Low plasma adiponectin is associated with coronary artery disease but not with hypertension in high-risk nondiabetic patients.

OBJECTIVE: To investigate the association of plasma adiponectin levels with coronary artery disease (CAD), arterial hypertension (HT), and insulin resistance (IR) in nondiabetic Caucasian patients. DESIGN: We measured plasma adiponectin levels, IR (HOMA index), and the CAD atherosclerotic burden (angiography-based modified Duke Index score) in 400 nondiabetic patients undergoing coronary angiography. HT was diagnosed by the European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines or if patients were on antihypertensive treatment. RESULTS: Coronary artery disease was found in 62% of the patients and ruled out in the rest (non-CAD group). Plasma adiponectin levels were inversely related to the CAD score (beta = -0.12, P = 0.029) and predicted the coronary atherosclerotic burden independent of other cardiovascular risk factors. However, they were similar in NT and HT and showed no correlation with blood pressure values. In non-CAD, but not in CAD patients, they were lower in patients with than without IR (8.3 +/- 1.2 vs. 11.3 +/- 1.3, respectively; P = 0.007). CONCLUSIONS: In nondiabetic high-risk Caucasian patients plasma adiponectin levels are inversely related to CAD severity and IR; however, they are not strongly related to blood pressure values.

Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1 hypertension: the HARVEST.

Factors related to the development of microalbuminuria in hypertension are not well known. We did a prospective study to investigate whether glomerular hyperfiltration precedes the development of microalbuminuria in hypertension. We assessed 502 never-treated subjects screened for stage 1 hypertension without microalbuminuria at baseline and followed up for 7.8 years. Creatinine clearance was measured at entry. Urinary albumin and ambulatory blood pressure were measured at entry and during the follow-up until subjects developed sustained hypertension needing antihypertensive treatment. Subjects with hyperfiltration (creatinine clearance >150 ml/min/1.73 m2, top quintile of the distribution) were younger and heavier than the rest of the group and had a greater follow-up increase in urinary albumin than subjects with normal filtration (P<0.001). In multivariable linear regression, creatinine clearance adjusted for confounders was a strong independent predictor of final urinary albumin (P<0.001). In multivariable Cox regression, patients with hyperfiltration had an adjusted hazard ratio for the development of microalbuminuria based on at least one positive measurement of 4.0 (95% confidence interval (CI), 2.1-7.4, P<0.001) and an adjusted hazard ratio for the development of microalbuminuria based on two consecutive positive measurements of 4.4 (95% CI, 2.1-9.2, P<0.001), as compared with patients with normal filtration. Age, female gender, and 24 h systolic blood pressure were other significant predictors of microalbuminuria. In conclusion, stage 1 hypertensive subjects with glomerular hyperfiltration are at increased risk of developing microalbuminuria. Early intervention with medical therapy may be beneficial in these subjects even if their blood pressure falls below normal limits during follow-up.

Leptospira interrogans activation of peripheral blood monocyte glycolipoprotein demonstrated in whole blood by the release of IL-6.

Glycolipoprotein (GLP) from pathogenic serovars of Leptospira has been implicated in the pathogenesis of leptospirosis by its presence in tissues of experimental animals with leptospirosis, the inhibition of the Na,K-ATPase pump activity, and induced production of cytokines. The aims of the present study were to investigate the induction of IL-6 by GLP in peripheral blood mononuclear cells (PBMC) and to demonstrate monocyte stimulation at the cellular level in whole blood from healthy volunteers. PBMC were stimulated with increasing concentrations (5 to 2500 ng/ml) of GLP extracted from the pathogenic L. interrogans serovar Copenhageni, lipopolysaccharide (positive control) or medium (negative control), and supernatants were collected after 6, 20/24, and 48 h, and kept at -80 degrees C until use. Whole blood was diluted 1:1 in RPMI medium and cultivated for 6 h, with medium, GLP and lipopolysaccharide as described above. Monensin was added after the first hour of culture. Supernatant cytokine levels from PBMC were measured by ELISA and intracellular IL-6 was detected in monocytes in whole blood cultures by flow-cytometry. Monocytes were identified in whole blood on the basis of forward versus side scatter parameters and positive reactions with CD45 and CD14 antibodies. GLP ( > or = 50 ng/ml)-induced IL-6 levels in supernatants were detected after 6-h incubation, reaching a peak after 20/24 h. The percentage of monocytes staining for IL-6 increased with increasing GLP concentration. Thus, our findings show a GLP-induced cellular activation by demonstrating the ability of GLP to induce IL-6 and the occurrence of monocyte activation in whole blood at the cellular level.

