Showing papers by "Giuseppe Mancia published in 2018"
TL;DR: De Backer et al. as mentioned in this paper developed the ESC Guidelines for the ESC Review Co-ordinator, which are used for the evaluation of the ESC review process and the review process.
Abstract: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Hector Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
1,781 citations
TL;DR: Authors/Task Force Members: Bryan Williams* (ESC Chairperson), Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands), Enrico Agabiti Rosei ( Italy), Michel Azizi (France), Michel Burnier (Switzerland), Denis L. Kjeldsen (Norway), Reinhold Kreutz (Germany), Stephane Laurent (France)
Abstract: Authors/Task Force Members: Bryan Williams* (ESC Chairperson) (UK), Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands), Enrico Agabiti Rosei (Italy), Michel Azizi (France), Michel Burnier (Switzerland), Denis L. Clement (Belgium), Antonio Coca (Spain), Giovanni de Simone (Italy), Anna Dominiczak (UK), Thomas Kahan (Sweden), Felix Mahfoud (Germany), Josep Redon (Spain), Luis Ruilope (Spain), Alberto Zanchetti (Italy), Mary Kerins (Ireland), Sverre E. Kjeldsen (Norway), Reinhold Kreutz (Germany), Stephane Laurent (France), Gregory Y. H. Lip (UK), Richard McManus (UK), Krzysztof Narkiewicz (Poland), Frank Ruschitzka (Switzerland), Roland E. Schmieder (Germany), Evgeny Shlyakhto (Russia), Costas Tsioufis (Greece), Victor Aboyans (France), Ileana Desormais (France)
1,352 citations
555 citations
University College London1, University of Milano-Bicocca2, Utrecht University3, University of Brescia4, Paris Descartes University5, University Hospital of Lausanne6, Ghent University7, University of Barcelona8, University of Glasgow9, Karolinska Institutet10, Saarland University11, University of Valencia12, University of Milan13, Oslo University Hospital14, Charité15, University of Birmingham16, Gdańsk Medical University17, University of Zurich18, National and Kapodistrian University of Athens19
TL;DR: These practice guidelines on the management of arterial hypertension are a concise summary of the more extensive ones prepared by the Task Force jointly appointed by the European Society of Hypertension and theEuropean Society of Cardiology.
Abstract: These practice guidelines on the management of arterial hypertension are a concise summary of the more extensive ones prepared by the Task Force jointly appointed by the European Society of Hypertension and the European Society of Cardiology. These guidelines have been prepared on the basis of the best available evidence on all issues deserving recommendations; their role must be educational and not prescriptive or coercive for the management of individual subjects who may differ widely in their personal, medical and cultural characteristics. The members of the Task Force have participated independently in the preparation of these guidelines, drawing on their academic and clinical experience and by objective examination and interpretation of all available literature. A disclosure of their potential conflict of interest is reported on the websites of the ESH and the ESC.
270 citations
212 citations
TL;DR: Higher visit-to-visit systolic blood pressure variability is associated with increased risk of cardiovascular events in patients with hypertension, irrespective of baseline risk ofiovascular events.
Abstract: Aims Blood pressure variability is associated with increased risk of cardiovascular events, particularly in high-risk patients. We assessed if variability was associated with increased risk of cardiovascular events and death in hypertensive patients at different risk levels. Methods and results The Valsartan Antihypertensive Long-term Use Evaluation trial was a randomized controlled trial of valsartan vs. amlodipine in patients with hypertension and different risks of cardiovascular events, followed for a mean of 4.2 years. We calculated standard deviation (SD) of mean systolic blood pressure from visits from 6 months onward in patients with ≥3 visits and no events during the first 6 months. We compared the risk of cardiovascular events in the highest and lowest quintile of visit-to-visit blood pressure variability, using Cox regression. For analysis of death, variability was analysed as a continuous variable. Of 13 803 patients included, 1557 (11.3%) had a cardiovascular event and 1089 (7.9%) died. Patients in the highest quintile of SD had an increased risk of cardiovascular events [hazard ratio (HR) 2.1, 95% confidence interval (95% CI) 1.7-2.4; P < 0.0001], and a 5 mmHg increase in SD of systolic blood pressure was associated with a 10% increase in the risk of death (HR 1.10, 95% CI 1.04-1.17; P = 0.002). Associations were stronger among younger patients and patients with lower systolic blood pressure, and similar between patients with different baseline risks, except for higher risk of death among patients with established cardiovascular disease. Conclusion Higher visit-to-visit systolic blood pressure variability is associated with increased risk of cardiovascular events in patients with hypertension, irrespective of baseline risk of cardiovascular events. Associations were stronger in younger patients and in those with lower mean systolic blood pressure.
