Aerobic physical activity based on fast walking does not alter blood pressure values in non-dipper essential hypertensives.

AIM: Walking is a very acceptable form of aerobic exercise. Several trials have demonstrated significant benefits of fast walking on the risk factors of cardiovascular disease, particularly for hypertension. Aim of our study was to assess whether physical activity obtained through fast walking might lead to a different reduction of blood pressure levels in hypertensive patients in relation to different circadian profile of blood pressure. METHODS: We have enrolled 84 hypertensive patients, with evidence of stage I hypertension and non-dipper nocturnal profile. All subjects underwent a six weeks physical intervention based on fast walking, three sessions a week. Main outcome measurements were diurnal, nocturnal and 24-h blood pressure levels. RESULTS: After the sixth week of physical exercise there was not any significant change in 24-hour mean systolic blood pressure and diastolic blood pressure ABPM values when compared to baseline (respectively 143.2±5.2 vs. 141±4.4 and 91.4±4.8 vs. 90.1±2.5); also no differences in heart rate have been found. CONCLUSION: In non-dipper hypertensives a light aerobic program of physical activity based on fast walking seems to be less effective to reduce blood pressure values, contrary to what has been observed in dipper ones.

Effects of physical exercise on inflammatory markers of atherosclerosis.

It is well established that physically fit individuals have a reduced risk of developing CVD (cardiovascular disease) and other age-related chronic disorders. Regular exercise is an established therapeutic intervention with an enormous range of benefits. Chronic low-grade systemic inflammation may be involved in atherosclerosis, diabetes and in pathogenesis of several chronic pathological conditions; recent findings confirm that physical activity induces an increase in the systemic levels of a number of cytokines and chemokines with anti-inflammatory properties. The possibility that regular physical exercise exerts anti-inflammation activity, being the interaction between contracting muscle and the other tissues and the circulating cells mediated through signals transmitted by "myokines" produced with muscle contractions. To date the list of myokines includes IL-6, IL-8, and IL-15. During muscle contractions are also released IL-1 receptor antagonis and sTNF-R, molecules that contribute to provide anti-inflammatory actions. Nevertheless discrepancies, analysis of available researches seem to confirm the efficacy of regular physical training as a nonpharmacological therapy having target chronic low-grade inflammation. Given this, physical exercise could be considerate a useful weapon against local vascular and systemic inflammation in atherosclerosis. Several mechanisms explain the positive effect of chronic exercise, nevertheless, these mechanisms do not fully enlighten all pathways by which exercise can decrease inflammation and endothelial dysfunction, and hence modulate the progression of the underlying disease progress.

Agenesis of the renal segment of inferior vena cava associated with venous stasis.

Congenital anomalies of the inferior vena cava is an extremely rare vascular anomaly with controversial pathogenesis. Anomalies of the inferior vena cava (IVC) are present in 0.3% to 0.5% of otherwise healthy individual and in 0.6% to 2% of patients with other cardiovascular defects. The phenomenon of absence of the IVC has been described in a variety of ways such as absence, agenesis, anomalous, and interruption of a particular segment ([infra] hepatic, prerenal, renal, or infrarenal) of the IVC. We describe a 42-year-old man with chronic venous insufficiency, without DVT, caused by congenital absence of renal segment of the IVC.

Superficial venous thrombosis: role of inherited deficiency of natural anticoagulants in extension to deep veins.

AIM: Superficial venous thrombosis (SVT) has been considered for a long time a limited clinical condition of low importance, but this approach has changed in recent years, when several studies demonstrated that extension to deep veins occurs in 7.3 to 44% of patients, with high prevalence of pulmonary embolism. The aim of this study was to evaluate the prevalence of inherited deficiency of natural coagulation inhibitors in patients suffering from SVT in both normal and varicose veins, and to understand their role in extension to deep veins. METHODS: The study included 83 patients with SVT, without clinically obvious risk factors. Ultrasound examination was performed, and deficiencies of Protein C, Protein S and Antithrombin (AT) were investigated. RESULTS: In the patients where SVT occurred in normal veins, coagulation inhibitor deficiencies were 6.45% in the absence of extension and 62.5% in patients with extension to deep veins. In the patients with varicose vein SVT, the presence of these factors was less evident, but their prevalence was considerably higher in those with extension to deep veins (36.3%) than in non-extension (6.06%). CONCLUSIONS: Present data confirm the role of inherited thrombophilic states related to inhibitor deficiency, considering them as risk factors for SVT in normal veins. Furthermore, an association has been found between their presence and the progression of SVT to deep veins.

Changes of arterial hemodynamics in patients with type 2 diabetes mellitus or impaired glucose tolerance.

