-
[show abstract]
[hide abstract]
ABSTRACT: Cardiovascular (CV) complications such as myocardial infarction, heart failure, stroke and renal failure are related to both the degree and the duration of blood pressure (BP) increase. Resistant hypertension (RH) is associated with a higher risk of CV complications and a higher prevalence of target organ damage (TOD). The relationship between CV disease and TOD can be bidirectional. Elevated BP in RH may cause CV structural and functional alterations, and the development or persistence of left ventricular hypertrophy, aortic stiffness, atherosclerotic plaques, microvascular disease and renal dysfunction, may render hypertension more difficult to control. Specifically, RH is related to several conditions, including obesity, sleep apnea, diabetes, metabolic syndrome and hyperaldosteronism, characterized by an overexpression of humoral and hormonal factors that are involved in the development and maintenance of TOD. Optimal therapeutic strategies, including pharmacological treatment and innovative invasive methodologies, have been shown to achieve adequate BP control and induce the regression of TOD, thereby potentially improving patient prognosis.Hypertension Research advance online publication, 18 April 2013; doi:10.1038/hr.2013.30.
Hypertension Research 04/2013; · 2.58 Impact Factor
-
Massimo Volpe, Enrico Agabiti Rosei,
Ettore Ambrosioni,
Santina Cottone,
Cesare Cuspidi,
Claudio Borghi,
Nicola De Luca,
Francesco Fallo,
Claudio Ferri,
Alberto Morganti,
Maria Lorenza Muiesan,
Riccardo Sarzani,
Leonardo Sechi,
Agostino Virdis,
Giuliano Tocci,
Bruno Trimarco,
Alessandro Filippi,
Giuseppe Mancia
[show abstract]
[hide abstract]
ABSTRACT: Observational clinical studies have demonstrated that only 30-40 % of patients with arterial hypertension achieve the recommended blood pressure goals (below 140/90 mmHg). In contrast, interventional trials consistently showed that it is possible to achieve effective blood pressure targets in about 70 % of treated hypertensive patients with different cardiovascular risk profiles, especially through the use of rational, effective and well tolerated combination therapies. In order to bridge the gap between current and desired blood pressure control and to achieve more effective prevention of cardiovascular diseases, the Italian Society of Hypertension (SIIA) has developed an interventional strategy aimed at reaching nearly 70 % of treated controlled hypertensive patients by 2015. This ambitious goal can be realistically achieved by a more rational use of modern tools and supports, and also through the use of combination therapy in hypertension in daily clinical practice, especially if this approach can be simplified into a single pill (fixed combination therapy), which is a therapeutic option now also available in Italy. Since about 70-80 % of treated hypertensive patients require a combination therapy based on at least two classes of drugs in order to achieve the recommended blood pressure goals, it is of key importance to implement this strategy in routine clinical practice. Amongst the various combination therapies currently available for hypertension treatment and control, the use of those strategies based on drugs that antagonize the renin-angiotensin system, such as angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and ACE inhibitors, in combination with diuretics and/or calcium channel blockers, has been shown to significantly reduce the risk of major cardiovascular events and to improve patient compliance to treatment, resulting in a greater antihypertensive efficacy and better tolerability compared with monotherapy. The present document of the Italian Society of Arterial Hypertension (SIIA) aims to gather the main indications for the implementation of combination therapy in the treatment of hypertension, in order to improve blood pressure control in Italy.
High Blood Pressure & Cardiovascular Prevention 03/2013;
-
The American journal of emergency medicine 02/2013; · 1.54 Impact Factor
-
Gianfranco Parati,
Stefano Omboni,
Angelo Compare,
Enzo Grossi,
Edward Callus,
Achille Venco,
Maurizio Destro,
Giuseppe Villa,
Paolo Palatini, Enrico Agabiti Rosei,
Simonetta Scalvini,
Stefano Taddei,
Dario Manfellotto,
Stefano Favale,
Carmine Matteis,
Michele Guglielmi
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient's therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated.Methods/design: The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension - both in the office and in ambulatory conditions over 24 h - and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n=84) or HBPT (n=168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (<135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome). DISCUSSION: The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients.Trial registration: Clinical Trials.gov: NCT01541566.
