Obesity related changes in cardiac structure and function: role of blood pressure and metabolic abnormalities.

BACKGROUND: It has been reported that changes in cardiac structure and ventricular function associated with obesity have to be attributable to hemodynamic and non-hemodynamic alterations. Accordingly, the aim of this was to evaluate left ventricular hypertrophy (LVH) prevalence and its effect on left ventricular systolic and diastolic function in a cohort of obese patients. MATERIALS AND METHODS: LV internal diameter (LVID), left ventricular mass (LVM) and LVM/height2.7(LVMI), relative wall thickness (RWT), LV ejection fraction (LVEF), E/A ratio, isovolumic relaxation time, deceleration time of E velocity by echocardiography and pulsed-wave Doppler and total circulating adiponectin (ADPN) b…

Heredity and obesity-associated hypertension: impact of hormonal characteristics and left ventricular mass.

Objectives : To investigate the influence of heredity on obesity-associated hypertension, we evaluated casual and 24-h blood pressure, left ventricular mass and some metabolic and hormonal measurements in normotensive obese subjects. Design : Healthy, normotensive obese subjects (n = 81) with positive or negative family history of hypertension were studied. Both groups were also subdivided according to a positive or a negative family history of obesity. Accordingly, 45 obese subjects had a positive family history of hypertension, 25 of these having a positive (subgroup A) and 20 having a negative family history of obesity (subgroup B). The other 36 obese subjects had a negative family histo…

Angiotensin converting enzyme gene polimorfism and central obesity: relationship with blood pressure and left ventricular structure and function

Endothelial nitric oxide synthase gene polymorphisms and cardiovascular damage in hypertensive subjects: an Italian case-control study

Abstract Background Nitric oxide (NO) synthesized by endothelial nitric oxide synthase (eNOS) plays an important role in regulation of endothelial function and in the control of blood pressure. However, the results from some studies on the association between three clinically relevant eNOS gene polymorphisms (G894T, T786C and intron 4b/a) and essential hypertension are unclear. We designed a case-control study to evaluate the influence of eNOS polymorphisms on target organ damage in 127 hypertensives and 67 normotensives. Clinical evaluation, biochemical parameters, Urinary Albumin Excretion (UAE) and echocardiogram were performed to characterize target organ damage. eNOS polymorphism were …

Left ventricular diastolic and systolic function in normotensive obese subjects: influence of degree and duration of obesity.

The present study was carried out to evaluate systolic and diastolic parameters in overweight and moderately obese, but otherwise healthy subjects, and in a lean control group, to determine whether degree and duration of obesity can influence left ventricular function. A total of 27 subjects, 17 overweight or with moderate obesity and 10 lean, healthy subjects were included. Patients were divided into three groups according to their body mass index (BMI) and to Garrow's criteria as follows: lean control group (BMI less than 25 kg.m-2); overweight subjects (BMI from 25 to 30 kg.m-2); moderately obese subjects (BMI greater than 30 less than 40 kg.m-2). Systolic and diastolic parameters were m…

Transforming growth factor ß1 ed effetto nefroprotettivo dell’associazione ACE-inibitore/ AT1 antagonista in soggetti ipertesi con iniziale danno renale.

Iperuricemia: significato clinico e nuove prospettive di trattamento

Advice for health-care professionals on how to retrieve more efficiently scientifically strong and up-to-date studies on treatments by PubMed.

AND trial (Title/Abstract))). Obviously, clini- cians using the PubMed Clinical Queries may be unaware of the PubMed search engine technical approach even whether they can remain unaware of what the PubMed search engine is doing. We demonstrated substantial mild retrieval bias of PubMed Clinical Queries filter focusing on therapy (narrow search) that can miss up-to-date scientifically information on treatments. This bias occurs because the search string does not consider the Britannic English variant of the term randomized (i.e., randomised). We suggested a slight change in the original search string by the addition of the term randomised as follows: (randomized controlled trial (Publicatio…

Non-alcoholic fatty liver disease: Severity of fibrosis and its relationships with clinical and biological variables

Methodological matters on an Alzheimer's dementia trial: is a double-blind randomized controlled study design sufficient to draw strong conclusions on treatment? Reply to Dr Mazza and colleagues.

Obesity and cardiovascular risk: the new public health problem of worldwide proportions

Obesity could be considered a new global health epidemic above all others, especially when it is characterized by central fat distribution. This is illustrated by dramatic provisional data, indicating a continuous increase in the trend of overweight and obese individuals in several countries, including the USA and countries in Europe. Several epidemiological, pathophysiological and clinical studies clearly indicate that two of the major independent risk factors for cardiovascular disease or events are being overweight, and obesity. Accordingly, weight loss and prevention of weight gain has to be considered one of the most important strategies to reduce the incidence of cardiovascular diseas…

Micro-albuminuria in obese subjects: relationship among body fat distribution, blood pressure and left ventricular structure and function.

OBJECTIVE: To evaluate the relationships among micro-albuminuria, blood pressure and measurements of left ventricular structure and function in centrally and peripherally obese subjects compared with members of a lean control group. METHODS: Centrally obese subjects were subdivided according to whether they had levels of micro-albuminuria higher than 30 mg/24 h (micro-albuminuric group) or lower than or equal to 30 mg/24 h (normo-albuminuric group). For all the subjects we measured heart rate, casual mean blood pressure (MBP), 24 h MBP, total cholesterol level, high-density lipoprotein cholesterol, lipoprotein (a) level, fasting immunoreactive insulin level, plasma renin activity, plasma al…

Sindrome metabolica: fatti e compromessi.

Hemostatic function in young subjects with central obesity: relationship with left ventricular function.

This study was designed to evaluate coagulation and fibrinolysis activity and their relationship with left ventricular function in young obese subjects with central fat distribution. We assessed coagulation and fibrinolysis activity by evaluation of factor VII activity, fibrinogen and plasminogen, plasminogen activator inhibitor (PAI), and tissue plasminogen activator antigen basally (tPA1) and after venous occlusion (tPA2). These measures were evaluated in young (< 40 years) obese subjects with central fat distribution (n = 19) and in comparable lean subjects (n = 20). Blood glucose, triglycerides, total and high-density lipoprotein (HDL) cholesterol, apolipoprotein (apo) A1 and apo B, fas…

Thyroid function and release of thyroid-stimulating hormone and prolactin from the pituitary in human obesity

Thyroid function, basal serum thyroid-stimulating hormone (TSH) and prolactin concentrations, and the effects of 200 micrograms TSH-releasing hormone (TRH) given intravenously on TSH (delta TSH) and prolactin (delta prolactin) were investigated in 25 euthyroid obese subjects and 20 lean controls. No significant differences in serum thyroid hormone concentrations, glucose metabolism parameters, or basal TSH and prolactin concentrations were detected between groups, but a significant (P less than 0.01) increase in delta TSH and a significant (P less than 0.01) decrease in delta prolactin were observed in obese subjects. No significant differences in basal TSH and prolactin were observed in ob…

Is losartan able to improve renal haemodynamics in hypertensives? a long term study

Diastolic dysfunction and central obesity related hypertension: role of trasforming growth factor beta-1

Abstract P-368 Key Words: Diastolic Dysfunction, Obesity Related Hypertension, Trasforming Growth Factor beta-1

Central obesity and hypertension. Relationship between fasting serum insulin, plasma renin activity, and diastolic blood pressure in young obese subjects

This study was designed to evaluate the role of fasting serum insulin and plasma renin activity in obesity-induced hypertension. In view of this, plasma catecholamines, fasting serum insulin (IRI), urinary sodium excretion (NaU), plasma renin activity (PRA), and plasma aldosterone (PA) levels were assessed in young (age less than 40 years) normotensive (n = 27) and hypertensive (n = 14) subjects with central obesity and in lean normotensives (n = 20). Central obesity was evaluated by waist-to-hip ratio (WHR) according to the indication of the Italian Consensus Conference of Obesity. PRA, PA, IRI, and plasma norepinephrine levels were significantly (P < .05) higher in both obese groups than …

Scompenso cardiaco da disfunzione diastolica.