AIM: The aim of our study was to evaluate the arterial hemodynamics in patients with type 2 diabetes mellitus or impaired glucose tolerance without clinical or Doppler evidence of peripheral arterial disease, in order to early detect vascular damage. METHODS: We studied 20 subjects (12 men and 8 women, aged between 48 and 62 years) with type 2 diabetes mellitus (Group 1), 20 subjects (11 men and 9 women, aged between 49 and 61 years) with reduced glucose tolerance (Group 2), and 20 normal subjects (10 men and 10 women, aged between 48 and 62 years) (Group 3). Each subject underwent strain-gauge plethysmography and the following parameters were evaluated: rest flow (RF); peak flow (PF); PF/RF ratio; time to peak flow (tPF); half-time (t 1/2) and total time (tT) of hyperemic response; basal vascular resistances (BVR) and minimal vascular resistances (MVR). RESULTS: There was no difference among groups in RF, but maximal postischemic flow was reduced in patients with diabetes and with impaired glucose tolerance. The MVR showed a similar behavior, while the basal ones were increased only in the diabetic group. Finally, the t1/2 and the tT of the hyperemic response, that reflect arteriolar reactivity, were significantly reduced, if compared with controls. No significant differences between Group 1 and 2 were found. CONCLUSIONS: These results confirm the presence of hemodynamic modifications in the vascular bed of both diabetics and patients with impaired glucose tolerance, as compared with normal subjects.

Iloprost treatment in patients with Raynaud's phenomenon secondary to systemic sclerosis and the quality of life: a new therapeutic protocol.

OBJECTIVES: To evaluate the clinical efficacy and the effects on the quality of life of iloprost, a prostacyclin analogue, used according to a new protocol in patients with Raynaud's phenomenon secondary to systemic sclerosis. METHODS: In this randomized study, we treated 30 patients with iloprost, given by intravenous infusion, at progressively increasing doses (from 0.5 to 2 ng/kg/min) over a period of 6 h each day for 10 days in two consecutive weeks, with repeated cycles at regular intervals of 3 months for 18 months. The results were compared with those obtained in 30 other patients who received the same drug but with different dosing schemes. RESULTS: The total average daily duration of the attacks, the average duration of a single attack and the average daily frequency of the attacks were reduced significantly in all treatment groups, but the comparison between the groups demonstrated significant differences between patients treated with the new protocol and the others at later times (12 and 18 months). The effects on the quality of life in the group treated with the new protocol, evaluated with the Short Form-36, demonstrated a marked improvement regarding both the scale relating to the physical aspect of the illness and, especially, the scale relating to the mental aspect. CONCLUSIONS: In patients with systemic sclerosis, cyclic intravenous iloprost infusion is efficacious in the treatment of Raynaud's phenomenon. The protocol that we used, compared with others, not only has favourable clinical effects but also leads to a marked improvement in the quality of life.

Critical limb ischemia: definition and natural history.

The term critical limb ischemia refers to a condition characterized by chronic ischemic at-rest pain, ulcers, or gangrene in one or both legs attributable to objectively proven arterial occlusive disease. Critical limb ischemia implies chronicity and is to be distinguished from acute limb ischemia. Its incidence is approximately 500 to 1000 per million year, with the highest rates among older subjects, smokers and diabetics. The rate of primary amputation ranges from 10% to 40%, and was performed only when no graftable distal vessels were present, or in neurologically impaired or hopelessly nonambulatory patients. Contrarily, in some highly specialized and aggressive centres about 90% of patients with CLI had an attempted revascularization. Furthermore, patients with critical limb ischemia have an elevated risk of future myocardial infarction, stroke and vascular death, 3-fold higher than patients with intermittent claudication. Therefore, due to its negative impact on the quality of life and the poor prognosis both in terms of limb salvage and survival, critical limb ischemia is a critical public health issue.

Effects of PGE-1 in patients suffering from peripheral arterial occlusive disease.

BACKGROUND: The purpose of the research is to determine the effects of PGE-1 in patients with chronic obliterans arteriopathy of the lower extremities and to investigate the possibility of its having an influence on local hemodynamics. METHODS: The study comprises 123 patients aged between 39 and 75 years, suffering from Fontaine's Stage Two peripheral arteriopathy randomised into 2 therapeutic groups: the patients of Group 1 were treated with PGE-1, those of Group 2 with the association pentoxyfillin-buflomedil by venous infusion. The following were evaluated: the free walking distance on a treadmill; Rest Flow, Peak Flow and basal and minimum vascular resistance by means of strain gauge plethysmography; RF, PF, tPF and tRF by means of laserdoppler. RESULTS: After 4 weeks of treatment an increase of 370% was observed in the absolute free walking distance and of 260% in that relative to patients treated with PGE-1, while the increase in the same parameters in Group 2 patients was considerably lower. Further, in Group 1 patients there was a significant increase in Peak Flow and an improvement in laserdoppler parameters markedly greater than those measured in the control group. CONCLUSIONS: In conclusion, the data obtained point to the effectiveness of PGE-1 in patients suffering from Fontaine's Stage 2 obliterans arteriopathy: this substance in fact improves the microcirculation and leads to the development of collateral circuits with a consequent improvement in local hemodynamics and an increase in walking distance.

[The role of the ambulatory care center in angiology services]. / Il ruolo del day hospital nelle strutture angiologiche.

