Current state of genomic policies in healthcare among EU member states: results of a survey of chief medical officers.

Background: A need for a governance of genomics in healthcare among European Union (EU) countries arose during an international meeting of experts on public health genomics (PHG). We have conducted a survey on existing national genomic policies in healthcare among Chief Medical Officers (CMOs) of the 28 EU member states, plus Norway. Methods: A questionnaire was sent to CMOs after a meeting on the policy implications of PHG held during the Italian presidency of the Council of EU in 2014. The survey was closed in November 2015. Results: CMOs response rate was 65.5% (19/29). Twelve (63.2%) reported that their countries had a policy for genomics in healthcare in place, and 15 (78.9%) reported that public funding existed. Public research facilities for the development of such policies were documented in 13 (68.4%) countries, and 15 (83.3%) had working groups devoted to policy development. National agencies carrying out Health Technology Assessment of genomic-based technologies were present in nine countries (50%). Sixteen (88.9%) countries reported having agencies dealing with ethical issues related to genomic technologies. About 55% of countries disclosed the lack of information campaigns aimed at citizens, and 44.4% reported they had a legal framework for direct-to-consumer genetic tests. Conclusion: Belgium, France, Italy, Spain and UK documented the presence of a policy on genomics in healthcare. While many caveats are necessary because of the methodology, results suggest a need for a co-ordinated effort to foster development and harmonization of dedicated policies across EU to responsibly integrate genomics policies into existing health systems.

Knowledge, attitudes and behaviors of the Italian population towards Neisseria meningitidis, Streptococcus pneumoniae and HPV diseases and vaccinations: A cross-sectional multicentre study.

OBJECTIVES: This study addressed knowledge of Streptococcus pneumoniae, Neisseria meningitidis and human papillomavirus (HPV), and attitudes and behaviours towards vaccines against them. STUDY DESIGN: This is a cross-sectional, multicentre study. METHODS: Data were collected through a questionnaire administered to 530 adults who accessed four Departments of Prevention of the Italian National Health Service in 2013. RESULTS: Less than 50% of people gave the right answer to all the questions concerning the three diseases, but 96.2%, 94% and 92.7% agreed with the importance of vaccination against N. meningitidis, S. pneumoniae and HPV, respectively, and 58.4% expressed own willingness to have their children vaccinated with N. meningitidis B vaccine. The attitude towards vaccination was more positive in women for N. meningitidis and in people having children for HPV. Furthermore, individuals giving correct answers to all knowledge items were more in favour of both HPV and S. pneumoniae vaccination. A total of 68.8%, 82.6% and 84.5% of respondents vaccinated their own children against N. meningitidis C, S. pneumoniae and HPV, respectively. About 50% of the respondents reported paediatricians' or other health professionals' recommendations as the main reason for vaccination. CONCLUSIONS: Vaccinations may be promoted through actions aimed at increasing citizens' knowledge. Health professionals should be educated to actively provide information on vaccinations in a clear, comprehensive and effective way.

[Effect of treatment with selective serotonin reuptake inhibitors on lipid profile: state of the art]. / Effetto del trattamento con inibitori selettivi del reuptake della serotonina sul profilo lipidico: stato dell'arte.

Selective Serotonin Reuptake Inhibitors (SSRI) are an effective treatment for depressive disorder. Nevertheless, there is evidence suggesting a negative effect of these drugs on the lipid profile of the patients. We carried out a systematic review of the literature evaluating the influence of therapy with SSRI on lipid profile. Data source was MEDLINE. Clinical trials, prospective studies, retrospective studies and reviews published until November 2011 were considered. We identified twelve studies published from 1994 to 2011, of which four were randomized clinical trials, six were prospective studies and two were retrospective studies. Sertraline and Paroxetine seemed to have negative effects on the serum levels of Total and LDL Cholesterol. Citalopram did not demonstrate any influence on Total and LDL Cholesterol blood levels, being conversely associated with a slight increase of the HDL Cholesterol levels. Few data were found about the effects of Fluoxetina e Fluvoxamina on lipid profile and no data were found about Escitalopram. Sertaline and Paroxetine, two effective and widely used drugs for the treatment of major depression, seem to have a negative effect on the lipid profile; Citalopram, with its neutral or positive effect on lipid profile, should be considered the treatment of choice for depressive patients affected by dyslipidemia.

