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Das AS, Gokcal E, Regenhardt RW, Horn MJ, Schwab K, Daoud N, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Rost N, Rosand J, Schwamm LH, Greenberg SM, Gurol ME. Improving detection of cerebral small vessel disease aetiology in patients with isolated lobar intracerebral haemorrhage. Stroke Vasc Neurol 2023; 8:26-33. [PMID: 35981809 PMCID: PMC9985798 DOI: 10.1136/svn-2022-001653] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE We evaluate whether non-haemorrhagic imaging markers (NHIM) (white matter hyperintensity patterns, lacunes and enlarged perivascular spaces (EPVS)) can discriminate cerebral amyloid angiopathy (CAA) from hypertensive cerebral small vessel disease (HTN-cSVD) among patients with isolated lobar intracerebral haemorrhage (isolated-LICH). METHODS In patients with isolated-LICH, four cSVD aetiologic groups were created by incorporating the presence/distribution of NHIM: HTN-cSVD pattern, CAA pattern, mixed NHIM and no NHIM. CAA pattern consisted of patients with any combination of severe centrum semiovale EPVS, lobar lacunes or multiple subcortical spots pattern. HTN-cSVD pattern consisted of any HTN-cSVD markers: severe basal ganglia PVS, deep lacunes or peribasal ganglia white matter hyperintensity pattern. Mixed NHIM consisted of at least one imaging marker from either pattern. Our hypothesis was that patients with HTN-cSVD pattern/mixed NHIM would have a higher frequency of left ventricular hypertrophy (LVH), which is associated with HTN-cSVD. RESULTS In 261 patients with isolated-LICH, CAA pattern was diagnosed in 93 patients, HTN-cSVD pattern in 53 patients, mixed NHIM in 19 patients and no NHIM in 96 patients. The frequency of LVH was similar among those with HTN-cSVD pattern and mixed NHIM (50% vs 39%, p=0.418) but was more frequent in HTN-cSVD pattern compared with CAA pattern (50% vs 20%, p<0.001). In a regression model, HTN-cSVD pattern (OR: 7.38; 95% CI 2.84 to 19.20) and mixed NHIM (OR: 4.45; 95% CI 1.25 to 15.90) were found to be independently associated with LVH. CONCLUSION Among patients with isolated-LICH, NHIM may help differentiate HTN-cSVD from CAA, using LVH as a marker for HTN-cSVD.
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Affiliation(s)
- Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Daien V, Granados L, Kawasaki R, Villain M, Ribstein J, Du Cailar G, Mimran A, Fesler P. Retinal vascular caliber associated with cardiac and renal target organ damage in never-treated hypertensive patients. Microcirculation 2018; 24. [PMID: 27987377 DOI: 10.1111/micc.12344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/12/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to assess the relationship between retinal vascular caliber and target organ damage in HT patients. METHODS Data were collected on cardiac, renal, vascular, and retinal variables in 88 consecutive never-treated HT subjects. Retinal vascular calibers were measured from fundus photographs by using a semi-automated computer-assisted program and summarized as CRAE and CRVE. RESULTS Mean CRAE and CRVE were significantly lower in patients with left ventricular hypertrophy (left ventricular mass ≥110 g/m² for women, 125 g/m² for men) than in those with normal left ventricular (CRAE: 129.4±3.7 vs 138.2±2.3 μm; P=.04; CRVE: 195.6±4.4 vs 209.8±2.7 μm; P=.008). CRAE and CRVE were negatively correlated with urinary albumin excretion (β±SE=-15.4±3.2, P<.0001 and β±SE=-11.9±4.4, P=.001, respectively) but were not correlated with estimated glomerular filtration rate (P=.21 and P=.75, respectively), carotid-to-femoral pulse wave velocity (P=.24 and P=.14), or carotid augmentation index (P=.43 and P=.16). CONCLUSION In never-treated HT patients, reduced CRAE and CRVE were associated with cardiac and renal preclinical damage, ie, left ventricular hypertrophy and albuminuria, but not estimated glomerular filtration rate or vascular stiffness.
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Affiliation(s)
- Vincent Daien
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France.,National Institute for Health and Medical Research (INSERM), U1061, Montpellier, France
| | - Loic Granados
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Max Villain
- Department of Opthalmology, Hôpital Gui de Chauliac, Montpellier, France.,Université Montpellier 1, Montpellier, France
| | - Jean Ribstein
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Guilhem Du Cailar
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Albert Mimran
- Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France
| | - Pierre Fesler
- Université Montpellier 1, Montpellier, France.,Department of Internal Medicine, Hôpital Lapeyronie, Montpellier, France.,PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier 34295 Montpellier Cedex 5, France
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Ahmad FS, Cai X, Kunkel K, Ricardo AC, Lash JP, Raj DS, He J, Anderson AH, Budoff MJ, Wright Nunes JA, Roy J, Wright JT, Go AS, St. John Sutton MG, Kusek JW, Isakova T, Wolf M, Keane MG. Racial/Ethnic Differences in Left Ventricular Structure and Function in Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort. Am J Hypertens 2017; 30:822-829. [PMID: 28444108 DOI: 10.1093/ajh/hpx058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease (CVD) and it is especially common among Blacks. Left ventricular hypertrophy (LVH) is an important subclinical marker of CVD, but there are limited data on racial variation in left ventricular structure and function among persons with CKD. METHODS In a cross-sectional analysis of the Chronic Renal Insufficiency Cohort Study, we compared the prevalence of different types of left ventricular remodeling (concentric hypertrophy, eccentric hypertrophy, and concentric remodeling) by race/ethnicity. We used multinomial logistic regression to test whether race/ethnicity associated with different types of left ventricular remodeling independently of potential confounding factors. RESULTS We identified 1,164 non-Hispanic Black and 1,155 non-Hispanic White participants who completed Year 1 visits with echocardiograms that had sufficient data to categorize left ventricular geometry type. Compared to non-Hispanic Whites, non-Hispanic Blacks had higher mean left ventricular mass index (54.7 ± 14.6 vs. 47.4 ± 12.2 g/m2.7; P < 0.0001) and prevalence of concentric LVH (45.8% vs. 24.9%). In addition to higher systolic blood pressure and treatment with >3 antihypertensive medications, Black race/ethnicity was independently associated with higher odds of concentric LVH compared to White race/ethnicity (odds ratio: 2.73; 95% confidence interval: 2.02, 3.69). CONCLUSION In a large, diverse cohort with CKD, we found significant differences in left ventricular mass and hypertrophic morphology between non-Hispanic Blacks and Whites. Future studies will evaluate whether higher prevalence of LVH contribute to racial/ethnic disparities in cardiovascular outcomes among CKD patients.
