Showing papers by "Giuseppe Mancia published in 2006"
TL;DR: The guidelines lean on the taskforce report on CVD prevention suggesting ‘considering a lower threshold for institution of pharmacological therapy for hypertension (130/85) for patients with established coronary heart disease’.
Abstract: Under the heading ‘Hypertension, diabetes, and other disorders’ on page 1358, the guidelines1 lean on the taskforce report on CVD prevention2 suggesting ‘considering a lower threshold for institution of pharmacological therapy for hypertension (130/85) for patients with established coronary heart disease (which would include patients with …
1,211 citations
TL;DR: A secondary analysis of data from a large trial of 2 antihypertensive drug regimens in patients with known coronary artery disease found a J-shaped relationship between diastolic blood pressure and all-cause death and myocardial infarction.
Abstract: Because blood flow in the coronary arteries takes place largely during diastole, an increase in risk for coronary artery disease with excessive lowering of diastolic blood pressure is plausible, al...
724 citations
TL;DR: There was indeed a progressive increase in both CV and all-cause mortality risk from subjects in whom office, home, and ambulatory BP were all normal to those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered.
Abstract: In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, office, home, and ambulatory blood pressure (BP) values were measured contemporaneously between 1990 and 1993 in a large population sample (n=2051). Cardiovascular (CV) and non-CV death certificates were collected over the next 148 months, which allowed us to assess the prognostic value of selective and combined elevation in these 3 BPs over a long follow-up. There were 69 CV and 233 all-cause deaths. Compared with subjects with normal office and 24-hour BP, the hazard ratio for CV death showed a progressive increase in those with a selective office BP elevation (white-coat hypertension), a selective 24-hour BP elevation (masked hypertension), and elevation in both office and 24-hour BP. This was the case also when the above conditions were identified by office versus home BP values. Selective elevation in home versus ambulatory BP or vice versa also carried an increased risk. There was indeed a progressive increase in both CV and all-cause mortality risk from subjects in whom office, home, and ambulatory BP were all normal to those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered. The trends remained significant after adjustment for age and gender, as well as, in most instances, after further adjustment for other cardiovascular risk factors. Thus, white-coat hypertension and masked hypertension, both when identified by office and ambulatory or by office and home BPs, are not prognostically innocent. Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations.
669 citations
TL;DR: This series of debates was initiated for the Journal of Applied Physiology because it believes an important means of searching for truth is through debating point-to-point results.
Abstract: PURPOSE AND SCOPE OF THE POINT:COUNTERPOINT DEBATESThis series of debates was initiated for the Journal of Applied Physiology because we believe an important means of searching for truth is through...
317 citations
TL;DR: Evidence is provided that compared with diuretics and beta-blockers, new-onset diabetes is less common with 'new' drugs, and that conventional antihypertensive compounds, particularly when combined together, may amplify the natural time-dependent tendency towards the development of this metabolic disease.
Abstract: Observational studies have provided evidence that a consistent fraction (approximately 15-20%) of hypertensive patients displays a glucose intolerance state that may be aggravated by antihypertensive drug regimens based on thiazide diuretics or beta-blockers. This review examines the relative and absolute diabetogenic effects of antihypertensive drugs, by comparing the impact of 'new' (calcium antagonists, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) versus 'old' (diuretics and beta-blockers) drugs on new-onset diabetes in recent clinical trials. Evidence is provided that compared with diuretics and beta-blockers, new-onset diabetes is less common with 'new' drugs, and that conventional antihypertensive compounds, particularly when combined together, may amplify the natural time-dependent tendency towards the development of this metabolic disease. This paper provides new insights into the potential mechanisms responsible for the phenomenon and the clinical significance of antihypertensive drug-induced diabetes.
284 citations
TL;DR: The results show for the first time that hot weather is associated with an increase in systolic pressure at night in treated elderly hypertensive subjects, which may be because of a nocturnal BP escape from the effects of a lighter summertime drug regimen.
