Showing papers by "Giuseppe Mancia published in 2002"
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TL;DR: The greater efficacy of lacidipine on carotid IMT progression and number of plaques per patient, despite a smaller ambulatory blood pressure reduction, indicates an antiatherosclerotic action of lacIDipine independent of its antihypertensive action.
Abstract: Background— Most cardiovascular events associated with hypertension are complications of atherosclerosis. Some antihypertensive agents influence experimental models of atherosclerosis through mechanisms independent of blood pressure lowering. Methods and Results— The European Lacidipine Study on Atherosclerosis (ELSA) was a randomized, double-blind trial in 2334 patients with hypertension that compared the effects of a 4-year treatment based on either lacidipine or atenolol on an index of carotid atherosclerosis, the mean of the maximum intima-media thicknesses (IMT) in far walls of common carotids and bifurcations (CBMmax). This index has been shown by epidemiological studies to be predictive of cardiovascular events. A significant (P<0.0001) effect of lacidipine was found compared with atenolol, with a treatment difference in 4-year CBMmax progression of −0.0227 mm (intention-to-treat population) and −0.0281 mm (completers). The yearly IMT progression rate was 0.0145 mm/y in atenolol-treated and 0.0087 ...
517 citations
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TL;DR: This article summarizes the discussion of the dedicated Task Force during the first Conference of Consensus on Arterial Stiffness held in June 2000 (Paris, France) and analyses methods and devices used worldwide to evaluate the arterial stiffness.
349 citations
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TL;DR: The world situation is even worse than it appears from these data because adequate antihypertensive treatment is poorly implemented even in patients with diabetes, nephropathy or prior myocardial infarction, in whom blood pressure reductions have extremely large lifeor disease-saving effects.
Abstract: All published studies agree that hypertension is a poorly diagnosed and treated condition [1,2]. That is, (i) in all countries, the number of subjects in which hypertension is identified is noticeably smaller than that suffering from a blood pressure elevation; (ii) individuals who, after the diagnosis of hypertension, undergo antihypertensive treatment are even less; and (iii) those who have their blood pressure reduced below 140/90 mmHg (systolic/diastolic) because of treatment are no more than a minimal fraction of the overall or even the treated hypertensive population. Indeed, the world situation is even worse than it appears from these data because adequate antihypertensive treatment is poorly implemented even in patients with diabetes [3], nephropathy [4] or prior myocardial infarction [5,6], in whom blood pressure reductions have extremely large lifeor disease-saving effects. Furthermore, control rate is particularly low for systolic blood pressure [7,8], which prevails over the diastolic counterpart in determining the overall risk profile [9,10]. Finally, the number of patients with controlled blood pressures becomes dramatically small if values well below 140/90 mmHg (i.e. those offering the greatest degree of protection in several conditions) are considered.
278 citations
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TL;DR: In this article, the authors investigated the relationship between LVMI and 24-hour average blood pressure values in the population, and showed that there is a significant positive relationship with LVMI (beta = 0.38 and beta=0.88 for systolic and diastolic BP, respectively, P < 0.05 and P< 0.01).
Abstract: In hypertensive patients, 24-hour blood pressure (BP) variability (V) shows a positive relationship with organ damage, organ damage progression, and cardiovascular morbidity. The clinical relevance of BPV in the population has never been investigated. In a sample of 3200 individuals, randomly selected from the general population of Monza (Milan, Italy), we evaluated BP by an automatic oscillometric device every 20 minutes for 24 hours and left ventricular mass index (LVMI) by echocardiography. In each subject, individual systolic and diastolic BP readings were averaged to obtain a 24-hour mean. Systolic BPV was obtained by calculating (1) the standard deviation of the 24-hour mean, which was taken as the overall BPV, (2) the cyclic components (Fourier spectral analysis) that in the population as a whole explained >95% of the overall BPV, and (3) the fraction of the overall BPV that in each subject was not accounted for by the 2 cyclic components, termed individual residual BPV. A similar procedure was used for diastolic BP and heart rate. Participation rate was 64.1%. Patients receiving antihypertensive therapy (n=403) were excluded from the analysis, which was therefore limited to 1648 participants. In the population as a whole, LVMI significantly related to 24-hour systolic and diastolic BP mean (beta=0.40 and beta=0.37, respectively, P<0.001 for both) but not to the 2 cyclic components that accounted for most of the BPV. On the other hand, the individual residual BPV (which accounts on average for about 50% of overall BPV) showed a significant positive relationship with LVMI (beta =0.38 and beta=0.88 for systolic and diastolic BP, respectively, P<0.05 and P<0.01). No relationship was found between LVMI and heart rate values. These findings provide evidence that there is a relationship between LVMI and 24-hour average BP values in the population. They also provide the first demonstration that in the population there is also a positive independent association between LVMI and BPV. This association, however, can be exclusively seen with the BPV component that has an erratic rather than a cyclic nature.
