Giuseppe Schillaci

• University of Perugia

The original Riva-Rocci method to measure blood pressure (BP) using a cuff at the upper arm assumed the pressure obtained by this technique was a good proxy for central aortic BP.1,2 The clinical (prognostic) importance of brachial cuff BP is undeniable for both the assessment of cardiovascular risk associated with elevated BP and the benefits of t...

Left ventricular (LV) afterload is a major determinant of cardiac stress and a key factor for the development of hypertensive heart disease and load-induced ventricular dysfunction. Office brachial blood pressure (BP) is an established predictor of LV mass (with BP components in the following order: systolic > mean > pulse > diastolic),¹ although t...

Background and purpose: In contrast with the carotid arteries, the vertebral arteries (VAs) show considerable variation in length, caliber, and vessel course. This study investigated whether the variation in diameter and flow characteristics of the VAs might be inherited. Methods: A total of 172 Italian twins from Padua, Perugia, and Terni (54 m...

Metabolic syndrome (MS), a cluster of metabolic abnormalities linked to insulin-resistance and abdominal obesity, is associated with an increased risk of Type II diabetes mellitus (DM) and cardiovascular (CV) disease. Its prevalence is high, affecting 20%–30% of the general population, and increases with age in a sex-specific manner: in fact, while...

BACKGROUND: Hypertension control is often inadequate in HIV patients. In a contemporary, nationwide cohort of Italian HIV-infected adults, we assessed time trends in hypertension prevalence, awareness, treatment, and control. We also evaluated predictors of cardiovascular events and of new-onset hypertension. METHODS: Multicenter prospective cohort...

Background: The measurement of femoral intima-media thickness (IMT) is underutilized in the clinical practice, although it is a surrogate marker of cardiovascular disease. Materials and methods: 388 Hungarian and Italian twins (121 monozygotic, 73 dizygotic pairs) underwent bilateral B-mode sonography of femoral arteries. IMT was measured by sem...

Elevated blood pressure is the strongest modifiable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in preven...

Objective: An excess morning blood pressure surge (MBPS) may portend an increased cardiovascular risk, but the mechanisms thereof have been little investigated. The link between MBPS, short-term blood pressure (BP) variability, and arterial stiffness has not been entirely defined. Methods: In 602 consecutive untreated hypertensive patients (48 ±...

Although microvascular disease is a hallmark of systemic sclerosis (SSc), a higher prevalence of macrovascular disease and a poorer related prognosis have been reported in SSc than in the general population. The simultaneous assessment of prognostically relevant functional properties of larger and smaller arteries, and their effects on central hemo...

Objective: Ideal cardiovascular health (ICH) among adolescents is defined as the optimal levels of three CV risk factors (SBP/DBP < 90°percentile, fasting glucose <100 mg/dL, total cholesterol <170 mg/dL) and four behaviours (body mass index (BMI) <85°percentile, not smoking, presence of >=4 healthy components in diet, moderate or vigorous physica...

Background: the MACISTE study (Metabolic and Cardiovascular Investigation at School, Terni) aimed at evaluating the metabolic and cardiovascular abnormalities and behaviors in healthy adolescents attending a High School. We evaluated the prevalence of smoking habits and the relationship between smoking and physical activity. Methods: 539 students (...

Objective/background: Vitamin D deficiency has been associated with the prevalence and severity of peripheral arterial disease (PAD); nevertheless, data on bone turnover in patients with PAD is lacking. The present study investigates a possible relationship between the markers of bone turnover and the presence and severity of PAD. Methods: The s...

Sympathetic overactivity may have a role in triggering and maintaining resistant hypertension, and catheter-based renal denervation (RDN) has emerged as a promising treatment in refractory hypertension. Recently, the results of the Symplicity HTN-3, the first randomized, sham-controlled trial, failed to confirm the previously reported BP-lowering e...

Background Systemic sclerosis (SSc) patients are characterized by premature cardiovascular (CV) mortality. In this setting, the disease represents an intriguing model to evaluate premature endothelial damage. Indeed, both macrovascular and microvascular damage characterizes subclinical atherosclerosis (ATS) in these patients (1). Traditional CV ris...

