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Lembo M, Trimarco V, Izzo R, Manzi MV, Rozza F, Gallo P, Morisco C, Bardi L, Esposito G, Forzano I, Santulli G, Trimarco B. Achieving a Systolic Blood Pressure Below 130 mmHg Reduces the Incidence of Cardiovascular Events in Hypertensive Patients with Echocardiographic Left Ventricular Hypertrophy. J Pharmacol Exp Ther 2024; 390:4-10. [PMID: 38135511 PMCID: PMC11192578 DOI: 10.1124/jpet.123.001952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Background: Recent reports have evidenced an increased mortality rate in hypertensive patients with electrocardiographic left ventricular hypertrophy (ECG-LVH) achieving systolic blood pressure (SBP) <130 mmHg. However, to the best of our knowledge, the actual effects of blood pressure reduction to the ≤130/80 mmHg target on the incidence of cardiovascular (CV) events have never been determined in hypertensive patients with a diagnosis of left ventricular hypertrophy based on echocardiographic criteria (Echo-LVH). Methods: To fill this long-standing knowledge gap, we harnessed a population of 9511 hypertensive patients, followed-up for 33.6 [interquartile range 7.9-72.7] months. The population was divided into six groups according to the average SBP achieved during the follow-up (≤130, 130-139, and ≥140 mmHg) and absence/presence of Echo-LVH. The primary endpoint was a composite of fatal or nonfatal myocardial infarction and stroke, sudden cardiac death, heart failure requiring hospitalization, revascularization, and carotid stenting. Secondary endpoints included atrial fibrillation and transient ischemic attack. Results: During the follow-up, achieved SBP and diastolic blood pressure (DBP) were comparable between patients with and without Echo-LVH. Strikingly, the rates of primary and secondary endpoints were significantly higher in patients with Echo-LVH and SBP >130 mmHg, reaching the highest values in the Echo-LVH group with SBP ≥140 mmHg. By separate Cox multivariable regressions, after adjusting for potential confounders, both primary and secondary endpoints were significantly associated with SBP ≥140 mmHg and Echo-LVH. Instead, DBP reduction ≤80 mmHg was associated with a significant increased rate of secondary events. Conclusions: In hypertensive patients with Echo-LVH, achieving an average in-treatment SBP target ≤130 mmHg has a beneficial prognostic impact on incidence of CV events. SIGNIFICANCE STATEMENT: Contrary to recent findings, achieving in-treatment SBP ≤130 mmHg lowers the incidence of CV events in hypertensive patients with Echo-LVH. However, reducing DBP ≤80 mmHg is linked to increased CV complications. Cox multivariable regression models, considering potential confounders, reveal that the rate of hard and soft CV events is significantly associated with Echo-LVH and SBP ≥140 mmHg. Our data indicate that therapeutic strategies for Echo-LVH patients should target SBP ≤130 mmHg while avoiding lowering DBP ≤80 mmHg.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Valentina Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Francesco Rozza
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Paola Gallo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Luca Bardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Imma Forzano
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy (M.L., R.I., M.V.M., F.R., C.M., L.B., G.E., I.F., G.S., B.T.); Department of Neuroscience, Federico II University, Naples, Italy (V.T., P.G.); International Translational Research and Medical Education (ITME) Consortium, Naples, Italy (C.M., G.S., B.T.); and Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, New York (G.S.)
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Bruno A, Prabu P, Vedala K, Sethuraman S, Nichols FT. Distribution of cerebral age-related white matter changes in relation to risk factors in stroke patients. Clin Neurol Neurosurg 2023; 235:108018. [PMID: 37924721 DOI: 10.1016/j.clineuro.2023.108018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION The distribution of cerebral age-related white matter changes (ARWMC) may be indicative of the underlying etiology and could suggest optimal interventions. We aimed to determine if left ventricular hypertrophy (LVH), a marker of uncontrolled hypertension, along with additional risk factors are associated with the distribution of cerebral ARWMC. METHODS We analyzed data of 172 patients from a hospital stroke registry who had acute stroke and brain MRI. We classified lesion location as superficial (frontal, parieto-occipital, or temporal) or deep (basal nuclei) using the ARWMC scale. We defined a superficial ARWMC index as the superficial minus the deep score. We excluded infratentorial lesions and patients with bilateral strokes. Regression analysis analyzed LVH and other relevant clinical factors for independent association with the superficial ARWMC index. RESULTS The superficial ARWMC scores ranged from 0 to 6, the deep scores from 0 to 3, and the superficial ARWMC index from -2 to 6. We categorized the superficial ARWMC index as -2 to 1 (n = 65), 2 (n = 50), and 3 - 6 (n = 57). In bivariate analysis, ARWMC distribution was significantly associated with older age, lower household income (HI), and lower serum triglyceride (TG) levels. In multiple logistic regression analysis, higher superficial ARWMC index was significantly associated with lower HI (OR 10.72, 95 % CI 2.30-49.85), lower serum low density cholesterol (LDL) (OR 0.86, 95 % CI 0.75-0.98, per 10 mg/dL), and lower serum TG levels (OR 0.91, 95 % CI 0.85-0.99, per 10 mg/dL). The area under the curve in receiver operating characteristic analysis (95 % CI) for HI was 0.63 (0.49-0.76), LDL level 0.64 (0.51-0.77), and TG level 0.77 (0.65-0.88). CONCLUSION In this study, LVH was not associated with the distribution of cerebral ARWMC. Using an alternate classification of ARWMC distribution and analyzing additional risk factors in larger studies may yield further discoveries.