Cardiac involvement in inflammatory bowel disease: role of acylcarnitine esters.

OBJECTIVES: Cardiovascular complications have been frequently described in Inflammatory Bowel Disease (IBD). Both Crohn disease and Ulcerative Colitis are characterized by malabsorption of some micronutrients, such as carnitine, which is a very important element for myocardial metabolism, being demonstrated that its deficiency correlates with heart involvement in coeliac disease. Aims of this study are to evaluate cardiac function in IBD patients asymptomatic for cardiovascular diseases and to correlate the cardiac data with the profile of carnitine esters plasma levels. MATERIALS AND METHODS: The study was carried out on 20 IBD patients by comparison with 18 sex- and age-matched clinically healthy controls. Personal and familial history, physical examination, standard electrocardiogram and echocardiogram were performed in all subjects. Complete panel of nutritional status parameters and serum levels of free carnitine and its esters were evaluated both in IBD patients and control subjects. RESULTS: Isovaleryl-carnitine, Tiglyl-carnitine, Octenoylcarnitine and Decanoyl-carnitine, were found to be significantly lower in IBD patients. Significant correlations were found between some carnitine esters and echocardiographic parameters although total and free carnitine were meanly more elevated in IBD. No statistically significant differences in echocardiographic parameters were found between IBD patients and control subjects. CONCLUSIONS: Deficiency of some isoforms of carnitine, especially those esterified with short chain fatty acids, may play an important role in cardiac involvement in course of IBD and could lead, over time, to dilated cardiomiopathy.

Análisis del modelo simple e integral (MODSI) como instrumento de evaluación del riesgo a lesiones músculo esqueléticas / Analysis of the simple integral model (MODSI) as a tool for risk assessment of musculoskeletal disorders

Objetivo: Aplicar el Modelo Simple e Integral (MODSI) para conocer los niveles de riesgo de padecer lesiones músculo-esqueléticas. Material y metodología: En 18 puestos de trabajo aplicamos el MODSI. Cada actividad fue filmada para el posterior estudio biomecánico del trabajo. Se obtuvieron la frecuencia cardiaca (FC), el esfuerzo percibido (EP) por el trabajador (de acuerdo con la escala de Borg), y factores psicosociales (FPS) como la iniciativa, el estatus social y la identificación con la actividad. Resultados: En el 62% de los puestos de trabajo el nivel de riesgo fue de alto a extremadamente alto. Encontramos una asociación (p<0,05) entre la respuesta cardiovascular del trabajador y las posturas menos neutrales. El EP estuvo muy relacionado con la FC (p<0,05) en los puestos de alta exigencia física. Solo en 8 actividades laborales se presentaron los FPS como estresantes. Conclusión: el MODSI es un sistema de fácil aplicación y sus componentes son capaces de discriminar los factores que determinan el nivel de riesgo de lesiones del aparato locomotor (AU)

Aim: The Simple and Comprehensive Model (MODSI) was applied to know the levels of risk of musculoskeletal disorders. Materials and Methods: Eighteen jobs were analyzed according to MODSI procedure, each activity was filmed in real time for studying the biomechanics of labor demand. The heart rate (HR) was measured electronically. Perceived exertion (PE) by the worker according to the activity was evaluated using the Borg Scale. Psychosocial Factors (SPF) as initiative, social status and identification with the activity were studied. Results: In 62% of the jobs the risk level was high to extremely high. It was found a significant association (P <0.05) between the cardiovascular response of the worker and less neutral postures. The EP was closely related to HR (P <0.05) in those high physical demands of work and continuous dynamics. Only in 8 working activities FPS were presented as stressful. Conclusions: We conclude that MODSI is easy to apply, and its components are able to discriminate the factors determining the level of risk of muscle-skeletal disorders (AU)

Unmasking aortic dissection in patients of transient global amnesia: case report and diagnostic algorithm for the emergency department.