Background: Peak of bone mass (PBM) is generally reached about the age of 18 both in boys and girls. Maximizing PBM during growth may contribute to fracture risk reduction in adulthood and in the elderly. The aim of our study was to evaluate the effects on bone mineral density (BMD) of global physical activity (PA), carried out in the past 15 year...

Background: Increased urine albumin excretion (UAE) is a well known predictor of cardiovascular events in patients with primary hypertension. Whether a reduction in UAE is associated to an improvement in cardiovascular risk is at present unclear. We performed a systematic review and meta-regression analysis of available trials to investigate wheth...

We compared intima–media thickness (IMT) and the prevalence of plaques in the common carotid artery (CCA) and common femoral artery (CFA) in apparently healthy participants. This multicenter study included 322 participants (59.9% female; age 20-78 years, mean 52.1 ± 15.3 years) who underwent Echo-color Doppler examination of the CCA and CFA bilater...

Background: Local blood pressure (BP) changes induced by arm tilting may influence pressure wave transmission and reflection. We investigated the effects of upper-limb tilting on radial augmentation index (rAIx) and related central measures [aortic augmentation index (aAIx)]. Methods: In 45 volunteers (age 49 ± 19 years), supine brachial BP and...

Epidemiological evidence has indicated that the risk of cardiovascular complications associated with hypertension may not only depend on the magnitude of blood pressure elevation per se, but also, on the presence of increased blood pressure variability. Although the neurogenic influences to the peripheral vasculature and the heart are major determi...

β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure (cSBP) as compared with peripheral SBP (pSBP). Whether this effect is less pronounced with vasodilating β-blockers (VBB) when compared with nonvasodilating β-blockers (NVBB) remains unsettled. We conducted a systematic review and meta-...

Purpose: Our study evaluated brain natriuretic peptide (BNP) changes over time after adjuvant radiotherapy (RT) in women with left-sided breast cancer investigating its correlation with heart dosimetric parameters. Methods: Forty-three patients underwent clinical cardiac examination, electrocardiogram (ECG), echocardiography and BNP measurement...

When blood pressure (BP) is measured several times in a given individual, as it typically happens during ambulatory or home BP monitoring, the linear relationship between systolic and diastolic BP can be taken as the basis for a number of clinical markers, which may give information on the large-artery functional properties without the need for ded...

Introduction: A growing amount of data supporting the pathogenic role of the IL-23/IL-17 axis in inflammatory/autoimmune disorders has provided the rationale to target the system for therapeutic purpose. Several compounds have been and are currently under intense investigation in psoriasis and psoriatic arthritis (PsA) yielding impressive results....

Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between...

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial (hypopnea) or complete interruption (apnea) in breathing during sleep due to airway collapse in the oral or pharyngeal region. Prospective studies have established the adverse cardiovascular consequences of OSA, including an increased risk for developing hypertension, c...

Increased arterial stiffness has been reported in subjects with systemic lupus erythematosus (SLE) compared with healthy controls, and this association is partially reverted by immunosuppressive treatment. In SLE, indexes of organ damage are related to a poor clinical status and worse prognosis independently from the activity of the disease. Data a...

Femoral atherosclerosis, a major cause of peripheral artery disease, has been associated with higher cardiovascular risk in lower extremity peripheral arterial disease patients. The purpose of our study was to assess the effects of the heritable components of atherosclerotic plaque formation in the femoral artery. 161 Hungarian and Italian twin pai...

Pulse pressure (PP) is a complex physiologic trait affected by many variables, including left ventricular contractility (reflected by stroke volume), arterial stiffness, and central-to-brachial amplification. The impact of age on the relationship between stroke volume and central or brachial PP has not been investigated. 3765 adult subjects with un...

Background Increasing evidence suggests that accelerated atherosclerosis accounts for increased morbidity and premature mortality for cardiovascular (CV) disease in systemic lupus erythematosus (SLE) patients (1). Both traditional CV risk factors and disease specific features, including disease activity and damage, have been demonstrated to signifi...

