A GIANT ANEURYSM OF PROPER HEPATIC ARTERY IN A CRYOGLOBULINEMIC PATIENT ON HEMODIALYSIS: A CASE REPORT.

Introductrion. Hepatic artery aneurysms (HAAs) are unusual vascular lesions often associated with many different pathological conditions. Most of reported cases are described in association with connective tissue diseases, such as polyarteritis nodosa and systemic lupus erythematosus. Case report. We observed a 52-year-old man with hypertension and HCV-related cryoglobulinemia complicated by end stage renal disease on replacement therapy by hemodialysis. He was admitted to our hospital because of the worsening of blood pressure values (170/110 mmHg) associated to new onset abdominal pain. After an initial physical examination, that showed a periumbelical bruit associated to a pulsatile mass…

Serum uric acid is not independently associated with plasma renin activity and plasma aldosterone in hypertensive adults

Background and Aims In experimental investigations conducted in rats, raising serum uric acid (SUA) levels resulted in the stimulation of intrarenal 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 of SUA with plasma aldosterone concentration (PAC). The study aimed to assess the relationship between SUA levels, PRA, and PAC and the influence of age, gender, body mass index (BMI), and hyperuricemia on these relationships in subjects with essential hypertension (EH). Methods and Results We enrolled 372 hypertensive patients (mean age 45 ± 12 years, men 67%) with u…

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…

The renal resistive index: is it a misnomer?

Progress in digital ultrasound technology and diffusion of Doppler ultrasound evaluation of the kidney enable a widespread non-invasive evaluation of renal haemodynamics. Initially most attention has been paid to the study of extraparenchymal renal arteries, mainly to detect renovascular disease. However, this approach has low reproducibility and accuracy. Therefore, interest has gradually moved towards the duplex evaluation of intrarenal anatomy, where the best and most reliable signals are obtained from the large segmental or interlobar arteries that run directly towards the transducer. Among the sonographic parameters used in the last decade, great emphasis has been placed on the intrare…

SYSTEMIC ARTERIAL CHANGES AND PULSE PRESSURE: DIFFERENT IMPACT ON RENAL HAEMODYNAMICS IN HYPERTENSIVE PATIENTS.

Objective: Renal resistance index (RRI) is used for kidney disease detection and prognosis, but it also appears a good indicator of systemic vascular changes in hypertensive subjects. Structural atherosclerotic damage, arterial stiffness and pulse pressure may interact each other, and the relationship between intrarenal haemodynamics and systemic vascular alterations has been widely investigated. However, the independent impact of all these parameters on renal haemodynamics and the mechanisms by which they affect renal vasculature remain to be clarified. Design and method: We enrolled 463 hypertensive patients (30–70 years) with normal renal function (group 0; n = 280) and with chronic kidn…

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…

LIPID PARAMETERS AND LEFT VENTRICULAR MASS IN ESSENTIAL HYPERTENSIVE PATIENTS

ASSOCIAZIONE TRA INDICE DI RESISTENZA INTRARENALE E STIFFNESS AORTICA IN SOGGETTI CON MALATTIA RENALE CRONICA

RAZIONALE. L’indice di resistenza intraparenchimale renale (IR), valutato mediante eco-color-Doppler, è stato classicamente utilizzato quale valido strumento di valutazione diagnostica e prognostica delle patologie renali. Studi recenti suggeriscono che i parametri emodinamici intrarenali, e l’IR in particolare, possano essere anche associati ad alterazioni vascolari sistemiche, nonché ad un incremento del rischio cardiovascolare. Tuttavia, dati contrastanti esistono in letteratura circa l'associazione indipendente tra IR e pulse wave velocity aortica (PWVa), indice di stiffness arteriosa, nonché espressione di danno d'organo subclinico. Scopo di questo studio è stato dunque quello di valut…

The relationships between lipid ratios and arterial stiffness

Although dyslipidemia is associated with cardiovascular disease, there are conflicting data about the role of serum lipids and their ratios in promoting arterial stiffness. The authors aimed to compare serum lipid profiles to predict arterial stiffness, which was assessed by brachial‐ankle pulse wave velocity in young Chinese men. A total of 1015 participants aged 18 to 44 years without serious comorbidities were recruited for conventional detection. Anthropometrics, brachial‐ankle pulse wave velocity, serum lipids, and other laboratory data were measured. Univariate analysis and multivariate logistic regression were performed to examine the relationship between serum lipid profiles and bra…

Inflammatory activation and endothelial dysfunction markers in patients with permanent atrial fibrillation: A cross-sectional study

In recent years a growing body of evidence supported the role of inflammation in the initiation, maintenance and outcome of atrial fibrillation (AF). Nevertheless, despite a large amount of information, whether AF or the underlying structural heart disease (SHD) is the cause of the inflammatory process is still under debate. We, therefore, sought to determine if the inflammatory process reflect an underlying disease or the arrhythmia 'per se'. We evaluated plasma levels of soluble Interleukin 2 Receptor Alpha (sIL-2Rα), TNF-α and IL-18 in 100 consecutive patients with permanent AF, (43 with a SHD and 57 without a SHD) compared to 121 age and sex-matched controls which had normal sinus rhyth…

