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…

1.12 C-Reactive Protein is Associated with Aortic Stiffness Independently of Microalbuminuria in Essential Hypertension

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…

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…

Value of Home Blood Pressures as Predictor of Target Organ Damage in Mild Arterial Hypertension

Home blood pressure measurement has gained increasing importance for the management of hypertensive patients. The aim of our study was to compare levels of clinic (CBP), ambulatory (ABP), and home blood pressure (HBP) measurements, and their relationships with various indexes of target organ damage in I-II grade essential hypertension.Thirty-eight essential hypertensives underwent evaluation of clinic, ambulatory and home blood pressures. Each patient recorded HBP for 2 days with a digital BP monitor three times daily, the first time on the same day during which ABP monitoring was simultaneously performed. Moreover, in all subjects electrocardiogram recording, echocardiographic study, micro…

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

Influence of metabolic syndrome on hypertension-related target organ damage

EFFECTS OF ALLOPURINOL ON RENAL FUNCTION DECLINE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASES

Aim: To evaluate retrospectively the effects of allopurinol treatment on renal function decline in non-gouty hypertensive patients with moderate-to-severe CKD. Methods: We selected 22 patients treated with allopurinol (A) (100–300 mg/die) that were compared with 44 subjects not treated with this drug (B), matched with A for estimated glomerular filtration rate (eGFR), age, gender and blood pressure values. Results: After a mean follow-up period of 16 months no significant difference was observed between the two groups regarding eGFR decline (A: -6.8 ± 11.6 ml/min/1.73 m2; B: -4.2 ± 9.3 ml/min/1.73 m2). Furthermore, the percentage of subjects with a value of eGFR reduction above the median w…

Screening for congenital renovascular hypoplasia and renal artery stenosis by acute converting enzyme inhibition.

To evaluate the usefulness of the captopril test for identifying renal artery stenosis (RAS) and renovascular hypoplasia (RAH), we studied 48 hypertensive patients. In 20 hypertensives with screening procedures indicating renovascular disease and in 28 essential hypertensives (EH), the plasma renin activity (PRA) responses to an oral test dose of captopril (50 mg) were studied. A 60-min post-captopril PRA increase of 150% (or 400% if baseline PRA < or = 3 ng/ml/h) was considered as positive. Renal angiography was performed in all cases. Among the 20 renovascular hypertensive patients, RAH in 9 and RAS in 11 subjects were proved by angiography. The captopril test in all patients with RAH res…

INVERSE RELATIONSHIP BETWEEN CHOROIDAL THICKNESS AND SUBCLINICAL RENAL DAMAGE IN ESSENTIAL HYPERTENSION

The introduction in last years of advanced techniques of optical coherence tomography (OCT) has greatly increased our understanding of the choroid, that is the most important vascular layer of the eye. Our study was aimed to assess choroidal thickness by using Swept-Source OCT (SS-OCT) in essential hypertensive patients (EHs) with and without subclinical renal damage (SRD). We enrolled 100 EHs of which 65 without kidney damage and 35 with SRD. In all the participants SS-OCT and a routine biochemical workup were performed. Glomerular filtration rate (GFR) was estimated by the CKD-EPI equation (eGFR). SRD was defined, by the presence of microalbuminuria or eGFR between 30 and 60 mL/min/1.73 m…

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…

Left ventricular structure and function in hypertensives with chronic renal insufficiency.

RELATIONSHIP BETWEEN OBESITY AND LEFT VENTRICULAR MASS IN CAUCASIAN HYPERTENSIVE SUBJECTS. DOES SEX MATTER?

Objective The excess of adiposity affects the heart through haemodynamic and non haemodynamic mechanisms leading to left ventricular hypertrophy (LVH) and ultimately to heart failure. It has been been previously observed, in a large study performed in American Indians, that the impact of obesity on left ventricular mass (LVM) is greater in women than men, while the results of other investigations carried out in other ethnic groups have yielded conflicting results .The aim of our study was to evaluate the potential influence of gender on the relationships between obesity and LVM in Caucasian patients with essential hypertension (EHs) . Design and method We enrolled 724 subjects with EH (mean…

Epidemiology and pathophysiology of left ventricular abnormalities in chronic kidney disease: a review.

Introduction Cardiovascular diseases are highly prevalent in patients with chronic kidney disease (CKD), and represent the major hazard for mortality in this population. Anomalies of left ventricular (LV) structure and function are very frequent too among CKD patients, and show a negative impact on cardiovascular prognosis. Methods We searched PubMed for manuscripts regarding left ventricular hypertrophy (LVH) in CKD. Definition of LVH was different according to different studies. Results In patients with end-stage renal disease, the prevalence of LVH is higher than 70%. Studies in patients with less advanced CKD have reported increasing prevalence of LVH along with declining renal function…

Relationships between glomerular filtration rate and left ventricular mass in uncomplicated essential hypertension

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…

Relationship of transforming growth factor-beta(1) with tumour necrosis factor-alpha and endothelial activation in patients with stable renal transplantation.

SUMMARY: Aim:  To evaluate whether or not transforming growth factor-beta1 is related to inflammation markers and to intercellular and vascular cell adhesion molecules in patients with stable renal transplantation. Methods:  Serum concentrations of transforming growth factor-beta1, tumour necrosis factor-alpha, C-reactive protein and adhesion molecules were analysed in 33 renal transplanted patients, 33 patients with chronic renal insufficiency (matched to the transplanted group for level of renal function), and 33 hypertensives with normal renal function. anova, Student's t-test and simple regression analysis were used to analyse the data. Results:  Transplanted patients showed higher valu…

Early Vascular Aging in Normotensive Patients With Systemic Lupus Erythematosus

Connective tissue diseases, like systemic lupus erythematosus (SLE), are associated with early and accelerated atherosclerosis. Recently, the concept of “early vascular aging” (EVA) has been more widely accepted. Aortic stiffness is one of the important markers of EVA. We evaluated EVA and subclinical atherosclerosis, by measuring aortic pulse wave velocity (aPWV) and carotid intima–media thickness (cIMT), in 50 normotensive patients with SLE (mean age: 39 ± 12 years). We compared these participants with 50 age- and sex-matched patients with essential hypertension (EH) and 20 healthy controls. Each participant underwent 24-hour ambulatory blood pressure monitoring (ABPM), aPWV, and cIMT me…

Geometria ventricolare sinistra nell’insufficienza renale cronica.

Indice ambulatoriale di rigidità arteriosa e filtrazione glomerulare nell’ipertensione arteriosa essenziale

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…

Endothelin-1 and F2-isoprostane relate to and predict renal dysfunction in hypertensive patients.

Background. Hypertension and additional non-traditional risk factors can damage the kidney directly and by promoting atherogenesis. Evidence indicates that increased oxidative stress and inflammation may mediate a large part of the effects of risk factors on the kidney. We hypothesized that in hypertensive patients (HT), oxidative stress, measured as 8-ISO-prostaglandin F2alpha (8-ISO-PGF2alpha), should raise paralleling decreasing renal function and should correlate with estimated glomerular filtration rate (eGFR). Methods. In 626 HT with renal function ranging from stages 1 to 5 and 100 healthy controls, plasma levels of 8-ISO-PGF2alpha, high-sensitivity C-reactive protein (CRP), transfor…

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…

Controllo pressorio e farmaci anti-ipertensivi in 490 pazienti con malattia renale cronica e ipertensione arteriosa

Factors Associated with Renal Dysfucntion in Arterial Hypertension: the REDHY study.

Il controllo pressorio nell’insufficienza renale cronica: valutazione mediante monitoraggio ambulatorio (ABPM).

Fetuina e massa ventricolare nell’ipertensione essenziale e nell’insufficienza renale cronica di grado moderato

Left ventricular hypertrophy in hypertensives with chronic renal insufficiency

Oxidative Stress, Inflammation and Endothelial Biomarkers in Arterial Hypertension

Role of Renin-Angiotensin-Aldosterone System and of Sympathetic Activity in Arterial Hypertension Associated with Autosomal Dominant Polycystic Kidney Disease

Epinephrine and Norepinephrine Pattern in Elderly Patients with Borderline and Established Hypertension

To evaluate the activity of sympathetic system and of plasm renin in elderly patients with borderline (BH) and established essential hypertension (EH), 31 BH mean age 38 years and 30 EH, mean age 39 years; 15 BH, mean age 66 years, and 15 EH, mean age 68 years, were studied at rest and after dynamic exercise. At the same time blood pressure and heart rate were automatically recorded, while blood samples were collected for PRA and plasma epinephrine (E) and norepinephrine (NE) assays. Plasma E levels showed no significant differences between the groups examined at rest. Nevertheless, young BH had higher plasma E levels than young EH after stress and elderly BH showed plasma E levels higher t…

Markers di fibrosi miocardica e di infiammazione in ipertesi con e senza ipertrofia ventricolare.

Left ventricular hypertophy in overweight and obese hypertensives patients: impact of metabolic syndrome

Relationship between metabolic syndrome and left ventricular structure and function in subjects with isolated clinic hypertension

The REDHY Study: Prevalence of Decreased Renal Function in Uncomplicated Essential Hypertension

Relationship between obesity and plasma aldosterone in essential hypertension: influence of gender

Valutazione della funzione diastolica del ventricolo sinistro in soggetti ipertesi con insufficienza renale cronica

Il propeptide carbossi-terminale del collagene tipo I è un predittore indipendente della massa del ventricolo sinistro in pazienti con ipertensione essenziale.

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…

Left ventricular hypertrophy in the hypertensives with chronic renal insufficiency.

Diastolic function in hypertensives with chronic renal insufficiency and without left ventricular hypertrophy.