255 citations
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TL;DR: Ultrasound assessment of the heart and carotid wall helps to obtain a more valid assessment of global cardiovascular risk in hypertensive patients without evidence of target-organ damage after routine examination.
Abstract: BackgroundEchocardiography and carotid ultrasonography, by providing a more accurate assessment of cardiac and vascular damage related to hypertension, may lead to a more precise stratification of the global cardiovascular risk. However, current guidelines do not recommend systematic use of ultrasou
194 citations
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TL;DR: In males, hypertension is characterized by a higher prevalence of increased iron stores and metabolic abnormalities that are part of theIRHIO syndrome, which may have clinical implications due to the increased risk of IRHIO patients to develop hepatic cirrhosis and also for the role of iron in early atherogenesis.
Abstract: Objectives Insulin-resistance-associated hepatic iron overload syndrome (IRHIO) is characterized by high serum ferritin and presence of metabolic alterations that are part of insulin-resistance syndrome (IRS). Thus, clinical conditions characterized by a high prevalence of IRS may also be characteri
172 citations
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TL;DR: The data suggest that baroreflex dysfunction in OSAS may be at least partly accounted for by nocturnal intermittent hypoxemia, and can be reversed by long-term CPAP treatment.
Abstract: The role of the arterial baroreflex in the cardiovascular changes associated with the obstructive sleep apnea syndrome (OSAS), and the effect of nasal continuous positive airway pressure (CPAP) treatment on baroreflex function during sleep are unknown. Baroreflex control of heart rate was studied in 29 normotensive patients with OSAS under no treatment, in 11 age-matched control subjects, and in 10 patients at CPAP withdrawal after 5.5 ± 3.7 (range 3–14) months of treatment. Baroreflex control of heart rate was assessed by “sequence method” analysis of continuous blood pressure recordings (Finapres) obtained during nocturnal polysomnography. In untreated OSAS, baroreflex sensitivity (BRS) was low during wakefulness and non–rapid eye movement (REM) stage 2 sleep compared with control subjects, and correlated inversely with mean lowest SaO2 and the blood pressure increase after apneas. After CPAP treatment, the apnea-hypopnea index was lower, and mean lowest SaO2 higher than before treatment. After CPAP, pa...
149 citations
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TL;DR: A moderate dietary sodium restriction triggers a sympathetic activation and a baroreflex impairment, and maintenance of low-sodium diet for several weeks does not attenuate these adverse adrenergic and reflex effects.
Abstract: Background— In essential hypertension, marked restrictions in dietary sodium intake cause in the short-term period an increase in muscle sympathetic nerve traffic (MSNA) and a baroreflex impairment. The present study was set out to assess on a long-term basis the neuroadrenergic and reflex effects of moderate sodium restriction. Methods and Results— In 11 untreated mild to moderate essential hypertensive patients (age 42.0±2.6 years, mean±SEM), we measured beat-to-beat blood pressure (Finapres), heart rate (ECG), and MSNA (microneurography) at rest and during stepwise intravenous infusions of phenylephrine and nitroprusside. Measurements were performed at regular sodium intake, after 1 and 8 weeks of low-sodium diet (80 mmol NaCl/d), and repeated again at regular sodium intake. After 1 week, urinary sodium excretion was markedly reduced. This was accompanied by a slight blood pressure reduction, no heart rate change, and a significant increase in plasma renin activity, aldosterone, and MSNA (+23.0±4.6% P<...
128 citations
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TL;DR: In the PAMELA population, blood pressure control by treatment was much less frequent than DBP control by Treatment, demonstrating that inadequate SBP control is not limited to artificial BP-measuring methods but occurs in daily life.
