[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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
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
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
XXX Congress of The Italian Society of Hypertension (SIIA), Rome; 10/2013
[Show abstract][Hide abstract] 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; · 2.79 Impact Factor
[Show abstract][Hide abstract] 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.
European journal of preventive cardiology. 05/2012;
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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
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
[Show abstract][Hide abstract] ABSTRACT: Obesity is associated with well-known cardiovascular risk factors and a lower life expectancy. This study investigated whether nonoperative nutritional treatment of obesity without comorbidities influenced the carotid intima-media thickness (c-IMT) in the long run. Fifty-four subjects of an original cohort of 251 subjects were re-evaluated 10 years after a medical nutritional treatment (MNT) with cognitive-behavioral approach for uncomplicated obesity. Forty subjects were classified as failure (10-year body weight change > 0.5 kg) and 14 (body weight change ≤ 0.5 kg) as a success of the MNT. Ten years after MNT, c-IMT significantly increased (0.06 ± 0.02 mm; P = 0.004) in the failure group and significantly decreased (-0.07 ± 0.03 mm; P = 0.027) in the success group. Ten-year change in c-IMT correlated significantly with 10-year change in body weight (r = 0.28; P = 0.040). Multiple stepwise linear regression analysis demonstrated that age, final BMI, and group (success or failure) influenced independently the 10-year c-IMT. In conclusion, this study is in agreement with the possibility that the successful MNT of obesity may be an effective choice in the long run and seems to indicate that it may be able to reduce the cardiovascular risk as reflected by the change in c-IMT.
[Show abstract][Hide abstract] ABSTRACT: There is clear evidence that urinary albumin excretion levels, even below the cut-off values currently used to diagnose microalbuminuria, are associated with an increased risk of cardiovascular events. The relationships of microalbuminuria with a variety of risk factors, such as hypertension, diabetes and metabolic syndrome and with several indices of subclinical organ damage, may contribute, at least in part, to explain the enhanced cardiovascular risk conferred by microalbuminuria. Nonetheless, several studies showed that the association between microalbuminuria and cardiovascular disease remains when all these risk factors are taken into account in multivariate analyses. Therefore, the exact pathophysiological mechanisms explaining the association between microalbuminuria and cardiovascular risk remain incompletely understood. The simple search for microalbuminuria in hypertensive patients may enable the clinician to better assess absolute cardiovascular risk, and its identification may induce physicians to encourage patients to make healthy lifestyle changes and perhaps would prompt to more aggressive modification of standard cardiovascular risk factors.
Journal of Hypertension 12/2010; 28(12):2357-69. · 4.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction Evidence suggests that decreased haemoglobin plasma concentration may be a predictor of adverse cardiovascular events in patients with chronic kidney disease (CKD). We hypothesized that in CKD patients, oxidative stress could influence the development of cardiovascular damage via a relationship with haemoglobin levels.Methods We assayed plasma levels of the biomarker of oxidative stress 8-ISO-prostaglandin F2α (8-ISO-PGF2α) and of haemoglobin in 193 stage 2-5 CKD patients, investigating their relationship. Eighty healthy subjects and 80 patients with primary hypertension having normal renal function were enrolled as controls.Results The CKD group was divided according to 8-ISO-PGF2α quartiles, and decreasing levels of both haemoglobin and estimated glomerular filtration rate (eGFR) along with increasing quartiles were observed. In the 193 CKD patients, the linear analysis of correlation showed inverse correlations of 8-ISO-PGF2α with both haemoglobin and eGFR (r = −0.47; r = −0.81; p < 0.00001, respectively). In the control groups, no correlation between haemoglobin and 8-ISO-PGF2α was found. The multiple regression analysis carried out in CKD patients, by a model with 8-ISO-PGF2α as the dependent variable, and including haemoglobin and all confounding factors, confirmed the inverse relationship between haemoglobin and 8-ISO-PGF2α (β = −0.50; p < 0.00001). In this model, only when eGFR was added did the relationship between haemoglobin and 8-ISO-PGF2α lose statistical significance. In this final multivariate model, 8-ISO-PGF2α correlated independently with eGFR (β = −0.82; p < 0.0001).Conclusions In CKD, haemoglobin plasma level is inversely related to oxidative stress, depending on GFR. It remains to be elucidated whether or not the biochemistry of nitric oxide and haemoglobin interaction has a role in causing this relationship.Received for publication 20 August 2010; accepted for publication 3 October 2010.
High Blood Pressure & Cardiovascular Prevention 11/2010; 17(4):227-233.
