Giuseppe Mancia

Bio: Giuseppe Mancia is an academic researcher from University of Milano-Bicocca. The author has contributed to research in topics: Blood pressure & Ambulatory blood pressure. The author has an hindex of 145, co-authored 1369 publications receiving 139692 citations. Previous affiliations of Giuseppe Mancia include University of Milan & Instituto Politécnico Nacional.

Reflex control of circulation in the elderly

Abstract: Baroreceptor control of heart rate is markedly reduced in elderly subjects. However, the effects of aging on baroreceptor control of blood pressure and on the vascular and neurohumoral influences of volume cardiopulmonary receptors are unknown. In this paper we report evidence that in both conscious rats and humans aging is associated with a fall in the baroreceptor ability to rapidly cause blood pressure changes, but that the more long-term carotid baroreceptor control of blood pressure remains similar to that observed in younger individuals. Early and late cardiopulmonary receptor modulation of vascular resistance is impaired by aging, which also reduces the influence of this reflex on renin secretion. These dynamic and steady-state alterations in reflex cardiovascular control account for several hemodynamic abnormalities of the advanced age.

Early and late sympathetic activation in hypertension

Abstract: In several experimental animal models of hypertension, sympathetic factors have been shown to be involved in the development and/or maintenance of high blood pressure. Although the information available on this issue in man is more scarce, recent evidence clearly indicates the participation of adrenergic mechanisms in the early and late phases of the hypertensive process. In addition, several cardiovascular risk factors frequently associated with hypertension, such as obesity, insulin-resistance, cigarette smoking, and the atherogenic process, are also characterized by alterations in sympathetic cardiovascular drive. This contributes to a further activation of the sympathetic nervous system thus favoring the development of the end organ damage (e.g. cardiac and vascular hypertrophy) associated with the hypertensive state.

Masked hypertension and echocardiographic left ventricular hypertrophy: an updated overview.

Abstract: Masked hypertension (MH) is an emerging clinical entity predisposing to subclinical organ damage and to increased cardiovascular risk. We sought to review the recent literature focusing on the association between MH and echocardiographic left ventricular hypertrophy (LVH). A MEDLINE search was performed in order to identify relevant papers using the key words such as 'masked hypertension', 'ambulatory hypertension', 'left ventricular hypertrophy', 'cardiac damage', 'target organ damage', 'left ventricular dysfunction'. Full articles published in English language in the last decade, namely from 1 December 1999 to 31 July 2011, reporting studies in adult or elderly individuals, were considered. Checks of the reference lists of selected papers complemented the electronic search. A total of 13 studies, including 966 patients with MH (sample size range 17-222 patients, mean age range 30-70 years; men 71%) and 2640 controls with sustained normotension, controlled hypertension, and white coat hypertension were considered. The prevalence of LVH, defined according to six criteria, ranged from 7 to 66% in MH and from 0.4 to 42% in non-MH counterparts (average 29 vs. 9%, P<0.01). In conclusion, available evidence linking a selective blood pressure elevation outside office to echocardiographic LVH in clinically normotensive individuals is supported by limited evidence. Further studies are needed to expand our knowledge in this area and to explore the beneficial effects of antihypertensive treatment on subclinical cardiac damage in patients with MH.

Vascular aging: shifting the paradigm of risk assessment and reduction in hypertension.

Abstract: The words above by Jonathan Swift could be used to summarize the focus of this supplement, since they apply to many modern attitudes towards the aging process. Although as a population we are living increasingly longer, as individuals we do not desire the common comorbidities that old age brings. Aging is often associated with hypertension and related cardiovascular disease (CVD) states, since these conditions tend to occur more frequently in older patients. Although many antihypertensive treatments have been proven effective in clinical practice, there remains a high residual risk of morbidity and mortality, so we can hypothesize that these treatments do not change the natural history of CVD. There are several possible reasons for this residual risk; for example, treatment may be initiated too late when sub-clinical organ damage is already well advanced and largely irreversible. Therefore, a need exists for sensitive and specific markers of subclinical organ damage, which can identify when organ damage appears, show how it progresses and guide appropriate therapy. It has been known for some time that vascular changes occur with aging, but we have only recently begun to develop the concept of vascular aging as a potential therapeutic target. Over 15 years ago, results from the crosssectional Third National Health and Nutrition Examination Survey (1988–1991) of 9901 US citizens demonstrated a general tendency for SBP to increase progressively with age in both men and women throughout adult life. However, DBP was shown to increase more gradually from early adulthood until the end of the fifth decade, then plateau and begin to decrease from the sixth decade onwards. Therefore pulse pressure, a measurement of the difference between SBP and DBP, becomes increasingly wider with advancing age beyond 60 years [1]. In the absence of disturbed ventricular ejection, such increases in pulse pressure indicate a progressive increase in arterial stiffness, a process central to vascular aging. In healthy young individuals, the natural elasticity of the aorta buffers large changes in pulse pressure due to ventricular ejection, ensuring that vital organs do not receive damaging high pulsatile blood flow. As arteries stiffen with age, they are no longer able to buffer these pressure changes. Such vascular aging can increase cardiovascular risk by causing systolic hypertension, which can lead to heart failure and

Obstructive sleep apnea and cardiac mechanics: how strain could help us?

Abstract: Obstructive sleep apnea (OSA) syndrome is the most common sleep-breathing disorder, which is associated with increase cardiovascular morbidity and mortality. OSA increases risk of resistant arterial hypertension, coronary artery disease, heart failure, pulmonary hypertension, and stroke. Studies showed the significant relationship between OSA and cardiac remodeling. The majority of investigations were focused on the left ventricle and its hypertrophy and function. Fewer studies investigated right ventricular structure and function revealing deteriorated diastolic and systolic function. Data regarding left and right ventricular mechanics in OSA patients are scarce and controversial. The results of the studies that were focused on the influence of continuous positive airway pressure and weight reduction on cardiac remodeling revealed favorable effect on left and right ventricular structure and function. Recently published analyses confirmed positive effect of treatment on cardiac mechanics. Deterioration of left and right ventricular mechanics occurs before functional and structural cardiac impairments in the cascade of cardiac remodeling and therefore the assessment of left and right ventricular strain may represent a cornerstone in detection of subtle cardiac changes that develop significantly before other, often irreversible, alterations. Considering the fact that left and right ventricular strains have important predictive value in wide range of cardiovascular diseases, one should consider the evaluation of left and right ventricular strains in the routine echocardiographic assessment at all stages of disease-from diagnosis, during follow-up and evaluation of therapeutic effects. The main aim of this review is to provide the current overview of cardiac mechanics in OSA patients before and after (during) therapy, as well as mechanisms that could be responsible for cardiac changes.

Cochrane Handbook for Systematic Reviews of Interventions

Abstract: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

Abstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount.

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …