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Omega-3 Polyunsaturated Fatty Acids in the Treatment of Non-Alcoholic Fatty Liver Disease: Are They So Good?
No full textEditorial. No abstract available
Heart failure in the elderly: A geriatric syndrome. Picture of the modern situation
Full text linkAmong the older patients’ cohort, the aetiology of heart failure is peculiar and differs in many ways from the younger one, both in its epidemiology, diagnostic work-up and clinical presentation. Focusing on this population, we could assume that heart failure is a real geriatric syndrome, characterized by several features, which coexist with other comorbidities and require specific and targeted cares. It is therefore necessary to examine the global burden of heart failure and the patient’s history rather than the causal cardiomyopathy - frequently more than one in the elderly - facing with the condition, bearing in mind the quality of life even before its duration
Omega-3 Polyunsaturated Fatty Acids in the Treatment of Non-Alcoholic Fatty Liver Disease: Are They So Good?
Full text linkDecreased fibrinolytic activity is associated with carotid artery stiffening in arterial hypertension
Full text linkBackground: A prothrombotic state is associated with the presence and severity of organ damage in hypertensive patients. In these patients, evidence of subclinical carotid functional changes anticipates major cardiovascular events. The aim of this study was to investigate the association of hemostatic markers with carotid artery stiffness in hypertension. Materials and Methods: In 116 untreated essential hypertensive patients recruited at a referral center in the University of Udine, we assessed common carotid artery stiffness by B-mode ultrasonography and measured plasma fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1), and homocysteine by the currently available methods. For statistical reasons, the patients were divided according to the median value of each index of carotid stiffness, and continuous variables were further analyzed by univariate correlation and stepwise multivariate regression analysis. Results: PAI-1 levels were significantly higher in patients with low coefficient of distensibility (P = 0.018) and high Young's elastic modulus (P = 0.012), whereas no association of fibrinogen, D-dimer, and homocysteine levels was observed with carotid coefficient of distensibility, Young's elastic modulus, and β-stiffness. On univariate analysis, Young's elastic modulus was significantly and positively correlated with PAI-1 levels (r = 0.286, P= 0.002), a correlation that on multivariate regression resulted to be independent of other confounders (β = 0.289, P= 0.028). Conclusion: An independent association of plasma PAI-1 levels with carotid artery stiffness suggests a possible contribution of decreased fibrinolytic activity to the early functional abnormalities of arterial vessels in hypertensive patients. This contribution might be relevant for subsequent development of hypertension-related cardiovascular complications
Functioning or Non-Functioning Adrenal Adenoma? Probably, Just a Matter of Time
No full textWe present a 44-year-old female with an adrenal adenoma characterized by late autonomous secretion of aldosterone. The patient was admitted at our Hypertension Unit for a resistant form of severe hypertension with target organ damage and a history of adrenal non-functioning adenoma. Seven years before admission, the patient was evaluated for a mild normokalemic hypertension associated with accessional headache and a diagnosis of essential hypertension and left adrenal incidentaloma was made. After few years of well-controlled hypertension, blood pressure levels worsened and a significant cardiac remodeling and a second grade retinopathy appeared despite of the increased number of antihypertensive drugs. Hormone tests were then repeated and showed an elevated aldosterone to renin ratio with normal cortisol and catecholamines. Primary aldosteronism was confirmed by the lack of suppression of aldosterone levels after an intravenous saline loading test. Computerized tomography scanning confirmed the left adrenal adenoma that was increased respect to the previous evaluation. Successful adrenalectomy was performed, which resulted in a decrease of blood pressure and no need of antihypertensive drugs. This case-report confirms the need for an accurate diagnostic work-up for primary aldosteronism and a strict follow-up of patients with mild hypertension and apparently non-functioning adrenal adenoma
Functioning or Non-Functioning Adrenal Adenoma? Probably, Just a Matter of Time