Objective: Left ventricular mass (LVM) and its major anthropometric and hemodynamic determinants (body size, blood pressure, stroke volume) are all highly genetically determined. Independently from its absolute value, the amount of LVM that adapts to measures of body size and cardiac workload may be separated from its inappropriate component, namel...

Objective: Increased femoral intima-media thickness (IMT) is considered a surrogate marker of cardiovascular disease and a prognostic factor of future cardiovascular events. Our aim was to assess the heritability of IMT of the common and superficial femoral arteries (CFA, SFA). Design and method: 161 Hungarian and Italian twin pairs from Padua, Per...

While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Additional tools to further stratify the risk of patients at an individual level are biomarkers. A surrogate endpoint is a biomarker that is intended as a substitute for a clinical endpoint. In order to be con...

Insulinoma is a rare pancreatic endocrine tumor, typically sporadic and solitary. Although the Whipple triad, consisting of hypoglycemia, neuroglycopenic symptoms, and symptoms relief with glucose administration, is often present, the diagnosis may be challenging when symptoms are less typical. We report a case of road accident due to an episode of...

Elevated nighttime blood pressure (BP) and a reduced day-night BP fall ("nondipping" condition) are strong predictors of cardiovascular complications, both in hypertension and in the general population. A reduced or inverted nocturnal BP fall might also be theoretically used to define the most appropriate timing for drug administration. In a system...

Objective Systemic autoimmune diseases, in particular systemic lupus erythematosus and rheumatoid arthritis, are characterized by a high risk of premature cardiovascular (CV) events. Disease-related characteristics and traditional CV disease risk factors may contribute to atherosclerotic damage. However, there are limited data on the risk of overt...

Cerebrovascular resistance is a pressure-dependent mechanism resulting from cerebral autoregulation, which is the normal buffering of changes in arterial blood pressure. Lifestyle habits are known to have an influence; however, its magnitude is still unclear. The aim of this study was to assess the contribution of additive genetic, shared and unsha...

AIMS: Estimated central systolic blood pressure (cSBP) and amplification (Brachial SBP-cSBP) are non-invasive measures potentially prognostic of cardiovascular (CV) disease. No worldwide, multiple-device reference values are available. We aimed to establish reference values for a worldwide general population standardizing between the different ava...

Method: We investigated whether aortic characteristic impedance (Zc), that is, the ratio between the pulsatile change in pressure and flow in the proximal aorta, is related to left ventricular hypertrophy and geometry independently of blood pressure (BP). A total of 438 never-treated hypertensive individuals (men 62%, age 48 ± 11 years, BP 147/90...

The relationship between arterial stiffness, measured as pulse wave velocity (PWV), and the left ventricle is confounded by the effects of blood pressure. We evaluated the relationship between carotid–femoral PWV and cardio-ankle vascular index (CAVI), a less pressure-dependent measurement of the stiffness constant (β) of the aorta and the iliac, f...

To the Editor: In their article on the SYMPLICITY HTN-3 study, Bhatt et al. (April 10 issue)(1) report that renal-artery denervation did not reduce blood pressure in patients with resistant hypertension, as compared with a control sham procedure. We suggest that technical aspects of the procedure could explain in part the negative findings of the s...

Hypobaric hypoxia, physical and psychosocial stress may influence key cardiovascular parameters including blood pressure (BP) and pulse pressure (PP). We investigated the effects of mild hypobaric hypoxia exposure on BP and PP reactivity to mental and physical stress and to passive elevation by cable car. 36 healthy volunteers participated in a def...

Objective: Multiple twin studies have demonstrated the heritability of anthropometric and metabolic traits. However, assessment of body composition parameters by bioimpedance analysis (BIA) has not been routinely performed in this setting. Design: A cross-sectional study. Setting: Study subjects were recruited and assessed at twin festivals or...

