Showing papers by "Giuseppe Mancia published in 1997"
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TL;DR: This data indicates that ambulatory blood pressure correlates more closely than clinic BP with the organ damage of hypertension and whether ABP predicts development or regression of hypertension-related morbidity and mortality is still under investigation.
Abstract: Background In cross-sectional studies, ambulatory blood pressure (ABP) correlates more closely than clinic BP with the organ damage of hypertension. Whether ABP predicts development or regression o...
581 citations
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TL;DR: The finding that antiarrhythmic treatment was a significant predictor of increased mortality in ibopamine-treated patients may be important, but exploratory analyses must be interpreted with caution.
338 citations
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TL;DR: The high blood-pressure values commonly found in treated hypertensive individuals cannot be accounted for by a white-coat effect but by a true lack of daily-life blood- pressure control.
297 citations
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TL;DR: It is speculated that neurohumoral overactivity, known to stimulate cardiac tissue growth, may challenge the heart, promoting fibrosis and exerting a further hindrance to ventricular relaxation in patients with cirrhosis experiencing episodes of ascites.
272 citations
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TL;DR: Time and frequency domain estimates of spontaneous BRS allow earlier detection of diabetic autonomic dysfunction than classical laboratory autonomic tests, and are suggested to be more evident than the simple quantification of the RR interval variability.
Abstract: Diabetic autonomic dysfunction is associated with a high risk of mortality which makes its early identification clinically important. The aim of our study was to compare the detection of autonomic dysfunction provided by classical laboratory autonomic function tests with that obtained through computer assessment of the spontaneous sensitivity of the baroreceptor-heart rate reflex (BRS) by time domain and frequency domain techniques. In 20 normotensive diabetic patients (mean age ± SD 41.9 ± 8.1 years) with no evidence of autonomic dysfunction on laboratory autonomic testing (D0) blood pressure (BP) and ECG were continuously monitored over 15 min in the supine position. BRS was assessed as the slope of the regression line between spontaneous increases or reductions in systolic BP and linearly related lengthening or shortening in RR interval over sequences of at least 4 consecutive beats (sequence method), or as the squared ratio between RR interval and systolic BP spectral powers around 0.1 Hz. We compared the results with those of 32 age-matched normotensive diabetic patients with abnormal autonomic function tests (D1) and with those of 24 healthy age-matched control subjects with normal autonomic function tests (C). Compared to C, BRS was markedly less in D1 when assessed by both the slope of the two types of sequences (data pooled) and by the spectral method (–71.3 % and –60.2 % respectively, both p < 0.01). However, BRS was consistently although somewhat less markedly reduced in D0, the reduction being clearly evident for all the estimates (–57.0 % and –43.5 %, both p < 0.01). The effects were more evident than those obtained by the simple quantification of the RR interval variability. These data suggest that time and frequency domain estimates of spontaneous BRS allow earlier detection of diabetic autonomic dysfunction than classical laboratory autonomic tests. The estimates can be obtained by short non-invasive recording of the BP and RR interval signals in the supine patient, i. e. under conditions suitable for routine outpatient evaluation. [Diabetologia (1997) 40: 1470–1475]
210 citations
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TL;DR: These results provide the first direct evidence that in congestive heart failure chronic ACE inhibitor treatment is accompanied by a marked reduction in central sympathetic outflow, and may depend on a persistent restoration of baroreflex restraint on the sympathetic neural drive.
Abstract: Background In congestive heart failure ACE inhibitors chronically reduce plasma norepinephrine. No information exists, however, on whether and to what extent this reduction reflects a true chronic inhibition of sympathetic outflow and which mechanisms may be responsible. Methods and Results In 24 patients aged 60.3±2.0 years (mean±SEM) affected by congestive heart failure (New York Heart Association class II) and treated with diuretics and digitalis, we measured mean arterial pressure (Finapres), plasma renin activity and angiotensin II levels (radioimmunoassay), plasma norepinephrine (high-performance liquid chromatography), and muscle sympathetic nerve activity (microneurography at a peroneal nerve) at rest and during baroreceptor stimulation and deactivation caused by stepwise intravenous infusions of phenylephrine and nitroprusside, respectively. In 12 patients measurements were repeated after a 2-month addition of the ACE inhibitor benazepril (10 mg/d PO), while in the remaining 12 patients they were...
