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ABSTRACT: The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage.
Cross-sectional study.
Outpatient hypertension clinic.
A total of 353 young and middle-aged hypertensives, free from cardiovascular and renal diseases (and 37% of whom had MS), underwent echocardiographic examination, microalbuminuria determination and non-mydriatic retinography.
When compared with subjects without MS, hypertensive patients with MS exhibited more elevated left ventricular (LV) mass (either normalized by body surface area or by height elevated by a power of 2.7), higher myocardial relative wall thickness, albumin excretion rate (AER) and a greater prevalence of LV hypertrophy (57.7% vs. 25.1%; P < 0.00001), of microalbuminuria (36.2% vs. 19.3%; P = 0.002) and of hypertensive retinopathy (87.7% vs. 48.4%; P < 0.00001). These results held even after correction for age, 24-h blood pressures, duration of hypertension, previous antihypertensive therapy, and gender distribution. The independent relationships between LV mass and MS, and between AER and MS, were confirmed in multivariate regression models including MS together with its individual components.
MS may amplify hypertension-related cardiac and renal changes, over and above the potential contribution of each single component of this syndrome. As these markers of target organ damage are well-known predictors of cardiovascular events, our results may partly explain the enhanced cardiovascular risk associated with MS.
Journal of Internal Medicine 06/2005; 257(6):503-13. · 5.48 Impact Factor
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ABSTRACT: To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness.
Cross-sectional study.
Outpatient hypertension clinic.
Seventy patients with mild-to-moderate essential hypertension, aged 42 +/- 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotid-femoral PWV, by means of a computerized method, and AER.
Microalbuminuric patients (AER > or = 20 microg min(-1); n = 19), when compared with normoalbuminuric subjects, showed more elevated 24-h BP (136/88 +/- 10/10 vs. 128/83 +/- 7/6 mmHg; P < 0.001 and P = 0.013, for systolic and diastolic BP respectively) and higher values of carotid-femoral PWV (10.4 +/- 2 m s(-1) vs. 9.2 +/- 1.3; P = 0.006). This latter difference remained statistically significant, even after correction by ancova for 24-h systolic and diastolic BP, and body mass index (BMI, P = 0.016). Univariate regression analysis disclosed a tight correlation between AER and carotid-femoral PWV (r = 0.42; P = 0.0003). This association was confirmed in a multiple regression model (beta = 0.35; P = 0.009) in which, as independent variables, besides PWV, 24-h BP, age, serum glucose values, smoking status, gender and BMI, were added.
Our results seem to confirm that microalbuminuria may represent the early renal manifestation of a widespread vascular dysfunction, and therefore it is an integrated marker of cardiovascular risk.
Journal of Internal Medicine 07/2004; 256(1):22-9. · 5.48 Impact Factor
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ABSTRACT: In order to explore the relations between left ventricular mass (LVM) and the pulsatile (pulse pressure) and steady (mean pressure) components of the blood pressure (BP) curve, 304 young and middle-aged essential hypertensive patients were studied by means of 24-h ambulatory BP monitoring and echocardiography. In the overall study population, both the BP components showed significant correlations with LVM. These correlations were unevenly distributed in the subgroups of subjects younger and in those older than 50 years. While in this latter subgroup, in multivariate analysis, both 24-h mean BP (24-MBP) (beta = 0.27; P = 0.008) and 24-h pulse pressure (24-h PP) (beta = 0.23; P = 0.02) were associated with LVM, in the subset of younger hypertensives only 24-h MBP (beta = 0.21; P = 0.009) was related to LVM, independent of other covariates. The relations observed between 24-h PP and LVM in the entire study population and in the patients older than 50 years lost statistical significance when the effect of 24-h systolic blood pressure (24-h SBP) was taken into account, in a multiple regression model in which 24-h MBP was replaced by 24-h SBP. Our findings seem to suggest that the association of PP with LVM in middle-aged hypertensives may partially explain the increased cardiovascular risk, documented in subjects with high PP. However, this relation is not independent, but is mediated by SBP.
Journal of Human Hypertension 05/2003; 17(4):231-8. · 2.80 Impact Factor
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ABSTRACT: To analyse the relationships between 24 h blood pressure load (the percentage of systolic/diastolic blood pressures exceeding 140/90 mmHg while awake and 120/80 mmHg during sleep) and some indices of hypertensive target organ involvement, independently of the mean level of 24 h blood pressure.
One hundred and thirty patients with mild-to-moderate hypertension underwent 24 h ambulatory blood pressure monitoring, ocular fundus examination, microalbuminuria assay and two-dimensional guided M-mode echocardiography. The study population was divided into subsets according to the systolic and diastolic 24 h blood pressure load values predicted from the regression equation relating 24 h blood pressure load to 24 h mean blood pressure. The subjects with an observed load above this predicted value were included in the higher blood pressure load groups, the remaining ones being included in the lower groups.
