Franco Veglio

Università degli Studi di Torino, Torino, Piedmont, Italy

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Publications (303)911.92 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to investigate the short-term blood pressure (BP) variability (BPV) derived from ambulatory blood pressure monitoring (ABPM) in patients with primary aldosteronism (PA), either idiopathic hyperaldosteronism (IHA) or aldosterone-producing adenoma (APA), in comparison with patients with essential hypertension (EH) and normotensive (NT) controls. Thirty patients with PA (16 with IHA and 14 with APA), 30 patients with EH, and 30 NT controls, matched for sex, age, body mass index, and antihypertensive therapy, were studied. The standard deviation (SD) of 24-hour, daytime, and nighttime BP; 24-hour weighted SD of BP; and 24-hour BP average real variability were not different between patients with PA and those with EH (P=not significant). All BPV indices were higher in patients with PA, either IHA or APA subtypes, and patients with EH, compared with NT controls (P<.001 to P<.05). ABPM-derived short-term BPV is increased in patients with PA, and it may represent an additional cardiovascular risk factor in this disease. The role of aldosterone excess in BPV has to be clarified. ©2015 Wiley Periodicals, Inc.
    Journal of Clinical Hypertension 04/2015; DOI:10.1111/jch.12551 · 2.96 Impact Factor
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    ABSTRACT: Primary aldosteronism (PA) is associated with a high rate of cardio- and cerebrovascular complications and metabolic alterations. PA is also recognized as the most frequent, although often unrecognized, secondary form of hypertension. Guidelines have been released to assist clinicians in the diagnostic work-up and subtype differentiation of PA. In this review we discuss and compare the available guidelines in the context of our professional experience and evaluate diagnostic and therapeutic aspects that are still a matter of debate.
    High Blood Pressure & Cardiovascular Prevention 04/2015; DOI:10.1007/s40292-015-0084-5
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    ABSTRACT: Patients with autonomic failure are characterized by orthostatic hypotension, supine hypertension, high blood pressure variability, blunted heart rate variability, and often have a "non-dipping" or "reverse dipping" pattern on 24-h ambulatory blood pressure monitoring. These alterations may lead to cardiovascular and cerebrovascular changes, similar to the target organ damage found in hypertension. Often patients with autonomic failure are on treatment with anti-hypotensive drugs, which may worsen supine hypertension. The aim of this review is to summarize the evidence for cardiac, vascular, renal, and cerebrovascular damage in patients with autonomic failure.
    Clinical Autonomic Research 03/2015; DOI:10.1007/s10286-015-0275-0 · 1.86 Impact Factor
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    ABSTRACT: The prevalence of orthostatic hypotension (OH) in hypertensive patients ranges from 3 to 26%. Drugs are a common cause of non-neurogenic OH. In the present study, we retrospectively evaluated the medical records of 9242 patients with essential hypertension referred to our Hypertension Unit. We analysed data on supine and standing blood pressure values, age, sex, severity of hypertension and therapeutic associations of drugs, commonly used in the treatment of hypertension. OH was present in 957 patients (10.4%). Drug combinations including α-blockers, centrally acting drugs, non-dihydropyridine calcium-channel blockers and diuretics were associated with OH. These pharmacological associations must be administered with caution, especially in hypertensive patients at high risk of OH (elderly or with severe and uncontrolled hypertension). Angiotensin-receptor blocker (ARB) seems to be not related with OH and may have a potential protective effect on the development of OH.Journal of Human Hypertension advance online publication, 29 January 2015; doi:10.1038/jhh.2014.130.
  • European Heart Journal – Cardiovascular Imaging 12/2014; 15 Suppl 2:ii165-ii167. · 2.65 Impact Factor
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    ABSTRACT: Essential hypertension arises from the combined effect of genetic and environmental factors. A pharmacogenomics approach could help to identify additional molecular mechanisms involved in its pathogenesis. The aim of SOPHIA study was to identify genetic polymorphisms regulating blood pressure response to the angiotensin II receptor blocker, losartan, with a whole-genome approach. We performed a genome-wide association study on blood pressure response in 372 hypertensives treated with losartan and we looked for replication in two independent samples. We identified a peak of association in CAMK1D gene (rs10752271, effect size -5.5 ± 0.94 mmHg, p = 1.2 × 10(-8)). CAMK1D encodes a protein that belongs to the regulatory pathway involved in aldosterone synthesis. We tested the specificity of rs10752271 for losartan in hypertensives treated with hydrochlorothiazide and we validated it in silico in the GENRES cohort. Using a genome-wide approach, we identified the CAMK1D gene as a novel locus associated with blood pressure response to losartan. CAMK1D gene characterization may represent a useful tool to personalize the treatment of essential hypertension. Original submitted 7 May 2014; Revision submitted 29 July 2014.