Choroidal thickness is associated with renal hemodynamics in essential hypertension

The choroid is the most vascularized structure of the eye and plays a central role in the development of the retinal vascular changes that occur in arterial hypertension. Changes of choroidal thickness (ChT) assessed by optical coherence tomography (OCT) technology could reflect the vascular complications of hypertension. Also, intrarenal hemodynamic damage, associated with endothelial dysfunction, demonstrated to be a good indicator of systemic morphofunctional arterial impairment. The aim of this study is to assess the relationship between ChT and renal hemodynamics in subjects with essential hypertension. Routine laboratory tests, clinical history, and physical examination, including blo…

BILATERAL RENAL ARTERY STENOSIS IN A HYPERTENSIVE LUPUS PATIENT WITHOUT RENAL DYSFUNCTION: A CASE REPORT

Systemic lupus erythematosus (SLE) is associated with a high prevalence of atherosclero-sis and an enhanced cardiovascular mortality. In adult subjects, several studies have shown the coexistence of SLE and renal artery stenosis, most of them with unilateral in-volvement or with renal dysfunction. We observed a 62-year-old man with SLE and a 10-year history of moderate-to-severe hy-pertension who was admitted to our hospital because of uncontrolled blood pressure val-ues (152/95 mmHg), despite drug therapy. No signs of renal impairment were evident. After an initial physical examination, which presented a periumbilical bruit, a renal ultra-sound was performed with evidence of bilateral rena…

Relationship of a Body Shape Index and Body Roundness Index with carotid atherosclerosis in arterial hypertension.

Background and aims: A Body Shape Index (ABSI) and Body Roundness Index (BRI) are two new anthropometric adiposity indices that have shown to be associated better than BMI with adipose abdominal tissue, with the onset of diabetes and the risk of premature death. Little is known about the influence of ABSI and BRI on subclinical vascular damage. The study was aimed to assess the relationship between ABSI and BRI with carotid atherosclerosis damage in subjects with arterial hypertension. Methods and results: A total of 468 patients with arterial hypertension (30–80 years old) were enrolled; adiposity indices were calculated (BMI, WC, ABSI, BRI) and carotid ultrasonographic examination was per…

ASSOCIATION OF RENAL RESISTIVE INDEX WITH CAROTID INTIMA-MEDIA THICKNESS IN HYPERTENSIVE PATIENTS

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…

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 (…

Resistive index of ophthalmic artery as an imaging biomarker of hypertension-related vascular and kidney damage

Aim: Resistive index of ophthalmic artery (RI-OA) is associated with atherosclerotic diseases. The aim of this study was to evaluate the association of RI-OA and hypertension-related vascular and kidney damage. Materials and methods: Two-hundred and eighty hypertensive patients underwent evaluation of RI-OA, carotid atherosclerosis and level of 24 h albuminuria. Results: Albuminuria and carotid atherosclerosis were positively associated with RI-OA independently of other cardiovascular risk factors. Receiver-operating characteristic curve analysis allowed us to calculate a cut-off value of RI-OA >0.625, which would be suspicious about the existence of atherosclerotic disease. Conclusion:…

Renal haemodynamics and coronary atherosclerotic burden are associated in patients with hypertension and mild coronary artery disease

Intrarenal hemodynamic alterations are independent predictors of cardiovascular events in different populations. It has been hypothesized that there is an association between renal hemodynamics and coronary atherosclerotic burden in patients with hypertension. Therefore, the present study examined the associations between renal hemodynamics, coronary atherosclerotic burden and carotid atherosclerotic disease. A total of 130 patients with hypertension aged between 30-80 years who had been referred for an elective coronary angiography were enrolled in the present study. A duplex ultrasound of the intrarenal vasculature was performed to evaluate the resistive index (RI), pulsatility index (PI)…

Relazione tra indice di resistenza renale e severità dell’aterosclerosi carotidea in soggetti con ipertensione arteriosa.

RAZIONALE. L’indice di resistenza intraparenchimale renale (IR), valutato mediante eco-color-Doppler, è stato classicamente considerato mera espressione di resistenza vascolare distrettuale renale. Studi più recenti, tuttavia, hanno mostrato come tale indice sia anche influenzato da fattori a tergo, compliance vasale in primis, a prova di un suo possibile ruolo quale marker di alterazioni vascolari sistemiche. Diversi studi hanno dimostrato, inoltre, come lo spessore intimale (IMTc) e la placca a livello carotideo, valutati mediante ultrasonografia, siano documentati marcatori di danno d'organo subclinico nonché espressioni progressive di malattia aterosclerotica. Scopo del nostro studio è …

Is echocardiography mandatory for patients with chronic kidney disease?