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Affiliation(s)
- Askiel Bruno
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States.
| | - Pranav Prabu
- Medical College of Georgia, Augusta, GA, United States
| | | | - Sankara Sethuraman
- Department of Mathematics, Augusta University, Augusta, GA, United States
| | - Fenwick T Nichols
- Department of Neurology, Medical College of Georgia at Augusta University, Augusta, GA, United States
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Trimarco V, Izzo R, Mone P, Lembo M, Manzi MV, Pacella D, Falco A, Gallo P, Esposito G, Morisco C, Santulli G, Trimarco B. Therapeutic concordance improves blood pressure control in patients with resistant hypertension. Pharmacol Res 2023; 187:106557. [PMID: 36402254 PMCID: PMC9943685 DOI: 10.1016/j.phrs.2022.106557] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION An empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients. METHODS We designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients. RESULTS From a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012). CONCLUSIONS Taken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.
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Affiliation(s)
- Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, NY, USA
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, “Federico II” University, Naples, Italy
| | - Angela Falco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Paola Gallo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy; Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, NY, USA; International Translational Research and Medical Education (ITME) Consortium, Naples, Italy; Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY, USA.
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
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Trimarco V, Izzo R, Morisco C, Mone P, Manzi MV, Falco A, Pacella D, Gallo P, Lembo M, Santulli G, Trimarco B. High HDL (High-Density Lipoprotein) Cholesterol Increases Cardiovascular Risk in Hypertensive Patients. Hypertension 2022; 79:2355-2363. [PMID: 35968698 PMCID: PMC9617028 DOI: 10.1161/hypertensionaha.122.19912] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension. METHODS To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy. RESULTS We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C<40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C>80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes. Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients. CONCLUSIONS Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.
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Affiliation(s)
| | | | - Carmine Morisco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy; International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
| | - Pasquale Mone
- Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, NY
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Angela Falco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, “Federico II” University, Naples, Italy
| | - Paola Gallo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy; International Translational Research and Medical Education (ITME) Consortium, Naples, Italy; Division of Cardiology, Department of Medicine, Wilf Family Cardiovascular Research Institute, Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy; International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
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Mancusi C, Manzi MV, de Simone G, Morisco C, Lembo M, Pilato E, Izzo R, Trimarco V, Trimarco B, De Luca N. Carotid Atherosclerosis Predicts Blood Pressure Control in Patients With Hypertension: The Campania Salute Network Registry. J Am Heart Assoc 2022; 11:e022345. [PMID: 35043688 PMCID: PMC9075070 DOI: 10.1161/jaha.121.022345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The 2018 European Society of Cardiology/European Society of Hypertension arterial hypertension guidelines do not recommend routine carotid ultrasound as a tool to identify hypertension‐mediated organ damage, unless clinically indicated. However, carotid plaque (CP) is a strong correlate of increased arterial stiffness, which influences blood pressure (BP) control over time. Thus, we assessed whether evidence of CP at first visit could predict BP control during follow‐up. Methods and Results From the CSN (Campania Salute Network) Registry, 6684 patients with hypertension had complete carotid ultrasound examination and were categorized by the presence of CP at baseline. Optimal BP control was defined as average BP <140/90 mm Hg and <135/85 during follow‐up for office and home BP, respectively. At baseline, participants with CP (n=3061) were more likely to be men, to be older, to have diabetes, and to exhibit higher systolic BP, lower diastolic BP, worse lipid profile, and higher prevalence of left ventricular hypertrophy (all P<0.0001) than patients without CP. Optimal office BP control was adjudicated in 54% with and 62% without CP (P<0.0001), and optimal home BP in 51% with and 58% without CP (P<0.01). Presence of CP was significantly associated with the reduced probability of controlled office BP during follow‐up (both P<0.0001), independently of significant effect of older age, male sex, higher baseline BP values, classes of medication, and presence of left ventricular hypertrophy, and only attenuated by duration of hypertension. Conclusions Presence of CP in treated patients with hypertension is associated with suboptimal BP control during follow‐up, independently of worse metabolic profile and presence of left ventricular hypertrophy.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | | | - Giovanni de Simone