Trials 01/2013; 14(1):22. · 2.02 Impact Factor
-
Carolina de Ciuceis,
Claudia Rossini,
Enzo Porteri,
Elisa la Boria,
Claudia Corbellini,
Francesco Mittempergher,
Ernesto di Betta,
Beatrice Petroboni,
Annamaria Sarkar,
Claudia Agabiti-Rosei,
Claudio Casella,
Riccardo Nascimbeni,
Rita Rezzani,
Luigi F Rodella,
Francesca Bonomini, Enrico Agabiti-Rosei,
Damiano Rizzoni
[show abstract]
[hide abstract]
ABSTRACT: It is not known whether, in obesity, the capillary density or the number of circulating endothelial progenitor cells (EPCs) are reduced, or whether fibrosis of small vessels is also present. In addition, possible effects of weight reduction on these parameters have never been evaluated. Therefore, we investigated EPCs and capillary density in 25 patients with severe obesity, all submitted to bariatric surgery, and in 18 normotensive lean subjects and 12 hypertensive lean patients as controls. All patients underwent a biopsy of subcutaneous fat during bariatric surgery. In five patients, a second biopsy was obtained after consistent weight loss, about 1 year later, during a surgical intervention for abdominoplasty. EPCs and capillary density were reduced in obesity, and EPCs were significantly increased after weight reduction. Vascular collagen content was clearly increased in obese patients. No significant difference in vascular collagen was observed between normotensive obese patients and hypertensive obese patients. After pronounced weight reduction, collagen content was nearly normalized. No difference in stress-strain relation was observed among groups or before and after weight loss. In conclusion, our data suggest that microvascular rarefaction occurs in obesity. EPCs were significantly reduced in obese patients. Pronounced weight loss induced by bariatric surgery seems to induce a significant improvement of EPC number, but not of capillary rarefaction. A pronounced fibrosis of subcutaneous small resistance arteries is present in obese patients, regardless of the presence of increased blood pressure values. Consistent weight loss induced by bariatric surgery may induce an almost complete regression of microvascular fibrosis.
Blood pressure 01/2013; · 1.26 Impact Factor
-
Massimo Volpe,
Ettore Ambrosioni,
Claudio Borghi,
Santina Cottone,
Cesare Cuspidi,
Nicola De Luca,
Francesco Fallo,
Claudio Ferri,
Alberto Morganti,
Maria Lorenza Muiesan,
Riccardo Sarzani,
Leonardo Sechi,
Agostino Virdis,
Giuliano Tocci, Enrico Agabiti-Rosei,
Bruno Trimarco,
Alessandro Filippi,
Giuseppe Mancia
[show abstract]
[hide abstract]
ABSTRACT: Observational studies demonstrate that the proportion of treated hypertensive patients who attain the recommended blood pressure goals (140/90 mmHg) does not exceed 30-40%. Conversely, clinical trials have consistently shown that effective blood pressure control within the recommended targets can be achieved in 70-80% of treated hypertensive patients with different cardiovascular risk profile, especially when appropriate, effective and well tolerated combination therapies are used. In order to bridge the gap between current and optimal blood pressure control rates and to achieve a more effective cardiovascular prevention, the Italian Society of Hypertension has recently developed an interventional strategy that aims to approximate 70% of treated controlled patients by 2015. This ambitious goal can be realistically achieved by the appropriate use of modern aids and tools, also including the implementation of combination therapy, especially if this approach can be simplified into a single pill, now available in Italy. At present, 70-80% of hypertensive patients require combination therapies based on at least two classes of antihypertensive drugs to achieve the recommended blood pressure goals. It is therefore of paramount importance to implement this strategy in routine clinical practice. Among the different combination therapies, the use of combination strategies based on drugs inhibiting the renin-angiotensin system, such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, combined with diuretics and/or calcium-channel blockers, have demonstrated to significantly reduce the rates of major cardiovascular events and discontinuations from prescribed therapies, resulting in higher antihypertensive efficacy and better tolerability than monotherapy. The present document of the Italian Society of Hypertension aims to provide main indications for implementing combination therapy in the clinical management of hypertension in order to improve blood pressure control in Italy.