202 citations
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TL;DR: Similar to data from younger subjects, clinic, home, and ambulatory BPs are higher in treated hypertensive than normotensive elderly subjects, indicating that in hypertensive elderly Subjects, antihypertensive treatment does not commonly achieve full BP control both inside and outside the clinic environment.
Abstract: To determine ambulatory blood pressure (BP) means and distributions in an elderly population, we studied a random sample of 800 subjects stratified by sex and representative of residents aged 65 to 74 years of the city of Monza. Participation was 50%. Measurements consisted of clinic BP (average of three measurements with mercury sphygmomanometry), home BP (average of morning and evening measurements with a semiautomatic device), and ambulatory BP (SpaceLabs 90207). Clinic BP was obtained before and after home and ambulatory BP measurements. In normotensive and untreated hypertensive subjects (n=248), clinic, home, and ambulatory BPs were significantly related ( P P P
173 citations
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TL;DR: Acute cigarette smoking reduces distensibility not only in medium-sized but also in large elastic arteries, therefore causing a systemic artery stiffening.
Abstract: Objective Cigarette smoking acutely induces a marked increase of blood pressure and heart rate. This is accompanied by a marked reduction of radial artery distensibility. Whether this reflects an alteration of arterial mechanics of large elastic arteries as well is not established, however. Design and methods In this study we addressed the acute effects of smoking on the stiffness of a peripheral medium-sized muscular artery and a large elastic vessel. We studied seven healthy normotensive smokers (age 28 ± 7 years, mean ± SEM), in the absence of smoking for at least 24 h. Radial artery (NIUS 02) and carotid artery diameter (WTS) were concomitantly acquired beat-to-beat in the 5 min before, during and after smoking of a cigarette containing 1.2 mg of nicotine. Blood pressure and heart rate were concomitantly recorded by a Finapres device. Radial and carotid artery distensibility were calculated according to the Langewouters and Reneman formulae, respectively. Data were collected for consecutive 30 s periods. Statistical comparisons were performed between the three different phases and, within each phase, between 30 s periods. In five subjects the protocol was repeated after 1 week using a stran rather than a cigarette to obtain data under sham smoking. Results Smoking increased systolic blood pressure by 14%, diastolic blood pressure by 10% and heart rate by 27%. Radial artery diameter was reduced during smoking (-3.7%) and more so after smoking (-14.8%), while carotid artery diameter did not change significantly either during or after smoking. Radial artery distensibility was also significantly reduced only after smoking (-41.3%, P < 0.01), while carotid artery distensibility was significantly reduced both during (-33.3%) and after smoking (-27.2%) (P < 0.01 versus before). No changes in blood pressure, heart rate and arterial wall mechanics were induced by sham smoking. Conclusions Acute cigarette smoking reduces distensibility not only in medium-sized but also in large elastic arteries, therefore causing a systemic artery stiffening. The mechanisms of these effects remain to be determined. However, it is likely that adrenergic mechanisms are responsible for the arterial distensibility alterations.
132 citations
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TL;DR: Muscular sympathetic nerve activity was significantly increased by aging and hypertension, and reduced by physical training, and the noradrenaline changes were much less marked and consistent, suggesting that muscle sympathetic nerveActivity has a greater short- and medium-term reproducibility than norad Renaline.
