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ABSTRACT: Hypertension and high serum cholesterol levels are two of the most relevant risk factors for cardiovascular diseases. A combined
increase in both risk factors has been reported in a significant proportion of patients with coronary artery disease. Statins
are the most widely used drugs to treat hypercholesterolemia, and they interact with blood pressure control in different populations
of hypertensive patients. A significant reduction in blood pressure associated with the use of statins has been described
in patients with untreated hypertension and in patients treated with antihypertensive drugs, particularly angiotensin converting
enzyme inhibitors and calcium channel blockers. The effect of statins on blood pressure control has also been reported in
diabetic patients. The mechanisms responsible for the hypotensive effect seem to be largely independent of the effect of statins
on lipid profile, and are probably related to their interaction with endothelial function or angiotensin II receptors. The
capacity of statins to improve blood pressure control could be a useful consideration for an integrated approach to better
prevention of cardiovascular diseases.
Current Hypertension Reports 04/2012; 3(4):281-288. · 2.50 Impact Factor
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ABSTRACT: We enrolled 347 hypertensive patients, randomly allocated them to different first-line treatments, and followed-up for 24 months. Persistence on treatment was significantly higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs. CCBs (51.6%), β-blockers (44.8%), and diuretics (34.4%). No ARB, ACE inhibitor, β-blocker, or diuretic was associated with a greater persistence in therapy as compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs. other CCBs (59.3% vs. 46.6%). Systolic and diastolic BP decreased more in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) when compared to ß-blockers (-4.0/-2.3 mmHg) and diuretics (-2.3/-2.1 mmHg).
07/2009; 29(8):553-562.
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ABSTRACT: Recent evidences suggest a relationship between angiotensin 1 (AT1) receptor gene expression and low density lipoprotein cholesterol (LDL-C) plasma level. We enrolled 16 untreated hypertensive hypercholesterolemic patients (57.4 +/- 7 years old) in a randomized, single-blind, cross-over design. All the patients were allocated to treatment with simvastatin 20 mg/day for 2 weeks, then randomly assigned to telmisartan (40-80 mg/day) or bisoprolol (5-10 mg/day). After 4 weeks the antihypertensive drugs have been withdrawn for a wash-out period of 2 weeks when they were treated with simvastatin alone, then they have been allocated to the alternative antihypertensive treatment for four additional weeks. We measured: systolic (SBP) and diastolic BP (DBP), 24-h mean BP (MBP), Baseline and post-ischemia forearm blood flow (FBF) and vascular resistance (FVR), and Lipid profile. After 2 weeks of treatment with Simvastatin, baseline and post-ischemic FBF increased (both P < 0.05), while baseline and post-ischemic FVR decreased (both P < 0.05). Standing DBP and MBP were reduced more after treatment with telmisartan than with bisoprolol (P < 0.05). Basal and post-ischemic FBF were significantly increased (P < 0.05 and P < 0.005, respectively) and basal and post-ischemic FVR significantly decreased (both P < 0.005) only after treatment with telmisartan, as well as plasma triglycerides (TG) (P < 0.05). From this preliminary study carried out on hypercholesterolemic hypertensive patients it appears that the association of telmisartan and simvastatin (but not of bisoprolol and simvastatin) could exert positive effects on a large quantity of vascular functionality parameters, just after a short treatment.