Leptospira interrogans activation of peripheral blood monocyte glycolipoprotein demonstrated in whole blood by the release of IL-6

Glycolipoprotein (GLP) from pathogenic serovars of Leptospira has been implicated in the pathogenesis of leptospirosis by its presence in tissues of experimental animals with leptospirosis, the inhibition of the Na,K-ATPase pump activity, and induced production of cytokines. The aims of the present study were to investigate the induction of IL-6 by GLP in peripheral blood mononuclear cells (PBMC) and to demonstrate monocyte stimulation at the cellular level in whole blood from healthy volunteers. PBMC were stimulated with increasing concentrations (5 to 2500 ng/ml) of GLP extracted from the pathogenic L. interrogans serovar Copenhageni, lipopolysaccharide (positive control) or medium (negative control), and supernatants were collected after 6, 20/24, and 48 h, and kept at -80°C until use. Whole blood was diluted 1:1 in RPMI medium and cultivated for 6 h, with medium, GLP and lipopolysaccharide as described above. Monensin was added after the first hour of culture. Supernatant cytokine levels from PBMC were measured by ELISA and intracellular IL-6 was detected in monocytes in whole blood cultures by flow-cytometry. Monocytes were identified in whole blood on the basis of forward versus side scatter parameters and positive reactions with CD45 and CD14 antibodies. GLP ( > or = 50 ng/ml)-induced IL-6 levels in supernatants were detected after 6-h incubation, reaching a peak after 20/24 h. The percentage of monocytes staining for IL-6 increased with increasing GLP concentration. Thus, our findings show a GLP-induced cellular activation by demonstrating the ability of GLP to induce IL-6 and the occurrence of monocyte activation in whole blood at the cellular level.

Osteoprotegerin and bone turnover markers in heavily pretreated HIV-infected patients.

OBJECTIVES: To characterize osteoprotegerin (OPG) levels, bone remodelling and bone mineral density (BMD) in heavily pretreated HIV-infected patients on antiretroviral therapy, and to evaluate the clinical factors associated with bone density decline. METHODS: Heavily pretreated (> 5 years) HIV-positive patients were enrolled in this cross-sectional, observational study, which was based on a total body bone densitometry examination and a comprehensive evaluation of bone and mineral parameters. RESULTS: Sixty-eight patients (55 male and 13 female) with a median age of 41 years (range 25-60 years) were included in the study. Their antiretroviral treatment lasted for 82 months. On the basis of the World Health Organization criteria, nine patients (13.2%) were osteoporotic [T-score < -2.5 standard deviation (SD)] and 19 patients (27.9%) were osteopenic (T-score between -1 and -2.5). The principal outcomes associated with the presence of a low BMD were high OPG and lysylpyridinoline/creatinine ratio (Dpd) values. Most of the patients (39 of 48; 81.25%) showed vitamin D insufficiency [Vitamin D (25(OH)D) < 18 ng/mL] with secondary hyperparathyroidism (13 of 50 patients: 26%), which proved to be correlated to osteocalcin (BGP) levels [parathyroid hormone (PTH) vs. BGP: r = 0.34; P < 0.01]. There was an inverse correlation between T-scores and serum osteocalcin and alkaline phosphatase (AP) levels, on one hand, and Dpd, on the other. High AP and Dpd values were associated with relative risks of 4.1 [95% confidence interval (CI) = 1.01-17.6] and 7.2 (95% CI = 1.67-31.03), respectively, of a pathological T-score. Multivariate analysis revealed that the factors associated with the presence of osteopenia or osteoporosis were older age and lower body mass index. CONCLUSIONS: About 40% of our heavily pretreated subjects with advanced HIV infection had a low BMD, and 56% (24 of 44 patients) showed a high bone turnover rate with marked osteoclast activation. High OPG levels may protect against bone resorption.