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Maria Lembo
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Emanuele Pilato
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences Federico II University Naples Italy
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Manzi MV, Mancusi C, Trimarco V, Izzo R, Franco D, Barbato E, Morisco C, Trimarco B. The intergated approach to the management of arterial hypertension: The CampaniaSalute Network. Panminerva Med 2021; 63:451-457. [PMID: 33908729 DOI: 10.23736/s0031-0808.21.04384-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The second half of the last century was characterized by intense research in the field of arterial hypertension and related therapies. These studies showed that the management of arterial hypertension requires a robust coordination with close integration of the "health care systems" and "health care professionals". In 1998, the health care organization named "Campania Salute Network" was set up at the University of Naples Federico II. The Campania Salute Network involves 23 outpatient hypertensive clinics distributed in different community hospitals of the Regione Campania's area, 60 randomly selected general practitioners uniformly distributed in the same area, and the Hypertension Clinic of the Federico II University in Naples (coordinating centre). Through this network, clinical data collected at each visit are shared (via text messages or emails) with peripheral units (general practitioners and community hospital outpatient hypertensive clinics). The coordinating centre works in co-operation with the peripheral units in the treatment and follow-up of all hypertensive patients (i.e. assessing hypertension mediated organ damage and associated diseases). Informations about patients are shared through on-line access to the remote web-based database. The integrated approach to the mamangement of hyperetension determined a better control of blood pressure, that was associated with a reduction of hypertension mediated organ damage and decreased incidence of fatal or non-fatal cardiovascular events. Furthermore, this innovative approach improved the adherence and the persistence to the initial pharmacologic treatment. Campania Salute Network is also a powerful tool for the clinical and translational research with more 15,000 hypertensive patients followed for more than 15 years. This database allowed, in prospetic, large scale studies, to identify the hemodimìnamic and metabolic determinants of hypertension mediated organ damage and major cardiovascular events. The experience of Campania Salute Netwiork indicates that the creation of large databases from real life experiences becomes an indispensable condition also for artificial intelligence which, in the near future, thanks to scientific knowledge, the availability of particularly advanced hardware and software, will also be able to transform the management of arterial hypertension.
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Affiliation(s)
- Maria V Manzi
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
| | - Costantino Mancusi
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
| | - Valentina Trimarco
- Dipartimento di Neuroscienze e Scienze riproduttive ed odontostomatologiche, Università Federico II, Napoli, Italy
| | - Raffaele Izzo
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
| | - Danilo Franco
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
| | - Emanuele Barbato
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
| | - Carmine Morisco
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy -
| | - Bruno Trimarco
- Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
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Mancusi C, Losi MA, Albano G, De Stefano G, Morisco C, Barbato E, Trimarco B, De Luca N, de Simone G, Izzo R. Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting: The Campania Salute Network. Am J Hypertens 2020; 33:414-421. [PMID: 31930302 DOI: 10.1093/ajh/hpaa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/01/2019] [Accepted: 01/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertensive urgencies (HypUrg) are defined as severe elevation in blood pressure (BP) without acute target organ damage. In the office setting, treated asymptomatic patients, with severe BP elevation meeting criteria for urgency are often seen. We evaluate incident Cardiovascular (CV) events (n = 311) during follow-up (FU) in patients with HypUrg at first outpatient visit. METHODS HypUrg was defined by systolic BP ≥180 mm Hg and/or diastolic BP ≥110 mm Hg. Patients were >18 years old, with available ultrasound data, without prevalent CV disease, and no more than stage III Chronic Kidney Disease. BP control was defined as the average BP during FU <140/90 mm Hg. RESULTS Four hundred and sixty-nine of 6,929 patients presented with HypUrg at first visit. Patients with HypUrg were more likely to be women, obese and diabetic and with higher prevalence of left ventricle (LV) hypertrophy and carotid plaque (all P < 0.05). During FU patients with HypUrg had 5-fold higher risk of uncontrolled BP (95% confidence interval (CI) 4.1-6.8, P < 0.0001). In Cox regression presenting with HypUrg was not associated with increased CV risk after adjusting for significant covariates, including age, sex, BP control, LV hypertrophy, and carotid plaque (hazard ratio (HR) 1.42, 95% CI (0.96-2.11), P = 0.08). CONCLUSIONS Patients with HypUrg have worst CV risk profile, reduced probability of BP control during FU and greater prevalence of target organ damage, but the excess CV event risk appears to be mediated through BP control, non-BP cardio-vascular disease risk factors, and demographic attributes. CLINICALTRIALS.GOV IDENTIFIER NCT02211365.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Giovanni Albano