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Affiliation(s)
- Faraz S. Ahmad
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Xuan Cai
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Katherine Kunkel
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Dominic S. Raj
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Los Angeles, USA
| | - Amanda H. Anderson
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute, Torrance, California, USA
| | | | - Jason Roy
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jackson T. Wright
- Department of Medicine, Case Western University School of Medicine, Cleveland, Ohio, USA
| | - Alan S. Go
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
- Departments of Epidemiology and Biostatistics and Department of Medicine, University of California School of Medicine, San Francisco, San Francisco, California, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
| | - Martin G. St. John Sutton
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John W. Kusek
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Tamara Isakova
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Myles Wolf
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Martin G. Keane
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Nardi E, Mulè G, Nardi C, Averna M. Differences in Cardiac Structure and Function Between Black and White Patients: Another Step in the Evaluation of Cardiovascular Risk in Chronic Kidney Disease. Am J Hypertens 2017. [PMID: 28645164 DOI: 10.1093/ajh/hpx093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emilio Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Chiara Nardi
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
| | - Maurizio Averna
- Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Italy
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Waist circumference compared with other obesity parameters as a determinant of coronary artery disease in essential hypertension: from statistics to clinical practice. Hypertens Res 2016; 40:517. [PMID: 27928150 DOI: 10.1038/hr.2016.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Santoro L, Ferraro PM, Flex A, Nesci A, De Matteis G, Di Giorgio A, Zaccone V, Gambaro G, Gasbarrini A, Santoliquido A. New semiquantitative ultrasonographic score for peripheral arterial disease assessment and its association with cardiovascular risk factors. Hypertens Res 2016; 39:868-873. [PMID: 27412797 PMCID: PMC5506242 DOI: 10.1038/hr.2016.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/16/2016] [Accepted: 05/16/2016] [Indexed: 01/19/2023]
Abstract
The data concerning the distribution, extent and progression of peripheral arterial disease (PAD), as well as its association with traditional cardiovascular (CV) risk factors, have generally been obtained from studies of patients in advanced stages of the disease undergoing surgical or endovascular treatment. In this study, we have introduced a new semiquantitative ultrasonographic score (ultrasonographic lower limb atherosclerosis (ULLA) score) that is able to categorize lower limb atherosclerotic lesions at all stages of PAD. We then associated these ultrasonographic categories with a CV risk profile. We enrolled 320 consecutive subjects with symptoms suggestive of PAD or with known CV risk factors referring to our angiology unit between 1 July 2014 and 30 June 2015 for ultrasonographic evaluation of the lower limb arteries. Femoropopliteal and run-off segments were categorized together and separately based on their ultrasonographic characteristics. In univariate and multivariate analyses, the ULLA scores were significantly associated with the main CV risk factors, that is, age, male gender, cigarette smoking, arterial hypertension, diabetes, dyslipidemia, sedentary lifestyle, previous CV events and family history of CV disease, and also confirming the specific association of single risk factors with different segments of lower limb arteries. The proposed ULLA score enables a complete evaluation of the entire lower limb atherosclerotic burden, extending the results concerning the association of PAD with CV risk factors to all stages of the disease, including the early stages. It can be feasible that this new score will facilitate better evaluation of the progression of PAD and its prospective role in CV risk stratification.
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Affiliation(s)
- Luca Santoro
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | | | - Andrea Flex
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - Antonio Nesci
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | | | - Angela Di Giorgio
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - Vincenzo Zaccone
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Catholic University of Rome, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Catholic University of Rome, Rome, Italy
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Cuspidi C, Facchetti R, Bombelli M, Sala C, Tadic M, Grassi G, Mancia G. Does QRS Voltage Correction by Body Mass Index Improve the Accuracy of Electrocardiography in Detecting Left Ventricular Hypertrophy and Predicting Cardiovascular Events in a General Population? J Clin Hypertens (Greenwich) 2016; 18:415-21. [PMID: 26395327 PMCID: PMC8031592 DOI: 10.1111/jch.12678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 11/29/2022]
Abstract
The authors assessed the value of body mass index (BMI) correction of two electrocardiographic criteria in improving detection of left ventricular hypertrophy (LVH) and prediction of cardiovascular and all-cause mortality in the Italian study Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) population. At entry, 1549 patients underwent diagnostic tests, 24-hour ambulatory blood pressure (BP) monitoring, standard electrocardiography, and echocardiography. The BMI-corrected Cornell voltage and Sokolow-Lyon voltage criteria provided better results for detection of echocardiographic LVH as compared with unadjusted electrocardiographic parameters. Cornell voltage index, but not Sokolow-Lyon index, was associated with an increased risk of cardiovascular events (and all-cause mortality). The adjusted risk of cardiovascular events related to one-standard deviation increment of BMI-corrected Cornell voltage was similar to that conferred by the uncorrected criterion in the total population, but outperformed in obese participants. These findings show that correction for BMI may improve the diagnostic accuracy of Cornell voltage index in detecting LVH and prediction of cardiovascular mortality in obese individuals.
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Affiliation(s)
- Cesare Cuspidi
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
- Istituto Auxologico Italiano IRCCSMilanoItaly
| | - Rita Facchetti
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
| | - Michele Bombelli
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
| | - Carla Sala
- Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore PoliclinicoMilanoItaly
| | - Marijana Tadic
- University Clinical Hospital Centre “Dragisa Misovic”BelgradeSerbia
| | - Guido Grassi
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
- IRCCS MultimedicaMilanoItaly
| | - Giuseppe Mancia
- Department of Health ScienceUniversity of Milano‐BicoccaMilanoItaly
- Istituto Auxologico Italiano IRCCSMilanoItaly
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Prognostic value of left ventricular mass normalized to different body size indexes: findings from the PAMELA population. J Hypertens 2016; 33:1082-9. [PMID: 25668356 DOI: 10.1097/hjh.0000000000000527] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM We estimated the risk of cardiovascular and all-cause mortality associated with left ventricular hypertrophy (LVH) as assessed by left ventricular mass (LVM), normalized by various indexation methods in 1716 representatives of the general population of Monza, enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study. METHODS LVH was defined according to four sex-specific criteria derived from the upper limits of normality for LVM index in the healthy normotensive fraction of the Pressioni Arteriose Monitorate E Loro Associazioni population. Death certificates were collected over an average 211 months of follow-up. RESULTS During follow-up, 89 fatal cardiovascular events and 264 all-cause deaths were observed. LVH prevalence rates in the whole population ranged from 14.2% [LVM/body surface area (BSA)] to 18.0% (LVM/height). Adjusted risk (for baseline covariates, including ambulatory blood pressure) of cardiovascular mortality was increased in patients with LVH, regardless of the indexation type: LVH/BSA [hazard ratio 3.19, 95% confidence interval (CI) 2.02-5.06, P < 0.0001], LVH/height (hazard ratio 2.39, 95% CI 1.51-3.78, P = 0.0002), LVH/height (hazard ratio 2.38, 95% CI 1.50-3.76, P = 0.0002), LVH/height (hazard ratio 2.28, 95% CI 1.44-3.60 P = 0.0004). Similar findings were observed for all-cause mortality and when LVM was assessed as a continuous variable. The fraction of patients (5%) classified into the LVH group by height, but not by BSA, had a mild increased LVM index and showed no increased risk. CONCLUSIONS LVH, irrespective of indexation methods for LVM, confers an increased risk of cardiovascular and all-cause mortality in the general population. LVH, detected by height-based indexes, but not by BSA-based criteria, was not associated with increased mortality; this finding, however, was based on a small group of patients and will deserve further investigations.