Objective: Cardiovascular (CV) risk is of increasing concern in HIV-infected individuals. The aim of the present study was to compare CV risk profile in HIV-infected patient in two Italian nationwide survey performed, 6 years apart. Design: Multicenter, case-control study. Methods: We analyzed CV risk in 765 Caucasian HIV-infected patients enrolled...

Background Patients with systemic inflammatory and autoimmune diseases display an increased risk of cardiovascular (CV) mortality. Inflammatory and immune-mediated mechanisms have been identified to promote induction and progression of atherosclerotic endothelial injury (1). Sjögren’s syndrome (SS) represents an interesting model to investigate pat...

Objective Multiple twin studies have demonstrated the heritability of anthropometric and metabolic traits. However, assessment of body composition parameters by bioimpedance analysis (BIA) has not been routinely performed in this setting. Design A cross-sectional study. Setting Study subjects were recruited and assessed at twin festivals or at ma...

Carotid intima-media thickness (IMT) and arterial stiffness parameters, including aortic augmentation index (AIx) and pulse wave velocity (PWV), are independent predictors of stroke and cardiovascular disease. Genetic effects on these traits were never explored in a Mediterranean country. The present study aims to quantify the contribution of genes...

The variety of clinical information provided by the echocardiogram (i.e. assessment of left ventricular (LV) structure and geometry, systolic/diastolic function, left atrial and aortic size) in addition to its superior sensitivity for LV hypertrophy detection compared to electrocardiogram are strong arguments supporting the paramount importance of...

Arterial stiffness is an independent predictor of cardiovascular, cerebrovascular and all-cause mortality. Quantifying the genetic influence on the stiff arterial phenotype allows us to better predict the development of arterial stiffness. In this study, we aimed to determine the heritability of carotid artery stiffness in healthy twins. We studied...

We aimed to assess the prevalence of hypertension in an unselected human immunodeficiency virus (HIV)-infected population and to identify factors associated with hypertension prevalence, treatment, and control. We used a multicenter, cross-sectional, nationwide study that sampled 1,182 unselected, consecutive, HIV-infected patients. Office blood pr...

Carotid-femoral pulse wave velocity, a predictor of cardiovascular outcome, is conventionally measured using a tonometer sequentially placed upon the carotid and femoral arteries, gated using an electrocardiogram. Leg cuff detection of the femoral pulse removes the need for signal gating, reduces the time required for a single measurement, but give...

βa-blocking drugs have long been used as a first-line therapy for hypertension because of their well-established efficacy in lowering brachial blood pressure (BP)¹ and their long-term favorable effects on all-cause and cardiovascular mortality, as shown in a number of prospective large-scale trials and meta-analyses.² More recently, their use as a...

The very first rigorously designed, randomized controlled trial (RCT) in the history of modern medicine was published in 1948. The study, designed and carried out by the Streptomycin in Tuberculosis Trials Committee of the Medical Research Council, demonstrated the efficacy of streptomycin in treating pulmonary tuberculosis on top of bed rest, whic...

Pregnancy is associated with profound vascular adaptive changes. Cross-sectional studies show greater arterial stiffness in gestational diabetes than in normal pregnancy. However, the time course of maternal cardiovascular hemodynamics in normal and diabetic pregnancy can only be appreciated in longitudinal studies. Thirty-six women with gestationa...

Morning blood pressure surge is associated with increased cardiovascular risk, possibly due to its ability to reflect short-term BP variability and/or its link with arterial stiffness. The link between morning BP surge and vascular stiffness is not defined. 689 untreated hypertensives (48±10 years, BP 149/92±17/10 mmHg) underwent c-f PWV and 24-h a...

Obesity, blood pressure and arterial stiffness are heritable traits interconnected to each other but their possible common genetic and environmental etiologies are unknown. We studied 228 monozygotic and 150 dizygotic twin pairs aged 18-82 years from Italy, Hungary and the United States, of which 45 monozygotic and 38 dizygotic pairs were discordan...

Statin therapy is followed by reductions in carotid intima-media thickness (CIMT) and C-reactive protein (CRP) levels, but a significant number of treated patients still have increased CIMT. We investigated whether on-treatment levels of CRP is associated with CIMT in hypercholesterolemic patients receiving statin therapy. The influence of blood pr...