The Association of Microalbuminuria With Aortic Stiffness Is Independent of C-Reactive Protein in Essential Hypertension

BACKGROUND It has not been fully elucidated whether microalbuminuria (MAU) and high-sensitivity C-reactive protein (hsCRP) are associated with aortic distensibility independently of each other. Our study was aimed to evaluate the independent relationships of urinary albumin excretion rate (AER) and hsCRP with aortic stiffness in hypertensive patients. METHODS We enrolled 140 untreated nondiabetic essential hypertensives (mean age: 48 +/- 12 years). In all subjects, 24-hour AER and plasma levels of hsCRP were determined by immunoenzymatic assay. MAU was defined as an AER of 20-200 microg/min. Aortic stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV). RESULTS C…

Hyperuricemia and high blood pressure at rest and during exercise: Guilty or innocent? The jury is still out

The authors investigated the hypothesis that high serum uric acid concentrations may be related to an exaggerated systolic blood pressure (SBP) response to maximal exercise testing in men with normotension, independent of potential confounding variables. In 4640 healthy men with normotension who underwent maximal treadmill exercise testing and fasting blood chemistry studies, including serum uric acid concentrations, an exaggerated SBP response, defined as SBP ≥ 210 mm Hg, was detected in 152 men (3.3%). After adjusting for potential confounders, participants in the highest quartile of serum uric acid (>6.6 mg/dL) had a higher odds ratio of demonstrating an exaggerated SBP to maximal exerci…

Association of Oxidative Stress with Aortic Stiffness in Hypertensive Patients with Chronic Kidney Disease

Several studies have consistently demonstrated that arterial stiffness becomes progressively worse as CKD progresses and a negative correlation of oxidative stress with renal function has been described. There is also sound experimental evidence indicating that oxidative stress is involved in atherogenesis. The contribution of oxidative stress to aortic stiffness is less clear. Aim: To analyse the relationship between plasma levels of 8-ISO-prostaglandin F2alpha (8-ISOPGF2alpha), an index of lipid peroxidation, considered a reliable biomarker of oxidative stress, and aortic stiffness in a group of hypertensive patients with chronic kidney disease. Methods: We enrolled 126 hypertensive patie…

Interleukin 6 plasma levels predict with high sensitivity and specificity coronary stenosis detected by coronary angiography

SummaryIn recent years new biomarkers able to measure the coronary atherosclerotic burden have been investigated. The aim of the present study was: i) to measure plasma levels of four biomarkers: C reactive protein (CRP), soluble intercellular adhesion molecule-1 (sICAM-1), interleukin 6 (IL-6), 8-isosprostane (8-ISO),in a series of patients undergoing coronary angiography; ii) to assess the power of the biomarkers to predict critical coronary stenosis detected by angiography. The study population consisted of a group of 438 subjects undergoing coronary angiography; 160 patients with 0, 1, 2, or 3 critical vessels were selected, and biomarkers plasma levels were measured in plasma samples o…

Value of home blood pressure as predictor of target organ damage in mild arterial hypertension

Relationship between aortic stiffness and albumin excretion rate in untreated essential hypertensive patients

Microalbuminuria and endothelial activation in treated and untreated diabetic and non-diabetic hypertensives

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…

Relazioni tra aldosterone plasmatico, sindrome metabolica e massa ventricolare sinistra nell’ipertensione arteriosa essenziale

Sympathetic Overactivity and 24-Hour Blood Pressure Pattern in Hypertensives with Chronic Renal Failure

In order to assess the activity of the sympathetic system and to evaluate the 24-h blood pressure pattern in hypertensives with chronic renal failure (CRF), 12 CRF patients and 16 essential hypertensives (EHs) were studied. In all subjects, plasma samples for catecholamines and renin activity were obtained both in the basal condition and after standing, and 24-h blood pressure monitoring (ABPM) was performed. The 24-h mean blood pressure results were quite similar between CRFs and EHs. In 50% of the CRFs, ABPM showed a nighttime decrease in diastolic BP (DBP) greater than 10%, while in the remaining 50% the ABPM indicated a nondipper blood pressure pattern. Of the 16 EHs, 4 had a nighttime …

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…

I polimorfismi del gene VDR FokI e BsmI non sembrano essere associati all’ipertensione arteriosa

Scopo. Il nostro obiettivo è stato quello di analizzare la relazione tra livelli plasmatici di vitamina D (VitD) e valori di pressione arteriosa clinica ed ambulatoria in ipertesi essenziali e di identificare un’eventuale associazione fra l’ipertensione e i polimorfismi del gene VDR, FokI e BsmI. Materiali e metodi. Abbiamo arruolato 71 ipertesi essenziali e 72 controlli di età compresa fra 18 e 75 anni. Nei pazienti sono stati valutati: pressione arteriosa clinica, monitoraggio ambulatorio della pressione arteriosa delle 24 ore, parametri antropometrici, indagini bioumorali di routine e livelli plasmatici di VitD con metodica HPLC. Entrambi i gruppi sono stati sottoposti a tipizzazione dei…

Influence of Vascular Load on Plasma Endothelin-1, Cytokines and Catecholamine Levels in Essential Hypertensives

In vitro studies demonstrated a relationship between ET-1 and basic Fibroblast Growth Factor (bFGF), and of bFGF with Platelet Derived Growth Factor (PDGF). The present study was carried out to investigate in vivo the behaviour after vascular stress of circulating ET-1, bFGF and PDGF, and catecholamines, and their relationship. In 12 healthy normotensives (NTs) and 15 essential hypertensives (Ehs) venous blood samples to determine circulating ET-1, bFGF and PDGF, and catecholamine (EPI and NE) levels were drawn before and at the third minute of a handgrip test. Blood pressures (BP) and heart rate were automatically recorded before starting, and at 1, 2, and 3 minutes during the test. The NT…

Associazione tra aldosterone plasmatico, sindrome metabolica e massa ventricolare sinistra nell’ipertensione arteriosa essenziale

Infiammazione, stress ossidativo ed attivazione endoteliale: confronto tra pazienti uremici in trattamento sostitutivo e pazienti con insufficienza renale cronica in trattamento conservativo.

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

Stato nutrizionale e citochine nell’insufficienza renale cronica

Fetuina-A, infiammazione e massa del ventricolo sinistro in pazienti con chronic kidney disease stage 3-4

Ruolo della Ciclofosfamide nel trattamento del Lupus Eritematoso Sistemico in paziente afroamericana con severo incremento degli indici di funzionalità renale.

Introduzione: la Ciclofosfamide rappresenta con il Micofenolato Mofetile uno tra i farmaci di scelta nelle fasi di induzione della nefrite lupica. Tuttavia, risulta ancora controverso il suo utilizzo nei soggetti di razza afroamericana. Caso Clinico: Paziente afroamericana puerpera di 36 anni, che giungeva alla nostra osservazione dopo parto cesareo in urgenza alla 34° settimana per riscontro di preclampasia. La paziente si presentava in stato anasarcatico, oligoanurica, con severa alterazione degli indici di funzione renale (Cr 4 mg/dl) proteinuria in range nefrosico ed anemizzazione severa. Storia di TBC linfonodale. Riscontro di positività ad esami bioumorali di autoimmunità: ANA, Anti- …

Renal artery denervation for treating resistant hypertension: Definition of the disease, patient selection and description of the procedure

Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications. Arterial hypertension is arbitrarily defined as 'resistant' or 'refractory' when the recommended blood pressure goals (clinic blood pressure below…

Metabolic syndrome in overweight and obese hypertensives patients: impact on left ventricular mass.

Nell’ipertensione arteriosa associata ad obesità ed insulino-resistenza lo stress ossidativo non è influenzato dal metabolismo glucidico

Relazione tra stress ossidativo ed attivazione endoteliale in pazienti dializzati

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…

Relationships between estimates of glomerular filtration rate and ultrasonographically determined renal volume in hypertensive patients.

Relazione tra aldosteronemia, sindrome metabolica e massa ventricolare sinistra nell’ipertensione essenziale

Trattamento non farmacologico dell'ipertensione arteriosa

Un adeguato trattamento dell’ipertensione arteriosa include sia la terapia farmacologica sia quella non farmacologica, mirando ad ottenere un effetto additivo e complementare. Le modificazioni dello stile di vita costituiscono il trattamento non farmacologico di prima scelta della malattia ipertensiva, come indicato da tutte le Linee guida internazionali. Uno stile di vita sano può prevenire o ritardare l’insorgenza dello stato ipertensivo e può ridurre il rischio cardiovascolare del paziente iperteso, oltre ad offrire la possibilità di aumentare l’efficacia antipertensiva della terapia farmacologica.

Valutazione della funzione diastolica del ventricolo sinistro mediante Doppler tissutale in soggetti ipertesi con e senza insufficienza renale cronica

Rapporti tra stato nutrizionale e citokine nell’insufficienza renale cronica

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

We are grateful to Dr Zhao Li and coauthors [1] for their interest in our work [2] and we appreciate the opportunity to comment some issues raised in their letter, a part of which have been already addressed in the discussion section of our article.They assessed the relationship between glomerular filtration rate (GFR), estimated by the chronic kidney disease (CKD)-Epidemiology Collaboration equation, and the aortic annular diameter measured from trailing edge to leading edge at the hinging points of the aortic cusps to the annulus in a general population of 5538 Chinese hypertensive patients [3]. At variance with our findings, no association was detected between GFR and aortic annular diam…

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…

Insulin, renin-aldosterone system and blood pressure in obese people.

OBJECTIVE: To evaluate the relationship between insulin, the renin-aldosterone system and blood pressure in obese subjects. DESIGN AND METHODS: A cross sectional study of a group of severely obese normotensive subjects who were surgical candidates (n=39; mean BMI: 47.8±1.4) and a group of hypertensive patients (n=57; mean BMI: 28.0±0.7) twenty-nine of whom had BMI>27. All subjects were studied after 15 days on a balanced diet. Insulin, plasma renin activity and aldosterone were measured. RESULTS: Fasting insulin, plasma renin activity and aldosterone were higher in severely obese normotensive subjects than in hypertensive subjects (respectively 32.3±3.0 vs 13.1±1.0 mU/l, P=0.0001; 1.34±0.22…

Blood Presssure Control and Anti-Hypertensive Drugs in 490 Patients with Arterial Hypertension and Chronic Kidney Disease.

Endotelina-1 e 8-isoprostano predicono il GFR stimato nell’ipertensione arteriosa

Hypertension, microalbuminuria and renal dysfunction. The REDHY (REnal Dysfunction in HYpertension) study

Sympathetic Activity and Blood Pressure Pattern in Autosomal Dominant Polycystic Kidney Disease Hypertensives

To study the potential role of sympathetic activity in the pathogenesis of arterial hypertension associated with autosomal dominant polycystic kidney disease (ADPKD) and to analyze its relationship with 24-hour blood pressure pattern, plasma catecholamines and 24-hour ambulatory blood pressure monitoring were evaluated in 30 ADPKD hypertensive patients (of which 17 without and 13 with renal failure) and in 50 essential hypertensives. The groups were matched for sex, body mass index, known duration of hypertension, and clinic blood pressure. Plasma catecholamines, determined in resting position, were higher in ADPKD patients without renal failure than in essential hypertensives. Nighttime di…

Relationships between 24 h blood pressure load and target organ damage in patients with mild-to-moderate essential hypertension.

Objective: To analyse the relationships between 24 h blood pressure load (the percentage of systolic/diastolic blood pressures exceeding 140/90 mmHg while awake and 120/80 mmHg during sleep) and some indices of hypertensive target organ involvement, independently of the mean level of 24 h blood pressure. Methods: One hundred and thirty patients with mild-to-moderate hypertension underwent 24 h ambulatory blood pressure monitoring, ocular fundus examination, microalbuminuria assay and two-dimensional guided M-mode echocardiography. The study population was divided into subsets according to the systolic and diastolic 24 h blood pressure load values predicted from the regression equation relat…

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…

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

Relazione tra stress ossidativo e attivazione endoteliale in pazienti emodializzati.

How common is isolated nocturnal hypertension?

The growing use of methods to measure blood pressure (BP) under everyday life conditions in ‘out-of-office’ settings, through either 24-h ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM), for defining BP status has led to identification of four specific hypertension phenotypes, characterized by variable agreement or disagreement between office BP (OBP) and out-of-office BP: true normotension (normal office and out-of-office BP), sustained hypertension (both elevated office and out-of-office BP), masked hypertension (normal office BP and out-of-office BP), and white-coat hypertension (WCH), when OBP is elevated, but out-of-office BP levels are within normal limits. The term ‘whit…

Endothelial activation and insulin resistance: Comparison between essential hypertensives and hypertensive patients with Metabolic Syndrome

Microalbuminuria Is Associated With Increased Aortic Stiffness Independently of C-Reactive Protein in Essential Hypertension

Pattern di ipertrofia ventricolare sinistra negli ipertesi con insufficienza renale cronica.