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10
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Cao C, Hu JX, Dong YF, Zhan R, Li P, Su H, Peng Q, Wu T, Huang X, Sun WH, Wu QH, Cheng XS. Association of Endothelial and Mild Renal Dysfunction With the Severity of Left Ventricular Hypertrophy in Hypertensive Patients. Am J Hypertens 2016; 29:501-8. [PMID: 26232035 DOI: 10.1093/ajh/hpv128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/13/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The association between impaired renal function and increase left ventricular mass was shown to be related to increase in arterial stiffness, which indicates that vascular homeostasis and remodeling may impact the left ventricular hypertrophy (LVH) in patients with renal dysfunction. METHODS We measured the peripheral arterial reactive hyperemia index (RHI) and estimated glomerular filtration rate (eGFR) in 317 hypertensive patients comprising 115 normal RHI (RHI > 1.67) and normal eGFR (eGFR ≥ 90ml/min per 1.73 m(2)), 136 low RHI (RHI ≤ 1.67), 27 low eGFR (60 ≤ eGFR < 90ml/min per 1.73 m(2)) and 39 low RHI combined with low eGFR. RESULTS Multivariate logistic regression analysis identified lg RHI (odds ratio (OR): 0.001, 95% confidence interval (CI): 10(-6) to 0.426, P = 0.024) and lg eGFR (OR: 0.009, 95% CI: 10(-4) to 0.414, P = 0.016) as independent factors correlated with LVH respectively in hypertensive patients. Compared with normal RHI and eGFR patients, the extent of LVH in patients with either low RHI (OR: 1.224 95% CI: 0.451 to 3.327, P = 0.691) or low eGFR (OR: 0.593 95% CI: 0.070 to 5.037, P = 0.632) did not significantly increase, while it increased significantly in patients with low RHI combined with low eGFR (OR: 4.629 95% CI: 1.592 to 13.458, P = 0.005). CONCLUSIONS The concurrence of endothelial and mild renal dysfunction was significantly associated with the severity of LVH in hypertensive patients.
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Affiliation(s)
- Cheng Cao
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Jian-Xin Hu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Yi-Fei Dong
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China; Key Laboratory of Molecular Biology in Jiangxi Province, Nanchang City, Jiangxi Province, China.
| | - Rui Zhan
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Ping Li
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Hai Su
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qiang Peng
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Tao Wu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiao Huang
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Wen-Hua Sun
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Qing-Hua Wu
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
| | - Xiao-Shu Cheng
- Department of Cardiovascular Medicine, Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province, China
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Waist circumference compared with other obesity parameters as determinants of coronary artery disease in essential hypertension: a 6-year follow-up study. Hypertens Res 2016; 39:475-9. [PMID: 26865004 DOI: 10.1038/hr.2016.8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 12/24/2022]
Abstract
This study aimed to assess the predictive role of body mass index (BMI), waist circumference (WC) and the waist-to-hip ratio (WHR) for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. We followed up 2266 essential hypertensive individuals (mean age, 57.8 years; males, 1083; office blood pressure (BP), 143/89 mm Hg) who were free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and, at baseline, underwent blood sampling and a complete echocardiographic study to determine the left ventricular (LV) mass index. CAD was defined as a history of myocardial infarction or significant coronary artery stenosis that was revealed by angiography or a coronary revascularization procedure. The incidence of CAD throughout the follow-up period was 2.33%. Hypertensive individuals who developed CAD (n=53) had a greater baseline WC (101.1±11.7 vs. 96.4±12 cm, P=0.005), WHR (0.94±0.07 vs. 0.89±0.08 cm, P<0.0001) and LV mass index (117±26.8 vs. 103.3±27 g m(-)(2), P<0.0001) compared with those without CAD at follow-up (n=2213), whereas no difference was observed compared with the baseline office BP and BMI values (P=NS for all). Using a multivariate Cox regression model, WC (hazard ratio (HR) 1.037, P=0.002) and LV mass index (HR 1.010, P=0.044) were found to be independent predictors of CAD. In essential hypertensive patients, WC could predict the future development of CAD, whereas BMI and WHR showed no independent prognostic value. These findings suggest that WC constitutes an easy clinical tool to assess risk in hypertension among individuals with obesity.