This study aims at evaluating the prevalence of left ventricular diastolic dysfunction in a group of 319 hypertensive patients with stage 3b–4–5 chronic kidney disease (according to Kidney Disease Improving Global Outcomes classification), compared with 216 patients with essential hypertension and normal renal function. All patients underwent echocardiographic examination. Patients on stage 1–2–3a chronic kidney disease, dialysis treatment, or with previous manifestations of heart failure or other cardiovascular diseases were excluded. Patients with renal disease had significantly worse diastolic function (both considering trans-mitral flow and tissue Doppler imaging parameters). Diastolic …

RELATIONSHIP BETWEEN AORTIC PULSE WAVE VELOCITY AND RENAL RESISTIVE INDEX IN HYPERTENSIVE PATIENTS.

INTRODUCTION: The assessment of renal hemodynamic parameters by duplex Doppler sonography has been used for many years as a diagnostic tool in the daily workup of kidney diseases. Recent data suggest that these parameters, especially the intrarenal resistive index (RI), may be also associated with systemic vascular changes and cardiovascular risk. However, conflicting data exist about the independent association of aortic stiffness with RI. AIM: The aim was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (PWV), in the hypertensive subjects consecutively attending our hypertension centre. METHODS: We enrolled 264 subjects, aged between 3…

Renal haemodynamics and severity of carotid atherosclerosis in hypertensive patients with and without impaired renal function.

Background and Aim. Renal resistance index (RRI), assessed by Duplex-Doppler sonography, has been classically considered as a mere expression of intrarenal vascular resistance. Recent studies, however, have showed that RRI is also influenced by upstream factors, especially arterial compliance, confirming its possible role as a marker of systemic vascular alterations. Several studies have shown that carotid intima-media thickness (cIMT) and carotid plaques (cP), assessed by ultrasonography, are documented markers of subclinical organ damage as well as expression of progressive atherosclerotic disease, and that they get worse with the progressive deterioration of renal function. The study was…

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…

RELATIONSHIPS BETWEEN SHORT-TERM BLOOD PRESSURE VARIABILITY AND EARLY RENAL DYSFUNCTION IN ESSENTIAL HYPERTENSIVE PATIENTS

Association between uric acid and renal function in hypertensive patients: which role for systemic vascular involvement?

The role of systemic vascular involvement in mediating the association between serum uric acid (SUA) and renal function in hypertension has not been explored. Main purpose of our study was to investigate whether morphofunctional vascular changes, assessed as carotid intima-media thickness (cIMT) and aortic pulse wave velocity (aPWV), might mediate the association between SUA and renal damage. We enrolled 523 hypertensive subjects with or without chronic kidney disease and divided population into tertiles of SUA based on sex-specific cutoff values. cIMT and aPWV were higher in uppermost SUA-tertile patients when compared to those in the lowest ones (all P < .001). Uricemia strongly correlate…

Relationships between mild hyperuricaemia and aortic stiffness in untreated hypertensive patients.

Background and aims: Clinical studies exploring the relationship between serum uric acid (SUA) and arterial stiffness yielded conflicting results. Only in a few of these studies, arterial distensibility was examined by measuring aortic pulse wave velocity (PWV), which is considered the gold standard for evaluating arterial stiffness. In none of the previous investigations was the influence of SUA on aortic distensibility assessed, taking into account the effect of albuminuria. The purpose of our study was to comprehensively analyse the relationships between SUA and aortic PWV in a group of essential hypertensive patients. Methods and results: We enrolled 222 untreated and uncomplicated hype…

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…

Inverse association between type 2 diabetes and aortic root dimension in hypertensive patients

Background Some data support the concept that aortic root diameter (ARD) in hypertension may be regarded as a marker of subclinical organ damage. The impact of type 2 diabetes mellitus (DM) on cardiac structure and function is known, although the relationship between DM and ARD is not clear. The aim of our study was to evaluate the influence of DM on ARD in hypertensive patients. Methods We enrolled 1693 hypertensive patients (aged 63.7 ± 9.6 years). The population was divided into two groups: the first one with DM (n = 747) and the second one without DM (n = 946). ARD was measured by echocardiography at level of Valsalva's sinuses using echocardiography M-mode tracings. It was considered a…

[OP.3B.03] INFLUENCE OF SUBCLINICAL RENAL DAMAGE ON EARLY VASCULAR AGING IN PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: It is well known that kidney is frequently involved in patients with Systemic Lupus Erythematosus (SLE) However, conflicting data exist about the impact of renal involvement on vascular damage in this group of patients. The aim of this study was to evaluate the influence of renal damage on assessed by aortic pulse wave velocity (aPWV), evaluated a by intima-media thickness (IMT) measurement and assessed by renal resistive index (RRI) measurement, in patients with SLE. Design and method: We enrolled 52 SLE subjects (mean age 39 +/- 12 years), divided in two subgroups according to ACR/SLICC classification: patients with lupus nephritis, (LNG), and individuals presenting other featu…

Association Between Uric Acid and Renal Hemodynamics: Pathophysiological Implications for Renal Damage in Hypertensive Patients