Fundamental and Clinical Pharmacology 06/2009; 23(5):583-8. · 1.80 Impact Factor
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ABSTRACT: Recent evidence suggests a strong relationship between angiotensin 1 (AT1) receptor gene expression and low-density lipoprotein cholesterol (LDL-C) plasma level. This article comparatively evaluates blood pressure-modulating effects and metabolic and haemodynamic actions of an antihypertensive treatment directly interacting (telmisartan) versus non-interacting (bisoprolol) with the AT1 receptor in statin-treated hypercholesterolaemic patients.Sixteen untreated hypertensive hypercholesterolaemic patients (aged 57.4 ± 7 years) were enrolled according to a randomized, single-blind, crossover design with a prospective randomized, open-label, blinded evaluation of the primary endpoint. All of the patients were allocated to treatment with simvastatin 20 mg/day for 2 weeks, and then randomly assigned to treatment with either telmisartan (40-80 mg/day) or bisoprolol (5-10 mg/day) whose daily dose was doubled after 2 weeks if blood pressure control was unsatisfactory. After a cumulative period of 4 weeks, the antihypertensive drugs were withdrawn for a washout period of 2 weeks when the patients were treated with simvastatin alone. They were then allocated to the alternative antihypertensive treatment (bisoprolol or telmisartan) for a cumulative period of 4 additional weeks with a dosage adjustment at week 2. The following were measured in each patient: lying and standing systolic blood pressure (SBP) and diastolic blood pressure (DBP); heart rate; 24-hour SBP and DBP by ambulatory blood pressure measurement; baseline forearm blood flow (FBF); and forearm vascular resistance (FVR), post-ischaemic FBF and FVR, lipid profile and fasting plasma glucose.After 2 weeks of treatment with simvastatin, baseline and post-ischaemic FBF increased (both p < 0.05), while baseline and post-ischaemic FVR decreased (both p < 0.05). Both antihypertensive treatments were associated with a significant reduction in SBP (p < 0.005), DBP (p < 0.05) and mean blood pressure (MBP) [p < 0.05]. Standing DBP and MBP were reduced more in the telmisartan than in the bisoprolol group (p < 0.05). Basal and post-ischaemic FBF were significantly increased (p < 0.05 and p < 0.005, respectively) and basal and post-ischaemic FVR were significantly decreased (both p < 0.005) only in the telmisartan-treated group. LDL-C plasma level significantly improved in both treatment groups (p < 0.05), while plasma triglycerides significantly decreased only in the telmisartan-treated group (p < 0.05).From the result of this preliminary study carried out on a small sample of hypercholesterolaemic hypertensive patients, it appears that the association with telmisartan and simvastatin could exert positive effects on a large quantity of vascular functionality parameters, after just a short treatment. This observation has not been confirmed in bisoprolol-treated patients.Received for publication on 27 February 2008; accepted for publication 15 January 2009.
High Blood Pressure & Cardiovascular Prevention 05/2009; 16(1):7-12.
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ABSTRACT: We enrolled 347 hypertensive patients, randomly allocated them to different first-line treatments, and followed-up for 24 months. Persistence on treatment was significantly higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs. CCBs (51.6%), beta-blockers (44.8%), and diuretics (34.4%). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a greater persistence in therapy as compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs. other CCBs (59.3% vs. 46.6%). Systolic and diastolic BP decreased more in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) when compared to beta-blockers (-4.0/-2.3 mmHg) and diuretics (-2.3/-2.1 mmHg).
Clinical and Experimental Hypertension 12/2007; 29(8):553-62. · 1.07 Impact Factor
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ABSTRACT: Persistence on treatment affects the efficacy of antihypertensive treatment. We prospectively investigated the persistence on therapy and the extent of blood pressure (BP) control in 347 hypertensive patients (age 59.4 +/- 6 years) randomly allocated to a first-line treatment with: angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers (CCBs), beta-blockers, angiotensin-II receptor blockers (ARBs), or diuretics and followed-up for 24-months. Persistence on treatment was higher in patients treated with ARBs (68.5%) and ACE inhibitors (64.5%) vs CCBs (51.6%; p < 0.05), beta-blockers (44.8%, p < 0.05), and diuretics (34.4%, p < 0.01). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher persistence in therapy compared with the other molecules used in each therapeutic class. The rate of persistence was significantly higher in patients treated with lercanidipine vs others CCBs (59.3% vs 46.6%, p < 0.05). Systolic and diastolic BP was decreased more successfully in patients treated with ARBs (-11.2/-5.8 mmHg), ACE inhibitors (-10.5/-5.1 mmHg), and CCBs (-8.5/-4.6 mmHg) compared with beta-blockers (-4.0/-2.3 mmHg p < 0.05) and diuretics (-2.3/-2.1 mmHg, p < 0.05). No ARB, ACE inhibitor, beta-blocker, or diuretic was associated with a higher BP control compared with the other molecules used in each therapeutic class. A trend toward a better BP control was observed in response to lercanidipine vs other CCBs (p = 0.059). The present results confirm the importance of persistence on treatment for the management of hypertension in clinical practice.