Relative myocardial wall thickness and total peripheral resistance were greater, and mid-wall fractional shortening, end-systolic stress-corrected mid-wall fractional shortening and cardiac index lower, in the subjects with a higher systolic blood pressure load. Moreover, the stroke index:pulse pressure ratio was reduced, and a greater prevalence of hypertensive retinopathy was observed in the higher systolic load group. On the contrary, no statistically significant difference was found for any of the cardiac, renal and funduscopic parameters examined when the two groups with a higher and lower 24 h diastolic blood pressure load were compared.
Our results seem to suggest that, in mild-to-moderate arterial hypertension, a high 24 h systolic blood pressure load may be associated, independently of the average level of 24 h systolic ambulatory blood pressure, with an adverse cardiovascular risk profile.
Blood Pressure Monitoring 07/2001; 6(3):115-23. · 1.52 Impact Factor
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ABSTRACT: Am J Hypertens (2001) 14, 49A–49A; doi:10.1016/S0895-7061(01)01539-4
P-61: Value of home blood pressure as predictor of target organ damage in mild arterial hypertension
G. Mulè1, E. Nardi1, G. Piazza1, V. Volpe1, F. Raspanti1, D. Ferrara1, M. Federico1, G. Andronico1, S. Cottone1 and G. Cerasola11Istituto di Clinica Medica e Malattie Cardiovascolari, University of Palermo, Italy
American Journal of Hypertension 03/2001; · 3.18 Impact Factor
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ABSTRACT: Am J Hypertens (1999) 12, 68A–68A; doi:10.1016/S0895-7061(99)80224-6
I007: Hyperinsulinaemia and reninaldosterone system in morbid obesity.
G. Andronico*1, R. Ferraro-Mortellaro1, L. Ferrara1, M.T. Mangano1, G. Mulé1, G. Piazza1 and G. Cerasola11Institute of Internal Medicine and Cardiovascular Diseases, University of Palermo, Italy.
American Journal of Hypertension 03/1999; · 3.18 Impact Factor
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ABSTRACT: Am J Hypertens (1998) 11, 188A–188A; doi: 10.1016/S0895-7061(97)91402-3
K021: Left ventricular mass and circulating growth factors in essential hypertension
S. Cottone, E. Nardi, A. Vadalà, R. Riccobene, M.C. Vella, A.L. Neri, G. Mulé, G. Piazza, C. Zagarrigo and G. Cerasola
American Journal of Hypertension 03/1998; · 3.18 Impact Factor
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ABSTRACT: Am J Hypertens (1998) 11, 01A–01A; doi: 10.1016/S0895-7061(97)90706-8
Relationship of microalbuminuria endothelin-1, and growth factors in human essential hypertension
S. Cottone, A. Vadalà, R. Riccobene, M.T. Mangano, G. Mulé, G. Piazza, M.C. Vella, A.L. Neri, C. Zagarrigo and G. Cerasola
American Journal of Hypertension 03/1998; · 3.18 Impact Factor
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ABSTRACT: Am J Hypertens (1997) 10, 71A–71A; doi: 10.1016/S0895-7061(97)88900-5
G47: Influence of light cigarette smoking on blood pressure and target organ damage in essential hypertension
G. Mulé, S. Cottone, E. Nardi, M.T. Mangano, G. Piazza, V. Volpe, P. Galione and G. Cerasola
American Journal of Hypertension 03/1997; · 3.18 Impact Factor
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G Cerasola,
S Cottone,
G Mulé,
E Nardi,
M T Mangano,
G Andronico,
A Contorno,
M Li Vecchi,
P Galione,
F Renda, G Piazza,
V Volpe,
A Lisi,
L Ferrara,
N Panepinto,
R Riccobene
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ABSTRACT: To evaluate the prevalence of microalbuminuria (albumin excretion rate, AER) in a wide hypertensive population, and to evaluate any relationship with cardiovascular damage and renal dysfunction.
A transversal study.
In 383 hospitalized Caucasian essential hypertensives (198 men, 185 women) of mean age 44 +/- 0.5 years and mean clinic blood pressure 170.3 +/- 0.95/ 103.4 +/- 0.47 mmHg, metabolic parameters, serum creatinine level (Cs), creatinine clearance rate (Ccs), 24 AER and plasma renin activity (PRA) were measured. Furthermore, each patient underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography to measure left ventricular mass, which was indexed both by body surface area to obtain left ventricular mass index (LVMI) and by height to obtain the left ventricular mass indexed for height (LVMH). By Doppler echocardiography, the diastolic compliance by early:late peak filling velocity ratio was analysed. The fundus oculi was also observed. Three subsets of hypertensives were obtained by dividing the 383 essential hypertensives on the basis of their AER: < or = 11 (group A), 11 < or = 20 (group B) and > 20 micrograms/min (group C).
Microalbuminuria, creatinine clearance, PRA, ABPM, LVMI, LVMH, early:late peak filling velocity ratio, hypertensive retinopathy.