150 citations
Innsbruck Medical University1, University of Cologne2, Vanderbilt University3, University of Bologna4, Mayo Clinic5, University of Milan6, Icahn School of Medicine at Mount Sinai7, New York University8, French Institute of Health and Medical Research9, University of Calgary10, University of Lisbon11, University of Health Sciences Antigua12, Leiden University13, National and Kapodistrian University of Athens14
TL;DR: The establishment of expert-based criteria to define nSH should standardize diagnosis and allow a better understanding of its epidemiology, prognosis and, ultimately, treatment.
Abstract: Patients suffering from cardiovascular autonomic failure often develop neurogenic supine hypertension (nSH), i.e., high blood pressure (BP) in the supine position, which falls in the upright position owing to impaired autonomic regulation. A committee was formed to reach consensus among experts on the definition and diagnosis of nSH in the context of cardiovascular autonomic failure. As a first and preparatory step, a systematic search of PubMed-indexed literature on nSH up to January 2017 was performed. Available evidence derived from this search was discussed in a consensus expert round table meeting in Innsbruck on February 16, 2017. Statements originating from this meeting were further discussed by representatives of the American Autonomic Society and the European Federation of Autonomic Societies and are summarized in the document presented here. The final version received the endorsement of the European Academy of Neurology and the European Society of Hypertension. In patients with neurogenic orthostatic hypotension, nSH is defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, measured after at least 5 min of rest in the supine position. Three severity degrees are recommended: mild, moderate and severe. nSH may also be present during nocturnal sleep, with reduced-dipping, non-dipping or rising nocturnal BP profiles with respect to mean daytime BP values. Home BP monitoring and 24-h-ambulatory BP monitoring provide relevant information for a customized clinical management. The establishment of expert-based criteria to define nSH should standardize diagnosis and allow a better understanding of its epidemiology, prognosis and, ultimately, treatment.
149 citations
TL;DR: The data suggest at optimal achieved SBP, risk is still defined by low or high DBP, and support guidelines which take DBP at optimal SBP control into consideration.
Abstract: Aims: Current guidelines of hypertensive management recommend upper limits for systolic (SBP) and diastolic blood pressure (DBP). J-curve associations of BP with risk exist for some outcomes suggesting that lower limits of DBP goals may also apply. We examined the association between mean attained DBP and cardiovascular (CV) outcomes in patients who achieved an on-treatment SBP in the range of 120 to 80 mmHg. The associations to outcomes were similar when patients were divided to SBP 120 to < 130 mmHg or 130 to < 140 mmHg for DBP or PP. Conclusion: Compared to a DBP of 70 to < 80 mmHg, lower and higher DBP was associated with a higher risk in patients achieving a SBP of 120 to < 140 mmHg. Associations of DBP and PP to risk were similar notably at controlled SBP. These data suggest at optimal achieved SBP, risk is still defined by low or high DBP. These findings support guidelines which take DBP at optimal SBP control into consideration.
93 citations
TL;DR: In this article, muscle sympathetic nerve activity (MSNA) has shown that sympathetic activation may occur in essential hypertension (EHT), however, the small sample size of the studies, the heterogeneity of the patients examined, and the presence of confounders represented major weaknesses not allowing to draw definite conclusions.
