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2.
Circ Res ; 128(7): 1062-1079, 2021 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793331

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associates with a considerable high rate of mortality and represents currently the most important concern in global health. The risk of more severe clinical manifestation of COVID-19 is higher in males and steeply raised with age but also increased by the presence of chronic comorbidities. Among the latter, early reports suggested that arterial hypertension associates with higher susceptibility to SARS-CoV-2 infection, more severe course and increased COVID-19-related deaths. Furthermore, experimental studies suggested that key pathophysiological hypertension mechanisms, such as activation of the renin-angiotensin system (RAS), may play a role in COVID-19. In fact, ACE2 (angiotensin-converting-enzyme 2) is the pivotal receptor for SARS-CoV-2 to enter host cells and provides thus a link between COVID-19 and RAS. It was thus anticipated that drugs modulating the RAS including an upregulation of ACE2 may increase the risk for infection with SARS-CoV-2 and poorer outcomes in COVID-19. Since the use of RAS-blockers, ACE inhibitors or angiotensin receptor blockers, represents the backbone of recommended antihypertensive therapy and intense debate about their use in the COVID-19 pandemic has developed. Currently, a direct role of hypertension, independent of age and other comorbidities, as a risk factor for the SARS-COV-2 infection and COVID-19 outcome, particularly death, has not been established. Similarly, both current experimental and clinical studies do not support an unfavorable effect of RAS-blockers or other classes of first line blood pressure lowering drugs in COVID-19. Here, we review available data on the role of hypertension and its management on COVID-19. Conversely, some aspects as to how the COVID-19 affects hypertension management and impacts on future developments are also briefly discussed. COVID-19 has and continues to proof the critical importance of hypertension research to address questions that are important for global health.


Assuntos
/tratamento farmacológico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Antagonistas de Receptores de Angiotensina/metabolismo , Antagonistas de Receptores de Angiotensina/farmacologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , /metabolismo , Inibidores da Enzima Conversora de Angiotensina/metabolismo , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/metabolismo , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Humanos , Hipertensão/metabolismo , Sistema Renina-Angiotensina/efeitos dos fármacos , Sistema Renina-Angiotensina/fisiologia , Fatores de Risco
3.
Eur Heart J ; 42(16): 1543-1544, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882573
5.
J Nephrol ; 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33755930

RESUMO

BACKGROUND: Hyperuricemia is commonly observed in patients with chronic kidney disease (CKD). However, a better understanding of the relationship among uric acid (UA) values, glomerular filtration rate (GFR) and albuminuria may shed light on the mechanisms underlying the excess of cardiovascular mortality associated with both chronic kidney disease and hyperuricemia and lead to better risk stratification. Our main goal was to study the relationships between serum uric acid and kidney disease measures (namely estimated GFR [eGFR] and albuminuria) in a large cohort of individuals at cardiovascular risk from the URic acid Right for heArt Health (URRAH) Project database. METHODS: Clinical data of 26,971 individuals were analyzed. Factors associated with the presence of hyperuricemia defined on the basis of previously determined URRAH cutoffs for cardiovascular and all-cause mortality were evaluated through multivariate analysis. Chronic kidney disease was defined as eGFR < 60 ml/min per 1.73 m2 and/or abnormal urinary albumin excretion diagnosed as: (i) microalbuminuria if urinary albumin concentration was > 30 and ≤ 300 mg/L, or if urinary albumin-to-creatinine ratio (ACR) was > 3.4 mg/mmol and ≤ 34 mg/mmol; (ii) macroalbuminuria if urinary albumin concentration was > 300 mg/L, or if ACR was > 34 mg/mmol. RESULTS: Mean age was 58 ± 15 years (51% males, 62% with hypertension and 12% with diabetes), mean eGFR was 81 ml/min per 1.73m22with a prevalence of eGFR < 60 and micro- or macroalbuminuria of 16, 15 and 4%, respectively. Serum uric acid showed a trend towards higher values along with decreasing renal function. Both the prevalence of gout and the frequency of allopurinol use increased significantly with the reduction of eGFR and the increase in albuminuria. Hyperuricemia was independently related to male gender, eGFR strata, and signs of insulin resistance such as body mass index (BMI) and triglycerides. CONCLUSIONS: The lower the eGFR the higher the prevalence of hyperuricemia and gout. In subjects with eGFR < 60 ml/min the occurrence of hyperuricemia is about 10 times higher than in those with eGFR > 90 ml/min. The percentage of individuals treated with allopurinol was below 2% when GFR was above 60 ml/min, it increased to 20% in the presence of CKD 3b and rose further to 35% in individuals with macroalbuminuria.