Evaluation of regional haemodynamic and alterations of vascular wall of the lower limbs in hypertensive subjects.

We-P13:336 Haemostatic and fibrinolytic abnormalities in obese patients and in patients with type 2 diabetes with metabolic syndrome

Efficacy and safety of long-term ezetimibe/simvastatin treatment in patients with familial hypercholesterolemia

Aim. Patients with heterozygous familial hypercholesterolemia (FH) have an increased risk of premature myocardial infarction, stroke, and surgical revascularization, and an increased rate of progression of carotid intima-media thickness (IMT). The most commonly used drugs for cholesterol lowering, statins, have a limited action in these patients. Ezetimibe, a novel compound, selectively inhibits cholesterol uptake and when associated with statins has an additional low-density lipoprotein cholesterol (LDL-C) reducing effect. The aim of this study is to evaluate the effects of long-term combined Ezetimibe/Simvastatin (EZE/SIMVA) therapy (30 months) on the lipidic pattern, inflammatory markers…

Echo-Doppler left ventricular filling abnormalities in patients with rheumatoid arthritis without clinically evident cardiovascular disease

Our investigation aimed at verifying diastolic abnormalities in rheumatoid patients, without clinically evident cardiovascular disease and other confounding complaints, by using pulsed Doppler examination of transmitral blood flow. We selected 40 patients fulfilling revised American Rheumatism Association (ARA) criteria for the diagnosis of rheumatoid arthritis having no symptoms of cardiac disease or clinical findings of other extracardiac diseases. We also studied 40 rheumatoid-matched healthy volunteers as a control group. An echocardiographic examination was carried out on each subject. Left ventricular structural and functional measurements were obtained. Interventricular, septal thick…

Sindrome metabolica oggi: che cosa c’è da sapere, che cosa c’è da fare.

Antihypertensive efficacy and effects of nitrendipine on cardiac and renal hemodynamics in mild to moderate hypertensive patients: Randomized controlled trial versus hydrochlorothiazide

In this study antihypertensive efficacy, safety, and the effects of short-term nitrendipine administration on central and renal hemodynamics were evaluated in mild to moderate hypertensives. Our final goal was to ascertain whether the reduction in blood pressure induced by nitrendipine treatment was associated with maintained renal function. After a run-in period with placebo, 26 hypertensives without cardiac or renal disease were randomly assigned to a double-blind 8-week controlled trial with nitrendipine (N) 20 mg once a day (13 pts) or hydrochlorothiazide (HCT) 25 mg once a day (13 pts). Renal hemodynamic measurements included effective renal plasma flow (ERPF) and glomerular filtration…

Salt-regulating hormones in young normotensive obese subjects. Effects of saline load.

To investigate whether the response of salt-regulating hormones to volume expansion is impaired in obese subjects, we assessed the effects of saline load (0.25 mL/kg.min.120 min) in 9 young, healthy, normotensive obese subjects (body mass index, &gt; 30 kg/m2) and in 10 lean control subjects (body mass index, &lt; 25 kg/m2) matched for age, gender, height, and mean blood pressure. Hematocrit, plasma renin activity (PRA), plasma aldosterone (PA), atrial natriuretic factor (ANF), and urinary sodium excretion (UNaV) were evaluated. Saline load increased ANF levels significantly (P &lt; .001) in lean subjects at both 60 and 120 minutes, whereas they decreased in obese subjects. Such decreases b…

Lymphocyte beta-adrenergic receptors in young subjects with peripheral or central obesity: relationship with central haemodynamics and left ventricular function

This study was designed to evaluate total (t) and surface (s) β-adrenergic receptor (BAR) density and their relationship with central haemodynamics and left ventricular function in young subjects with central or peripheral obesity. A total of 31 obese subjects (BMI ≥30.5 kg. m−2 for males and >27.3 kg. m−2 for females) aged less than 40 years and without other risk factors for cardiovascular diseases (smoking, hypertension, diabetes and lipid abnormalities) were studied. Nine had peripheral obesity and 22 central obesity according to WHR values; there were 20 lean controls (BMI <25 kg. m−2 for males and <24.7 kg. m−2 for females). Casual (c) and 24 h ambulatory mean blood pressures (MBP-24 …

La terapia dietetica nell’insufficienza renale cronica.

Cardiac involvement in rheumatoid arthritis: Evidence of silent heart disease

Background : Rlieumatoid arthritis (RA) is a systemic disease involving many organ systems and is frequently accompanied by cardiac alterations. However, there is considerable disagreement concerning the cardiac abnormalities found in patients with RA. The purpose of our investigation was to determine, by a non-invasive method such as echocardiography, the nature and extent of cardiac involvement in RA patients with no symptoms of cardiac disease, in comparison with a control sample. Methods : We selected 35 patients affected by rheumatoid arthritis (five men, 30 women), aged 51 ± 11 years. No patient had either symptoms of cardiac disease or extra cardiac complaint. As a control group we s…

Transforming growth factor β1 and additional renoprotective effect of combination ACE inhibitor and angiotensin II receptor blocker in hypertensive subjects with minor renal abnormalities: A 24-week randomized controlled trial

Objective To verify the benefit of renin–angiotensin system blockade in hypertension, the effects of 24 weeks’ losartan and ramipril treatment, both alone and in combination, on urinary albumin excretion (UAE) and circulating transforming growth factor b1 (TGFb1) have been evaluated in hypertensive subjects with minor renal abnormalities. Design and methods Fifty-one patients with stage 1 and 2 essential hypertension and with UAE &gt;—20 mg/24 h but with maintained renal function have been included. After a 4-week run-in with placebo administration, a randomized double-blind, three-arm double-dummy trial was used. All the hypertensives (HT) were allocated randomly to three treatment arms (1…

Inter-familial and intra-familial phenotypic variability in three Sicilian families with Anderson-Fabry disease.

