1,720,985 research outputs found
PULSE WAVE VELOCITY, IPERTENSIONE E LIVELLI DI ALDOSTERONE PLASMATICO
No full textLa pulse wave velocity (PWV) è un metodo semplice, riproducibile e non invasive per valutare la rigidità delle gradi arterie e può essere impiegato facilmente nella pratica.
Dati presenti in letteratura evidenziano il ruolo di predittivo indipendente di mortalità e morbilità in pazienti affetti da ipertensione arteriosa. Diverse evidenze dimostrano altresi il ruolo pro fibrotico e proinfiammatorio dell’aldosterone a livello delle pareti vascolari, sebbene non sia ancora del tutto chiaro come i livelli di questo possano incidere clinicamente sul profilo di rigidità arteriosa.
L’obiettivo del nostro studio è stato di valutare il profilo della PWV in pazienti ottenuto mediante metodo oscillometrico e valutarne la possibile correlazione la concentrazione plasmatica di aldosterone (PAC).
I risultati mostrano come la PAC correli positivamente e in modo significativo con la PWV clinica (Pearson r: 0.241; P=0.003) e delle 24 ore (Pearson r: 0.260; P=0.009) oltre che con l’età vascolare, la pressione media clinica e delle 24 ore.
Le attuali line guida riconoscono nella valutazione carotido femorale il gold standard per la misurazione della PWV, I nostri dati supportano l’importanza di ulteriori studi per valutare il possibile impiego nella pratica clinica della misurazione con metodo oscillometrico.Among different markers of vascular HMOD, pulse wave velocity (PWV) is a simple, non-invasive and reproducible tool for evaluate stiffness of large arteries, and thus, can be easily employed in the routine clinical practice. Data showed that PWV is an independent predictor of morbidity and mortality in patients with essential hypertension. Furthermore several studies performed in various populations demonstrated a significant pro-fibrotic and pro-inflammatory effect of aldosterone on vascular endothelium leading to arterial stiffness.The aim of the research was to analyse PWV profile obtained with a validated and simple oscillometric method in a population of hypertensive patients and evaluate potential correlation with plasma aldosterone levels and CV risk factors. In our study PAC resulted significantly and positively correlated with PWV at both clinic (Pearson r: 0.241; P=0.003) and 24-hour (Pearson r: 0.260; P=0.009) BP assessments, clinic Vascular Age, clinic and 24-hour systolic/diastolic BP levels, 24-hour central systolic and diastolic BP levels. Current Guidelines report carotid-femoral PW analysis as a gold standard for diagnosis of vascular HMOD but our data support the implementation in future studies investigating the role of oscillometric methods since the comfortable and non-invasive devices and relatively limited costs for the examination in a setting of clinical practice
Measuring central or peripheral blood pressure levels? That is the question in the modern clinical practice of Hypertension
No full textOver the last decades, blood pressure (BP) levels have been measured at brachial level by conventional sphygmomanometers and, more recently, by validated and accurate automated devices. This method has been systematically applied in observational studies and in large randomized controlled clinical trials for both diagnostic and therapeutic purposes in the clinical management of essential hypertension. As an example, data from the Framingham cohort of individuals have demonstrated the strong and independent relationship between BP levels, mostly systolic, and increased risk of major cardiovascular outcomes, including myocardial infarction, stroke, renal disease, congestive heart failure and cardiovascular death [1]. Similar findings have been observed in various epidemiological surveys in almost all countries all over the world, including Italy [2]. On the other hand, pharmacological and non pharmacological interventions aimed at reducing high peripheral (brachial) BP levels have convincingly and independently demonstrated the beneficial effects of antihypertensive therapies in different clinical settings and across the whole spectrum of cardiovascular continuum.
On the basis of these assumptions, current definition of hypertension has been founded on the assessment of peripheral BP levels, and therapeutic targets in hypertension have been set on clinic BP measurements, recorded at the brachial artery level.
More recently, however, several other techniques for measuring BP in other conditions and different arteries have been progressively becoming available. These techniques provided additional BP data compared to conventional assessment. Indeed, innovative and comfortable devices for 24-h ambulatory BP monitoring, home BP measurement, intra-arterial or cuff-less assessment of beat-to-beat BP levels have made available for the clinical management of hypertensive outpatients and gradually adopted not only in randomized clinical trials, but also in real world practice of hypertension
White-coat and masked hypertension and coronary artery disease. are they related or not?