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Cinza-Sanjurjo S, Calvo-Gómez C, Hermida-Ameijeiras A, López-Paz J, González-Juanatey J. Comparación del valor predictivo cardiovascular de MDRD y CKD-EPI en la estimación de la enfermedad renal crónica. Semergen 2016; 42:11-8. [DOI: 10.1016/j.semerg.2014.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/22/2014] [Accepted: 10/25/2014] [Indexed: 11/27/2022]
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14
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de Beus E, Meijs MFL, Bots ML, Visseren FLJ, Blankestijn PJ. Presence of albuminuria predicts left ventricular mass in patients with chronic systemic arterial hypertension. Eur J Clin Invest 2015; 45:550-6. [PMID: 25786814 DOI: 10.1111/eci.12433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 03/13/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Increased left ventricular mass (LVM) is known to predict cardiovascular morbidity and mortality. LVM is high in patients with advanced kidney disease. Our aim was to study the relationship between renal parameters and LVM in hypertensive subjects at high risk of cardiovascular disease. DESIGN Cardiac MRI was performed in 527 patients participating in the single-centre SMART cohort study. Participants free from previous symptomatic coronary heart disease but with a history of hypertension were recruited. Subjects were screened for cardiovascular risk factors in a standardized way. Multivariable linear regression was used to study the relationship of both estimated glomerular filtration rate (eGFR) and presence of albuminuria with left ventricular mass. RESULTS Mean LVM was 121 g for men (SD 26) and 87 g for women (SD 20). Mean eGFR was 82 mL/min/1.73 m(²) (SD 19). A total of 73 patients (14%) had albuminuria. After adjusting for known determinants of LVM (height, weight, sex and age) eGFR did not relate to LVM while presence of albuminuria did (mean change in LVM per 10 mL/min/1.73 m(2) change in eGFR 0.79 g, 95% CI -0.33 to 1.91, P = 0.17, mean change in LVM in presence vs. absence of albuminuria 9.9 g, 95% CI 4.33 to 15.45, P = 0.001). Additional adjustment for systolic blood pressure did not change results (B for eGFR 0.54, 95% CI -0.58 to 1.66, P = 0.35, B for albuminuria 9.09, 95% CI 3.57 to 14.60, P = 0.001). CONCLUSIONS In this study in hypertensive patients with high vascular risk, albuminuria was related to increased LVM and eGFR was not.
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Affiliation(s)
- Esther de Beus
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matthijs F L Meijs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
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15
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Barsukov AV, Glukhovskoy DV, Zobnina MP, Mirokhina MA, Dydyshko VT, Vasiliev VN, Kitzishin VP, Tishko VV. Left ventricular hypertrophy as a marker of adverse cardiovascular risk in persons of different age groups. ADVANCES IN GERONTOLOGY 2015. [DOI: 10.1134/s2079057015020022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Cuspidi C, Tadic M, Sala C. A New Electrocardiographic Marker of Hypertensive Cardiac Damage. J Clin Hypertens (Greenwich) 2015; 17:450-2. [PMID: 25772522 DOI: 10.1111/jch.12520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Cesare Cuspidi
- Department of Health Science, University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, Milan, Italy
| | - Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic," Belgrade, Serbia
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione IRCCS Policlinico di Milano, Milan, Italy
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17
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Carpinella G, Pagano G, Buono F, Petitto M, Guarino G, Orefice G, Rengo G, Trimarco B, Morisco C. Prognostic value of combined target-organ damage in patients with essential hypertension. Am J Hypertens 2015; 28:127-34. [PMID: 24936579 DOI: 10.1093/ajh/hpu098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Whether the combination of chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) affects the cardiovascular (CV) risk in patients with uncomplicated hypertension is poorly investigated. The aim of this study was to assess the effects of LVH, CKD, and their combination on CV events in hypertension. METHODS This study analyzed 1,078 patients with essential hypertension. RESULTS LVH was present in 104 (9.6%) patients, CKD was present in 556 (51.5%) patients, and the combination of LVH and CKD was found in 174 (16.1%) patients. During the follow-up (median = 84 months), 52 CV events were observed (0.64 events/100 patient-years): 6 (2.4%) in patients without target-organ damage (TOD), 6 (5.7%) in patients with LVH, 20 (3.6%) in patients with CKD, and 20 (11.4%) in patients with combined LVH+CKD. Adjusted hazard ratio (HR) for CV events was 1.62 (P = 0.34) for LVH, 0.951 (P = 0.94) for CKD, and 2.45 (P = 0.03) for LVH+CKD. After multivariable Cox proportional hazard analysis, the combination of LVH+CKD was significantly associated with risk of CV events, when the model was adjusted for sex and age (HR = 2.447; P = 0.03) and for the presence of 1 CV risk factor (HR = 3.226; P = 0.02). In contrast, the association of LVH+CKD was no longer significant when the model was adjusted for sex, age, and the presence of ≥ 2 CV risk factors. CONCLUSIONS The results of this study highlight the relevance of the interactions between TODs and hemodynamic, anthropometric, and metabolic abnormalities in the CV risk stratification of patients with essential hypertension.
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Affiliation(s)
- Gerardo Carpinella
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy
| | - Gennaro Pagano
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy
| | - Francesco Buono
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy
| | - Marta Petitto
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy
| | - Giovanna Guarino
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy
| | - Giuseppe Orefice
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy
| | - Giuseppe Rengo
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy
| | - Bruno Trimarco
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Naples, Italy
| | - Carmine Morisco
- Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
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18
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Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity: a 4-year prospective study. J Hypertens 2014; 32:415-22. [PMID: 24241057 DOI: 10.1097/hjh.0000000000000023] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Little is known regarding the clinical course and prognosis of resistant hypertension (RHT). We evaluated predictors of persistent RHT and the associated cardiovascular risk. METHODS We studied 1911 treated hypertensive patients (aged 59±11 years, 49% men) for a mean period of 3.9 years. At baseline, clinical data were collected and patients underwent echocardiographic measurements, routine blood testing and additional workup for exclusion of secondary causes of RHT (office-based uncontrolled hypertension under at least three drugs including a diuretic or controlled hypertension under four or more drugs). Endpoint of interest was the composite of coronary artery disease and stroke. MAIN RESULTS Four groups were identified depending on presence or absence of RHT at baseline and follow-up: 1153 patients (60%) never having RHT, 189 (10%) with resolved RHT, 204 (11%) with incident RHT and 365 (19%) with persistent RHT. Two-thirds of the patients with RHT at baseline remained resistant at the end of the study. Independent variables associated with both incident and persistent RHT were diabetes mellitus, history of cardiovascular disease, hypertension duration, SBP, left ventricular hypertrophy and glomerular filtration rate. Persistent RHT compared with never-having RHT was associated with a 2.2-fold increased risk for cardiovascular morbidity (95% CI: 1.21-4.05, P = 0.01) after adjustment for risk factors. CONCLUSION In treated hypertensive patients, among prospective RHT dynamic patterns, persistent RHT is frequent and independently associated with adverse cardiovascular prognosis.