Abstract: Background: Previous studies have shown that in the treated fraction of the hypertensive population, blood pressure (BP) control is less common for systolic BP (SBP) than for diastolic BP (DBP) as measured in the physician’s office. Whether this phenomenon is artifactually attributable to a temporary increase in BP owing to a “white-coat” effect or represents a true rarity of SBP control in daily life is unknown. Methods: Data were obtained from the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study population, which involved individuals ranging in age from 25 to 74 years who were representative of the residents of Monza (a city near Milan, Italy) and who were stratified according to sex. Office (an average of 3 sphygmomanometric measurements), home (an average of morning and evening self-measurements using a semiautomatic device), and 24-hour ambulatory (average of measurements performed every 20 minutes during the day and at night) BP values were obtained in all study subjects. In the treated hypertensive patients, BP was regarded as controlled if office values were less than 140 (SBP) or 90 (DBP) mm Hg. Home and 24-hour average SBP and DBP were regarded as controlled if the values were lower than 132/83 and 125/79 mm Hg, respectively. Results: In the study participants (n=2051), the number of patients with hypertension who were receiving antihypertensive treatment was 398, or approximately 42% of all individuals with hypertension. In-office SBP control by treatment was less frequent than DBP control (29.9% vs 41.5%, P.05). This was also the case when home and 24-hour SBP and DBP control was considered (38.3% vs 54.6% and 50.8 vs 64.9%, respectively, P.05 for both). Conclusions: In the PAMELA population, SBP control by treatment was much less frequent than DBP control by treatment. This was the case not only for office BP values but also for home and 24-hour BP values, demonstrating that inadequate SBP control is not limited to artificial BP-measuring methods but occurs in daily life. Arch Intern Med. 2002;162:582-586
108 citations
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TL;DR: In this paper, the authors measured office, home, and 24-hour ambulatory BP values, together with echocardiographic left ventricular mass and wall thickness, in 2051 subjects belonging to the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) Study population.
Abstract: Previous studies have shown that in the population, only a minority of treated hypertensive patients achieve blood pressure (BP) control. Whether and to what extent this inadequate control has reflection on hypertension-related organ damage has never been systematically examined. In 2051 subjects belonging to the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) Study population, we measured office, home, and 24-hour ambulatory BP values, together with echocardiographic left ventricular mass and wall thickness. Based on the fraction on antihypertensive treatment and on measurements of increased or normal office, home, or 24-hour ambulatory BP values, subjects were classified as normotensives, untreated hypertensives, treated hypertensives with inadequate BP control, and treated hypertensives with effective BP control. Compared with values in the normotensive group, left ventricular mass index, left ventricular wall thickness, and prevalence of left ventricular hypertrophy were markedly increased not only in untreated hypertensive patients but also in treated hypertensives with inadequate BP control. Echocardiographic abnormalities were less in treated hypertensives with BP control than in patients with inadequate BP control, but values were still clearly greater than in normotensive subjects. This was the case regardless whether BP control was assessed by office, home, and/or ambulatory values. Our data provide evidence that in the hypertensive fraction of the population, cardiac structural alterations can be frequently found in both the presence and absence of antihypertensive treatment. They also imply that even effective treatment of hypertension does not allow complete reversal of the cardiac organ damage characterizing high BP states.
106 citations
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TL;DR: The Framingham models should not be used to predict absolute CHD risk in the European population as a whole, however, these models may be used within each country, provided that cut-off points defining high-risk patients have been determined within each countries.
Abstract: Background Stratification of population groups according to cardiovascular risk level is recommended for primary prevention.Objective To assess whether the Framingham models could accurately predict the absolute risk of coronary heart disease (CHD) and stroke in a large cohort of middle-aged Europea
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TL;DR: Congestive heart failure is characterized by a reduction of Dist of large-elastic and middle-sized muscular arteries that can be reversed by drugs, effectively interfering with the renin-angiotensin system either at the ACE or at the angiotensIn receptor level.
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TL;DR: The evidence obtained by measuring distensibility through quantification of changes in arterial diameter versus blood pressure changes at large elastic and middle size muscle artery sites is reviewed.
