The nephroprotective effect of sacubitril/valsartan in heart failure: insights from the real-life clinical setting
Real-life data confirming the favourable renal outcome in patients with heart failure (HF) treated with Sacubitril/Valsartan, previously found in several trials (RCTs), are still scant. We evaluated the renal effects of Sacubitril/Valsartan in a real-life sample of HF patients. Observational analysis of 54 consecutive outpatients affected by HF with reduced ejection fraction (HFrEF) and clinical indication for Sacubitril/Valsartan. Patients were evaluated at baseline (T0) and after six (T6) and twelve (T12) months after initiating Sacubitril/Valsartan and compared with a group of 30 historical controls. Mean age: 65.5 ± 11.7 years. Older patients: 29 (53.7%). Mean baseline estimated glomeru…
RELATIONSHIPS BETWEEN PLASMA ALDOSTERONE LEVELS AND LEFT VENTRICULAR MASS AND GEOMETRY IN ESSENTIAL HYPERTENSIVE PATIENTS: DOES SEX MATTER?
Introduction: Experimental evidence suggested that aldosterone can cause myocardial hypertrophy and fibrosis. However, previous studies on the association between plasma aldosterone concentration (PAC) and left ventricular (LV) mass (LVM) and geometry, in subjects without primary aldosteronism yielded conflicting results. Aim: To evaluate the relationships of PAC with LV mass and geometry in patients with essential hypertension (EH), and to assess the influence of gender on these relationships. Methods: We enrolled 478 subjects (men: 63%; mean age 44 ± 12 years) with untreated EH. The measurements included 24-h blood pressures, plasma renin activity (PRA) and PAC, obtained by radioimmunoass…
The "Renocentric Theory" of Renal Resistive Index: Is It Time for a Copernican Revolution?
Ultrasound (US) with duplex Doppler scanning has spread to the capillary level, becoming an irreplaceable tool in daily clinical practice thanks to its characteristics: low cost, repeatability, and noninvasiveness. Moreover, US has become over time more sensitive and accurate; it can be considered an extension of the clinician’s hand. For this reason, it currently represents the ideal tool for first-level diagnostic use in several fields, and is the simplest and most flexible instrument for obtaining morphological and functional information on different organs, including the kidneys. In this issue of The Journal , Gigante, et al 1 propose to assess renal involvement in patients with systemi…
Relationship of choroidal thickness with pulsatile hemodynamics in essential hypertensive patients
Controversy exists about the association of choroidal thickness (CTh) with blood pressure (BP) values. There is some evidence suggesting that central hemodynamics changes are associated with microvascular disease. Our study was aimed to assess the relationships between CTh and clinic and 24-h BP and between CTh and estimated 24-h aortic pulse pressure (aPP), 24-h aortic systolic BP (aSBP), and 24-h aortic augmentation index (aAIx) in a group of hypertensive patients. We enrolled 158 hypertensive subjects (mean age 48 ± 13 years) all of which underwent evaluation of the choroidal district by Swept-Source optical coherence tomography (SS-OCT) and 24-h BP monitoring, in order to measure periph…
Should reduction of increased short‐term blood pressure variability be a target of antihypertensive therapy?
Abstract It has long been known that blood pressure (BP) is characterized by marked short‐term fluctuations occurring within a 24‐h period and also by long‐term oscillations occurring over more prolonged periods of time. An increased short‐term blood pressure variability (BPV) appears to importantly contribute to target organ damage and to the enhanced cardiovascular risk of hypertensive patients, over and above the effect of an increase in mean BP levels. Reducing 24‐h mean BP is the main aim of antihypertensive therapy, but initial data are available that additional cardiovascular protection can be achieved by reducing BPV. However, to definitively prove the prognostic role of short‐term …
An Elevated Neutrophil-Lymphocyte Ratio Increases the Risk of Cardiovascular Events and of Renal Function Decline in Hypertensive Patients with CKD
Introduction: Many epidemiological studies have shown that low-grade chronic inflammation, estimated through the neutrophil-lymphocyte ratio (NLR), is linked to traditional and non-traditional cardiovascular (CV) risk factors. Aim: The aim of our study was to investigate the potential prognostic role of NLR regarding the progression of chronic kidney disease (CKD) and the development of CV events in a cohort of renal and hypertensive patients. Methods: In this retrospective observational study, 403 patients consecutively attending our Nephrology and Hypertension clinics were included. At the baseline observation and control visits in all patients, in addition to the clinical-anamnestic eval…
Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control
For many years, casual blood pressure (BP) taken by a sphygmomanometer in the clinic or at the physician's office has been used as the standard method for diagnosing hypertension. Even if such measurement has been the cornerstone on which our understanding of the consequences of hypertension is based, there is a huge and very consistent body of evidence indicating that casual measurements of BP may provide a very unreliable index for the evaluation of hypertension because of their variability. The two alternative ways of measuring BP that have been most commonly used are measurements made at home by the patient himself (home or self‐BP monitoring—SBPM) and measurements by ambulatory blood p…
The Unsolved Conundrum of Optimal Blood Pressure Target During Acute Haemorrhagic Stroke: A Comprehensive Analysis
Intracerebral haemorrhage (ICH) is a devastating cerebrovascular disease, which accounts to 15% of all strokes. Among modifiable risk factors for ICH, hypertension is the most frequent. High blood pressure (BP) is detected in more than 75–80% of patients with ICH. Extremely elevated BP has been associated with early hematoma growth, a relatively frequent occur-rence and powerful predictor of poor outcome in patients with spontaneous ICH. On the other hand, excessively low BP might cause cerebral hypoperfusion and ultimately lead to poor outcome. This review will analyse the most important trials that have tried to establish how far should BP be lowered during acute ICH. These trials have de…