No full textCurrently, high blood pressure (BP) may cover different hypertension phenotypes, including white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT), all of which are characterized by substantially higher risk of cardiovascular (CV) events and mortality than normotension (NT) [1–5]. This has recently been reaffirmed by the latest sets of European guidelines [6], which emphasized the role of out-of-office BP assess- ment, such as 24-h ambulatory and home BP monitoring, to properly stratify apparently low-risk individuals with high- normal BP levels. The same guidelines also recommended that a search for hypertension-mediated organ damage or other risk factors and comorbidities should be performed in patients with WCHT or MHT, in view of the relative frequency of these risk factors and markers of organ damage in these hypertensive patients [6]. Despite this evidence, both WCHT and MHT are often undiagnosed or even untreated. Findings from large national databases or clinical studies have clearly demon- strated that both of these conditions are relatively common in the clinical practice of hypertension [7]. Other studies have also reported that, even in the presence of anti- hypertensive treatment, effective BP control is not achieved in patients with WCHT or MHT, with obvious and relevant consequences on the risk of developing major CV out- comes [8–10]
Time trend analysis of hypertension prevalence, awareness, treatment and control in Italy. novel insights from recent national surveys in the general population
No full textSystematic and periodic assessments of hypertension prevalence, awareness, treatment and control are available in various countries around the world. These reports have been used not only for epidemiological purposes, but mostly for planning educational and therapeutic interventions aimed at ameliorating the BP control rates and reducing the incidence of hypertension-related cardiovascular diseases at various levels or settings. Over the last few years, such analyses were made available also in Italy, thus confirming a high prevalence of hypertension in the general adult population, with relatively low rates of awareness and control. Among these surveys, the analysis provided by the National Institute of Health represents the first and most inclusive assessment of hypertension prevalence and control in the general population in our Countr
Inflammatory residual risk. An emerging target to reduce cardiovascular disease
Full text linkCardiovascular Residual Risk and Cardiovascular Preventio
Increased arterial stiffness and haemorrhagic transformation in ischaemic stroke after thrombolysis: A new marker of risk for cerebrovascular events and complications
No full textIncreased arterial stiffness is an independent risk factor for hemorrhagic transformation in ischemic stroke undergoing thrombolysis
Molecular and clinical implications of natriuretic peptides in aortic valve stenosis
No full textAortic valve stenosis (AS) is the most common heart valve disease in North America and Europe leading to an increased risk of heart failure and death. A multidisciplinary evaluation of symptoms, individual risk profile, echocardiographic parameters, biomarkers assessment is required for an appropriate clinical and therapeutic management of AS. The natriuretic peptides (NPs) represent an important biomarker for diagnostic, prognostic and therapeutic purposes in several cardiovascular diseases. The present review article provides an overview of the current knowledge on the role of NPs in the pathogenesis, diagnosis, risk stratification and potential therapeutic implications in AS. C-type natriuretic peptide (CNP) level is reduced in AS, favoring the formation of calcified aggregates and an increased expression of bone-related transcripts and proteins (Runx2, osteonectin, osteocalcin, alkaline phospahatase). Consistent results were obtained through the inhibition of the type A and B natriuretic peptide receptors (NPRA, NPRB) and of the proprotein convertase furin expression. Increased plasma B-type natriuretic peptide (BNP) level contributes to monitor the progression of AS and to identify patients who would most benefit from an early therapeutic intervention, such as surgical or transcatheter aortic valve replacement. Moreover, a risk stratification of AS patients that takes into account the NPs level has a major impact toward the occurrence of heart failure, syncope and sudden cardiac death. Finally, the development of novel therapeutic strategies, such as the neprilysin inhibition, may represent a suitable pharmacological approach for the treatment of AS. Due to the above mentioned multiple roles, NPs represent key players in AS development, management and treatment