Effect of blood pressure and physical activity on carotid artery intima-media thickness in stage 1 hypertensives and controls.

The aim of the study was to investigate whether hypertension and physical training induce parallel changes in the arterial wall. Ninety-seven never-treated stage 1 hypertensive patients (HT) (systolic blood pressure 140 to 159 mm Hg or diastolic blood pressure 90 to 99 mm Hg) aged 18 to 45 years taking part in the Hypertension and Ambulatory Recording Venetia Study and 27 normotensive volunteers (NT) aged 30 +/- 9 years were studied. Data on physical or sports activity were collected and scored, and target organ involvement was investigated by assessing microalbuminuria, echocardiography, and carotid ultrasound study. The carotid arteries were examined according to the Atherosclerosis Risk in Communities protocol. Mean (m-IMT) and maximal (M-IMT) carotid intima-media thickness were measured at end-diastole in the far wall common carotid artery, in the bulb and internal carotid artery, in the lateral and posterior projection, averaging the left and right sides. A comparable level of physical activity was present in HT patients and NT subjects. Twenty-four-hour blood pressure and blood lipid levels, as well as target organ damage, were similar in physically active and sedentary HT. The m-IMT of the common carotid was greater in sedentary HT than in sedentary NT, as well as in active than in sedentary NT. The m-IMT of the internal carotid artery was also greater in active HT than in active NT, as well as in active than in sedentary HT. In logistic regression, comparing the first and fourth quartile of m-IMT, scored physical activity was a predictor of m-IMT in the internal carotid artery. No statistical interaction was found between physical activity and hypertension, indicating that these two items have a cumulative effect and act independently of each other. Sedentary HT had significantly greater levels of M-IMT than sedentary NT in all sites but the bulbs; in the internal and common carotid arteries, HT exercisers had significantly greater M-IMT than NT exercisers. Therefore, physical activity appears to be an early independent predictor of carotid wall thickness. This factor should be taken into consideration in population-based studies aimed at investigating supraortic vessels as it can act as a confounder.

White-coat hypertension: a selection bias? Harvest Study Investigators. Hypertension and Ambulatory Recording Venetia Study.

BACKGROUND: Results of several studies have shown that subjects with white-coat hypertension (WCH) have more target-organ damage than do normotensive controls with similar ambulatory blood pressures. OBJECTIVE: To investigate whether this is due to a selection bias. SETTING: Seventeen hypertension clinics in northeast Italy. MAIN OUTCOME MEASURES: Echocardiographic data in relation to WCH status. PATIENTS AND METHODS: Mild hypertensive subjects from the HARVEST (n = 565) who underwent two ambulatory blood pressure monitorings 3 months apart and M-mode echocardiography, and 95 normotensive control subjects. RESULTS: From first ambulatory monitoring, 90 hypertensive subjects were classified as having WCH (mean daytime blood pressure < 130/80 mmHg). Their 24 h blood pressure was similar to that of the normotensive subjects, but their left ventricular mass index was greater. From second ambulatory monitoring, only 38 of the 90 subjects still had WCH, whereas 24 h blood pressure in the other 52 had risen beyond the limit of WCH. Left ventricular mass index (89.2 +/- 2.4 g/m2), wall thickness (18.1 +/- 0.3 mm), and relative wall thickness (0.359 +/- 0.006%) of the 38 subjects with WCH at both recordings were still greater than those of the normotensive subjects (82.4 +/- 1.5 g/m2, P = 0.02; 17.2 +/- 0.2 mm, P = 0.002; and 0.337 +/- 0.004%, P = 0.025) and similar to those of the 52 subjects who no longer had WCH (88.5 +/- 2.0 g/m2, 18.7 +/- 0.2 mm, and 0.375 +/- 0.005%, all NS). CONCLUSIONS: Owing to regression toward the mean, over 50% of the subjects with WCH could no longer be classified as such from repeated ambulatory monitoring, indicating that the current diagnosis of WCH is subject to selection bias. Cardiac remodeling was present also in the subjects confirmed to have WCH by repeated blood pressure recording, suggesting that the effect of WCH has an actual impact on target organs.

Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension. HARVEST Study Group.

It has been claimed that diastolic dysfunction is the earliest cardiac abnormality in hypertension, preceding the development of left ventricular (LV) structural abnormalities. To detect early signs of hypertensive cardiac involvement 722 subjects (533 men and 189 women), 18-45 years old, with stage I hypertension, were studied by M-mode and Doppler echocardiography. Blood pressure was measured by 24-h ambulatory monitoring. Ninety-five normotensive individuals of similar age and gender distributions were studied as controls. Significant, though modest, changes of LV mass and geometry were found in the participants in comparison with the normotensive controls. The increment was +10.4 g/m2 for LV mass index, +1.8 mm for LV wall thickness, and +0.032 for relative wall thickness. A slight increase in atrial filling peak velocity was found in the hypertensive subjects at Doppler analysis of transmitral flow, but the ratio of early to atrial velocity of LV diastolic filling did not differ between the two groups. In multiple regression analyses, which included age, body mass index, heart rate, smoking, and physical activity, 24-h mean blood pressure emerged as a significant predictor of LV mass index (men, P = .003; women, P = .04) and wall thickness (men, P = .03; women, P = .004) in the hypertensive subjects, whereas no index of diastolic filling was significantly associated with ambulatory blood pressure in either gender. The present data indicate that changes in LV anatomy are the earliest signs of hypertensive cardiac involvement. Left ventricular filling is affected only marginally in the initial phase of hypertension.

Interactive action of the white-coat effect and the blood pressure levels on cardiovascular complications in hypertension.

PURPOSE: This study was undertaken to investigate whether there is a relationship between the white-coat effect and the cardiovascular complications of hypertension. PATIENTS AND METHODS: In 1,013 consecutive borderline to severe hypertensive outpatients (889 men) with a mean age (+/-SE) of 33.6 +/- 0.5 years and a mean office blood pressure of 152.3 +/- 0.6/95.5 +/- 0.4 mm Hg, blood pressure was measured by noninvasive 24-hour ambulatory monitoring. Target organ damage was assessed by electrocardiogram, chest X-ray, echocardiography, and ophthalmoscopy. The degree of target organ damage and of left ventricular hypertrophy was assessed in the subjects divided according to the levels of their daytime blood pressure and the extent of their white-coat effect. RESULTS: The subjects with a high white-coat effect showed a greater degree of hypertensive complications than those with intermediate or a low white-coat effect. The significant association between the white-coat phenomenon and the hypertensive complications was confirmed by the results of stepwise regression analyses, where sex, age, duration of hypertension, and ambulatory blood pressure were added to the model. A two-way ANOVA showed that both ambulatory blood pressure and the white-coat effect were related to the degree of target organ damage and to left ventricular hypertrophy. Moreover, daytime blood pressure and the white-coat effect showed an interactive effect on hypertensive complications, as the influence of the white-coat effect on end organs increased with increasing levels of ambulatory blood pressure. CONCLUSIONS: The present results show that the white-coat effect is related to the degree of hypertensive complications and that this association is stronger in the subject with more severe hypertension.

Exposure to organic solvents and its effects on the central nervous system in workers of the Camaçari petrochemical complex in Brazil.

While numerous studies have been carried out in industrialized countries, only very few epidemiologic investigations performed in developing countries are reported in the international literature. This study is one of the few examples of investigations carried out in a region where industrialization is at its beginning. A sample of 188 workers employed at the Camaçari Petrochemical Complex in Bahia, Brazil, and exposed for over five years to organic solvents was submitted to neurobehavioral testing (QQS questionnaire, MANS battery) together with a 1/1 control group paired for age, school attendance and alcohol consumption. The exposed subjects showed differences significantly worse at emotional status, manual dexterity, recognition memory and subjective symptoms. Exposed subjects are therefore characterized by decreased psychophysical well-being.

Target organ damage and ambulatory blood pressure in stage I hypertension. The Hypertension and Ambulatory Recording Venetia Study.