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19
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Suzuki H, Inoue T, Dogi M, Kikuta T, Takenaka T, Okada H. Decline of Renal Function and Progression of Left Ventricular Hypertrophy Are Independently Determined in Chronic Kidney Disease Stages 3-5. Pulse (Basel) 2014; 2:29-37. [PMID: 26587441 PMCID: PMC4646155 DOI: 10.1159/000368678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
UNLABELLED Invasive and noninvasive methods for evaluating the effects of hemodynamics on progression of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD) have been proposed. Central aortic pressure (CAP) has been reported to be the best among selected measures of hemodynamics for predicting LVH. However, there are few studies examining the relation between longitudinal changes in CAP and renal dysfunction in patients with CKD. METHODS Sixty-seven patients with CKD stages 3-5 (female/male ratio: 26/41, age: 61.5 ± 13.1 years) were followed for 5 years. Before and at the end of the 5-year period, CAP was recorded by an automated tonometric system (HEM-9000 AI; Omron Healthcare, Kyoto, Japan). Second systolic aortic blood pressure (SBP2) was employed as an index of CAP. RESULTS Throughout the study, systolic blood pressure (SBP) was well controlled. Renal function followed by estimated glomerular filtration rate (eGFR) gradually worsened as a whole. Ten patients had renal replacement therapy, 3 patients developed cardiovascular diseases and 2 patients were found to have a neoplasm during the 5-year observation period. SBP2 increased from 120 ± 19 to 125 ± 33 mm Hg and eGFR decreased from 38.2 ± 18.2 to 29.5 ± 16.3 ml/min/1.73 m(2); however, these differences did not achieve significance. The left ventricular mass (LVM) index significantly increased from 115.5 ± 10.5 to 131.2 ± 11.7 g/m(2) (p < 0.05). Although the changes in SBP2 and eGFR looked like a mirror image, there was no significant correlation between the two factors. Moreover, multivariate regression analysis did not reveal a close correlation between SBP2 and CKD progression. In contrast to the decline of renal function, the baseline value of SBP2 predicted an increase in the LVM index. CONCLUSION Worsening of renal dysfunction is not solely dependent on hemodynamics. Other factors might be involved in a complex manner.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Tsutomu Inoue
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Mami Dogi
- Omron Health Care Co. Ltd., Kyoto, Japan
| | - Tomohiro Kikuta
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Tsuneo Takenaka
- Department of Nephrology, International University of Health and Welfare, Medical University Hospital, Saitama, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
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20
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Accuracy and prognostic significance of electrocardiographic markers of left ventricular hypertrophy in a general population. J Hypertens 2014; 32:921-8. [DOI: 10.1097/hjh.0000000000000085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Cuspidi C, Giudici V, Negri F, Sala C. Nocturnal nondipping and left ventricular hypertrophy in hypertension: an updated review. Expert Rev Cardiovasc Ther 2014; 8:781-92. [DOI: 10.1586/erc.10.29] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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22
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Cuspidi C, Muiesan ML, De Luca N, Salvetti M, Agabiti-Rosei E, Schillaci G. Echocardiography in Hypertension: a Call for Standardization from the Working Group on Heart and Hypertension of the Italian Society of Hypertension. High Blood Press Cardiovasc Prev 2013; 21:53-61. [DOI: 10.1007/s40292-013-0030-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/13/2013] [Indexed: 12/12/2022] Open
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23
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Tsioufis C, Tsiachris D, Kasiakogias A, Dimitriadis K, Petras D, Goumenos D, Siamopoulos K, Stefanadis C. Preclinical cardiorenal interrelationships in essential hypertension. Cardiorenal Med 2013; 3:38-47. [PMID: 23946723 DOI: 10.1159/000346817] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A diseased heart causes numerous adverse effects on kidney function, and vice versa renal disease can significantly impair cardiac function. Beyond these heart-kidney interrelationships at the clinical level, a reciprocal association has been suggested to exist even in the early stages of those organs' dysfunction. The aim of the present review is to provide evidence of the presence of a preclinical cardiorenal syndrome in the particular setting of essential hypertension, focusing on the subsequent hypertensive sequelae on heart and kidneys. In particular, a plethora of studies have demonstrated not only the predictive role of kidney damage, as expressed by either decreased glomerular filtration or increased urine albumin excretion, for adverse left ventricular functional and structural adaptations but also preclinical heart disease, i.e. left ventricular hypertrophy that is associated with deterioration of renal function. Notably, these reciprocal interactions seem to exist even at the level of microcirculation, since both coronary flow reserve and renal hemodynamics are strongly related with clinical and preclinical renal and cardiac damage, respectively. In this preclinical setting, common pathophysiological denominators, including the increased hemodynamic load, sympathetic and renin-angiotensin system overactivity, increased subclinical inflammatory reaction, and endothelial dysfunction, account not only for the reported associations between overt cardiac and renal damage but also for the parallel changes that occur in coronary and renal microcirculation.
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24
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Cuspidi C, Facchetti R, Bombelli M, Sala C, Negri F, Grassi G, Mancia G. Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy. Hypertension 2013; 62:78-84. [DOI: 10.1161/hypertensionaha.111.00682] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The relationship between circadian blood pressure (BP) variations and the extent of subclinical cardiac organ damage is still debated. In a general population, we investigated the association of night-to-day BP fall, as well as nocturnal BP level (mean and lowest values), with left ventricular (LV) hypertrophy and the value of both BP parameters in predicting new-onset LV hypertrophy. Office BP, 24-hour ambulatory BP values, and laboratory investigations were assessed on entry in 1682 subjects (50.2% men; mean age, 50.2±13.7 years) of the Pressioni Arteriose Monitorate E Loro Associazioni. Echocardiographic LV mass was measured at the initial evaluation and 10 years later. Multiple regression analyses, including daytime systolic BP (SBP), age, sex, and body mass index, showed that the lowest SBP level and the extent of nocturnal SBP decline were independently related to baseline LV mass. After adjustment for several confounders, both mean nocturnal SBP (relative risk for each 10-mm Hg increase in SBP, 1.15; 95% confidence interval, 1.01–1.23;
P
<0.0001) and the lowest SBP level (relative risk for each 10-mm Hg increase in SBP, 1.10; 95% confidence interval, 1.02–1.19;
P
=0.01) were independent predictors of new-onset LV hypertrophy. This was not the case for the magnitude of nighttime SBP fall (hazard ratio for each 10% decrease in SBP, 0.91; 95% confidence interval, 0.80–1.04;
P
=0.18). In a general population, nighttime BP level rather than the nocturnal BP decline may be regarded as a reliable parameter for predicting the development of LV hypertrophy in subjects with normal LV mass. This finding may have important implications for optimizing cardiovascular prevention in the general population.