    Pharmacogenomics 09/2014; 15(13):1643-52. DOI:10.2217/pgs.14.119 · 3.43 Impact Factor
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    ABSTRACT: Context: Adrenal vein sampling (AVS) is the only reliable means to distinguish between aldosterone producing adenoma and bilateral adrenal hyperplasia, the two most common subtypes of primary aldosteronism (PA). AVS protocols are not standardized and vary widely between centers. Objective: To retrospectively investigate whether the presence of contralateral adrenal (CL) suppression of aldosterone secretion was associated with improved postoperative outcomes in patients who underwent unilateral adrenalectomy for PA. Setting: The study was carried out in 8 different referral centers in Italy, Germany and Japan. Patients: From 585 consecutive AVS in patients with confirmed PA, 234 procedures met the inclusion criteria and were used for the subsequent analyses. Results: Overall, 82% of patients displayed contralateral suppression. This percentage was significantly higher in ACTH stimulated compared to basal procedures (90% vs 77%). CL ratio was inversely correlated with aldosterone level at diagnosis and, amongst AVS parameters, with lateralization index (p=0.02 and 0.01, respectively). The absence of contralateral suppression was not associated with a lower rate of response to adrenalectomy in terms of both clinical and biochemical parameters and patients with CL suppression underwent a significantly larger reduction in aldosterone levels after adrenalectomy. Conclusions: For patients with lateralizing indices of > 4 (which comprised the great majority of subjects in this study), CL suppression should not be required to refer patients to adrenalectomy, since it is not associated with a larger blood pressure reduction after surgery and might exclude patients from curative surgery.
    Journal of Clinical Endocrinology &amp Metabolism 08/2014; DOI:10.1210/jc.2014-2345 · 6.31 Impact Factor
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    ABSTRACT: The risk of thoracic aortic dissection is strictly related to the diameter of the ascending aorta. Arterial hypertension represents a major risk factor for the development of aortic dissection and is thought to be directly involved in the pathogenesis of aortic aneurysms. Recent studies have suggested a high prevalence of aortic root enlargement in the hypertensive population, but evidence of a direct link between blood pressure values and size of the aortic root has been inconclusive so far. The aim of the current study was to evaluate prevalence of aortic root dilatation (ARD) in the hypertensive population and to assess the correlates of this condition.
    Journal of Hypertension 06/2014; 32(10). DOI:10.1097/HJH.0000000000000286 · 4.22 Impact Factor
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    ABSTRACT: Patients with autonomic failure experience orthostatic hypotension (OH) often leading to syncope. Arrhythmias may cause severe syncope, characterized by an increased risk of mortality. We report two cases of patients with primary autonomic neuropathy suffering from both severe OH and arrhythmic syncope.
    Clinical Autonomic Research 05/2014; DOI:10.1007/s10286-014-0246-x · 1.86 Impact Factor
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    ABSTRACT: Arterial hypertension and cancer are two of the most important causes of mortality in the world; correlations between these two clinical entities are complex and various. Cancer therapy using old (e.g. mitotic spindle poisons) as well as new (e.g. monoclonal antibody) drugs may cause arterial hypertension through different mechanisms; sometimes the increase of blood pressure levels may be responsible for chemotherapy withdrawal. Among newer cancer therapies, drugs interacting with the VEGF (vascular endothelial growth factors) pathways are the most frequently involved in hypertension development. On the other hand, many retrospective studies have suggested a relationship between antihypertensive treatment and risk of cancer, raising vast public concern. The purposes of this brief review have then been to analyse the role of chemotherapy in the pathogenesis of hypertension, to summarize the general rules of arterial hypertension management in this field and finally to evaluate the effects of antihypertensive therapy on cancer disease. © 2013 Wiley Periodicals, Inc.