According to recent international guidelines the decision on whether to treat young subjects during the early phase of hypertension should be based not only on their office blood pressure but also on their ambulatory blood pressure and whether target organ damage has occurred. Few data on the prevalence of hypertensive complications in young subjects with mild hypertension are available. In the Hypertension and Ambulatory Recording Venetia Study (HARVEST), a multicenter trial conducted in northeast Italy, the percentage of young borderline-to-mild hypertensive subjects with echocardiographic left ventricular hypertrophy was 4.5% and the percentage with concentric remodeling was 4%. Clear differences in cardiac size and geometric adjustment to ambulatory systolic pressure between the two sexes were found. The impact of blood pressure on the walls of the left ventricle and on the left ventricular mass was remarkable in women but weak in men. The assessment of left ventricular systolic function confirmed that many young mild hypertensive subjects have an increased ejective performance. The left ventricular contractility evaluated by midwall measurement was, however, found to be depressed in 9.2% of the HARVEST participants. Their left ventricular diastolic function was similar to that of 50 normotensive controls. The prevalence of microalbuminuria [albumin excretion rate (AER) > 30 mg/24 h) was 6.1%, only slightly higher than that found by other authors among normotensive subjects and much lower than that observed among patients with more severe hypertension. For our stage I hypertensives, however, the AER was correlated to the 24 h blood pressure with high statistical significance, whereas we found no relationship between the AER and left ventricular mass index either for all of the subjects taken together or for the men and women considered separately. The results suggest that renal and cardiac involvement do not occur in parallel during the initial phase of hypertension.

Relation of 24-hour ambulatory blood pressure and short-term blood pressure variability to seasonal changes in environmental temperature in stage I hypertensive subjects. Results of the Harvest Trial.

We investigated the seasonal changes in blood pressure (BP) and in short-term BP variability determined using ambulatory blood pressure monitoring (ABPM). 1000 white subjects, who took part in the multicenter HARVEST study, underwent ABPM with the A&D TM-2420 or the Spacelabs 90207. Standard deviation of the mean daytime and nighttime BP was taken as an index of short-term BP variability (v). Maximal outdoor temperature (Tmax) during each ABPM was obtained from local Meteorological Centers. Subjects were divided according to season and to quartiles of Tmax. A subgroup of 46 persons who repeated ABPM in Winter and Summer was also studied. We observed evident seasonal differences in office and ambulatory systolic BP (SBP) with a peak during Winter. Diastolic BP (DBP) and heart rate did not vary throughout the four seasons. Office SBP (p < 0.01), 24-hour (p < 0.002), daytime SBP (p < 0.0001), both daytime SBPv (p < 0.0001), DBPv (p < 0.02), and nighttime SBPv (p < 0.05), DBPv (p < 0.02) as well as norepinephrine (p < 0.005) were significantly higher during Winter than Summer. Similar differences were observed in subjects grouped in quartiles of Tmax. In the subgroup daytime but not nighttime SBP was higher in the cold season. Average 24-hour SBP (p < 0.05), daytime SBP (p < 0.02), daytime SBPv (p < 0.001) and DBPv (p < 0.05) and norepinephrine (p < 0.0001) were significantly negatively correlated with Tmax in the whole population. BP is higher and subjected to wider oscillations during the cold season in patients with mild hypertension probably due to sympathetic activation. The assessment of a hypertensive subject may give different results according to the season.

Human T-cell lymphotropic virus type-I infection in the severe combined immunodeficiency mouse.