// Antonino Tuttolomondo 1 , Irene Simonetta 1 , Giovanni Duro 2 , Rosaria Pecoraro 1 , Salvatore Miceli 1 , Paolo Colomba 2 , Carmela Zizzo 2 , Antonia Nucera 3, 4 , Mario Daidone 1 , Tiziana Di Chiara 1 , Rosario Scaglione 1 , Vittoriano Della Corte 1 , Francesca Corpora 1 , Danai Vogiatzis 1 and Antonio Pinto 1 1 U.O.C di Medicina Interna con Stroke Care, Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.M.I.S), University of Palermo, Palermo, Italy 2 CNR-IBIM: Institute of Biomedicine and Molecular Immunology “A. Monroy” Palermo, Palermo, Italy 3 Stroke Unit, Neurology, Saint Andrea Hospital, La Spezia, Italy 4 Department of Clinical Neurological Sciences, Western Univer…

Associazione tra elevate livelli circolanti di Transforming growth factor ß1 (TGF ß1) ed alterato riempimento ventricolare sinistro in una popolazione di soggetti ipertesi.

Surgery during etanercept therapy in patients with rheumatoid arthritis: is it time to follow patient preferences?

Tumor necrosis factor (TNF)-a inhibitors, such as etanercept and infliximab, improve symptoms and function in patients affected by rheumatoid arthritis (RA) [1, 2] and, therefore, are playing an increasing role in the management of this disease. However, interference with endogenous TNF-a signalling has been reported to alter both normal inflammatory responses in tissue healing and infection surveillance [2, 3]. To our knowledge, the rates of surgery in RA are decreasing. However, with the duration of antiTNF therapy, the number of patients under these agents having surgery will be increasing. These data raise the question of whether TNF-inhibitors can be safely used in RA patients who shou…

Antihypertensive and cardiovascular effects of combined blockade of renin-angiotensin system with ACE inhibitor and angiotensin II type 1 receptor blocker in hypertensive patients: A 24-week randomized controlled double-dummy trial

BACKGROUND.: In this study the effects of 24 weeks losartan and ramipril treatment, both alone and in combination, on blood pressure and left ventricular mass (LVM) and function, have been evaluated in hypertensives. METHODS.: 57 hypertensives with stage 1 and 2 essential hypertension were included. After 4 weeks run in, a randomized double-blind, 3 arm, double dummy, independent trial was used. All patients were randomly allocated to 3 treatment arms consisting of losartan (50 mg/daily), ramipril (5 mg/daily), and combined (losartan 50 mg/ramipril 5 mg/daily) for 24 weeks. LVM, LVM/h(2.7) and other echocardiographic measurements, BUN, creatinine and clearance and potassium were determined …

Safety of etanercept therapy in rheumatoid patients undergoing surgery: preliminary report

This is a preliminary report on a case-series of rheumatoid patients that underwent various kinds of elective surgery but did not withdraw etanercept therapy in spite of physician advise. Elective surgery consisted of right knee surgical prosthesis, bilateral cataract, bilateral hallux valgus, right hip prosthesis, bladder stone by cystoscopy and left inguinal hernia. All the patients had a regular healing rate. During follow-up (6-12 months) no one of these patients were suffering from infective complications after surgery. According to same recent literature results, our data suggest that it is the time to value rheumatoid patient preferences through a correct information about cost-benef…

Relationship between transforming growth factor beta1 and progression of hypertensive renal disease.

In this study the role of circulating transforming growth factor beta1 (TGFbeta1) on progression of renal hypertensive disease has been investigated. Fifty consecutive outpatients with essential hypertension were enrolled and divided into three groups, according to their urinary albumin excretion (UAE). Group A comprised 10 hypertensives with UAEor=20 mg/24 h (normoalbuminuric group); Group B included 21 hypertensives with UAE20300 mg/24 h (microalbuminuric group); Group C encompassed 19 hypertensives with UAEor= 300 mg/24 h (proteinuric group). In all patients UAE by immunonephelometric assay, circulating TGFbeta1 by a solid phase specific sandwich ELISA technique, BUN and creatinine by ro…

Relationship between circulating E-selectin, DD genotype of angiotensin-converting-enzyme, and cardiovascular damage in central obese subjects

Fifty-six young central obese patients were investigated to evaluate relationships between soluble E-selectin (sE-S), angiotensin-converting enzyme (ACE) gene polymorphism, left ventricular function and structure, and carotid morphology by determination of sE-S and ACE genotypes. Our results indicated that central obese subjects with concomitant higher levels of sE-S and ACE DD genotype may be characterized by early cardiovascular alterations and then considered a particular subset of subjects at higher risk of cardiovascular disease.

The Usefulness of Bioelectrical Impedance Analysis in Differentiating Dyspnea Due to Decompensated Heart Failure

Acute dyspnea poses a diagnostic challenge for physicians, and the current methods in differentiating cardiac from non-cardiac causes have been limited to date. Recently, the brain natriuretic peptide (BNP) rapid test has been validated in the emergency room. Nevertheless, the early accumulation of fluid in the interstitial space in the body and in the lungs, which characterizes patients with ADHF, is well estimated by BIA. We investigate whether bioelectrical impedance analysis (BIA) can serve as a noninvasive diagnostic tool in the differential diagnosis of acute decompensated heart failure (ADHF) in the emergency department (ED).A total of 292 patients presenting with acute dyspnea to th…

Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study

No data exist about the possibility that vertebral fracture in PMR patients could be independent of steroid therapy. For this reason, we aimed to investigate this topic by a case cohort study with a 1-year follow-up for each patient. We selected ten consecutive patients who experienced vertebral fractures (VF-group) during the first month of 1-year follow-up period and without any other significant associated condition. As a control group we studied ten control patients, without vertebral fractures and with a follow-up of 1 year, randomly selected among a larger group of patients affected by polymyalgia rheumatica. The following data were analysed: eritrosedimention rate (ESR), visual analo…

Therapeutic management of elderly hypertensives with concomitant ischaemic heart disease.

CHARACTERISTICS OF ELDERLY HYPERTENSIVES: Hypertension is most prevalent in older patients and is associated with increasing morbidity and mortality with age. Elderly hypertensives often suffer from concomitant diseases, such as ischaemic heart disease, caused by age-induced modifications to the cardiovascular system, haemodynamic function and neurohormone activity. THERAPEUTIC MANAGEMENT: Therapeutic management of elderly hypertensives with concomitant ischaemic heart disease must take account of the pharmacodynamic and pharmacokinetic changes that occur in older subjects and drugs should be selected for their efficacy in both diseases. Since elderly subjects often metabolize drugs more sl…

Heart involvement in rheumatoid arthritis: systematic review and meta-analysis.

Abstract Objective The aim of our study was to conduct a systematic review with meta-analysis of the current case–control studies about the valvular and pericardial involvement in patients with Rheumatoid Arthritis (RA), asymptomatic for cardiovascular diseases. Methods Case–control studies were identified by searching PubMed (1975–2010) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1975–2010). Participants were adult patients with RA asymptomatic for cardiovascular diseases, and the outcome measure was the presence of cardiac involvement. Results Quantitative synthesis included 10 relevant studies out of 2326 bibliographic citations that had been found. RA resulted sign…

Analysis of 24-h noninvasive ambulatory blood pressure profiles by a third-degree polynomial approach

Extensive experience of the circadian variation of blood pressure (BP) has been reported. But some problems exist concerning the correct and satisfactory evaluation of 24-h BP profiles. A well-known approach is the Halberg's 'cosinor' method. But it could be considered inadequate for blood pressure recordings because it is based on a rigid model that does not practically fit empirical data. We suggest an approach based on a cubic function as a suitable method for such an analysis. Our investigation studied the behavior of 24-h blood pressure by a model where the function f(t) is a third-degree polynomial. We recruited 52 untreated patients affected by essential hypertension. Ambulatory BP r…

Antihypertensive and cardiovascular effects of combined blockade of renin-angiotensin system with ACE inhibitor and angiotensin II type 1 receptor blocker in hypertensive patients: a 24 week randomized controlled double-dummy trial.