Abstract: Muscle sympathetic nerve activity (MSNA) has shown that sympathetic activation may occur in essential hypertension (EHT). However, the small sample size of the studies, the heterogeneity of the patients examined, and the presence of confounders represented major weaknesses not allowing to draw definite conclusions. Among the 432 studies identified providing information in EHT on MSNA, 63 were eligible (1216 patients) and meta-analyzed grouping them on the basis of clinically relevant questions: (1) Is MSNA increased in hypertension of mild/moderate-to-severe degree? (2) Does sympathetic activation occur in borderline, white-coat, and masked EHT? (3) Is MSNA related to clinic and ambulatory blood pressure and target organ damage? (4) Are heart rate and venous plasma norepinephrine valuable surrogate markers of MSNA in clinical practice? The results show that MSNA was significantly greater (1.5×; P P r =0.67 and r =0.83; P r =−0.38; P r =0.28; P r =0.27; P
79 citations
TL;DR: In a real-life setting, a comparison of the incidence of early CV events during antihypertensive monotherapy and FDC shows that the latter strategy leads to a more effective CV protection.
Abstract: Aims Guidelines support use of drug combinations in most hypertensive patients, and recently treatment initiation with two drugs has been also recommended. However, limited evidence is available on whether this leads to greater cardiovascular (CV) protection compared to initial monotherapy. Methods and results Using the healthcare utilization database of the Lombardy Region (Italy), the 44 534 residents of the region (age 40-80 years) who in 2010 started treatment with one antihypertensive drug (n = 37 078) or a two-drug fixed-dose combination (FDC, n = 7456) were followed for 1 year after treatment initiation to compare the risk of hospitalization for CV disease associated with the two treatment strategies. To limit the confounding associated with non-randomized between-group comparisons, data were also analysed by: (i) matching the two groups by the high-dimensional propensity score (HDPS) and (ii) comparing, in patients experiencing one or more CV events (n = 2212), the CV event incidence during subperiods in which patients were prescribed mono- or FDC therapy (self-controlled case series design). Compared to initial monotherapy, patients on initial FDC therapy showed a reduced 1 year risk of hospitalization for any CV event (-21%, P < 0.01). This was the case also when groups were compared according to the HDPS analysis (-15%, P < 0.05). Finally, in patients experiencing CV events, the event incidence was much less when, during the 1 year follow-up, they were under FDC therapy than under monotherapy (-56%, P < 0.01). The reduced risk of hospitalization was always significant for ischaemic heart disease and new onset atrial fibrillation, and included hospitalization for cerebrovascular disease and heart failure when monotherapy and FDC therapy were compared within patients. Conclusion In a real-life setting, a comparison of the incidence of early CV events during antihypertensive monotherapy and FDC shows that the latter strategy leads to a more effective CV protection. This scores in favour of a two-drug FDC strategy as first step in the hypertensive population.
69 citations
University of Padua1, University of Brescia2, Macquarie University3, University of Pisa4, University of Milano-Bicocca5, University of Michigan6, University of Cambridge7, University of New South Wales8, University of Perugia9, University of Naples Federico II10, National and Kapodistrian University of Athens11, University of Milan12
TL;DR: Assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition, however, an increase in pulse wave velocity has been found in about 20% of the individuals with ISHY.
Abstract: Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. However, findings from previous studies have provided inconsistent results. From the analysis of the literature, two main lines of research and conceptualization have emerged. Simultaneous assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition. However, an increase in pulse wave velocity has been found by some authors in about 20% of the individuals with ISHY. In addition, obesity and metabolic disturbances have often been documented to be associated with ISHY both in children and young adults. The first aspect to consider whenever evaluating a person with ISHY is the possible presence of white-coat hypertension, which has been frequently found in this condition. In addition, assessment of central blood pressure is useful for identifying ISHY patients whose central blood pressure is normal. ISHY is infrequently mentioned in the guidelines on diagnosis and treatment of hypertension. According to the 2013 European Guidelines on the management of hypertension, people with ISHY should be followed carefully, modifying risk factors by lifestyle changes and avoiding antihypertensive drugs. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure.
TL;DR: Focusing the analysis on the individuals with age above the median value, SUA increase was significantly associated with an increased risk of new-onset metabolic syndrome, IFG and diabetes mellitus.