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Giuliano De Stefano
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Carmine Morisco
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Emanuele Barbato
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Science, Federico II University, Naples, Italy
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8
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D’Amato A, Mancusi C, Losi MA, Izzo R, Arnone MI, Canciello G, Senese S, De Luca N, de Simone G, Trimarco B. Target Organ Damage and Target Systolic Blood Pressure in Clinical Practice: The Campania Salute Network. Am J Hypertens 2018; 31:658-664. [PMID: 29566163 DOI: 10.1093/ajh/hpy007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/23/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Lowering systolic blood pressure (SBP) below the conventional threshold (140 mm Hg) reduces left ventricular (LV) hypertrophy and incident cardiovascular (CV) events. We assessed whether different thresholds of SBP as the average value during follow-up (FU) have different impact on changes in target organ damage (TOD). METHODS From the Campania Salute Network registry, we selected 4,148 hypertensive patients with average SBP-FU <140 mm Hg, and without history of prevalent CV or chronic kidney disease (i.e., <stage IV CKD). Patients were divided in "Tight" (SBP-FU <130 mm Hg) or "Usual" (SBP-FU ≥130) BP control. At baseline and at the last available control visit, we assessed LV mass index (LVMi, g/m2.7), carotid intimal-medial thickness (IMT, mm), and glomerular filtration rate by CKD-EPI equation (GFR, ml/min/1.73 m2) as markers of TOD. Time trend of TOD for tight and usual subgroups were compared, adjusting for significant confounders. RESULTS During a median of 74 months (interquartile range: 35-108 months), 1,824 patients (44%) were classified as tight control. They were younger, with less prevalent obesity, diabetes, lower initial LVMi, and IMT, and were taking less Ca++-channel blockers during FU than the usual control subgroup (all P < 0.05). In both subgroups, there were no changes over time in LVMi and GFR, whereas the IMT increased during the FU (P < 0.004), with no significant effect of degree of SBP control. CONCLUSIONS In a registry of treated hypertensive patients from a tertiary care center, progression of TODs is not related to average SBP during FU.
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Affiliation(s)
- Andrea D’Amato
- Hypertension Research Center, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Grazia Canciello
- Hypertension Research Center, Federico II University, Naples, Italy
| | | | - Nicola De Luca
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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9
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Depressed myocardial energetic efficiency is associated with increased cardiovascular risk in hypertensive left ventricular hypertrophy. J Hypertens 2017; 34:1846-53. [PMID: 27367264 DOI: 10.1097/hjh.0000000000001007] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Myocardial mechano-energetic efficiency (MEE) can be easily approximated by the ratio of stroke work [i.e. SBP times stroke volume (SV)] to a rough estimate of energy consumption, the 'double product' [SBP times heart rate (HR)], which can be simplified as SV/HR. We evaluated whether MEE is associated with adverse prognosis in relation to the presence of left ventricular hypertrophy (LVH). METHODS Hypertensive participants of the Campania Salute Network (n = 12 353) without prevalent coronary or cerebrovascular disease and with ejection fraction more than 50% were cross-sectionally and longitudinally analyzed, over a median follow-up of 31 months. MEE was estimated by echocardiographic SV (z-derived)/(HR × 0.6). RESULTS Due to the close relation with left ventricular mass (LVM) (P < 0.0001), MEE was normalized for LVM (MEEi) and divided into quartiles. The lowest quartile of MEEi (<0.29 ml/s per g) was considered 'low MEEi'. MEEi was greater in women than in men (P < 0.0001). Progressively lower MEEi was associated with older age, male sex, obesity, diabetes, LVH, concentric geometry, inappropriate LVM and diastolic dysfunction, more use of antihypertensive therapy, and higher BP (all P < 0.002). In Cox regression, after controlling for LVH, age, sex, and average follow-up SBP, low MEEi exhibited increased hazard of composite fatal and nonfatal cardiovascular end-points (P < 0.01), independently of antihypertensive therapy and associated cardiovascular risk factors. CONCLUSION A simple estimate of low myocardial mechano-energetic efficiency is associated with altered metabolic profile, LVH, concentric left ventricular geometry, and diastolic dysfunction and predicts cardiovascular end-points, independently of age, sex, LVH antihypertensive therapy, and cardiovascular risk factors.
