Valentina di Tizio

Università Politecnica delle Marche, Ancona, The Marches, Italy

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Publications (5)18.58 Total impact

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    ABSTRACT: Background and Aims Primary aldosteronism (PA), the most frequent form of secondary hypertension, is characterized by a higher rate of cardiovascular (CV) events than essential hypertension (EH). Aim of the study was to evaluate the cardiovascular risk according to the ESH/ESC 2007 guidelines, in patients with PA and with EH, at diagnosis and after treatment. Methods and Results We prospectively studied 102 PA patients (40 with aldosterone producing adenoma-APA and 62 with idiopathic hyperaldosteronism-IHA) and 132 essential hypertensives at basal and after surgical or medical treatment (mean follow-up period 44 months for PA and 42 months for EH). At baseline evaluation the stratification of CV risk was significantly different: the predominant risk category was the high CV risk (50% in total PA, 53% in PA matched for blood pressure values and 55% in EH), but the very high risk category was twice in PA than in EH patients (36% in total PA and 33% in matched PA vs. 17% in EH, p<0.05). The worse risk profile of PA was due to a higher prevalence of glycemic alterations, metabolic syndrome and left ventricular hypertrophy (LVH) (p<0.05). After adequate treatment, the CV risk was significantly reduced becoming comparable in PA and in EH patient due to a reduction of hypertension grading, prevalence of metabolic syndrome, hypertension persistence and LVH (p<0.05). Conclusion Patients with PA present a high CV risk, which is in part reversible after specific treatment, due both to the reduced blood pressure values and to the improvement of end-organ damage.
    No preview · Article · Jan 2013 · Nutrition, metabolism, and cardiovascular diseases: NMCD
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    ABSTRACT: Several lines of evidence suggest a detrimental effect of aldosterone excess on the development of metabolic alterations. Glucose metabolism derangements due to aldosterone action are frequently observed not only in patients with primary aldosteronism but also in patients with obesity. A contribution to the hyperaldosteronism observed in obese subjects can be attributed, at least in part, to the action of still unidentified adipocyte-derived factor. Aldosterone, through genomic and non-genomic actions contributes to induce several abnormalities: pancreatic fibrosis, impaired beta cell function, as well as reduced skeletal muscle and adipose tissue insulin sensitivity. Oxidative stress, systemic inflammation, together with these metabolic alterations may explain the appearance of the cardiometabolic syndrome and the progression of cardiovascular and renal diseases, in the presence of inappropriate aldosterone levels. The biological actions of aldosterone are mediated by mineralocorticoid receptor (MR), although MR can be activated through an aldosterone independent fashion. Besides salt-water homeostasis, MR activation promotes inflammation, endothelial dysfunction, cardiovascular remodelling and affects adipose tissue differentiation and function. Clinical and experimental studies have shown that MR blockade is able to suppress inflammation, to improve endothelium- dependent vasorelaxation, but most interestingly, to improve pancreatic insulin release as well as insulin-mediated glucose utilization. These actions indicate MR antagonists as a useful therapeutic tool able not only to reduce cardiovascular risk and renal damage, but also to improve metabolic sequaelae.
    No preview · Article · Mar 2012 · Current Vascular Pharmacology
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    ABSTRACT: A positive correlation between thyroid-stimulating hormone (TSH) and blood pressure (BP) has been identified in normotensives and in patients with essential hypertension (EH). This study was designed to evaluate, in primary aldosteronism (PA) and in EH, potential association of BP, TSH, and ultrasonographic changes of the thyroid. We studied 188 patients: 92 with PA and 96 matched essential hypertensives. Clinical and ambulatory BP (ABP), and thyroid function were evaluated in all patients. In PA and in a subgroup of EH patients (n = 65) thyroid ultrasonography was performed. In PA patients, diastolic office and diastolic ABP increased across TSH quartiles and multivariate analysis confirmed a positive significant correlation between TSH and diastolic BP, independently of aldosterone levels, body mass index (BMI), duration of hypertension, and age. In EH patients, we found a significant linear increase in systolic and diastolic ABP with increasing TSH. The prevalence of thyroid dysfunctions was similar in PA and EH (15% and 19%, respectively). In PA patients, we found a higher prevalence of ultrasonographic alterations than in EH (66% vs. 46%, P < 0.05). PA patients presenting morphological abnormalities had higher homeostasis model assessment-insulin resistance levels than patients with normal gland at ultrasonography (4.2 ± 1.8 vs. 3.1 ± 0.8 P < 0.05). We found a positive correlation between TSH and BP both in PA and EH patients. Moreover, in PA patients we observed a high prevalence of thyroid morphological alterations.
    No preview · Article · Aug 2011 · American Journal of Hypertension

  • No preview · Article · Jun 2011 · Journal of Hypertension
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    ABSTRACT: Objective: Recent guidelines promote adrenal venous sampling (AVS) as the reference test to document lateralized aldosterone hypersecretion in primary aldosteronism (PA). However, there are wide discrepancies between institutions in the criteria used. Our objective was to evaluate their impact on the interpretation of AVS results. Design and Methods: All 399 AVS performed from 2001 to 2008 in our institution were included. Results were interpreted using the criteria reported in recent papers from four experienced institutions where Cosyntropin is not infused during AVS (Brisbane, Padua, Paris, and Turin). AVS were classified as: (i) unsuccessful if they did not meet the criterion of selective AVS; (ii) left or (iii) right if successful and meeting the lateralisation criterion on the considered side; (iv) bilateral otherwise. When multiple samples were available on one side, we investigated the influence of using the highest valid aldosterone:cortisol ratio (presumably the most selective one), rather than the mean of all valid ratios (our current standard). Results: The proportion of AVS classified as unsuccessful was 5 times higher with the strictest criteria than with the least strict (16 vs. 3%, see tables). The proportion of AVS classified as lateralised was more than twice higher with the least stringent criteria than with the most stringent (58 vs. 24%, see tables). Multiple samples where available for at least one side in 111 AVS. Using the highest valid aldosterone:cortisol ratio rather than their mean changed the classification of 9/111 AVS according to the Padua criteria: 7 from lateralised to bilateral and 2 from bilateral to lateralised. Three patients only were reclassified when the other criteria were used. Conclusion: Different sets of criteria currently used in experienced institutions translate into extremely heterogeneous classifications, and ultimately surgical decisions, for PA patients. AVS cannot be regarded as a gold standard until appropriate diagnostic criteria have been defined. Large and well-designed studies, preferably multicentre, are needed to resolve this issue.
    No preview · Article · Jun 2010 · Journal of Hypertension