The role of vascular renal changes in mediating the association between serum uric acid (SUA) and renal damage is unclear. The purposes of this study were to investigate the relationship between SUA and renal resistive index (RRI), assessed by duplex Doppler ultrasonography, and to assess whether hemodynamic renal changes may explain the association between SUA and renal damage in hypertensive patients. A total of 530 hypertensive patients with and without chronic kidney disease were enrolled and divided into SUA tertiles based on sex-specific cutoff values. RRI and albuminuria were greater and glomerular filtration rate (GFR) was lower in the uppermost SUA tertile patients when compared wi…

Retinal vascular imaging in cardiovascular medicine: New tools for an old examination

The old concept that the eye is the only window through which the body microcirculation can be observed in life easily, safely and repeatedly is part of the cultural baggage of every physician. When Hermann von Helmholtz invented the direct ophthalmoscope in 1850, he opened the door to a non-invasive visualization of human microcirculation in vivo at the retina. Only a few years later, the Scottish ophthalmologist Marcus Gunn documented the close association between retinal changes, and renal and cardiovascular diseases (CVD) in hypertensive patient. In 1939, Keith, Wagener, and Barker showed that the severity of retinal microvascular abnormalities was predictive of mortality in patients wi…

The prognostic role of the cardio-ankle vascular index

The well‐performed meta‐analysis of Matsushita et al represents an important contribution to the knowledge about the clinical meaning of arterial stiffness parameters, suggesting that CAVI is associated positively with a slightly increased risk of CV events, but not of total mortality. However, caution is needed in interpreting these findings, due to the limited number of prospective studies eligible for the meta‐analysis and the relatively low number of subjects included, mostly living in Japan or China. Therefore, additional studies, preferably with a prospective design and involving participants also from non‐Asian countries, are required to better define the prognostic role and the clin…

Inflammation and Aortic Pulse Wave Velocity: A Multicenter Longitudinal Study in Patients With Inflammatory Bowel Disease

Background Inflammatory bowel disease ( IBD ) is characterized by a low prevalence of traditional risk factors, an increased aortic pulse‐wave velocity ( aPWV ), and an excess of cardiovascular events. We have previously hypothesized that the cardiovascular risk excess reported in these patients could be explained by chronic inflammation. Here, we tested the hypothesis that chronic inflammation is responsible for the increased aPWV previously reported in IBD patients and that anti‐TNFa (anti‐tumor necrosis factor‐alpha) therapy reduce aPWV in these patients. Methods and Results This was a multicenter longitudinal study. We enrolled 334 patients: 82 patients with ulcerative colitis, 85 pati…

R E L A Z I O N I T R A I N D I C E  D I R E S I S T E N Z A I N T R A PA R E N C H I M A L E R E N A L E E D E N S I TA’ VA S C O L A R E R E T I N I C A VA L U TATA M E D I A N T E A N G I O - O C T

PREVALENZA DI IPERTROFIA VENTRICOLARE SINISTRA NELL’IPERTENSIONE ARTERIOSA: RIVALUTAZIONE CON I NUOVI CUT-OFF

Nelle linee guida 2013 ESH/ESC per il trattamento dell’ipertensione arteriosa si consiglia di utilizzare come cut-off per l’ipertrofia ventricolare sinistra (LVH) valutata con ecocardiografia, 95 g/m2 per il sesso femminile e 110 g/m2 per il sesso maschile e spessore parietale relativo (RWT) 0,42 per differenziare la forma concentrica dalla forma eccentrica. Tali cut-off sono diversi da quelli suggeriti nella versione precedente delle linee guida (110 g/m2 per il sesso femminile, 125 g/m2 per il sesso maschile e 0.45 per RWT). Scopo del presente studio è di valutare se tale variazione abbia determinato variazioni di rilievo nella valutazione della prevalenza di LVH nei pazienti ipertesi. A …

Association of renal resistive index with aortic pulse wave velocity in hypertensive patients

Background: Recent data suggest that renal haemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RI), may be associated with systemic vascular changes. However, conflicting data exist about the independent relationship between aortic stiffness and RI. The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), in hypertensive patients. Design: Cross-sectional study. Methods: We enrolled 264 hypertensive subjects aged between 30 and 70 years. They were divided into two groups, either with normal renal function (n=140) or with chronic kidney disease (CKD) (n=124). E…

Correlations between non ivasive renal index and markers of atherosclerosis in lupus patients

Recent data suggest that renal hemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RI), may be associated with systemic vascular changes in some groups of patients. However, conflicting data exist about the relationship between aortic stiffness and RI in autoimmune disease, like systemic lupus erythematosus, characterized by high and early incidence of atherosclerotic disease. The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), and carotid atherosclerosis, evaluated by intimal medial thickness measurement (IMT) in patients with SLE. DESIGN: Cross-sectiona…

[OP.7B.08] INFLUENCE OF GENDER ON THE RELATIONSHIPS BETWEEN NEW INDICES OF ADIPOSITY AND LEFT VENTRICULAR MASS AND HYPERTROPHY IN HYPERTENSIVE PATIENTS