It is not unusual for doctors working in the emergency department (ED) to diagnose a benign syndrome of transient global amnesia (TGA). It is rare that the TGA patient is in danger of life because of a 'forgotten' acute aortic dissection (AAD). The present article deals with one of such rare cases of association between TGA and AAD, which presented laboratory findings never reported before. A practical diagnostic algorithm has also been drafted to help ED physicians facing such a puzzling situation.

[Impact of depression syndrome in the management of cardiovascular risk factors in primary prevention: State of the art]. / Impatto della sindrome depressiva sulla gestione dei fattori di rischio cardiovascolare in prevenzione primaria. Stato dell'arte.

Our aim is to investigate, through a broad review of medical literature, the role of depressive syndrome on the adherence to lifestyle modifications (TLC) in patients with risk factors for cardiovascular disease (CVD). We conducted a systematic computerized literature search of MEDLINE using the following key words: depressive syndrome, cardiovascular risk factors, lifestyle, physical activity, diet, smoking, blood pressure, metabolic syndrome and diabetes. We have considered metanalyses studies, reviews, original articles, case-control studies published between 1992 and 2010. Furthermore, we have considered the impact of depressive syndrome on the different cardiovascular risk factors. From our search we have selected 42 English articles published between 1992 and 2010 of whose 16 were longitudinal cohort studies, 5 research reports, 10 longitudinal case-control studies, 2 metanalyses, 5 reviews and 4 prevalence studies. All our selected studies agree to give to depressive syndrome a negative role on the adherence to lifestyle modifications. For this reason, depression represents an indirect and independent cardiovascular risk factor that needs to be detected and treated for a successful cardiovascular prevention.

A singular case of granulomatous lesions of unknown significance.

The acronym used for granulomatous lesion of unknown significance, (GLUS), was first employed in 1990, to describe epithelioid-cell granulomas occasionally observed in biopsies from liver, lymph-nodes and other tissues without any apparent cause than thorough diagnostic examinations. Authors describe a case of a 51-year-old woman who was admitted to hospital because of fever, nodules in the liver and spleen, skin ulcerative lesions on the legs. The patient had a very long medical history; recurrent fever, liver and spleen enlargement have been lasting since 1975. Laboratory data showed erythrocyte sedimentation rate increase (125 mm 1 hour), anemia, (Hb=8.1 g/dL), an increase of alkaline phosphatase activity (328.4 mU/mL NV=80-275) and also an increase of policlonal gamma-globulins; patient's total proteins was 6.8 g/dL while their gamma-globulins were 29.5%; IgG=2 260 mg/dL (NV=751-1 560 mg/dL), IgM=277 mg/dL (NV=46-230 mg/dL), IgA=405 mg/dL (NV=70-400 mg/dL). One culture of the blood and a needle aspiration specimen of liver nodule was positive for Staphylococcus coagulase negative. This case cannot be regarded as GLUS-syndrome because of the long time duration of the disease and other clinical features. The dramatic, even if transient, liver nodules improvement obtained by Linezolid therapy, and the well-being obtained by prolonged monociclin use, make the authors hypothesize that Staphylococcus coagulase negative could be the etiological agent of this granulomatous clinical picture.

[Hereditary hemorragic telangiectasia: the state of art]. / Teleangectasia emorragica ereditaria: stato dell'arte.