Abstract: Reduction of large artery distensibility has several adverse consequences for the cardiovascular system. This paper reviews the evidence obtained by measuring distensibility through quantification of changes in arterial diameter versus blood pressure changes at large elastic and middle size muscle artery sites. Evidence is available that arterial distensibility is reduced in conditions as varied as hypercholesterolemia, hypertension, diabetes and congestive heart failure. In some conditions (e.g. hypertension) the alterations are not uniformly distributed in arteries of different structure and size whereas in others (e.g. diabetes and heart failure) they are widespread. In diabetes evidence is available that distensibility changes occur early in the course of the disease. Evidence is also available that in all above conditions treatment can improve arterial distensibility thereby reversing the initial abnormality. This appears to be due to a variable combination of structural and functional factors. Technical ability to determine their precise role in distensibility changes in humans is limited, however.
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TL;DR: Irbesartan was more effective than valsartan in reducing DBP and SBP at trough and in providing greater overall 24-h blood pressure-lowering efficacy.
Abstract: BACKGROUND The primary objective of this study was to compare the change from baseline in mean diastolic ambulatory blood pressure (ABP) at 24 h post dose (trough measurement) after 8 weeks of treatment with irbesartan or valsartan in subjects with mild-to-moderate hypertension. Secondary objectives included comparing the mean changes from baseline in systolic ABP at trough; 24-h ABP; morning and night-time ABP; self-measured systolic blood pressure (SBP) and diastolic blood pressure (DBP); and office-measured SBP and DBP at trough. DESIGN After a 3-week, single blind, placebo lead-in period, 426 subjects were randomized to receive either irbesartan 150 mg or valsartan 80 mg for 8 weeks. METHODS Ambulatory blood pressure measurements were obtained at baseline and at week 8. Self-measured morning and evening DBP and SBP readings were obtained at home over a 7-day period at baseline and at week 8. Office-measured seated DBP and SBP measurements were obtained at trough, at baseline, and at week 8. RESULTS Irbesartan demonstrated significantly greater reductions than valsartan for mean change from baseline in diastolic ABP at trough (-6.73 versus -4.84 mmHg, respectively; P = 0.035). Irbesartan produced significantly greater reductions than valsartan for mean systolic ABP at trough (-11.62 versus -7.5 mmHg, respectively; P < 0.01) and for mean 24-h diastolic ABP (-6.38 versus -4.82 mmHg, respectively; P = 0.023) and systolic ABP (-10.24 versus -7.76 mmHg; P < 0.01). Irbesartan also produced significantly greater reductions than valsartan for office-measured seated DBP (-10.46 versus 7.28 mmHg, respectively; P < 0.01) and SBP (-16.23 versus -9.96 mmHg, respectively; P < 0.01) and for self-measured morning DBP (-6.28 versus -3.75 mmHg, respectively; P < 0.01) and SBP (-10.21 versus -6.97 mmHg, respectively; P < 0.01). Both drugs were well tolerated. CONCLUSION Irbesartan was more effective than valsartan in reducing DBP and SBP at trough and in providing greater overall 24-h blood pressure-lowering efficacy.
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TL;DR: This paper will focus on the following sets of evidence: that epidemiologically a selective elevation of systolic blood pressure has a major prevalence in the elderly population, and that isolated syStolic hypertension carries a marked increase in the risk of cardiovascular disease and that even in systo-diastolic hypertension this risk may be more closely related to systol than to diastolic blood Pressure.
Abstract: Classification of the severity of hypertension and recommendations on the blood pressure values to be achieved during antihypertensive drug treatment have for decades been based on diastolic values. It is now clear, however, that systolic blood pressure is by no means less important. This paper will focus on the following sets of evidence: (1) that epidemiologically a selective elevation of systolic blood pressure has a major prevalence in the elderly population; (2) that isolated systolic hypertension carries a marked increase in the risk of cardiovascular disease and that even in systo-diastolic hypertension this risk may be more closely related to systolic than to diastolic blood pressure; (3) that treatment of systolic hypertension greatly reduces cardiovascular complications and that in all conditions this reduction is related to the treatment-induced reduction in systolic blood pressure to a degree similar to or superior to the relationship with the reduction in diastolic blood pressure; and (4) that in the hypertensive fraction of the population, control of systolic blood pressure is achieved much less often than control of diastolic blood pressure. That this last point is also the case in major intervention trials suggests that normalization of systolic blood pressure may be intrinsically more difficult than normalization of diastolic blood pressure, possibly because of the difficulty of reversing the pathophysiological abnormalities responsible for the elevation of systolic blood pressure. This emphasizes the importance of research into new drugs or treatment types with greater efficacy in systolic hypertension.