[Show abstract][Hide abstract] ABSTRACT: Left ventricular hypertrophy (LVH) and diastolic dysfunction are very common in patients with chronic kidney disease (CKD). Aim of this study was to evaluate the impact of type 2 diabetes on LV geometry and diastolic function in hypertensive patients with CKD. We enrolled 288 Caucasian subjects with hypertension and CKD; of them, 112 had diabetes. Patients with cardiovascular (CV) diseases, glomerular filtration rate (GFR) >60 ml min(-1) per 1.73 m(2), dialysis treatment and other major non-CV diseases were excluded. All patients underwent routine biochemical analyses and echocardiographic examination with tissue Doppler imaging (TDI). Patients with diabetes had significantly higher LV wall thicknesses (P=0.0001), relative wall thickness (RWT) (P=0.0001) and left atrium volume index (P=0.03), when compared with patients without diabetes. Further, diabetic patients had very high prevalence of concentric LVH. Em, evaluated by TDI, was significantly lower in patients with diabetes (P=0.005). However, the difference lost statistical significance after correction by analysis of covariance for RWT. Multiple stepwise linear regression analysis showed that the variables independently associated with Em were: age (β 0.364; P=0.0001), GFR (beta 0.101; P=0.019), and the presence of diabetes (β 0.166; P=0.002). Our study showed that in hypertensive patients with CKD the presence of diabetes is associated with increased LV-wall thicknesses and concentric geometry; further, diabetes together with renal function (GFR) is associated with worse diastolic function, independently of potential confounders, such as age, gender, body mass index and blood pressure.
Journal of human hypertension 10/2010; 25(3):144-51. · 2.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aerobic capacity, as indicated by maximal oxygen uptake (VO(2) max) has an important role in contrasting the traditional cardiovascular risk factors and preventing cardiovascular morbidity and mortality. It is known that endothelial function, measured as flow-mediated dilation (FMD) of the brachial artery, is strictly linked to atherogenesis and cardiovascular risk. However, the relationship between VO(2) max and FMD has not been fully investigated especially in healthy non-obese subjects. This preliminary study cross-sectionally investigated the relationship between VO(2) max and FMD in 22 non-obese, healthy sedentary male subjects. Dividing the cohort in two subgroups of 11 subjects each according to the median value of VO(2) max, the FMD was significantly lower in the subgroup with lower VO(2) max (mean ± sem: 7.1 ± 0.7 vs. 9.5 ± 0.8 %; P = 0.035). Absolute VO(2) max (mL min(-1)) was significantly and independently correlated with body fat mass (r = -0.50; P = 0.018) and with FMD (r = 0.44; P = 0.039). This preliminary study suggests that maximal oxygen uptake is independently correlated with endothelial function in healthy non-obese adults. These results are also in agreement with the possibility that improving maximal oxygen uptake may have a favorable effect on endothelial function and vice versa.
[Show abstract][Hide abstract] ABSTRACT: Subjects who are at increased risk of developing diabetes may have increased glycaemic variability associated with endothelial dysfunction and possibly subclinical atherosclerosis, which may lead to increased cardiovascular risk observed at the time of diabetes diagnosis. To investigate this hypothesis, we measured endothelial function, carotid intima-media thickness and glycaemic variability using 48-h continuous subcutaneous glucose monitoring in 3 groups of overweight or obese subjects--those without the metabolic syndrome, and those with the metabolic syndrome with or without newly diagnosed Type 2 diabetes.
Consecutive subjects, aged 30-65 years with a body mass index >or= 25 kg/m(2) were recruited. Patients were classified as with or without the metabolic syndrome,or as metabolic syndrome with newly diagnosed Type 2 DM. Glycaemic variability was calculated in terms of the coefficient of variation. Endothelial function was measured using brachial artery flow-mediated dilation.
We identified 75 subjects. Mean flow mediated dilation decreased (P < 0.001) and carotid intima-media thickness increased (P < 0.05) across groups. Flow mediated dilation predictors included mean 48-h continuous subcutaneous glucose monitoring values (beta = -0.022; P < 0.005) and the coefficient of variation (beta = -0.10; P = 0.01). Carotid intima-media thickness predictors included age (beta = 0.009; P < 0.001) and flow mediated dilation (beta = -0.014; P = 0.076). Patients re-stratified according to cut-offs for mean 48-h glycaemia and variability demonstrated that subjects with high mean glycaemia but low coefficient of variability had similar flow mediated dilation and carotid intima-media thickness to subjects with low mean glycaemia but high coefficient of variation.
This study suggests that glycaemic variability influences endothelial function even in non-diabetic subjects. Such variability may explain the increased cardiovascular risk observed in patients prior to developing overt Type 2 diabetes.
Diabetic Medicine 08/2010; 27(8):872-8. · 3.24 Impact Factor