Background: In this study the effects of 24 weeks losartan and ramipril treatment, both alone and in combination, on blood pressure and left ventricular mass (LVM) and function,have been evaluated in hypertensives. Methods. 57 hypertensives with stage 1 and 2 essential hypertension were included. After 4 weeks run in, a randomized double-blind, 3 arm, double dummy, independent trial was used. All patients were randomly allocated to 3 treatment arms consisting of losartan (50 mg/daily), ramipril (5 mg/daily), and combined (losartan 50 mg/ramipril 5 mg/daily) for 24 weeks. LVM, LVM/h and other echocardiographic measurements, BUN, creatinine and clearance and potassium were determined after ru…

Hypoadiponectinemia: A Link between Visceral Obesity and Metabolic Syndrome

Metabolic syndrome (MetS) represents a combination of cardiometabolic risk factors, including visceral obesity, glucose intolerance or type 2 diabetes, elevated triglycerides, reduced HDL cholesterol, and hypertension. MetS is rapidly increasing in prevalence worldwide as a consequence of the “epidemic” obesity, with a considerable impact on the global incidence of cardiovascular disease and type 2 diabetes. At present, there is a growing interest on the role of visceral fat accumulation in the occurrence of MetS. In this review, the effects of adipocytokines and other proinflammatory factors produced by fat accumulation on the occurrence of the MetS have been also emphasized. Accordingly, …

Effects of moderate Sicilian red wine consumption on inflammatory biomarkers of atherosclerosis.

Objective: The aim of the study is to evaluate the effect of moderate Sicilian red wine consumption on cardiovascular risk factors and, in particular, on some inflammatory biomarkers. Methods: A total of 48 subjects of both sexes who were nondrinkers or rare drinkers of moderate red wine were selected and randomly subdivided into two groups assigned to receive with a crossover design a Sicilian red wine (Nero d’Avola or Etna Torrepalino) during meals: Group A (n ¼ 24), in whom the diet was supplemented for 4 weeks with 250 ml/day of red wine, followed by 4 weeks when they returned to their usual wine intake; and Group B (n ¼ 24), in whom the usual wine intake was maintained for 4 weeks, fol…

Prevalence of obesity and ischaemic heart disease in hypertensive subjects

In the present study the prevalence of obesity and its association with ischemic heart disease, recognized according to clinical criteria (chest pain or previous infarction) and/or instrumental data, were described in 8,847 normotensive subjects and in 867 hypertensive subjects, hospitalized during a ten years period (1983-1992), through a cross-sectional study. In view of this all the subjects were considered as lean or obese according to their body mass index (BMI) and to sex specific cut-off values reported in the Italian Consensus Conference on Obesity. In particular, according to BMI values, the subjects were grouped as lean, overweight, moderate and severe obese subjects. Our results …

Efficacia della associazione Atorvastatina e n-3 PUFA in pazienti affetti da dislipidemia combinata e ad alto rischio di eventi cardiovascolari

A family with various symptomatology suggestive of Anderson-Fabry disease and a genetic polymorphism of alpha galactosidase A gene.

Background: Anderson/Fabry disease expresses a wide range of clinical variability in patients that it is possible to explain referring to a genetic variability with numerous mutations described in the literature (more than 600). Methods: We report some clinical cases of some members of a Sicilian family to express phenotypical variability of this disease in subjects with the same genetic mutation. Results: The first case was a 59-year-old female. Brain MRI revealed right frontal periventricular white matter of likely vascular-degenerative origin. The proband's alpha galactosidase A activity was 3.7. nmol/mL/h. Molecular genetics revealed a polymorphism: - 10 C. &gt;. T; IVS 2-76_80del5; IVS…

Effects of cilazapril on renal haemodynamics and function in hypertensive patients: a randomised controlled study versus hydrochlorothiazide.

In this study the efficacy and safety of short-term cilazapril administration on renal haemodynamics were evaluated in mild to moderate hypertensive subjects. Our final goal was to evaluate whether the reduction in blood pressure achieved by treatment was associated with maintained renal function. After a run-in period with placebo, 40 hypertensive subjects without renal or cardiac diseases were randomly allocated to a double-blind 4 week controlled trial with cilazapril 5 mg once a day (20 patients) or hydrochlorothiazide 25 mg once a day (20 patients). Renal haemodynamics measurements included effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) by radionuclide study us…

Associazione tra elevati livelli circolanti di Transforming growth factor ß1 (TGF ß1) e alterato riempimento ventricolare sinistro in una popolazione di soggetti ipertesi.

Two-dimensional echocardiographic evaluation of left ventricular ejection fraction by the ellipsoid single-plane algorithm: a reliable method for assessing low or very low ejection fraction values?

The reliability of two-dimensional (2D) echocardiographic estimation of left ventricular ejection fraction (EF) is commonly recognized, but no satisfactory data are available about the accuracy of low or very low EF values determined by 2D echocardiography (ECHO-EF). The purpose of our study was to assess the reliability of low ECHO-EF values obtained using a simple time-economical algorithm such as the ellipsoid single-plane area-length method. Radionuclide angiography (RAD-EF) was taken as the standard of comparison. We studied 59 consecutive patients (31 women and 28 men) referred to our echocardiographic laboratory. Both 2D echocardiography and radionuclide angiography were blindly perf…

Heredity and obesity-associated hypertension: impact of hormonal characteristics and left ventricular mass. J Hypertens

OBJECTIVES: To investigate the influence of heredity on obesity-associated hypertension, we evaluated casual and 24-h blood pressure, left ventricular mass and some metabolic and hormonal measurements in normotensive obese subjects. DESIGN: Healthy, normotensive obese subjects (n = 81) with positive or negative family history of hypertension were studied. Both groups were also subdivided according to a positive or a negative family history of obesity. Accordingly, 45 obese subjects had a positive family history of hypertension, 25 of these having a positive (subgroup A) and 20 having a negative family history of obesity (subgroup B). The other 36 obese subjects had a negative family history…

Effetti cardioprotettivi del Blocco del Sistema Renina-Angiotensina-Aldosterone tramite l’associazione ACE-inibitore – Sartani: Relazione con i livelli circolanti di Transforming Growth Factor ß1.

Cardiovascular Events in Rheumatoid Arthritis-Time to See Beyond Articular Involvement in "Real World" Clinical Practice: Comment on the Article by Mackey et al.

No evidence-based practice by biased information from systematic reviews: the case of etanercept and infliximab for the treatment of psoriatic arthritis.

