1,721,026 research outputs found
Prognostic role of circadian blood pressure pattern in octogenarians. Is the evidence solid enough for a paradigm shift?
No full textBlood pressure components and target organ damage
No full textIn a given hypertensive patient, clinically overt cardiovascular disease is often preceded by a number of signs of target organ damage at the cardiac, arterial and renal levels. These changes have been collectively defined "pre-clinical cardiovascular disease", and carry a substantially increased risk for future cardiovascular complications. The present article examines the relationship between blood pressure components and target organ damage in essential hypertension. Arterial pressure can be split into a steady component (represented by the mean arterial pressure), which is a measure of the average level of pressure in a given artery, and a pulsatile component (represented by the pulse pressure), which estimates the cyclic oscillations around the mean. All blood pressure components show a positive, linear correlation with left ventricular mass, both in the general population and in patients with essential hypertension. However, the association is significantly stronger for the steady blood pressure components (systolic and mean arterial pressure) than for the pulse pressure. Available data regarding arterial changes suggest that the association is partly different. The majority of available studies show that large-artery intima-media thickening and discrete atherosclerotic plaques are better predicted by pulse pressure than by other blood pressure components, particularly in the elderly. After the age of 60, there is clear-cut evidence for a J-shaped relationship between diastolic blood pressure and arterial thickening or plaques, while for younger age groups the relationship appears to be linear. These data might offer an explanation for the observed superior prognostic value of pulse pressure in the elderly. The relationship between the different blood pressure components and renal damage is more controversial. In summary, pulsatile, cyclic stress (as represented by pulse pressure) appears to be more important in determining arterial changes in hypertensive patients, while steady blood pressure components play a dominant role in the development of hypertensive left ventricular hypertrophy
Impact of pulse pressure on degree of cardiac hypertrophy in patients with chronic uraemia
No full textLette
Rationale and methodology of the ICAI study, a randomised clinical trial of alprostadil in the treatment of chronic critical leg ischemia
No full textAbstract: Objective: to evaluate the safety and efficacy of a stable prostaglandin E(1) added to the usual therapeutic practice (either invasive or not) in patients with chronic critical leg ischemia.
Design: multicenter, controlled, randomised, open label trial.
Setting: a representative sample (56 centers) of vascular and general surgery, angiology and general medicine departments of the Italian National Health Service.
Patients: all patients suffering from leg ischemia considered as chronic and critical depending on the presence of persistently recurring rest pain for more than two weeks and/or foot ulceration or gangrene.
Intervention: a daily i.v. infusion of 60 mu g of alprostadil alpha-cyclodextrine for the overall hospital stay, up to a maximum of 28 days (as an adjunct to the standard procedures adopted In each center) to patients randomly assigned to the experimental treatment.
Measures: the primary evaluation of efficacy is based on the expected reduction of major amputations or persistence of critical leg ischemia at six months, The sum of these ''peripheral'' events, of death and of non-fatal myocardial infarction and stroke is used as a more comprehensive evaluation of the risk/benefit profile of the experimental treatment.
Results: a reduction from 40% to 32% of the incidence of the primary end-points is the trial hypothesis, The recruitment of 1500 patients is required to verify this.
Conclusions: this large-scale trial aims at providing a reliable estimate of the possibility of modifying hard end-points such as death and amputation in patients with critical leg ischemia
TAURINE THERAPY FOR INTERMITTENT CLAUDICATION - RESULTS OF A CONTROLLED-STUDY
No full textAbstract: The efficacy and tolerability of taurine (3 g daily) in the treatment of intermittent claudication were evaluated in a double-blind placebo-controlled study in 40 patients. Before therapy and after 3 and 6 months, besides standard treadmill exercise walking times, ankle/arm pressure ratios, plethysmographic peak flow values, transcutaneous oxygen pressure (TcPO2) was also monitored on the dorsum of the foot in basal conditions together with the half-recovery times after an induced ischemia. Taurine was more beneficial than placebo in lengthening the pain-free and total walking times and significantly shortened TcPO2 half-recovery time. These results suggest that taurine not only improves performance in patients with intermittent claudication but also increases oxygenation in the ischemic limb
Prostanoids for chronic critical leg ischemia - A randomized, controlled, open-label trial with prostaglandin E-1
No full textAbstract: Background: No effective pharmacologic intervention is available for critical leg ischemia, a severe clinical condition associated with high morbidity and mortality.
Objective: To assess the safety and efficacy of prostaglandin E-1 in improving the prognosis and quality of life in patients with critical leg ischemia.
Design: Multicenter, centrally randomized, controlled, open-label trial.
Setting: 56 vascular surgery and angiology departments of the Italian National Health Service.
Patients: 1560 patients with chronic critical leg ischemia.
Interventions: In addition to routine treatments practiced in each center, patients were randomly assigned to receive either a daily intravenous infusion of 60 mu g of prostaglandin E-1 in the form of alprostadil-alpha-cyclodextrine (n = 771) or no prostaglandin E-1 (n = 789) during their hospital stay. The treatment period lasted for up to 28 days.
Measurements: A combined end point consisting of death and peripheral and cardiocerebrovascular illness (major amputation or persistence of critical leg ischemia, acute myocardial infarction, or stroke) evaluated at hospital discharge and during 6 months of follow-up.
Results: The incidence of the combined outcome measure was lower in the alprostadil group than in controls at hospital discharge (493 [63.9%] patients compared with 581 [73.6%] patients; relative risk, 0.87 [95% CI, 0.81 to 0.93]; P < 0.001) but differed only modestly at 6 months (348 of 661 [52.6%] patients compared with 387 of 673 [57.5%] patients; relative risk, 0.92 [CI, 0.83 to 1.01]; P = 0.074). Most of the observed benefit was due to recovery from critical leg ischemia.
Conclusions: Short-term treatment with alprostadil-alpha-cyclodextrine provides patients with critical leg ischemia clinical benefit that is apparent in the short term but decreases over time
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