COMPARAZIONE DELLE RELAZIONI DI DIFFERENTI DEFINIZIONI DI SINDROME METABOLICA CON L'IPERTROFIA VENTRICOLARE SX NELL'IPERTENSIONE ESSENZIALE

Numerosi studi hanno dimostrato che la sindrome metabolica (SM), sia quando definita secondo i criteri dell'ATPIII, sia quando definita secondo i criteri dell'IDF, si associa ad un aumento della massa del ventricolo sx (VS). Tuttavia, non è noto se queste due differenti definizioni di SM abbiano la stessa capacità di identificare l'ipertrofia del VS (IVS) . Inoltre, una delle critiche mosse al concetto di SM è legata al fatto di essere una variabile dicotomica, limitando in tal modo la possibilità di definire la gravità del rischio cardiovascolare nel singolo paziente. Scopo del nostro studio è stato quello di valutare comparativamente la capacità di differenti definizioni di SM di identifi…

Comparison of the relationship among different defintions of metabolic syndrome and left ventricular hypertrophy in essential hypertension

Relationship Between Short-Term Blood Pressure Variability and Subclinical Renal Damage in Essential Hypertensive Patients

The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30 mL/min/1.73 m(2) and 60 mL/min/1.73 m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subc…

RELATIONSHIPS BETWEEN SHORT-TERM BLOOD PRESSURE VARIABILITY AND EARLY RENAL DYSFUNCTION IN HYPERTENSION

The prognostic significance of short–term blood pressure (BP) variability (STBPV), expressed as standard deviation (SD) of blood pressures (BP) intermittently recorded over 24 hours, is debated. Recently, indices of STBPV other than SD have been proposed. Among these, the 24-h BP Average Real Variability (ARV) seems to be associated more consistently than SD with an enhanced cardiovascular risk. The relationship between mild-to-moderate renal dysfunction (MMRD) and ARV was not investigated. Our study was aimed to analyse, in a large group of untreated essential hypertensives, the relationships between ARV, and other STBV indices, with MMRD. We enrolled 329 essential hypertensive patients, w…

LA VARIABILITA’ PRESSORIA A BREVE TERMINE NON E’ ASSOCIATA ALLA DISFUNZIONE RENALE LIEVE NELL'IPERTENSIONE ARTERIOSA PRIMARIA

RAZIONALE. Il significato prognostico della variabilità pressoria (VP) a breve termine, espressa come deviazione standard (SD), è controverso. Recentemente sono stati proposti altri indici di VP a breve termine, tra i quali l’Average Real Variability (ARV), sembra essere maggiormente associato al rischio cardiovascolare (CV). Non indagata, finora è la relazione tra ARV e disfunzione renale lieve. Scopo del nostro studio è stato quello di analizzare le relazioni dell’ ARV delle 24 h e di altri indici di VP a breve termine con l’ albuminuria (AER) ed il filtrato glomerulare (eGFR) in un gruppo di ipertesi essenziali, non trattati. CASISTICA E METODI. Sono stati arruolati 248 pazienti (età med…

PLASMA ENDOTHELIN-1 IS ASSOCIATED WITH AORTIC STIFFNESS IN ESSENTIAL HYPERTENSION

Background: Experimental studies documented that endothelin-1 (ET-1) contributes to arterial stiffness and recently, in patients with chronic kidney diseases, it has been observed that selective endothelin-A receptor antagonism reduces arterial stiffness, in part independently of blood pressure lowering. Little is known about the relationships between ET-1 plasma levels and aortic distensibility in subjects with essential hypertension. Objective: The aim of our study was to analyse the relationships between plasma concentrations of ET-1 and carotid-femoral pulse wave velocity (c-f PWV), as an index of aortic stiffness, in a group of hypertensive patients without overt renal insufficiency [e…

Relationship Between Ambulatory Artery Stiffness Index and Glomerular Filtration Rate in Essential Hypertension

Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men

Background and aim: Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. Methods and results: We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtai…

No independent association of serum uric acid with left ventricular mass in hypertensive patients

Seven-day subcutaneous continuous glucose monitoring demonstrates that treatment with acarbose attenuates late dumping syndrome in a woman with gastrectomy for gastric cancer.

Average real variability of 24-h systolic blood pressure is associated with microalbuminuria in patients with primary hypertension.