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TL;DR: While in previous studies `reversed white-coat hypertension' was regarded as rare, in Wing et al.'s study, this condition was found to have a noticeable prevalence and the possibility that daytime ambulatory values are greater rather than lower should be regarded as by no means remote.
Abstract: In this issue of the journal, Wing et al. [1] properly mention that the condition they refer to as `reversed white-coat hypertension' had already been described in previous studies. They also emphasize, however, the main novel ®nding of their study. While in previous studies `reversed white-coat hypertension' was regarded as rare, in their study, this condition was found to have a noticeable prevalence (i.e. to characterize from approximately one-third to one-half of the hypertensive population based on systolic and diastolic blood pressure measurements, respectively). This means that when physicians ®nd an elevated of®ce blood pressure, the possibility that daytime ambulatory values are greater rather than lower (as it may seem logical from the distribution of the two pressures in the general population) (Fig. 1) [2] should be regarded as by no means remote. Interestingly, this is the case also in the elderly hypertensive individuals studied by Wing et al. in which the average difference between the higher of®ce and the lower ambulatory blood pressure values is particularly pronounced [3].
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TL;DR: In the INSIGHT study, the long-term antihypertensive effect on 24 h blood pressure and the cardiovascular protection of nifedipine was similar to that of diuretics, thus demonstrating a similar well-balanced anti Hypertensive response to both drugs.
Abstract: Objectives The International Nifedipine GITS Study Intervention as a Goal in Hypertension Treatment (INSIGHT) showed, by means of office blood pressure measurements, that long-term treatment with nifedipine GITS is as effective as diuretics in preventing cardiovascular and cerebrovascular complications. However, since office blood pressure measurements reflect to a limited extent blood pressure outside the office, a side-arm INSIGHT study in which patients underwent both office measurement and 24 h ambulatory blood pressure monitoring was also performed. Design and methods The study had a randomized, double-blind, parallel group design. After 4 weeks of placebo, mild-to-moderate essential hypertensive patients were randomized to nifedipine GITS 30 mg or amiloride 2.5 + hydrochlorothiazide 5 mg for 3.1 years. Dose titration was performed by dose doubling and addition of atenolol 25–50 mg or enalapril 5–10 mg, or other drugs when needed. Analysis was carried out by intention-to-treat and included computation of 24 h, day and night ambulatory blood pressure and heart rate values. Additional analyses included computation of the trough-to-peak ratio and the smoothness index (the ratio between the average of the 24-hourly blood pressure reductions after treatment and its standard deviation). Results A total of 151 patients were recruited and 149 were valid for analysis: 78 patients had 24 h ambulatory recordings both at baseline and during treatment and 134 during treatment. Office, 24 h and day and night blood pressures were all significantly and similarly reduced by both treatments. Office and ambulatory heart rate was left unchanged by diuretics, while it was slightly reduced by nifedipine. Median trough-to-peak ratios were always > 0.5 and superimposable between the two treatment groups. Similarly, smoothness indices of systolic and diastolic blood pressures were comparably high for nifedipine and diuretics, thus demonstrating a similar well-balanced antihypertensive response to both drugs. No significant differences were observed between the two treatment groups in the number of cardiovascular events (17 in the nifedipine-based and 26 in the diuretics-based treatment group). Conclusions In the INSIGHT study, the long-term antihypertensive effect on 24 h blood pressure and the cardiovascular protection of nifedipine was similar to that of diuretics.
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TL;DR: In humans, blood viscosity is involved in the endothelial response to an increase in shear stress, which implies that this response may not be accurately assessed and compared by quantifying the stimulus only through a increase in blood flow.
Abstract: Endothelial function is noninvasively assessed by measuring nitric oxide-dependent increase in radial artery diameter accompanying the elevation in shear stress induced by increasing blood flow through a short-lasting ischemia of the hand. However, shear stress also depends on blood viscosity, whose changes might thus affect nitric oxide increase in a manner that is not properly reflected by blood flow changes. In 12 subjects with hemochromatosis, we measured ultrasonographically radial artery diameter and blood flow responses to a 4-minute ischemia of the hand. This was done also after removing 500 mL of blood (and concomitantly infusing 500 mL of saline), which significantly (P<0.01) reduced hemoglobin concentration and hematocrit. The increase in blood flow induced by the 4-minute ischemia was similar before and after blood removal (+76% and +80%), which, in contrast, markedly attenuated the accompanying increase in radial artery diameter (+25% versus +13%, P<0.01). Thus, in humans, blood viscosity is involved in the endothelial response to an increase in shear stress. This implies that this response may not be accurately assessed and compared by quantifying the stimulus only through an increase in blood flow.