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10
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Stabile E, Izzo R, Rozza F, Losi MA, De Luca N, Trimarco B. Hypertension Survey in Italy: Novel Findings from the Campania Salute Network. High Blood Press Cardiovasc Prev 2017; 24:363-370. [PMID: 28669066 DOI: 10.1007/s40292-017-0220-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/06/2017] [Indexed: 11/25/2022] Open
Abstract
The "Campania Salute" (CS) is a network system aimed at improving the management of essential hypertension by integrating the activity of general practitioners (GPs) with that of the hypertension specialists. It involves 23 outpatient hypertensive clinics distributed in different community hospitals of the Napoli's metropolitan area, 60 randomly selected GPs homogeneously distributed in the same area, and the Hypertension Clinic of the Federico II University in Naples (co-ordinating centre). Through the CS system it is possible to share clinical data collected during each visit at peripheral units (general practitioners and community hospitals hypertensive clinics), which manage low-risk hypertensive patients, and the co-ordinating centre, which mainly manages high-risk hypertensive patients. The co-ordinating centre works in co-operation with the peripheral units in the treatment and follow-up of all hypertensive patients. Since the first reports on the CS network activity, it has been evident the effectiveness of this network in ameliorating the clinical management of the hypertensive disease. CS network is also a large prospective registry that generated several scientific reports based on the longitudinal assessment of hypertensive patients during their treatment. Nowadays, as observed in the Health Search Database, the rate of BP control in Campania was 69.5%, almost reaching the "Objective 70%", a result that could be in part linked to the activity of the CS network.
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Affiliation(s)
- Eugenio Stabile
- Hypertension Research Center, Federico II University, Naples, Italy.
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Napoli "Federico II", Naples, Italy.
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Rozza
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University, Naples, Italy
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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11
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Mancusi C, Gerdts E, Losi MA, D'Amato A, Manzi MV, Canciello G, Trimarco V, De Luca N, de Simone G, Izzo R. Differential effect of obesity on prevalence of cardiac and carotid target organ damage in hypertension (the Campania Salute Network). Int J Cardiol 2017. [PMID: 28629621 DOI: 10.1016/j.ijcard.2017.06.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Whether increasing body mass index (BMI) is independently associated with parallel increased prevalence of hypertensive vascular and cardiac target organ damage (TOD) needs further clarification. METHODS We analyzed 8815 hypertensive patients without prevalent cardiovascular disease, participating in the Campania Salute Network, grouped into BMI classes (normal 20-24.9kg/m2, overweight 25-29.9kg/m2 and obese ≥30kg/m2). Vascular and cardiac TOD was defined as ultrasound plaque (intima-media thickness>1.5mm) in >1 of the common or internal carotid arteries and echocardiographic left ventricular (LV) hypertrophy (LVH) (LV mass/height2.7>47g/m2.7 in women and >50g/m2.7 in men), respectively. RESULTS A majority of patients were either overweight (49%) or obese (27%). In spite of more use of combination therapy, the obese group had higher blood pressure (BP) and prevalence of TOD. In multivariate logistic analyses, obesity was associated with a 6.9 times higher prevalence of LVH (95% confidence interval [CI] 5.84-8.17, p=0.0001), independent of significant associations with female sex, age, diabetes mellitus, office systolic BP, antihypertensive and antiplatelet treatment. In contrast, only a 17% increased prevalence of carotid plaques (OR=1.17; 95% CI 1.02-1.33, p=0.02) was found in obese patients independent of significant effect of male sex, older age and higher clinic systolic BP, an association that disappeared once effect of metabolic risk factors and related therapy was also considered. CONCLUSIONS In hypertensive patients participating in the Campania Salute Project, concomitant obesity was associated with a modestly increased prevalence of carotid plaques and a pronounced increase in prevalent LVH.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department for Clinical Science, University of Bergen, Bergen, Norway; Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Eva Gerdts
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department for Clinical Science, University of Bergen, Bergen, Norway
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Andrea D'Amato
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Maria Virginia Manzi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Advanced biomedical Science, Federico II University Hospital, Naples, Italy
| | - Valentina Trimarco
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Neurosciences, Federico II University Hospital, Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Naples, Italy; Department of Translational Medical Science, Federico II University Hospital, Naples, Italy
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12
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de Simone G, Wang W, Best LG, Yeh F, Izzo R, Mancusi C, Roman MJ, Lee ET, Howard BV, Devereux RB. Target organ damage and incident type 2 diabetes mellitus: the Strong Heart Study. Cardiovasc Diabetol 2017; 16:64. [PMID: 28499385 PMCID: PMC5427627 DOI: 10.1186/s12933-017-0542-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/28/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Recent analyses in a registry of hypertensive patients suggested that preceding left ventricular (LV) hypertrophy (LVH) and/or carotid atherosclerosis are associated with incident type 2 diabetes, independent of confounders. We assess the relation between prevalent cardio-renal target organ damage (TOD) and subsequent incident type 2 diabetes in a population-based study with high prevalence of obesity. METHODS We selected 2887 non-diabetic participants from two cohorts of the Strong Heart Study (SHS). Clinical exam, laboratory tests and echocardiograms were performed. Adjudicated TODs were LVH, left atrium (LA) dilatation, and high urine albumin/creatinine ratio (UACR). Multivariable logistic regression models were used to identify variables responsible for the association between initial TODs and incident diabetes at 4-year follow-up (FU). RESULTS After 4 years, 297 new cases of diabetes (10%) were identified, 216 of whom exhibited baseline impaired fasting glucose (IFG, 73%, p < 0.0001). Participants developing type 2 diabetes exhibited higher inflammatory markers, fat-free mass and adipose mass and higher prevalence of initial LVH and LA dilatation than those without (both p < 0.04). In multivariable logistic regression, controlling for age, sex, family relatedness, presence of arterial hypertension and IFG, all three indicators of TOD predicted incident diabetes (all p < 0.01). However, the effects of TOD was offset when body fat and inflammatory markers were introduced into the model. CONCLUSIONS In this population-based study with high prevalence of obesity, TOD precedes clinical appearance of type 2 diabetes and is related to the preceding metabolic status, body composition and inflammatory status. Trial registration Trial registration number: NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://clinicaltrials.gov/ct2/show/NCT00005134, Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988.