Abstract: 1. Although plasma noradrenaline and muscle sympathetic nerve traffic have been shown to be suitable markers of sympathetic activity in man, no study has systematically compared the reproducibility and sensitivity of these two indices of adrenergic tone. 2. Reproducibility data were collected in 10 subjects, in whom plasma noradrenaline was assessed by HPLC on blood samples withdrawn from an antecubital vein and efferent postganglionic muscle sympathetic nerve activity was measured by microneurography from a peroneal nerve, together with arterial blood pressure (Finapres technique). Measurements were obtained in a first session (session 1), 60 min later (session 2) and after 14 days (session 3). While muscle sympathetic nerve activity values recorded in the three different experimental sessions were closely and significantly correlated with each other (r always > 0.90, P < 0.001), noradrenaline showed a less significant correlation between sessions 1 and 2 (r = 0.71, P < 0.05) or no correlation between sessions 1 and 3 (r = 0.45, P not significant). 3. Sensitivity data were collected by evaluating muscle sympathetic nerve activity and noradrenaline values in three different age groups (young, middle-age and old subjects, n = 18), in three groups with different blood pressures (normotensive, mild and severe hypertensive subjects, n = 30) and in a group of eight subjects before and after a physical training programme, i.e. conditions known to increase or reduce sympathetic cardiovascular drive. Muscle sympathetic nerve activity was significantly increased by aging and hypertension, and reduced by physical training. The noradrenaline changes were much less marked and consistent. 4. These data suggest that muscle sympathetic nerve activity has a greater short- and medium-term reproducibility than noradrenaline. In several conditions known to modify sympathetic cardiovascular drive muscle sympathetic nerve activity also appears to change more clearly than noradrenaline.
128 citations
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TL;DR: In the anesthetized normotensive rat, sympathetic activity exerts a tonic restraint on large-artery distensibility, pronounced in elastic vessels and even more pronounced in muscle-type vessels.
Abstract: Sympathetic stimulation is accompanied by a reduction of arterial distensibility, but whether and to what extent elastic and muscle-type arterial mechanics is under tonic sympathetic restraint is not known. We addressed this issue by measuring, in the anesthetized rat, the diameters of the common carotid and femoral arteries with an echo-Doppler device (NIUS 01). Blood pressure was measured by a catheter inserted contralaterally and symmetrically to the vessel where the diameter was measured. Arterial distensibility over the systolic-diastolic pressure range was calculated according to the Langewouters formula. Data were collected in 10 intact (vehicle pretreatment) and 9 sympathectomized (6-hydroxydopamine pretreatment) 3-month-old Wistar-Kyoto rats. Compared with the intact animals, sympathectomized rats showed a marked increase in arterial distensibility over the entire systolic-diastolic pressure range. When quantified by the area under the distensibility-pressure curve, the increase was 59% and 62% for the common carotid and femoral arteries, respectively (P<.01 for both). In the femoral but not in the common carotid artery, sympathectomy was accompanied also by an increase in arterial diameter (+18%, P<.05 versus intact). Therefore, in the anesthetized normotensive rat, sympathetic activity exerts a tonic restraint on large-artery distensibility. This restraint is pronounced in elastic vessels and even more pronounced in muscle-type vessels.
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TL;DR: Baroreflex sensitivity, as assessed by the slope of spontaneous hypertension/bradycardia or hypotension/tachycardia sequences and by the alpha-coefficient, was significantly decreased during smoking, whereas there were no effects of smoking on the reflex changes in pulse interval induced by carotid baroreceptor stimulation through a neck suction device.
Abstract: In 10 healthy smokers, finger blood pressure was recorded continuously for 1 h in a supine control condition and for 1 h while smoking four cigarettes, one every 15 min. Smoking increased average s...
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TL;DR: The contribution of this activation to the organ damage related to hypertension together with the technical progress that has recently been made on quantification of neural cardiovascular modulation, which may greatly help future studies in this area of research are outlined.
Abstract: There is clear evidence that essential hypertension is accompanied by sympathetic activation. Many studies have shown that a number of cardiovascular risk factors frequently accompanying hypertension are characterized by increased sympathetic influences as well. This paper begins with a brief overview of the origin of the sympathetic activation in essential hypertension, and then outlines the contribution of this activation to the organ damage related to hypertension together with the technical progress that has recently been made on quantification of neural cardiovascular modulation, which may greatly help future studies in this area of research.
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TL;DR: Findings underline the importance that the therapeutical approach to hypertension is aimed not only at lowering BP but also at reducing sympathetic activity.