Vascular health in subjects with rheumatoid arthritis: assessment of endothelial function indices and serum biomarkers of vascular damage

Background The cardiovascular risk (CVD) in patients with rheumatoid arthritis (RA) is 1.5–2 times higher than that in individuals of the same age and sex. Aims To analyse the degree of endothelial dysfunction, the atherogenic immunoinflammatory serum background and the relationships among some vascular indices, cardiovascular comorbidities, and cognitive performance in subjects with RA. Patients and methods All consecutive patients with a rheumatoid arthritis diagnosis admitted to the Rheumatology Ward of “Policlinico Paolo Giaccone” Hospital of Palermo were enrolled from July 2019 to September 2020. We evaluated our patients’ cognitive functions by administering the Mini-Mental State Exam…

Obesità e rischio cardiovascolare.

L’obesità rappresenta attualmente la più diffusa patologia da malnutrizione delle Società occidentali industrializzate e si associa spesso a svariate complicanze invalidanti sia mediche che chirurgiche. Essa è, inoltre, una condizione ad elevata prevalenza ed in continuo e costante incremento, al punto da essere etichettata come una “Epidemia globale”. Nella presente review sono stati analizzati i risultati degli studi più recenti che hanno individuato nella patologia del tessuto adiposo uno dei meccanismi più importanti nello sviluppo dell’aterosclerosi e delle manifestazioni cliniche ad essa connesse. Particolare riguardo è stato dato, oltre che alle evidenze epidemiologiche riguardanti i…

Association Between Low Education and Higher Global Cardiovascular Risk

This study was designed to evaluate the impact of educational status on global cardiovascular risk in a southern Italian urban population. The study population consisted of 488 consecutive outpatients aged 18 years and older. Educational status was categorized according to the number of years of formal education as follows: (1) low education group (10 years) and (2) medium-high education group (10-15 years). In both groups, cardiometabolic comorbidities (obesity, visceral obesity, diabetes, dyslipidemia, metabolic syndrome, microalbuminuria, left ventricular hypertrophy) and global cardiovascular risk, according to international guidelines, were analyzed. Left ventricular mass index and eje…

Association between reduced lymphocyte beta-adrenergic receptors and left ventricular dysfunction in young obese subjects

This study was designed to evaluate total (t) and surface (s) beta-adrenergic receptors (BAR) density and their relationships with left ventricular function in young obese subjects. BAR density, plasma insulin, catecholamines and left ventricular function were evaluated in 27 young obese subjects (BMI30.5 kg/m2 for males and27.3 kg/m2 for females) without other risk factors for cardiovascular diseases (smoking, hypertension, diabetes and lipid abnormalities) and in 20 lean controls (BMI25 kg/m2 for males and24.7 kg/m2 for females). Both groups were matched for gender, age and body height. BAR density was evaluated according to Böyum and De Blasi methods. Plasma catecholamines by high perfus…

Left ventricular diastolic filling alterations in subjects with mitral valve prolapse: A Doppler echocardiographic study

To assess left ventricular diastolic filling in mitral valve prolapse (MVP), we studied 22 patients with idiopathic MVP and 22 healthy controls matched for sex, age, body surface area and heart rate. A two-dimensional, M-mode and Doppler echocardiographic examination was performed to exclude any cardiac abnormalities. The two groups had similar diastolic and systolic left ventricular volumes, left ventricle mass and ejection fraction. Doppler measurements of mitral inflow were: E and A areas (the components of the total flow velocity-time integral in the early passive period of ventricular filling, E; and the late active period of atrial emptying, A), the peak E and A velocities (cm.s-1), a…

No evidence of platelet activation in obesity.

Central obesity and hypertension: Pathophysiologic role of renal haemodynamics and function

OBJECTIVE: To investigate the role of alterations in renal haemodynamics and function and in plasma renin activity on obesity-induced hypertension. DESIGN: Renal haemodynamics and function, salt-regulating hormones and structural cardiac parameters were evaluated in 20 lean normotensives and in 64 obese subjects with central or peripheral fat distribution, 43 of them were normotensives and 21 of them were hypertensives. Obesity and central fat distribution were defined according to sex-specific 85th percentile respectively of Body Mass Index (BMI) and Waist to Hip Ratio (WHR). MEASUREMENTS: Serum immunoreactive insulin (IRI), plasma renin activity (PRA), plasma aldosterone (PA), microalbumi…

May Adiponectin be considered as a Novel Cardiometabolic Biomarker?

This study was designed to evaluate the interaction between total adiponectin (ADPN) and metabolic syndrome (MetS) on cardiac changes in 135 subjects with and without MetS, subgrouped according to normal or low ADPN. Left ventricular internal diameter (LVID/h), LV mass (LVM), LVM index (LVMI), interventricular septal thickness (IVST), relative wall thickness (RWT) and LV ejection fraction (EF) by echocardiography and diastolic parameters, by pulsed-wave Doppler were calculated. BMI, LVM, LVMI, LVID/h, IVST and RWT values were significantly (p<0.05) higher in both groups with low ADPN. Prevalence of left ventricular hypertrophy (p<0.001) and coronary artery disease (p<0.01) was significantly…

Effects of amlodipine on renal haemodynamics in mild to moderate hypertensive patients. A randomized controlled study versus placebo.

In this study the efficacy and safety of short-term amlodipine administration on renal haemodynamics were evaluated in mild to moderate hypertensive subjects. Our final goal was to evaluate whether the reduced blood pressure induced by treatment was associated with maintenance of renal function. After a run-in period with placebo, 30 hypertensive patients without cardiac or renal diseases were randomly allocated to a double-blind 4 weeks controlled study with amlodipine 10 mg once a day (15 patients) or placebo (15 patients). Renal haemodynamic measurements included effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) by radionuclide study using 131I-hippuran and 99mTc, w…

Hemodynamic Changes in Patients with Essential Hypertension after Therapy with Muzolimine

Muzolimine is a new nonsulfonamide diuretic belonging to the pyrazolinone group (1).It is a potent high-ceiling diuretic agent like furosemide and bumetanide with long duration of action like thiazides (1, 2).

Circulating adiponectin: a cardiometabolic marker associated with global cardiovascular risk

OBJECTIVE This study was designed to evaluate the relationship among circulating adiponectin (ADPN), left ventricular mass (LVM) and cardiometabolic comorbidities in subjects at higher global cardiovascular risk (score of “ Cuore Project “) METHODS. 115 consecutive subjects were grouped according to normal or low ADPN levels. Left ventricular internal diameter (LVID/h), total LV mass (LVM), LVM index (LVMI), relative wall thickness (RWT), LV ejection fraction by echocardiography and diastolic parameters, by pulsed-wave Doppler were calculated. RESULTS Low-ADPN subjects were characterized by a significant higher prevalence of some cardiometabolic comorbidities (obesity, visceral obesity, dia…

Education and hypertension: impact on global cardiovascular risk

Background: Improving cardiovascular risk prediction continues to be a major challenge and effective prevention of cardiovascular disease. Accordingly, several studies have recently reported on the role of cardiovascular risk education. This study was designed to evaluate the impact of education on global cardiovascular risk in hypertensive patients.Subjects and methods: The study population consisted of 223 consecutive hypertensive outpatients. Their educational status was categorized according to the number of years of formal education as follows: (1) low education (less than 10 years) and (2) medium-high education (10-15 years).Results: In both groups, cardiometabolic comorbidities, glob…

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction.