Hereditary Hemorrhagic Telangiectasia (HHT) or Rendu-Osler-Weber syndrome, is a multisystemic vascular dysplasia. The disease is transmitted as a dominant autosomic character. The Hereditary Hemorrhagic Telangiectasia is differentiated in two subclasses: (1) HHT1, which is caused by mutation of ENG gene. This gene is localized on long arm of chromosome 9: (2) HHT2, which is caused by mutation of ALK-1 gene. This gene is located on long arm of chromosome 12. These two genes codify for two receptorial proteins: the endoglin and the activin-like protein 1; these proteins belong to receptorial superfamily of TGF-beta, which is involved in vascular remodelling and angiogenesis. Clinically, the consequences of these mutations are represented by the formation of cutaneous and/or mucous telangiectases and artero-venous fistulas. In both cases histological alteration is the same: extremely ectatic venules with numerous layers of myocytes around them. Arterioles communicate with venules directly without a capillary filter. Essentially, telangiectases manifest themselves with hemorrhages, while more common consequences of fistulas are secondary to formation of shunts with a possible thromboembolism; that is particularly serious in case of pulmonary artero-venous malformations. In 2000. Shovlin published 4 diagnostic criteria (criteria of Curaçao): (1) spontaneous and recurrent epistaxis; (2) multiple telangiectases; (3) visceral artero-venous malformations; (4) familiarity for HHT. Actually there is no possibility for a genetic therapy of HHT. Therefore, the therapeutic efforts are turned to control of symptoms and to the prevention of complications.

Plasma glucose level decreases as collateral effect of fermented papaya preparation use.

AIM: Fermented Papaya Preparation (FPP) is a natural healthy drug that has been commercially sold in Japan and Philippines. This nutricetive, bio-normalizer product has antioxidant action, inhibitory effect on oxidative DNA damage and tissue injury, being a potent OH scavanger. The wide use of FPP, expecially by elderly people, made us note an unknown collateral effect, i.e., blood sugar level dropping signs especially in the afternoon. The aim of the present work was to scientifically verify the possibility that individuals, who are taking the nutriceutical FPP, might have a decrease of plasma sugar levels. MATERIALS AND METHODS: For this purpose, 50 subjects, divided in two groups, were enrolled. The first group was made of 25 patients: 13 females and 12 males affected by type-2 diabetes mellitus under treatment with the oral antidiabetic drug, glybenclamide. The control group included 25 clinically-healthy subjects: 16 females and 9 males, matching in age. All subjects were given 3 grams of FPP daily, during lunch, for two months. RESULTS: The results of this study confirmed the empirical experience that FPP use can induce a significant decrease in plasma sugar levels in both healthy subjects and type 2 diabetic patients. This hypoglycaemic effect, associated with clinical signs, induced the diabetic patients to reduce the dosage of their antidiabetic oral therapy (in one patient the therapy was really suspended). CONCLUSIONS: In accordance with these results, the FPP administration is suggested as an adjuvant drug to join the oral antidiabetic therapy in type 2 diabetes meltus.

Do hypertension and diabetes mellitus influence the site of atherosclerotic plaques?

BACKGROUND: The concomitant occurrence of atherosclerotic plaques in carotid, coronary and peripheral vessels has been described in a number of studies. A few studies were, on the contrary, done for determining the role of hypertension and/or type 2 diabetes mellitus for the occurrence of the atherosclerotic plaques in different anatomical sites. Moreover these studies deal with atherosclerotic lesions that are generally considered, without differentiating their morphology as a function of the underlying disease, territory, and risk factors. Primary aim of this study is, thus, to verify whether the two most common causes for atherosclerotic disease, i.e., hypertension and type 2 diabetes mellitus, may influence the site of appearance of the atherosclerotic plaque. A second aim is to verify if the anatomical site of the plaque influences plaque morphology and vulnerability. PATIENTS AND METHODS: A retrospective study of 244 patients affected with type 2 diabetes mellitus or hypertension was performed; 114 subjects were affected by moderate-severe and drugs-treated hypertension (Group A); 55 were affected by type 2 diabetes mellitus in treatment with oral antidiabetic drugs (Group B); 75 were diagnosed as affected by the association hypertension and diabetes (Group C). The inclusion criteria were: exhaustive images of the cardiovascular system (coronary angiography, colour Doppler ultrasound of lower limb arteries and carotid arteries, transthoracic Doppler echocardiography ) and a serum lipid profile (total serum cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides). Three different anatomical sites: carotid axis, ilio-femoral arteries and coronary district, were considered. In each site a plaque lesion-classification was performed to describe the morphology of the plaque. RESULTS: In patients with hypertension, carotid district seems to be the preferential site of onset of atherosclerotic plaques even if a statistical significant association between the two conditions was not found. Statistical evaluation didn't show significant association between different risk factors and coronary district too. On the opposite, a significant association (p < 0.001) between diabetes and the presence of atherosclerotic plaques into lower limb district was found. A very significant association (p < 0.001) between type 2-diabetes and the presence of non-ulcerative plaques was found too. CONCLUSIONS: Our study underlines the relationship between vessel plaques localization and concomitant risk factors for atherosclerosis and suggests a possible difference in plaque morphology and biological behaviour related to different anatomical site.

