[Show abstract][Hide abstract] ABSTRACT: Malignant hypertension causes anatomical and functional damage in several target organs, in particular brain, retina, heart and kidneys. Although vascular lesions in the gastroenteric tract are known to occur in several instances, their clinical relevance is unknown. In this study five cases of malignant hypertension, presenting with acute abdominal symptoms, are reported. A history of essential arterial hypertension was present in three patients; while one patient had a previous diagnosis of renovascular hypertension and one patient had renoparenchymal hypertension. However, in all cases the antihypertensive treatment was discontinued and inadequate before the accelerated malignant phase. The acute abdominal symptoms at presentation were due to intestinal infarction in 3 patients and acute pancreatitis in 2 patients. One patient with intestinal infarction died of postoperative cardiogenic shock. Our data are in agreement with previous reports describing the possible intra-abdominal complications of malignant hypertension. The therapeutic approach in such conditions should always consider an effective antihypertensive treatment in conjunction with surgical options.
No preview · Article · Sep 2001 · Clinical and Experimental Hypertension
[Show abstract][Hide abstract] ABSTRACT: Aim of the present study was to investigate factors for cardiac dysfunction in patients with renovascular hypertension (RVH).We have studied three groups of 20 patients each. Group 1 was composed by patients with renovascular hypertension, Group 2 was composed by patients with essential hypertension, Group 3 was composed by normotensive patients.The three groups were similar for age, sex distribution, body mass index and cardiovascular risk factors. Group 1 and 2 were similar for hypertension duration and drugs administration.All patients, after ten days of pharmacological wash-out, underwent: 1) simultaneous 24 h ambulatory blood pressure and ECG monitoring; 2) echocardiographic study; 3) bycicle exercise stress test; 4) PRA and aldosteronemia.Cardiac damage was defined by class 1 to 3 of score including LVH, silent or symptomatic myocardial ischemia, ventricular arrhythmias. The following results were noted: A) a significantly higher incidence of cardiac damage score in Group 1 (p < 0.001);B) the cardiac damage score in Group 1 was significantly related to: - 24 h SBP and/or DBP variability (p < 0.05);- 24 h HR variability (p < 0.01);- nocturnal BP incrase (p < 0.001);- PRA values (p < 0.01).Our data suggest that hemodynamic and metabolic factors play a relevant role in the incidence and evolution of cardiac damage in patients with RVH.
[Show abstract][Hide abstract] ABSTRACT: Am J Hypertens (1998) 11, 187A–187A; doi: 10.1016/S0895-7061(97)91398-4
K017: Incidence and prognostic relevance of silent myocardial ischemia (SMI) in essential arterial hypertension (EAH) associated with hyperlipemia
D. Melina, G. Guerrera, C. Guerrera, F. Travaglino and G. Melina
No preview · Article · Mar 1998 · American Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: The above study was undertaken in order to evaluate the efficacy and tolerability of low dose calcium heparin for postinfarct ischemic heart disease (CIPI). In particular, the incidence was checked of: cardiovascular death, reinfarction, angina pectoris, TIA or RIND, stroke, arterial thromboembolism, venous thromboses, heart failure, complex ventricular arrhythmias, silent myocardial ischemia. Eighty patients with CIPI were divided into two groups similar for age, sex, physical features, cardiovascular risk factors, site of infarction, length of hospitalization, complications during hospitalization, clinical and instrumental findings at discharge, concomitant pathology. Upon discharge, patients were randomized into group 1 for traditional treatment and group 2 which in addition received 12,000 U calcium heparin s.c. every 24 h. After 12 months, during which patients were submitted to periodical laboratory and instrumental (standard and dynamic ECG, echoG) evaluation, group 2 had significantly fewer cardiovascular events than group 1 both as to overall number of events and as to number of events per individual patient. Especially, silent myocardial ischemia and ventricular arrhythmias were less frequent in group 2 patients and these two events, especially if coincident, are known to have severe prognostic implications. The efficacy of low-dose calcium heparin must be attributed to the enhancement of physiological antithrombotic mechanisms with compensation of blood clotting disorders that are fairly frequent in CIPI patients. Long-term s.c. administration was well tolerated.