Vascular Health and Risk Management 01/2007; 3(6):999-1005.
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ABSTRACT: Am J Hypertens (2005) 18, 153A–153A; doi:10.1016/j.amjhyper.2005.03.425
P-407: Left ventricular structure and function and development of pregnancy-related hypertensive disorders in pregnant women with altered utero-placental flow
Daniela Degli Esposti1, Vincenzo Immordino1, Angela Carletti1, Tullio Ghi1, Ada Dormi1, Maddalena Veronesi1, Stefano Bacchelli1, Maria Grazia Prandin1, Claudio Borghi1 and Ettore Ambrosioni11
Internal Medicine, S.Orsola Hospital-University of Bologna, Bologna, Italy; Obstetric and Ginaecology, S.Orsola Hospital-University of Bologna, Bologna, Italy.
American Journal of Hypertension 04/2005; · 3.18 Impact Factor
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ABSTRACT: Am J Hypertens (2004) 17, 81A–82A; doi: 10.1016/j.amjhyper.2004.03.208
P-134: Assessment of B-type natriuretic peptide (BNP) and n-terminal (NT)-probnp in hypertensive patients with heart failure
Daniela Degli Esposti1, Maddelena Veronesi1, Eugenio Cosentino1, Ada Dormi1, Stefano Bacchelli1, Domenico Maione1, Maria Grazia Prandin1, Claudio Borghi1 and Ettore Ambrosioni11Internal Medicine, University of Bologna-S.Orsola Hospital, Bologna, Italy
American Journal of Hypertension 04/2004; · 3.18 Impact Factor
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ABSTRACT: Am J Hypertens (2003) 16, 85A–86A; doi:10.1016/S0895-7061(03)00294-2
P-129: Effects of an integrated approach to care in the management of hypertensive patients with heart failure
Daniela Degli Esposti1, Eugenio Cosentino1, Ada Dormi1, Stefano Bacchelli1, Domenico Maione1, Maria Grazia Prandin1, Vincenzo Immordino1, Claudio Borghi1 and Ettore Ambrosioni11Internal Medicine, Bologna University - S.Orsola Hospital, Bologna, Italy
American Journal of Hypertension 04/2003; · 3.18 Impact Factor
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ABSTRACT: The objective of this 8-week open-label study was to compare the tolerability of lercanidipine, a dihydropyridine calcium-channel antagonist (CA), with that of other CAs in the treatment of hypertension. Subjects already taking amlodipine, felodipine, nifedipine gastrointestinal therapeutic system (GITS), or nitrendipine and experiencing CA-specific adverse effects (AEs) were switched to lercanidipine for 4 weeks and then rechallenged with their initial treatment for 4 weeks. Results showed that at comparable levels of BP, lercanidipine was associated with a significantly lower incidence of ankle edema, flushing, rash, headache and dizziness compared with other CAs (p<0.001). After 4 weeks of lercanidipine, mean systolic blood pressure (SBP)/diastolic blood pressure (DBP) was 142.1/86.7 mmHg. After rechallenge with other CAs for 4 weeks, mean SBP/DBP was 141.1/86.7 mmHg. In this open-label study, lercanidipine compared with other CA seems to provide a significant improvement in tolerability with comparable antihypertensive effect.