Evaluation of oxidative stress in hypertensive patients with transplanted kidney

Oxidant stress inversely relates to renal function in hypertension

Vitamina D, ipertensione arteriosa e sistema renina-angiotensina

Relationship between obesity and plasma aldosterone in essential hypertension: influence of gender

Endothelial dysfunction and vitamin d status in essential hypertension, prelimary results

FOKI AND BSMI VITAMIN D RECEPTOR GENE POLYMORPHISMS, PLASMA RENIN ACTIVITY AND ESSENTIAL ARTERIAL HYPERTENSION

Objective: Our aims were to analyze the relationship between 25hydroxyvitamin D(25[OH]D) plasma levels and clinical and ambulatory blood pressure (BP) values, and to identify any possible association between hypertension and FokI and BsmI vitamin D receptor (VDR) gene polymorphisms in essential hypertensive patients. Design and method: Seventyone essential hypertensive patients and seventytwo controls, 18–75 years old, were enrolled. Clinical physical examination, routine blood chemistry, clinical BP, 24 hour ambulatory blood pressure monitoring, 25[OH]D and Plasma Renin Activity (PRA) assay, and FokI and BsmI VDR polymorphisms analysis were obtained. Results:We observed a significant negat…

No independent association of serum uric acid with left ventricular mass 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…

Relation of oxidant stress with endothelial activation in hemodialysis.

Introduction and Aims: Enhanced oxidative stress may be implicated in the pathogenesis of atherosclerosis in hemodialysed patients (HDs). We hypothesized that in hypertensive HDs oxidative stress should be elevated and associated to endothelial activation, and inflammation. Methods:We examined oxidative stress, as measured by 8-ISO-PGF2alpha, endothelial activation by measuring endothelin-1 (ET-1) and adhesion molecules ICAM-1 and VCAM-1, and the biomarker of acute-phase inflammation CRP. In 52 mild HDs and in 50 healthy controls (Cs) we analysed, in the interdialytic day, plasma levels of 8-ISO-PGF2alpha, ET-1, ICAM-1 and VCAM-1, and high sensitivity CRP. Results: The comparison between Cs…

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 (…

Influence of gender on the relationships between metabolic syndrome and left ventricular mass in hypertensive patients

Metabolic syndrome in hypertensive patients: An unholy alliance

For many years, it has been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance and hyperuricemia. This constellation of various conditions has been transformed from a pathophysiological concept to a clinical entity, which has been defined metabolic syndrome (MetS). The consequences of the MetS have been difficult to assess without commonly accepted criteria to diagnose it. For this reason, on 2009 the International Diabetes Federation, the American Heart Association and other scientific organizations pro…

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 &gt;0.625, which would be suspicious about the existence of atherosclerotic disease. Conclusion:…

C-reactive protein and ICAM-1 are stronger predictors of oxidant stress than blood pressure in established hypertension

Left ventricular diastolic function in hypertensives with chronic renal insufficiency.

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)…

Insufficienza renale cronica, ipertensione arteriosa e controllo pressorio: studio osservazionale di pazienti in terapia conservativa

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 …

Effects of hypocaloric very-low-carbohydrate diet vs. Mediterranean diet on endothelial function in obese women

Obesity is a cardiovascular risk factor associated with endothelial dysfunction, but the effect of different weight loss strategies on endothelial function is not known. The effect of diet on endothelial function in two hypocaloric diets, a very-low-carbohydrate diet (A) and a Mediterranean diet (M), was measured by brachial artery flow-mediated dilation (FMD). Design Using a longitudinal, randomized, open study design, subjects were engaged in a 2-month weight loss diet. FMD, inflammatory cytokines [interleukin-6 (IL-6) and tumour necrosis factor-alpha] and a marker of oxidative stress [8-iso-prostaglandin F2alpha (8-iso-PGF2alpha)] were measured in subjects on three occasions: before init…

Relationship between total arterial compliance and metabolic syndrome in essential hypertensive subjects

Influence of metabolic syndrome on hypertension-related target organ damage

MuleG, Nardi E, Cottone S, Cusimano P, Volpe V, Piazza G, MongioviR, Mezzatesta G, Andronico G, Cerasola G (Universitadi Palermo, Palermo, Italy). Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med 2005; 257: 503-513. Objectives. The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage. Design. Cros…

Changes of plasma endothelin and growth factor levels, and of left ventricular mass, after chronic AT1-receptor blockade in human hypertension.

The stimulation of autocrine and paracrine factors such as basic fibroblast- (bFGF) and platelet-derived (PDGF) growth factors mediates many of the growth-promoting actions of angiotensin II. The aim of this study was to evaluate the effect of chronic AT1-receptor blockade on plasma endothelin-1 (ET-1) and growth factors levels, and on left ventricular mass, in essential hypertension (EH). The study population consisted of 16 patients with mild-moderate EH, and 25 normotensive controls. In the EH patients under basal conditions, and after 3 and 6 months of chronic therapy with Losartan 50 mg/day, we measured serum levels of ET-1, bFGF and PDGF, and tumor necrosis factor (TNF). At the same t…

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…

Parathyroid hormone is inversely related to endothelin-1 in patients on haemodialysis

SUMMARY: Aim: Parathyroid hormone secretion is mainly influenced by hypocalcaemia, hyperphosphataemia and vitamin D deficiency. However, previous in vitro and in vivo studies showed that endothelin-1 can influence parathyroid hormone secretion. This study was aimed at evaluating this relationship in vivo in uraemic patients. Methods: Parathyroid hormone and endothelin-1 plasma concentrations were measured in 67 haemodialysed patients. Patients with history of cardiovascular diseases and those with parathyroid adenoma were excluded. Results: Plasma levels of endothelin-1 were found to be inversely related to those of parathyroid hormone (P < 0.04) The multiple regression analysis, carried ou…

11.5 Blood Pressure Control and Anti-Hypertensive Drugs in 490 Patients with Hypertension and Chronic Kidney Disease

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…

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…

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…

Aneurysm of the superior thyroid artery in a 80-year-old man: case report.

[PP.07.19] ASSOCIATION OF MAXIMUM SPEED OF BLOOD PRESSURE RISE DURING 24-H ABPM WITH SUBCLINICAL RENAL DAMAGE IN ESSENTIAL HYPERTENSION

Objective: Experimental studies documented that the mechanical injury of intravascular pressure on the vessel wall, which results in vascular remodelling and atherosclerosis, may be more closely associated to oscillatory than to steady laminar shear stress This suggests that the hypertensive patient's prognosis may depend not only on average BP level but also on the degree and rate of BP variation. Little is known about the relationships between early renal abnormalities and the rate of BP changes assessed by intermittent 24-h ambulatory BP monitoring (ABPM). Our study was aimed to analyse the relationships between subclinical renal damage (SRD), defined as the presence of microalbuminuria …

Infiammazione ed attivazione endoteliale sono connessi con la funzione renale nel trapianto a lungo termine

Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function

Some reports have suggested that white-coat hypertension (WCH) is associated with some features of the metabolic syndrome (MetS). These metabolic disturbances, instead of WCH per se, may potentially explain the greater extent of end-organ damage sometimes observed in WCH subjects (WCHs) when compared to normotensive individuals (NTs). The aim of the present cross-sectional study was to compare left ventricular (LV) structure and function in three groups of subjects: WCHs with MetS, WCHs without MetS and NTs. A total of 145 WCHs, 35% of whom had MetS, were enrolled. As controls, 35 NTs were also studied. In all subjects, routine blood chemistry, echocardiographic examination and 24-h ambulat…

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

Relazione tra stress ossidativo, angiotensina II ed endotelina-1: osservazione in pazienti con ipertensione essenziale.

EFFETTI DELL'ALLOPURINOLO SUL DECLINO DEL FILTRATO GLOMERULARE IN PAZIENTI IPERTESI CON INSUFFICIENZA RENALE CRONICA

Il ruolo dell’iperuricemia asintomatica quale fattore in grado di favorire in modo indipendente la progressione della malattia renale cronica rimane controverso. Inoltre, gli studi finalizzati a valutare l’influenza della terapia ipouricemizzante sulla evoluzione delle nefropatie croniche sono poco numerosi e hanno dato risultati contrastanti. Scopo del nostro studio osservazionale è stato quello di analizzare retrospettivamente l'effetto del trattamento con allopurinolo, sul declino del filtrato glomerulare, in pazienti ipertesi con insufficienza renale cronica di grado moderato-severo. Sono stati pertanto selezionati 22 pazienti trattati con allopurinolo (A) (100-300 mg/die) che sono stat…

PP.04.22

ASSOCIATION OF RENAL RESISTIVE INDEX WITH MARKERS OF EXTRARENAL VASCULAR CHANGES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Introduction: Recent data suggest that renal hemodynamic parameters obtained by duplex Doppler sonography, especially the intrarenal resistive index (RRI), may be associated with systemic vascular changes. However, limited and conflicting data exist about the relationship between aortic stiffness and RI in autoimmune diseases, like systemic lupus erythematosus (SLE). Aim: To evaluate the relationship between RRI and arterial stiffness, assessed by aortic pulse wave velocity (aPWV), and between RRI and carotid atherosclerosis, evaluated by intima-media thickness (IMT) measurement in patients with SLE. Methods: In this cross-sectional study, we enrolled 39 SLE subjects (mean age 39 years) tha…

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…

Correlazione di un marker di stress ossidativo con gli indici di disfunzione endoteliale in pazienti con ipertensione essenziale

Endothelial activation and insulin resistance: Comparison beween essential hypertensives and hypertensive patients with metabolic syndrome

Impact of the metabolic syndrome on total arterial compliance in essential hypertension patients.

The aim of the study was to cross-sectionally analyze, in a group of essential hypertension patients without diabetes mellitus, the influence of the metabolic syndrome (MS) on the stroke volume index to pulse pressure (SVi/PP) ratio, a measure of total arterial compliance. A total of 528 essential hypertension patients, aged 18 to 72 years, free from cardiovascular and renal disease (41% of whom had MS) were enrolled. All participants underwent routine blood chemistry, echocardiographic examination, and 3 blood pressure measurements at the end of echocardiographic examination. When compared with participants who did not have MS, hypertensive patients with MS exhibited lower SVi/PP ratio (0.…

Correlation between a marker of oxidative stress and a few indexes of endothelial dysfunction in essential hypertensive patients.

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…

VITAMIN D RECEPTOR FOKI AND BSMI POLYMORPHISMS DO NOT SEEM TO BE ASSOCIATED WITH ARTERIAL HYPERTENSION

Relazione inversa tra stress ossidativo e funzione renale nell’ipertensione arteriosa.