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Affiliation(s)
- Cesare Cuspidi
- From the Department of Health Science, University of Milano-Bicocca, Milano, Italy (C.C., R.F., M.B., G.G., G.M.); Istituto Auxologico Italiano IRCCS, Milano, Italy (C.C., F.N., G.G.); Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy (C.S.); and Multimedica, Sesto S. Giovanni, Milano, Italy (G.G.)
| | - Rita Facchetti
- From the Department of Health Science, University of Milano-Bicocca, Milano, Italy (C.C., R.F., M.B., G.G., G.M.); Istituto Auxologico Italiano IRCCS, Milano, Italy (C.C., F.N., G.G.); Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy (C.S.); and Multimedica, Sesto S. Giovanni, Milano, Italy (G.G.)
| | - Michele Bombelli
- From the Department of Health Science, University of Milano-Bicocca, Milano, Italy (C.C., R.F., M.B., G.G., G.M.); Istituto Auxologico Italiano IRCCS, Milano, Italy (C.C., F.N., G.G.); Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy (C.S.); and Multimedica, Sesto S. Giovanni, Milano, Italy (G.G.)
| | - Carla Sala
- From the Department of Health Science, University of Milano-Bicocca, Milano, Italy (C.C., R.F., M.B., G.G., G.M.); Istituto Auxologico Italiano IRCCS, Milano, Italy (C.C., F.N., G.G.); Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy (C.S.); and Multimedica, Sesto S. Giovanni, Milano, Italy (G.G.)
| | - Francesca Negri
- From the Department of Health Science, University of Milano-Bicocca, Milano, Italy (C.C., R.F., M.B., G.G., G.M.); Istituto Auxologico Italiano IRCCS, Milano, Italy (C.C., F.N., G.G.); Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy (C.S.); and Multimedica, Sesto S. Giovanni, Milano, Italy (G.G.)
| | - Guido Grassi
- From the Department of Health Science, University of Milano-Bicocca, Milano, Italy (C.C., R.F., M.B., G.G., G.M.); Istituto Auxologico Italiano IRCCS, Milano, Italy (C.C., F.N., G.G.); Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy (C.S.); and Multimedica, Sesto S. Giovanni, Milano, Italy (G.G.)
| | - Giuseppe Mancia
- From the Department of Health Science, University of Milano-Bicocca, Milano, Italy (C.C., R.F., M.B., G.G., G.M.); Istituto Auxologico Italiano IRCCS, Milano, Italy (C.C., F.N., G.G.); Department of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy (C.S.); and Multimedica, Sesto S. Giovanni, Milano, Italy (G.G.)
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25
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Leoncini G, Viazzi F, Storace G, Deferrari G, Pontremoli R. Blood pressure variability and multiple organ damage in primary hypertension. J Hum Hypertens 2013; 27:663-70. [PMID: 23739158 DOI: 10.1038/jhh.2013.45] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/16/2013] [Accepted: 04/26/2013] [Indexed: 02/06/2023]
Abstract
Organ damage (OD) is an indicator of increased cardiovascular risk. Blood pressure variability (BPV) is related to greater incidence of events, regardless of the severity of hypertension. We investigated the relationship between ambulatory blood pressure monitoring (ABPM)-derived indices of BPV and the presence of multiple OD in primary hypertension (PH). One hundred and sixty-nine untreated patients with PH were evaluated. Systolic (SBP) and diastolic blood pressure (DBP) variability were assessed as the crude and weighted (w.) standard deviation (s.d.), and average real variability (ARV) of the mean value of 24-h, awake and asleep ABPM recordings. Left ventricular mass index, intima-media thickness, estimated-glomerular filtration rate and urinary albumin excretion were assessed as indices of cardiac, vascular and renal damage, respectively. Risk profile progressively increased starting from patients without OD to patients with only one sign of OD, and then to those with multiple OD. In addition to greater severity of the organ involvement, the only variables that were found to significantly differ between subjects with multiple and single OD were office SBP (160 ± 14 vs 154 ± 11 mm Hg, P=0.0423) and DBP (101 ± 7 vs 97 ± 8 mm Hg, P=0.0291), ambulatory arterial stiffness index (AASI) (0.60 ± 0.10 vs 0.50 ± 0.17, P=0.0158) and indices of BPV (24-h SBP s.d., 23 ± 5 vs 20 ± 6 mm Hg, P=0.0300; awake SBP s.d., 22 ± 6 vs 19 ± 6 mm Hg, P=0.0366; 24-h SBP w.s.d., 20 ± 5 vs 17 ± 5 mm Hg, P=0.0385; and 24-h SBP ARV, 18 ± 4 vs 15 ± 5 mm Hg, P=0.0420). All the above mentioned BPV parameters turned out to be determinants of multiple OD, regardless of several confounding variables, including BP levels. Therefore, in hypertensive patients increased SBP variability is associated with multiple signs of OD, regardless of BP values.
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Affiliation(s)
- G Leoncini
- Department of Internal Medicine, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy
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Hipertrofia ventricular izquierda como factor de riesgo cardiovascular en el paciente hipertenso. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70372-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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27
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Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World J Cardiol 2012; 4:135-47. [PMID: 22655162 PMCID: PMC3364500 DOI: 10.4330/wjc.v4.i5.135] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 04/25/2012] [Accepted: 05/02/2012] [Indexed: 02/06/2023] Open
Abstract
The elderly are the most rapidly growing population group in the world. Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age. The risk of coronary artery disease, stroke, congestive heart disease, chronic kidney insufficiency and dementia is also increased in this subgroup of hypertensives. Hypertension in the elderly patients represents a management dilemma to cardiovascular specialists and other practioners. During the last years and before the findings of the Systolic Hypertension in Europe Trial were published, the general medical opinion considered not to decrease blood pressure values similarly to other younger patients, in order to avoid possible ischemic events and poor oxygenation of the organs (brain, heart, kidney). The aim of this review article is to highlight the importance of treating hypertension in aged population in order to improve their quality of life and lower the incidence of the cardiovascular complications.