Giornale italiano di cardiologia (2006) 12/2012; 13(12):853-60.
-
Massimo Volpe, Enrico Agabiti-Rosei,
Ettore Ambrosioni,
Santina Cottone,
Cesare Cuspidi,
Claudio Borghi,
Nicola De Luca,
Francesco Fallo,
Claudio Ferri,
Giuseppe Mancia,
Alberto Morganti,
Maria Lorenza Muiesan,
Riccardo Sarzani,
Leonardo Sechi,
Giuliano Tocci,
Agostino Virdis
[show abstract]
[hide abstract]
ABSTRACT: Hypertension is responsible for a relevant burden of cardiovascular morbidity and mortality worldwide. Although several appropriate and integrated pharmacological strategies are available, blood pressure control still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on overall cardiovascular risk, since it significantly increases the risk of both macrovascular and microvascular complications. Hypertension is arbitrarily defined as "resistant" or "refractory" when recommended blood pressure goals (clinic blood pressure <140/90 mmHg, or <130/80 mmHg in patients with type 2 diabetes mellitus) are not achieved, despite changes in lifestyle and treatment with adequate doses of at least three antihypertensive drugs from different classes, including a diuretic. A new non-pharmacological option for the treatment of patients with resistant hypertension has recently become available. Renal sympathetic denervation is a minimally invasive procedure performed via femoral access that uses radiofrequency catheter ablation to disable renal sympathetic afferent and efferent nerves. It results in isolation of renal parenchymal and juxtaglomerular cells from the abnormal enhancement of renal adrenergic nerve activity. The present position paper of the Italian Society of Hypertension provides a diagnostic and therapeutic approach to the early identification and effective clinical management of patients with resistant hypertension, who may be candidates for renal denervation. These indications may have important implications not only from a clinical viewpoint but also from an economic perspective. The accurate identification of patients with resistant hypertension and the appropriate selection of patients eligible for this procedure may help improve blood pressure control and reduce the risk of cardiovascular and cerebrovascular complications in these patients.
Giornale italiano di cardiologia (2006) 12/2012; 13(12):846-52.
-
Massimo Volpe, Enrico Agabiti Rosei,
Ettore Ambrosioni,
Santina Cottone,
Cesare Cuspidi,
Claudio Borghi,
Nicola De Luca,
Francesco Fallo,
Claudio Ferri,
Giuseppe Mancia,
Alberto Morganti,
Maria Lorenza Muiesan,
Riccardo Sarzani,
Leonardo Sechi,
Giuliano Tocci,
Agostino Virdis
[show abstract]
[hide abstract]
ABSTRACT: Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications.Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below 140/90 mmHg or below 130/80 mmHg in patients with type 2 diabetes mellitus or nephropathy) are not achieved in the presence of a therapeutic strategy that includes lifestyle changes and at least three classes of antihypertensive drugs, including a diuretic, at adequate doses.Recently, an innovative non-pharmacological option has become available for treating resistant hypertension. Sympathetic denervation of renal arteries is a minimally invasive procedure that is performed via percutaneous access from the femoral artery. It consists of radiofrequency ablation of the afferent and efferent nerves of the renal sympathetic nervous system, with consequent isolation of renal parenchymal and juxtaglomerular structures from abnormal stimulation of the efferent adrenergic system.The present position paper of the Italian Society of Hypertension (SIIA) offers a diagnostic and therapeutic approach for the proper identification and effective clinical management of patients with resistant hypertension, who are candidates for renal artery denervation. These indications may have important implications not only from a clinical point of view, but also from an economic point of view, since a proper identification of patients with true resistant hypertension and an accurate selection of patients suitable for the procedure of renal denervation can contribute to an improved control of blood pressure, and thus a reduced risk of cardiovascular and cerebrovascular complications in these patients.
