Author
Giuseppe Mancia
Other affiliations: University of Milan, Instituto Politécnico Nacional, Centra
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.
Papers published on a yearly basis
Papers
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TL;DR: New atrial fibrillation is common in high-risk vascular patients and is associated with several risk factors including history of hypertension, which was the strongest anthropometric predictor.
Abstract: Background: Evidence on new-onset atrial fibrillation inhigh-risk vascular patients without heart failure is limited.New-onset atrial fibrillation was a prespecified secondaryobjective of the Ongoing Telmisartan Alone and inCombination With Ramipril Global Endpoint Trial(ONTARGET)/Telmisartan Randomized AssessmeNt Study inACE iNtolerant subjects with cardiovascular Disease(TRANSCEND) studies.Methods: We studied 30424 ONTARGET/TRANSCENDpatients (mean age SD, 66.4 7.0) with vascular diseaseor complicated diabetes who were in sinus rhythm atentry. A copy of ECG was sent to central office every timenew atrial fibrillation was detected by investigators.Results: During a median follow-up period of 4.7 years,new atrial fibrillation occurred in 2092 patients (15.1 per1000patient-years). Risk of atrial fibrillation increased withage, SBP and pulse pressure, left ventricular hypertrophy,BMI, serum creatinine and history of hypertension,coronary artery disease and cerebrovascular disease (allP<0.01). After adjustment for BMI and other variables,atrial fibrillation risk increased with hip circumference.History of hypertension was associated with a 34% higherrisk of new atrial fibrillation. New atrial fibrillationportended an increased risk of congestive heart failure[hazard ratio 2.89, 95% confidence interval (CI) 2.45–3.40, P<0.01] and cardiovascular death (hazard ratio1.22, 95% CI 1.05–1.41, P<0.01). Risk of stroke wasunaffected (hazard ratio 1.14, 95% CI 0.93–1.40),whereas that of myocardial infarction was reduced (hazardratio 0.64, 95% CI 0.50–0.82). Patients with new atrialfibrillation were more likely to receive vitamin Kantagonists (P<0.01), statins (P<0.05) and b-blockers(P<0.01) than those in sinus rhythm.Conclusion: New atrial fibrillation is common in high-riskvascular patients and is associated with several risk factorsincluding history of hypertension. Hip circumference wasthe strongest anthropometric predictor. Despite extensiveuse of modern therapies, new atrial fibrillation carries ahigh risk of congestive heart failure and death over arelatively short term.Keywords: angiotensin-converting enzyme inhibitors,angiotensin receptor blockers, atrial fibrillation,hypertension, left ventricular hypertrophy, obesity, ramipril,telmisartan
58 citations
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TL;DR: Optimal blood pressure control may have to include the measurement of blood pressure every day, given the fluctuations ofBlood pressure and their prognostic importance independent of and in addition to that of classically measured blood pressure values.
Abstract: Hypertension has not always been recognized as a harbinger of cardiovascular complications and premature death. Only 70 years ago, hypertension was considered the body's adaptation to sclerotic blood vessel disease and essential to maintain organ perfusion; thus, treatment was regarded as undesirable. Epidemiologic studies have since established a strong linear relation between blood pressure and cardiovascular disease (CVD), and randomized trials have documented that blood pressure reductions by antihypertensive drugs confer cardiovascular protection, making the hypertension-related risk a reversible risk. There is now a consensus that blood pressure should be reduced to <140/90 mm Hg in all patients and that a more aggressive blood pressure target (<130/80 mm Hg) should be pursued in those in whom the cardiovascular risk is high. Despite this, blood pressure control remains elusive in most individuals in the hypertensive population, which makes improvement of blood pressure control in this population a priority goal. This goal may meet with new challenges, however. Optimal blood pressure control may have to include the measurement of blood pressure every day, given the fluctuations of blood pressure and their prognostic importance independent of and in addition to that of classically measured blood pressure values.
58 citations
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TL;DR: The aim of this article is to provide the community of cardiology with an update on appropriate and justified use of non-invasive imaging tests in the growing population of hypertensive patients.