Abstract: A downward titration of antihypertensive drug regimens in summertime is often performed on the basis of seasonal variations of clinic blood pressure (BP). However, little is known about the actual interaction between outdoor air temperature and the effects of antihypertensive treatment on ambulatory BP. The combined effects of aging, treatment, and daily mean temperature on clinic and ambulatory BP were investigated in 6404 subjects referred to our units between October 1999 and December 2003. Office and mean 24-hour systolic BP, as well as morning pressure surge, were significantly lower in hot (>90th percentiles of air temperature; 136+/-19, 130+/-14, and 33.3+/-16.1 mm Hg; P<0.05 for all), and higher in cold (<10th percentiles) days (141+/-12, 133+/-11, and 37.3+/-9.5 mm Hg; at least P<0.05 for all) when compared with intermediate days (138+/-18, 132+/-14, and 35.3+/-15.4 mm Hg). At regression analysis, 24-hour and daytime systolic pressure were inversely related to temperature (P<0.01 for all). Conversely, nighttime systolic pressure was positively related to temperature (P<0.02), with hot days being associated with higher nighttime pressure. Air temperature was identified as an independent predictor of nighttime systolic pressure increase in the group of elderly treated hypertensive subjects only. No significant relationship was found between air temperature and heart rate. Our results show for the first time that hot weather is associated with an increase in systolic pressure at night in treated elderly hypertensive subjects. This may be because of a nocturnal BP escape from the effects of a lighter summertime drug regimen and may have important implications for seasonal modulation of antihypertensive treatment.
220 citations
TL;DR: The association between elevated resting heart rate and cardiovascular morbidity and mortality has been demonstrated in a large number of epidemiologic studies, but elevated heart rate is not yet considered to be a risk factor for cardiovascular disease.
Abstract: IntroductionAlthough the association between elevated resting heart rate and cardiovascular morbidity and mortality has been demonstrated in a large number of epidemiologic studies, elevated heart rate is not yet considered to be a risk factor for cardiovascular disease. This is mainly due to the la
209 citations
TL;DR: Treatment of hypertensive patients at high cardiovascular risk with the angiotensin-receptor blocker valsartan prevents new-onset type 2 diabetes compared with the metabolically neutral calcium-channel antagonist (CCA) amlodipine, and reduces the risk of developing diabetes mellitus in high-risk hypertensive Patients.
Abstract: ContextType 2 diabetes is emerging as a major health problem, which tends to cluster with hypertension in individuals at high risk of cardiovascular disease.ObjectiveTo test for the first time the hypothesis that treatment of hypertensive patients at high cardiovascular risk with the angiotensin-rec
159 citations
TL;DR: In this paper, the authors pointed out that neural cardiovascular regulation is characterized by a complex interaction between central and reflex mechanisms, with the contribution of other important factors such as respiratory frequency and depth.
Abstract: To the Editor : As repeatedly underlined in this debate, neural cardiovascular (CV) regulation is characterized by a complex interaction between central and reflex mechanisms, with the contribution of other important factors such as respiratory frequency and depth. It would therefore be unrealistic
141 citations
TL;DR: The present results indicate that the early beneficial effect of ET-1 antagonism on pulmonary blood pressure is followed by an impairment in volume adaptation, which must be considered for the prevention and treatment of acute mountain sickness.
Abstract: Background— The degree of pulmonary hypertension in healthy subjects exposed to acute hypobaric hypoxia at high altitude was found to be related to increased plasma endothelin (ET)-1. The aim of the present study was to investigate the effects of ET-1 antagonism on pulmonary hypertension, renal water, and sodium balance under acute and prolonged exposure to high-altitude–associated hypoxia. Methods and Results— In a double-blind fashion, healthy volunteers were randomly assigned to receive bosentan (62.5 mg for 1 day and 125 mg for the following 2 days; n=10) or placebo (n=10) at sea level and after rapid ascent to high altitude (4559 m). At sea level, bosentan did not induce any significant changes in hemodynamic or renal parameters. At altitude, bosentan induced a significant reduction of systolic pulmonary artery pressure (21±7 versus 31±7 mm Hg, P<0.03) and a mild increase in arterial oxygen saturation versus placebo after just 1 day of treatment. However, both urinary volume and free water clearance ...