Abstract: Background:Although several data suggest that serum uric acid (SUA) predicts future development of metabolic abnormalities, the evidence is not conclusive in Mediterranean populations.Methods:A total of 3200 individuals were randomly selected from the residents of Monza (North Italy) to be represent
TL;DR: In many hypertensive patients, treatment is not upgraded despite lack of blood pressure control because of therapeutic inertia as discussed by the authors, however, the extent of this phenomenon is limited, however, this phenomenon in...
Abstract: In many hypertensive patients, treatment is not upgraded despite lack of blood pressure control because of therapeutic inertia. Information is limited, however, on the extent of this phenomenon in ...
TL;DR: Department of Medical and Surgical Sciences, University of Bologna, Italy Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, PoZnan, Poland Department ofHypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland
Abstract: Department of Medical and Surgical Sciences, University of Bologna, Italy Department of Hypertension, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland Department of Hypertension and Internal Medicine, Pomeranian Medical University, Szczecin, Poland First Department of Cardiology, Medical University of Warsaw, Poland Department of Internal Medicine and Cardiology with the Center for Diagnosis and Treatment of Venous Thromboembolism, Medical University of Warsaw, Poland Club 30, Polish Cardiac Society, Poland Heart and Vascular Center, Semmelweis University, Budapest, Hungary First Department of Cardiology, Medical University of Gdansk, Poland Department of Hypertension and Diabetology, Medical University of Gdansk, Poland Università Milano-Bicocca, Milan, Italy
TL;DR: Changes in UACR predicted changes in the risk of major clinical outcomes and mortality in type 2 diabetes, supporting the prognostic utility of monitoring albuminuria change over time.
Abstract: OBJECTIVE To assess the association between 2-year changes in urine albumin–to–creatinine ratio (UACR) and the risk of clinical outcomes in type 2 diabetes. RESEARCH DESIGN AND METHODS We analyzed data from 8,766 participants in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Post-Trial Observational Study (ADVANCE-ON). Change in UACR was calculated from UACR measurements 2 years apart, classified into three groups: decrease in UACR of ≥30%, minor change, and increase in UACR of ≥30%. By analyzing changes from baseline UACR groups, categorized into thirds, we repeated these analyses accounting for regression to the mean (RtM). The primary outcome was the composite of major macrovascular events, renal events, and all-cause mortality; secondary outcomes were these components. Cox regression models were used to estimate hazard ratios (HRs). RESULTS Over a median follow-up of 7.7 years, 2,191 primary outcomes were observed. Increases in UACR over 2 years independently predicted a greater risk of the primary outcome (HR for ≥30% UACR increase vs. minor change: 1.26; 95% CI 1.13–1.41), whereas a decrease in UACR was not significantly associated with lower risk (HR 0.93; 95% CI 0.83–1.04). However, after allowing for RtM, the effect of “real” decrease in UACR on the primary outcome was found to be significant (HR 0.84; 95% CI 0.75–0.94), whereas the estimated effect on an increase was unchanged. CONCLUSIONS Changes in UACR predicted changes in the risk of major clinical outcomes and mortality in type 2 diabetes, supporting the prognostic utility of monitoring albuminuria change over time.
TL;DR: The mechanisms responsible for the increase in blood pressure values in subjects with alteration in sleep quantity and quality, with or without breathing disorders, have been clearly established.
Abstract: To evaluate the relation between sleep alterations, with or without breathing disorders, and incidence of hypertension and other cardiovascular diseases Several studies have clearly shown the mechanisms linking sleep disorders and cardiovascular diseases. The sympathetic hyperactivity seems to play a fundamental role in favoring and sustaining the increase in blood pressure values. Several other mechanisms also contribute to this effect and to the increase cardiovascular risk. The mechanisms responsible for the increase in blood pressure values in subjects with alteration in sleep quantity and quality, with or without breathing disorders, have been clearly established. The recent findings refer to the result of meta-analysis of cross-sectional studies or longitudinal studies showing a significant association between short sleep duration and hypertension. It has also been shown that sleep fragmentation could be considered the main determinant of the sympathetic activation independently of the frequency and severity of oxygen desaturation.