Abstract: Arterial hypertension (HTN) accounts for the largest amount of attributable cardiovascular (CV) mortality worldwide, and risk stratification in hypertensive patients is of crucial importance to manage treatment and prevent adverse events. Asymptomatic involvement of different organs in patients affected by HTN represents an independent determinant of CV risk and the identification of target organ damage (TOD) is recommended to further reclassify patients' risk. Non-invasive CV imaging is progressively being used and continues to provide new technological opportunities to TOD evaluation at early stage. The aim of this article is to provide the community of cardiology with an update on appropriate and justified use of non-invasive imaging tests in the growing population of hypertensive patients.
58 citations
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TL;DR: In this paper, the effects of a fixed combination of perindopril and indapamide in combination with calcium channel blockers (CCBs) in patients with type 2 diabetes mellitus were determined.
Abstract: The objective of the present analysis was to determine the effects of a fixed combination of perindopril and indapamide in combination with calcium channel blockers (CCBs) in patients with type 2 diabetes mellitus. The Action in Diabetes and Vascular Disease: Preterax and Diamicron Controlled Evaluation (ADVANCE) trial was a factorial randomized controlled trial. A total of 11 140 patients with type 2 diabetes mellitus were randomly assigned to fixed combination of perindopril–indapamide (4/1.25 mg) or placebo. Effects of randomized treatment on mortality and major cardiovascular outcomes were examined in subgroups defined by baseline use of CCBs. Patients on CCB at baseline (n=3427) constituted a higher risk group compared with those not on CCB (n=7713), with more extensive use of antihypertensive and other protective therapies. Active treatment reduced the relative risk of death by 28% (95% confidence interval, 10%–43%) among patients with CCB at baseline compared with 5% (−12% to 20%) among those without CCB ( P homogeneity=0.02) and 14% (2%–25%) for the whole population. Similarly, the relative risk reduction for major cardiovascular events was 12% (−8% to 28%) versus 6% (−10% to 19%) for those with and without CCB at baseline although the difference was not statistically significant ( P homogeneity=0.38). There was no detectable increase in adverse effects in those receiving CCB. The combination of perindopril and indapamide with CCBs seems to provide further protection against mortality in patients with type 2 diabetes mellitus.
58 citations
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TL;DR: Multiple blood pressure readings obtained semi-automatically in the outpatient clinics increase blood pressure reproducibility and make the value similar to that obtained by ambulatory blood pressure monitoring.
Abstract: Objective To evaluate whether increasing the number of blood pressure readings obtained in the clinic environment increases the blood pressure reproducibility. Patients Thirteen mild essential hypertensive patients studied in the outpatient clinics, following withdrawal of antihypertensive treatment for 4 weeks. Methods The systolic and diastolic blood pressures were measured three times, using a mercury sphygmomanometer, with the patient in the sitting position. Measurements were then performed with the patient in the lying position using an oscillometric device (SpaceLabs 90202 or 90207). The device was operated semi-automatically at 3-min intervals until 25 readings had been collected. The same procedure was repeated 4 weeks later. The systolic blood pressure, diastolic blood pressure and heart rate were averaged by considering a progressively greater number of readings, from 1 to 25. The reciprocal of the standard deviation (1/SD) of the mean difference after 4 weeks was taken as the measure of reproducibility. Results 1/SD increased progressively as the number of semi-automatic blood pressure readings from which the average was calculated increased. For a similar number of blood pressure readings the reproducibility was similar for semi-automatic readings to that for automatic readings obtained by 24-h ambulatory blood pressure monitoring. Conclusion Multiple blood pressure readings obtained semi-automatically in the outpatient clinics increase blood pressure reproducibility and make the value similar to that obtained by ambulatory blood pressure monitoring. The advantage of an increase in reproducibility for studies on antihypertensive drugs thus depends on the number of readings, and can also be obtained by semi-automatic measurements in the clinic environment.
58 citations
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28,685 citations
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23 Sep 2019TL;DR: 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.
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.
21,235 citations
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TL;DR: In those older than age 50, systolic blood pressure of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP, and hypertension will be controlled only if patients are motivated to stay on their treatment plan.
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.
14,975 citations
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TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
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 …
14,173 citations
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TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
13,400 citations