Analysis of the chaotic component of the sinusal R-R intervals as a tool for detecting a silent cardiac dysautonomia in type 2 diabetes mellitus.

This study explores the heart rate (HR) variability (V) in order to detect whether the chaotic component of the sinusal R-R intervals (SRRI) can be interpreted as an early indicator of a silent cardiac neurovegetative dysautonomia in apparently uncomplicated Type 2 diabetic patients (DP). The SRRI were provided by the 24-h Holter ECG of 10 Type 2 DP (5 M and 5 F, mean age = 41 +/- 5 years). Control data were obtained by the 24-h Holter ECG of 10 clinically healthy subjects (CHS, 5 M and 5 F, mean age = 38 +/- 6 years). The chaotic component of HRV was investigated via the correlation dimension (CD) analysis (A) of the SRRI, performed per each hour of the ECG recording. The hourly-qualified series of SRRI, HR and CD index (I) were, in turn, analyzed via methods of conventional statistics and chronobiology, the latter ones for assessing the circadian rhythm (CR). The CDI CR was found to peak during the night in CHS, and to be unphysiologically rotated to the diurnal hours of the day in Type 2 DP. The diurnal inversion of the CDI CR in Type 2 DP suggests that the chaotic component of HRV shows an abnormal rhythnic pattern over the day-night period. Considering that the investigated Type 2 DP were lacking of documentable signs of cardiac neuropathy, it is hypothesized that the diurnal phase of shift CDI CR might be a potential indicator of a silent autonomic cardiac dysfunction in Type 2 DP. Such a hypothesis waits for further confirmations.

[Sodium channels and multiple sclerosis]. / Canali del sodio e sclerosi multipla.

Multiple Sclerosis is a chronic demyelinating disease of the central nervous system of undetermined etiology. Damage of myelinated fibers leads to block of conduction of impulses. In myelinated axons sodium channels are expressed at high density and they play a very important role in the conduction of nervous impulse. In myelinated fibers affected by Multiple Sclerosis substantial variations of sodium channels pattern occurs. These variations can help to explain pathophysiological and clinical aspects of Multiple Sclerosis and open a new way to approach and, probably, treat this disease.

[A five year follow-up of an HHV-8 related lymphoma in an HIV-negative elderly patient]. / Follow-up a 5 anni di un caso di Linfoma Primitivo delle cavità correlato all'HHV-8, in un paziente anziano HIV negativo.