Blood pressure 01/2003; 12 Suppl 1:14-21. · 1.26 Impact Factor
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ABSTRACT: Background:Tinnitus is a common symptom in audiology and neurologypatients. Controversial data have been reported in the literature about the prevalence of tinnitus in hypertensive patients, whereas its relationship with the extent of blood pressure (BP) control has not been substantially explored.Objective:The aim of this study was to determine the prevalence of tinnitus in hypertensive patients, and the impact of different antihypertensive drugs on the incidence of tinnitus in these patients.Methods:This prospective, single-blind, observational study was conducted at the Hypertension Clinic, St. Orsola-Malpighi Hospital, Bologna, Italy. Patients aged 18 to 75 years with uncontrolled hypertension and receiving antihypertensive therapy were enrolled. Patients were asked to complete a standardized questionnaire to assess the presence, frequency, and duration of tinnitus and the apparent effect of their antihypertensive treatment on it. Patients considered by the investigator to have tinnitus, regardless of their audiologic condition, underwent a complete clinical cardiovascular examination, including supine systolic BP (SBP) and diastolic BP measurement and standard 12-lead electrocardiography. Twelve-hour ambulatory BP monitoring was also performed, and patients were asked to record, using patient diaries, times of the onset and resolution of tinnitus that occurred during those 12 hours. From these data, correlations between the onset of tinnitus and BP were calculated.Results:A total of 476 patients participated in the study (283 men, 193 women). Of these, 84 (17.6%) patients reported occasional or prolonged spontaneous tinnitus, whereas 392 (82.4%) reported no tinnitus. The incidence of tinnitus was significantly higher in patients receiving diuretics (72/265 [27.2%]) compared with those receiving angiotensin lI receptor blockers (5/37 [13.5%]), α-blockers (12/55 [21.8%]), or 3-hydroxy-3-methylglutaryl coenzyme A reduc tase inhibitors (9/73 [12.3%]) (all, P < 0.05). Mean (SD) SBP was significantly higher in patients without tinnitus compared with those with it (143.2 [11.1 ] vs 140.6 [10.3] mm Hg; P < 0.005). In 10 (11.9%) patients with tinnitus, the onset was correlated with a sudden decrease in SBP (<140 mm Hg).Conclusions:In this study of tinnitus in patients receiving antihypertensivetherapy, tinnitus was found in 17.6% of patients. Tinnitus was associated with the use of diuretics and with low SBP. Further studies are needed.
Current Therapeutic Research.
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ABSTRACT: Unsatisfactory blood pressure (BP) control in the treated hypertensive patient is largely related to poor compliance with antihypertensive drug regimens. The aim of the present study was to prospectively evaluate the rate of persistence on treatment and the extent of BP control in 301 elderly, uncomplicated grade I or II hypertensive patients randomly allocated to monotherapy with angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), beta-blockers, angiotensin II receptors (ARBs), or diuretics according to an open-label single-blind study design. After 24 months, the percentage of patients continuing their initial therapy was higher in those treated with ARBs (68.5%) and ACE inhibitors (64.5%) and lower in patients taking diuretics (34.4%; P<.01). The logistic regression model using ARBs as reference term showed that patients treated with ACE inhibitors (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.79-0.99) or CCBs (OR, 0.76; 95% CI, 0.54-0.85) were more likely to continue their initial antihypertensive therapy when compared with those treated with beta-blockers (OR, 0.67; 95% CI, 0.57-0.79) or diuretics (OR, 0.56; 95% CI, 0.38-0.84). The average systolic and diastolic BP decrease was greater in patients treated with ARBs (-11.2+/-4/-5.8+/-2 mm Hg), ACE inhibitors (-10.5+/-4/-5.1+/-2 mm Hg), and CCBs (-8.5+/-3/-4.6+/-2 mm Hg) and lesser in those treated with diuretics (-2.3+/-4/-2.1+/-3 mm Hg, P<.05) and beta-blockers (-4.0+/-2/-2.3+/-2 mm Hg; P<.05). The study confirms the importance of persistence with treatment for the effective management of hypertension in clinical practice.
The American Journal of Geriatric Cardiology 16(5):280-6. · 1.04 Impact Factor