High Blood Pressure & Cardiovascular Prevention 12/2012; 19(4):237-44.
-
Maria Lorenza Muiesan,
Massimo Salvetti,
Damiano Rizzoni,
Anna Paini,
Claudia Agabiti-Rosei,
Carlo Aggiusti,
Fabio Bertacchini,
Deborah Stassaldi,
Alice Gavazzi,
Enzo Porteri,
Carolina De Ciuceis, Enrico Agabiti-Rosei
[show abstract]
[hide abstract]
ABSTRACT: The possible relationships between indicators of small resistance artery structure and of arterial stiffness and central hemodynamics have not yet been evaluated. Aim of this study was to assess the relationship between indicators of large arteries stiffness, including carotido-femoral pulse wave velocity and of vascular alterations in small resistance arteries (media/lumen ratio, M/L) in patients with primary and secondary hypertension. In 73 patients (mean age, 53±14 years, 34 females, 25 with type 2 diabetes mellitus, 18 never treated) with essential (n=37) and secondary (n=36) hypertension, carotido-femoral pulse wave velocity was measured. In all patients, small resistance arteries were dissected from subcutaneous fat biopsies and mounted on an isometric myograph, for the measurement of the M/L. Pulse wave analysis was performed in 67 patients. M/L ratio was significantly related to brachial systolic blood pressure and pulse pressure (r=0.36 and 0.31, P<0.001, respectively) and to central systolic and pulse pressure (r=0.44 and 0.42, P<0.001, respectively). A positive correlation was observed between M/L ratio and carotido-femoral pulse wave velocity (r=0.45; P<0.001); this correlation remained statistically significant after adjustment for age and mean blood pressure. M/L ratio was also associated to aortic augmentation index (r=0.33; P=0.008), and this correlations remained statistically significant after adjustment for potential confounders. In hypertensive patients, the presence of structural alterations of small resistance arteries may be associated with the increase in large arteries stiffness and possibly contribute to an increase in central pressure by increasing the magnitude of wave reflections.
Hypertension 11/2012; · 6.21 Impact Factor
-
Maria Lorenza Muiesan,
Ettore Ambrosioni,
Francesco Vittorio Costa,
Gastone Leonetti,
Achille Cesare Pessina,
Massimo Salvetti,
Bruno Trimarco,
Massimo Volpe,
Roberto Pontremoli,
Giacomo Deferrari, Enrico Agabiti Rosei
[show abstract]
[hide abstract]
ABSTRACT: AIM:: The aim of this study is to evaluate the differences in the prevalence of chronic kidney disease (CKD) and of cardiovascular risk factors and diseases between men and women participating in the Italy Developing Education and awareness on MicroAlbuminuria in patients with hyperteNsive Disease (I-DEMAND) study. METHODS:: This is an observational, cross-sectional, multicenter study aimed at assessing prevalence and correlates of CKD among Italian hypertensive patients attending out-patient referral clinics. CKD was defined as glomerular filtration rate (GFR) less than 60 ml/min per 1.73 m [Modification of Diet in Renal Disease (MDRD) study equation and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation] and/or urine albumin-to-creatinine ratio of at least 2.5 mg/mmol in men and of at least 3.5 mg/mmol in women or both. Left-ventricular hypertrophy (LVH) was diagnosed by either ECG or echocardiography. RESULTS:: A total of 3558 study patients with renal data available were considered for this analysis: mean age was 61 ± 4 years and 37% had diabetes mellitus. Female patients (n = 1636, 46%) were older, with a greater prevalence of obesity and lower prevalence of smoking. The prevalence of concomitant coronary artery and peripheral artery diseases, but not of hypertension, diabetes mellitus, or heart failure, was lower in women than in men. The overall prevalence of albuminuria (21 vs. 32%; P = 0.001) and of microalbuminuria (16 vs. 23%; P = 0.001) was lower in women than in men. In women the prevalence of a reduced GFR estimated by both MDRD (33 vs. 21%; P = 0.001) and CKD-EPI equations (32 vs. 23%; P = 0.001) was higher than in men. CKD prevalence was similar in women and men (44 vs. 41%; P = 0.095 and 43 vs. 43%; P = 0.475, respectively, when MDRD and CKD-EPI eGFR estimations were used). The prevalence of LVH (diagnosed by either ECG or echocardiography) was similar in men and women (18 vs. 20%; P = 0.12).The main independent determinants of CKD were age, glycemia, uricemia, pulse pressure, hypertension duration, and previous cardiovascular diseases in men, and increasing age, glycemia, uricemia, pulse pressure, and a lower BMI in women. CONCLUSION:: Renal abnormalities are present in a significant number of female hypertensive patients attending hypertension clinics. Prevalence of reduced eGFR and of microalbuminuria, associated risk factors, and clinical conditions are different between men and women, suggesting the need to develop specific therapeutic strategies to prevent renal dysfunction and reduce associated morbidity and mortality.
