G Cerasola

Università degli Studi di Palermo, Palermo, Sicily, Italy

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Publications (223)465.83 Total impact

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    ABSTRACT: Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects. We enrolled 611 hypertensive individuals (mean age: 52 ± 15 years; men 63%) consecutively attending our outpatient unit of Nephrology and Hypertension. Patients on dialysis treatment, with valvulopathy more than mild, bicuspid aortic valve, previous cardiovascular events and genetic aortic diseases were excluded. All the subjects underwent echocardiography. ARD was measured at the level of Valsalva's sinuses by M-mode tracings, under two-dimensional control. In line with the PAMELA study, ARD, ARD indexed to body surface area (ARD/BSA) and to height (ARD/H) were considered increased when they exceeded 3.8 cm, 2.1 cm/m2, 2.3 cm/m in men and 3.4 cm, 2.2 cm/m2, 2.2 cm/m in women, respectively. GFR was estimated by the CKD-EPI equation. The study population was categorized in seven groups: subjects without chronic kidney disease (no CKD) and subjects with increasing severity of CKD (1, 2, 3a, 3b, 4, 5), according to KDIGO classification. Estimated GFR (eGFR) was lower in subjects with values of ARD, ARD/BSA and ARD/H above the sex-specific cut-offs when compared to those with normal aortic root size (all p < 0.001). The analysis of the distribution ARD/BSA in subjects with and in those without CKD, showed a progressive increase of ARD/BSA from the group with normal renal function to the groups with greater severity of CKD (figure).eGFR correlated significantly with ARD (r = - 0.17), ARD/BSA (r = - 0.43) and ARD/H (r = - 0.40; all p < 0.001). The associations of eGFR with ARD/BSA (β= - 0.23) and ARD/H (β= - 0.17; all p < 0.001) held in linear multiple regression analyses, after adjustment for various confounding factors.(Figure is included in full-text article.) CONCLUSIONS:: Our study seems to suggest that a reduced renal function may adversely influence ARD. This may contribute to explain the enhanced cardiovascular risk associated with renal insufficiency.
    Journal of Hypertension 06/2015; 33 Suppl 1 - ESH 2015 Abstract Book:e15. DOI:10.1097/01.hjh.0000467390.20851.2a · 4.22 Impact Factor
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    ABSTRACT: The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30 mL/min/1.73 m(2) and 60 mL/min/1.73 m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities. © 2015 Wiley Periodicals, Inc.
    Journal of Clinical Hypertension 03/2015; DOI:10.1111/jch.12534 · 2.96 Impact Factor
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    ABSTRACT: Introductrion. Hepatic artery aneurysms (HAAs) are unusual vascular lesions often associated with many different pathological conditions. Most of reported cases are described in association with connective tissue diseases, such as polyarteritis nodosa and systemic lupus erythematosus. Case report. We observed a 52-year-old man with hypertension and HCV-related cryoglobulinemia complicated by end stage renal disease on replacement therapy by hemodialysis. He was admitted to our hospital because of the worsening of blood pressure values (170/110 mmHg) associated to new onset abdominal pain. After an initial physical examination, that showed a periumbelical bruit associated to a pulsatile mass in right hypocondrium, an abdominal ultrasound was performed with evidence of aneurysms of both the right branch (diameter max 4,5 cm) and the left branch (diameter max 1.5 cm) of the hepatic artery. An abdominal CT study was also performed and it confirmed the diagnosis of right intrahepatic artery aneurysm with partially thrombosed area in its peripheral distal portion. Discussion. Many different factors can contribute to the aneurysm formation in this patient. Vasculitic involvement due to cryoglobulinemic disease, therapy with steroid drugs, inflammatory state associated to HCV-related hepatitis, chronic kidney disease and replacement therapy by hemodialysis may all be involved in the development of the aneurysmatic hepatic lesion.