Left ventricular ejection fraction (EF) is helpful to differentiate heart failure (HF) phenotype in clinical practice. The aim of the study was to identify simple echocardiographic predictors of post-discharge all-cause mortality in hospitalized HF patients. Patients with acute HF (75 ± 9.8 years), classified in preserved (≥ 50%) and reduced (&lt; 50%) EF (HFpEF and HFrEF, respectively), were enrolled. The mean follow-up period was of 25.4 months. Patients definitively analyzed were 135. At multivariate Cox model, right ventricular diameter (RVd), inferior vena cava diameter (IVCd) and blood urea nitrogen (BUN) resulted to be significantly associated with all-cause mortality in HFpEF (HR 2.…

The Relationship between the Transforming Growth Factor β1 T29C Gene Polymorphism and Left Ventricular Geometry and Function in Hypertensive Subjects

The distribution of the T29C TGFβ1 gene polymorphism was analyzed in 198 hypertensives with left ventricular hypertrophy (LVH) and in 235 hypertensives without LVH. Circulating TGFβ1 levels, procollagen type III levels, microalbuminuria, and left ventricular geometry and function were evaluated in all the hypertensives with LVH subgrouped according to T29C TGFβ1 gene polymorphism. Circulating TGFβ1 was evaluated by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, and left ventricular geometry and function by echocardiography. All groups were comparable for gender, age, and sex. Regarding T29C TGFβ1 gene polymorphism, prevalence of T…

Central obesity and hypertensive renal disease: association between higher levels of BMI, circulating transforming growth factor beta1 and urinary albumin excretion.

OBJECTIVE: In this study, the relationship between circulating transforming growth factor beta1 (TGFbeta1) and urinary albumin excretion (UAE) has been investigated in non-obese and central obese hypertensive patients. DESIGN AND PATIENTS: Fifty-eight consecutive hypertensive outpatients both lean and with central obesity were enrolled and divided in three groups, according to their body mass index (BMI) values. Group A: 16 lean hypertensives (men with BMI or = 25 kg/m2 and 24.7 kg/m2 and or = 30 kg/m2 and women with BMI > or = 27.3 kg/m2). MEASURES: In all patients, UAE, by immunonephelometric assay, circulating TGFbeta1 by a solid-phase specific sandwich enzyme-linked immunosorbent assay …

Early carotid atherosclerosis and cardiac diastolic abnormalities in hypertensive subjects

Despite the fact that it is known that hypertension may be associated to early atherosclerosis manifestations, few data are to date available on the relationship between early carotid abnormalities and left ventricular diastolic dysfunction. To address this issue, 142 hypertensive patients (64 females and 78 males) younger than 55 years, at the first diagnosis of mild-to-moderate essential hypertension (WHO/ISH criteria), were selected from a database consisting of 3541 subjects referred to ultrasound cardiovascular laboratory in the last 5 years. Carotid intima-media thickness (IMT) was detected by high-resolution vascular ultrasound and left ventricular structure and function by the use o…

Effects of a short-term hypoenergetic diet on morphofunctional left ventricular parameters in centrally obese subjects

BACKGROUND: We aimed to study centrally obese subjects without other diseases, to establish whether a short-term hypoenergetic balanced regimen is able to positively modify left ventricular (LV) patterns. METHODS: We studied 32 obese subjects (out of 52 recruited for this study) with central fat distribution and without associated diseases. Each subject had undergone a moderately hypoenergetic diet for a four-month follow-up period and had a regular loss in weight. Some relevant clinical and echocardiographic parameters were evaluated. Baseline data and those evaluated at the end of the follow-up period were used for outcome analysis. RESULTS: We found a considerable reduction in LV mass an…

Transforming growth factor beta1 T29C gene polymorphism and hypertension: relationship with cardiovascular and renal damage.

Distribution of T29C TGFβ1 gene polymorphism was analysed in 260 hypertensive and 134 normotensive subjects. Circulating TGFβ1 and procollagen type III levels, microalbuminuria, left ventricular geometry and function were evaluated in all the hypertensives subgrouped according to T29C TGFβ1 gene polymorphism. Circulating TGFβ1 by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, left ventricular geometry and function by echocardiography were determined. All groups were comparable for gender, age and sex. Regarding T29C TGFβ1 gene polymorphism, prevalence of TC or CC genotypes was significantly (p &lt; 0.05) higher in hypertensives th…

Clinical and haemodynamic effects of ketanserin in lean and obese hypertensive patients.

Systemic and central haemodynamics were evaluated in 10 lean and 10 obese hypertensive patients (World Health Organization stage I – II) after treatment for 8 weeks with a serotoninergic antagonist, such as ketanserin. Blood pressure and heart rate were recorded and first-pass radionuclide angiocardiography was performed to determine cardiac output, cardiac index and ejection fraction of the left ventricle; total peripheral resistance was also calculated. In both obese and lean patients, ketanserin significantly reduced diastolic ( P &lt; 0.05) and mean ( P &lt; 0.005) blood pressure but no significant changes in systolic blood pressure, cardiac output, cardiac index and ejection fraction …

Fast recovery with etanercept in patients affected by polymyalgia rheumatica and decompensated diabetes: a case-series study

We enrolled nine consecutive patients affected by newly diagnosed polymyalgia rheumatica and decompensated diabetes mellitus. All patients were treated with etanercept (25 mg twice weekly) and prednisone and were followed up to 1 year. At the sixth-month follow-up, etanercept and prednisone were withdrawn. Patients were seen at regular intervals (days 0, 30, 60, 90, 150, 180) and the following variables determined: erythrocytes sedimentation rate, C-reactive protein, fasting serum glucose, pain measured by visual analog scale, and the Health Assessment Questionnaire. Our results indicate that etanercept might have some steroid-sparing effects, but controlled investigations are needed to sup…

Optimized search strategy for detecting scientifically strong studies on treatment through PubMed.

OBJECTIVE: To develop optimal MEDLINE search strategies for retrieving sound clinical studies of the etiology, prognosis, diagnosis, prevention, or treatment of disorders in adult general medicine. DESIGN: Analytic survey of operating characteristics of search strategies developed by computerized combinations of terms selected to detect studies meeting basic methodologic criteria for direct clinical use in adult general medicine. MEASURES: The sensitivities, specificities, precision, and accuracy of 134,264 unique combinations of search terms were determined by comparison with a manual review of all articles (the "gold standard") in ten internal medicine and general medicine journals for 19…

Central obesity and hypertensionThe role of plasma endothelin

Hypertension and central obesity are two conditions closely linked, but the mechanisms responsible for obesity-associated hypertension are still unclear. In the last few years, several studies addressed the role of endothelin-1 (ET-1) in the development and maintenance of hypertension. This study was designed to evaluate plasma ET-1 in normotensive and hypertensive central obese subjects compared with a lean healthy group. Our final goal was to analyze the relationship between plasma ET-1, blood pressure, and left ventricular structure and function in central obese subjects (both normotensives and hypertensives). ET-levels have been assessed by the radioimmunoassay method in 20 lean normote…

Relationship between left ventricular hypertrophy, diastolic function and extracardiac atherosclerosis in newly diagnosed hypertensives

Changes in natriuretic peptide and cytokine plasma levels in patients with heart failure, after treatment with high dose of furosemide plus hypertonic saline solution (HSS) and after a saline loading

BACKGROUND AND AIMS: Neurohormonal activation and inflammation characterizes heart failure, relates to outcome, and is a therapeutic target. The aim of this study was to evaluate the effects of high-dose furosemide plus small-volume hypertonic saline solutions (HSS) on natriuretic peptides and immuno-inflammatory marker levels and to analyze, after treatment, the response to acute saline loading. METHODS AND RESULTS: 120 patients with heart failure treated with high-dose furosemide+HSS (Furosemide/HSS group) were matched with: 30 subjects with heart failure treated with high-dose furosemide (furosemide group), 30 controls with asymptomatic left-ventricular dysfunction (ALVD) (asymptomatic g…

Correlation between different degree and duration of metabolic control and thyroid hormone levels in type 1 and type 2 diabetics.