OBJECTIVE: The unfavourable effects of the association of obesity with hypertension on cardiac structure and function have been extensively studied. However, controversy still exists about the influence of gender on the relationship between obesity and left ventricular mass (LVM) and hypertrophy (LVH). Even if body mass index (BMI) and waist circumference (WC) are widely used as anthropometric predictors for cardiovascular diseases (CVD), their validity has been questioned. Recently, Body Shape Index (ABSI) and Body Roundness Index (BRI) were proposed as alternative measures of adiposity that may better reflect health status (1-2).Our study was aimed to assess the ability of ABSI and BRI in…

[OP.4B.03] CIRCULATING ALDOSTERONE LEVELS ARE ASSOCIATED WITH CONCENTRIC LEFT VENTRICULAR GEOMETRY IN ESSENTIAL HYPERTENSIVE PATIENTS

OBJECTIVE: Sound evidence indicates that aldosterone has a fundamental role in determining functional and structural changes in the heart. Moreover, it has been observed that high plasma aldosterone concentration (PAC) is related to the development of congestive heart failure and to cardiovascular mortality. However, previous studies on the association between circulating aldosterone levels and left ventricular (LV) mass (LVM) and LV geometry, in subjects without primary aldosteronism yielded conflicting results. The aim of our study was to evaluate in patients with essential hypertension the relationships of PAC with LV mass and geometry, and to asses the influence of gender on these relat…

SHORT-TERM VARIABILITY OF 24-H SYSTOLIC BLOOD PRESSURE IS ASSOCIATED WITH MICROALBUMINURIA IN PATIENTS WITH PRIMARY HYPERTENSION

Introduction: Limited and conflicting data are available about the association between short-term blood pressure (BP) variability and urinary albumin excretion rate (uAER). Aim: To analyse the relationships between microalbuminuria, defined as an uAER between 20 and 200 lg/min, and short-term BP variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-h BP, and as SD of daytime and nighttime BP. Methods: The study population consisted of 316 untreated essential hypertensive patients with normal estimated glomerular filtration rate ([60 ml/min/1.73m2), which underwent 24-h ambulatory BP monitoring and 24-h uAER determination. Results: Microalbuminuria w…

EARLY VASCULAR AGEING IN NORMOTENSIVE SUBJECTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS. COMPARISON WITH YOUNG HYPERTENSIVE PATIENTS

Objective: Aortic pulse wave velocity (aPWV), is one of the most important markers of vascular aging. It is well known that connective tissue diseases are associated with accelerated atherosclerosis, but only a few data are available about aPWV in patients with systemic lupus erythematosus (SLE). The aim of this study was to evaluate early vascular aging, assessed by measuring aPWV, in a group of normotensive patients with SLE and to compare these subjects with a group of young essential hypertensive (EH) individuals Design and method: Crosssectional study. We have enrolled 39 normotensive SLE subjects (mean age: 38.7±8.3 years) matched for age with a group of essential hypertensive patient…

Bowel resection reduces aortic pulse wave velocity in patients with ulcerative colitis. A longitudinal study.

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Plasma aldosterone and its relationship with left ventricular mass in hypertensive patients with early-stage chronic kidney disease

Plasma aldosterone concentrations (PACs) are often increased in the advanced stages of chronic kidney disease (CKD); however, PAC has not been fully investigated in early CKD. Moreover, little is known about the relationship between aldosteronemia and left ventricular (LV) mass in subjects with mild-to-moderate CKD. The study objectives were to analyze PAC, LV mass (LVM), LV geometry and their relationships, in a group of hypertensive patients with stage I-III CKD. One hundred ninety-five hypertensive patients with stage I-III CKD were enrolled and compared with a control group of 82 hypertensive patients without renal dysfunction. LVM was higher in subjects with CKD than in the control gro…

Relationship between aortic stifness and renal resistance index in hypertensive patients

ABSENCE OF AN ASSOCIATION BETWEEN SHORT-TERM BLOOD PRESSURE VARIABILITY AND MILD RENAL DYSFUNCTION IN ESSENTIAL HYPERTENSIVE PATIENTS.

Introduction: Studies investigating the prognostic implications of short-term blood pressure (BP) variability (STBPV), expressed as standard deviation (SD) and assessed by noninvasive 24-h ambulatory BP monitoring (ABPM), yielded conflicting results. In last years further indices of STBPV have been proposed. Among these, the 24-h BP average real variability (ARV) seems to be associated with an increased cardiovascular risk more closely than the SD. Little is known about the association between mild renal dysfunction (MRD) and STBPV, and particularly between 24-h BP ARV and MRD. Aim: To analyse, in a group of essential hypertensives, the relationships between MRD and STBPV, expressed as SD o…

INFLUENCE OF HIV INFECTION AND ANTIRETROVIRAL THERAPY ON AORTIC STIFFNESS

Objective: A growing body of evidence indicates that risk of CV events is higher in HIV-infected patients (HIV+) when compared to HIV-uninfected persons (HIV-). This enhanced risk may in part be mediated through preclinical CV damage. Large artery stiffness, a well-documented marker of arterial damage and predictor of adverse CV prognosis, is usually assessed by measuring aortic pulse wave velocity (PWV). Several studies examined arterial stiffness in HIV+ with inconsistent results. In a previous meta-analysis, showing increased arterial stiffness in HIV+ than in HIV- subjects, studies assessing aortic and peripheral PWV were pooled together. This may be misleading, because only the former …

Diabetes and aortic root dimension: A controversial subject.