Abstract: Animal studies have provided clearcut evidence that sympathetic factors are involved in the development and maintenance of high blood pressure (BP) This also appears to be the case in humans, in which sympathetic activation, detected through plasma noradrenaline measurement, noradrenaline spillover technique and direct recording of muscle sympathetic nerve activity, has been shown to characterize the early phases of the hypertensive state and parallel its severity Sympathetic factors also play in a variety of pathophysiological states frequently associated with hypertension, such as obesity, insulin resistance and atherosclerosis In addition evidence has been collected that adrenergic factors represent one of the mechanisms involved in determining BP variability, which is strictly associated with end organ damage Taken together these findings underline the importance that the therapeutical approach to hypertension is aimed not only at lowering BP but also at reducing sympathetic activity
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TL;DR: Evidence is raised that in humans sodium restriction may impair the arterial baroreflex, which may be responsible for the sympathetic activation occurring in this condition and for the impairment of blood pressure homeostasis.
Abstract: Low sodium intake is the most widely used nonpharmacological approach to the treatment of hypertension. Although nonpharmacological treatment is by definition regarded as safe, the suggestion has been made that low sodium intake is not totally devoid of inconveniences, and animal data have shown it to be accompanied by an impairment of reflex blood pressure control and homeostasis. However, no data exist on this issue in humans. In mild essential hypertensive patients (age, 34.1±3.3 years [mean±SEM]), we measured beat-to-beat arterial blood pressure (finger photoplethysmographic device), heart rate (electrocardiogram), and efferent postganglionic muscle sympathetic nerve activity (microneurography) at rest and during baroreceptor stimulation and deactivation, induced by stepwise intravenous infusions of phenylephrine and nitroprusside, respectively. Measurements were performed at the end of three dietary periods, ie, after 8 days of regular sodium intake (210 mmol NaCl/d), low sodium intake (20 mmol NaCl/d) with unchanged potassium intake, and again regular sodium intake. Compared with the initial regular sodium diet, low sodium intake reduced urinary sodium excretion, whereas urinary potassium excretion was unchanged. Systolic blood pressure was significantly ( P P P
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TL;DR: Ang II markedly enhances sympathetic influences on coronary circulation in humans, presumably by acting at the arteriolar level, which may explain the blunting effect of ACE inhibition on sympathetic coronary vasoconstriction in patients with coronary artery disease.
Abstract: Background In humans with coronary artery disease, ACE inhibition attenuates coronary sympathetic vasoconstriction. Whether this is due to removal of angiotensin (Ang) II production or to a reduced bradykinin breakdown, however, is unknown. Methods and Results In eight normotensive patients with angiographic evidence of mild left coronary artery lesions (≤50%), mean arterial pressure (MAP, intra-arterial catheter), heart rate (HR, ECG lead), coronary sinus blood flow (CBF, thermodilution method), and coronary vascular resistance (CVR, ratio between MAP and CBF) were measured before and during a 15-minute left intracoronary infusion of Ang II at a dose that had no direct coronary or systemic vasomotor effects. The same measurements were made before and during a 15-minute infusion of saline. A 2-minute cold pressor test (CPT) and a 45-second diving were performed at the end of either infusion period. These maneuvers were used because their coronary vasomotor effects are abolished by phentolamine and thus depend on sympathetic activation. During saline infusion, both CPT and diving caused a marked increase in MAP. HR increased with CPT and fell with diving. CBF increased in parallel to the MAP increase, with little change in CVR. The MAP and HR responses were similar during Ang II infusion, which, however, caused either no change or a reduction in CBF with a consequent marked increase in CVR with both CPT and diving. In four additional patients, the diameter of the stenotic vessels remained unchanged during the CPT performed under saline and Ang II infusion. Conclusions Ang II markedly enhances sympathetic influences on coronary circulation in humans, presumably by acting at the arteriolar level. This may explain the blunting effect of ACE inhibition on sympathetic coronary vasoconstriction in patients with coronary artery disease.