Primary Effusion Lymphoma (PEL) associated with the Human Herpes Virus 8 (HHV-8), is a rare type of non-Hodgkin lymphoma. It mainly strikes HIV-positive men. Five-year follow-up of a case of PEL HHV-8 related in HIV negative elderly man, is described. The patient was admitted to our Department for dyspnea, thoracic pain and persistent slight temperature. Chest radiography showed a left pleural effusion. Cytomorphological, immunohistochemical and molecular assays performed on pleural fluid, demonstrated the presence of a PEL HHV-8 related, in absence of Epstein-Barr virus (EBV) infection in the tumour cells. Serologic test for HIV (ELISA) resulted negative. Chest TC, taken after thoracentesis, showed marked thickening of diaphragmatic pleura. Because patient's age and general conditions, no chemotherapy was performed. Five years after diagnosis, clinical examination and chest tomographyshowed resolution of the described syndrome; particularly chest TC showed complete disappearance of diaphragmatic pleura thickening. This biological behaviour is unusually for PEL: medical literature shows that this lymphoma has a very poor prognosis; this case-report suggests, as already proposed from some authors, that PEL, in HIV-negative EBV-negative patients, is a distinct clinical entity, with a different clinical behaviour.

Severity of human hypertension in relation to the age in which high blood pressure makes its presumptive appearance.

PURPOSE: The present study investigates the properties of blood pressure (BP) circadian rhythm (CR) in newly-diagnosed hypertensives (NDH) as a function of the chronological age in which hypertension became manifest. MATERIALS AND METHODS: The study was performed on 141 NDH (71 males and 70 females, ranging in age from 24 year to 79 years), who were monitored in their 24-h BP via a non-invasive, ambulatory, automated recorder. The relation between the properties of BP CR and the age of the development of hypertension was investigated via the Clinospectror method, a trend analysis (periodic-linear regression method) for rhythmic biophenomena. RESULTS: A trend was detected for each one of the three properties of BP CR in relation with the age in which high BP made its appearance. As a matter of fact, the daily mean level (mesor) of BP CR was seen to be progressively less pronounced. The amplitude was found to show a progressive increment of its extent. The acrophase was seen to show a progressive antemeridian rotation of its timing. CONCLUSIONS: These trends suggest that hypertension tends to be less severe when its development occurs in subjects older in age. Such a less pronounced severity is, however, accompanied by a more pronounced oscillation of BP values during the 24-h of the day. Such a higher circadian variability, in turn, tends to show its highest expression during the morning hours of the day.

[Evaluation of C3c, C4 and C1-esterase inhibitor (C1-INH) during unstable angina]. / Valutazione del C3c, del C4 e dell'inibitore della C1q-esterasi (C1-INH) in corso di angina instabile.

BACKGROUND: The complement system plays an important role in the physiopathology of acute myocardial infarction (AMI) taking part in myocardial damage and reperfusion injury. The aim of this study is to investigate the plasmatic levels of some complement components (C3c, C4 and C1-INH) during unstable angina (C1-INH) and their different concentrations in relation to the different myocardial areas affected by ischemia. METHODS: The plasmatic levels of C1-INH, C3c and c4 in 30 patients affected by unstable angina, and those of 22 clinically healthy subjects (control group) were evaluated (Nefelometer Behering). The patients were divided into four groups according to the different myocardial area affected by ischemia (anterior, antero-lateral, lateral or inferior ischemia), RESULTS: No statistically significant differences were found in plasmatic levels of C3c, C4 and C1-INH between the group of patients and the control group. There is a statistically significant difference between the C1-INH levels of the patients with inferior ischemia and the plasmatic concentrations of the whole patients' group (p<0,01), the control group (p<0,01) and the group of patients with lateral ischemia (p<0,02). CONCLUSIONS: There seems to be a different activation of the complement system during unstable angina, in relation to the different myocardial area affected by ischemia.

[Circadian rhythm of serum levo-carnitine: parameters]. / Ritmo circadiano della levo-carnitina sierica: parametri ritmometrici per programmare una eventuale cronoterapia.

