[Show abstract][Hide abstract]ABSTRACT: To evaluate in type 2 diabetes mellitus the relationship between masked hypertension (MH) and left ventricular (LV) morpho-functional characteristics.
Using 24-hour BP monitoring and echocardiography, we evaluated 71 type 2 diabetic patients, without overt cardiac disease and never treated with antihypertensive drugs: 45 normotensive subjects with clinic BP <130/85 mmHg and 26 sustained hypertensives (SH)(clinic BP > or = 140 and/or 90 mmHg and 24-hour BP > or =125 and/or 80 mmHg), matched for age, gender, BMI and duration of diabetes with clinically normotensive patients. MH was diagnosed with clinic BP <130/85 mmHg and 24-hour BP > or =125 and/or 80 mmHg.
Among clinically normotensive patients, 21 (47%) had MH and 24 were true normotensive (NT, 24-hour BP <125/80 mmHg). LV mass increased from NT to MH to SH (p < 0.001); the parameters of LV diastolic function were similar between MH and SH and significantly lower than in NT.
In type 2 diabetic patients with clinic BP <130/85 mmHg, MH is frequent and is associated with LV remodelling characterized by increased myocardial mass and preclinical impairment of LV diastolic function; the remodelling is qualitatively and for some aspects also quantitatively similar to that found in sustained hypertensive patients. Therefore it would be useful to look for MH in diabetic subjects with clinic BP <130/85 mmHg, who, following the guidelines, are not entitled to antihypertensive treatment: the finding of MH could identify a subgroup of patients at higher cardiovascular risk and therefore needing a prompt antihypertensive treatment.
No preview · Article · Nov 2007 · American Journal of Hypertension
[Show abstract][Hide abstract]ABSTRACT: Although extensive experimental evidence supports a primary role of polymorphonuclear leukocytes (PMNs) in atherosclerosis, few data exist concerning the functional properties of these cells and their pharmacological modulation in high-risk individuals.
The production of the proinflammatory chemokine interleukin-8 (IL-8), migration and chemotaxis, and reactive oxygen species (ROS) generation were investigated in a longitudinal study in PMNs obtained from high-risk individuals during statin treatment. As a secondary endpoint we compared PMN function of high-risk patients with that of controls.
PMNs were isolated from 21 high-risk individuals before treatment and 3 and 30 days after the beginning of simvastatin treatment, and from healthy controls. During treatment a significant reduction was observed both in resting (P = 0.009) and N-formyl-Met-Leu-Phe (fMLP)-stimulated (P = 0.008) IL-8 production, and in the chemotactic index (P = 0.038), whereas ROS generation did not significantly change. In comparison with cells from controls, PMNs obtained from patients before starting simvastatin treatment showed higher resting and fMLP-stimulated IL-8 release (P = 0.007 and P = 0.002, respectively) and ROS generation (resting, P = 0.009; and fMLP-stimulated, P = 0.046), whereas migration and the chemotactic index did not significantly differ.
An activation of neutrophils is present in high-risk individuals, shown by the enhanced production of IL-8, and increased ROS generation. The 4-week statin treatment is able to reduce the cell capability to produce IL-8, and to decrease chemotaxis, thus affecting the proinflammatory properties of PMNs.
No preview · Article · Jan 2007 · Journal of Hypertension
[Show abstract][Hide abstract]ABSTRACT: Left ventricular (LV) diastolic dysfunction is a main feature of diabetic heart disease. The aim of this prospective study was to evaluate the influence of glycemic control on diastolic function in type 1 diabetes mellitus. Thirty-six normotensive (24-hour blood pressure <130/80 mm Hg) subjects with inadequately controlled (glycated hemoglobin >7%) type 1 diabetes, without clinically detectable heart disease, were enrolled. After the basal evaluation, insulin therapy was modified to improve glycemic control. Glycated hemoglobin, LV echocardiography, 24-hour blood pressure monitoring, and laboratory tests were repeated after 6 months in all patients and after 12 months in 27 patients. At the basal evaluation, LV anatomy and systolic function were normal in all, and diastolic function was impaired in 14 patients. After 6 months, the mean values of body mass index, 24-hour blood pressure, and LV anatomy and systolic function were unchanged; mean glycated hemoglobin was decreased (p < 0.001), and mean values of diastolic parameters were significantly improved. After 12 months, the mean values of all blood pressure, metabolic, and LV parameters were unchanged. Percent changes of diastolic parameters were inversely correlated with percent changes of glycated hemoglobin, considering changes from the basal to the 6-month evaluation, as well as changes from the 6- to the 12-month evaluation. In conclusion, in normotensive patients with type 1 diabetes, a close relation was found between glycemic control and LV diastolic function, which improves when glycemic control improves. Therefore, diastolic dysfunction can be prevented or reversed, at least partly, by tight glycemic control.
No preview · Article · Feb 2006 · The American Journal of Cardiology
[Show abstract][Hide abstract]ABSTRACT: The present study was performed to investigate the production of the proinflammatory chemokine interleukin (IL)-8 in polymorphonuclear leukocytes (PMNs) obtained from high-risk patients. Patients were studied before institution of treatment with simvastatin 20 mg/die (1D-e) and thereafter, at 3 days (3D-e) and at 30 days of treatment (30D-e). Age- and sex-matched healthy subjects were included as controls.Eight high-risk patients (mean age 61±8 years; 5 patients with type-2 diabetes in diet treatment, 3 dyslipidemic patients; non-smokers, no heavy sporting activities) were studied. Total cholesterol, LDL-c and ApoB were found significantly reduced with respect to pretreatment values at both 3D-e and 30D-e. Both resting levels as well as fMLP-stimulated production of IL-8 in PMNs from patients at 1D-e were significantly higher than those in cells from controls (resting: 929.4±327.1 pg/ml vs 110.9±34.4; fMLP-stimulated: 1415.0±301.4 pg/ml vs 427.1±89.7 pg/ml; in both cases, P
No preview · Article · May 2005 · American Journal of Hypertension
[Show abstract][Hide abstract]ABSTRACT: To investigate whether the treatment with simvastatin 20 mg/die may change polymorphonuclear leukocyte (PMN) function in high-risk patients, the chemotactic index (CI, i.e. stimulated chemotaxis/spontaneous migration) and reactive oxygen species (ROS) production were studied in isolated PMNs obtained from patients before institution of statin treatment (1D-e) and thereafter, at 3 days (3D-e) and at 30 days of treatment (30D-e). Functional responses were obtained by stimulation of the cells with fMLP, a chemotactic peptide acting on membrane receptors, and PMA, a direct activator of protein kinase C.Eight high-risk subjects (mean age 61±8 years; 5 patients with type-2 diabetes in diet treatment, 3 dyslipidemic patients; non-smokers, no heavy sporting activities) were studied. In patients at 1D-e the mean total cholesterol (T-c) was 238±23 mg/dl, LDL-c was 165±17 mg/dl, HDL-c was 47.5±5.3 mg/dl, and triglycerides were 125±50 mg/dl. T-c, LDL-c and ApoB significantly decreased at both 3D-e (202±27 mg/dl, 134±25 mg/dl, and 108±15 mg/dl, respectively) and 30D-e (164±28 mg/dl, 96±21 mg/dl, and 70±32 mg/dl, respectively). Differences were always statistically significant vs 1D-e (P
No preview · Article · May 2005 · American Journal of Hypertension