    Experimental and clinical cardiology 10/2014; 20(10):6484-6492. · 0.76 Impact Factor
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    ABSTRACT: For many years, it has been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance and hyperuricemia. This constellation of various conditions has been transformed from a pathophysiological concept to a clinical entity, which has been defined metabolic syndrome (MetS). The consequences of the MetS have been difficult to assess without commonly accepted criteria to diagnose it. For this reason, on 2009 the International Diabetes Federation, the American Heart Association and other scientific organizations proposed a unified MetS definition. The incidence of the MetS has been increasing worldwide in parallel with an increase in overweight and obesity. The epidemic proportion reached by the MetS represents a major public health challenge, because several lines of evidence showed that the MetS, even without type 2 diabetes, confers an increased risk of cardiovascular morbidity and mortality in different populations including also hypertensive patients. It is likely that the enhanced cardiovascular risk associated with MetS in patients with high blood pressure may be largely mediated through an increased prevalence of preclinical cardiovascular and renal changes, such as left ventricular hypertrophy, early carotid atherosclerosis, impaired aortic elasticity, hypertensive retinopathy and microalbuminuria. Indeed, many reports support this notion, showing that hypertensive patients with MetS exhibit, more often than those without it, these early signs of end organ damage, most of which are recognized as significant independent predictors of adverse cardiovascular outcomes.
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    ABSTRACT: Clinical studies exploring the relationship between serum uric acid (SUA) and arterial stiffness yielded conflicting results. Only in a few of these studies, arterial distensibility was examined by measuring aortic pulse wave velocity (PWV), which is considered the gold standard for evaluating arterial stiffness. In none of the previous investigations was the influence of SUA on aortic distensibility assessed, taking into account the effect of albuminuria. The purpose of our study was to comprehensively analyse the relationships between SUA and aortic PWV in a group of essential hypertensive patients. We enrolled 222 untreated and uncomplicated hypertensive subjects (mean age: 44 ± 10 years; 60% males), without gout. In all patients, SUA and urinary albumin excretion rate (AER) were determined. Moreover, carotid-femoral (c-f) PWV was measured. C-f PWV was significantly higher in hypertensive patients belonging to the uppermost tertile of SUA distribution, compared to subjects of the lowest tertiles (10.9 ± 2.2 vs. 10 ± 1.8 vs. 9.9 ± 1.7 m s(-1); p = 0.001). In univariate analysis, SUA correlated with c-f PWV (r = 0.24; p < 0.001). This association disappeared when AER was added in a multiple regression model, including SUA, age, mean arterial pressure, gender, metabolic syndrome components and glomerular filtration rate. The results of our study showed that, in essential hypertensive subjects, there is a positive relationship between mild hyperuricaemia and aortic stiffness. This association weakened after adjustment for covariates and lost statistical significance after further correction for albuminuria.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 01/2014; DOI:10.1016/j.numecd.2014.01.014 · 3.88 Impact Factor
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    ABSTRACT: Introduction: In experimental studies conducted in rats, raising serum uric acid (SUA) levels resulted in stimulation of renin expression. Studies in humans exploring the association of SUA with plasma renin activity (PRA) yielded conflicting results. Moreover, little is known about the relationship between plasma aldosterone concentration (PAC) and SUA. Aim: To analyse the relationships between SUA, PRA and PAC in a group of subjects with primary hypertension. Methods: We enrolled 372 patients (mean age 45 ± 12 years; women 33 %), with untreated primary hypertension, with normal renal function and without cardiovascular complications. Results: Spearman’s rank-correlation analyses showed that SUA was significantly associated with PRA and with PAC in the overall study population (q = 0.127, p = 0.01 and q = 0.206, p\0.0001, respectively). Age-adjusted SUA levels sere higher in the top tertiles of the distribution of PRA and PAC, when compared to the lower tertiles (p = 0.04 and p\0.0001, respectively). All the associations between SUA, PRA and PAC lost statistical significance in logistic multiple regression analyses aimed at assessing the factors independently associated with an elevation of PRA and of PAC (third tertiles of their distribution). Conclusions: Our results, showing significant relationships of SUA with PRA and PAC only in univariate analyses, seem to suggest that the associations previously reported in some studies between these variables, and particularly that between SUA and PRA, may be mediated by various confounding factors, such as serum creatinine and body mass index.
