Development of new atherosclerotic plaque in hypertensive patients: an observational registry study from the Campania-Salute network.

BACKGROUND AND PURPOSE: Carotid atherosclerotic plaques (CAPs) can develop despite appropriate antihypertensive therapy. In this observational study, we assessed characteristics associated with risk of incident CAP in a large hypertensive registry. METHODS: We evaluated 2143 hypertensive patients without evidence of CAP. Incident CAP was censored at the time of the first ultrasound control in which CAP was detected. CAP was defined according to European Society of Hypertension/European Society of Cardiology guidelines. RESULTS: At a median follow-up period of 56.6 months, about one-third of patients (32%; N = 688) exhibited new CAP. Those patients were older, more frequently smokers, diabetic, more often with metabolic syndrome, chronic kidney disease (CKD), longer hypertension history, higher baseline SBP, pulse pressure (PP), fasting glucose, total cholesterol and triglycerides, greater left ventricular mass index, higher PP/stroke index ratio and carotid intima-media thickness (IMT; all P < 0.05). In-treatment BP control was similar in both groups. In multivariable Cox regression, CAP was predicted by older age, diabetes, smoking habit, CKD and higher value of initial IMT (all P < 0.02), independently of BP control during follow-up, antihypertensive therapy and other confounders. CONCLUSION: In this registry of treated hypertensive patients, after adjusting for age and other confounders, risk of incident CAP did not depend on BP control and type of antihypertensive therapy, whereas it was independently related to the magnitude of initial IMT, independently of significant effect of prevalent diabetes and smoking habit. These findings suggest that antihypertensive treatment strategy to stop progression of cardiovascular disease might be difficult to achieve, once target organ damage is established.

Transradial approach for the endovascular treatment of type I endoleak after aortic aneurysm repair: a case report.

BACKGROUND: Endovascular repair of aortic aneurysms (EVAR) is obtained through the positioning of an aortic stent-graft, which excludes the aneurysmatic dilation. Type I endoleak is the most common complication, and it is caused by an incompetent proximal or distal attachment site, causing the separation between the stent-graft and the native arterial wall, and in turn creating direct communication between the aneurysm sac and the systemic arterial circulation. Endoleak occurrence is associated with high intrasac pressures, and requires a quick repair to prevent abdominal aortic aneurysm rupture. CASE PRESENTATION: We report the first case of a 80-year-old man undergoing percutaneous closure of a peri-graft endoleak (type I) by transcatheter embolization through radial arterial access. CONCLUSION: The transradial approach has been shown to be a safe and effective alternative to the traditional transfemoral approach. A decrease in vascular complications and improved patient comfort are the primary benefits of this technique in patients with previous EVAR.

A survey on blood pressure levels and hypertension control in a sample of the Italian general population.

BACKGROUND: Hypertension represents a major cardiovascular risk factor with relevant consequences on morbidity and mortality in the general population. An optimal control of blood pressure (BP) is far from being achieved. AIM: The objective of this study was to explore awareness of BP levels, prevalence of risk factors and status of hypertension control in a sample of the Italian general population. METHODS: Subjects aged 18 years or older were enrolled on a voluntary basis during the 7th and 8th World Hypertension Days at our hospital centre, S. Andrea Hospital in Rome, and at other hospitals throughout the Italian Lazio region. Along with BP measurement, a short questionnaire was completed at the time of the interview. RESULTS: Of 1165 individuals enrolled into the analysis, 71.7% were aware of their BP levels (82.5% among hypertensive patients). Within the whole cohort, 31.9% of subjects were under antihypertensive treatment, while the overall rate of subjects found to be hypertensive patients at our visit was 52.9% (n = 616). Among hypertensive patients taking antihypertensive drugs, 47.1% had controlled BP values with the remaining 52.9% showing uncontrolled hypertension. Mean systolic blood pressure (SBP) was 138.2 ± 20.7 mmHg and mean diastolic blood pressure (DBP) was 80.4 ± 11.3 mmHg in subjects receiving antihypertensive treatment. Among older hypertensive patients (71-94 years of age), only 76.9% were under treatment. Hypertensive males were more frequently treated than females in all age groups (p = 0.001). Smoking habit negatively affected efficacy of antihypertensive therapy in the age groups of 48-53 and 54-62 years (p = 0.008 and p = 0.01, respectively). Diabetic patients had higher mean SBP values than non-diabetic subjects (137.3 ± 22.1 vs 129.3 ± 18.2 mmHg, p = 0.02). CONCLUSION: The results of our survey strongly support the need for a continuing educational effort aimed at providing correct advertisement of healthy lifestyles and awareness of adequate BP control. Based on our observations, particular attention has to be paid to women, younger subjects, elderly subjects and diabetic patients in order to reach appropriate BP control and reduction of cardiovascular risk in these subject categories.