UTILITÀ DI UN BASSO CUT-OFF DI INDICE DI RESISTENZA INTRARENALE NEL PREDIRE ALTERAZIONI VASCOLARI SISTEMICHE PRECOCI IN SOGGETTI CON IPERTENSIONE ARTERIOSA ESSENZIALE

Studi recenti mostrano come l’indice di resistenza intraparenchimale renale (IR), classicamente considerato espressione di resistenza vascolare renale, possa avere un importante ruolo quale marker di alterazioni vascolari sistemiche. Il valore soglia di IR il più spesso utilizzato per identificare pazienti con maggiore probabilità di danno d’organo e di mortalità è stato 0.70. Non è stato tuttavia verificato se un cut-off più basso abbia una maggiore capacità di identificare alterazioni vascolari sistemiche subcliniche. Scopo del nostro studio è pertanto quello di determinare, in soggetti con ipertensione arteriosa essenziale (EH), il valore di IR renale che meglio predica l’esistenza di un…

ASSOCIATION OF RENAL RESISTIVE INDEX WITH AORTIC PULSE WAVE VELOCITY IN HYPERTENSIVE PATIENTS.

The assessment of renal hemodynamic parameters by duplex Doppler sonography has been used for many years as a diagnostic tool in the daily work-up of kidney diseases. Recent data suggest that these parameters, especially the intrarenal resistive index (RI) may be also associated with systemic vascular changes and with an enhanced cardiovascular risk. However, conflicting data exist in literature about the independent association of aortic stiffness with RI. The aim of this study was to evaluate the relationship between RI and arterial stiffness, assessed by aortic pulse wave velocity (PWV), in the hypertensive subjects consecutively attending our hypertension centre. We enrolled 264 subject…

FATTORI ASSOCIATI ALLA DISCORDANZA TRA ALTERAZIONI DELLA PULSE WAVE VELOCITY AORTICA E AUMENTO DELLO SPESSORE MIO-INTIMALE CAROTIDEO IN SOGGETTI IPERTESI: DATI PRELIMINARI

Numerosi studi hanno dimostrato come lo spessore mio-intimale carotideo (IMTc), valutato mediante eco-color-Doppler, sia un importante marcatore di danno d’organo subclinico nonché espressione di alterazione vascolare sistemica. Recenti dati, d’altro canto, hanno evidenziato come anche la pulse wave velocity aortica (PWVa), nota misura di stiffness arteriosa, sia indice di precoce danno vasale. Pur dipendendo parzialmente da comuni fattori patogenetici, IMTc e PWVa non hanno un significato clinico del tutto sovrapponibile e risultano non raramente discordanti tra loro. Appare pertanto interessante identificare quali siano i fattori associati al divergente comportamento di tali parametri. So…

Relationship Between Carotid Atherosclerosis and Pulse Pressure with Renal Hemodynamics in Hypertensive Patients.

BACKGROUND Structural atherosclerotic damage, arterial stiffness, pulse pressure (PP), and renal hemodynamics may interact and influence each other. Renal resistance index (RRI) appears as a good indicator of systemic vascular changes. The aim of our study was to assess the independent relationships of carotid intima-media thickness (cIMT), aortic pulse wave velocity (aPWV), and peripheral PP with RRI in hypertensives with various degrees of renal function. METHODS We enrolled 463 hypertensive patients (30-70 years) with normal renal function (group 0; n = 280) and with chronic kidney disease (groups I-V; n = 183). All subjects underwent ultrasonographic examination of intrarenal and caroti…

Relationship between kidney findings and systemic vascular damage in elderly hypertensive patients without overt cardiovascular disease

Few studies have investigated the influence of age on the relationships between systemic vascular damage, kidney dysfunction, and intrarenal hemodynamic changes in patients with hypertension without overt cardiovascular disease. The authors enrolled 126 elderly patients with hypertension (aged ≥65 years) and 350 nonelderly patients with hypertension (aged <65 years). Carotid intima‐media thickness, renal resistive index, and aortic pulse wave velocity were performed in all patients. Elderly patients with hypertension had lower estimated glomerular filtration rates and higher albuminuria, renal resistive index, carotid intima‐media thickness, and aortic pulse wave velocity compared with none…

Left ventricular hypertrophy in chronic kidney disease: A diagnostic criteria comparison.