    XXX Congress of The Italian Society of Hypertension (SIIA), Rome; 10/2013
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    Giuseppe Mule, Giovanni Cerasola
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    ABSTRACT: The intima-media thickness (IMT) is considered as a surrogate marker for atherosclerotic disease. The aim of this study was to analyze the relationship of carotid IMT with fetuin-A in patients with essential hypertension (EH) and normal renal function. The plasma levels of fetuin-A, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) and the biomarker of oxidative stress 8-iso-PGF2alpha were assayed in samples from 105 untreated EH patients. Carotid IMT measurements were also performed. EH was studied overall and after dividing in EH with IMT  and <0.9 mm. All of the biomarkers were significantly different between the two subgroups, in particular, the fetuin-A level was lower in the patients with an IMT 0.9 mm. In the overall group, the linear analysis of correlation demonstrated that the IMT was significantly inversely correlated with the fetuin-A level (r=-0.40, P<0.0001) and directly with TNF-α (r=0.39, P<0.0001), IL-6 (r=0.38, P<0.0001) and 8-iso-PGF2alpha (r=0.356, P<0.0003). The multiple regression analysis performed that assigned IMT as a dependent variable showed that fetuin-A (β=-0.268, P<0.0001) was independently correlated with the IMT. Receiver-operator curves demonstrated that fetuin-A levels have a predictive power of IMT>0.9 mm (AUC (area under the curve) 0.738, P<0.0001). Our results suggest that in EH, fetuin-A is associated with the IMT independently of oxidative stress and renal function, thus predicting increases in the IMT.Hypertension Research advance online publication, 13 September 2012; doi:10.1038/hr.2012.136.
    Hypertension Research 09/2012; 36(2). DOI:10.1038/hr.2012.136 · 2.94 Impact Factor
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    ABSTRACT: Background: Electrocardiography (ECG) has low sensitivity for detecting left ventricular hypertrophy (LVH), while echocardiography cannot be routinely performed.Design/methods: In this study we evaluate the prevalence of LVH and diastolic dysfunction in hypertensive patients with normal ECG. We excluded patients with cardiovascular (CV) diseases, diabetes, chronic kidney disease, or presenting ECG-LVH or other ECG anomalies. The enrolled 440 hypertensive patients underwent echocardiographic examination (Acuson Sequoia 512); LV mass was indexed by body surface area (LVMI) and LVH was defined as LVMI >125 g/m(2) in men and >110 g/m(2) in women. Diastolic function was evaluated by mitral inflow and tissue Doppler imaging (TDI).Results: The prevalence of LVH was 8.18% (95% confidence interval [CI] 5.97-11.1%). Multiple regression analysis showed that the only variable independently associated with LVH was duration of hypertension (p < 0.001). The receiver operating characteristic (ROC) curve showed that duration of hypertension was a powerful predictor of LVH, with an area under the curve (AUC) of 0.878 and p < 0.0001. Further, in patients with LVH the mean difference of LVMI from the cut-off value for LVH was 12.3 ± 9.19 g/m(2). Diastolic dysfunction, defined as early diastolic myocardial velocity (Em) <0.08 m/s, was detected only in 3.2% of patients.Conclusions: The prevalence of LVH among hypertensive patients with normal ECG, free of diabetes and of CV diseases is low; moreover, patients with echocardiographic LVH presented LVMI values that identified mild LVH. Few cases of impaired diastolic function were registered.We suggest that in hypertensive patients with such characteristics the echocardiographic examination should be reserved to those who present with higher duration of hypertension.
    05/2012; 20(5). DOI:10.1177/2047487312447845
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    ABSTRACT: BACKGROUND AND AIM: Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. METHODS AND RESULTS: We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtained. In the overall population we observed no significant correlation of SUA with LV mass indexed for height(2.7) (LVMH(2.7)) (r = 0.074). When the same relationship was analysed separately in men and women, we found a statistically significant correlation in female gender (r = 0.27; p < 0.001), but not in males (r = -0.042; p = NS). When we grouped the study population in sex-specific tertiles of SUA, an increase in LVMH(2.7) was observed in the highest tertiles in women (44.5 ± 15.6 vs 47.5 ± 16 vs 55.9 ± 22.2 g/m(2.7); p < 0.001), but not in men. The association between SUA and LVMH(2.7) in women lost statistical significance in multiple regression analyses, after adjustment for age, 24 h systolic BP, body mass index, serum creatinine and other potential confounders. CONCLUSIONS: Our findings do not support an independent association between SUA and LV mass in Caucasian men and women with arterial hypertension.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 04/2012; 23(8). DOI:10.1016/j.numecd.2012.01.007 · 3.88 Impact Factor
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    ABSTRACT: Branchio-oto-renal (BOR) syndrome is an autosomal dominant disease clinically characterized by the coexistence of some or all of the following major disorders: deafness, cervical branchial fistulae, preauricular pits, and renal abnormalities. Most families with BOR syndrome have mutations on the EYA-1 gene on chromosome 8q. We present the case of a 23-year-old Italian woman without a familial history of BOR syndrome. The patient, who had hearing loss and a history of surgeries for correction of bilateral cervical branchial fistulae and bilateral preauricular pits, presented with renal impairment, hypertension and overt proteinuria. DNA sequencing showed a novel heterozygous mutation 1420-1421delCC in exon 14 of EYA-1 gene.
