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1.
Eur Heart J Suppl ; 22(Suppl H): H70-H73, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32884475

RESUMO

Cardiovascular (CV) diseases are burdened by high mortality and morbidity, being responsible for half of the deaths in Europe. Although hypertension is recognized as the most important CV risk factor, hypertension awareness and blood pressure (BP) control are still unsatisfactory. In 2017, 30.6% of a >10 000 individual sample who took part in the May Measurement Month (MMM) campaign in Italy was found to have high BP. To raise awareness on the hypertension issue and to report BP data on a nation-wide scale in Italy. In the frame of the MMM campaign, an opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2018. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screenings were conducted in multiple sites by health care personnel. Among the 5554 people screened (females: 48.3%, mean age 58 ± 17 years) mean BP was 127/77 mmHg, and after imputations, 1462 (26.3%) participants were found to have high BP levels. Body mass index >25 was associated with higher systolic BP and diastolic BP (DBP), while diabetes was associated with high DBP only. Our data provide a nation-wide snapshot of BP control in a sample of individuals participating in a national health care campaign, and confirm the power of this kind of healthcare-related activities in reaching a significant number of people to raise awareness on health topics. The apparent positive trend in BP control compared to available data from other similar campaigns carried out during the past years needs to be confirmed with more methodologically robust studies.

2.
Vasc Med ; 24(2): 164-189, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30648921

RESUMO

This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD), which was commissioned by the working group 'Hypertension and the Kidney' of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.


Assuntos
Angiografia/normas , Angioplastia/normas , Fármacos Cardiovasculares/uso terapêutico , Displasia Fibromuscular/diagnóstico por imagem , Displasia Fibromuscular/terapia , Angioplastia/efeitos adversos , Fármacos Cardiovasculares/efeitos adversos , Tomada de Decisão Clínica , Consenso , Displasia Fibromuscular/epidemiologia , Predisposição Genética para Doença , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento
3.
Eur Heart J ; 32(21): 2642-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21606079

RESUMO

AIMS: Renin is the key regulator of the renin-angiotensin-aldosterone system. Previous studies have reported conflicting results on the relation of plasma renin with fatal cardiovascular events. This study in a large cohort of patients sought to evaluate the association between plasma renin concentration (PRC) and cardiovascular mortality after long-term follow-up of almost 10 years. METHODS AND RESULTS: Plasma renin concentration [median: 11.4 (6.0-24.6) pg/mL] was measured in 3303 patients (mean age: 62.7 ± 10.6 years; 30.3% women) referred to coronary angiography. After a median follow-up of 9.9 years, 554 participants (16.8%) with PRC measurement at baseline had died due to fatal cardiovascular events. Multivariable-adjusted Cox analysis revealed that when compared with participants in the lowest PRC quartile, those in the highest quartile were at increased risk of cardiovascular mortality (hazard ratio: 1.79, 95% CI 1.28-2.48). Analyses of specific causes of cardiovascular death showed that for each standard deviation increase in log-PRC there was a 22% (P = 0.006) increase in risk of sudden cardiac death and a 23% (P = 0.033) greater risk of death due to heart failure. The association of PRC with cardiovascular mortality remained stable after adjustment for established cardiovascular risk factors, ongoing antihypertensive medication, immunoreactive angiotensin II, and aldosterone levels. Age, N-terminal pro-B-type natriuretic peptide levels, coronary artery disease, the use of angiotensin-converting enzyme-inhibitors, beta-blockers, diuretics, and kidney function were important effect modifiers. CONCLUSIONS: Plasma renin concentration is associated with long-term cardiovascular mortality in patients referred to coronary angiography. Further intervention studies should determine whether renin is a potential therapeutic target or only a marker of mortality risk in various cardiovascular risk groups.