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Affiliation(s)
- Nikolaos Lionakis
- Nikolaos Lionakis, Dimitrios Mendrinos, Georgios Favatas, Maria Georgopoulou, Department of Cardiology, General Hospital of Nafplio, Asklipiou and Kolokotroni St, 21100 Nafplio, Greece
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Cuspidi C, Meani S, Sala C, Valerio C, Negri F, Mancia G. Age related prevalence of severe left ventricular hypertrophy in essential hypertension: echocardiographic findings from the ETODH study. Blood Press 2012; 21:139-45. [PMID: 22416806 DOI: 10.3109/08037051.2012.668662] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM We sought to investigate the prevalence and correlates of severe left ventricular hypertrophy (LVH) in relation to age in a large cohort of essential hypertensives referred to a single outpatient hypertension clinic. METHODS A total of 3752 (mean age 53±13 years, 53% men) untreated (29.5%) and treated hypertensive patients categorized in three age groups (I: 18-40 years; II: 41-64 years; III: ≥65 years) were considered for this analysis. All patients underwent extensive investigations searching for target organ damage. LVH, defined as LV mass ≥49/45 g/m(2.7) in men/women, respectively, was graded as mild, moderate and severe according to Lang's report. RESULTS LVH prevalence was 29.4% in group I, 48.2% in group II and 63.6% in group III. Overall, more than one fourth of patients with LVH had a severely increased LV mass index; the likelihood of having severe LVH was two- and four-fold higher in elderly hypertensives than in their middle-aged and young counterparts, respectively. Increasing age and LVH degree were both associated with a greater prevalence of concentric LV geometry as well as of extra-cardiac organ damage (i.e. carotid intima-media thickness). CONCLUSIONS LVH is a highly prevalent organ damage in essential hypertensives, particularly in the elderly, who exhibited a more severe increase of LV mass index, higher relative wall thickness and extra-cardiac organ damage compared with young and middle-aged sub-groups. Our findings suggest that the assessment of cardiovascular risk by grading LVH rather than simply defining the presence/absence of this cardiac phenotype could improve therapeutic strategies in the hypertensive population, particularly in the elderly.
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Affiliation(s)
- Cesare Cuspidi
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
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30
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Left ventricular hypertrophy and renal dysfunction during antihypertensive treatment adversely affect cardiovascular prognosis in hypertensive patients. J Hypertens 2012; 30:411-20. [DOI: 10.1097/hjh.0b013e32834e90d8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Zannad F, De Backer G, Graham I, Lorenz M, Mancia G, Morrow DA, Reiner Z, Koenig W, Dallongeville J, Macfadyen RJ, Ruilope LM, Wilhelmsen L. Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques. Fundam Clin Pharmacol 2012; 26:163-74. [PMID: 22220636 DOI: 10.1111/j.1472-8206.2011.01023.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.
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Affiliation(s)
- Faiez Zannad
- Centre for Clinical Investigation, Institut Lorrain du Coeur et des Vaisseaux, CHU Brabois, 54500 Vandoeuvre, France.
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Prevalence of left-ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens 2011; 26:343-9. [PMID: 22113443 DOI: 10.1038/jhh.2011.104] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Left-ventricular hypertrophy (LVH) is a cardinal manifestation of hypertensive organ damage associated with an increased cardiovascular (CV) risk. We reviewed recent literature on the prevalence of LVH, as assessed by echocardiography, in order to offer an updated information on the magnitude of subclinical alterations in LV structure in contemporary human hypertension. A MEDLINE search using key words 'left ventricular hypertrophy', 'hypertension', 'echocardiography' and 'cardiac organ damage' was performed in order to identify relevant papers. Full articles published in English language in the last decade, (1 January 2000-1 December 2010), reporting studies in adult or elderly individuals, were considered. A total of 30 studies, including 37,700 untreated and treated patients (80.3% Caucasian, 52.4% men, 9.6% diabetics, 2.6% with CV disease) were considered. LVH was defined by 23 criteria; its prevalence ranged from 36% (conservative criteria) to 41% (less conservative criteria) in the pooled population. LVH prevalence was not different between women and men (range 37.9-46.2 versus 36.0-43.5%, respectively). Eccentric LVH was more frequent than concentric hypertrophy (range 20.3-23.0 versus 14.8-15.8, respectively, P<0.05); concentric phenotype was found in a consistent fraction (20%) of both genders. Despite the improved management of hypertension in the last two decades, LVH remains a highly frequent biomarker of cardiac damage in the hypertensive population. Our analysis calls for a more aggressive treatment of hypertension and related CV risk factors leading to LVH.
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Mancia G, Schumacher H, Redon J, Verdecchia P, Schmieder R, Jennings G, Yusoff K, Ryden L, Liu GL, Teo K, Sleight P, Yusuf S. Blood pressure targets recommended by guidelines and incidence of cardiovascular and renal events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET). Circulation 2011; 124:1727-36. [PMID: 21947289 DOI: 10.1161/circulationaha.110.008870] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hypertension treatment guidelines recommend that blood pressure (BP) be lowered to <140/90 mm Hg, but that a reduction to <130/80 mm Hg be adopted in patients at high cardiovascular (CV) risk. We investigated the CV and renal benefits associated with these BP targets in the high-CV-risk population of the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET). METHODS AND RESULTS Patients were divided into 4 groups according to the proportion of in-treatment visits before the occurrence of an event (<25%->75%) in which BP was reduced to <140/90 or <130/80 mm Hg. After adjustment for demographic and clinical variables, a progressive increase in the proportion of visits in which BP was reduced to <140/90 or <130/80 mm Hg was associated with a progressive reduction in the risk of stroke, new onset of microalbuminuria or macroalbuminuria, and return to normoalbuminuria in albuminuric patients. An increased frequency of BP control to either target did not have any consistent effect on the adjusted risk of myocardial infarction and heart failure. The adjusted risk of CV events was reduced by increasing the frequency of BP control to <140/90 mm Hg, but not to <130/80 mm Hg. Similar findings were obtained for the achievement of the BP target in the visit preceding a CV event. CONCLUSION The more frequent achievement of the BP targets recommended by guidelines led to cerebrovascular and renal protection, but did not increase cardiac protection. Overall, CV protection was favorably affected by the less tight but not by the tighter BP target. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00153101.
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Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, Monza, Italy.
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Andrikou E, Tsioufis C, Dimitriadis K, Flessas D, Chatzistamatiou V, Grassos C, Papavasiliou M, Papadopoulos D, Stefanadis C. Parallel deterioration of albuminuria, arterial stiffness and left ventricular mass in essential hypertension: integrating target organ damage. Nephron Clin Pract 2011; 119:c27-34. [PMID: 21654180 DOI: 10.1159/000324215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 01/07/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Albuminuria, arterial stiffening and left ventricular hypertrophy (LVH) constitute target organ damage. We estimated whether increased urinary albumin excretion, assessed by albumin-to-creatine ratio (ACR), and carotid to femoral pulse wave velocity (c-f PWV) were accompanied by augmented left ventricular (LV) mass index (LVMI) in hypertension. METHODS In 428 non-diabetic untreated hypertensives (257 men, mean age = 52 years, office blood pressure (BP) = 146/93 mm Hg) the distributions of ACR and c-f PWV were split by the median (8 mg/g and 7.8 m/s, respectively). RESULTS Age, male sex, 24 h systolic BP, ACR and c-f PWV were the independent predictors of LVMI (R(2) = 0.478, p < 0.0001). Among patients with low ACR (n = 198), those with high c-f PWV (n = 84) compared to those with low c-f PWV (n = 114) were characterized by increased LVMI (by 8.9 g/m(2), p = 0.012) and prevalence of LVH (30 vs. 14%, p = 0.015). Similarly among patients with high ACR (n = 230), those with high c-f PWV (n = 123) compared to those with low c-f PWV (n = 107) exhibited heightened LVMI (by 13.6 g/m(2), p = 0.001). CONCLUSIONS Increased ACR in conjunction with pronounced arterial stiffness is accompanied by augmented LV mass and higher LVH rates. Furthermore, the interrelationships between albuminuria, c-f PWV and LVMI suggest parallel target organ damage progression.