Background and aims: CKD patients have a high prevalence of LVH and this leads to an increase of cardiovascular risk. The aim of this study was to assess the prevalence of left ventricular hypertrophy (LVH) and left ventricular geometry in a group of 293 hypertensive patients with stage 2–5 chronic kidney disease (CKD), compared with 289 essential hypertensive patients with normal renal function. Methods and results: All patients underwent echocardiographic examination. Patients on stage 1 CKD, dialysis treatment, or with cardiovascular diseases were excluded. LVH was observed in 62.8% of patients with CKD and in 51.9% of essential hypertensive patients (P &lt; 0.0001). We found increasingl…

SHORT-TERM VARIABILITY OF 24H SYSTOLIC BLOOD PRESSURE IS ASSOCIATED WITH MICROALBUMINURIA IN PATIENTS WITH PRIMARY HYPERTENSION

Objective: Limited and conflicting data are available about the association between shortterm blood pressure (BP) variability and urinary albumin excretion rate (uAER). The objective of our study was to analyze the relationships between microalbuminuria, defined as an uAER between 20 and 200mg/ min, and shortterm BP variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24h BP, and as SD of daytime and nighttime BP. Design and method: The study population consisted of 315 untreated essential hypertensives with normal estimated glomerular filtration rate (> 60ml/min/1.73 m2), which underwent 24h ambulatory BP monitoring and 24h uAER determination. Result…

ASSOCIATION BETWEEN RENAL RESISTIVE INDEX AND CAROTID INTIMA-MEDIA THICKNESS IN HYPERTENSIVE PATIENTS.

Introduction: The assessment of renal hemodynamic parameters by duplex Doppler sonography has been used for many years as a diagnostic tool in the daily work-up of kidney diseases. Recent data suggest that these parameters, especially the intrarenal resistive index (RI) may be also associated with changes of the systemic vascular tree and with an enhanced cardiovascular risk. However, conflicting data exist in literature about the independent association of carotid intima-media thickness (IMT) with RI. Aim: To evaluate the relationship between RI and carotid IMT in the hypertensive subjects consecutively attending our hypertension centre. Methods: We enrolled 264 subjects, aged between 30 a…

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…

Para-perirenal distribution of body fat is associated with reduced glomerular filtration rate regardless of other indices of adiposity in hypertensive patients

Obesity is a well‐known risk factor for the development and progression of chronic kidney disease. Recently, para‐perirenal ultrasonographic fat thickness (PUFT) has shown to correlate with both total and visceral fat better than body mass index (BMI), waist circumference (WC), and other indices of obesity. Moreover, a local paracrine and mechanical action of the PUFT on kidney has been described in recent studies. Aim of our study was to assess the relationship between glomerular filtration rate (GFR) and PUFT in comparison with other anthropometric and ultrasonographic indices of adiposity. Two hundred and ninety‐six hypertensive patients were enrolled. PUFT, cutis‐rectis thickness and re…

Haemodynamics of primary aldosteronism associated with adrenocortical adenoma: insights from bioimpedance cardiography measurements

In mid 1950s, Dr Jerome Conn described a patient with hypertension, and renal potassium wasting associated with adrenocortical adenoma and increased urinary excretion of a sodium-retaining hormone, initially termed electrocortin, which was subsequently shown to be aldosterone. This was the first full report of primary hyperaldosteronism associated with an aldosterone-producing adenoma (APA). It subsequently became apparent that similar abnormalities can occur in the absence of an adrenocortical tumor, and it is now recognized that the APA is just one of many subtypes of primary aldosteronism (PA).

L’aldosterone plasmatico e la sua relazione con la massa ventricolare sinistra nei pazienti ipertesi con malattia renale cronica I-III stadio NKF

RAZIONALE. La malattia renale cronica (CKD) è associata ad un’incrementata massa ventricolare sinistra (LVM), che può predisporre ad un aumentato rischio di eventi cardiovascolari. Le concentrazioni plasmatiche di aldosterone (PAC) sono spesso incrementate negli stadi avanzati di CKD. Poco è noto sui livelli di aldosterone e la loro relazione con la LVM nei soggetti con CKD lieve-moderataL’obiettivo del nostro studio è stato quello di analizzare PAC e LVM e la loro relazione in un gruppo di pazienti ipertesi con CKD agli stadi I-III National Kidney Foundation (NKF). CASISTICA E METODI. Abbiamo arruolato 195 pazienti ipertesi con CKD agli stadi I-III NKF e li abbiamo comparati ad un gruppo d…

Alterazioni dell’emodinamica intrarenale e del microcircolo coroideo valutate mediante OCT in soggetti con ipertensione arteriosa

INVERSE RELATIONSHIPS BETWEEN CHOROIDAL THICKNESS AND RENAL RESISTANCE INDEX IN HYPERTENSIVE PATIENTS

Introduction: Alterations of the renal microcirculation have been documented in animal models of hypertensive renal damage. Traditionally, the retina has been considered the easiest accessible window to study the systemic microcirculation, even though the choroid is the most important vascular layer of the eye. The introduction in the past few years of advanced optical coherence tomography (OCT) techniques has greatly increased our understanding of the choroid. Although the renal resistive index (RRI) was initially considered to reflect intrarenal vascular pathological processes, this index is actually regarded as the result of complex interaction between renal and systemic vascular wall pr…