    International Journal of Cancer 05/2014; 134(10). DOI:10.1002/ijc.28334 · 5.01 Impact Factor
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    ABSTRACT: Primary aldosteronism comprises subtypes that need different therapeutic strategies. Adrenal vein sampling is recognised by Endocrine Society guidelines as the only reliable way to correctly diagnose the subtype of primary aldosteronism. Unfortunately, despite being the gold-standard procedure, no standardised procedure exists either in terms of performance or interpretation criteria. In this Personal View, we address several questions that clinicians are presented with when considering adrenal vein sampling. For each of these questions we provide responses based on the available evidence, and opinions based on our experience. In particular, we discuss the most appropriate way to prepare the patient, whether adrenal vein sampling can be avoided for some subgroups of patients, the use of ACTH (1-24) during the procedure, the most appropriate criteria for interpretation of adrenal vein cannulation and lateralisation, the use of contralateral suppression, and strategies to improve success rates of adrenal vein sampling in centres with little experience.
    05/2014; DOI:10.1016/S2213-8587(14)70069-5
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    ABSTRACT: Volume overload is typical of haemodialysis patients; correct volume status evaluation is crucial in achieving blood pressure homeostasis, hypertension management and good treatment planning. This study evaluates the effect of acute volume depletion on ultrasonographic parameters and suggests two of them as able to predict patients volume overload. 27 patients with end stage renal disease treated with haemodialysis underwent a complete echocardiographic exam before, after 90 min and at the end of the dialysis. Blood pressure levels significantly drop during the first 90 min of dialysis (139 ± 20 vs 126 ± 18; p < 0.0001), reaching a steady state with significantly lower values compared to baseline (130 ± 28; p = 0.02). LV and left atrial volume significantly decreased (baseline vs end dialysis 98 ± 32 vs 82 ± 31 p = 0.003 and 28 ± 10 vs. 21 ± 9 cc/m(2) p < 0.001). A significant reduction of systolic function (EF 61.6 % ± 9 vs 58.7 % ± 9 p = 0.04), of diastolic flow velocities (E/A 1.13 ± 0.37 vs. 0.87 ± 0.38 p < 0.001) and mitral annulus TDI tissue velocity (i.e. E' lat 10.6 ± 3 vs. 9.4 ± 3 cm/s; p 0.0001) were observed. Stroke work (SW) and LV end-diastolic diameter (LVEDd) indexed to height 2.7(LVEDdi) were able to predict volume overload: cut off values of respectively 13.5 mm/m(2.7) for LVEDdi and 173 cJ for SW were able to predict with a specificity of 100 % the presence of a volemic overload of at least 4 %. Blood pressure, cardiac morphology and function are significantly modified by acute volume depletion and such variations are strictly interrelated. SW and LVEDd/height(2.7) may identify ESRD patients carrying an higher volume load.
    High Blood Pressure & Cardiovascular Prevention 02/2014; 21(4). DOI:10.1007/s40292-014-0045-4
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    ABSTRACT: A correct diagnosis of primary aldosteronism (PA) requires adrenal venous sampling (AVS) for the classification of subtypes (bilateral hyperplasia, BAH, or adenoma, APA). Since such testing is not easily practicable, appropriate markers for the definition of subtypes are desirable. We hypothesized that an aldosterone excess was associated with abnormalities in urinary proteome, specific for PA subtypes. The project work was divided into 3 phases: (1) screening/identification by proteomic analysis and further characterization by RT-PCR and immunohistochemistry of the candidate protein; (2) clinical validation by quantitative ELISA assay of 57 (33 M, 24 F) PA patients and 50 normotensive controls (21 M, 29 F); (3) analysis of adrenal tissue of 8 individuals who had undergone adrenalectomy for APA or other adrenal tumors. The proteomic analysis showed a different expression of Serpin B3 Inhibitor-SCCA1 (SB3) in APA and BAH patients. Urine SB3 concentrations in normotensive controls, quantified by ELISA assay and normalized by urinary creatinine, resulted much lower in males (6.72 ng SB3 per mg creatinine, C.I. 4.43-10.19) than in females (20.56 ng SB3 per mg creatinine, C.I. 12.43-33.99, p < 0.00001). SB3 concentrations were not significantly different in males affected by different PA subtypes (BAH, n = 19 and APA, n = 14) compared with normotensive subjects (n = 21). In contrast, in PA females, SB3 was significantly higher in APA (n = 13) than in BAH patients (n = 11) or in normotensive controls (n = 29) (P < 0.01 and <0.05, respectively). Neither messenger RNA nor SB3 protein were identified in tissue obtained from adrenal tumors and from the surrounding normal gland. In conclusion urine SB3 concentrations are physiologically much lower in males than in females. Hypertensive women, affected by APA, present urinary SB3 concentrations significantly higher than women affected by BAH.