111 citations
TL;DR: Even in a small Mediterranean country with high health-care standards, hypertension awareness, treatment and control are inadequate and hypertension clusters with metabolic abnormalities and risk factors as in non-Mediterranean areas are found.
Abstract: Background The aim of the SMOOTH (San Marino Observational Outlooking Trial on Hypertension) study was to explore hypertension awareness, treatment and control and the associated metabolic abnormalities and risk factors in the population of San Marino, a small state in the Mediterranean area, for which limited evidence is available. Methods Nine general practitioners enrolled 4590 consecutive subjects (44% of the San Marino population age 40-75 years), seen in their office by collecting history, physical and laboratory data and office blood pressure (BP) measurements. Results Of these subjects, 2446 were normotensive and 2144 hypertensive; 62.3% of hypertensive patients were aware of their condition, 58.6% were treated (monotherapy 31.5%, combination therapy 27.1%), and 21.7% were controlled. Hypertension awareness and treatment were more frequent above age 50 and in females; BP control was similarly low in both genders. As compared to normotensives, hypertensive subjects were less frequently smokers (20.1 versus 27.8%), had greater body mass index (28.1 +/- 4.5 versus 25.8 +/- 3.7 g/m), and a higher prevalence of diabetes mellitus (15.8 versus 6.3%), lower high-density lipoprotein (HDL) cholesterol and higher prevalence of increased blood total cholesterol (66.1 versus 51.3%), triglycerides and serum uric acid. Values of subjects with 'high-normal' blood pressure were closer to those of hypertensive subjects. The prevalence of metabolic syndrome was higher in hypertensive than in normotensive subjects, and in treated than in untreated hypertensives. Conclusions Even in a small Mediterranean country with high health-care standards, hypertension awareness, treatment and control are inadequate and hypertension clusters with metabolic abnormalities and risk factors as in non-Mediterranean areas.
TL;DR: Modern techniques, based on computer analysis of spontaneous blood pressure and heart rate fluctuations, are now available and allow baroreflex sensitivity to be assessed under real‐life conditions with no need for external stimulation and offer the possibility of investigating the dynamic modulation of barore Flex sensitivity.
Abstract: Assessment of arterial baroreflex function in humans through laboratory tests has provided a great deal of information of pathophysiological and clinical relevance. Indeed, the sensitivity of the baroreceptor-heart rate reflex quantified through these laboratory methods was shown to predict the risk of cardiovascular events and death from myocardial infarction, heart failure, and in diabetic patients. This traditional approach, however, does not provide information on daily life baroreflex cardiovascular control. Modern techniques, based on computer analysis of spontaneous blood pressure and heart rate fluctuations, are now available and allow baroreflex sensitivity to be assessed under real-life conditions with no need for external stimulation. In particular, these methods offer the possibility of investigating the dynamic modulation of baroreflex sensitivity occurring either on a minute-to-minute basis or over 24 hours.
TL;DR: In conclusion, therapeutic interventions aimed at blocking the renin–angiotensin system exert favourable effects on the haemodynamic, metabolic and renal profile, which has important implications for the treatment of hypertension, congestive heart failure, renal insufficiency and metabolic syndrome.
Abstract: BackgroundBlood pressure, as well as blood volume homeostasis, depends to a large extent on humoral influences stemming from the renin–angiotensin axis and the sympathetic nervous system. Evidence has been provided that a large part of this homeostatic modulation is effected by the complex interacti
TL;DR: In hypertensive patients with CAD, increased risk for adverse outcomes was associated with conditions related to the severity of CAD and diminished left ventricular function, and lower follow-up BP and addition of trandolapril to verapamil SR each were associated with reduced risk.
TL;DR: This review will examine the main features of cardiovascular reflex control in hypertension and the effects of the different classes of antihypertensive drugs in uncomplicated and complicated hypertension.