Thyroxine (T4), triiodothyronine (T3), reverse T3 (rT3) and HbA1c were assayed in 21 insulin-dependent (type 1) diabetics and in 45 non-insulin-dependent (type 2) diabetics with normal thyroid function and different levels of control, and were compared to values found in apparently healthy controls. rT3 and rT3/T3 ratio were significantly increased both in type 1 and type 2 diabetics. T3 and T4 were significantly lower in type 2 diabetics than in the controls. Significant positive correlations of HbA1c to rT3 (r = 0.63) and to rT3/T3 ratio (r = 0.53) were found in type 1, and in type 2 diabetics (HbA1c, rT3-r = 0.50), (HbA1c, rT3/T3-r = 0.37). There was no correlation between glycemia (BG),…

Visceral obesity and metabolic syndrome: two faces of the same medal?

In this review, we have analyzed the role of visceral obesity in the occurrence of metabolic syndrome (MetS). MetS is a common metabolic disorder that has been related recently to the increasing prevalence of obesity. The disorder is defined in various ways, but in the near future a new definition(s) should be applicable worldwide. The pathophysiology has been largely attributed, in the past years, to insulin resistance, although several epidemiological and pathophysiological data now indicate visceral obesity as a main factor in the occurrence of all the components of MetS. In view of this, relationships among visceral obesity, free fatty acids, dyslipidemia and insulin resistance have bee…

Hypoadiponectinemia, cardiometabolic comorbidities and left ventricular hypertrophy

This study was designed to evaluate the prevalence of cardiometabolic comorbidities and the changes in left ventricular geometry and function in 135 subjects subgrouped according to low or normal total adiponectin plasma (ADPN) levels. Left ventricular (LV) internal diameter/height, total LV mass (LVM) and LVM index (LVMI), relative wall thickness (RWT), LV ejection fraction by echocardiography and diastolic parameters by pulsed-wave Doppler were calculated. Body mass index (BMI) (p < 0.0001), waist-to-hip ratio (p < 0.03), triglycerides (p < 0,001), prevalence of obesity (p < 0.005), visceral obesity (p < 0.003), left ventricular hypertrophy (LVH) (p < 0.001), metabolic syndrome (p < 0.000…

Central obesity and hypertension: the role of plasma endothelin. Am J Hypertens

Hypertension and central obesity are two conditions closely linked, but the mechanisms responsible for obesity-associated hypertension are still unclear. In the last few years, several studies addressed the role of endothelin-1 (ET-1) in the development and maintenance of hypertension. This study was designed to evaluate plasma ET-1 in normotensive and hypertensive central obese subjects compared with a lean healthy group. Our final goal was to analyze the relationship between plasma ET-1, blood pressure, and left ventricular structure and function in central obese subjects (both normotensives and hypertensives). ET-levels have been assessed by the radioimmunoassay method in 20 lean normote…

Evaluation of regional haemodynamics and alterations of vascular wall of the lower limbs in hypertensive subjects

This study was designed to analyse the relationship between arterial hypertension and changes in arterial blood flow and vascular wall damage of the lower limbs in hypertensive patients with various degrees of hypertension. Six hundred and fifty-four hypertensive patients (421 males and 233 females) aged 35 to 70 years and 88 healthy subjects (63 males and 25 females) aged 39 to 60 years were studied. Strain-gauge plethysmography of the lower limbs was used to calculate arterial calf blood flow (RF), arterial calf blood flow after post-ischaemic hyperaemia (PF), basal and minimal vascular resistances (BVR and MVR), time to reach peak flow (tPF), time until 50% reduction of peak flow (tT1/2)…

Effects of Middle-Term Treatment with Nifedipine on Hemodynamic Parameters and on Left Ventricular Function in Hypertensive Patients

[Prevalence of pericardial effusion in subjects with rheumatoid arthritis: an echocardiographic study].

We used echocardiography to determine the prevalence of pericardial effusion in rheumatoid arthritis (RA) patients without cardiac systems and compared our results to those obtained in a control group of age-matched subjects. Thirty-six patients with RA (6 men, 30 women; mean age 51 +/- 11 years) were selected from a patient population in treatment at our outpatient Rheumatology Clinic. None of the patients had any symptoms of cardiac disease, and all patients with signs and/or systems of extracardiac disease were excluded from the study. The control group consisted of 60 volunteers (mean age 51 +/- 12 years) randomly selected from a larger group of subjects with neither symptoms, signs and…

Haemostatic and fibrinolytic abnormalities in obese patients and in patients with type 2 diabetes with metabolic syndrome

Sindrome Metabolica

Nutrizione,sovrappeso e sindrome metabolica

Long-term evaluation of quinapril in mild to moderate hypertension: assessment of renal haemodynamics and function.

Effect of dual blockade of renin–angiotensin system on TGFβ1 and left ventricular structure and function in hypertensive patients

The effects of 24 weeks losartan and ramipril treatment, both alone and in combination, on left ventricular mass (LVM), circulating transforming growth factor beta1 (TGFbeta1), procollagen type I (PIP) and III (PIIIP), have been evaluated in hypertensive (HT) patients. A total of 57 HT with stage 1 and 2 essential hypertension were included. After 4 weeks run in, a randomized double-blind, three arms, double dummy, independent trial was used. All HT patients were randomly allocated to three treatment arms consisting of losartan (50 mg/daily), ramipril (5 mg/ daily) and combined (losartan 50 mg/daily + ramipril 5 mg/daily) for 24 weeks. TGFbeta1, PIP and PIIIP, LVM, LVM/h(2.7) and other echo…

Il paziente iperteso ad alto rischio cadiovascolare

Pathogenetic Mechanisms of Hypertension-Brain-Induced Complications: Focus on Molecular Mediators.

There is growing evidence that hypertension is the most important vascular risk factor for the development and progression of cardiovascular and cerebrovascular diseases. The brain is an early target of hypertension-induced organ damage and may manifest as stroke, subclinical cerebrovascular abnormalities and cognitive decline. The pathophysiological mechanisms of these harmful effects remain to be completely clarified. Hypertension is well known to alter the structure and function of cerebral blood vessels not only through its haemodynamics effects but also for its relationships with endothelial dysfunction, oxidative stress and inflammation. In the last several years, new possible mechani…

Effects of amlodipine on renal haemodynamics in mild to moderate hypertensive patients. A randomized controlled study versus placebo. Eur J Clin Pharmacol

In this study the efficacy and safety of short-term amlodipine administration on renal haemodynamics were evaluated in mild to moderate hypertensive subjects. Our final goal was to evaluate whether the reduced blood pressure induced by treatment was associated with maintenance of renal function. After a run-in period with placebo, 30 hypertensive patients without cardiac or renal diseases were randomly allocated to a double-blind 4 weeks controlled study with amlodipine 10 mg once a day (15 patients) or placebo (15 patients). Renal haemodynamic measurements included effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) by radionuclide study using 131I-hippuran and 99mTc, w…

Ultrasonography NAFLD subclinical carotid atherosclerosis and inflammatory markers in patients with and without metabolic syndome.