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Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center and Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, bld 1, 80131 Naples, Italy
- Weill Cornell Medicine, New York, NY USA
| | - Wenyu Wang
- Center for American Indian Health Research, College of Public Health, University of Oklahoma, Oklahoma City, OK USA
| | - Lyle G. Best
- Epidemiology Department, Missouri Breaks Industries Research Inc, Timber Lake, SD USA
| | - Fawn Yeh
- Center for American Indian Health Research, College of Public Health, University of Oklahoma, Oklahoma City, OK USA
| | - Raffaele Izzo
- Hypertension Research Center and Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, bld 1, 80131 Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center and Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, bld 1, 80131 Naples, Italy
| | | | - Elisa T. Lee
- Center for American Indian Health Research, College of Public Health, University of Oklahoma, Oklahoma City, OK USA
| | - Barbara V. Howard
- MedStar Health Research Institute, Washington, DC USA
- Georgetown/Howard Universities Center for Clinical and Translational Studies, Washington, DC USA
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13
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Lønnebakken MT, Izzo R, Mancusi C, Gerdts E, Losi MA, Canciello G, Giugliano G, De Luca N, Trimarco B, de Simone G. Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network). J Am Heart Assoc 2017; 6:JAHA.116.004152. [PMID: 28275070 PMCID: PMC5523992 DOI: 10.1161/jaha.116.004152] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Regression of left ventricular (LV) hypertrophy (LVH) has been a goal in clinical trials. This study tests the external validity of results of clinical trials on LVH regression using a large registry from a tertiary care center, to identify phenotypes less likely to achieve regression of LVH. Methods and Results Patients from the Campania Salute Network, free of prevalent cardiovascular disease, but with echocardiographic LVH (defined as LV mass index [LVMi] >47 g/m2.7 in women and >50 g/m2.7 in men) were included. During a median follow‐up of 67 months, clear‐cut regression of LVH was documented in 14% of patients (13±8% reduction of initial LVMi) or 23% when also considering those with a reduction of LVMi ≥5 g/m2.7. Patients with persistent LVH were older with longer duration of hypertension, suboptimal blood pressure (BP) control, larger body mass index, LV mass, and carotid intima‐media thickness and included more women and subjects with diabetes mellitus, isolated systolic hypertension, and metabolic syndrome (all P<0.05). Number and class of antihypertensive drugs during follow‐up did not differ between groups. In multiple logistic regression analysis, older age, female sex, obesity, higher baseline LVMi and carotid intima‐media thickness, and suboptimal BP control were significant covariates of persistent LVH (all P≤0.01), independent of diabetes, duration of hypertension, isolated systolic hypertension, follow‐up time and number and class of antihypertensive drugs. Conclusions Early initiation of antihypertensive treatment, aggressive BP control, and attention to metabolic aspects are critical to avoid irreversible LVH.