Blood pressure targets achievement according to 2018 ESC/ESH guidelines in three european excellence centers for hypertension
No full textIntroduction The most recent European guidelines on hypertension rede ned o ce blood pressure (BP) treatment targets according to age strata and cardiovascular (CV) risk pro le. Aim To evaluate proportions of adult outpatients achieving o ce BP treatment targets recommended by current compared to previous hypertension guidelines. Methods We extracted data from medical databases of adult outpatients followed in three excellence centers in hyperten- sion (Rome, Italy; L’Aquila, Italy; Valencia, Spain). O ce BP treatment targets were de ned according to either 2013 ESH/ ESC guidelines (< 140/90 mmHg in non-diabetic individuals aged 18–80 years, < 150/90 mmHg in those aged ≥ 80 years, and < 140/85 mmHg in diabetic individuals), or 2018 ESC/ESH guidelines: (< 130/80 mmHg in individuals aged 18–65 years, < 140/80 mmHg in those aged 65–79 and ≥ 80 years). SCORE risk was assessed in all patients. Results From an overall sample of 14,229 adult subjects, 4049 (28.5%) resulted normotensive individuals, 3088 (21.7%) were untreated and 7092 (49.8%) treated hypertensive outpatients. Treated hypertensives showed signi cantly higher ESC score risk (8.3 ± 13.0% vs. 3.9 ± 8.4%; P < 0.001) and lower systolic/diastolic BP (140.6 ± 18.8/83.9 ± 11.5 vs. 148.3 ± 14.2/94.7 ± 10.1 mmHg; P < 0.001) than untreated hypertensives. Compared to previous guidelines, BP control signi cantly lowered in non-diabetic outpatients (n = 5847) of all age groups [18–65 years: (13.1% vs. 42.9%), 65–79 years (25.8% vs. 42.5%) and ≥ 80 years (29.1% vs. 66.0%); P < 0.001 for all comparisons]; similar reductions were observed in diabetic outpatients (n = 1245) [18–65 years (32.7% vs. 14.8%), 65–79 years (37.3% vs. 24.7%) and ≥ 80 years (47.1% vs. 27.9%); P < 0.001]. Conclusions According to the recommended new o ce BP treatment targets, the proportions of treated uncontrolled hyper- tensive patients substantially increased. These ndings should prompt a tighter application of therapeutic recommendations and, thus, highlight the need for improving hypertension management and control strategies
Search of multiple markers of organ damage for better cardiovascular risk stratification in hypertension. Role of “SHATS” syndrome in the clinical practice
No full textEssential hypertension is a chronic, asymptomatic disease characterized by sustained and persistent rise in systolic/diastolic blood pressure (BP) levels and increased risk of developing major cardiovascular (CV) complications, including stroke, myocardial infarction, renal disease, congestive heart failure and CV death. Risk of hypertension-related CV complications can be estimated by comprehensive evaluation of individual global CV risk profile, which includes search for CV risk factors and comorbidities, as well as assessment of markers of organ damage (OD)
ARB-based combination therapy for the clinical management of hypertension and hypertension-related comorbidities: a spotlight on their use in COVID-19 patients
Full text linkEssential hypertension is the most common cardiovascular (CV) risk factor, being primarily involved in the pathogenesis of CV disease and mortality worldwide. Given the high prevalence and growing incidence of this clinical condition in the general population in both high and low-income countries, antihypertensive drug therapies are frequently prescribed in different hypertension-related CV diseases and comorbidities. Among these conditions, evidence are available demonstrating the clinical benefits of lowering blood pressure (BP) levels, particularly in those hypertensive patients at high or very high CV risk profile. Preliminary studies, performed during the Sars-COVID-19 epidemic, raised some concerns on the potential implication of hypertension and antihypertensive medications in the susceptibility of having severe pneumonia, particularly with regard to the use of drugs inhibiting the renin-angiotensin system (RAS), including angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These hypotheses were not confirmed by subsequent studies, which independently and systematically demonstrated no clinical harm of these drugs also in patients with Sars-COVID-19 infection. The aim of this narrative review is to critically discuss the available evidence supporting the use of antihypertensive therapies based RAS blocking agents in hypertensive patients with different CV risk profile and with additional clinical conditions or comorbidities, including Sars-COVID-19 infection, with a particular focus on single-pill combination therapies based on olmesartan medoxomil
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