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TL;DR: Isobaric compliance and isobaric distensibility reverses the effect of hypertension on arterial compliance and causes arterial stiffening, as when present alone.
Abstract: Compliance and distensibility of middle-sized conduit arteries are increased in hypertension and reduced in hypercholesterolemia. Despite their frequent association in the same individual, the comb...
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TL;DR: Broadband spectral analysis found that changes in SBP and R-R interval variability in very elderly individuals may in part reflect the baroreflex impairment and autonomic dysfunction that characterize aging.
Abstract: Systolic blood pressure (SBP) variability is increased and R-R interval variability is reduced in the elderly. Little is known, however, about how SBP and R-R interval variabilities change in the very elderly. More important, however, it is not known which frequency components of SBP and R-R interval variability are affected significantly. We addressed this issue in subjects older than 70 years by broadband spectral analysis, which allows all variability components from the lowest to the highest frequency to be considered. In 20 very elderly normotensive subjects (mean±SD age, 78.1±6.8 years) and 28 normotensive adult subjects (36.1±7.1 years), noninvasive finger blood pressure and R-R intervals were recorded continuously for 30 minutes in the supine position and 15 minutes in the upright position. SBP and R-R interval power spectral densities were computed over the entire frequency region between 0.005 Hz (0.007 Hz in the upright position) and 0.5 Hz. Overall SBP variability (SD) was greater and overall R-R interval variability was less in very old subjects than in adult subjects. All spectral R-R interval powers were reduced significantly in very elderly individuals. The spectral SBP powers were greater in the very elderly group than in the adult group only in the very-low-frequency range (
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TL;DR: In this article, the arterial baroreflex may play a role although probably a non specific and late one in the mechanism responsible for the increase in sympathetic activity in essential hypertension.
Abstract: While animal models of hypertension have clearly shown an increase in sympathetic activity, a similar demonstration in humans has been more difficult to obtain for methodological reasons. There is now clear evidence, however, of an increase sympathetic activity in essential hypertension by the finding of either an increase in plasma norepinephrine and an increase in muscle sympathetic nerve traffic. Among the mechanisms responsible for this sympathetic activation the arterial baroreflex may play a role although probably a non specific and late one. Central neural influences associated with an excessive hypothalamic response to stress may also be involved, but conclusive evidence is still lacking due to the difficulty of assessing cardiovascular reactivity to stress in man. A deeper insight into the features of human sympathetic cardiovascular control may be offered now by new techniques which allow neural cardiovascular regulation to be assessed in daily life through computer analysis of noninvasive ambulatory beat-by-beat blood pressure and heart rate recordings.
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TL;DR: Hypothyroidism is associated with early arterial structural and functional alterations, which involve more muscular than elastic arteries, however, these alterations are reversible by hormonal replacement therapy.
Abstract: Background Hypothyroidism is frequently accompanied by cardiac dysfunction, increased vascular resistance and a greater prevalence of hypertension. Whether this condition is also accompanied by alterations of large artery function and structure is not known, however.
Patients and methods We investigated radial artery compliance and wall thickness as well as carotid artery compliance in 11 normotensive recently diagnosed and never treated hypothyroid patients. Fifteen euthyroid healthy age- and sex-matched subjects served as controls. No subject had evidence of large artery atherosclerotic lesions. Carotid artery diameter was evaluated continuously by a B-M mode device and carotid compliance obtained by the Reneman formula. Radial artery diameter and wall thickness were continuously acquired over the systodiastolic blood pressure range (beat-to-beat finger measurement) by an echo-tracking device, and compliance (Langewouters formula) was expressed as the integral of the area under the compliance/blood pressure curve normalized for pulse pressure.
Results Patients with hypothyroidism showed greater radial wall thickness (+109%, P <0·01) and compliance (+58%, P <0·03) than controls. Carotid artery compliance was not different in the two groups. In 10 hypothyroid patients L- tiroxine therapy for 9·0±2·3 months did not change carotid artery function but markedly reduced radial artery wall thickness (−36%, P <0·05) and compliance (−20%, P <0·05).