Journal of hypertension 11/2012; · 4.02 Impact Factor
-
Massimo Volpe,
Allegra Battistoni,
Giuliano Tocci, Enrico Agabiti Rosei,
Alberico L Catapano,
Rosanna Coppo,
Stefano del Prato,
Sandro Gentile,
Elmo Mannarino,
Salvatore Novo,
Domenico Prisco,
Giuseppe Mancia
[show abstract]
[hide abstract]
ABSTRACT: Cardiovascular risk assessment in the clinical practice is mostly based on risk charts, such as Framingham risk score and Systemic Coronary Risk Estimation (SCORE). These enable clinicians to estimate the impact of cardiovascular risk factors and assess individual cardiovascular risk profile. Risk charts, however, do not take into account subclinical organ damage, which exerts independent influence on risk and may amplify the estimated risk profile. Inclusion of organ damage markers in the assessment may thus contribute to improve this process.
Our aim was to evaluate the influence of implementation of SCORE charts with widely available indexes of organ damage, with the purpose to ameliorate individual risk assessment.
We searched www.Pubmed.gov for evidence about the predictive value of left ventricular hypertrophy (LVH), estimated glomerular filtration rate (eGFR), microalbuminuria (MAU) and metabolic syndrome on different risk profiles estimated by SCORE. Interventional and observational trials including at least 200 patients and published after 2000 were selected.
The presence of organ damage as well as the number of abnormal parameters indicating organ damage is associated with increased cardiovascular risk, independently of SCORE. In the area of high risk, the impact of different markers of organ damage is heterogeneous. Combined risk models of SCORE and subclinical organ damage have major impact on risk stratification and may impact on recommendation in primary prevention in all SCORE categories.
Available evidence suggests a tangible clinical advantage of adding the evaluation of simple organ damage markers to risk charts in cardiovascular risk prediction.
Journal of hypertension 06/2012; 30(6):1056-64. · 4.02 Impact Factor
-
Giuliano Tocci, Enrico Agabiti Rosei,
Ettore Ambrosioni,
Claudio Borghi,
Claudio Ferri,
Andrea Ferrucci,
Giuseppe Mancia,
Alberto Morganti,
Roberto Pontremoli,
Bruno Trimarco,
Alberto Zanchetti,
Massimo Volpe
[show abstract]
[hide abstract]
ABSTRACT: Blood pressure (BP) control is poorly achieved in hypertensive patients, worldwide.
We evaluated clinic BP levels and the rate of BP control in hypertensive patients included in observational studies and clinical surveys published between 2005 and 2011 in Italy.
We reviewed the medical literature to identify observational studies and clinical surveys on hypertension between January 2005 and June 2011, which clearly reported information on clinic BP levels, rates of BP control, proportions of treated and untreated patients, who were followed in different clinical settings (mostly in general practice, and also in outpatient clinics and hypertension centres).
