Showing papers by "G. Mancia published in 2010"

Sympathetic, baroreflex and metabolic abnormalities in the optimal, normal and high-normal blood pressure state: 9c.02

Abstract: Objective:Essential hypertension is characterized by a marked sympathetic activation, which is coupled with an impairment of baroreceptor-heart rate control. Whether the behaviour of sympathetic and baroreceptor function is peculiar of the established hypertensive state or it does also characterize

Relationship between 24-hour ambulatory blood pressure and retinal vascular abnormalities in hypertension: 3d.03

Abstract: Objective: Essential hypertension is characterized by retinal vascular alterations, whose degree is related to the severity of the high blood pressure (BP) state. The information obtained so far, however, is mainly limited to clinic BP, and no data are available on the relationships between the various components of the 24-hour BP profile and the patterns of the retinal vascular alterations seen in hypertension. Design and Method: In 193 patients of both genders (age 53.5 ± 7.2 yrs, mean ± SEM) affected by a hypertensive state of mild-to-moderate degree under antihypertensive drug treatment, we measured body mass index and clinic BP values, 24-hour, day and night systolic, diastolic and mean BP as well as heart rate and pulse pressure profiles (ABPM, 90207 Spacelabs). Measurements also included arterial-venular ratio (AVR), central retinal artery and vein equivalents [CRAE and CRVE, non-mydriatic retinography {(TopCon TRC-NW200)}. Results: 19% of the subjects showed an AVR value in the normal range (>0.92), while 61% between 0.91 and 0.79 (mild arterial narrowing) and 20% < 0.78 (severe arterial narrowing). AVR, was significantly and inversely related to age and body mass index (r = −0.31 and −0.43, P < 0.005 for both). It was also significantly and inversely related to 24-hour, day and night systolic BP (r = −0.34, −0.27, −0.22, p < 0.001 for all), and pulse pressure r = −0.35, −0.36 and −0.27 respectively, P < 0.001). No AVR difference was found in dippers vs non-dippers. No correlation was found between AVR and 24-hour DBP or heart rate values. At the multivariate analysis the independent predictor of the AVR abnormalities was daytime pulse pressure. In contrast CRAE was significantly related to 24-hour DBP, the relationship being lost at the multivariate analysis Conclusion: These data provide evidence that in treated hypertensive patients SBP and pulse pressure loads during the 24-hour period and subperiods represent the major determinants of the retinal abnormalities. They also suggest that AVR reflects the 24-hour BP load detected in hypertension better than CRAE.

Hypertension and Obstructive Sleep Apnea: Is the Berlin Questionnaire a Valid Screening Tool?: Pp.32.273:

Abstract: Obstructive sleep Apnea Syndrome (OSA) increases the risk of cardiovascular diseases, in particular hypertension. The gold standard for the diagnosis of OSA is polysomnography (PSG). Berlin questionnaire (BQ) is a validated approach to indirectly quantify the risk of OSA in a general population. Aim of our study was to explore the actual prevalence of OSA in a group of unselected hypertensive patients and to evaluate sensitivity and specificity of BQ in determining the risk of OSA in this population vs PSG. Methods. 151 subjects referred to the Hypertension Center of our Institute, were also administered the BQ; 66 of these also performed a cardiorespiratory PSG (Embletta device). 17 subjects were excluded because inconsistency or lack of questionnaire responses or technical problems during PSG. Results: BQ suggested a high risk of OSA in 96% of cases. PSG showed that 59.2% of subjects presented an apnea-hypopnea index (AHI) > 5, and 40.8% an AHI <5. The two groups were comparable by gender and age and subjective daytime sleepiness. BMI was significantly higher in patients with OSA (OSA 30.3 kg/m2, non-OSA 27.1 kg/m2, p < 0.05). Application of BQ as compared to PSG showed an high sensitivity (0.94) but an extremely low specificity (0), if the BQ is interpreted according to standard guidelines (use of 3 categories of questions, international criteria). If we exclude from the analysis the 3th category (not appropriate in this population because specifically asking for presence of hypertension or BMI >30), the sensibility is 0.88 and the specificity increases significantly until to 0.39. Conclusions: Our data confirm the high prevalence of OSA in patients with hypertension. For the first time we compare BQ and PSG data in hypertensive patients. Our data suggest that caution is needed when applying BQ in this population because of inappropriate questions in patients with known hypertension. A specific version of BQ applicable to hypertensive subjects is thus needed for a reliable screening of OSA in this population.