Within the organization of national health care based on the DRG/ROD system, angiology services provided in "day hospital" play not only a large social role in the life of the community and the patient but also an economic one in hospital administration as there facilities allow continuation of inpatient care. Many diseases can be managed in an outpatient setting, both in diagnosis and treatment, particularly arterial hypertension, chronic obliterating arteriopathies of the lower extremities, microcirculatory and collagen disorders, VTE, and leg ulcers. A review of case records from the recent past confirms the importance of the role of the Angiology Outpatient Services plays within the Polyclinic of the University of Palermo. The exponential growth in the services provided by our facility has led to a twofold increase in the number of outpatient admissions over the past two years. This growth has produced a wider impact on the service area and allowed the introduction of angiology services that are economically profitable, while avoiding unprofitable services, through effective service management recognization. Our study results show that, where possible, outpatient care should be increasingly used. We believe that an optimal model for angiology services permits the integration of the two types of hospital care, with short stays on an inpatient basis, especially for the treatment of more severe or acute disease, and greater outpatient service utilization in ambulatory care.

[Hypertension and peripheral arterial hemodynamics]. / Ipertensione ed emodinamica arteriosa periferica.

Sixty uncomplicated hypertensive patients (40 stable and 20 borderline) were studied, by strain gauge plethysmography, in comparison with 25 normotensive subjects, in order to evaluate the arterial hemodynamics of the lower limbs in essential hypertension and to verify the different pattern in borderline and in stable hypertensives. Resting blood flow, even if lightly decreased in hypertensive groups, didn't show significant differences in its mean values; Peak Flow, instead, was reduced proportionally to the severity of hypertension in all the hypertensive patients, but only in the stable hypertensives did it prove statistically significant. Minimal Vascular Resistances showed a similar behaviour; they were significantly increased only in the stable hypertensives, whereas Basal Vascular Resistances, were raised in all hypertensive patients, in the borderline group too. Finally, half time and total hyperemic time, which indicate vascular reactivity, were significantly decreased in all hypertensives. These results suggest that the stable hypertensive patients principally develop arterial structural changes, while the borderline hypertensive patients have only functional modifications, such as a reduced compliance and a hyperdynamic condition.

Hypertension and peripheral arterial disease: a plethysmographic study.

Sixty patients suffering from arterial hypertension and/or obliterative arteriopathy of the lower limbs (20 hypertensive uncomplicated [H group], 20 normotensive affected by obliterative arteriopathy [A group], 20 suffering from both hypertension and peripheral arterial disease [HA group]) were studied, by strain gauge plethysmography, in comparison with 20 healthy subjects (N group). The aims were to evaluate the arterial and venous hemodynamics of the lower limbs in such conditions and also to determine whether the vascular damage is primary or represents a consequence of the hypertensive pathology in the patients affected by both hypertension and peripheral arterial disease. The resting blood flow did not show significant differences in the mean values, even if lightly decreased in hypertensive patients (with or without peripheral arteriopathy). The peak flow was reduced significantly both in the H group and in the A and HA groups. The half-time (t1/2) and total time (tT), which indicate vascular reactivity, were significantly decreased in the H group, but they were increased in the A and HA groups. Finally, the venous compliance was decreased in the H group, did not vary significantly in the A group, and showed an intermediate behavior in the HA group. These results suggest that hypertensive and arteriopathic patients develop similar arterial structural changes. However, they show a different behavior with regard to vascular reactivity and venous hemodynamics, as demonstrated by venous plethysmography.

Hypertension and peripheral arterial hemodynamics.

Sixty uncomplicated hypertensive patients (30 stable and 30 borderline) were studied, by strain gauge plethysmography, in comparison with 25 normotensive subjects, in order to evaluate the arterial hemodynamics of the lower limbs in essential hypertension and to verify the different pattern in borderline and in stable hypertensives. Resting blood flow, even if slightly decreased in hypertensive groups, did not show significant differences in its mean values; peak flow, instead, was reduced proportionally to the severity of hypertension in all the hypertensive patients, but only in the stable hypertensives was it statistically significant. Minimal vascular resistance showed a similar behavior: it was significantly increased only in the stable hypertensives, whereas basal vascular resistance was raised in all hypertensive patients and also in the borderline group. Finally, the half-time and the total hyperemic response time, which indicate vascular reactivity, were significantly decreased in all the hypertensives. These results suggest that the stable hypertensive patients develop principally arterial structural changes, while the borderline hypertensive patients have only functional modifications, such as a reduced compliance and a hyperdynamic condition.

Ticlopidine in the treatment of multiple atherosclerotic arteriopathy: a strain gauge plethysmography and Döppler spectrum analysis evaluation.

The effect of ticlopidine was compared with flunarizine in patients with iliac-femoral and/or femoral-popliteal arteriosclerotic arteriopathy accompanied by lesions of the cervical arteries of no haemodynamic significance. In the lower limbs, plethysmography (strain gauge measurements) and Döppler ultrasonography integrated by spectral analysis of the cervical arteries showed qualitative and quantitative improvements of the regional haematic flow. Side-effects were negligible which suggests that ticlopidine is useful in the treatment of multiple arteriosclerotic arteriopathy.