    Molecular BioSystems 02/2014; 10(6). DOI:10.1039/c3mb70538b · 3.18 Impact Factor
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    Journal of Clinical Hypertension 01/2014; 16(3). DOI:10.1111/jch.12251 · 2.96 Impact Factor
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    ABSTRACT: Aldosterone-producing adenomas (APAs) cause a sporadic form of primary aldosteronism and somatic mutations in the KCNJ5 gene, which encodes the G-protein-activated inward rectifier K(+) channel 4, GIRK4, account for ≈40% of APAs. Additional somatic APA mutations were identified recently in 2 other genes, ATP1A1 and ATP2B3, encoding Na(+)/K(+)-ATPase 1 and Ca(2+)-ATPase 3, respectively, at a combined prevalence of 6.8%. We have screened 112 APAs for mutations in known hotspots for genetic alterations associated with primary aldosteronism. Somatic mutations in ATP1A1, ATP2B3, and KCNJ5 were present in 6.3%, 0.9%, and 39.3% of APAs, respectively, and included 2 novel mutations (Na(+)/K(+)-ATPase p.Gly99Arg and GIRK4 p.Trp126Arg). CYP11B2 gene expression was higher in APAs harboring ATP1A1 and ATP2B3 mutations compared with those without these or KCNJ5 mutations. Overexpression of Na(+)/K(+)-ATPase p.Gly99Arg and GIRK4 p.Trp126Arg in HAC15 adrenal cells resulted in upregulation of CYP11B2 gene expression and its transcriptional regulator NR4A2. Structural modeling of the Na(+)/K(+)-ATPase showed that the Gly99Arg substitution most likely interferes with the gateway to the ion binding pocket. In vitro functional assays demonstrated that Gly99Arg displays severely impaired ATPase activity, a reduced apparent affinity for Na(+) activation of phosphorylation and K(+) inhibition of phosphorylation that indicate decreased Na(+) and K(+) binding, respectively. Moreover, whole cell patch-clamp studies established that overexpression of Na(+)/K(+)-ATPase Gly99Arg causes membrane voltage depolarization. In conclusion, somatic mutations are common in APAs that result in an increase in CYP11B2 gene expression and may account for the dysregulated aldosterone production in a subset of patients with sporadic primary aldosteronism.
    Hypertension 09/2013; 63(1). DOI:10.1161/HYPERTENSIONAHA.113.01733 · 7.63 Impact Factor
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    ABSTRACT: Objectives:to compare cardio- and cerebrovascular events in patients with primary aldosteronism (PA) and matched essential hypertensives (EH).Background:aldosterone plays a detrimental role on the cardiovascular system and PA patients display a higher risk of events compared to EH.Methods:We compared retrospectively the percentage of patients experiencing events at baseline and during a median follow-up of 12 years in 270 PA patients case-control matched 1:3 with EH patients, and in PA subtypes [aldosterone-producing adenoma, APA (n = 57); bilateral adrenal hyperplasia, BAH (n = 213)] versus matched EH.Results:a significantly higher number of PA patients experienced cardiovascular events over the entire period of the study (22.6% vs 12.7%, p<0.001). At diagnosis of PA a higher number of patients had experienced total events (14.1% vs 8.4% EH, p=0.007); further, during the follow-up period, PA patients had a higher rate of events (8.5% vs 4.3% EH, p=0.008). In particular, stroke and arrhythmias were more frequent in PA patients. During the follow-up a higher percentage of PA patients developed type 2 diabetes. Parameters that were independently associated with the occurrence of all events were age, duration of hypertension, systolic blood pressure, presence of diabetes mellitus and PA diagnosis. After division into PA subtypes, patients with either APA or BAH displayed a higher rate of events compared to matched EH.Conclusions:this study demonstrate in a large population of patients the pathogenetic role of aldosterone excess in the cardiovascular system and thus the importance of early diagnosis and targeted PA treatment.