No preview · Article · Jan 1993 · La Clinica terapeutica
[Show abstract][Hide abstract] ABSTRACT: Aim: To investigate possible haemodynamic abnormalities during night and morning in ambulant treated hypertensives. Design: Observational, prospective with consecutive sampling of treated hypertensives and age-matched normotensives. Patients and method: Twelve normotensive subjects and 22 hypertensive patients effectively treated with ace-inhibitor (n.11) or calcium antagonists (n.11) were studied. Cardiac output and blood pressure were monitored every 20 min from three hours before sleep to three hours after awakening by using a wheeltransportable unit consisting of a computer-assisted impedance cardiograph couple with an automatic blood prossure monitor. While not in bed patients were free to attend their usual activity within the constraints of a 4 motor-long cable. Results: Nocturnal mean arterial pressure drop in normotensives and in hypertensives treated with ace-inhibitor or calcium antagonist was associatod with a decrease in cardiac output secondary to a reduction in heart rate with a slight increase in total peripheral resistance (12.35% (4.17), 12.75% (4.12), 8.69% (10.09), p<0.05, respectively)). Morning blood pressure rise occurred in normotensives with a decrease in total peripheral resistance (-6.68% (3.32) p<0.05), whereas no changes or a slight increase were observed in hypertensives treated with ace-inhibitor (3.80%(3.53)) or calcium antagonists (7.72%(5.45)). Conclusion: A defective decrease in morning total peripheral resistance may occur in hypertensives even during effective treatment.
[Show abstract][Hide abstract] ABSTRACT: Seventy-eight men with borderline hypertension according to the World Health Organization criteria underwent echocardiographic examination, followed by simultaneous ambulatory blood pressure and electrocardiographic monitorings for 24 h. The prevalence of echocardiographic left ventricular hypertrophy was 16.6% (13/78). Borderline hypertensives with left ventricular hypertrophy had more supraventricular (P less than .001) and ventricular ectopic beats (P less than .001) than normotensive controls and borderline hypertensives without cardiac involvement. Furthermore, ventricular ectopic activity was significantly related to left ventricular mass (r = 0.58, P less than .05) in borderline hypertensives showing echocardiographic evidence of left ventricular hypertrophy. Our findings suggest that noninvasive assessment of target organ status, including echocardiography, should be employed to optimize risk stratification in borderline hypertension.
No preview · Article · Sep 1992 · American Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: The antihypertensive efficacy of combination therapy with N-E-A was evaluated during 6 months in 15 patients with hypertension associated with mild to moderate kidney failure. After 6 months a significant reduction of SBP and DBP (p < 0.001), with improvement of creatinine clearance and with no adverse effects on ECG, heart rate and routine laboratory tests test, was observed in 3 patients treated with N 20 mg x 2/d + E 10 mg/d + A 50 mg/d and in 8 patients treated with N 20 mg x 3 + E 10 mg x 2, + A 50 mg x 2. Four patients did not respond to this therapy.
No preview · Article · Jun 1992 · Annales de Cardiologie et d Angéiologie
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to analyse electrocardiographic alterations in 30 patients with slight to moderate essential arterial hypertension during the course of hypertensive attacks (DAP greater than 115 mmHg). Standard hematochemical tests were performed in basal conditions, together with 24-h ECG monitoring and an echocardiogram to measure the left ventricular mass index. Echographic monitoring was carried out during hypertensive attacks and for 2 h after the return to basal pressure values. In basal conditions patients showed slight hypopotassemia (23%), left ventricular echographic involvement (57%), left ventricular hypertrophy with or without systolic strain (43%), and ventricular extrasystole (VE) classified as Lown's 1st and 2nd class (17%). During the course of hypertensive attacks, there was a significant increase in systolic strain, the appearance of anterolateral subendocardial ischemia (10%), left anterior hemiblock (3%), lateral subepicardial ischemia (3%), and a marked increase in VE (67%) which were complex in 40% of cases (Lown's classes 3, 4 and 5). A significant correlation was found between the left ventricular mass index and VE/h. The authors stress the multifactorial pathogenesis of echographic alterations and underline left ventricular involvement, acute hemodynamic strain and consequent alterations of coronary perfusion, hypopotassemia, and increased levels of circulating catecholamines.