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TL;DR: The Editors areattered by the kind invitation of the Board of Management, representing the two prestigious scienti®c Societies of which the Journal is the ofcial organ, to continue their task for a further 3 years beyond their previous mandate expiring by the end of 2002.
Abstract: The Editors are ̄attered by the kind invitation of the Board of Management, representing the two prestigious scienti®c Societies of which the Journal is the of®cial organ, to continue their task for a further 3 years beyond their previous mandate expiring by the end of 2002. We are grateful to all those who have generously helped us during the past years, the Associate Editors, all members of the Editorial Board, the several hundred reviewers and the several hundred authors who have submitted manuscripts. Their help and contributions have made the Journal a lively and growing body of scienti®c information attracting an increasing number of remarkable manuscripts, which are being read and cited more and more, as shown by the steadily rising impact factor (3.640 according to the last evaluation published in September 2001).
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TL;DR: New insights into the mechanisms responsible for the appearance of chronic hypertension in individuals suffering from recurrent nocturnal apnoeic episodes are provided, based both on experimental studies in animals and on clinical studies in humans.
Abstract: This review article provides an update on two major issues. First, the most recent evidence supporting the occurrence of an association between obstructive sleep apnoea syndrome, or more generally sleep-disordered breathing, and arterial hypertension in humans is summarized and discussed. This includes an evaluation of both cross-sectional and longitudinal studies. Second, new insights into the mechanisms responsible for the appearance of chronic hypertension in individuals suffering from recurrent nocturnal apnoeic episodes are provided, based both on experimental studies in animals and on clinical studies in humans. The relevance of these data for the clinical management of hypertensive patients with sleep-disordered breathing, and the possibility of obtaining a reduction in blood pressure through the application of nasal continuous positive air pressure, is also addressed.
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TL;DR: The data demonstrate that the MSNA responses to spontaneous PVCs are similar in controls and EH but markedly impaired in CHF, presumably because of the baroreflex alteration.
Abstract: Provoked premature ventricular contractions (PVCs) evoke, in concomitance with an early and late blood pressure fall and overshoot, an early sympathoexcitation and a later period of sympathoinhibition, respectively The present study was designed to examine whether in healthy subjects this is the case for spontaneous PVCs Because of their pathophysiological relevance for arrhythmogenesis, it was also designed to determine whether the sympathetic responses are different from those seen in essential hypertension and congestive heart failure In 14 untreated mild essential hypertensives (EH; age, 538±26 years; mean±SEM), 20 untreated congestive heart failure patients (CHF; age, 567±25 years; New York Heart Association class, II or III), and 16 age-matched healthy subjects (control) in Lown class P P
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TL;DR: It is suggested to limit the clinical use of ambulatory blood pressure recording only to those expert centres able to guarantee high quality tracings and an appropriate interpretation of the results, and to restrict its application to carefully selected cases.
Abstract: In this issue of the journal, Palatini [1] summarizes the evidence that ambulatory blood pressure monitoring is superior to clinical blood pressure in the diagnostic and prognostic evaluation of hypertensive patients. However, some inherent limitations of the techniques employed for ambulatory blood pressure monitoring are also emphasized, including the likelihood of artefactual readings which are often disregarded in the context of an uncritical use in clinical practice. On this background, the current indications for ambulatory blood pressure monitoring in hypertension (e.g. the identification of patients with isolated office hypertension) are discussed vis-à-vis the possible role of alternative approaches, and somewhat negative conclusions are reached. That is, that ambulatory blood pressure monitoring does not have clear advantages over multiple clinical measurements or self blood pressure monitoring at home. As a consequence, a suggestion is made to limit the clinical use of ambulatory blood pressure recording only to those expert centres able to guarantee high quality tracings and an appropriate interpretation of the results, and to restrict its application to carefully selected cases.