Assuntos
Doenças Cardiovasculares/mortalidade , Renina/metabolismo , Idoso , Biomarcadores/metabolismo , Doenças Cardiovasculares/sangue , Morte Súbita Cardíaca/epidemiologia , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
4.
J Hypertens ; 40(10): 1902-1908, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35983863

RESUMO

OBJECTIVE: Percutaneous transluminal renal angioplasty (PTRA), the recommended treatment in children with renovascular hypertension (RVH), often has unsatisfactory outcomes. Cutting balloons may improve the results of angioplasty in different vascular beds with complex and resistant lesions. We retrospectively analysed the effects of percutaneous cutting balloon angioplasty (PCBA) on blood pressure, cardiac mass and renal artery acceleration time in children/adolescents referred to our centre for RVH. PATIENTS AND METHODS: Thirteen patients (aged 9-19 years) with renal artery stenosis (RAS) and severe hypertension were identified. RASs were focal fibromuscular (FMD) or FMD-like dysplasia (in six cases bilateral, in five associated with mid aortic syndrome). Ten patients had uncontrolled hypertension, in nine cases associated with left ventricular hypertrophy (LVH). Acceleration time was abnormal in all stenotic arteries. Eighteen PCBA were performed, in three arteries associated with stent implantation. RESULTS: PCBA was technically successful in all individuals without major complications. In one patient, an intra-stent restenosis occurred, successfully redilated with conventional angioplasty without recurrence at 4 years distance. One year after PCBA, mean SBP and DBPs were markedly reduced from 146 ±â€Š25 to 121 ±â€Š10 mmHg and from 87 ±â€Š11 to 65 ±â€Š12 mmHg, respectively ( P  < 0.001 for both). At that time, hypertension was cured in seven children and controlled in five individuals. This favourable outcome was confirmed with ambulatory blood pressure measurement in four patients. At the latest follow-up, left ventricular mass and acceleration time were normal in all patients. CONCLUSION: PCBA proved to be a well tolerated and effective procedure that can be considered as an alternative to PTRA to treat hypertensive children/adolescents with recurrent or resistant RAS.


Assuntos
Angioplastia com Balão , Hipertensão Renovascular , Hipertensão , Obstrução da Artéria Renal , Adolescente , Angioplastia/efeitos adversos , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/métodos , Monitorização Ambulatorial da Pressão Arterial , Criança , Humanos , Hipertensão/complicações , Hipertensão Renovascular/etiologia , Hipertensão Renovascular/terapia , Artéria Renal , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/cirurgia , Estudos Retrospectivos
5.
Blood Press ; 20(1): 3-9, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20825358

RESUMO

BACKGROUND AND AIM: The prevalence of left ventricular hypertrophy (LVH) in human hypertension has been mostly documented in population-based samples and selected hypertensive cohorts. Rather scant data are available from clinical practice. Thus, we examined the prevalence of LVH in a large group of hypertensive patients referred by general practitioners to a routine echocardiographic examination. METHODS: A total of 2249 hypertensive subjects (mean age 62 years, 52.3% men, 84.5% treated) referred by their practitioners to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive early cardiac damage were included in the study. LVH was defined as left ventricular mass (A) ≥ 225/163 g, (B) ≥ 116/96 g/m(2), (C) ≥ 49/45 g/m(2.7) in men/women, respectively; LVH was graded as mild, moderate and severe according to Lang's report. RESULTS: Overall, patients with LVH were 58%, 58% and 65% by criteria A, B and C, respectively. LVH was mild in 33% (A), 36% (B) and 29% (C), moderate in 31% (A), 28% (B) and 27% (C), and severe in 36% (A), 36% (B) and 44% (C). CONCLUSIONS: Data provided by this multicentre nationwide survey support the view that, despite therapeutic interventions, LVH remains a highly frequent phenotype in human hypertension and that severe LVH is present in a large fraction of hypertensives.