    Clinical nephrology 10/2011; 76(4):330-3. DOI:10.5414/CN106676 · 1.23 Impact Factor
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    ABSTRACT: Introduzione. Studi recenti hanno evidenziato una relazione tra Ipovitaminosi D ed ipertensione arteriosa. I meccanismi di questo legame non sono ancora chiari, ma sembrano coinvolgere diversi sistemi, tra cui l’asse renina-angiotensinaaldosterone e la disfunzione endoteliale. Inoltre, non è ancora stato stabilito un intervallo di normalità della concentrazione plasmatica di Vitamina D3, essendo il range in atto considerato (30-80 μg/L) soltanto indicativo. Scopo. Lo studio si propone di valutare la relazione tra la concentrazione plasmatica della Vit. D3, la pressione arteriosa ed il sistema renina angiotensina in 200 soggetti con ipertensione essenziale non trattata farmacologicamente. Materiali e Metodi. Vengono presentati i risultati preliminari dei 50 soggetti ad oggi studiati con età media di 44±13 anni, di entrambi i sessi, affetti da ipertensione arteriosa essenziale neodiagnosticata (PASc: 146.9±17.7 mmHg; PADc: 91.8±10 mmHg), con normale funzione renale (eGFR-MDRD: 97.9±24.1 mL/min/1.73 m2). Risultati. L’intero gruppo di pazienti presenta valori di Vit. D (21.3±7.9 μg/L) inferiori al cut-off di riferimento. La Vitamina D correla in maniera inversa e significativa con la pressione arteriosa sistolica clinica (r=-0.367; p=0.01), mentre non sono state osservate correlazioni significative della Vit. D con pressione arteriosa media delle 24 ore, PRA e GFR. Al contrario, pur in presenza di normali valori plasmatici di PTH, è stata rilevata una correlazione negativa e significativa di questo con la Vit. D (r=-0.39; p=0.01). Conclusioni. Questi dati preliminari suggeriscono che nell’ipertensione arteriosa essenziale, anche nella popolazione siciliana che per motivi geografici è più esposta alle radiazioni solari, le concentrazioni di Vit. D sono
    52 ° CONGRESSO SOCIETA' ITALIANA DI NEFROLOGIA G ITAL NEFROL, GENOVA; 09/2011
  • Minerva urologica e nefrologica = The Italian journal of urology and nephrology 09/2011; 63(3):261-2. · 0.70 Impact Factor
  • Journal of Hypertension 03/2011; 29(3):621-2; author reply 622. DOI:10.1097/HJH.0b013e3283435a87 · 4.22 Impact Factor
  • Journal of Hypertension 01/2011; 29:e55. DOI:10.1097/00004872-201106001-00138 · 4.22 Impact Factor
  • Journal of Hypertension 01/2011; 29:e127-e128. DOI:10.1097/00004872-201106001-00315 · 4.22 Impact Factor
  • Journal of Hypertension 01/2011; 29:e185. DOI:10.1097/00004872-201106001-00484 · 4.22 Impact Factor
  • Journal of Hypertension 01/2011; 29:e479. DOI:10.1097/00004872-201106001-01447 · 4.22 Impact Factor
  • Journal of Hypertension 01/2011; 29:e194. DOI:10.1097/00004872-201106001-00516 · 4.22 Impact Factor