TL;DR: Clinical use of HGI in type 2 diabetes cannot currently be recommended, given the discordant results and uncertain relevance beyond HbA1c.
Abstract: AIMS/HYPOTHESIS: Previous studies have suggested that the haemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications in individuals with type 1 and type 2 diabetes. We investigated whether HGI was a predictor of adverse outcomes of intensive glucose lowering and of diabetes-related complications in general, using data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. METHODS: We studied participants in the ADVANCE trial with data available for baseline HbA1c and fasting plasma glucose (FPG) (n = 11,083). HGI is the difference between observed HbA1c and HbA1c predicted from a simple linear regression of HbA1c on FPG. Using Cox regression, we investigated the association between HGI, both categorised and continuous, and adverse outcomes, considering treatment allocation (intensive or standard glucose control) and compared prediction of HGI and HbA1c. RESULTS: Intensive glucose control lowered mortality risk in individuals with high HGI only (HR 0.74 [95% CI 0.61, 0.91]; p = 0.003), while there was no difference in the effect of intensive treatment on mortality in those with high HbA1c. Irrespective of treatment allocation, every SD increase in HGI was associated with a significant risk increase of 14-17% for macrovascular and microvascular disease and mortality. However, when adjusted for identical covariates, HbA1c was a stronger predictor of these outcomes than HGI. CONCLUSIONS/INTERPRETATION: HGI predicts risk for complications in ADVANCE participants, irrespective of treatment allocation, but no better than HbA1c. Individuals with high HGI have a lower risk for mortality when on intensive treatment. Given the discordant results and uncertain relevance beyond HbA1c, clinical use of HGI in type 2 diabetes cannot currently be recommended.
University of Chicago1, University of Florence2, Gdańsk Medical University3, University of Barcelona4, Peking University5, University of Zagreb6, Paris Descartes University7, University of Milan8, University of Oxford9, University of Padua10, Medical University of Graz11, University of Valencia12, Dongguk University13, CEU Cardinal Herrera University14, National and Kapodistrian University of Athens15, University of Belgrade16, Hospital Italiano de Buenos Aires17, Peking Union Medical College18
TL;DR: The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed.
Abstract: Introduction Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. Methods and analysis MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP Ethics and dissemination MASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal. Trial registration number NCT02804074; Pre-results.
TL;DR: The heterogeneity of the blood pressure-lowering response point to the clinical need to identify predictors for efficacy, and questions on long-term safety could not have been answered due to the short duration of the sham-controlled randomized clinical trials.
Abstract: This ESH update was deemed necessary with the publication of new results of sham-controlled randomized blinded prospective trials with renal denervation (RDN). Proof of concept studies and first randomized trials (some were sham-controlled) displayed discrepant results about the efficacy of RDN. Three sham-controlled randomized trials of the 2.0 generation yielded now similarity in the average blood pressure decrease following RDN. Reduction of ambulatory blood pressure was approximately 5 to 7 mmHg and of office blood pressure 10 mmHg. Such a decrease in blood pressure by pharmacologic therapy has been found to be associated with lower incidence of cardiovascular events in particular with respect to heart failure and stroke by roughly 25%. Nevertheless, some questions about renal denervation are unanswered. The heterogeneity of the blood pressure-lowering response point to the clinical need to identify predictors for efficacy, and questions on long-term safety could not have been answered due to the short duration of the sham-controlled randomized clinical trials.
TL;DR: Higher BMI is an independent predictor of major renal events in patients with type 2 diabetes, and the findings encourage weight loss to improve nephroprotection in these patients.