ENDOTHELIAL DYSFUNCTION AND VITAMIN D STATUS IN ESSENTIAL HYPERTENSION. PRELIMARY RESULTS

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…

Microalbuminuria and early endothelial activation in essential hypertension

We hypothesized that in essential hypertensive patients (EHs), plasma levels of pro-atherogenic adhesion molecules would be increased and related with urine albumin excretion (UAE). Thus, this study was aimed at evaluating biochemical markers of endothelial activation and their relationship with UAE in a group of patients with uncomplicated EH. In basal condition soluble forms of adhesion molecules intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1, as well as 24-h UAE were assayed. One hundred patients with essential hypertension and no diabetes or ultrasonographic evidence of atherosclerosis were included in the study. Seventy normotensive healthy subjec…

Left ventricular hypertrophy and geometry in hypertensive patients with chronic kidney disease.

To evaluate 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.All patients underwent echocardiographic examination. Patients on stage 1 CKD, dialysis treatment, or with cardiovascular diseases were excluded.LVH was observed in 47.1% of patients with CKD and in 31.14% of essential hypertensive patients (P0.0001). We found increasingly higher left ventricular diameters, thicknesses, and mass from stage 2 to 5 CKD. Distribution of concentric and eccentric LVH was not different between the two groups. H…

Influence of the metabolic syndrome on aortic stiffness in never treated hypertensive patients

Summary Background and aim Metabolic syndrome (MS) carries an increased risk for cardiovascular events and there is a growing awareness that large artery stiffening is a powerful predictor of cardiovascular morbidity and mortality. Little is known about the relationship of MS with aortic stiffness. The aim of our study was to analyze, in patients with essential hypertension, the influence of MS, defined according to the criteria proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP-ATP III), on carotid–femoral pulse wave velocity (PWV), a measure of aortic stiffness. Methods N…

Intra-renal hemodynamics and carotid intima-media thickness in the metabolic syndrome.

Aims: Metabolic syndrome (MetS) is associated with increased cardiovascular risk. We hypothesize that early vascular changes are already present at the time of diagnosis of MetS. The relationship of different measures of early vascular impairment with body fat distribution and the natural progression of MetS was examined in newly diagnosed subjects non-pharmacologically treated. Methods: 246 consecutively enrolled subjects were categorized according to the presence of MetS and type 2 diabetes (T2D). Intra-renal Doppler flow was used to ascertain resistive (RI) and pulsatility (PI) indices as markers of vascular resistance. Carotid intima-media thick- ness (IMT), cutis-rectis (CR) and rectis…

Relationship of Fetuin-A with Glomerular Filtration rate and endothelial dysfunction in hypertensives with moderate-severe chronic kidney disease.

INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS

Introduction: Dilatation of aortic root is associated with presence and severity of aortic regurgitation and risk for aortic dissection. Recent studies performed in general population 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. Aim: 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 %) consecutively attending our outpatient nephrology and hypertension unit. Patients on dialysis treatment, with valvulopathy more than mil…

Relation of C-reactive protein to oxidative stress and to endothelial activation in essential hypertension.

Background: C-reactive protein (CRP) predicts cardiovascular outcome. Oxidative stress is considered to be involved in endothelial alteration. We hypothesized that in essential hypertension (EH), oxidative stress, as measured by 8-iso-prostaglandin-F2 alfa (8-iso-PGF2alfa), should be associated with increased CRP and endothelial activation, as evaluated by soluble intercellular adhesion molecule–1 (ICAM-1) and vascular adhesion molecule–1 (VCAM-1) plasma levels. Methods: In 83 subjects with mild EH and in 50 healthy control subjects we measured, in basal conditions, plasma levels of hs-CRP, 8-iso-PGF2 alfa, ICAM-1 and VCAM-1, and tumor necrosis factor–alfa (TNF-alfa). Results: Subjects with…

Endothelial adhesion molecules in essential hypertension: response to arginine infusion

Micro-albuminuria as a predictor of cardiovascular damage in essential hypertension

In renal transplanted patients inflammation and oxidative stress are interrelated.

Introduction: The inflammatory state plays a well-documented role to cause oxidative stress, especially in end-stage renal disease (ESRD) patients, wherein several cardiovascular risk factors are amplified by the coexistence of a microinflammatory state with increased oxidative stress. Methods: We measured serum concentrations of high sensitivity C-reactive protein (CRP), tumor necrosis factor α (TNFα), 8-iso-prostaglandin F2α (8-iso-PGF2α-in vivo oxidative stress marker) in 15 chronic renal failure (CRF) and 15 transplant patients versus 15 healthy controls. Exclusion criteria were: age 65 years as well as a diagnosis of diabetes or cardiovascular diseases. We evaluated systolic (SBP) and …

5.16 Left Ventricular Geometry In Chronic Kidney Disease

Comparazione dei promotori dell’aterosclerosi in pazienti nefropatici in terapia conservativa e dialitica

Left Ventricular Remodelling Conditions Left Atrial Volume and Function In Hypertensive Patients? Evaluation in RT3D Echocardiography

Oxidant stress is inversely related to renal function in hypertension.

Spessore intimo-mediale, fetuina-A, attivazione endoteliale e stress ossidativo in ipertesi con differenti gradi di funzione renale

C-Reactive Protein is Associated with Aortic Stiffness Independentely of Microalbuminuria in Essential Hypertension

Markers of endothelial activation and left ventricular hypertrophy in essential hypertension

Clinical correlates of renal dysfunction in hypertensive patients without cardiovascular complications: the REDHY study

Our study was aimed to assess the clinical correlates of different degrees of renal dysfunction in a wide group of non-diabetic hypertensive patients, free from cardiovascular (CV) complications and known renal diseases, participating to the REDHY (REnal Dysfunction in HYpertension) study. A total of 1856 hypertensive subjects (mean age: 47+/-14 years), attending our hypertension centre, were evaluated. The glomerular filtration rate (GFR) was estimated by the simplified Modification of Diet in Renal Disease Study prediction equation. A 24-h urine sample was collected to determine albumin excretion rate (AER). Albuminuria was defined as an AER greater than 20 mug min(-1). We used the classi…

Influence of metabolic syndrome on clinic and 24-h pulse pressure in essential hypertension.

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

RELATIONSHIP BETWEEN VITAMIN D STATUS AND EARLY ARTERIAL CHANGES IN PRIMARY HYPERTENSION. PRELIMINARY DATA

L’associazione tra stiffness aortica e proteina C-reattiva è indipendente dalla microalbuminuria nell’ipertensione essenziale

Fetuin-A plasma concentration and left ventricular mass in essential hypertension

Controllo pressorio e farmaci anti-ipertensivi in 490 pazienti con ipertensione arteriosa e malattia renale cronica.

Relationship between plasma endothelin-1 and aortic stiffness in hypertensive patients with chronic kidney disease

Impact of metabolic syndrome on left ventricular mass in overweight and obese hypertensive subjects

BACKGROUND: Metabolic syndrome (MS) has been associated with an increased left ventricular (LV) mass in recent reports. Little is known about the association of MS with LV mass (LVM) in overweight and obese individuals. The aim of our study was to investigate the relation between MS and LVM in a population of overweight and obese hypertensive subjects. METHODS: 289 non-diabetic essential hypertensives with a body mass index >25 kg/m2, were enrolled. In all subjects routine blood chemistry, echocardiographic examination and 24-h ambulatory blood pressure monitoring were performed. RESULTS: In the group of overweight patients, participants with MS (n=58), when compared to those without it (n=…

La disfunzione renale nell’ipertensione essenziale: lo studio REDHY

Influenza del sesso sulla relazione tra sindrome metabolica e massa ventricolare sinistra.

Inhibition of sympathetic activity induced by losartan in essential hypertensives.

Left Ventricular Geometry in Chronic Kidney Disease.

Evaluation of oxidative stress in hypertensive patients with transplanted kidney

Relationships of “ambulatory” white coat effect with target organ damage in arterial hypertension

[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…

Circulating Levels of Adhesion Molecules in Chronic Kidney Disease Correlate with the Stage of Renal Disease and with C-Reactive Protein

Patients with chronic renal failure (CRF) suffer from a series of complications linked to the atherosclerotic process in which the endothelial dysfunction mediated by the activation of some adhesion molecules plays an important role. This study aims to evaluate circulating levels of intercellular adhesion molecules-1 (ICAM-1) and vascular cell adhesion molecules-1 (VCAM-1) in patients with predialysis CRF, on maintenance hemodialysis (HD) and after kidney transplantation (KTx) and to correlate them with some inflammation and nutritional indexes.Thirty two patients with predialysis CRF, 30 on maintenance HD, 36 after KTx and 28 subjects as a control group (C) were included in this study. Cir…

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

Blood pressure variability

Oxidative stress and inflammation in long-term renal transplanted hypertensives.

INTRODUCTION Several studies have shown that chronic renal failure (CRF) is characterized by "accelerated atherosclerosis". More recent studies emphasize that inflammation and oxidative stress play a central role in atherosclerosis, and it is well-established that C-reactive protein (CRP) is a cardiovascular risk marker in the general population, in end-stage renal disease (ESRD) patients and in allograft recipients. METHODS We measured the serum concentration of high sensitivity CRP, TNFalpha, 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha, an in vivo oxidative stress marker) in 15 CRF patients and in 15 transplant recipients. Exclusion criteria were age 65 years, smoking, diabetes mellitus …

Oxidant stress and endothelial activation in hypertensive patients with and without left ventricular hypertrophy

Vitamina D e biomarcatori di attivazione endoteliale e di infiammazione nell'ipertensione arteriosa essenziale

RELATIONSHIP BETWEEN OBESITY AND PLASMA ALDOSTERONE IN ESSENTIAL HYPERTENSION: INFLUENCE OF GENDER: PP.34.372

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…

Association between early-stage chronic kidney disease and reduced choroidal thickness in essential hypertensive patients.

The introduction in the past few years of advanced optical coherence tomography (OCT) techniques has greatly increased our understanding of the choroid, which is the most important vascular layer of the eye. Our study aimed to assess choroidal thickness by using swept-source OCT (SS-OCT) in essential hypertensive patients (EHs) with and without early-stage chronic kidney disease (CKD). We enrolled 100 EHs, of whom 65 were without kidney damage, and 35 had stage 1-3 CKD. In all of the participants, SS-OCT and a routine biochemical workup were performed. Glomerular filtration rate (GFR) was estimated by the CKD Epidemiology Collaboration equation (eGFR). CKD was defined in agreement with the …

Circulating levels of molecular adhesion correlate with stage of renal disease and C-reactive protein in chronic kidney disease

BACKGROUND: Patients with chronic renal failure (CRF) suffer from a series of complications linked to the atherosclerotic process in which the endothelial dysfunction mediated by the activation of some adhesion molecules plays an important role. This study aims to evaluate circulating levels of intercellular adhesion molecules-1 (ICAM-1) and vascular cell adhesion molecules-1 (VCAM-1) in patients with predialysis CRF, on maintenance hemodialysis (HD) and after kidney transplantation (KTx) and to correlate them with some inflammation and nutritional indexes. METHODS: Thirty two patients with predialysis CRF, 30 on maintenance HD, 36 after KTx and 28 subjects as a control group (C) were inclu…

MIF rs755622 and IL6 rs1800795 Are Implied in Genetic Susceptibility to End-Stage Renal Disease (ESRD)

Chronic kidney disease (CKD) is characterized by an increased risk of kidney failure and end-stage renal disease (ESRD). Aging and comorbidities as cardiovascular diseases, metabolic disorders, infectious diseases, or tumors, might increase the risk of dialysis. In addition, genetic susceptibility factors might modulate kidney damage evolution. We have analyzed, in a group of ESRD patients and matched controls, a set of SNPs of genes (Klotho rs577912, rs564481, rs9536314; FGF23 rs7955866; IGF1 rs35767; TNFA rs1800629; IL6 rs1800795; MIF rs755622, rs1007888) chosen in relation to their possible involvement with renal disease and concomitant pathologies. Analysis of the raw data did indicate …

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…

CORRELATIONS BETWEEN NON INVASIVE RENAL INDEX AND MARKERS OF ATHEROSCLEROSIS IN LUPUS PATIENTS.