No preview · Article · Oct 1991 · Minerva cardioangiologica
[Show abstract][Hide abstract] ABSTRACT: Twenty-eight men with borderline hypertension according to the World Health Organization criteria underwent maximal exercise testing, and then were followed for a two year period. The prevalence of abnormal blood pressure behavior during exercise was 53.58% (n = 15). During follow-up established hypertension developed in 63.33% (n = 10) of subjects with an abnormal blood pressure response to exercise, and only in 15% (n = 2) of subjects with normal blood pressure behavior. In predicting established hypertension development in a two year follow-up, maximal exercise testing has the following statistical values: sensitivity = 83.33%, specificity = 68.75%, accuracy = 75%, positive predictive value = 66.66%, negative predictive value = 84.61%.
No preview · Article · Apr 1991 · American Journal of Hypertension
[Show abstract][Hide abstract] ABSTRACT: Aim of this study was to assess blood pressure (BP) response to exercise in borderline hypertensive subjects and to evaluate its predictive value for subsequent established hypertension development: 74 male subjects (28 borderline subjects, 26 normotensive subjects and 20 subjects with established hypertension) underwent a maximal exercise testing in the sitting position with a bicycle ergometer at the beginning of the study and then after 1 and 2 years; besides casual BP was controlled every 3 months for 2 years. Systolic BP exceeding 220 and/or diastolic BP exceeding 105 mmHg at maximal exercise and/or diastolic BP exceeding 100 mmHg at th fifth min of recovery were considered as abnormal. On the basis of BP response to exercise we divided our study group in: normotensive subjects with a normal BP response (Group A: 88%); normotensive subjects with an abnormal BP response (Group B: 12%); borderline subjects with a normal BP response (Group C: 46%); borderline subjects with an abnormal BP response (Group D:56%). At the end of a 2-year follow-up established hypertension developed in 1 subject of Group B (33%), in 2 subjects of Group C (15%) and in 10 subjects of Group D (67%); 7 subjects of Group C returned to normotension (54%). The incidence of established hypertension is significantly higher in borderline subjects with an abnormal BP response to exercise. This finding is probably due to both functional and organic factors and stresses the predictive value of exercise testing in borderline hypertension.
No preview · Article · Jan 1991 · Cardiologia (Rome, Italy)
[Show abstract][Hide abstract] ABSTRACT: Aim of the study was to assess the effectiveness and tolerability of sublingual captopril (SLC) versus sublingual nifedipine (SLN) in treating hypertensive emergencies. During hypertensive crises (systolic blood pressure exceeding 200 mmHg and diastolic blood pressure exceeding 115 mmHg) forty hypertensive patients received either 25 mg of SLC or 10 mg of SLN in a randomized single blind fashion. Blood pressure and heart rate were then controlled after 5, 10, 15, 20, 30, 45, 60, 120 min. and, in 18 cases, up to the 8th hour from the administration. Our results showed: 1) a satisfactory control of the hypertensive crises in 80% of patients treated with SLC with a significant blood pressure reduction after 10 min. (13/8 mmHg, p less than 0.02), while the maximum hypotensive effect was achieved after 30 min. (52/36 mmHg, p less than 0.001); SLN was able to reduce blood pressure in 90% of all the cases, with a significant reduction after 5 min. (15/11 mmHg, p less than 0.02) and hypotensive peak after 20 min (57/38 mmHg, p greater than 0.001); 2) no significant differences for hypotensive effectiveness between the two groups, but with SLC having a mildly delayed onset of action when compared to SLN; 3) antihypertensive effect lasting for about 6 hours in patients treated with SLC and blood pressure progressively raising after 4 hours in patients who received SLN; 4) a significant correlation between blood pressure reduction and blood pressure before drug administration in both groups; a significant correlation between pretreatment PRA and antihypertensive effect in the SLC group. We conclude that both drugs are effective and useful in treating hypertensive emergencies. Anyway we think that in severe forms SLN should be preferred for the shorter time preceding onset of action.