Assuntos
Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Pressão Sanguínea , Estudos Transversais , Ecocardiografia , Feminino , Clínicos Gerais , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença
6.
Blood Press ; 20(5): 267-73, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21388253

RESUMO

BACKGROUND AND AIM: Aortic root dilatation (ARD) is a cardiovascular phenotype of adverse prognostic value; its prevalence has been mostly investigated in population-based samples and selected hypertensive cohorts. Data from clinical practice are rather scant. Thus, we examined the prevalence and correlates of ARD in a large sample of hypertensive patients referred by general practitioners for a routine echocardiographic examination. METHODS: A total of 2229 untreated and treated hypertensive subjects (mean age 62 years) referred to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive subclinical cardiac damage were included in the study. ARD was defined by aortic diameter exceeding 3.7 cm in women and 3.9 cm in men. RESULTS: ARD was found in 263 patients, with an overall prevalence of 11.8% (16.9% in men and 6.2% in women, p < 0.05). In multivariate regression analyses, body surface area (BSA), left ventricular (LV) mass and age were in ranking order the most important correlates of aortic root size in the whole population study as well as in men. In women, LV mass and its derivative indexes were the most important independent variables associated to aortic root size. CONCLUSIONS: This multicenter nationwide survey indicates that ARD is a frequent cardiovascular phenotype in hypertensives referred to echo-labs for detection of hypertensive organ damage. BSA, LV mass and age are the most important correlates of this phenotype. The hierarchical order of these factors differs between genders, LV mass being the strongest independent variable in women.


Assuntos
Aorta/patologia , Dilatação Patológica/diagnóstico por imagem , Ecocardiografia , Hipertensão , Hipertrofia Ventricular Esquerda/fisiopatologia , Adulto , Fatores Etários , Idoso , Aorta/diagnóstico por imagem , Pressão Sanguínea , Superfície Corporal , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
7.
Clin Exp Hypertens ; 33(5): 328-35, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21649531

RESUMO

Prevalence of left atrial enlargement (LAE) in hypertension has been mostly assessed in population-based samples and selected hypertensive groups. A few data are available in clinical practice. We examined LAE prevalence and severity in a cohort of hypertensive patients referred by general practitioners to a routine echocardiographic examination. A total of 2170 hypertensive individuals (mean age 62 years, 53% men) referred by practitioners to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive cardiac disease were included in the study. LAE was defined as: A) absolute LA diameter >4.0 cm in men and >3.8 cm in women; B) LA diameter normalized to body surface area (BSA) >2.3 cm/m(2) in both sexes. Left atrial enlargement was graded as mild, moderate, and severe according to Lang's report. Patients with LAE were 38% by criterion A, and 20% by criterion B. A moderate/severe increase in LA size was present in 34% (A) and 32% (B) of patients with LAE. Severe LAE was 3.3-fold (A) and 2.6-fold (B) more frequent in women than in men. Left ventricular mass was the strongest correlate of absolute LA diameter as well as of normalized LA diameter, after age. Left atrial enlargement defined either by absolute or normalized LA diameter is a frequent cardiac phenotype in hypertensive patients referred to echo-labs in clinical practice. This cardiac parameter is closely related to LV mass and its severity is highly prevalent in women.


Assuntos
Cardiomegalia/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Idoso , Cardiomegalia/epidemiologia , Cardiomegalia/etiologia , Ecocardiografia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/patologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
8.
Clin Exp Hypertens ; 33(3): 192-201, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21446894

RESUMO

We examined the difference between self-reported and measured body size values and their impact on detection of left ventricular hypertrophy (LVH) by echocardiographic LV mass indexation. A total of 1963 subjects referred by their practitioners for routine echocardiographic examination to nine outpatient echocardiographic laboratories across Italy were included in the study. Left ventricular hypertrophy was defined according to two gender- specific criteria as: A) Left ventricular mass (LVM) index ≥49 g/h(2.7) in men and ≥45 g/h(2.7) in women; B) LVM index ≥125 g/m(2) in men and ≥110 g/m(2) in women. Prevalence of LVH was calculated by indexing LVM to both self-reported and measured anthropometric values. In the whole population, LVH tended to be underestimated by self-reported values by 5.4% according to criterion A (48.5% vs. 53.9%, p < 0.001) and by 1.2% according to criterion B (29.6% vs. 30.8%, p < 0.01); similar findings were observed in the hypertensive subgroup encompassing one-half of the sample. Underestimation of LVH was more pronounced in older patients than in younger patients: 8.6% vs. 3.2% (p < 0.001) by criterion A, 3.1% vs. 0.1% (p < 0.001) by criterion B, in women than in men (8.6% vs. 3.3% (p < 0.001) by criterion A and 1.8% vs. 0.5% (p < 0.01) by criterion B. In a sample of outpatients attending echocardiographic laboratories, LVH is misclassified when left ventricular mass is normalized to self-reported weight and height. The error is related to the clinical characteristics of patients and is more pronounced when LVM is normalized to height(2.7).