The overall sample included 158 876 hypertensive patients (94 907 women, mean age 56.6 ± 9.6 years, BMI 27.2 ± 4.2 kg/m(2), known duration of hypertension 90.2 ± 12.4 months). In the selected studies, average SBP and DBP levels were 145.7 ± 15.9 and 87.5 ± 9.7 mmHg, respectively; BP levels were higher in patients followed in hypertension centres (n = 10 724, 6.7%; 146.5 ± 17.3/88.5 ± 10.3 mmHg) than in those followed by general practitioners (n = 148 152, 93.3%; 143.5 ± 13.9/84.8 ± 8.9 mmHg; P < 0.01). More than half of the patients were treated (n = 91 318, 57.5%); among treated hypertensive patients, only 31 727 (37.0%) had controlled BP levels.
The present analysis confirmed inadequate control of BP in Italy, independently of the clinical setting. Although some improvement was noted compared with a similar analysis performed between 1995 and 2005, these findings highlight the need for a more effective clinical management of hypertension.
Journal of hypertension 06/2012; 30(6):1065-74. · 4.02 Impact Factor
-
Damiano Rizzoni,
Enzo Porteri,
Sarah Duse,
Carolina De Ciuceis,
Claudia Agabiti Rosei,
Elisa La Boria,
Francesco Semeraro,
Ciro Costagliola,
Adolfo Sebastiani,
Paola Danzi,
Guido A M Tiberio,
Stefano M Giulini,
Franco Docchio,
Giovanna Sansoni,
Annamaria Sarkar, Enrico Agabiti Rosei
[show abstract]
[hide abstract]
ABSTRACT: Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media-to-lumen ratio, are frequently present in hypertensive and/or diabetic patients, and may represent the earliest alteration observed. Furthermore, media-to-lumen ratio of small arteries evaluated by micromyography has a strong prognostic significance; however, its extensive evaluation is limited by the invasivity of the assessment, since a biopsy of subcutaneous fat is needed. Noninvasive measurement of wall-to-lumen of retinal arterioles using scanning laser Doppler flowmetry (SLDF) has recently been introduced. However, this new technique has not yet been compared to micromyographic measurement, generally considered the gold standard approach.
We investigated 40 individuals and patients, 24 of them were hypertensive patients and 16 normotensive individuals. All patients underwent a biopsy of subcutaneous fat during an elective surgical intervention. Subcutaneous small resistance arteries were dissected and mounted on a wire myograph, and media-to-lumen ratio was measured. In addition, an evaluation of wall-to-lumen ratio of retinal arterioles by SLDF was performed (Heidelberg Retina Flowmeter, Heidelberg Engineering). A close correlation was observed between media-to-lumen ratio of subcutaneous small arteries and wall-to-lumen ratio of retinal arterioles (r = 0.76, P < 0.001; P < 0.001, r(2) = 0.57).
A noninvasive and easily repeatable procedure (intraobserver and interobserver variation coefficient <13%) such as an evaluation of the arterioles in the fundus oculi by SLDF may provide similar information regarding microvascular morphology compared with an invasive, accurate and prognostically relevant micromyographic measurement of media-to-lumen ratio of subcutaneous small arteries.
Journal of hypertension 04/2012; 30(6):1169-75. · 4.02 Impact Factor
-
Athanasios J. Manolis, Enrico Agabiti Rosei,
Antonio Coca,
Renata Cifkova,
Serap E. Erdine,
Sverre Kjeldsen,
Gregory Y.H. Lip,
Krzysztof Narkiewicz,
Gianfranco Parati,
Josep Redon,
Roland Schmieder,
Costas Tsioufis,
Giuseppe Mancia
[show abstract]
[hide abstract]
ABSTRACT: Hypertension is the most common cardiovascular disorder and atrial fibrillation is the most common clinically significant arrhythmia. Both these conditions frequently coexist and their prevalence increases rapidly with aging. There are different risk factors and clinical conditions predisposing to the development of atrial fibrillation, but due its high prevalence, hypertension is still the main risk factor for the development of atrial fibrillation. Several pathophysiologic mechanisms (such as structural changes, neurohormonal activation, fibrosis, atherosclerosis, etc.) have been advocated to explain the onset of atrial fibrillation. The presence of atrial fibrillation per se increases the risk of stroke but its coexistence with high blood pressure leads to an abrupt increase of cardiovascular complications. Different risk models are available for the risk stratification and the prevention of thromboembolism in patients with atrial fibrillation. In all of them hypertension is present and is an important risk factor. Antihypertensive treatment may contribute to reduce this risk, and it seems some classes are superior to others in the prevention of new-onset atrial fibrillation and prevention of stroke. Antithrombotic treatment with warfarin is effective in the prevention of thromboembolic events, although quite recently, new classes of anticoagulants that do not require international normalized ratio monitoring have been introduced with promising results.