Limited and conflicting data are available about the association between short-term blood pressure (BP) variability and urinary albumin excretion rate (uAER). The objective of our study was to analyze the relationships between microalbuminuria (MAU), defined as an uAER between 20 and 200 μg min(-1), and short-term BP variability (BPV), assessed as average real variability (ARV), weighted s.d. of 24-h BP and as s.d. of daytime and night-time BP. The study population consisted of 315 untreated essential hypertensives with normal estimated glomerular filtration rate (>60 ml min(-1) per 1.73 m(2)), who underwent 24-h ambulatory BP monitoring and 24-h uAER determination. MAU was detected in 82 (…

Unfavourable interaction of microalbuminuria and mildly reduced creatinine clearance on aortic stiffness in essential hypertension

The aim of our study was to assess the independent relationships of urinary albumin excretion rate (AER), of creatinine clearance (CrCl) and of their interaction with aortic stiffness in hypertensive patients without overt renal insufficiency. We studied 222 untreated nondiabetic essential hypertensives. In patients with reliable 24-h urine collections, AER and CrCl were determined. Microalbuminuria (MAU) was defined as an AER of 20 to 200microg/min. Aortic stiffness was assessed by measurement of carotid-femoral pulse wave velocity (c-f PWV). C-f PWV was higher in subjects with MAU than in those without it (p<0.001, even after adjustment for age, sex and mean arterial pressure) and in subj…

PREVALENCE OF DIASTOLIC DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC KIDNEY DISEASE

Introduction: In patients with arterial hypertension and chronic kidney disease (CKD), the prevalence of diastolic heart failure (HF-PEF) is probably very high. However, in these patients the diagnosis is difficult, especially because the signs and symptoms suggestive of HF-PEF are very common in CKD; in these cases the detection of left ventricular structural and functional alterations (as reported in the 2012 ESC guidelines on heart failure), assumes a decisive role for the diagnosis of HF-PEF. Aim: To evaluate the prevalence of patients with diastolic dysfunction according to ESC guidelines 2012 in a population of Hypertensive patients with CKD. Methods: We studied 466 hypertensive patie…

LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSIVE PATIENTS WITH NORMAL ELECTROCARDIOGRAM

Objective: In hypertensive patients the presence of left ventricular hypertrophy (LVH) is associated with increased cardiovascular (CV) morbidity and mortality. Unfortunately electrocardiogram (ECG) has a low sensitivity in detecting LVH, while echocardiography cannot be routinely and extensively performed in all hypertensive patients. In this study we evaluated the prevalence of LVH and of anomalies of diastolic function in a group of hypertensive patients with normal ECG, and free of diabetes and CV diseases. Design and Methods: Patients with CV diseases, diabetes, chronic kidney disease (CKD), electrocardiographic LVH (Sokolow-Lyons or Cornell criterion) or “strain” were excluded. We enr…

Relationships of different defintions of metabolic syndrome and left ventricular mass in essential hypertensive patients

Relationships between metabolic syndrome and left ventricular mass in hypertensive patients. Does sex matter ?

Several studies documented an association between metabolic syndrome (MetS) and left ventricular (LV) hypertrophy. However, only in a few of these studies the impact of MetS on left ventricular mass (LVM) was separately analysed by gender, with conflicting results. The aim of our study was to verify, in a wide sample of essential hypertensive patients, the influence of gender, if any, on the relationship between MetS and LVM. We enrolled 475 non-diabetic subjects (mean age: 46 +/- 11 years), with mild-to-moderate essential hypertension, of whom 40% had MetS, defined on the basis of Adult Treatment Panel III (ATPIII) criteria. All the patients underwent a 24-h ambulatory blood pressure monit…

Inverse Relationship Between Ambulatory Arterial Stiffness Index and Glomerular Filtration Rate in Arterial Hypertension

BACKGROUND: Arterial stiffness and mild-to-moderate renal dysfunction are predictors of cardiovascular (CV) morbidity and mortality. Recently, the ambulatory arterial stiffness index (AASI) has been proposed as a surrogate index of arterial stiffness. It has been associated with an enhanced risk of stroke. The aim of our study was to assess the relationship between AASI and glomerular filtration rate (GFR) in a group of hypertensive patients with no CV complications. METHODS: A total of 143 untreated hypertensive subjects (mean age: 44 +/- 12 years; men 57%), with serum creatinine <1.5 mg/dl, were enrolled. AASI was calculated as one minus the regression slope of diastolic on systolic blood…

Different Morning Blood Pressure Increases are Associated to a Diverse Microvascular Damage

RELATIONSHIP BETWEEN OXIDATIVE STRESS AND AORTIC STIFFNESS IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE

RELATIONSHIPS OF SERUM URIC ACID WITH PLASMA RENIN ACTIVITY AND PLASMA ALDOSTERONE IN PRIMARY HYPERTENSION.

Introduction: In experimental studies conducted in rats, raising serum uric acid (SUA) levels resulted in stimulation of renin expression. Studies in humans exploring the association of SUA with plasma renin activity (PRA) yielded conflicting results. Moreover, little is known about the relationship between plasma aldosterone concentration (PAC) and SUA. Aim: To analyse the relationships between SUA, PRA and PAC in a group of subjects with primary hypertension. Methods: We enrolled 372 patients (mean age 45 ± 12 years; women 33 %), with untreated primary hypertension, with normal renal function and without cardiovascular complications. Results: Spearman’s rank-correlation analyses showed th…