RELATIONSHIP BETWEEN URIC ACID AND RENAL DAMAGE IN HYPERTENSIVE PATIENTS: WHICH ROLE FOR RENAL HAEMODYNAMICS

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Relationship between aortic root size and glomerular filtration rate in hypertensive patients

OBJECTIVE: Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects. METHODS: We enrolled 611 hypertensive individuals (mean age: 52 ± 15 years; men 63%). ARD was measured by echocardiography at the level of Valsalva's sinuses using M-mode tracings. It was considered as absolute measure, normalized to body surface area (ARD/BSA) and indexed to height (ARD/H). GFR was estimated by the Chronic Kidney Disease Epidemiology Collaborati…

Subclinical Kidney Damage in Hypertensive Patients: A Renal Window Opened on the Cardiovascular System. Focus on Microalbuminuria

The kidney is one of the major target organs of hypertension. Kidney damage represents a frequent event in the course of hypertension and arterial hypertension is one of the leading causes of end-stage renal disease (ESRD). ESRD has long been recognized as a strong predictor of cardiovascular (CV) morbidity and mortality. However, over the past 20 years a large and consistent body of evidence has been produced suggesting that CV risk progressively increases as the estimated glomerular filtration rate (eGFR) declines and is already significantly elevated even in the earliest stages of renal damage. Data was supported by the very large collaborative metaanalysis of the Chronic Kidney Disease …

FOKI AND BSMI VITAMIN D RECEPTOR GENE POLYMORPHISMS, ARE THEY ASSOCIATED WITH INTIMA MEDIA THICKNESS IN ESSENTIAL HYPERTENSIVE INDIVIDUALS

Objective: Analyzing 25hydroxyvitaminD (25[OH]D) serum levels and common carotid intimamedia thickness (IMT) relationship, and evaluating the association of FokI and BsmI vitamin D receptor (VDR) gene polymorphisms with IMT in essential hypertensive patients were our study aims. Design and method: We enrolled seventyone essential hypertensive patients, 18–75 years old. Patients underwent clinical blood pressure (BP) measurement, 24 hour ambulatory blood pressure monitoring, routine blood test, 25[OH]D assay and common carotid IMT evaluation. FokI and BsmIVDRpolymorphisms were analyzed by polymerase chain reactionrestriction fragment length polymorphism (PCRRFLP).

The Relationship Between Aortic Root Size and Hypertension: An Unsolved Conundrum

Thoracic aortic aneurysms rupture and dissection are among the most devastating vascular diseases, being characterized by elevated mortality, despite improvements in diagnostic imaging and surgical techniques. An increased aortic root diameter (ARD) represents the main risk factor for thoracic aortic dissection and rupture and for aortic valve regurgitation. Even though arterial hypertension is commonly regarded as a predisposing condition for the development of thoracic aorta aneurysms, the role of blood pressure (BP) as determinant of aortic root enlargement is still controversial. The use of different methods for indexation of ARD may have in part contributed to the heterogeneous finding…

Renal resistive index: Beyond the hemodynamics

We read with great interest the original article entitled “Prognostic significance of the renal resistive index in the primary prevention of type II diabetes” by Delsart et al1 In this issue of The Journal, the authors interestingly underlined the prognostic value of renal resistive index (RRI) in diabetic subjects and its role as an independent predictor of a first cardiovascular or renal event. Similar conclusions were previously obtained by others in different subsets of patients (hypertension, chronic kidney disease, or heart failure), in which intrarenal hemodynamic alterations showed to be independent predictors of cardiovascular events. It is likely that the mechanisms underlying ren…

SEVERITY OF CAROTID DISEASE AND RENAL HEMODYNAMICS IN HYPERTENSIVE PATIENTS WITH AND WITHOUT IMPAIRED RENAL FUNCTION

Early vascular aging in normotensive subjects with systemic lupus erythematous. Comparison with young hypertensive patients

early vascular aging

RELAZIONI TRA PARAMETRI LIPIDICI E MASSA VENTRICOLARE SINISTRA IN SOGGETTI CON IPERTENSIONE ARTERIOSA ESSENZIALE

Dati non univoci sono riportati in letteratura sul ruolo della dislipidemia nello sviluppo dell’ipertrofia ventricolare sinistra. Scopo del nostro studio, è stato quello di valutare le potenziali associazioni dei principali parametri lipidici con la massa ventricolare sinistra (LVM) in pazienti con ipertensione essenziale (EHs). Abbiamo arruolato 724 soggetti con EH (età media 45±12 anni; 63% maschi), senza complicanze cardiovascolari e non trattati con farmaci ipolipemizzanti. In tutti i soggetti dono stati dosati la colesterolemia totale (Tchol), la trigliceridemia (TG) e il colesterolo HDL (HDLc). Il colesterolo LDL (LDLc) è stato stimato con la formula di Friedewald ed è stato calcolato…