Abstract: We aimed to evaluate the relationship between BMI and the risk of renal disease in patients with type 2 diabetes in the Action in Diabetes and Vascular Disease: PreterAx and DiamicroN Modified-Release Controlled Evaluation (ADVANCE) study. Participants were divided into six baseline BMI categories: <18.5 (underweight, n = 58); ≥18.5 to <25 (normal, n = 2894); ≥25 to <30 (overweight, n = 4340); ≥30 to <35 (obesity grade 1, n = 2265); ≥35 to <40 (obesity grade 2, n = 744); and ≥40 kg/m2 (obesity grade 3, n = 294); those underweight were excluded. The composite outcome “major renal event” was defined as development of new macroalbuminuria, doubling of creatinine, end stage renal disease, or renal death. These outcomes and development of new microalbuminuria were considered individually as secondary endpoints. During 5-years of follow-up, major renal events occurred in 487 (4.6%) patients. The risk increased with higher BMI. Multivariable-adjusted HRs (95% CIs), compared to normal weight, were: 0.91 (0.72–1.15) for overweight; 1.03 (0.77–1.37) for obesity grade 1; 1.42 (0.98–2.07) for grade 2; and 2.16 (1.34–3.48) for grade 3 (p for trend = 0.006). These findings were similar across subgroups by randomised interventions (intensive versus standard glucose control and perindopril-indapamide versus placebo). Every additional unit of BMI over 25 kg/m2 increased the risk of major renal events by 4 (1–6)%. Comparable results were observed with the risk of secondary endpoints. Higher BMI is an independent predictor of major renal events in patients with type 2 diabetes. Our findings encourage weight loss to improve nephroprotection in these patients.
TL;DR: The accelerated arterial aging in treated hypertensive subjects is in large measure explained by age and BP values.
Abstract: Objective: The role of risk factors on the progression of arterial stiffness has not yet been extensively evaluated. The aim of the current longitudinal study was to evaluate the determinants of th...
TL;DR: A blunted dipping of nocturnal HR is associated with preclinical cardiac damage in terms of left atrial enlargement and is predictive cardiovascular morbidity and mortality in the general population.
Abstract: AIM Studies addressing the association between a reduced drop of heart rate (HR) at night with subclinical organ damage and cardiovascular events in the general population are scanty. We evaluated this issue in individuals enrolled in the Pressioni Monitorate E Loro Associazioni study. METHODS At entry, 2021 individuals underwent diagnostic tests including laboratory investigations, 24-h ambulatory blood pressure (BP) monitoring and echocardiography. Participants were followed from the initial medical visit for a time interval of 148 ± 27 months. To explore the association of circadian HR rhythm and outcomes, participants were classified in the primary analysis according to quartiles of nocturnal HR decrease. In secondary analyses, the population was also classified according nondipping nocturnal HR (defined as a drop in average HR at night lower than 10% compared with day-time values) and next in four categories: first, BP/HR dipper, second, BP/HR nondipper, third, HR dipper/BP nondipper, fourth, HR nondipper/BP dipper). RESULTS A flattened circadian HR rhythm (i.e. lowest quartile of night-time HR dip) was independently associated with left atrial enlargement, but not to left ventricular hypertrophy; moreover, it was predictive of fatal and nonfatal cardiovascular events, independently of several confounders (hazard ratio 1.8, confidence interval: 1.13-2.86, P < 0.01 vs. highest quartile). CONCLUSION A blunted dipping of nocturnal HR is associated with preclinical cardiac damage in terms of left atrial enlargement and is predictive cardiovascular morbidity and mortality in the general population.
TL;DR: The view that MetS is a risk factor for early carotid atherosclerosis in members of the general population, regardless of sex is supported, and the ultrasound search of subclinicalCarotid disease may refine cardiovascular risk stratification and decision-making strategies in MetS individuals.