6.
J Hum Hypertens ; 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33758349

RESUMO

The aim of our study was to evaluate the prevalence, awareness, and control of hypertension in an apparently healthy company population. We conducted a cross-sectional study on a total sample of 2058 individuals with a mean age of 38 ± 9 years, enrolled for the first time to the Ferrari corporate wellness program "Formula Benessere". Hypertension was defined as systolic blood pressure (SBP) level ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg or use of antihypertensive medication, whereas BP control was defined as BP level <130/80 mmHg. All 2058 participants were divided into three groups based on age: Group 1 aged <40 years (n = 1177, 57%), Group 2 aged 40-50 years (n = 627, 30%), and Group 3 aged >50 years (n = 254, 13%). Four-hundred and one subjects had BP levels ≥130/80 mmHg (19.5%). Two-hundred and sixty-one individuals (12.7%) had high-normal BP values and 140 subjects had rest SBP ≥140 mmHg and/or DBP ≥90 mmHg (6,8%), of which 41 (29.3%) with grade 2 hypertension. In the overall population, 259 individuals (12.5%) were affected by hypertension, the prevalence increasing with age. Only a minority (51%) was aware of being hypertensive and already treated with antihypertensive medications (45.9%). An adequate BP control was achieved in only 57% of subjects who received BP-lowering therapy. Corporate wellness programs may represent an essential tool in identifying apparently healthy subjects with an inadequate control of cardiovascular (CV) risk factors, such as hypertension. These preventive programs in the workplace may help to improve and spread primary CV prevention at the population level.

7.
High Blood Press Cardiovasc Prev ; 28(3): 255-262, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33710599

RESUMO

Essential hypertension is the most common cardiovascular (CV) risk factor, being primarily involved in the pathogenesis of CV disease and mortality worldwide. Given the high prevalence and growing incidence of this clinical condition in the general population in both high and low-income countries, antihypertensive drug therapies are frequently prescribed in different hypertension-related CV diseases and comorbidities. Among these conditions, evidence are available demonstrating the clinical benefits of lowering blood pressure (BP) levels, particularly in those hypertensive patients at high or very high CV risk profile. Preliminary studies, performed during the Sars-COVID-19 epidemic, raised some concerns on the potential implication of hypertension and antihypertensive medications in the susceptibility of having severe pneumonia, particularly with regard to the use of drugs inhibiting the renin-angiotensin system (RAS), including angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These hypotheses were not confirmed by subsequent studies, which independently and systematically demonstrated no clinical harm of these drugs also in patients with Sars-COVID-19 infection. The aim of this narrative review is to critically discuss the available evidence supporting the use of antihypertensive therapies based RAS blocking agents in hypertensive patients with different CV risk profile and with additional clinical conditions or comorbidities, including Sars-COVID-19 infection, with a particular focus on single-pill combination therapies based on olmesartan medoxomil.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Olmesartana Medoxomila/uso terapêutico , Sistema Renina-Angiotensina/efeitos dos fármacos , Comorbidade , Humanos , Pandemias , Pneumonia Viral/virologia
9.
Expert Rev Clin Immunol ; : 1-6, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33770445

RESUMO

Objectives: The authors aimed to evaluate the role of N-terminal proANP (NT-proANP) and of NT-proBNP circulating levels as predictive markers of death due to systemic sclerosis (SSc).Methods: The authors retrospectively enrolled 51 SSc patients. At baseline, NT-proBNP and NT-proANP circulating levels and clinical features were collected. Date and causes of death were extracted during a 6-year follow-up.Results: 13 SSc patients (23.2%) died for SSc complications (9 for interstitial lung disease and 4 for pulmonary arterial hypertension). The median NT-proBNP plasma level did not significantly differ (p > 0.05) in SSc patients died or alive [645 (448-1026) fmol/ml vs 592 (409-789) fmol/ml]. The median NT-proANP plasma level was significantly (p < 0.01) higher in SSc died than in SSc patients alive [4000 (2100-6722) fmol/ml vs 1640 (1381-2721) fmol/ml]. The Kaplan-Meier analysis revealed that SSc patients with increased NT-proANP level had increased mortality (p < 0.05). In the multivariate analysis, DLco [HR 0.966 (0.934-0.999), p < 0.05] and NT-proANP level [HR 1 (1-1), p < 0.05] were predictive markers of death due to SSc.Conclusions: NT-proANP plasma level is a predictive marker of death due to SSc.

13.
High Blood Press Cardiovasc Prev ; 28(2): 151-157, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33544372

RESUMO

The approach to hypertensive emergiencies (HE) and urgencies (HU) may be different according to local clinical practice, despite recent guidelines and position papers recommendations. The Italian Society of Hypertension (Società Italiana della Ipertensione Arteriosa, SIIA) developed an online survey, in order to explore the awareness, management and treatment of HU in Italy, sending by e mail a 12 items questionnaire to the members of the SIIA. The results show that the definition of HU was correctly identified by 62% of the responders. Most physicians identified the role of pharmacological therapy or legal/illegal substances abuse as possible cause of BP elevation; the use of a benzodiazepine drugs was considered worthwhile by 65% of responders. The prescription of diagnostic test and drug administration significantly differed from guidelines recommendations and only 57% of the physicians reported to treat HU with oral drug administration. Sub-lingual nifedipine was prescribed by 13% or responders. This survey shows the need to further spread the updated scientific information on the management and treatment of HE and HU, along with the improvement of the interrelationship with the general practitioner health system in Italy.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Medicina Geral/tendências , Hipertensão/tratamento farmacológico , Padrões de Prática Médica/tendências , Adolescente , Adulto , Idoso , Uso de Medicamentos/tendências , Emergências , Feminino , Fidelidade a Diretrizes/tendências , Pesquisas sobre Serviços de Saúde , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
15.
Eur J Prev Cardiol ; 2021 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-33582757