Journal of Hypertension 01/2012; 30(2):239–252. · 4.02 Impact Factor
-
P Strazzullo,
G Cairella,
A Campanozzi,
M Carcea,
D Galeone,
F Galletti,
S Giampaoli,
L Iacoviello,
L Scalfi,
Gianvincenzo Barba, [......],
Giacinta Giacchetti,
Lorenzo Malatino,
Paolo Manunta,
Alberto Morganti,
Ermanno Rossi,
Riccardo Sarzani,
Franco Veglio,
Massimo Volpe,
Bruno Trimarco,
Simona Giampaoli
[show abstract]
[hide abstract]
ABSTRACT: Excess dietary sodium chloride (salt) intake is etiologically related to hypertension and cardiovascular disease (CVD). Moderate reduction of salt intake reduces blood pressure (BP) and is expected to contribute to reduce the risk of CVD. Previous community-based trials to reduce BP by means of salt reduction were very success-ful. The initial positive results of national strategies of dietary salt intake reduction in several European countries, driven by the initiative of the World Health Organisation (WHO) and non- (for SIPREC), Gaetano Lombardi and Franco Mantero (for SIE), Paolo Vitti (for AIT), Loris Borghi, Antonio Nouvenne, Francesca Mallamaci and Carmine Zoccali (for SIN), Licia Iacoviello (for SISET), Angelo Campanozzi (for SIGENP).
Nutrition, metabolism, and cardiovascular diseases: NMCD 01/2012; · 3.52 Impact Factor
-
Athanasios J Manolis, Enrico Agabiti Rosei,
Antonio Coca,
Renata Cifkova,
Serap E Erdine,
Sverre Kjeldsen,
Gregory Y H Lip,
Krzysztof Narkiewicz,
Gianfranco Parati,
Josep Redon,
Roland Schmieder,
Costas Tsioufis,
Giuseppe Mancia
[show abstract]
[hide abstract]
ABSTRACT: Hypertension is the most common cardiovascular disorder and atrial fibrillation is the most common clinically significant arrhythmia. Both these conditions frequently coexist and their prevalence increases rapidly with aging. There are different risk factors and clinical conditions predisposing to the development of atrial fibrillation, but due its high prevalence, hypertension is still the main risk factor for the development of atrial fibrillation. Several pathophysiologic mechanisms (such as structural changes, neurohormonal activation, fibrosis, atherosclerosis, etc.) have been advocated to explain the onset of atrial fibrillation. The presence of atrial fibrillation per se increases the risk of stroke but its coexistence with high blood pressure leads to an abrupt increase of cardiovascular complications. Different risk models are available for the risk stratification and the prevention of thromboembolism in patients with atrial fibrillation. In all of them hypertension is present and is an important risk factor. Antihypertensive treatment may contribute to reduce this risk, and it seems some classes are superior to others in the prevention of new-onset atrial fibrillation and prevention of stroke. Antithrombotic treatment with warfarin is effective in the prevention of thromboembolic events, although quite recently, new classes of anticoagulants that do not require international normalized ratio monitoring have been introduced with promising results.