TL;DR: Dietary PUFA supplementation markedly potentiates baroreflex function and enhances heart rate variability in patients with stable congestive heart failure andPolyunsaturated fatty acids treatment also significantly increased R-R interval total variance and low-frequency and high-frequency spectral powers.
TL;DR: The occurrence of a transient pressor response when blood pressure is measured in a clinic or office environment was first described in 1897 by Scipione Riva-Rocci and provided the first quantitative assessment of the magnitude and the time course of this phenomenon in 1983.
Abstract: The occurrence of a transient pressor response when blood pressure is measured in a clinic or office environment was first described in 1897 by Scipione Riva-Rocci [1]. Nearly 50 years later, Ayman and Goldshine [2] observed that blood pressure values measured by the patient at home were invariably lower than blood pressure values recorded by physicians in their office, and that such a difference persisted over a relatively long followup period. The quantitative assessment of the magnitude and the time course of this phenomenon was first provided in 1983 by Mancia et al. [3,4] through the use of continuous intra-arterial ambulatory blood pressure recordings carried out before and during a doctor’s visit (Fig. 1) [3,4].
TL;DR: Limits of morbidity and mortality research have been discussed and the consequences this has for current concepts and recommendations on the management of hypertension are addressed.
TL;DR: Technical aspects The number of devices available for ABPM continues to increase and both devices based on auscultatory methods and those based on oscillometric methods are available.
Abstract: Technical aspects The number of devices available for ABPM continues to increase. Both devices based on auscultatory methods and those based on oscillometric methods are available. In order to be acceptable for practical use, however, a device must have been validated according to international protocols [1,2]. One of these protocols has been described by the Working Group on ABPM of the European Society of Hypertension [3].
TL;DR: Antihypertensive therapy should form one component of a multifactorial approach aimed at treating all reversible risk factors, and research should be aimed at controlling or reversing subclinical target-organ damage.
Abstract: Recognition that cardiovascular risk factors, such as hypertension, dyslipidaemia and diabetes mellitus, often cluster together has focused attention on the concept of total cardiovascular risk. Most current hypertension management guidelines emphasize the importance of assessing and managing the to
TL;DR: Measurement of the appropriateness of LV mass in single patients allows acceptable risk stratification, with a coefficient of consistency similar to that reported for LV mass.
Abstract: BackgroundThe appropriateness of left ventricular (LV) mass to cardiac workload may be calculated by the ratio of observed LV mass to the value predicted for an individual's sex, height, and stroke work at rest.ObjectiveTo investigate test–retest reproducibility of observed/predicted LV mass in a si
TL;DR: Findings indicate that in the aortic banding rat model, α-adrenoceptors are importantly involved in the pathogenesis of cardiovascular deterioration and disease progression.
Abstract: We observed previously that in rats with aortic banding (Bd), development of left ventricular (LV) hypertrophy is opposed by β-blockade, whereas interventions interfering with α-adrenoceptor functi...
TL;DR: This document is focused on global risk-based stratification, aimed at identifying ‘low-risk’ and ‘high- risk’ patients within those presenting with MS, and may be particularly effective in clinical practice in identifying patients with MS with different degrees of cardiovascular disease risk profile.
TL;DR: The question now is whether the results from these recent trials should affect the choice of antihypertensive treatment, particularly for special groups, and whether the key goal is still to reduce BP, and this usually requires combinations of drugs.
Abstract: Recent large hypertension trials have shown great differences in incidence of new-onset diabetes mellitus among patients receiving different antihypertensive drug therapies. The incidence of diabetes is unchanged or increased by the use of thiazide diuretics and β-adrenoceptor antagonists (β-blockers) and unchanged or decreased by ACE inhibitors, calcium channel blockers (CCBs), and angiotensin II type 1 receptor antagonists (angiotensin receptor blockers). Recent results from ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) showed superiority of the ‘new’ combination of CCBs and ACE inhibitors over the ‘old’ or ‘conventional’ combination of β-blockers and diuretics. In this review, the results from some of the large hypertension trials are discussed, and the hypotheses on how different antihypertensive drug regimens can affect glucose homeostasis are considered. The question now is whether the results from these recent trials should affect the choice of antihypertensive treatment, particularly for special groups. However, the key goal is still to reduce BP, and this usually requires combinations of drugs.