Assuntos
Estatura , Peso Corporal , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Autorrelato , Adulto , Fatores Etários , Idoso , Feminino , Ventrículos do Coração/patologia , Humanos , Hipertrofia Ventricular Esquerda/patologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Prevalência , Fatores Sexuais , Ultrassonografia
9.
J Nephrol ; 23(1): 55-61, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20091487

RESUMO

BACKGROUND: On the basis of cardiovascular compliance, hemodialysis (HD) patients can be classified as hypotension prone (HP) or hypotension resistant (HR). METHODS: We compare the hemodynamic behavior and myocardial performances in 6 HP and 6 HR patients before and after an isolated ultrafiltration (IU) session removing 3% of total body water. RESULTS: HP show higher basal plasma angiotensin II levels during IU (p<0.01), whereas angiotensin II remained unchanged in HR patients (p<0.001 between groups). The percentage changes of plasma volume (PV) was similar in the 2 groups. A significant reduction of cardiac index was observed only in the HP group (p<0.001 between groups). The mean values of heart rate remained significantly higher, whereas total peripheral resistances significantly fell in the HP in comparison with the HR group (p<0.001 between groups). During IU, the mean arterial pressure (MAP) changes were -10 +/- 3 mm Hg in the HP vs. -3.3 +/- 2 mm Hg in the HR group (p<0.001). Echocardiography data were collected before and after IU. All enrolled patients presented left ventricular hypertrophy; following IU, HP patients showed a reduction of mean left ventricular diameter (p<0.01), left atrial diameters and right atrial diameter, and a change in percentage of right atrium ejection fraction (p<0.001, p<0.01). CONCLUSIONS: In comparison with HR patients, HP patients before and after IU showed a defective arteriovenous tone adjustment to the PV changes, with a hemodynamic picture of abnormal sympathetic stimulation. Moreover, a reduced cardiac preload with both atrial and ventricular underfilling in these patients is at risk for a sudden drop in MAP.


Assuntos
Pressão Sanguínea/fisiologia , Fenômenos Fisiológicos Cardiovasculares , Deslocamentos de Líquidos Corporais/fisiologia , Glomerulonefrite/terapia , Síndrome Hemolítico-Urêmica/terapia , Pielonefrite/terapia , Diálise Renal , Feminino , Glomerulonefrite/fisiopatologia , Coração/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Hemodinâmica/fisiologia , Síndrome Hemolítico-Urêmica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/fisiopatologia , Ultrassonografia , Vasodilatação/fisiologia
10.
J Hypertens ; 38(10): 1919-1928, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32890264

RESUMO

: Autonomous aldosterone overproduction represents the underlying condition of 5-10% of patients with arterial hypertension and carries a significant burden of mortality and morbidity. The diagnostic algorithm for primary aldosteronism is sequentially based on hormonal tests (screening and confirmation tests), followed by lateralization studies (adrenal CT scanning and adrenal venous sampling) to distinguish between unilateral and bilateral disease. Despite the recommendations of the Endocrine Society guideline, primary aldosteronism is largely underdiagnosed and undertreated with high between-centre heterogeneity. Experts from the European Society of Hypertension have critically reviewed the available literature and prepared a consensus document constituting two articles to summarize current knowledge on the epidemiology, diagnosis, treatment, and complications of primary aldosteronism.