Abstract: AIM Metabolic syndrome (MetS) is a phenotype of growing prevalence in the general population. Information on the association between MetS and vascular damage in this setting is only based on data provided by single reports. We performed a meta-analysis of population-based studies aimed to assess the association of MetS with carotid atherosclerosis. DESIGN Studies were identified by the following search terms: 'metabolic syndrome', 'general population,' 'carotid intima-media thickness' (IMT), 'carotid atherosclerosis,' 'carotid damage,' 'ultrasonography.' The OVID-MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials databases were searched for English-language articles without time restriction up to 30 September 2016. RESULTS Overall, 34 635 study participants (22.9% with MetS) of both sexes were included in 21 studies (sample size range 182-11 502). Mean common carotid IMT was higher in MetS study participants as compared with their non-MetS counterparts (759 ± 41 vs. 695 ± 27 μm), the standard means difference being 0.39 ± 0.05 (confidence interval: 0.29-0.48, P < 0.0001). This was also the case when pooled data were separately analysed according to sex. Differences in carotid IMT were unaffected by the presence of publication bias or single-study effect. CONCLUSION Our findings support the view that MetS is a risk factor for early carotid atherosclerosis in members of the general population, regardless of sex. From a practical perspective, the ultrasound search of subclinical carotid disease may refine cardiovascular risk stratification and decision-making strategies in MetS individuals.
TL;DR: In this paper, the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, clinical and metabolic variables as well as office, home and ambulatory blood pressure (BP) values were simultaneously measured at baseline and after a 10-year follow-up.
Abstract: Aim In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, clinical and metabolic variables as well as office, home and ambulatory blood pressure (BP) values were simultaneously measured at baseline and after a 10-year follow-up. The study design allowed us to assess the value of selective and combined elevation of different BP phenotypes in predicting new-onset metabolic syndrome (MetS). Methods The present analysis included 1182 participants without MetS at baseline, as defined by the APT III criteria. On the basis of office, 24-h ambulatory BP and home values, participants were divided into four groups: normal, white-coat hypertension (WCH), masked hypertension and sustained hypertension. Results Compared with participants with in-office and out-of-office normal BP, a greater incidence of new-onset age-adjusted and sex-adjusted MetS was observed in WCH (OR = 1.75, CI 1.01-3.04, P = 0.0046), masked hypertension (OR = 2.58, CI 1.26-5.30; P = 0.009) and sustained hypertension (OR = 2.14, CI 1.20-3.79, P = 0.009)) when out-of-office BP was defined by ambulatory criteria. This was not the case when out-of-office BP was defined by home criteria, as only the WCH group showed a greater risk (OR 2.16, CI 1.28-3.63, P = 0.003). Similar findings were obtained for single components of the MetS such as abdominal obesity and hyperglycemia. Conclusion Our study provides evidence that either isolated or combined BP elevations identified by office/ambulatory measurements, carry an increased risk of new-onset MetS, whereas, only WCH is associated with a greater risk of incident MetS whenever BP phenotypes are identified by office/home measurements. In a clinical perspective, a comprehensive evaluation of BP status based on office/ambulatory measurements may improve diagnosis of new-onset MetS and activate measures for its prevention.
TL;DR: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines as discussed by the authors have several important elements of novelty, and some weaknesses, as well as some weaknesses.
Abstract: The 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines1 have several important elements of novelty, and some weaknesses, as well. One strength is that, unlike the most recent US hypertension guidelines (the Joint National Commission 8 guidelines), the ACC/AHA document does not cover only a few items, eg, blood pressure (BP) threshold and target for treatment, but rather it deals with multiple aspects of hypertension diagnosis and treatment that, although unaddressed or nonaddressable by randomized clinical trials, have major importance for clinical practice. Another is that each issue is synthetically and clearly discussed in terms of its scientific evidence (thereby fulfilling the guidelines’ educational role) while still providing simple conclusions and recommendations according to a format that resembles the one used in the European Society of Hypertension/European Society of Cardiology guidelines.2 However, the new guidelines discuss the available evidence in a manner that is more complete than that used by the European and other guidelines, because it includes the level and strength of evidence for a given intervention, separating those which do not provide benefits from those which may cause harm.
The ACC/AHA guidelines take a strong position in favor of 3 major changes in antihypertensive …
TL;DR: A systematic meta-analysis of echocardiographic studies suggests that alterations in cardiac structure and function in pre-HTN subjects are intermediate between normotensive and HTN individuals and suggests that pre- HTN may not be a benign entity.
TL;DR: In those with aortic stenosis, exaggerated blood pressure was strongly related to higher resting blood pressure values, left ventricular mass, and increased arterial stiffness independent of hypertension.