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Affiliation(s)
- Eirini Andrikou
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Greece
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Left ventricular hypertrophy: not so much determinant of renal outcome? J Hypertens 2011. [DOI: 10.1097/hjh.0b013e3283435a9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Left ventricular hypertrophy: not so much determinant of renal outcome? J Hypertens 2011; 29:621-2; author reply 622. [DOI: 10.1097/hjh.0b013e3283435a87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2010; 27:2121-58. [PMID: 19838131 DOI: 10.1097/hjh.0b013e328333146d] [Citation(s) in RCA: 1002] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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In-hospital worsening renal function is an independent predictor of one-year mortality in patients with acute myocardial infarction. Int J Cardiol 2010; 155:97-101. [PMID: 21078526 DOI: 10.1016/j.ijcard.2010.10.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 10/05/2010] [Accepted: 10/23/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND We investigated the incidence, clinical predictors and prognostic value of worsening renal function (WRF) regarding 1-year mortality in patients with acute myocardial infarction (AMI). METHODS We collected in-hospital data from 447 patients hospitalized for AMI in our institute within 12h of symptoms' onset. WRF was defined as a 25% or more decrease in estimated glomerural filtration rate during hospital stay. From blood samples obtained on admission and throughout hospitalization hemoglobin, white blood cell count, C-reactive protein, B-type natriuretic peptide, plasma glucose, troponin I and baseline and peak creatinine levels were measured. Ejection fraction was calculated on admission with 2D echocardiography. All patients underwent coronary arteriography and the revascularization status (complete or not) was also recorded. The end point was all-cause mortality after one-year of follow-up. RESULTS WRF was detected in 63 pts (16.7%) and age, ejection fraction and white blood cell count emerged as the only independent predictors. The incidence of 1-year mortality was 10.7% (48 deaths). Patients with WRF exhibited higher 1-year mortality (37.5% vs. 6.3%, log rank p<0.001) and were characterized by more severe and less completely treated coronary artery disease, greater degree of myocardial necrosis and marked neurohormonal activation. By applying multivariate Cox regression analysis WRF, B-type natriuretic peptide, ejection fraction and admission diastolic blood pressure were identified as the only independent predictors of death. CONCLUSIONS WRF is associated with adverse 1-year outcome in patients with AMI. Close monitoring of renal function in the acute phase of MI may substantially contribute to long-term risk stratification.
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Left ventricular hypertrophy as a determinant of renal outcome in patients with high cardiovascular risk. J Hypertens 2010; 28:2299-308. [DOI: 10.1097/hjh.0b013e32833d95fe] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsiachris D, Tsioufis C, Thomopoulos C, Syrseloudis D, Antonakis V, Lioni L, Kallikazaros I, Makris T, Papademetriou V, Stefanadis CI. New-onset diabetes and cardiovascular events in essential hypertensives: a 6-year follow-up study. Int J Cardiol 2010; 153:154-8. [PMID: 20826018 DOI: 10.1016/j.ijcard.2010.08.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 07/15/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Controversy still exists regarding the impact of new-onset diabetes (NOD) on CV outcomes among patients with hypertension. Our aim was to determine the incidence of NOD in essential hypertensives and to evaluate its association with major cardiovascular (CV) events. METHODS We followed-up for a mean period of 6 years 1572 essential hypertensives (mean age 54.3 years, 696 males) for the incidence of NOD, as well as of fatal and non-fatal coronary artery disease and stroke. Based on the development of NOD, the cohort was divided into patients with pre-existing diabetes (10%), patients with NOD (10%) and those who remained free from diabetes. RESULTS During the follow-up period, new or recurrent cases of coronary artery disease and stroke events occurred at a rate of 5.6% (n = 88) and 4.65% (n = 73). The independent predictors for NOD were age (OR = 1.026, p = 0.041), waist circumference (OR = 1.044, p < 0.001), family history of diabetes (OR = 2.173, p = 0.003) and systolic BP at follow-up (OR 1.022, p = 0.044). The presence of NOD was independently associated with greater incidence of stroke (HR 2.404, p = 0.046), along with age (HR 1.078, p < 0.001), duration of hypertension (HR 1.039, p = 0.017) and office systolic blood pressure at follow-up (HR 1.022, p = 0.026), whereas development of NOD had no relationship with the incidence of coronary artery disease. CONCLUSIONS Our findings indicate the high incidence of NOD and its close association with stroke in essential hypertension. Poorer control of hypertension appears to be a common denominator of both NOD and stroke in this setting.
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Affiliation(s)
- Dimitris Tsiachris
- First Cardiology Clinic, Hippokration Hospital, University of Athens Medical School, Athens, Greece
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¿Qué ha cambiado en el manejo actual de la hipertensión arterial desde el punto de vista renal? Rev Clin Esp 2010; 210 Suppl 1:12-7. [DOI: 10.1016/s0014-2565(10)70003-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cuspidi C, Giudici V, Lonati L, Sala C, Valerio C, Mancia G. Left ventricular hypertrophy detection and body mass index in essential hypertension. Blood Press 2010; 19:337-43. [DOI: 10.3109/08037051.2010.506029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jolobe OMP. The wider issue of potential early-onset target organ damage. Am J Emerg Med 2010; 28:529-30. [PMID: 20466248 DOI: 10.1016/j.ajem.2010.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 03/05/2010] [Indexed: 11/16/2022] Open
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Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, Cifkova R, Clément D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HAJ, Van Zwieten PA, Viigimaa M, Zanchetti A. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2010; 18:308-47. [PMID: 20001654 DOI: 10.3109/08037050903450468] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, 20052 Monza, Milan, Italy.
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