Objective: 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 in some groups of patients. However, conflicting data exist about the relationship between aortic stiffness and RI in autoimmune disease, like systemic lupus 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 and method: Cross-sectional study. We enrolled 39 SLE subjects (mean age 39 years). Each …

PP.42.06

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…

Plasma endothelin-1 and 8-Iso-ProstaglandinF2alpha levels are related to renal function and predict estimated glomerular filtration rate in hypertensive patients

Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensives

In order to explore the relations between left ventricularmass (LVM) and the pulsatile (pulse pressure) andsteady (mean pressure) components of the bloodpressure (BP) curve, 304 young and middle-agedessential hypertensive patients were studied by meansof 24-h ambulatory BP monitoring and echocardio-graphy. In the overall study population, both the BPcomponents showed significant correlations with LVM.These correlations were unevenly distributed in thesubgroups of subjects younger and in those older than50 years. While in this latter subgroup, in multivariateanalysis, both 24-h mean BP (24-MBP) (b¼0.27;P¼0.008) and 24-h pulse pressure (24-h PP) (b¼0.23;P¼0.02) were associated with LVM, in th…

DIFFERENTE IMPATTO NEI DUE SESSI DELL’OBESITÀ SULLA MASSA VENTRICOLARE SINISTRA IN SOGGETTI CAUCASICI 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…

Relazione tra fetuina-A, filtrato glomerulare (GFR) e disfunzione endoteliale in pazienti ipertesi con insufficienza renale cronica di grado moderato-severo

Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensives

In order to explore the relations between left ventricular mass (LVM) and the pulsatile (pulse pressure) and steady (mean pressure) components of the blood pressure (BP) curve, 304 young and middle-aged essential hypertensive patients were studied by means of 24-h ambulatory BP monitoring and echocardiography. In the overall study population, both the BP components showed significant correlations with LVM. These correlations were unevenly distributed in the subgroups of subjects younger and in those older than 50 years. While in this latter subgroup, in multivariate analysis, both 24-h mean BP (24-MBP) (beta = 0.27; P = 0.008) and 24-h pulse pressure (24-h PP) (beta = 0.23; P = 0.02) were a…

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

RELATIONSHIPS OF SERUM URIC ACID WITH PLASMA RENIN ACTIVITY AND PLASMA ALDOSTERONE IN UNTREATED HYPERTENSIVE SUBJECTS

In experimental studies conducted in rats, raising serum uric acid (SUA) levels resulted in 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 between plasma aldosterone concentration (PAC) and SUA. The aim of our study was to analyse the relationships between SUA, PRA and PAC and the influence of age and gender on these relationships in a group of subjects with primary hypertension. We enrolled 281 patients (men 59%), with untreated primary hypertension and normal renal function. The study population wad divided in two subgroups on the b…

Blood pressure and glycaemia, not insulin-resistance, influence endothelial dysfunction in metabolic syndrome

The Relationship between an Oxidative Stress Biomarker and Plasma Haemoglobin in Patients with Chronic Kidney Disease

Introduction: Evidence suggests that decreased haemoglobin plasma concentration may be a predictor of adverse cardiovascular events in patients with chronic kidney disease (CKD). We hypothesized that in CKD patients, oxidative stress could influence the development of cardiovascular damage via a relationship with haemoglobin levels. Methods: We assayed plasma levels of the biomarker of oxidative stress 8-ISO-prostaglandin F2α (8-ISO-PGF2α) and of haemoglobin in 193 stage 2–5 CKD patients, investigating their relationship. Eighty healthy subjects and 80 patients with primary hypertension having normal renal function were enrolled as controls. Results: The CKD group was divided according to 8…

Oxidative stress relates to endothelial activation and inflammation in essential hypertensive patients

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…

Fetuin-A and left ventricular hypertrophy in essential hypertension.

Nutritional status and endothelial factors in chronic renal failure

8.1 Factors Associated With Renal Dysfunction In Arterial Hypertension: The REDHY Study

Impatto del diabete sulla geometria ventricolare sinistra in soggetti ipertesi con malattia renale cronica

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…

Resistin: a new marker of cardiorenal risk?

ASSOCIATION OF SERUM URIC ACID WITH AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS.

INTRODUCTION: Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV, that is considered the gold standard for measuring arterial stiffness. Moreover, the studies exploring the influence of SUA on aortic distensibility in subjects with arterial hypertension yielded conflicting results. AIM: The purpose of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients. METHODS: We enrolled 222…

The Association of Microalbuminuria With Aortic Stiffness is Independent of C-Reactive Protein in Essential Hypertension

[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…

Endothelium-derived factors in microalbuminuric and nonmicroalbuminuric essential hypertensives

Previous evidence has demonstrated a relationship between growth factors and cardiovascular diseases. This study was aimed at evaluating levels of some endothelium-derived growth factors, and their relationship with microalbuminuria (MAU), in essential hypertension. Ninety-nine mild-moderate essential hypertensives (EH) and 25 healthy controls were studied. All patients underwent 24-h blood pressure monitoring, serum endothelin-1 (ET-1), basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF), and 24-h MAU assays. Later, EH were divided into two subsets consisting of microalbuminurics (MAU >11 microg/min) and nonmicroalbuminurics (MAU <11 microg/min). In microalbumin…

[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…

Adhesion molecules, endothelial products, and microalbuminuria in essential hypertension

Usefulness of microalbuminuria in cardiovascular risk stratification of essential hypertensive patients

&lt;i&gt;Background/Aims:&lt;/i&gt; To evaluate the influence of microalbuminuria (albumin excretion rate – AER) determination and echocardiography (ECHO) on cardiovascular risk stratification, initially performed according the 1999 WHO/ISH guidelines by using only routine diagnostic procedures with or without fundal examination. &lt;i&gt;Methods:&lt;/i&gt; 312 essential hypertensives attending our institution were studied retrospectively. Cardiovascular risk was assessed in a semiquantitative way using four categories of absolute cardiovascular disease risk (low, medium, high and very high risk), as proposed by the 1999 WHO/ISH guidelines, on the basis of data on the average 10-year risk o…

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…

Prevalenza della riduzione lieve e moderata della funzione renale nell’ipertensione arteriosa non complicata. Risultati preliminari dello studio REDHY.

Markers of myocardial fibrosis and inflammation in hypertensives with and without left ventricular hypertrophy

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 …

Relationship between aortic stiffness and serum uric acid in essential hypertension

In last years hyperuricemia has been associated with an increased incidence of renal and cardiovascular events in general population, as well as in patients with diabetes and hypertension. However, the role of serum uric acid (SUA) as independent cardiovascular risk factor is still controversial. It is well known that increased aortic stiffness is a powerful independent predictor of cardiovascular events. Little is known about the influence of uric acid on aortic distensibility in subjects with arterial hypertension. The aim of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive patients, attending our Hypertension Centre. We enr…

8.2 Glomerular Filtration Rate by Creatinine and Cystatin C Measurements in Essential Hypertensive Patients

Comparison of tumour necrosis factor and endothelin-1 between essential and renal hypertensive patients

The present study was performed to compare circulating levels of tumour necrosis factor-alpha (TNFalpha) and plasma endothelin 1 (ET-1), of hypertensive patients with or without renal failure and with those of normotensive healthy subjects. The study population consisted of 21 healthy normotensive subjects and 22 hypertensive patients, 11 with essential hypertension, and 11 with hypertension and chronic renal failure (CRF). Plasma ET-1 levels, serum TNFalpha and creatinine, creatinine clearance, 24-h urinary albumin excretion (UAE) were assayed, and 24-h blood pressure monitoring was obtained in all subjects. Office blood pressure was similar between hypertensive patients with and without C…

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…

L’ipertrofia ventricolare sinistra negli ipertesi con insufficienza renale cronica.

RELATIONSHIP BETWEEN VITAMIN D STATUS AND EARLY ARTERIAL CHANGES IN PRIMARY HYPERTENSION. PRELIMINARY DATA

Relationships between metabolic syndrome and steady and pulsatile components of clinic and 24-h blood pressure

La sindrome metabolica negli ipertesi essenziali mai trattati farmacologicamente: effetti sulla stiffness aortica

Glycaemic variability and inflammation in subjects with metabolic syndrome.

Subjects who develop diabetes have an increased cardiovascular risk even before the appearance of diabetes. The aim of this study was to investigate the glycaemic variability measured by continuous glucose monitoring (CGM CV%) in nondiabetic subjects with metabolic syndrome (MS) and to explore if glycaemic variability was associated with circulating levels of interleukin-6 (IL-6), a proinflammatory cytokine, or with an anti-inflammatory factor like adiponectin. Three groups of obese subjects with (MS+: 6m, 8f; BMI 33.1 ± 1.4 mean ± SEM) or without metabolic syndrome (MS−: 2m, 4f; BMI 29.2 ± 2.2) and with MS associated with type 2 diabetes (MS/T2D: 3m, 5f; BMI 32.9 ± 1.4) were investigated. …

Relationship of Metabolic Syndrome With Pulse Pressure in Patients With Essential Hypertension

BACKGROUND: Pulse pressure is largely dependent on arterial stiffness. Recent studies have documented reduced large artery compliance in nondiabetic subjects with metabolic syndrome (MS). The aim of our study was to analyze, in a group of patients with essential hypertension and without diabetes mellitus, the influence of MS on clinic and 24-h pulse pressures. METHODS: A total of 528 hypertensive subjects, aged 18 to 72 years, who were free of cardiovascular and renal diseases were enrolled. Of the subjects, 41% had MS. In all subjects routine blood chemistry, echocardiographic examination, and 24-h ambulatory blood pressure monitoring were performed. RESULTS: When compared with subjects wi…

La relazione tra microalbuminuria e stiffness aortica è indipendente dal filtrato glomerulare nell’ipertensione essenziale

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…

Infiammazione, stress ossidativo e funzione renale nell'ipertensione arteriosa.