Abstract: Background Exaggerated blood pressure response during exercise predicts future hypertension and cardiovascular events in general population and different patients groups. However, its clinical and ...
TL;DR: RV mechanics is worse in night-time and daytime–night-time hypertension patients than in normotensive controls and isolated daytime hypertensive patients, and a 24-h SBP is independently associated with right heart mechanics.
Abstract: Background We sought to investigate right ventricular (RV) and right atrial mechanics in patients with daytime, night-time and daytime-night-time hypertension. Methods This cross-sectional study included 256 untreated patients who underwent 24-h ambulatory blood pressure monitoring and complete echocardiographic examination including strain analysis. Night-time hypertension was defined as nocturnal SBP at least 120 mmHg and/or DBP at least 70 mmHg and daytime hypertension as SBP at least 135 mmHg and/or DBP at least 85 mmHg. Results RV structure, diastolic function and global longitudinal RV strain in patients with nocturnal hypertension are intermediate between daytime and daytime-night-time hypertension. On the other side, RV systolic and diastolic strain rates referring to the RV free wall are significantly deteriorated in the patients with nocturnal and daytime-night-time hypertension in comparison with normotension and daytime hypertension. Right atrial conduit function is significantly reduced in the patients with nocturnal and day-night-time hypertension comparing with other two groups, whereas right atrial reservoir and pump functions are intermediate between daytime and daytime-night-time hypertension. A 24-h SBP is independently of other clinical and echocardiographic parameters associated with RV and right atrial global strain. Conclusion RV mechanics is worse in night-time and daytime-night-time hypertensive patients than in normotensive controls and isolated daytime hypertensive patients. A 24-h SBP is independently associated with right heart mechanics.
TL;DR: The present meta‐analysis shows that MetS is associated with both ultrasonographic phenotypes of carotid damage, consistent with the view of MetS as a cluster of hemodynamic and nonhemodynamic factors promoting vascular hypertrophy and plaque.
Abstract: We performed a meta-analysis of population studies reporting data on carotid intima-media thickness and plaque in patients with and without metabolic syndrome (MetS) to provide a new piece of information on the relationship of MetS with both phenotypes of vascular damage. The Ovid MEDLINE, PubMed, and Cochrane CENTRAL databases were searched without time restriction up to December 31, 2016. Overall, 19 696 patients (22.2% with MetS) were included in eight studies. Common carotid intima-media thickness was greater in patients with MetS compared with those without it (788 ± 47 μm vs 727 ± 44 μm), with a standard means difference of 0.28 ± 0.06 (P = .00003). Increased intima-media thickness in patients with MetS was paralleled by a higher prevalence of plaques. The present meta-analysis shows that MetS is associated with both ultrasonographic phenotypes of carotid damage. This finding is consistent with the view of MetS as a cluster of hemodynamic and nonhemodynamic factors promoting vascular hypertrophy and plaque.
TL;DR: The evidence for and against a conservative or more aggressive blood pressure target for treated diabetic hypertensive individuals is discussed based on the evidence provided by randomised trials, trial meta-analyses and large observational studies.
Abstract: When associated with high blood pressure, type 2 diabetes mellitus is characterised by a high risk of adverse cardiovascular (CV) and renal outcomes. However, both can be effectively reduced by antihypertensive treatment. Current guidelines on the treatment of hypertension emphasize the need to effectively treat high blood pressure in diabetic individuals, but their recommendations differ in terms of the optimal target blood pressure value to aim for in order to maximise CV and renal protection. In some guidelines the recommended target blood pressure values are <140/90 mmHg (systolic/diastolic), whereas in others, blood pressure values close or even less than 130/80 mmHg are recommended. This paper will discuss the evidence for and against a conservative or more aggressive blood pressure target for treated diabetic hypertensive individuals based on the evidence provided by randomised trials, trial meta-analyses and large observational studies. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90 mmHg, and that values approaching 130/80 mmHg should be recommended. However, evidence in favour of even lower systolic values, i.e. <130 mmHg, is limited and is definitively against a reduction to <120 mmHg.