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TL;DR: In centenarians 24-h blood pressure values are: lower than sphygmomanometric blood pressures and slightly less than in subjects aged 80 years, presumably because of a derangement in the central sleep influences on the cardiovascular system.
Abstract: Objective Ambulatory blood pressure in the elderly has been studied in the past, the age range most frequently examined being 65 to 80 years. The present study was aimed at determining 24-h blood pressure means and profile in centennial human beings.Patients and methods Sphygmomanometric blood press
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TL;DR: This issue of Hypertension includes an article by Bur et al that focuses on the comparison between clinic and ambulatory blood pressure (ABP) values in patients with moderate to severe hypertension, and adds interesting information to the existing database on the clinical value of ABP.
Abstract: This issue of Hypertension includes an article by Bur et al1 that focuses on the comparison between clinic and ambulatory blood pressure (ABP) values in patients with moderate to severe hypertension. The primary goal of the Bur study was to obtain a classification of hypertensive patients, based on the ABP values corresponding to the clinic blood pressure (BP) values that have been used to stage hypertension by the World Health Organization–International Society of Hypertension (WHO-ISH) and the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC) VI guidelines.2,3 An additional goal was to evaluate whether this ABP-based classification has prognostic value, as shown for the prognostic value of the clinic BP staging. Both clinic BP and ABP were measured in 736 hypertensive patients (557 of whom were under treatment) at the time of their first admission to the local Hypertension Unit. All patients then entered a follow-up period with an average duration of 52 months (range, 6 to 96 months), during which only clinic BP was obtained. During the observation time, 82 patients had nonfatal cardiovascular events and 9 patients died of cardiovascular causes.
The article adds interesting information to the existing database on the clinical value of ABP. In particular, it contributes to the available knowledge on the prognostic importance of ABP as well as on its relation to clinic BP in the context of treating patients in a hypertension center.4
Stratifying patients into different risk categories on the basis of ABP values requires studies that (1) establish in populations or in large groups of hypertensive patients the relation of cardiovascular morbidity and mortality with the different 24-hour ABP values selected5,6 and (2) evaluate how prognosis of patients is modified when ABP is reduced by treatment, leading to a change in …
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TL;DR: This paper will examine the main differences in the haemodynamic, vascular, metabolic and neurohumoral profile characterizing normotensive as well as hypertensive females as compared with age-matched males.
Abstract: Although during the past two decades there has been considerable progress in the understanding of the pathophysiology of human essential hypertension, the basic mechanisms responsible for the development and progression of the disease still remain largerly undefined. This also applies to the pathophysiology of hypertension in women, although a number of haemodynamic, vascular, metabolic and neurohumoral factors have been identified throughout the years as being characterized by a gender-specific relation. This paper will examine the main differences in the haemodynamic, vascular, metabolic and neurohumoral profile characterizing normotensive as well as hypertensive females as compared with age-matched males. Although in some instances clearcut differences between genders can be found, overall the pathophysiological picture of the hypertensive state does not seem to have significant differences in men and women, at least up to the years when the menopausal-related hormonal changes take place.
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TL;DR: The results of this subgroup analysis are consistent with INSIGHT's overall findings of no significant differences in efficacy, suggesting that post-MI hypertensive patients are no more likely to suffer further events when treated with long-acting nifedipine than on co-amilozide.
Abstract: Post-myocardial infarction (Ml) patients have a higher risk for subsequent cardiovascular and cerebrovascular events than the average population. This study was to test the effects on outcomes of nifedipine GITS compared to the diuretic combination co-amilozide in hypertensive patients with a history of Ml on outcomes (subset of the INSIGHT study). The multinational, randomised, double-blind International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) study compared the treatment effects of nifedipine GITS 30 mg and co-amilozide (hydrochlorothiazide 25 mg plus amiloride 2.5 mg) in hypertensive patients aged 55-80 years with a blood pressure of 150/95 mmHg (or 160 mmHg systolic). This pre-specified subanalysis was performed in patients with a history of Ml. The primary outcome was a composite of cardiovascular death, non-fatal stroke, Ml, and heart failure. Of 6,321 randomised patients, 383 (6.1%) had a previous Ml. The percentage of primary outcomes in post-MI patients did not differ between the two treatment groups (14.9%). The number of post-MI patients with composite secondary outcomes was 53 (27.2%) in the nifedipine GITS group and 60 (31.9%) in the co-amilozide group. The incidence rates of primary and secondary outcomes were higher in patients with a previous Ml than in patients without a history of Ml. For the randomised use of nifedipine GITS and co-amilozide in hypertensive patients with a previous Ml, the choice seemed unimportant for outcomes and blood pressure lowering. The results of this subgroup analysis are consistent with INSIGHT's overall findings of no significant differences in efficacy, suggesting that post-MI hypertensive patients are no more likely to suffer further events when treated with long-acting nifedipine than on co-amilozide.