OBJECTIVE: The present study investigates the circadian rhythm (CR) of levo-carnitine (L-c) in systemic venous blood, in order to detect rhythmometric parameters that can be used for programming an eventual chronoterapy with such a molecule. MATERIALS AND METHODS: The L-c CR was investigated in 10 clinically healthy subjects (5 M; 5 F; mean age: 26.02 +/- 1.11 yrs), who were diurnally active and nocturnally resting. Blood samples were taken at 06:00; 08:00; 12:00; 18:00; 20:00; 24:00, not juxtaposed to breakfast, lunch and dinner. The serum concentrations of L-c were assayed via a spectrophotometric method. RESULTS: A nychtohemeral variability in circulating levels of L-c was observed, with a peak in the afternoon. Such a intradiem variability was validated to have the properties of a significant CR (MESOR = 33.37 mumol/l with a SEM of 1.19 mumol/l; amplitude = 6.31 mumol/l with 95%CL ranging from 3.58 mumol/l to 9.69 mumol/l; acrophase at 15:52 h:min with 95%CL ranging from 13:28 h:min to 17:00 h:min). CONCLUSIONS: It is important to remark that the validation of a CR for the systemic serum levels of L-c was obtained in diurnally-active/nocturnally resting subjects. Such validated rhythmometric properties are parameters that can be used for programming an eventual chronotherapy, considering that the molecule L-c is used for treating its various types of primary and secondary deficiency.

The ambulatory monitoring documents a more elevated blood pressure regimen (pre-hypertension) in normotensives with endothelial dysfunction.

PURPOSE: The present study investigates the blood pressure (BP) 24-h values in normotensives with and without endothelial dysfunction (ED). The scope is to detect differences in BP regimen supporting the hypothesis that the ED is associated with vasopressant effects that can cause a condition of "pre-hypertension". MATERIALS AND METHODS: Thirty-eight normotensives were investigated in their endothelial function by mean of the non-invasive post-ischemic brachial artery vasodilation test (endothelium-dependent vasomotricity). Their were also automatically and non-invasively monitored in their systolic (S) and diastolic (D) BP over the 24-h period in order to confirm that they were not hypertensive. RESULTS: Eight of the investigated normotensives were found to show an ED. A significantly higher daily mean level as well as a more prominent nychtohemeral variability in SBP and DBP 24-h values were observed in the normotensives with ED as compared to the normotensives without ED. The higher BP regimen in the normotensives with ED was found to maintain a circadian rhythm. However, a significant amplification the second harmonic component, with a 12-h period, was observed. The different structure of the BP 24-h pattern in the normotensives with ED was confirmed by the detection of additional ultradian components at the linear-in-period spectral analysis. CONCLUSIONS: The present study documented a significant elevation of BP 24-h values in normotensives with ED that is the reflex of consistent changes in the frequency organization of the BP circadian pattern. The elevation of BP regimen suggests that the ED is associated with vasopressant effects even in normotensives. Such a condition of higher BP in normotensives with ED can be regarded as a status of "pre-hypertension".

Higher blood pressure load (baric impact) in normotensives with endothelial dysfunction: a paraphysiological status of "pre-hypertension".

PURPOSE: The present study investigated the blood pressure (BP) load (L), namely Baric Impact (BI), in normotensives with and without endothelial dysfunction (ED). The aim was to detect baric differences supporting the thesis that the ED is associated with vasopressant effects that are responsible for a paraphysiological condition of higher BP (pre-hypertension) even in normotensives. MATERIALS AND METHODS: Thirty-eight normotensives were investigated in their endothelium-dependent vasomotricity by mean of the non-invasive post-ischemic brachial artery vasodilation test. Additionally, their underwent a non-invasive ambulatory (A) BP monitoring (M) over the 24-h span in order to confirm that they were not hypertensive. The ABPM served also to compute the systolic (S) and diastolic (D) BI. RESULTS: The ED was detected in eight normotensives of the investigated group. These cases with ED were found to show a significantly higher SBI and DBI as compared to the normotensives without ED. CONCLUSIONS: The significant elevation of the SBI and DBI in normotensives with ED is an evidence convincing that a dysfunctional endothelium is responsible for vasopressant effects that cause a paraphysiological status of "pre-hypertension".