Twenty-four-hour blood pressure (BP) variability, by ambulatory BP monitoring (ABPM), has been related to left ventricular hypertrophy, independent of mean BP values. We tested the hypothesis that short-term BP variability (BPV) is also related to subclinical left ventricular systolic dysfunction. We assessed 24-h SBP and DBP variabilities, quantif...

Nitric oxide has an important role in the development of the structure and function of the airways and vessel walls. Fractional exhaled nitric oxide (FENO) is inversely related to the markers and risk factors of atherosclerosis. We aimed to estimate the relative contribution of genes and shared and non-shared environmental influences to variations...

Although the objective recording of arterial pulse as a tool for estimating vascular stiffness was developed about 150 years ago, many years before the measurement of arterial pressure became possible,¹ clinical and scientific interest in sphygmography tapered off by the end of the nineteenth century and remained negligible throughout most of the t...

Background and aimsEctopic artery calcification has been documented in women with postmenopausal osteoporosis, in whom an imbalance in the number of circulating osteoprogenitor cells (OPCs) has been identified. Circulating OPCs form calcified nodules in vitro; however, it remains unknown whether an association exists between the number of circulati...

Hypercholesterolemia is important in the pathogenesis of arterial stiffness. Treatment with a combination of red yeast rice, berberine and policosanols reduced cholesterol levels in hypercholesterolemic patients. We investigated whether this nutraceutical combination would improve aortic stiffness in hypercholesterolemia.Seventy hypercholesterolemi...

Background: An association between reduced lung function and increased cardiovascular risk has been reported, but the underlying mechanisms are unknown. The aim of this study was to assess the heritability of lung function and to estimate its genetic association with arterial stiffness. Methods: 150 monozygotic and 42 dizygotic healthy Hungarian...

Aim: Experimental and clinical evidence supports the view that right ventricular hypertrophy (RVH) may parallel left ventricular hypertrophy in systemic hypertension; a comprehensive analysis of this issue, however, is lacking. Thus, we analyzed the literature in order to provide an updated information on the right ventricular structural changes a...

Introduction Morbid obesity is often accompanied by insulin resistance and increased ectopic fat surrounding the heart. We evaluated the relation of epicardial and pericardial fat with insulin resistance and left ventricular (LV) structure and function. Methods Epicardial and pericardial fat thicknesses were determined at 2-dimensional echocardiog...

OBJECTIVE. The non-invasive measurement of carotid-femoral pulse wave velocity (cfPWV) is conventionally performed using a tonometer to detect the pulse in the carotid and femoral arteries, gated with the electrocardiogram for transit time measurement. Detection of the femoral pulse using a cuff removes the need for signal gating and reduces the ti...

Objective: HIV infection has been associated with increased cardiovascular risk. Twenty-four-hour ambulatory blood pressure (BP) is a more accurate and prognostically relevant measure of an individual's BP load than office BP, and the ambulatory BP-derived ambulatory arterial stiffness index (AASI) and symmetric AASI (s-AASI) are established cardi...

Background. There is increasing interest in cuff-based devices for assessment of arterial pulse wave velocity (PWV). A recently developed device utilises a thigh cuff and carotid applanation tonometry for assessment of carotid to femoral PWV (cPWV; SphygmoCor XCEL, AtCor Medical; test device). Our aim was to validate the device against ECG gated to...

Background and purpose: Few family studies reported moderate genetic impact on the presence and scores of carotid plaques. However, the heritability of carotid plaque characteristics remains still unclear. Twin studies more reliably estimate the relative contribution of genes to these traits in contrast to family study design. Methods: One hundr...

Objectives: The Vicorder is a new brachial cuff-based device that estimates central blood pressure (cBP) using a brachial-to-aortic transfer function. The aim of this study was to evaluate cBP estimated by the Vicorder. Methods: During cardiac angiography, cBP estimated by the Vicorder and the SphygmoCor was evaluated against simultaneous invasi...