Assuntos
Hiperaldosteronismo , Aldosterona/sangue , Consenso , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/genética , Hipertensão , Prevalência
11.
Int J Cardiol Hypertens ; 5: 100029, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33447758

RESUMO

BACKGROUND AND AIM: Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism. METHODS: To identify the most relevant studies, the authors utilized a systematic literature review in international databases by applying the PICO strategy, and then they were required to make use of only those meeting predefined quality criteria. For studies of diagnostic tests, only those that fulfilled the Standards for Reporting of Diagnostic Accuracy recommendations were considered. RESULTS: Each section was jointly prepared by at least two co-authors, who provided Class of Recommendation and Level of Evidence following the American Heart Association methodology. The guidelines were sponsored by the Italian Society of Arterial Hypertension and underwent two rounds of revision, eventually reexamined by an External Committee. They were presented and thoroughly discussed in two face-to-face meetings with all co-authors and then presented on occasion of the 36th Italian Society of Arterial Hypertension meeting in order to gather further feedbacks by all members. The text amended according to these feedbacks was subjected to a further peer review. CONCLUSIONS: After this process, substantial updated information was generated, which could simplify the diagnosis of primary aldosteronism and assist practicing physicians in optimizing treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.

12.
Clin Chem ; 55(5): 867-77, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19264850

RESUMO

BACKGROUND: Measurement of plasma renin is important for the clinical assessment of hypertensive patients. The most common methods for measuring plasma renin are the plasma renin activity (PRA) assay and the renin immunoassay. The clinical application of renin inhibitor therapy has thrown into focus the differences in information provided by activity assays and immunoassays for renin and prorenin measurement and has drawn attention to the need for precautions to ensure their accurate measurement. CONTENT: Renin activity assays and immunoassays provide related but different information. Whereas activity assays measure only active renin, immunoassays measure both active and inhibited renin. Particular care must be taken in the collection and processing of blood samples and in the performance of these assays to avoid errors in renin measurement. Both activity assays and immunoassays are susceptible to renin overestimation due to prorenin activation. In addition, activity assays performed with peptidase inhibitors may overestimate the degree of inhibition of PRA by renin inhibitor therapy. Moreover, immunoassays may overestimate the reactive increase in plasma renin concentration in response to renin inhibitor therapy, owing to the inhibitor promoting conversion of prorenin to an open conformation that is recognized by renin immunoassays. CONCLUSIONS: The successful application of renin assays to patient care requires that the clinician and the clinical chemist understand the information provided by these assays and of the precautions necessary to ensure their accuracy.


Assuntos
Imunoensaio/métodos , Renina/sangue , Humanos , Hipertensão/sangue , Hipertensão/diagnóstico
13.
J Hypertens ; 37(2): 229-252, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30640867

RESUMO

This article is a comprehensive document on the diagnosis and management of fibromuscular dysplasia (FMD) which was commissioned by the Working Group 'Hypertension and the Kidney' of the European Society of Hypertension (ESH) and the Society for Vascular Medicine (SVM). This document updates previous consensus documents/scientific statements on FMD published in 2014 with full harmonization of the position of European and US experts. In addition to practical consensus-based clinical recommendations, including a consensus protocol for catheter-based angiography and percutaneous angioplasty for renal FMD, the document also includes the first analysis of the European/International FMD Registry and provides updated data from the US Registry for FMD. Finally, it provides insights on ongoing research programs and proposes future research directions for understanding this multifaceted arterial disease.


Assuntos
Displasia Fibromuscular/terapia , Sistema de Registros , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/etiologia , Dissecção Aórtica/terapia , Angiografia , Angioplastia , Diagnóstico Diferencial , Gerenciamento Clínico , Displasia Fibromuscular/diagnóstico por imagem , Displasia Fibromuscular/etiologia , Humanos , Hipertensão
14.
J Hypertens ; 26(9): 1801-8, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18698215