Metabolic syndrome and cardiac morphofunctional changes in subjects with white-coat hypertension

Relationship between metabolic syndrome and aortic stiffness in untreated hypertensive patients

Relationship between fetuin-A, glomerular filtration rate and endothelial dysfunction in hypertensive patients with moderate to severe chronic kidney disease

Valutazione dello stress ossidativo in pazienti ipertesi sottoposti a trapianto renale

Relationship between aortic stifness and renal resistance index in hypertensive patients

Short and middle term effects of hypocaloric low carbohydrate diet vs hypocaloric Mediterranean diet on endothelial function in obese subjects

Adequate nutritional treatment is required to address the problem of increasing prevalence of obesity in Western countries. The Mediterranean diet style is now acknowledged to have large scientific evidences in terms of cardiovascular prevention. However, many popular diets are diffusing also as self-prescribed treatments. Among those, the efficacy of low-carbohydrate diets (also known as Atkins’ diet in its most popular variety) has been addressed by some investigations. It is generally concluded that the low-carbohydrate diet is able to induce a greater weight loss, at least in the middle term, and a better serum lipid profile than the conventional diet. In this longitudinal, randomised, …

Valutazione della funzione diastolica del ventricolo sinistro mediante Doppler tissutale in soggetti ipertesi diabetici e non diabetici

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

Subclinical atherosclerosis and fetuin-A plasma levels in essential hypertensive patients

The intima-media thickness (IMT) is considered as a surrogate marker for atherosclerotic disease. The aim of this study was to analyze the relationship of carotid IMT with fetuin-A in patients with essential hypertension (EH) and normal renal function. The plasma levels of fetuin-A, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) and the biomarker of oxidative stress 8-iso-PGF2alpha were assayed in samples from 105 untreated EH patients. Carotid IMT measurements were also performed. EH was studied overall and after dividing in EH with IMT ≥ and 0.9 mm (AUC (area under the curve) 0.738, P<0.0001). Our results suggest that in EH, fetuin-A is associated with the IMT independently of oxid…

RELATIONSHIP BETWEEN SERUM URIC ACID AND AORTIC STIFFNESS IN UNTREATED HYPERTENSIVE SUBJECTS

Recent studies have reported an association between serum uric acid (SUA) and reduced arterial elasticity. However, in these studies arterial elastic properties have been assessed chiefly by measuring brachial-ankle pulse wave velocity (PWV) or peripheral PWV and only sometimes by using aortic PWV. Moreover, the relationships between SUA and arterial stiffness have never been statistically adjusted for albuminuria. Furthermore, the studies exploring the influence of uric acid on aortic distensibility in subjects with arterial hypertension yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and aortic stiffness in a group of essential hypertensive …

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 …

Inflammation and endothelial activation are linked to renal function in long-term kidney transplantation

The aim of this study was to investigate the relationships between inflammation and adhesion molecules in long-term kidney transplantation. We measured serum concentrations of tumor necrosis factor-alpha (TNFalpha) and intercellular and vascular cell adhesion molecules (ICAM-1 and VCAM-1) in 35 renal transplant recipients (mean age of transplantation 5 +/- 3 years) and in 35 chronic renal insufficiency (CRI) patients; twenty-six healthy subjects were enrolled as controls. Transplanted showed higher values than controls of TNFalpha (P < 0.0001), ICAM-1 (P < 0.0001), and VCAM-1 (P < 0.0001). CRI group as well exhibited higher concentrations than controls of TNFalpha (P < 0.0001), ICAM-1 (P < …

Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients

. Objectives.  To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness. Design.  Cross-sectional study. Setting.  Outpatient hypertension clinic. Subjects.  Seventy patients with mild-to-moderate essential hypertension, aged 42 ± 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotid-femoral PWV, by means of a computerized method, and AER. Results.  Microalbuminuric patients (AER ≥ 20 μg min−1; n = 19), when comp…

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…

SERUM URIC ACID IS INCREASED IN NORMOTENSIVE OBESE CHILDREN WITH A PARENTAL HYSTORY OF HYPERTENSION

Introduction: Increased uric acid levels are associated with new-onset hypertension in children. Nevertheless, controversy remains concerning a direct causative role of serum uric acid (SUA) in the pathogenesis of essential hypertension (EH). Aim: To determine if normotensive obese children and adolescent offspring of adults with EH show SUA levels different than those of paediatric subjects in whom there is no family history of EH. Methods: Fifty-nine obese normotensive children and adolescents, aged between 8 and 17 years, attending for metabolic assessment the Paediatric Diabetes Unit, Children’s Hospital ‘‘G. Di Cristina’’, and for cardiovascular evaluation the ESH Hypertension excellen…

Stato nutrizionale e citokine nell’Insufficienza Renale Cronica

Fetuin-A and left ventricular mass in essential hypertension and in moderate chronic kidney disease.

Prospective appraisal of the prevalence of primary aldosteronism in hypertensive patients presenting with atrial flutter or fibrillation (PAPPHY Study): rationale and study design

Primary aldosteronism (PA) is the most common endocrine form of hypertension and may carry an increased risk of atrial flutter or fibrillation (AFF). The primary goal of this multicentre cohort study is thus to prospectively establish the prevalence of PA in consecutive hypertensive patients referred for lone (non-valvular), paroxysmal or permanent AFF. Secondary objectives are to determine: (1) the predictors of AFF in patients with PA; (2) the rate of AFF recurrence at follow-up after specific treatment in the patients with PA; (3) the effect of AFF that can increase atrial natriuretic peptide via the atrial stretch and thereby blunt aldosterone secretion, on the aldosterone-to-renin rati…

Relationships between plasma aldosterone and left ventricular mass in hypertensive patients with the metabolic syndrome

Endotelin-1 and 8-isoprostanes Predict Estimated Glomerular Filtration Rate in Arterial Hypertension

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…

Acute prostaglandins and sympathetic activity changes due to amino acids load in essential hypertension

SUBCLINICAL RENAL DAMAGE IS ASSOCIATED WITH A REDUCED CHOROIDAL THICKNESS IN PATIENTS WITH PRIMARY HYPERTENSION

Objective: The retina is considered the easiest accessible window to study the state of the systemic microcirculation, even if the choroid is the most important vascular layer of the eye. Our understanding of the choroid has been greatly increased in last years since the introduction of advanced techniques of optical coherence tomography (OCT). Our study was aimed to assess choroidal thickness by using Swept-Source OCT (SS-OCT) in essential hypertensive patients (EHs) with and without subclinical renal damage (SRD). Design and method: We enrolled 100 EHs of which 65 without kidney damage and 35 with SRD. In all the participants SS-OCT and a routine biochemical work-up were performed. Glomer…

Relationship between metabolic syndrome and aortic stiffness in untreated hypertensive patients

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…

Influenza di differenti metodi di stima del filtrato glomerulare sulla prevalenza della riduzione lieve e moderata della funzione renale nell’ipertensione arteriosa non complicata. Risultati preliminari dello studio REDHY.

Microalbuminuria Is Associated With Aortic Stiffness Independently of Creatinine Clearance in Essential Hypertension

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…

Relazione tra stiffness aortica ed uricemia nell'ipertensione arteriosa essenziale

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…

Blood Pressure control by 24-hour Ambulatory Monitoring in Chronic Renal Failure.

La funzione diastolica del ventricolo sinistro negli ipertesi con insufficienza renale cronica e senza ipertrofia ventricolare.

La disfunzione renale nell’ipertensione arteriosa

L’ipertensione arteriosa rappresenta una causa sempre più comune di insufficienza renale cronica terminale; è ben noto inoltre come la presenza di una disfunzione renale, anche lieve, comporti un significativo incremento del rischio cardiovascolare. Recentemente è stata valutata la prevalenza della disfunzione renale in pazienti ipertesi senza complicanze cardiovascolari o patologia renale nota, partecipanti allo studio Renal Dysfunction in Hypertension (REDHY), utilizzando quattro metodi di stima del filtrato glomerulare (GFR): la clearance della creatinina (CrCl), l’equazione semplificata dello studio Modification of Diet in Renal Disease (MDRD), la formula di Cockcroft-Gault (CG) e l’equ…

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

Introduction: It is well known that connective tissue diseases, like Systemic Lupus Erythematosus, are associated with early and accelerated atherosclerosis. During the last year, it has well established the concept of ‘‘Early vascular aging’’ (EVA), whose the aortic stiffness represents one of the most important markers. Aim: To evaluate early vascular aging, assessed by measuring Aortic pulse wave velocity (aPWV), as an arterial stiffness index, in a group of normotensive patients with SLE and to compare these subjects with a group of young essential hypertensive (EH) individuals.Methods: In this cross-sectional study we have enrolled 50 normotensive SLE subjects (45 women and 5 men) with…

Linkage between inflammation, endothelial activation and renal function in kidney transplantation.

The referral centers for the diagnosis and treatment of hypertension in adolescents

Primary hypertension in adolescence was felt to be quite rare. However, the worldwide childhood obesity epidemic has had a profound impact on the frequency of high blood pressure (BP) with the result that primary hypertension should now be viewed as one of the most common health conditions in the young (estimated prevalence 1–5%). Therefore, current guidelines recommend that all children and adolescents seen in a medical setting should have their BP measured. The availability of BP tables with normal BP percentiles for age, sex and height has improved BP values classification. Studies conducted at referral clinics for evaluation of hypertension have indicated that as many as 30 to 40% of ad…

Relationships between ambulatory white coat effect and left ventricular mass in arterial hypertension

The aim of our study was to analyze, in a group of 296 essential hypertensives, the relationship between left ventricular mass (LVM) and ambulatory white coat effect (WCE); that is the difference between the elevation of the first measurements of ambulatory blood pressure monitoring and the mean daytime pressure. The study population was separated into two groups according to the median of the WCE. The LVM was greater in the groups with higher systolic and diastolic ambulatory WCE. The significant association between ambulatory WCE and LVM was confirmed by the results of multiple regression analysis, suggesting that ambulatory WCE may not be an innocent phenomenon.

[OP.2D.05] RELATIONSHIP OF OXIDATIVE STRESS WITH CARDIAC HYPERTROPHY IN HYPERTENSIVE PATIENTS

OBJECTIVE: Left ventricular hypertrophy is common in hypertensive patients. In these subjects increased oxidative stress has been observed. Our aim was to evaluate the association of biomarkers of both oxidative stress and inflammation with markers of cardiovascular damage in a large group of hypertensives with different stages of renal function. DESIGN AND METHOD: In 517 hypertensives we analyzed left ventricular mass indexed for body surface area, and we assayed plasma levels of 8-isoprostaglandin F2alpha and high sensitivity C reactive protein. RESULTS: Multivariate analysis carried out considering left ventricular mass as dependent variable, and including 8-isoprostaglandin F2alpha, hig…

Microalbuminuria fractional clearance and early renal permselectivity changes in essential hypertension.

In order to verify if, in essential hypertension (EH), the microalbuminuria (AER) increase could be due to hemodynamic modifications or to glomerular structural changes, in 15 essential hypertensives (EHs) with 24-hour AER16 micrograms/min and in 15 EHs with 24-hour AERor = 16 micrograms/min, the day- and nighttime behavior of creatinine clearance (Ccr), as well as AER clearance (AER-C) and fractional clearance (AER-FC), and behavior of blood pressure (BP) was evaluated. Patients with 24-hour AER16 micrograms/min showed significantly higher values of 24-hour and daytime Ccr than the other group of EHs, while during the night period, there were no significant differences between the two grou…

Adiponectin relates inversely to atherosclerotic factors independently of blood pressure in essential hypertension

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

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…

Correlation between a marker of oxidative stress and few indexes of endothelial dysfunction in essential hypertensive patients

Association between Plasma Aldosterone plasmatico, Metabolic Syndrome and Left Ventricular Mass in Essential Hypertension.