Among the 383 essential hypertensives, AER was < 11 micrograms/min in 55% of the patients (group A), 18% had AER in the range 11-20 micrograms/min (group B) and 27% had AER > 20 micrograms/min (group C). In the entire essential hypertensive population the prevalence of left ventricular hypertrophy was 44.39% and hypertensive retinopathy was observed in 54.83%. Moreover, AER significantly correlated with clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP), with 24 SBP and DBP and with 24 h daytime and night-time mean blood pressure (MBP). AER was correlated also with LVMH and creatinine clearance. The analysis of the three subsets revealed no differences in age, body mass index, serum creatinine level and PRA. Group C in comparison with group A showed higher values of clinic SBP, 24 h SBP, DBP and MBP, and of daytime and night-time MBP. Furthermore, in group C, LVMI and LVMH were significantly greater than in group A, with a prevalence of left ventricular hypertrophy of 55% in the former group. Group C showed a prevalence of hypertensive retinopathy of 69% whereas in group A the prevalence was 48%. In group C, AER was significantly correlated with serum creatinine level.
The transversal phase of our research, performed in a homogeneous population of Caucasian essential hypertensives with no metabolic disturbances, confirms the relationship between blood pressure pattern and early glomerular changes in essential hypertensives without overt proteinuria. Furthermore, these results emphasize the role of microalbuminuria as a marker of early cardiac, renal and retinal structural and functional changes in essential hypertension. The longitudinal study, which is in progress, will confirm the prognostic value of microalbuminuria in essential hypertension.
Journal of Hypertension 08/1996; 14(7):915-20. · 4.02 Impact Factor
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G Cerasola,
S Cottone,
G Mulé,
E Nardi,
M T Mangano,
G Andronico,
A Contorno,
P Galione,
D LaMilia,
F Renda, G Piazza,
V Volpe,
A Lisi,
L Ferrara,
N Panepinto
Contributions to nephrology 02/1996; 119:130-34. · 1.49 Impact Factor
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Journal of hypertension. Supplement: official journal of the International Society of Hypertension 01/1994; 11(5):S274-5.
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ABSTRACT: The aim of this work was to study the insulin-like growth factor 1 (IGF1), a substance able to promote cell proliferation in vascular smooth muscle, in patients with mild-to-moderate hypertension and to analyse its relationship to sodium-lithium countertransport, a genetic marker of hypertension that is related to cardiovascular complications.
We studied 32 hypertensive subjects, some with left ventricular hypertrophy, and 14 healthy subjects. Fasting plasma IGF1 was measured by means of a radioimmunoassay after octadecylsilica chromatography and Na(+)-Li+ countertransport was determined by the method of Canessa.
Hypertensive patients had higher values of both IGF1 and Na(+)-Li+ countertransport. We found a positive correlation, irrespective of age, between IGF1 and Na(+)-Li+ countertransport. The patients with left ventricular hypertrophy had significantly higher plasma IGF1 levels than those without left ventricular hypertrophy.
Our results confirm a possible role for IGF1 in the cardiovascular complications of hypertension and emphasize its relationship to genetically determined factors.
Journal of Hypertension 11/1993; 11(10):1097-101. · 4.02 Impact Factor
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ABSTRACT: Hypertensive obese subjects with glucose intolerance have hyperinsulinaemia, insulin resistance and intracellular cation imbalance resulting in increased sodium content. The aim of our study was to assess in these patients plasma levels of endogenous digoxin-like factor (EDLF), an inhibitor of the sodium-pump mechanism. We studied 14 hypertensive and 12 normotensive subjects with obesity and glucose intolerance for fasting blood glucose, and plasma insulin, C-peptide and EDLF levels: the two groups were matched for age and BMI and were studied after a 2-week wash-out period from hypotensive drugs. Compared with normotensives, hypertensive subjects had higher plasma insulin levels, a greater immunoreactive insulin/C-peptide ratio, a lower glucose/insulin ratio and higher plasma EDLF levels. Our results confirm that among obese people with glucose intolerance, hypertensives are more hyperinsulinaemic and insulin-resistant than normotensives and indicate that the intracellular cation imbalance in these patients may be attributable, at least in part, to EDLF.
Acta Diabetologica 02/1992; 28(3-4):203-5. · 2.78 Impact Factor
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Journal of hypertension. Supplement: official journal of the International Society of Hypertension 01/1992; 9(6):S408-9.
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ABSTRACT: To compare the metabolic effects of nifedipine and enalapril, we studied 21 obese patients (BMI of 31.6 +/- 1.1) with mild-to-moderate hypertension and glucose intolerance. None of the patients were receiving insulin or hypoglycemic agents. After a washout period of 15 days, blood pressure was recorded and fasting blood glucose, insulin, and lipid concentrations were determined. At random, 11 patients were started on nifedipine and 10 patients on enalapril. At the 90th day of treatment, clinical and laboratory tests were again performed. Both of the drugs reduced blood pressure values comparably. No significant variation of metabolic parameters was found after 90 days of treatment in the enalapril group. In the nifedipine group, the fasting insulin level was decreased and the glucose/insulin ratio was significantly increased, suggesting an improvement in insulin sensitivity; moreover, total plasma cholesterol was significantly reduced. Enalapril and nifedipine seem to be effective and safe drugs in the treatment of hypertensive subjects with obesity and glucose intolerance. Nifedipine can ameliorate insulin resistance and the lipid state.
Journal of Cardiovascular Pharmacology 02/1991; 18 Suppl 10:S52-4. · 2.29 Impact Factor
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