Conclusions Hypothyroidism is associated with early arterial structural and functional alterations, which involve more muscular than elastic arteries. These alterations, however, are reversible by hormonal replacement therapy.
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Yeshiva University1, Oregon Health & Science University2, University of Paris3, McMaster University4, University of Melbourne5, University of California, San Francisco6, Cornell University7, University of Colorado Denver8, University of Toronto9, Humboldt University of Berlin10, University of Milan11, University of Alabama at Birmingham12, Katholieke Universiteit Leuven13, University of California, Davis14
TL;DR: The statement reviews more recent studies and critiques the arguments for a sodium health claim, and invites the readers to respond to the discussion in this controversial area of nutrition science and policy.
Abstract: Nutrition Reviews has had a continuing interest in the scientific basis of arguments for and against health claims on foods. Such claims were first authorized by the Food and Drug Administration (FDA) in 1993 under the terms of the Nutrition Labelling and Education Act of the U.S. Congress, passed in 1990. Since then there have been petitions that have resulted in a newly authorized claim for oats and other petitions directed toward modification or deletion of the originally approved claims. The Salt Institute, an industry-supported organization, has actively participated in the discussions regarding the sodium and hypertension health claim. The scientists signing this statement are familiar with the evolving understanding of the relationship between sodium and hypertension. The statement reviews more recent studies and critiques the arguments for a sodium health claim. We invite our readers to respond to the discussion in this controversial area of nutrition science and policy.
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TL;DR: The effect of the combination of verapamil and trandolapril was greater than the effect of either of the two drugs administered alone, but the clinic blood pressure measurements failed to show any systematically greater effect with the combination versus monotherapy, indicating that ambulatory blood pressure is superior to conventional blood pressure in the assessment of antihypertensive drugs.
Abstract: ADVANTAGES OF AMBULATORY BLOOD PRESSURE MONITORING: Ambulatory blood pressure monitoring is now used widely to assess the efficacy of antihypertensive drugs in daily life conditions. These 24-h measurements have a number of advantages compared to conventional sphygmomanometric readings. Although a small placebo effect is observed in the first few hours after placebo administration, 24-h average blood pressure is substantially devoid of any placebo effect. Moreover, ambulatory blood pressure is not affected by the alerting reaction usually observed during the doctor's visit. When the 24-h average value is considered, ambulatory blood pressure is more reproducible than clinic blood pressure. Finally, ambulatory blood pressure is prognostically more important than clinic blood pressure, since the end-organ damage associated with hypertension is more closely related to 24-h than to clinic blood pressure. Ambulatory blood pressure monitoring is therefore particularly useful when testing the efficacy of new antihypertensive agents on 24-h blood pressure. TESTING THE COMBINATION OF VERAPAMIL AND TRANDOLAPRIL: In a recent study we evaluated the efficacy of a fixed combination of verapamil and trandolapril using both clinic and ambulatory blood pressure measurements. Ambulatory blood pressure monitoring showed that the effect of the combination of verapamil and trandolapril was greater than the effect of either of the two drugs administered alone. However, the clinic blood pressure measurements failed to show any systemically greater effect with the combination versus monotherapy. This further indicates that ambulatory blood pressure is superior to conventional blood pressure in the assessment of antihypertensive drugs.
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TL;DR: Pressure and/or volume overload has been regarded in the past as the leading mechanism through which an increase in blood pressure may trigger the development of left ventricular hypertrophy, but studies performed in recent years have suggested that not only mechanical but also sympathetic, genetic and hormonal factors may significantly contribute to the developed of the cardiac structural alterations.
Abstract: Pressure and/or volume overload has been regarded in the past as the leading mechanism through which an increase in blood pressure may trigger the development of left ventricular hypertrophy1. However, studies performed in recent years both in experimental animals and in man have suggested that not only mechanical but also sympathetic, genetic and hormonal factors (e.g. angiotensin II, insulin, thyroid hormones, etc) may significantly contribute to the development of the cardiac structural alterations frequently detected in the clinical course of the hypertensive state2,3.