Impact of metabolic syndrome on left ventricular mass: Is the same in all ethnic groups and in men and women?

[1] Mule G, Nardi E, Cottone S, et al. Impact of metabolic syndrome on left ventricular mass in overweight and obese hypertensive subjects. Int J Cardiol 2007;121:267–75. [2] Grundy SM, Brewer Jr HB, Cleeman JI, Smith Jr SC, Lenfant C. American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433–8. [3] IsomaaB,Almgren P, TuomiT, et al. Cardiovascularmorbidity andmortality associated with the metabolic syndrome. Diabetes Care 2001;24:683–9. [4] Reilly MP, Rader DJ. The metabolic syndrome:…

Vitamin D receptor gene polymorphisms and plasma renin activity in essential hypertensive individuals.

Several studies analyzed 25-hydroxyvitamin D (25[OH]D) and blood pressure (BP) relationship with mixed results. Moreover, a relationship between the risk of hypertension and vitamin D receptor (VDR) gene polymorphisms, FokI and BsmI, was reported. This study was aimed to analyze these relationships in essential hypertensive (EH) patients. Seventy-one EH patients, 18-75 years old, were enrolled. Patients underwent clinical BP, 24-h ambulatory BP monitoring, 25[OH]D and plasma renin activity (PRA) evaluations. FokI and BsmI VDR polymorphisms were analyzed and compared with those of 72 healthy controls. In EH patients, the median 25[OH]D levels were lower than 30 ng ml(-1). We found a signific…

Infiammazione e stress ossidativo: confronto tra pazienti con insufficienza renale cronica e pazienti sottoposti a trapianto renale

NEFROPATIA E RISCHIO CARDIOVASCOLARE

Diastolic function in chronic renal insufficiency

Nell’ipertensione essenziale, proteina C reattiva ed ICAM-1 sono predittori di stress ossidativo maggiori dei valori pressori.

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…

Left ventricular mass in hypertensive patients

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…

The changing landscape of thromboprophylaxis for atrial fibrillation: insights from the ISPAF-2 survey

Atrial fibrillation is the most common sustained cardiac dysrhythmia. It represents a major public health problem due to increased mortality risk, reduced quality of life, and increased health costs [1, 2]. The prevalence of nonvalvular atrial fibrillation (AF) continues to increase worldwide, largely affecting the elderly, but also occurring in younger patients as a result of structural heart disease, autonomic imbalance, genetic abnormality, or previous cardiac surgery [3]. The rise in prevalence of AF is largely due to the increasing age of the population. About 1–2% of the total population is affected by AF, but the prevalence of this condition rises to ≈ 10% in individuals aged &gt; 75…

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

Influence of chronic renal insufficiency on left ventricular diastolic function in hypertensives without left ventricular hypertrophy

PP.22.05

RELAZIONE TRA ENDOTELINA-1 PLASMATICA E STIFFNESS AORTICA IN PAZIENTI IPERTESI CON MALATTIA RENALE CRONICA

Vari studi hanno dimostrato come la stiffness arteriosa aumenti con il progressivo deterioramento della funzione renale. Una correlazione inversa è stata altresì dimostrata fra livelli plasmatici di endotelina-1 (ET-1) e filtrato glomerulare (GFR). Dati sperimentali hanno evidenziato che l’infusione di ET-1 è seguita da un incremento della stiffness arteriosa ed il trattamento con antagonisti del recettore ET-A dell’ET-1 in pazienti nefropatici ha comportato una riduzione della rigidità aortica, in parte indipendentemente dagli effetti sulla pressione arteriosa. Pochi dati esistono in letteratura sulle relazioni tra distensibilità aortica e concentrazioni plasmatiche di ET-1 in pazienti con…

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…

Relazione tra sindrome metabolica e pressione di polso in soggetti con ipertensione arteriosa essenziale

Relazione tra stiffness aortica e catecolamine plasmatiche in ipertesi essenziali mai trattati farmacologicamente.

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…

AORTIC STIFFNESS IS INCREASED IN NORMOTENSIVE PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS Abstracts from the 17th National Congress of the Italian Society of Cardiovascular Prevention (SIPREC), Naples, 21-23 March 2019

Introduction: Patients with systemic lupus erythematosus (SLE) have an increased risk of developing cardiovascular (CV) events. A marker of early vascular aging (EVA) is aortic pulse wave velocity (aPWV) which is a measure of arterial stiffness. Aim: To evaluate aPWV and the prevalence of EVA in a group of normotensive patients with SLE and to compare these values with those obtained in age- and gender-matched control subjects. Method: Aortic PWV was measured by a validated oscillometric device (Arteriograph). EVA was identified when the age-adjusted z-score of aPWV exceeded ? 1.96 (EVA1). The aPWV z-score was calculated using the ratio ‘‘Observed PWV–Predicted PWV/SD Predicted’’ and we obt…

Microalbuminuria, renal dysfunction and cardiovascular complication in essential hypertension

To evaluate the prevalence of microalbuminuria (albumin excretion rate, AER) in a wide hypertensive population, and to evaluate any relationship with cardiovascular damage and renal dysfunction.A transversal study.In 383 hospitalized Caucasian essential hypertensives (198 men, 185 women) of mean age 44 +/- 0.5 years and mean clinic blood pressure 170.3 +/- 0.95/ 103.4 +/- 0.47 mmHg, metabolic parameters, serum creatinine level (Cs), creatinine clearance rate (Ccs), 24 AER and plasma renin activity (PRA) were measured. Furthermore, each patient underwent 24 h ambulatory blood pressure monitoring (ABPM) and echocardiography to measure left ventricular mass, which was indexed both by body surf…

Correlation between a marker of oxidative stress and few indexes of endothelial dysfunction in essential hypertensive patients

Relazioni tra stiffness aortica ed indice di resistenza intrarenale nell’ipertensione arteriosa

Per molti anni lo studio mediante eco-color-doppler dei parametri semiquantitativi emodinamici renali è stato utilizzato per rilevare le alterazioni della perfusione del rene trapiantato, per la diagnosi della stenosi dell’arteria renale o per valutare la progressione di alcune nefropatie. Più recentemente è stato osservato che tali parametri, ed in particolare l’indice di resistenza intrarenale (IR), non sono soltanto espressione della perfusione parenchimale, ma sono associati anche ad alterazioni morfo-funzionali sistemiche dell’albero vascolare. Vari studi hanno dimostrato come la stiffness aortica vada aumentando con il progressivo deterioramento della funzione renale. Tuttavia, dati c…

Arterial Hypertension and the Hidden Disease of the Eye: Diagnostic Tools and Therapeutic Strategies.

Hypertension is a major cardiovascular risk factor that is responsible for a heavy burden of morbidity and mortality worldwide. A critical aspect of cardiovascular risk estimation in hypertensive patients depends on the assessment of hypertension-mediated organ damage (HMOD), namely the generalized structural and functional changes in major organs induced by persistently elevated blood pressure values. The vasculature of the eye shares several common structural, functional, and embryological features with that of the heart, brain, and kidney. Since retinal microcirculation offers the unique advantage of being directly accessible to non-invasive and relatively simple investigation tools, the…

I polimorfismi del gene VDR FokI e BsmI non sembrano essere associati all’ipertensione arteriosa

RAZIONALE. Il nostro obiettivo è stato quello di analizzare la relazione tra livelli plasmatici di VitaminaD (VitD) e valori di pressione arteriosa clinica ed ambulatoria in ipertesi essenziali e di identificare un’eventuale associazione fra l’ipertensione e i polimorfismi del gene VDR, FokI e BsmI. CASISTICA E METODI. Abbiamo arruolato 71 ipertesi essenziali e 72 controlli di età compresa fra 18 e 75 anni. Nei pazienti sono stati valutati: pressione arteriosa clinica, monitoraggio ambulatorio della pressione arteriosa delle 24 ore, parametri antropometrici, indagini bioumorali di routine e livelli plasmatici di VitD con metodica HPLC. Entrambi i gruppi sono stati sottoposti a tipizzazione …

AGATSTON SCORE E MARKER DI ATEROGENESI IN PAZIENTI CON INSUFFICIENZA RENALE CRONICA

C-reactive protein and intercellular adhesion molecule-1 are stronger predictors of oxidant stress than blood pressure in established hypertension

Oxidant stress is implicated in the pathogenesis of atherosclerosis in cardiovascular diseases. Our aim was to test oxidative stress, as 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha), and its relationship with inflammation markers C-reactive protein (CRP) and tumour necrosis factor-alpha (TNFalpha), and endothelial activation assayed as soluble intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 in essential hypertension.In 216 essential hypertensive patients and 55 healthy control individuals, plasma levels of high-sensitivity CRP and TNFalpha, 8-iso-PGF2alpha, ICAM-1 and VCAM-1 were measured in basal conditions. Moreover, basal and 24-h ambulatory blood p…

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 …

Relationship of transforming growth factor-beta1 with tumor necrosis factor-alpha and endothelial activation in patients with stable renal transplantation

Association between biomarkers of inflammation and left ventricular hypertrophy in moderate chronic kidney disease.

Aims: Left ventricular hyper- trophy (LVH) is a predictor for cardiovascu- lar mortality, and it is considered to be a surro- gate marker of preclinical cardiovascular dis- ease. This study aimed at evaluating whether fetuin-A plasma levels are decreased in pa- tients with moderate chronic kidney disease (CKD) and their linkage to plasma concentra- tions of hs-C-reactive protein (CRP), cardio- trophyn-1 (CT-1), tumor necrosis factor- (TNF-), propeptide of collagen Type I (PIP) and to LVH. Material and methods: We enrolled 64 moderate CKD and 55 essential hypertensives (EH) with normal renal func- tion as controls. All the patients underwent an echocardiographic examination; plasma sam- ples…

Ipertensione arteriosa, sistema renina-angiotensina e ruolo terapeutico di olmesartan.

Impact of diabetes on left ventricular geometry in hypertensive patients with chronic kidney disease

Inverse relationship between ambulatory artery stiffness index and glomerular filtration rate in essential hypertension

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).