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Affiliation(s)
- Mai Tone Lønnebakken
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy.,Department of Clinical Science, University of Bergen, Norway
| | - Raffaele Izzo
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Norway
| | - Maria Angela Losi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Division of Cardiology, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Grazia Canciello
- Hypertension Research Center, Federico II University Hospital, Naples, Italy
| | - Giuseppe Giugliano
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Division of Cardiology, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Nicola De Luca
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Federico II University Hospital, Naples, Italy .,Division of Cardiology, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
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14
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Tanabe A, Asayama K, Hanazawa T, Watabe D, Nomura K, Okamura T, Ohkubo T, Imai Y. Left ventricular hypertrophy by electrocardiogram as a predictor of success in home blood pressure control: HOMED-BP study. Hypertens Res 2017; 40:504-510. [PMID: 28077858 DOI: 10.1038/hr.2016.176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/07/2016] [Accepted: 10/30/2016] [Indexed: 01/12/2023]
Abstract
Few studies have focused on the effect of organ damage on achievement of long-term home blood pressure (BP) control. Based on the nationwide home BP-based trial data, we aimed to investigate the factors associated with home BP control, in particular, left ventricular hypertrophy (LVH) using the electrocardiogram in patients who started antihypertensive drug treatment. According to the trial protocol, we defined BP as controlled when systolic home BP reached specified targets (125-134 mm Hg in usual control (UC), n=1261; <125 mm Hg in tight control (TC), n=1288). At baseline, before drug treatment started, the mean Sokolow-Lyon voltage was 2.57±0.87 mV, and the mean Cornell product was 1573±705 mm·ms. The numbers of patients who achieved the target BP level in the UC and TC groups were 892 (70.7%) and 576 (44.7%), respectively. In both the UC and TC groups, systolic home BP at baseline was significantly lower in patients who achieved target levels than in those who did not achieve target levels (P<0.0001). Sokolow-Lyon voltage was significantly lower in patients who achieved target levels than in those who did not (P⩽0.0055). The Cornell product levels in each group were similar (P⩾0.12), although significantly different between patients who did or did not achieve the target level when the UC and TC groups were combined for analysis (P=0.031). Sokolow-Lyon voltage was significantly associated with achievement of home BP control in the multivariable-adjusted model (odds ratio, 1.13; 95% confidence intervals, 1.02-1.26; P=0.015), but Cornell product was not (P=0.13). These results indicate the difficulty of sufficient antihypertensive treatment when untreated patients had target organ damage, that is, LVH diagnosed by Sokolow-Lyon voltage.
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Affiliation(s)
- Ayumi Tanabe
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Tomohiro Hanazawa
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.,Japan Development and Medical Affairs, GlaxoSmithKline KK, Tokyo, Japan
| | - Daisuke Watabe
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.,Department of Pharmacy, National Cancer Center Hospital, Tokyo, Japan
| | - Kyoko Nomura
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.,Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
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15
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Mancusi C, Losi MA, Izzo R, Canciello G, Manzi MV, Sforza A, De Luca N, Trimarco B, de Simone G. Effect of diabetes and metabolic syndrome on myocardial mechano-energetic efficiency in hypertensive patients. The Campania Salute Network. J Hum Hypertens 2016; 31:395-399. [PMID: 28032631 DOI: 10.1038/jhh.2016.88] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/11/2016] [Accepted: 11/14/2016] [Indexed: 01/16/2023]
Abstract
Reduced myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM), and expressed in μl s-1 g-1 (MEEi), is a strong predictor of cardiovascular (CV) events, independently of LV hypertrophy and other confounders, including type II diabetes (DM). Decreased MEEi is more frequent in patients with diabetes. In the present analysis we evaluated the interrelation among MEEi, DM and metabolic syndrome (MetS) in the setting of arterial hypertension. Hypertensive patients from the Campania Salute Network, free of prevalent CV disease and with ejection fraction >50% (n=12 503), were analysed. Coexistence of MetS and DM was ordinally categorized into 4 groups: 8235 patients with neither MetS nor DM (MetS-/DM-); 502 without MetS and with DM (MetS-/DM+); 3045 with MetS and without DM (MetS+/DM-); and 721 with MetS and DM (MetS+/DM+). After controlling for sex, systolic blood pressure, body mass index, relative wall thickness (RWT), antihypertensive medications and type of antidiabetic therapy, MEEi was 333 μl s-1 g-1 in MetS-/DM-, 328 in MetS-/DM+, 326 in MetS+/DM- and 319 in MetS+/DM+ (P for trend <0.0001). In pairwise comparisons (Sidak-adjusted), all conditions, except MetS-/DM+, were significantly different from MetS-/DM- (all P<0.02). No statistical difference was detected between MetS-/DM+ and MetS+/DM-. Both MetS and DM are associated with decreased MEEi in hypertensive patients, independently to each other, but the reduction is statistically less evident for MetS-/DM+. MetS+/DM+ patients have the lowest levels of MEEi, consistent with the alterations of energy supply associated with the combination of insulin resistance with insulin deficiency.