RESUMO

BACKGROUND AND PURPOSE: Hypertension is known to be highly prevalent among patients with diabetes and associated with an increased risk of cardiovascular damage. In contrast, relatively few investigations have addressed the prevalence of diabetes among patients with hypertension. The purpose of the present study was to examine the prevalence of type 2 diabetes, the effectiveness of hypertension and diabetes control and the association with other cardiovascular risk factors and previous cardiovascular diseases in a cohort of patients with hypertension referred to 30 hospital outpatient clinics for the treatment of hypertension. METHODS AND PATIENTS: Patients were considered as having diabetes if they were already on an antidiabetic treatment either with diet or medications. All other patients had fasting plasma glucose measured on two separate occasions and were classified as having diabetes if both values were at least 140 mg/dl (7.8 mmol/l) and as not having diabetes if both values were less than 110 mg/dl (6.1 mmol/l). In patients with a single determination of at least 110 mg/dl, the final diagnosis of diabetes was established according to the result of an oral glucose tolerance test. A secondary definition of diabetes was also used, that is two fasting plasma glucose values of at least 126 mg/dl (7.0 mmol/l). In all patients, serum total, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, fasting serum triglycerides, serum creatinine and urinary albumin were also evaluated. RESULTS AND CONCLUSION: Among the 1397 recruited patients, 242 (17.3%) were diagnosed as having diabetes according to the primary definition and 244 (17.5%) according to the secondary definition. In 195 out of the 242 (14%), the diagnosis was already known whereas, in the remaining 47 (3.3%), it was made de novo. In 61.4% of those already having diabetes, plasma glucose was at least 140 mg/dl (7.8 mmol/l), whereas only in 8.4% of them was it less than 110 mg/dl (6.1 mmol/l). Patients with diabetes were older, heavier and with a greater familiar predisposition. Patients with diabetes had higher values of systolic blood pressure than individuals without diabetes (150 +/- 17 vs. 144 +/- 16 mmHg, respectively; P < 0.001), lower high-density lipoprotein cholesterol and higher triglycerides and microalbuminuria. Overall, among patients with hypertension and diabetes, only 3% had blood pressure and HbA1c within the recommended limits. The prevalence of previous cardiovascular disorders was two to three times higher than among individuals without diabetes.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Glicemia , Pressão Sanguínea , Estudos de Coortes , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Teste de Tolerância a Glucose , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
15.
Eur J Intern Med ; 50: 6-11, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29287767

RESUMO

Resistant hypertension (RH) can be diagnosed if blood pressure (BP) is not controlled with the combination of three antihypertensive drugs, including a diuretic, all at effective doses. Patients affected by this condition exhibit a marked increase in the risk of cardiovascular and renal morbid and fatal events. They also exhibit an increased activity of the sympathetic nervous system which is likely to importantly contribute at the renal and other vascular levels to the hypertensive state. Almost 10years ago renal denervation (RDN) by radiofrequency thermal energy delivery to the walls of the renal arteries was proposed for the treatment of RH. Several uncontrolled studies initially reported that this procedure substantially reduced the elevated BP values but this conclusion has not been supported by a recent randomized control trial, which has almost marginalized this therapeutic approach. A revival, however, is under way because of recent positive findings and technical improvement that hold promise to make renal denervation more complete. The antihypertensive efficacy and overall validity of RDN will have to be tested against drug treatment of RH. Several studies indicate that an excess of aldosterone production contributes to RH and recent evidence documents indisputably that anti-aldosterone agents such as spironolactone can effectively control BP in many RH patients, although with some side effects that require close patients' monitoring. At present, it is advisable to treat RH with the addition of an anti-aldosterone agent. If BP control is not achieved or serious side effects become manifest RDN may then be considered.