Journal of hypertension 12/2011; 30(2):239-52. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Renal dysfunction is associated with an increased risk of cardiovascular events in hypertensive patients. Chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) are both independent prognostic factors for cardiovascular events. The relation between changes in renal function and/or cardiac structure with subsequent prognosis has not yet been definitely assessed, and the aim of this study was to evaluate the relationships between renal and cardiac target-organ damage not only at baseline but also during treatment, and their influence on cardiovascular prognosis in hypertensive patients.
Among 436 uncomplicated hypertensive individuals, 246 with a baseline and follow-up (last examination 68 ± 34 months apart) echocardiogram and creatinine measurements were followed for an additional 55 ± 29 months. All patients received treatment by their family doctor. After the last follow-up echocardiogram, a first major cardiovascular event occurred in 54 patients.
By multivariate Cox regression analysis, persistence and development of LVH from baseline to follow-up [adjusted hazard ratio 2.36, 95% confidence interval (CI) 1.03-3.68, P = 0.041] and persistence/development of CKD (estimated glomerular filtration rate according to the Modification of Diet in Renal Disease formula <60 ml/min) (adjusted hazard ratio 1.94, 95% CI 1.12-3.87, P = 0.021) from baseline to follow-up were identified as independent predictors of cardiovascular events.
This study indicates that in hypertensive patients free of cardiovascular disease, both persistence or development of a reduced renal function and of LVH represent independent prognostic factors of cardiovascular events.
Journal of hypertension 12/2011; 30(2):411-20. · 4.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media to lumen ratio, are frequently present in hypertensive and/or diabetic patients. However, the evaluation of microvascular structure is not an easy task. Among the methods that may be applied to humans, plethysmographic evaluation of small arteries and wire or pressure micromyography were extensively used in the last decades. Media to lumen ratio of small arteries evaluated by micromyography was demonstrated to possess a strong prognostic significance; however, its extensive evaluation is limited by the invasiveness of the assessment, since a biopsy of subcutaneous fat is needed. Non-invasive approaches were then proposed, including capillaroscopy, which provides information about microvascular rarefaction. Recently, the interest of investigators has focused on the retinal microvascular bed. In particular, a non-invasive measurement of wall thickness to internal lumen ratio of retinal arterioles using scanning laser Doppler flowmetry has been recently introduced. Preliminary data suggest a fairly good agreement between this approach and micromyographic measurements, generally considered the gold standard approach. Therefore, the evaluation of microvascular structure is progressively moving from bench to bedside, and it could represent, in the immediate future, an evaluation to be performed in all hypertensive patients, in order to obtain a better stratification of cardiovascular risk.
High Blood Pressure & Cardiovascular Prevention 12/2011; 18(4):169-77.
-
Internal and Emergency Medicine 11/2011; 7 Suppl 2:S135-7. · 2.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In cardiovascular and metabolic diseases, small resistance arteries may show the presence of structural alterations. In particular, in essential hypertension, an increased media-to-lumen ratio of subcutaneous small arteries with no change in the total amount of vascular wall tissue (eutrophic remodelling) has already been described several years ago. Similar alterations have been demonstrated also in patients with diabetes mellitus and obesity; in this case, however, a more evident contribution of vascular smooth muscle cell growth (hypertrophic remodelling) is present. This review addresses the effects of obesity on small resistance artery structure. Similar to diabetic patients, obese patients show an increased media-to-lumen ratio of subcutaneous small arteries, which appears associated with hypertrophic remodelling, as demonstrated by an increase in media cross-sectional area. Endothelial dysfunction evaluated as vasodilator response to acetylcholine has also been observed. Several studies have shown that increased media-to-lumen ratio of subcutaneous small resistance arteries possesses a prognostic significance in relation to cardiovascular outcome. Appropriate antihypertensive treatment may improve microvascular alterations both in essential hypertension and in type 2 diabetes mellitus. In obesity, a pronounced weight loss may improve microvascular structure. However, further studies are needed to elucidate the effects of other pharmacological and non-pharmacological interventions in obesity.
Basic & Clinical Pharmacology & Toxicology 08/2011; 110(1):56-62. · 2.18 Impact Factor