Changes in albuminuria predict mortality and morbidity in patients with vascular disease: ps.3.04

Abstract: Background: Albuminuria is a powerful, independent, predictor of progression of renal disease, cardiovascular disease and death in people with renal disease, hypertension, diabetes, vascular disease, and in the general population. However, it is not known whether changes in albuminuria are predictive of cardiovascular outcome and mortality. Methods: In 23480 patients with vascular disease or complicated diabetes changes in albuminuria (at least doubling or halving) in spot urine from baseline to 2 years, measured in a central laboratory, were related to the incidence of cardiovascular and renal outcomes and total mortality over the subsequent 32 months. Results: An increase in albuminuria from baseline to 2 years (doubling or more), found in 28%, was associated with increased mortality [HR 1.47, 95 % CI 1.31–1.65, p < 0.0001], and a decrease in albuminuria (at least halving), noted in 21%, with reduced mortality [HR 0.85, 95% CI 0.74 - 0.98, p = 0.025] compared to those with lesser minor changes in albumin excretion, after adjustment for baseline albuminuria, initial blood pressure and its changes and other confounding factors. Changes in albuminuria were also significantly associated with cardiovascular death, composite cardiovascular outcomes (cardiovascular death, myocardial infarction, stroke and hospitalization for heart failure) and renal outcomes (dialysis or doubling of serum creatinine). Overall, all cause mortality increased by 19% and composite cardiovascular outcomes by 39% in patients with an increase in albuminuria (doubling or more) compared to those with minor changes in albuminuria. Conclusions: In patients with vascular disease, changes in albuminuria predict cardiovascular and renal outcomes, and mortality independent of baseline albuminuria. Thus, monitoring of albuminuria is a useful strategy for predicting cardiovascular risk.

Left ventricular geometry, ambulatory blood pressure and extracardiac organ damage in untreated essential hypertension: pp.22.380

Abstract: Back-ground and Aim: Limited information is available on the association between left ventricular (LV) geometric patterns defined according to updated criteria and blood pressure (BP) levels as well as extra-cardiac organ damage (OD) in human hypertension. Thus, in untreated essential hypertensives we assessed the relationship between LV geometry, ambulatory BP and markers of vascular and renal OD. Methods: A total of 669 hypertensives were categorized in four groups according to LV geometric patterns defined by two sets of gender specific criteria (i.e.LV mass indexed to body surface area (BSA) and height2.7) and by the relative wall thickness (RWT) partition value of 0.42. Ambulatory BP variables were derived from two 24-h monitoring sessions performed within 4-weeks. Results: Lower clinic and ambulatory BP values were associated with normal LV geometry, intermediate values with either LV concentric remodelling or eccentric LV hypertrophy (LVH) and higher values with concentric LVH, regardless of the criteria used to categorize these cardiac phenotypes. A decrease in nocturnal BP dip occurred from normal LV geometry to concentric LVH and this was associated by a parallel increase in the prevalence of carotid and renal OD, which was highest in concentric LVH. In a multivariate analysis age (fÒ = 0.204, p < 0.0001), followed by LDL cholesterol (fÒ = 0.113, p = 0.004), and night-time BP (fÒ = 0.101, p = 0.009) turned out to be the best independent correlates of RWT. Conclusions: These findings indicate that LV geometric patterns, regardless of categorization criteria, reflect different degrees of BP load as well as subclinical extra-cardiac alterations and may be regarded, in addition to absolute values of LV mass, as a reliable marker of CV risk.

Infusion of e. coli lipopolysaccharides toxin in rats produces a severe impairment of baroreflex function in absence of blood pressure changes: pp.32.261

Abstract: Septic shock is characterized by a severe impairment of baroreflex function and by high mortality rate. In these patients baroreflex dysfunction is a negative prognostic factor. Nevertheless the causes of baroreflex dysfunction during septic shock have not been completely clarified. In particular it is not clear whether this is consequence of acute changes in blood pressure or it is a direct effect of the toxin. Our aim was to verify whether E. coli lipopolysaccharides (LPS) infusion could alter the baroreflex function even in absence of blood pressure (BP) changes. Methods: E.Coli LPS was infused in 7 rats for 20 minutes at an infusion rate (0.05 mg/kg/min) that we previously observed not to have any significant effect on BP. Systolic BP (SBP), diastolic BP (DBP) and pulse interval (PI) were continuously recorded for 30 minutes before, during and for 1 hour after the E. Coli LPS infusion. Baroreflex sensitivity was evaluated by applying the sequence method (BRS seq) and by calculating the alpha index in the high-frequency band (HF-BRS). Results: Neither SBP, nor DBP or PI showed significant differences after the infusion of E.Coli LPS with respect to the basal condition (SBP mean ± SD: from 93 ± 22 to 99 ± 25 mmHg; DBP: from 57 ± 23 to 50 ± 20 mmHg; PI from 166 ± 49 to 158 ± 43 ms). By contrast, the baroreflex sensitivity was significantly reduced after LPS infusion (BRS seq: from 1.29 ± 0.79 to 0.46 ± 0.27 ms/mmHg, p < 0.02; HF-BRS from 1.28 ± 0.97 to 0.31 ± 0.12 ms/mmHg). Conclusion: In rats, E coli LPS infusion can produce a severe impairment of baroreflex function even in absence of significant changes in blood pressure.