Menopause not aldosterone-to-renin ratio predicts blood pressure response to a mineralocorticoid receptor antagonist in primary care hypertensive patients.

BACKGROUND: It has been suggested that hypertensive patients with raised aldosterone-to-renin ratio (ARR) are specifically sensitive to mineralocorticoid receptor antagonists (MRAs). We have previously shown that patients with an elevated ARR are relatively frequent in the setting of primary care. We therefore designed an interventional study to ascertain whether primary care hypertensive patients with an elevated ARR presented a superior response to MRA treatment than subjects with normal ratio. METHODS: According to the previously observed distribution in general population, 1/3 and 2/3 of hypertensive patients with high or normal ARR, respectively, were treated with kanrenoate 50-100 mg/day for 2 months. To avoid uncontrolled blood pressure (BP), 49% of patients continued also "ARR-neutral" drugs such as verapamil and/or alpha-adrenergic blockers. Patients groups were matched for most features but an elevated ARR was more frequent in female than in male gender; moreover, 90% of women with raised ARR were in menopause. RESULTS: A clear reduction of BP values was recorded after both the first and the second month of treatment with kanrenoate, with the maximal effect obtained when the dosage titration at 100 mg/day was accomplished. However, patients previously identified by a raised ARR did not have a larger response to MRA treatment than patients with normal ratio. In contrast, MRA was twofold more effective in reducing SBP in women than in men (after 2 months of treatment -16.4 mm Hg vs.-8.2 mm Hg). CONCLUSIONS: These results suggest that postmenopausal hypertension is largely dependent on mineralocorticoid receptor activation and selectively sensitive to MRAs.

[Geographical analysis of mortality in a municipality of the Veneto region, where a landfill is located, and the surrounding area. Years 1995-2003]. / Analisi geografica della mortalità in un comune del Veneto sede di una discarica di rifiuti e nell'area circostante. Anni 1953-2003.

OBJECTIVE: the study explores whether a potential source of environmental pollution (a dumping ground with different kinds of waste, in Spinea, an area adjacent to Venice, population 25,000) could have led to an excess of mortality from certain pathologies, and in particular some cancers which have been reported to be associated to the presence of dumping grounds. Besides traditional estimation techniques, Bayesian estimators (BMR) have been used, which--if based on appropriate statistical analysis techniques--allow to consider the spatial dependence of the data. The smoothed geographical distribution of mortality in the area surrounding the pollution source is then represented as a map and the presence of particular mortality patterns is verified. Compared to traditional techniques, this approach produces more reliable data in a relatively short time and leads to an analysis with a better information level. Communication to the decision makers and to the population should be based on these data and results. DESIGN: the data were derived from ISTAT mortality reports coded at a local health district level. The following analysis have been carried out: a. a traditional descriptive analysis, i.e. comparison of age. standardized rates in the Spinea municipality and the surrounding area with crude regional rates; b. an analysis of heterogeneity of BMR distribution (reference rates = age-specific rates in the population of the investigated area) in the area itself c. the application of execution of the Martuzzi-Hills test and d. the creation of a mortality distribution map (divided into BMR value classes) in the investigated area. SETTING: the examined area includes Spinea and the surrounding municipalities within the Veneto Region borders, considering Spinea in the centre and a 15 km radius. RESULTS: the total number of deaths in the examined area in the 9 years covered by the present analysis is 49,739 (13% of the regional total). The annual age-standardized rate was 89.91 deaths/10,000. The results of the analysis do not suggest any particular mortality patterns either in the area (compared with the Veneto Region) or within it. CONCLUSIONS: the study has not highlighted geographical mortality clusters of deaths from the causes which have been selected for the analysis.

Aldosterone to Renin ratio in a primary care setting: the Bussolengo study.

The aim of the study was to evaluate the prevalence of hypertension associated with an elevated aldosterone to renin activity ratio (ARR) in a sample of adults aged 35-74 yr, randomly selected from the population register of the Bussolengo Health District (northern Italy) and representative of the total population of the district. Subjects (n = 1462) were randomly selected from the population register and examined by their general practitioners. Complete data for 1348 individuals were available for final statistical analysis. Apart from verapamil or alpha-blockers, no hypotensive drugs were allowed during the 4 wk before assay. Direct active renin and aldosterone were measured in the plasma of hypertensive patients after 2 h in the upright posture. Of 412 identified hypertensive patients, 287 subjects agreed to give blood (70% response rate). An aldosterone to active renin ratio (AARR) of 32 pg/ml was taken as the cut-off value, equivalent to an ARR of 50 ng/dl/ng/ml.h. An elevated AARR was observed in 32.4% of the hypertensive patients, with increased prevalence in females and in people aged 55 yr or older. As an elevated AARR is frequent in the general hypertensive population, screening should not be limited to the patients referred to specialist units.