No preview · Article · Jan 1990 · Minerva cardioangiologica
[Show abstract][Hide abstract] ABSTRACT: Data in the literature suggest that cases of hypoalphalipoproteinemia involve an increase in thromboxane B2 (TXB2) together with an increased risk of atherosclerosis. A recent detailed examination of a 32-year-old man revealed clinical and biochemical features strongly indicative of that pathology. The case presented several unusual features: marked infiltration of the skin and mesenteric lymph nodes by histiocytic lipids with sufficient hyperplasia to induce acute intestinal occlusion combined with an in vivo TXB2 generation curve, subsequently inhibited by aspirin, that was comparable to the curves of the control subjects. Furthermore there were no signs of early atherosclerotic damage so that it was possible to postulate the hypothesis that despite the 50% drop in alpha-lipoprotein levels, they were still sufficient to ensure normal turnover of the other lipoproteins so that, however complex the clinical condition, it was an incomplete expression of a phenotype.
[Show abstract][Hide abstract] ABSTRACT: In order to investigate whether the severity of ventricular ectopic beats in hypertensive patients is influenced by the autonomic drive to the heart, we evaluated the relationship between the degree of dysrhythmias and 24-h spontaneous heart rate variability, an index of sympatho-vagal balance at cardiac level. Ambulatory 24-h ECG monitoring was used to examine 42 untreated essential hypertensives, previously scored for the presence and the extent of hypertensive target organ damage. No significant difference was found in the prevalence of complex ventricular ectopic beats in patients with a heart rate variability that was lower and higher than the arbitrary cut off points selected to divide subjects into groups. Neither heart rate variability nor the degree of arrhythmias was correlated with blood pressure levels, whereas the degree of ectopy was influenced by the presence of target organ damage and left ventricular hypertrophy (by ECG). Our results seem to exclude an association between dysrhythmias in hypertensives and autonomic outflow to the heart as detected by the analysis of heart rate variability.
No preview · Article · Jan 1990 · Journal of hypertension. Supplement: official journal of the International Society of Hypertension
[Show abstract][Hide abstract] ABSTRACT: The aim of this study, whose preliminary findings are reported, is to evaluate the efficacy of captopril, administered by a sublingual route, in the treatment of hypertensive emergencies. Captopril has been given by this route to 20 hypertensive patients while these had an ongoing hypertensive crisis (defined as a systolic arterial pressure above 200 mmHg associated with a diastolic arterial pressure above 115 mmHg). Arterial pressure has been measured after 5, 20, 10, 15, 30, 45, 60 and 120 min. For 8 patients it has been measured until the eighth hour. Results were the following: a satisfactory control of hypertensive crisis in 85% of patients, as stated by a slight but significant drop of arterial pressure after 10 min (15/10 mmHg; p less than 0.05) and by a maximum antihypertensive effect after 30 min (57/39 mmHg; p less than 0.001); an antihypertensive effect was evident until 6 hours after the administration of the drug; a positive correlation between the antihypertensive effect and pretreatment levels of arterial pressure and plasma renin activity; drug was free from relevant side effects; sublingual captopril can be considered an efficacious, easy to use and valuable tool in the treatment of hypertensive emergencies.
No preview · Article · Mar 1989 · Cardiologia (Rome, Italy)
[Show abstract][Hide abstract] ABSTRACT: Although ambulatory blood pressure monitoring has been used widely for the evaluation of antihypertensive treatment, little information is available regarding the comparison between this method and casual BP measurement during drug trials. In our study, we tested the efficacy of a new formulation of verapamil, 240 mg sustained-release tablets, and compared the degree of BP reduction as detected by casual (standard mercury manometer) and by 24-hour ambulatory recording (Spacelab ICR 5300). A statistically significant fall in casual BP was observed after verapamil with respect to placebo. Moreover, 24-hour, waking and sleeping ambulatory BPs were significantly reduced by verapamil. The mean BP reduction was similar for office (20.1/16.1 +/- 4.3/3.1 mmHg) and for day-time ambulatory monitoring (13.4/10.7 +/- 4.2/1.9 1.9 mmHg), but no correlation was found between BP fall recorded by the two techniques for individual subjects. This study suggests that sustained-release verapamil is an effective antihypertensive drug. Individual mean BP reduction outside the clinic may not be predicted from office readings and therefore ambulatory BP recording seems to provide a better basis for testing the efficacy of drugs.
No preview · Article · Apr 1988 · Journal of Human Hypertension