Assuntos
Denervação , Resistência a Medicamentos/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Hipertensão/cirurgia , Espironolactona/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial , Humanos , Hiperaldosteronismo/complicações , Rim/inervação , Cooperação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Artéria Renal , Falha de Tratamento
16.
J Hypertens ; 36(2): 344-352, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29059090

RESUMO

OBJECTIVE: To determine plasma aldosterone concentration (PAC) and plasma renin concentration (PRC) and aldosterone-to-renin ratio (ARR) values in a population attending a Clinic for Cardiovascular Risk Assessment in Children. METHODS: We assessed ARR and associated factors in a cohort of 287 children (137 female, 4-18 years). Weight and blood pressure (BP) were recorded. PAC (ng/dl) and PRC (mU/l) were measured using direct immunochemiluminescent assays. Data were examined by sex and according to four age classes. RESULTS: Median PAC was similar from the youngest to the oldest age class ranging from 7.5 to 9.9 ng/dl in males and from 11.0 to 12.6 ng/dl in females. Median PRC was also similar across age classes in males ranging from 58.2 to 55.5 mU/l, whereas it progressively decreased from 61.5 to 36.6 mU/l in females (P < 0.01). Median PRC was higher in prepubertal than in pubertal females only (53.6 vs. 40.2 mU/l, P < 0.03). As a result ARR was unchanged with increasing age in males (from 0.18 to 0.19), whereas in females it increased from 0.19 to 0.36 (P < 0.03). After adjusting for body weight, BP and other possible confounders, age was inversely related with PRC and directly with PAC and ARR (P < 0.001 for all), in females only. No relationship was found in both sexes between ARR values, BP, weight and family history of hypertension. CONCLUSION: In our children population, ARR is lower than in adults and diverges with increasing age between sexes, due to the age and puberty driven fall in PRC observed only in females. BP and weight are not associated with ARR distribution.


Assuntos
Aldosterona/sangue , Renina/sangue , Adolescente , Fatores Etários , Pressão Sanguínea , Peso Corporal , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Hipertensão/genética , Itália/epidemiologia , Masculino , Medição de Risco , Fatores de Risco , Fatores Sexuais , Maturidade Sexual
17.
J Nephrol ; 20 Suppl 12: S1-3, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-18050136

RESUMO

Meta-analyses are frequently criticized because in most cases they are compiled from quite heterogeneous studies. In spite of this limitation meta-analyses are increasingly published because in many areas of clinical research the results of individual studies are devoid of statistical power and end up with conflicting results. Meta-analyses, if performed with a rigorous and exhaustive search of all accountable information on a specific topic, have the potential of overcoming the drawbacks of single studies and, in addition, of adjusting for publication bias and interstudy variability. These strengths of meta-analyses can be exploited to provide conclusive answers on diagnostic and therapeutic issues being debated, which in turn may help guide doctors toward more rational decisions.


Assuntos
Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Metanálise como Assunto , Humanos
18.
High Blood Press Cardiovasc Prev ; 24(4): 413-417, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28733831

RESUMO

INTRODUCTION: During sleep there is reduction of blood pressure (BP) caused by a decrease of the sympathetic nervous tone. This nocturnal "dipping" phenomenon, assessable with ambulatory blood pressure monitoring (ABPM), is blunted with increasing age. AIM: To assess the effect of hospitalization on night-time BP fall in old-elderly patients. METHODS: We analysed 78 ABPM of old-elderly hospitalized patients (mean age 91 ± 0.5 years) and those of 18 outpatients as control group. The nocturnal BP fall was assessed calculating: the dipping value (DV) i.e. the difference between mean diurnal systolic BP (mDSBP) and mean nocturnal systolic BP (mNSBP) and the "dipping pattern" i.e. mNSBP/mDSBPx100. RESULTS: Hospitalized patients showed a lower rate of normal dipping patterns (9 vs. 39%), an higher rate of reverse dippers (59 vs. 28%; p < 0.05) and a lower DV (-0.9 ± 1 vs. 9 ± 4 mmHg; p < 0.05) than patients of control group. At multivariate regression analysis including age, gender and hospitalization, DV was significantly correlated only with the hospitalization (ß -0.3, t -2.9; p < 0.05). CONCLUSIONS: In old-elderly hospitalized patients nocturnal BP fall is abolished. This enhancement of the age related reduction of nocturnal BP dipping may be due to the stress associated with hospital environment.