[Statistical approaches to test for spatial heterogeneity of relative risks of cause-specific mortality in Alto Vicentino Municipalities (years 1991-2000)]. / Valutazione dell'eterogeneità nei rischi relativi di mortalità per causa: un'applicazione ai Comuni dell'ULSS Alto Vicentino (decessi 1991-2000).

OBJECTIVE: To review the statistical approaches to test for spatial heterogeneity of relative risks. Three different statistical tests (Gail, Martuzzi-Hills and Potthoff-Whittinghill) are reviewed and applied--as motivating example--to the analysis of cause-specific mortality records (years: 1991-2000) of the Municipalities belonging to the Local Health Unit Alto Vicentino. METHODS: Spatial heterogeneity was found in 17 (Martuzzi-Hills) and 18 (Gail, Potthoff-Whittinghill) among 70 selected causes of death. Cohens Kappa test was chosen to assess the agreement among the tests (k = 0.596; p < or = 0.001). CONCLUSION: Spatial heterogeneity must be interpreted with great caution, taking into account the available evidence about risk factors for specific causes of death and carefully evaluating available exposure data.

Association between PM10 concentrations and school absences in proximity of a cement plant in northern Italy.

Dusts are one of the main air pollutants emitted during cement manufacturing. A substantial part of these are breathable particles that are less than 10 µm in diameter (PM10), which represent a potential threat for the health of the exposed population. This study aimed at evaluating the short-term effects of PM10 concentrations on the health of children, aged 6-14 years, who attended the schools in Fumane (Italy), in proximity (1.2 km) to a large cement plant. School absenteeism was used as a proxy indicator of child morbidity. Time series of daily school absences and PM10 concentrations were collected for 3 school-years from 2007 to 2010 (541 school-days, 462 children on average). The associations between PM10 concentrations and school absence rates in the same day (lag0) and in the following 4 days (lag1 to lag4) were evaluated using generalised additive models, smoothed for medium/long term trends and adjusted for day of the week, influenza outbreaks, daily temperature and rain precipitations. The average concentration of PM10 in the period was 34 (range: 4-183) µg/m(3). An average 10 µg/m(3) increase of PM10 concentration in the previous days (lag0-4) was associated with a statistically significant 2.5% (95%CI: 1.1-4.0%) increase in the rate of school absences. The highest increase in the absence rates (2.4%; 95%CI: 1.2-3.5%) was found 2 days after exposure (lag2). These findings provide epidemiological evidence of the acute health effects of PM10 in areas with annual concentrations that are lower than the legal European Union limit of 40 µg/m(3), and support the need to establish more restrictive legislative standards.

Gestrinone versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation.

OBJECTIVE: To compare danazol and gestrinone treatment as preoperative endometrial preparation for operative hysteroscopy. DESIGN: Prospective, randomized clinical study. SETTING: University department of gynecological, obstetrical sciences and reproductive medicine. PATIENT(S): One hundred thirty-five patients with endouterine pathologies (endometrial polyps, submucous myoma, septate uterus). INTERVENTION(S): Patients pretreated with gestrinone (n = 68) and with danazol (n = 67) underwent operative hysteroscopy. MAIN OUTCOME MEASURE(S): Endometrial response to the medical pretreatment, side effects, procedure time, intraoperative bleeding, infusion volume, patient satisfaction. RESULT(S): Side effects were infrequent in both groups, though the patients' personal satisfaction was in favor of gestrinone. The rate of endometrial response was higher for the gestrinone group (97.1% vs. 83.6%). Operative time (mean +/- SD) was 12 +/- 1.8 and 15.2 +/- 1.9 minutes for the gestrinone and danazol groups, respectively. The gestrinone group showed a lower incidence of moderate bleeding (3% vs. 22.4%) and a lower infusion volume (2,100 +/- 200 mL vs. 2,400 +/- 250 mL). Regarding cervical dilatation time, no significant difference was found between the two groups (1.6 +/- 0.3 minutes vs. 1.5 +/- 0.4 minutes). CONCLUSION(S): Both treatments are good ways to prepare the endometrium for operative hysteroscopy. However, the data suggest that gestrinone pretreatment is preferable to danazol.