Impact of diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

Plasma Aldosterone and Its Relationships With Left Ventricular Mass in Essential Hypertensive Patients With the Metabolic Syndrome

BACKGROUND: The association of aldosterone with the metabolic syndrome (MetS) has not been fully elucidated. The aim of our study was to evaluate the relationships of plasma aldosterone concentration (PAC) with MetS and left ventricular mass (LVM) in nondiabetic Caucasian patients with essential hypertension. METHODS: Measurements were taken with the patients off antihypertensive medications. The measurements included 24-h blood pressure (BP) readings, plasma renin activity (PRA) and aldosterone, and an echocardiogram. RESULTS: Subjects with MetS (n = 201) had higher age-adjusted PAC (10.2 +/- 5.8 vs. 11.6 +/- 5.9 ng/dl; P = 0.01) and greater age-adjusted LVM indexed for height2.7 (LVMH2.7)…

The Renal Dangers of an Increased Cardio-Ankle Vascular Index

Although a number of longitudinal investigations assessed the ability of aortic PWV to predict the development of kidney disfunction or progression of renal disease, little is known about the association of CAVI with the risk of renal function deterioration. In the current issue of the American Journal of Hypertension is published a paper of Itano S et al, that add a new piece of evidence in this scenario. The authors analyzed data from the national health check-up system in Japan, including 24.297 participants with normal baseline kidney function. They found that those with CAVI measurements ≥8.1 had a higher risk for CKD events compared to their counterparts with CAVI measurements &lt;8.1…

Vitamin D, blood pressure and intima media thickness in essential hypertension

Ipertrofia ventricolare sinistra nell’iperteso obeso: influenza della sindrome metabolica

BRUGADA PATTERN IN HEROIN ADDICTION: SYNDROME OR PHENOCOPY?

Brugada phenocopies (BrPs) are clinical entities that show an electrocardiogram (ECG) pattern similar to what is observed in Brugada syndrome (BrS). They are caused by different clinical conditions. We describe a case of BrP in a man that developed acute kidney failure secondary to rhabdomyolysis, after heroin addiction. His initial ECG showed Brugada type 1 pattern resolved after hemodialytic treatment. A provocative test with ajmaline, which resulted negative, was performed to confirm the diagnosis. BrPs can mimic a true BrS and a fast recognition of these clinical and electrocardiographic findings may avoid diagnostic mistakes thus preventing unnecessary or inaccurate treatmen

12.8 Endotelin-1 and 8-Isoprostanes Predict Estimated Glomerular Filtration Rate in Arterial Hypertension

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…

Sindrome metabolica ed alterazioni morfo-funzionali cardiache nei soggetti con ipertensione clinica isolata

Influence of the calcium antagonist amlodipine on left ventricular mass and function in patients with essential hypertension

This study was conducted to evaluate the influence of antihypertensive treatment with the calcium antagonist amlodipine on left ventricular structure and systolic and diastolic function in patients with essential hypertension.

Relationship of metabolic syndrome with pulse pressure in essential hypertensive patients.

ESH/ESC guidelines for the management of arterial hypertension: how to implement in daily practice

Relationship between Plasma Aldosterone and Left Ventricular Mass in Hypertensive Subjects with Mild-to-Moderate Chronic Kidney Disease

Introduction: Plasma aldosterone (ALD) levels are generally increased in subjects with chronic kidney disease (CKD), especially in those with end-stage renal disease. Convincing clinical and experimental data indicate that aldosterone plays a fundamental role in determining functional and structural changes of the heart. On the other hand, it is known that hypertensive patients with renal dysfunction, also of mild degree, show an increased prevalence of cardiovascular organ damage. Little is known about the relationships between aldosteronaemia and left ventricular mass in subjects with mild-to-moderate CKD. Aim: To analyse the relationships between ALD and left ventricular mass (LVM), in a…

Influence of AT-1 receptor blockade on endothelium - derived factors in essential hypertension.

Favorable clinical heart and bone effects of anti-thyroid drug therapy in endogenous subclinical hyperthyroidism

Although subclinical hyperthyroidism (SCH) has been associated with increased risk of osteoporosis and cardiac arrhythmias, its treatment is still controversial. This study was designed as a prospective, randomized, intervention, control-study with a 1-year follow-up in order to investigate whether normalization of serum TSH in SCH using methimazole has favorable bone and heart clinical effects. Fourteen patients with endogenous SCH (not Graves' disease) were enrolled, 7 (5 women/2 men; group T) were treated with methimazole (2.5-7.5 mg/day), and 7 (5 women/2 men; group C) were followed without treatment; 10 healthy subjects were also included in the study as controls. Serum free-T3 (FT3), …

Metabolic syndrome amplifies hypertension-related target organ damage

Left ventricular mass in hypertensive patients with mild-to-moderate reduction of renal function

Aim: Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular (CV) morbidity and mortality. The aim of the present study was to evaluate the relationship between LV mass and mild-to-moderate renal dysfunction in a group of non-diabetic hypertensives, free of CV diseases, participating in the Renal Dysfunction in Hypertension (REDHY) study. Methods: Patients with diabetes, a body mass index (BMI) of more than 35 kg/m 2 , secondary hypertension, CV diseases and a glomerular filtration rate (GFR) of less than 30 mL/min per 1.73 m 2 were excluded. The final sample included 455 patients, who underwent echocardiographic examination and ambulatory blood pressure monitoring.…

L-arginine for testing endothelium-derived factors in essential hypertension

Evidenza di una relazione inversa tra paratormone ed endotelina-1 in pazienti emodializzati

RELATIONSHIP BETWEEN ASYMPTOMATIC HYPERURICEMIA AND RENAL FUNCTION DECLINE IN HYPERTENSIVE SUBJECTS.

Introduction: It is well known that the deposition of uric acid crystals exert direct toxic effect on the renal parenchyma and vasculature. Both experimental and some clinical studies suggest the possibility that an increased uric acid level can lead to kidney disease even without deposition of uric acid crystals. However, other studies yielded conflicting results, especially regarding the role of uric acid in the progression of established kidney disease. Aim: To evaluate retrospectively the relationship between asymptomatic hyperuricemia and renal function decline in non-gouty hypertensive patients. Methods: We enrolled 97 hypertensive subjects, 48 with chronic kidney diseases (CKD) and 4…

The Influence of Sex on The Relationships Between Metabolic Syndrome and Left Ventricular Mass in Hypertensive Patients

Relazione tra riduzione lieve-moderata della funzione renale e massa ventricolare sinistra nell’ipertensione arteriosa essenziale

Electrocardiography for Assessment of Hypertensive Heart Disease: A New Role for an Old Tool

Left ventricular (LV) hypertrophy (LVH), detected either by electrocardiography (ECG) or echocardiography (ECHO), has long been recognized as a powerful predictor of serious cardiovascular (CV) sequelae. A very large and highly consistent body of evidence indicates that LVH is not only an adaptation to increased hemodynamic load in hypertension, but is also independently associated with an enhanced risk for myocardial infarction, cardiac sudden death, congestive heart failure, and stroke in the general population, as well as in patients with systemic hypertension, coronary heart disease, chronic kidney disease, and atrial fibrillation. Intriguingly, the cumulative incidence of cardiovascula…

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…

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…

Relazione tra obesità ed aldosteronemia nell'ipertensione essenziale: influenza del sesso.

Una relazione tra obesità e aldosteronemia (ALD), indipendente dall’attività reninica plasmatica (PRA), è stata ipotizzata sulla base di diverse evidenze sperimentali, ma non è stata confermata in tutti gli studi clinici effettuati sull’argomento. Inoltre, pochi dati esistono in letteratura sull’eventuale influenza del sesso su tale relazione. Scopo del nostro studio è stato quello di esaminare, prima globalmente e poi separatamente nei due sessi, l’eventuale associazione tra indice di massa corporea (BMI), circonferenza addominale (W) e ALD in un ampio gruppo di ipertesi essenziali non diabetici, afferenti al nostro Centro di Riferimento per lo studio dell’Ipertensione Arteriosa. Sono stat…

CORRELAZIONE TRA ALDOSTERONE E PARATORMONE PLASMATICI NELL’IPERTENSIONE ARTERIOSA ESSENZIALE

Studi sperimentali e clinici hanno indotto ad ipotizzare una interazione fisiopatologica tra aldosterone (PAC) e paratormone (PTH) nello sviluppo dell’ipertensione arteriosa e delle alterazioni cardiovascolari . Scopo di questo studio è stato di valutare il rapporto tra PAC e PTH nell’ipertensione essenziale (EH) e le eventuali interazioni con FGF23, proteina modulatrice della secrezione di PTH. In 105 H ed in 50 controlli sani sono stati analizzati i livelli plasmatici di PAC, PTH, FGF23 Vitamina D. L’analisi di correlazione multipla condotta considerando PAC come variabile dipendente ha mostrato una correlazione di PAC con FGF23 (β = 0.337; p = 0.0021) e con PTH (β = 0.241; p = 0.039) ind…

Need for anti-hypertensive drugs and blood pressure control in 490 consecutive patients with chronic kidney diseases and hypertension.

9.11 Association between Plasma Aldosterone, Metabolic Syndrome and Left Ventricular Mass in Essential Hypertension

Effects of dynamic exercise and metabolic control on left ventricular performance in insulin-dependent diabetes mellitus

In subclinical diabetic cardiomyopathy, previous reports did not positively correlate the altered cardiac performance with metabolic parameters. Fifteen insulin-dependent diabetic subjects, without any clinical or instrumental evidence of heart diseases, were studied. Signs of diabetic microangiopathy were absent. Systolic time intervals, metabolic and hormonal parameters (blood glucose, free fatty acids, blood lactate and plasma norepinephrine) were evaluated at rest and after dynamic exercise during poor (MAGE 6.36 +/- 0.72 mmol/l) and good (MAGE 3.46 +/- 0.66 mmol/l) metabolic control, obtained by means of insulin therapy. Rest values of systolic time intervals were normal during poor an…

Influence of gender on the relation between the metabolic syndrome and left ventricular mass

Influence of gender on the relation between the metabolic syndrome and left ventricular mass

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease.

Left ventricular hypertrophy (LVH) and diastolic dysfunction are very common in patients with chronic kidney disease (CKD). Aim of this study was to evaluate the impact of type 2 diabetes on LV geometry and diastolic function in hypertensive patients with CKD. We enrolled 288 Caucasian subjects with hypertension and CKD; of them, 112 had diabetes. Patients with cardiovascular (CV) diseases, glomerular filtration rate (GFR)60 ml min(-1) per 1.73 m(2), dialysis treatment and other major non-CV diseases were excluded. All patients underwent routine biochemical analyses and echocardiographic examination with tissue Doppler imaging (TDI). Patients with diabetes had significantly higher LV wall t…

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

White-coat hypertension and cardiovascular risk

OBJECTIVE: To compare cardiovascular risk in white-coat hypertensives, normotensives and established hypertensives. METHODS: We studied 61 hypertensive individuals, 27 of whom were white-coat hypertensives, and 35 normotensives. All subjects underwent 24 h noninvasive blood pressure monitoring and Doppler echocardiographic examination of the heart; urine was tested for microalbuminuria and the fundi of the eyes examined for retinopathy. RESULTS: The 24 h as well as the day- and night-time mean systolic blood pressure (SBP) was slightly but significantly higher in white-coat hypertensives than in normotensives; no significant difference was observed in diastolic blood pressure (DBP) between …

Relationship of oxidant stress with endothelial activation in hemodialysed hypertensive patients.

Il controllo pressorio nell’insufficienza renale cronica. Valutazione mediante ABPM

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…

Fattori associati alla disfunzione renale nell’ipertensione arteriosa: lo studio REDHY

Relationships of Plasma Aldosterone with Metabolic Syndrome and Left Ventricular Mass in Essential Hypertensive Patients

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