Human T-cell lymphotropic virus type-I (HTLV-I) is the etiologic agent of HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia (ATL). HAM/TSP and ATL occur infrequently among HTLV-I-infected individuals, and rarely develop in the same individual. To study host and viral factors involved in the induction, tissue tropism, as well as pathogenesis of HAM/TSP, peripheral blood lymphocytes (PBL) from 14 patients with HAM/TSP and from 9 controls were introduced into severe combined immunodeficiency (SCID) mice by intraperitoneal injection. Mice were followed for up to 26 weeks. Human IgG was produced from 2 to 14 weeks after reconstitution in all animals. Thirty-two of 44 mice (72%) showed circulating human antibody against the major viral protein products of HTLV-I. Analysis of viral sequences by polymerase chain reaction (PCR) demonstrated HTLV-I sequences in 21/38 (55%) brains and in 7/17 (41%) spinal cords from HTLV-I-hu SCID mice. No animal had clinical evidence of neurological impairment or pathological findings similar to those seen in HAM/TSP. Seven mice who received PBL from Epstein Barr virus (EBV)-seropositive patients developed an intraperitoneal lymphoma. In 2 mice an infiltration of brain by a lymphoblastic tumor of B/T cell type was observed. By PCR, all the tumors were EBV-positive; HTLV-I sequences were detected in 5 of them. Our study suggests that the HTLV-I-hu-SCID mouse provides a potentially valuable system for studying the production, kinetics, and pathogenicity of anti-HTLV-I antibody, and may help clarify the interaction of EBV and retroviruses in the development of disease.

Prevalence and clinical correlates of microalbuminuria in stage I hypertension. Results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST Study).

The objective of the present study was to examine the association between albumin excretion rate (AER) and office and ambulatory blood pressures (BP), and other recognized cardiovascular risk factors in stage I hypertension. The study was carried out in 870 never-treated 18- to 45-year-old hypertensives (628 men, 242 women). Office and ambulatory BP, 24-h urinary collection for AER assessment, and echocardiographic left ventricular mass (n = 587) were obtained. AER was similar in men and women (12.3 v 12.5 mg/24 h) and was unrelated to age and body mass index. In 85.2% of the subjects, AER was < 16 mg/24 h, in 8.3% it was between 16 and 29 mg/24 h (borderline microalbuminuria), and in 6.1% it was >or= 30 mg/24 h (overt microalbuminuria). Office systolic BP was not different in the three groups, whereas 24-h systolic BP was higher in the subjects with microalbuminuria than in those with normal AER (P < .0001) and was similar in the two microalbuminuric groups. Office and 24-h diastolic BPs were higher in the subjects with overt microalbuminuria than in those with normal AER. Left ventricular mass was correlated to systolic (P < .0001) and diastolic (P = .01) 24-h BP, but was unrelated to AER. Family history for hypertension, smoking, coffee and alcohol intake, and physical activity habits did not influence AER. In a logistic regression analysis, 24-h systolic BP emerged as the only determinant of microalbuminuria (P < .0001). In conclusion, these results indicate that borderline levels of microalbuminuria may also be clinically relevant in stage I hypertension. Overweight and lifestyle factors do not appear to influence AER in these patients. Finally, the lack of correlation between AER and left ventricular mass suggests that renal and cardiac involvement do not occur in a parallel fashion in the initial phase of hypertension.

[The relationship between overweight, life style and casual and 24-hour pressures in a population of male subjects with mild hypertension. The results of the HARVEST study]. / Relazione tra sovrappeso, abitudini di vita e pressione casuale e delle 24 ore in una popolazione di soggetti di sesso maschile con ipertensione lieve. Risultati dello studio HARVEST.