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TL;DR: T and T HCTZ are both well tolerated in patients of all ages and have placebo-like tolerabilities, and the overall incidence of drug-related laboratory abnormalities was low in all treatment groups.
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01 Jan 2002
TL;DR: The author examines the changing aspects of hypertension in children and adolescents, the impact of guidelines in the clinical practice, and treatment strategies selecting the proper Weber therapeutic agent.
Abstract: Introduction: How to use this book The Editor Section 1. Epidemiology Julius 1.1 Hypertension as a cardiovascular risk factor Dr W Kannel 1.2 Results of intervention trials Professor R Fagard Section 2. Etiology and Pathophysiology Julius 2.1 The animal modes of hypertension Professor A Ferrari 2.2 Hypertension as a genetic disease Professor P Hamet 2.3 Salt and other dietary factors Dr I Puddey 2.4 The renin-angiotension system Professor M Nicholls 2.5 Neural factors Professor M Esler 2.6 Hormones and other humoral factors Dr O Carretero 2.7 Cell membrane abnormalities Dr A Semplicini Section 3. Blood pressure measurement Mancia 3.1 Office assessment of blood pressure Dr M Weber 3.2 Home blood pressure Professor J Mallion 3.3 Ambulatory blood pressure Dr G Parati 3.4 Special blood pressure measuring devices Professor E OBrien Section 4. Specific (secondary) causes of hypertension Saruta 4.1 Renovascular hypertension Professor J Pohl 4.2 Renal parenchymal hypertension Professor M Epstein 4.3 Phaeocromocytoma Dr G Grassi 4.4 Cortico-adrenal hypertension Professor J Whitworth 4.5 Rare forms of secondary hypertension Professor R Gordon 4.6 Hypertension from exogenous substances Dr Y Saruta Section 5. Essential hypertension Weber 5.1 Diagnosing essential hypertension 5.2 Excluding secondary causes of hypertension Dr A Morganti 5.3 Routine assessment of end-organ damage Dr L Hansson 5.4 Special measurer of end-organ damage Dr T Pickering Section 6. Antihypertensive drugs Chalmers 6.1 Diuretics 6.2 Beta-blockers Dr B Prichard 6.3 Calcium antagonists Professor F Meredith 6.4 ACE inhibitors Professor D Clement 6.5 Alpha-blockers Dr H Elliot 6.6 Angiotensin II receptor antagonists Dr J Reid 6.7 Central agents Professor P van Zweiten 6.8 Other drugs Professor A Pessina Section 7. Treatment strategies selecting the proper Weber therapeutic agent 7.1 Goal blood pressure Professor A Zanchetti 7.2 Life-style changes Dr L Beilin 7.3 The step-care approach Dr B Materson 7.4 The substitution and other approaches Professor P de Leeuw 7.5 The pros and cons of fixed combinations 7.6 The problem of compliance to treatment Dr B Waeber Section 8. Treatment in special conditions Ferrari 8.1 Hypertension in children and adolescents Dr B Falkner 8.2 Hypertension in the elderly Professor F Messerli 8.3 Hypertension in blacks Dr K Jamerson 8.4 The patients with multiple risk factors Dr G Jennings 8.5 The diabetic hypertension patient 8.6 Hypertension in pregnancy Dr M Brown 8.7 Hypertension in transplant patients Dr A Mimran 8.8 Resistant hypertension Dr K Rahn Section 9 Changing aspects of hypertension Chalmers 9.1 Malignant hypertension Dr Y Seedat 9.2 Impact of guidelines in the clinical practice Professor J Chalmers 9.3 Failure of antihypertensive treatment in the population Dr S Oparil Assessment of cost-benefit of antihypertensive Prof E Ambrosioni treatment 9.5 Isolated office hypertension Professor G Mancia