RESUMO

AIMS : Whether the association between uric acid (UA) and cardiovascular disease is influenced by some facilitating factors is unclear. The aim of this study was to investigate whether the risk of cardiovascular mortality (CVM) associated with elevated UA was modulated by the level of resting heart rate (HR). METHODS AND RESULTS : Multivariable Cox analyses were made in 19 128 participants from the multicentre Uric acid Right for heArt Health study. During a median follow-up of 11.2 years, there were 1381 cases of CVM. In multivariable Cox models both UA and HR, either considered as continuous or categorical variables were independent predictors of CVM both improving risk discrimination (P ≤ 0.003) and reclassification (P < 0.0001) over a multivariable model. However, the risk of CVM related to high UA (≥5.5 mg/dL, top tertile) was much lower in the subjects with HR

16.
Eur Heart J ; 42(8): 809-810, 2021 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-33611397
17.
Clin Res Cardiol ; 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33604722

RESUMO

INTRODUCTION: Serum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis. AIM: We assessed the prognostic role of SUA in patients with and without MS. METHODS: We used data from the multicentre Uric Acid Right for Heart Health study and considered cardiovascular mortality (CVM) as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. RESULTS: A total of 9589 subjects (median age 58.5 years, 45% males) were included in the analysis, and 5100 (53%) patients had a final diagnosis of MS. After a median follow-up of 142 months, we observed 558 events. Using a previously validated cardiovascular SUA cut-off to predict CVM (> 5.1 mg/dL in women and 5.6 mg/dL in men), elevated SUA levels were significantly associated to a worse outcome in patients with and without MS (all p < 0.0001) and provided a significant net reclassification improvement of 7.1% over the diagnosis of MS for CVM (p = 0.004). Cox regression analyses identified an independent association between SUA and CVM (Hazard Ratio: 1.79 [95% CI, 1.15-2.79]; p < 0.0001) after the adjustment for MS, its single components and renal function. Three specific combinations of the MS components were associated with higher CVM when increasing SUA levels were reported, and systemic hypertension was the only individual component ever-present (all p < 0.0001). CONCLUSION: Increasing SUA levels are associated with a higher CVM risk irrespective of the presence of MS: a cardiovascular SUA threshold may improve risk stratification.

18.
J Hum Hypertens ; 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33589761

RESUMO

Isolated systolic hypertension (ISHT) is common in elderly patients, whilst its prevalence and clinical impact in young adults are still debated. We aimed to estimate prevalence and clinical characteristics of ISHT and to evaluate out-of-office BP levels and their correlations with office BP in young adults. A single-center, cross-sectional study was conducted at our Hypertension Unit, by including treated and untreated individuals aged 18-50 years, who consecutively underwent home, clinic and 24 h ambulatory BP assessment. All BP measurements were performed and BP thresholds were set according to European guidelines: normotension (NT), clinic BP <140/<90 mmHg; ISHT, BP ≥140/<90 mmHg; isolated diastolic hypertension (IDHT), BP <140/≥90 mmHg; systolic-diastolic hypertension (SDHT), BP ≥140/≥90 mmHg. European SCORE, vascular and cardiac HMOD were also assessed. From an overall sample of 13,053 records, we selected 2127 young outpatients (44.2% female, age 40.5 ± 7.4 years, BMI 26.7 ± 5.0 kg/m2, clinic BP 141.1 ± 16.1/94.1 ± 11.8 mmHg, 24 h BP 129.0 ± 12.8/82.4 ± 9.8 mmHg), among whom 587 (27.6%) had NT, 391 (18.4%) IDHT, 144 (6.8%) ISHT, and 1005 (47.2%) SDHT. Patients with ISHT were predominantly male (61.1%), younger and with higher BMI compared to other groups. They also showed higher home and 24 h ambulatory SBP levels than those with NT or IDHT (P < 0.001), though similar to those with SDHT. ISHT patients showed significantly higher pulse pressure (PP) levels than other groups, at all BP measurements (P < 0.001 for all comparisons), and significantly higher proportion (65.3%) of patients with ISHT had PP >60 mmHg. European SCORE resulted significantly higher in patients with ISHT (1.6 ± 2.9%) and SDHT (1.5 ± 2.7%) compared to those with IDHT (0.9 ± 1.5%) or NT (0.8 ± 1.9%) (P = 0.017). Though relatively rare, ISHT should be not viewed as a benign condition, being associated with sustained SBP elevation, high European SCORE risk, and vascular HMOD.

19.
Eur Heart J ; 42(12): 1130-1131, 2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33585891
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