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TL;DR: An ACE inhibitor with a dual route of excretion, such as fosinopril, may be especially useful in treating patients with CHF, which is accompanied with a decline or some sort of effect on renal function.
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TL;DR: The most widely known discrepancy between the latest guidelines issued by the United States Joint National Committee (JNC V) and thoseissued by the World Health Organization/International Society of Hypertension (WHO/ISH) concerns the choice of the drug to start antihypertensive treatment.
Abstract: The most widely known discrepancy between the latest guidelines issued by the United States Joint National Committee (JNC V) and those issued by the World Health Organization/International Society of Hypertension (WHO/ISH) concerns the choice of the drug to start antihypertensive treatment. While the JNC V guidelines advise starting treatment with a diuretic or a beta-blocker [1], the WHO/ISH guidelines take a more liberal approach and indicate the first-choice drugs to be not only diuretics and betablockers, but also angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists, and alpha1blockers [2]. The restriction of the initial drug selection to diuretics and beta-blockers by the JNC V guidelines originates from a clear-cut argument, that is, that all trials with a controlled design that have been performed and have shown a reduced cardiovascular morbidity in the group undergoing antihypertensive treatment have made use of drugs belonging to one or the other class. Hence, no demonstration of any benefit has ever been provided for other agents, whose use should thus be limited to the patients in whom diuretics and betablockers are contraindicated, ineffective, or undesirable for clinical considerations. The arguments in favor of the less rigid approach suggested by the WHO/ISH guidelines, however, are multifold and informative. For example, treatment of malignant hypertension has been proved to be capable of delaying the rapid and severe cardiovascular complications associated with this condition and with saving patients’ lives before diuretics and beta-blockers were in use [3]. Furthermore, in trials on antihypertensive treatment, the reduction of cardiovascular events appeared to be related to the magnitude of the decrease in diastolic and/or systolic blood pressure achieved by treatment [4]. Finally, and most importantly, the WHO/ISH guidelines emphasize that the initial use of diuretics or betablockers in the antihypertensive treatment trials was often complemented by drugs belonging to other classes, because in most instances the goal of these trials was to investigate not the relative benefit of different antihypertensive drugs but the benefit of a blood-pressure–lowering treatment. Indeed, it can be seen from Table 1 that most classes of antihypertensive agents have been employed in varying proportions in antihypertensive drug trials. It can also be seen from Figure 1 that in both the oldest and newest trials, a high proportion of patients were undergoing combination treatment with two or more drugs rather than monotherapy with a diuretic and beta-blocker, which was intended when designing trial design to only be a first step toward trying to achieve satisfactory blood pressure control. It therefore seems inappropriate to ascribe to two classes of drugs only a benefit that was clearly obtained by a therapeutic strategy that included many different antihypertensive agents in many patients. This is properly phrased by the following sentence of the WHO/ISH guidelines: “No evidence is so far available that benefits are due to any particular class of antihypertensive agents rather than to lowering blood pressure per se” [2].
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TL;DR: The AM-5600 provides an accurate average estimate of resting and ambulatory SBP and, for DBP, a less accurate estimate that is slightly improved by editing, and may be suitable to describe the abrupt BP changes accompanying a number of clinical events.
Abstract: Omboni, Stefano, Gianfranco Parati, Antonella Groppelli, Luisa Ulian, and Giuseppe Mancia. Performance of the AM-5600 blood pressure monitor: comparison with ambulatory intra-arterial pressure.J. A...
01 Jan 1997
TL;DR: While assessing the cardiovascular risk of hypertensive patients, different types of blood pressure measurements can be regarded as suitable surrogate endpoints and the possible role of clinic, stress, exercise, basal, home and ambulatory blood pressures is briefly discussed.
Abstract: While assessing the cardiovascular risk of hypertensive patients, different types of blood pressure measurements can be regarded as suitable surrogate endpoints. In this context the possible role of clinic, stress, exercise, basal, home and ambulatory blood pressures is briefly discussed. The clinical value of night-time blood pressure, of the clinic-daytime blood pressure difference and of blood pressure variability is also addressed.