cardiovascular risk, over and above the contribution of elevated mean BP levels. The present paper provides a review on the main methods currently employed for assessment of BPV as well as on the mechanisms, clinical interpretation and prognostic significance of different types of BPV, addressing the question on whether BPV should be a target for antihypertensive treatment for the current prevention of cardiovascular disease.Blood pressure 04/2013; · 1.26 Impact Factor -
Article: Acute high-altitude exposure reduces lung diffusion: Data from the HIGHCARE Alps Project.
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ABSTRACT: The causes and development of lung fluid, as well as the integrity of the alveolar-capillary membrane at high altitude, are undefined. This study was conceived to see whether fluid accumulates within the lung with acute high altitude exposure, and whether this is associated with alveolar capillary membrane damage. We studied lung carbon monoxide diffusion (DLco), its components-membrane diffusion (DM) and capillary volume (Vc)-and alveolar volume (Va) measured in 43 healthy subjects in Milan (122m) and after 1 and 3 days at Capanna Regina Margherita (4559m). DLCO measurement was adjusted for hemoglobin and inspired oxygen. We also measured plasma Surfactant derived Protein B (SPB) and Receptor of Advanced Glycation End-products (RAGE) as markers of alveolar-capillary membrane damage, and ultrasound lung comets as a marker of extravascular lung water. 21 subjects received acetazolamide and 22 placebo. Dlco was lower at Capanna Regina Margherita (day 1: 24.3±4.7mL/mmHg/min and day 3: 23.6±5.4), than in Milan (25.8±5.5; p<0.001 vs. day 1 and 3) due to Dm reduction (Milan: 50.5±14.6mL/mmHg/min, Capanna Regina Margherita day 1: 45.1±11.5, day 3: 43.2±13.9; p<0.05 Milan vs. day 3) with a partially compensatory Vc increase (Milan: 96±37mL, Capanna Regina Margherita day 1: 152±66, day 3: 153±59; p<0.001 Milan vs. day 1 and day 3). Acetazolamide did not prevent the fall in Dlco albeit, between day 1 and 3, such a trend was observed. Regardless of treatment lung comets increased from 0 to 7.2±3.6 (p<0.0001). SPB and RAGE were unchanged. Lung fluid increased at high altitude without evidence from plasma measurements, supporting alveolar-capillary damage. Clinical trial registration: Eudract Number [2010-019986-27].Respiratory Physiology & Neurobiology 04/2013; · 2.24 Impact Factor -
Article: Combined exercise training in postmenopausal women: implications for vascular hemodynamics.
Journal of Clinical Hypertension 04/2013; 15(4):221-3. · 1.83 Impact Factor -
Article: Assessment and management of blood-pressure variability.
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ABSTRACT: Blood pressure (BP) is characterized by marked short-term fluctuations occurring within a 24 h period (beat-to-beat, minute-to-minute, hour-to-hour, and day-to-night changes) and also by long-term fluctuations occurring over more-prolonged periods of time (days, weeks, months, seasons, and even years). Rather than representing 'background noise' or a randomly occurring phenomenon, these variations have been shown to be the result of complex interactions between extrinsic environmental and behavioural factors and intrinsic cardiovascular regulatory mechanisms. Although the adverse cardiovascular consequences of hypertension largely depend on absolute BP values, evidence from observational studies and post-hoc analyses of data from clinical trials have indicated that these outcomes might also depend on increased BP variability (BPV). Increased short-term and long-term BPV are associated with the development, progression, and severity of cardiac, vascular, and renal damage and with an increased risk of cardiovascular events and mortality. Of particular interest are the findings from post-hoc analyses of large intervention trials in hypertension, showing that within-patient visit-to-visit BPV is strongly prognostic for cardiovascular morbidity and mortality. This result has prompted discussion on whether antihypertensive treatment should be targeted not only towards reducing mean BP levels but also to stabilizing BPV with the aim of achieving consistent BP control over time, which might favour cardiovascular protection.Nature Reviews Cardiology 03/2013; 10(3):143-55. · 8.83 Impact Factor -
Article: Changes in Subendocardial Viability Ratio With Acute High-Altitude Exposure and Protective Role of Acetazolamide.
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ABSTRACT: High-altitude tourism is increasingly frequent, involving also subjects with manifest or subclinical coronary artery disease. Little is known, however, on the effects of altitude exposure on factors affecting coronary perfusion. The aim of our study was to assess myocardial oxygen supply/demand ratio in healthy subjects during acute exposure at high altitude and to evaluate the effect of acetazolamide on this parameter. Forty-four subjects (21 men, age range: 24-59 years) were randomized to double-blind acetazolamide 250 mg bid or placebo. Subendocardial viability ratio and oxygen supply/demand ratio were estimated on carotid artery by means of a validated PulsePen tonometer, at sea level, before and after treatment, and after acute and more prolonged exposure to high altitude (4559 m). On arrival at high altitude, subendocardial viability ratio was reduced in both placebo (from 1.63±0.15 to 1.18±0.17; P<0.001) and acetazolamide (from 1.68±0.25 to 1.35±0.18; P<0.001) groups. Subendocardial viability ratio returned to sea level values (1.65±0.24) after 3 days at high altitude under acetazolamide but remained lower than at sea level under placebo (1.42±0.22; P<0.005 versus baseline). At high altitude, oxygen supply/demand ratio fell both under placebo (from 29.6±4.0 to 17.3±3.0; P<0.001) and acetazolamide (from 32.1±7.0 to 22.3±4.6; P<0.001), its values remaining always higher (P<0.001) on acetazolamide. Administration of acetazolamide may, thus, antagonize the reduction in subendocardial oxygen supply triggered by exposure to hypobaric hypoxia. Further studies involving also subjects with known or subclinical coronary artery disease are needed to confirm a protective action of acetazolamide on myocardial viability under high-altitude exposure.Hypertension 02/2013; · 6.21 Impact Factor