    The Journal of Clinical Endocrinology and Metabolism 09/2013; 98(12). DOI:10.1210/jc.2013-2805 · 6.31 Impact Factor
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    ABSTRACT: According to recent hypertension guidelines, resistant hypertension is a clinical condition characterized by the presence of BP values above the recommended limits of the reference values (BP >140/90 mmHg). The prevalence of this clinical condition is about 10 % of the essential hypertensives. A proper diagnosis and management of resistant hypertension should go trough careful, mandatory clinical step, aimed at excluding the presence of pseudo-resistance hypertension. In this report, we summarized the practical recommendations are targeting both the general practitioner and the specialist who play an active role in the clinical management of patients with arterial hypertension.
    High Blood Pressure & Cardiovascular Prevention 08/2013; DOI:10.1007/s40292-013-0022-3
  • Alberto Milan, Sara Abram, Franco Veglio
    JAMA The Journal of the American Medical Association 07/2013; 310(2):204-5. DOI:10.1001/jama.2013.7973 · 30.39 Impact Factor
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    ABSTRACT: 6.16 Rapid Cortisol Assay during Adrenal Vein Sampling in Patients with Primary AldosteronismIntroduction. Adrenal vein sampling (AVS) is considered the ‘gold standard’ test to identify the subtypes of primary aldosteronism, the most frequent form of secondary hypertension. In fact imaging techniques (CT, RM and scintigraphy) have a low sensitivity and specificity in the diagnosis of surgically treatable forms of primary aldosteronism (PA).Technical difficulties with this procedure may be overcome by monitoring cortisol concentrations in the different sampling sites, during catheterization.Methods. We applied a rapid automated cortisol assay performed on a bench-top immunoassay analyzer near the operating suite during the catheterization procedures in sixteen patients with a confirmed PA. All patients further underwent a computed tomography scan of adrenal glands before AVS. A mean 7.8 samples (range, 5–13) were collected from vena cava as well as from right and left adrenal veins. ...
    High Blood Pressure & Cardiovascular Prevention 07/2013; 15(3):251-251. DOI:10.1007/BF03263663
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    ABSTRACT: The diagnosis of childhood hypertension based upon percentile tables proposed by the international guidelines is complex and often a cause of underdiagnosis, particularly among physicians who have not had specific training in the field of adolescent hypertension. The use of a simple and accurate screening test may improve hypertension diagnosis in adolescents. The aim of our study is to compare the different screening methods currently used in the literature to improve the diagnosis of childhood hypertension. We have conducted a cross-sectional population-based study of 1412 Caucasian adolescents among students of public junior high schools of Turin, Italy. In this population we have defined the hypertensive status with four different screening tests: BPHR, Somu's equations, Ardissino, and Kaelber methods. Finally, we compared the diagnostic accuracy of the 4 screening tests with the gold standard. Our analysis identifies in BPHR the test which combines ease of use and diagnostic accuracy.
    06/2013; 2013. DOI:10.5402/2013/107915

Publication Stats

4k Citations
911.92 Total Impact Points

Institutions

  • 1984–2015
    • Università degli Studi di Torino
      • • Department of Medical Science
      • • Dipartimento di Scienze Cliniche e Biologiche
      Torino, Piedmont, Italy
  • 2009
    • Ospedale San Giovanni Battista, ACISMOM
      Torino, Piedmont, Italy
  • 2007
    • Università Politecnica delle Marche
      • Department of Clinical and Experimental Medicine
      Ancona, The Marches, Italy
  • 2006
    • University of Padova
      • Department of Medicine DIMED
      Padova, Veneto, Italy
  • 2005
    • Ospedali Vito Fazzi
      Lecce, Apulia, Italy
  • 1994–2002
    • University of Camerino
      • Dipartimento di Medicina Sperimentale e Sanità Pubblica
      Camerino, The Marches, Italy
  • 1995–1999
    • Sapienza University of Rome
      • Department of Cardiovascular, Respiratory, Nephrologic and Geriatric Sciences
      Roma, Latium, Italy