Assuntos
Pressão Sanguínea , Sistema Cardiovascular/inervação , Ritmo Circadiano , Pacientes Internados , Sistema Nervoso Simpático/fisiopatologia , Fatores Etários , Idoso de 80 Anos ou mais , Monitorização Ambulatorial da Pressão Arterial , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Fatores de Risco , Sono , Estresse Psicológico/complicações , Estresse Psicológico/fisiopatologia , Fatores de Tempo
19.
J Hypertens ; 24(9): 1687-96, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16915013

RESUMO

Renal artery stenosis (RAS) is usually observed in hypertensive patients with extensive atherosclerosis. There is some evidence that in these patients the atherosclerotic process and the consequent target-organ damage is more severe than in hypertensive patients without RAS. In this review we will entertain the hypothesis that some of the humoral factors that are activated by RAS may contribute to accelerate the progression of atherosclerosis. Several studies identified RAS as a predictor of cardiovascular events in high-risk patients, although in most cases the contribution of blood pressure per se to the progression of vascular lesions could not be determined. As a result of experimental RAS, hypertension and increased oxidative stress are stimuli for atherosclerosis as well as cardiac and renal damage. In the presence of RAS, the renin-angiotensin system is stimulated, and it has been shown that angiotensin II exerts proinflammatory, pro-oxidant and procoagulant activities in experimental models and humans. The potential contribution of reactive oxygen species to the prohypertensive and proatherosclerotic effects of RAS is supported by evidence that nicotinamide adenine dinucleotide phosphate, reduced form oxidase is specifically stimulated by angiotensin II, an activity not shared by epinephrine. Moreover, angiotensin II triggers the release of aldosterone, endothelin 1, thromboxane A2 and other derivatives of the arachidonic acid metabolism, all of which can further and independently aggravate cardiovascular damage. Epidemiological and experimental evidence so far available suggests that accelerated atherosclerosis can be both the cause and the consequence of RAS.


Assuntos
Aterosclerose/complicações , Aterosclerose/diagnóstico , Obstrução da Artéria Renal/complicações , Obstrução da Artéria Renal/diagnóstico , Anti-Hipertensivos/farmacologia , Humanos , Hipertensão/patologia , Inflamação , Modelos Biológicos , Espécies Reativas de Oxigênio , Sistema Renina-Angiotensina
20.
High Blood Press Cardiovasc Prev ; 23(3): 255-8, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27272934

RESUMO

INTRODUCTION: Alarm reaction to clinical blood pressure (BP) measurement, defined white-coat effect (WCE), can cause overestimation of true BP values. AIM: To assess whether ambulatory blood pressure monitoring (ABPM) can similarly affect BP values during the initial hours of recording. METHODS: In 420 ABPMs selected for a first systolic BP (SBP) reading at least 10 mmHg higher than the mean daytime SBP, we calculated mean diurnal and 24 h SBP with and without the exclusion of the two first hours of recording defined as the WCE window (WCEw). We also calculated the magnitude and duration of WCE. These analyses were also performed separately in patients off anti-hypertensive treatment (n = 156), and on treatment with and without the inclusion of beta-blockers (respectively n = 113 and 151). RESULTS: Exclusion of WCEw period reduced mean diurnal and 24 h SBP respectively from 135 ± 0.5 to 133 ± 0.5 (p < 0.01) and from 131 ± 0.5 to 130 ± 0.5 (p < 0.02). As a result the percentage of patients diagnosed as having diurnal or 24 h hypertension was reduced respectively from 48 to 40 % and from 52 to 47 %. The magnitude of WCEw was similar in both genders but the duration was longer in females (66 ± 2 vs. 56 ± 2 min, p < 0.01). Treatment with beta-blockers was associated with a shorter duration of WCE in both genders but this effect was statistically significant only in males. CONCLUSIONS: In some patients ABPM is not free from WCE. WCE may affect the overall estimation of BP profile and is longer but less blunted by beta-blockers in females than in males.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea/efeitos dos fármacos , Hipertensão do Jaleco Branco/tratamento farmacológico , Ritmo Circadiano , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/fisiopatologia , Hipertensão do Jaleco Branco/psicologia
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