TL;DR: The usefulness of ABPM in pharmacologic studies aimed at evaluating the 24-hour antihypertensive efficacy of different drugs and drug combinations is acknowledged and the ABPM-derived smoothness index provides a superior measure of the homogeneity of BP control compared with trough:peak ratios.
Abstract: Compared with isolated clinic measurements, ambulatory blood pressure monitoring (ABPM) provides an insight into blood pressure (BP) changes in everyday life and an estimate of the overall BP load exerted on the cardiovascular system over 24 hours. Cross-sectional evidence suggests a direct and significant relationship between ambulatory BP and organ damage. There is also longitudinal evidence for a superior predictive value of 24-hour BP in relation to the risk for cardiovascular morbidity and mortality as opposed to clinic BP. The usefulness of ABPM in pharmacologic studies aimed at evaluating the 24-hour antihypertensive efficacy of different drugs and drug combinations is now acknowledged. Among the mathematical indices available to explore 24-hour BP coverage by treatment, the ABPM-derived smoothness index provides a superior measure of the homogeneity of BP control compared with trough:peak ratios. The main applications of clinical practice should be in identifying patients with isolated office hypertension and those who are nonresponders to treatment, in assessing coverage of the 24-hour BP profile in high-risk patients and in diagnosing suspected treatment-related hypotension.
TL;DR: Facing the availability of therapeutic interventions currently employed to manage the life-threatening complications of the most advanced phases of cirrhotic disease, the knowledge of their impact on cardiovascular function is of paramount relevance.
TL;DR: The clinical relevance of this reflex dysfunction is based on the evidence that these alterations may favor the occurrence of an increased sympathetic vasoconstrictor drive, thereby promoting the development of the hypertensive state.
Abstract: The interactions linking high blood pressure with hypertensive heart disease are reciprocal. Hypertension can be regarded as a source of adverse effects on myocardial structure and function by favoring the development and progression of left ventricular hypertrophy and of left ventricular dysfunction and failure in the advanced phases of the disease. Conversely, the heart can be regarded as a source of reflex influences on the cardiovascular system, which appear to be deranged in the hypertensive state. The clinical relevance of this reflex dysfunction is based on the evidence that these alterations may favor the occurrence of an increased sympathetic vasoconstrictor drive, thereby promoting the development of the1 hypertensive state. Both phenomena have important clinic and therapeutic implications potentiating the cardiovascular risk profile of the hypertensive patient.
TL;DR: Blood pressure (BP) control is a major issue in nephrology, both in the predialysis phase of chronic kidney disease (CKD) and while patients are on dialysis.
Abstract: Blood pressure (BP) control is a major issue in nephrology, both in the predialysis phase of chronic kidney disease (CKD) and—more complex and controversial—while patients are on dialysis ([1][1]–[7][2]). There is no doubt that in renal patients hypertension aggravates progression and
TL;DR: This review provides an extensive and critical review of the drug treatment of this complex pathologic entity, which is associated with important cardiovascular and cerebrovascular and metabolic risks.
Abstract: Metabolic syndrome is characterized by a clustering of cardiovascular and metabolic risk factors This syndrome is now widely recognized as a distinct pathologic entity It is receiving a great deal of attention in the medical literature and also in the lay press People with metabolic syndrome have a clustering of the following risk factors, including detrimental changes in glucose tolerance and insulin resistance, abdominal (visceral) obesity, atherogenic dyslipidemia, and hypertension Metabolic syndrome is associated with important cardiovascular and cerebrovascular and metabolic risks Prevention and treatment are therefore of great importance Preventive measures involving lifestyle are mandatory In addition, metabolic syndrome patients will require pharmacologic treatment, usually for the rest of their lives Complex patterns of drug treatment are required This review provides an extensive and critical review of the drug treatment of this complex pathologic entity