AIM OF THE STUDY: To evaluate the relationship of coffee use, smoking, physical inactivity, alcohol intake and overweight with casual and ambulatory blood pressure in a large population of borderline to mild hypertensive subjects. METHODS: Six hundred and thirty men with a mean (+/- SE) age of 33 +/- 0.4 years (range = 18-45 years) and a mean office blood pressure of 146 +/- 0.4/94 +/- 0.2 mm Hg, participating in the multicentre HARVEST study, were divided into three categories according to: coffee consumption (0 cups, 1-3 cups, > 3 cups/day), number of cigarettes smoked per day (0, 1-10, 11-20), degree of physical activity (no activity, regular training, competitive activity), alcohol intake (no alcohol, < 50 g, > or = 50 g/day) and body mass index (tertiles). All patients underwent non invasive ambulatory blood pressure monitoring with either the A&D TM-2420 model 7 or the Spacelabs 90207 monitor. Moreover, 24-hour urine collection was made for epinephrine and norepinephrine assessment (n = 611). RESULTS: Twenty-four-hour systolic blood pressure was higher in the coffee drinkers than the nondrinkers (+2.6 mm Hg in the moderate drinkers). Instead, 24-hour diastolic blood pressure was mainly influenced by overweight (3.2 mm Hg difference between the low and high BMI tertiles) and physical inactivity (3.2 mm Hg difference between the sedentary men and the athletes). Generally, the association of the above factors was stronger with ambulatory than with office blood pressure, whereas alcohol intake was only related to office diastolic blood pressure. However, in a multivariate regression analysis alcohol use did not show an independent effect on either office or ambulatory blood pressure. Smoking showed a different effect on office and ambulatory blood pressure. In fact, office blood pressure was higher in the nonsmokers, while 24-hour blood pressure was higher in the smokers. Smoking, coffee and physical inactivity were associated with sympathetic overactivity, as documented by increased urinary catecholamines output. CONCLUSIONS: The results of the present study indicate that overweight and behavioural factors affect 24-hour blood pressure to a larger extent than office blood pressure does. This is likely to be due to their effect on the sympathetic nervous system activity, which would enhance the blood pressure response to daily life stressors.

Diltiazem vs. nicardipine on ambulatory and exercise blood pressure and on peripheral hemodynamics.

The present study was aimed at evaluating the antihypertensive efficacy of sustained-release diltiazem 180 mg vs. sustained-release nicardipine 40 mg both given twice daily. To this end 20 patients with mild to moderate hypertension were studied. After a two-week placebo period diltiazem and nicardipine were administered for 4 weeks according to a crossover design. To assess the antihypertensive efficacy of the two drugs all patients underwent Twenty-four-hour non-invasive blood pressure (BP) monitoring and a submaximal bicycle ergometric test. Ambulatory BP monitoring showed a tendency for systolic BP to be lower with nicardipine than with diltiazem during waking hours, while diastolic BP was lowered to the same extent by the two drugs. During sleep a slightly greater BP fall was observed with diltiazem. 24-hour spontaneous BP variability was slightly reduced with diltiazem and unchanged with nicardipine. Mean 24-hour heart rate was also unchanged with nicardipine and slightly reduced with diltiazem. Peripheral resistance measured by plethysmography significantly decreased with the former but not with the latter. BP and heart rate response to exercise was left unchanged by nicardipine and was slightly decreased by diltiazem. This study demonstrates that both sustained-release diltiazem and nicardipine are effective in controlling BP throughout the 24 hours without increasing BP variability. While the antihypertensive action of nicardipine was associated with a decrease of peripheral resistance, this was not the case with diltiazem.

[Effect of high and low altitude exposure on the blood pressure response to physical exercise]. / Effetto dell'esposizione alle alte e basse quote sulla risposta pressoria all'esercizio fisico.

Altitude exposure is known to cause an increase in adrenergic activity, blood pressure (BP) and heart rate (HR) in resting conditions. Much less is known on the effects of the hypoxic environment on the BP and HR response to physical exercise. Five physically trained young normotensive subjects underwent a 1-hour long bicycle ergometric test to exhaustion at sea level and after 24 hours of low (1322 m) and high (3322 m) altitude exposure. HR, BP and Hb oxygen (HbO2) saturation were measured throughout the test and the recovery period. The values obtained at 60, 70, 80, 90 and 100% maximum HR were calculated. Resting BP increased by 17.9/20.9 mmHg at 3322 m (p = 0.062/0.012) and by 10.0/12.8 mmHg at 1322 m (NS). However, the BP difference present at rest gradually flattened throughout effort and at peak exercise similar BP values were obtained during the 3 tests. HbO2 saturation was lower at 3322 m compared to the other 2 settings (91.5% vs 96.7% at sea level; p less than 0.0001) and this difference progressively and remarkably increased throughout the ergometric test. At 3322 m a lower workload was reached (189 +/- 39.4 vs 240 +/- 54.8 W; p less than 0.05). In agreement with previous results these data show that exposure to both high and low altitude causes an increase in resting BP and HR; however, during strenuous exercise maximum BP and HR do not exceed the levels attained at sea level, probably on account of the lower workload that may be reached in the hypoxic environment.