Effect of dual blockade of renin-angiotensin system on TGF beta 1 and left ventricular structure and function in hypertensive patients

The effects of 24 weeks losartan and ramipril treatment,both alone and in combination, on left ventricular mass (LVM), circulating transforming growth factor b1(TGFb1), procollagen type I (PIP) and III (PIIIP), havebeen evaluated in hypertensive (HT) patients. A total of 57 HT with stage 1 and 2 essential hypertension were included. After 4 weeks run in, a randomized double blind, three arms, double dummy, independent trial was used. All HT patients were randomly allocated to three treatment arms consisting of losartan (50 mg/daily),ramipril (5 mg/ daily) and combined (losartan 50 mg/daily plus ramipril 5 mg/daily) for 24 weeks. TGFb1, PIP and PIIIP, LVM, LVM/h 2.7 and other echocardiograph…

Evidence-Based Practice Needs Stronger Prognostic Scores for the Prediction of Recurrent Stroke

To the Editor: The article by Weimer et al1 is of great interest for internists and neurologists that have to prognostically stratify patients with acute or subacute cerebrovascular disease based on risk scores. However, we have to comprehend the actual and pragmatic value of the study findings for clinical practice. We previously underscored the …

Improving Efficacy of PubMed Clinical Queries for Retrieving Scientifically Strong Studies on Treatment

The authors evaluated the retrieval power of PubMed "Clinical Queries," narrow search string, about therapy in comparison with a modified search string to avoid possible retrieval bias. PubMed search strategy was compared to a slightly modified string that included the Britannic English term "randomised." The authors tested the two strings joined onto each of four terms concerning topics of broad interest: hypertension, hepatitis, diabetes, and heart failure. In particular, precision was computed for not-indexed citations. The added word "randomised" improved total citation retrieval in any case. Total retrieval gain for not-indexed citations ranged from 11.1% to 21.4%. A significant number…

Plasma adiponectin: a contributing factor for cardiac changes in visceral obesity-associated hypertension.

This study has been designed to evaluate the impact of adiponectin levels on left ventricular geometry and function in visceral obesity-associated hypertension. 94 consecutive subjects, 53 of them were hypertensives and 41 normotensives with age <= 65 years, subgrouped according to the presence or absence of visceral obesity, were studied. Total adiponectin levels were measured by a validated competitive radioimmunoassay. Left ventricular telediastolic internal diameter, interventricular septum, posterior wall thickness, total left ventricular mass (LVM) and normalized for height to the 2.7 power (LVM/h(2.7)), relative wall thickness, left ventricular ejection fraction by echocardiography a…

Transforming growth factor beta1 T29C gene polymorphism and hypertension: relationship with cardiovascular and renal damage.

Distribution of T29C TGFb1 gene polymorphism was analysed in 260 hypertensive and 134 normotensive subjects. Circulating TGFb1 and procollagen type III levels, microalbuminuria, left ventricular geometry and function were evaluated in all the hypertensives subgrouped according to T29C TGFb1 gene polymorphism. Circulating TGFb1by ELISA technique, procollagen type III by a specific radioimmunoassay, microalbuminuria by radioimmunoassay, left ventricular geometry and function by echocardiography were determined. All groups were comparable for gender, age and sex. Regarding T29C TGFb1 gene polymorphism, prevalence of TC or CC genotypes was significantly (pv0.05) higher in hypertensives than nor…

Evidence-Based Knowledge Management: an approach to effectively promote good health-care decision-making in the Information Era.

The sharing of information and the growth of knowledge together represent a foundation for the promotion of quality improvement of health care systems. This paper concerns knowledge, not only from an epistemological point of view, but also from a pragmatic one. In our paper, knowledge is discussed as the hub to promote better decision making and continuous professional development. Effective thinking is particularly needed. The critical point is to think about how health care systems can develop both an effective knowledge management network and how health-care organizations can actually be based on it. In this way, knowledge and knowledge hierarchy are defined according to Russel Achkoff's…

Obesità, Diabete e Rischio Cardiovascolare.

Il crescente interesse del mondo scientifico e delle organizzazioni sanitarie nei riguardi dell’obesità deriva dalla diffusione epidemica di questa condizione osservata negli ultimi decenni non solo nel mondo occidentale industrializzato, ma anche nei paesi in via di sviluppo (1). Nelle società più ricche, l'eccesso di peso è maggiore negli strati socio-economici più bassi e nelle fasce d'età più avanzate (2), e la percentuale di soggetti in sovrappeso (BMI>25) e con obesità franca (BMI>30) ha superato negli Stati Uniti d'America il 60% dei maschi adulti ed il 30 % delle donne tra i 50 ed i 60 anni (3). L'aspetto epidemiologico che colpisce e preoccupa di più è il trend secolare, per cui ne…

Left ventricular filling abnormalities and obesity-associated hypertension: relationship with overproduction of circulating transforming growth factor β1

This study has been designed to evaluate the relationship among transforming growth factor beta1 (TGFbeta1) and some measurements of diastolic function in a population of hypertensive subjects with normal left ventricular ejection fraction. We studied 67 hypertensive outpatients who according to their BMI levels were subdivided into three groups: lean (L), overweight (OW) and obese (OB) hypertensives (HT). Circulating TGFbeta1 and M- and B-mode echocardiography was determined. All hypertensives were further subgrouped, according to European Society of Cardiology Guidelines, into two subsets of patients with normal diastolic function or with diastolic dysfunction. Prevalence of left ventricu…

Rapid left ventricular filling in untreated hypertensive subjects with or without left ventricular hypertrophy

In this study, independent contribution of age, HR, BMI, casual and ambulatory blood pressure, LVM and LVEF in evaluating diastolic filling have been investigated in 34 never-treated hypertensive patients and in 15 healthy normotensive subjects. All the subjects were free from coronary artery disease, valvular disease, heart failure, renal disease and psychiatric problems. All the hypertensive subjects (never treated) were subgrouped according to presence or absence of LVH. The PFR decreased significantly and tPFR increased significantly in hypertensive patients in comparison with normotensive subjects and they did not change in the presence vs absence of LVH. The PFR was inversely correlat…

Heredity and obesity-associated hypertension:impact on hormonal characteristics and left ventricular mass.

A meta-analysis of the effect size of rheumatoid arthritis on left ventricular mass: comment on the article by Rudominer et al

We appreciate the work of Rudominer et al, who recently published a report describing the association of rheumatoid arthritis (RA) with increased left ventricular mass.

Transforming growth factor beta1 ed effetto nefroprotettivo dell’associazione ACE-inibitori-AT1 antagonista in soggetti ipertesi con iniziale danno renale