No full textWe present a 44-year-old female with an adrenal adenoma characterized by late autonomous secretion of aldosterone. The patient was admitted at our Hypertension Unit for a resistant form of severe hypertension with target organ damage and a history of adrenal non-functioning adenoma. Seven years before admission, the patient was evaluated for a mild normokalemic hypertension associated with accessional headache and a diagnosis of essential hypertension and left adrenal incidentaloma was made. After few years of well-controlled hypertension, blood pressure levels worsened and a significant cardiac remodeling and a second grade retinopathy appeared despite of the increased number of antihypertensive drugs. Hormone tests were then repeated and showed an elevated aldosterone to renin ratio with normal cortisol and catecholamines. Primary aldosteronism was confirmed by the lack of suppression of aldosterone levels after an intravenous saline loading test. Computerized tomography scanning confirmed the left adrenal adenoma that was increased respect to the previous evaluation. Successful adrenalectomy was performed, which resulted in a decrease of blood pressure and no need of antihypertensive drugs. This case-report confirms the need for an accurate diagnostic work-up for primary aldosteronism and a strict follow-up of patients with mild hypertension and apparently non-functioning adrenal adenoma
Moderate alcohol consumption is associated with left ventricular diastolic dysfunction in nonalcoholic hypertensive patients
No full textEthanol consumption is associated with left ventricular dysfunction in heavy ethanol drinkers. The effect of moderate ethanol intake on left ventricular function in hypertension, however, is unknown. We investigated the relationship between ethanol consumption and cardiac changes in nonalcoholic hypertensive patients. In 335 patients with primary hypertension, we assessed daily ethanol consumption by questionnaires that combined evaluation of recent and lifetime ethanol exposure and examined cardiac structure and function by echocardiography. Patients with abnormal liver tests, previous cardiovascular events, left ventricular ejection fraction <50%, and creatinine clearance <30 mL/min 1.72 m(2) were excluded. Left ventricular hypertrophy was found in 21% of hypertensive patients and diastolic dysfunction was detected in 50% by tissue-Doppler imaging. Ethanol consumption was comparable in hypertensive patients with and without left ventricular hypertrophy, whereas patients with left ventricular diastolic dysfunction had significantly greater consumption than patients with normal ventricular filling. Left atrial diameter, e wave velocity, e/a ratio, and E/e ratio changed progressively with increasing levels of ethanol consumption, and prevalence of left ventricular diastolic dysfunction increased with a change that became statistically significant in patients consuming 20 g/d of ethanol or more. The e wave velocity was inversely correlated with ethanol consumption, and multivariate logistic regression indicated that ethanol consumption predicted diastolic dysfunction independently of age, body mass index, blood pressure, insulin sensitivity, and left ventricular mass index. In conclusion, ethanol consumption is independently associated with left ventricular diastolic dysfunction in nonalcoholic hypertensive patients and might contribute to development of diastolic heart failure
Intrarenal Vascular Resistance is Associated With a Prothrombotic State in Hypertensive Patients
Full text linkBackground/Aims: Hypertensive nephroangiosclerosis is associated with progressive increase of intrarenal vascular resistance. In addition to blood pressure, other factors can contribute to hypertensive renal damage including a prothrombotic state. We investigated the relationship between hemostatic markers and intrarenal vascular resistance in hypertension. Methods: In 115 untreated, nondiabetic, hypertensive subjects free of cardiovascular complications and advanced renal function impairment, we measured 24-hour creatinine clearance (GFR) and urinary albumin excretion (UAE), fasting plasma glucose, HOMA-index, and plasma levels of fibrinogen, D-dimer, prothrombin fragment 1+2, plasminogen activator inhibitor-1, homocysteine, and lipoprotein(a). In all patients, measurement of intrarenal resistance was obtained by renal Doppler ultrasound with calculation of the renal resistance index (RI). Results: Patients in the highest tertile of RI were older and had greater body mass index, pulse pressure, fibrinogen, and D-dimer levels and lower GFR than patients in the lowest RI tertile. RI was directly correlated with age, pulse pressure, HOMA-index, UAE, D-dimer, and inversely with GFR. On multivariate analysis, RRI was independently associated with age, GFR, and plasma D-dimer. Conclusions: A prothrombotic state is associated with increased intrarenal vascular resistance in nondiabetic hypertensive patients and might contribute to the early stages of hypertensive renal disease
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