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Affiliation(s)
- C Mancusi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Advanced Medical Bioscience, Federico II University Hospital, Naples, Italy
| | - M A Losi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Advanced Medical Bioscience, Federico II University Hospital, Naples, Italy
| | - R Izzo
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - G Canciello
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Advanced Medical Bioscience, Federico II University Hospital, Naples, Italy
| | - M V Manzi
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - A Sforza
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - N De Luca
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - B Trimarco
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Advanced Medical Bioscience, Federico II University Hospital, Naples, Italy
| | - G de Simone
- Hypertension Research Center, Federico II University Hospital, Naples, Italy.,Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
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16
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Izzo R, Losi MA, Stabile E, Lönnebakken MT, Canciello G, Esposito G, Barbato E, De Luca N, Trimarco B, de Simone G. Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients: The Campania Salute Network. Hypertension 2016; 69:136-142. [PMID: 27895192 DOI: 10.1161/hypertensionaha.116.08158] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/25/2016] [Accepted: 10/17/2016] [Indexed: 01/27/2023]
Abstract
There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline. Incident LVH was defined as the first detection of echocardiographic LV mass index ≥47 in women or ≥50 g/m2.7 in men. During a median 48-month follow-up, 915 patients (21.3%) developed LVH. They were older, more frequently women, and obese (P<0.0001), with initial higher fasting glucose, diastolic and systolic blood pressure, LV mass index, lower heart rate and glomerular filtration rate, longer hypertension history and follow-up, and higher average systolic blood pressure during follow-up (all P<0.05), despite a more frequent treatment with Ca++-channel blockers and diuretics (both P<0.02). At multivariable Cox regression, incident LVH was independently associated with older age, female sex, obesity, higher average systolic blood pressure during follow-up, and initial greater LV mass index (all P<0.02). By categorizing patients according to obesity and sex, obesity independently increased the risk for incident LVH in both sexes (obese versus nonobese men: hazard ratio, 1.34; confidence interval, 1.05-1.72; P=0.019; and obese versus nonobese women: hazard ratio, 1.34; confidence interval, 1.08-1.66; P=0.007). Despite more aggressive antihypertensive therapy, 21% of hypertensive patients develop clear-cut LVH. After adjusting for confounders, risk of incident LVH is particular relevant among women and is further increased by the presence of obesity. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT02211365.
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Affiliation(s)
- Raffaele Izzo
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Maria-Angela Losi
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Eugenio Stabile
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Mai Tone Lönnebakken
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Grazia Canciello
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Giovanni Esposito
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Emanuele Barbato
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Nicola De Luca
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
| | - Bruno Trimarco
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.).
| | - Giovanni de Simone
- From the Hypertension Research Center (R.I., M.-A.L., E.S., M.T.L., G.C., G.E., E.B., N.D.L., B.T., G.d.S.), Department of Translational Medical Sciences (R.I., G.C., N.D.L., G.d.S.), and Department of Advanced Biomedical Sciences (M.-A.L., E.S., G.E., E.B., B.T.), Federico II University, Naples, Italy; and Department of Clinical Science, University of Bergen, Norway (M.T.L.)
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Natchimuthu V, Bandaru S, Nayarisseri A, Ravi S. Design, synthesis and computational evaluation of a novel intermediate salt of N-cyclohexyl-N-(cyclohexylcarbamoyl)-4-(trifluoromethyl) benzamide as potential potassium channel blocker in epileptic paroxysmal seizures. Comput Biol Chem 2016; 64:64-73. [PMID: 27266485 DOI: 10.1016/j.compbiolchem.2016.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/11/2016] [Accepted: 05/19/2016] [Indexed: 01/26/2023]
Abstract
The narrow therapeutic range and limited pharmacokinetics of available Antiepileptic drugs (AEDs) have raised serious concerns in the proper management of epilepsy. To overcome this, the present study attempts to identify a candidate molecule targeting voltage gated potassium channels anticipated to have superior pharmacological than existing potassium channel blockers. The compound was synthesized by reacting (S)-(+)-2,3-dihydro-1H-pyrrolo[2,1-c][1,4] benzodiazepine5,11(10H,11aH)-dione with 4-(Trifluoromethyl) benzoic acid (C8H5F3O2) in DMF and N,N'-dicyclohexylcarbodiimide (DCC) which lead to the formation of an intermediate salt of N-cyclohexyl-N-(cyclohexylcarbamoyl)-4-(trifluoromethyl)benzamide with a perfect crystalline structure. The structure of the compound was characterized by FTIR, 1H NMR and 13C NMR analysis. The crystal structure is confirmed by single crystal X-ray diffraction analysis. The Structure-Activity Relationship (SAR) studies revealed that substituent of fluoro or trifluoromethyl moiety into the compound had a great effect on the biological activity in comparison to clinically used drugs. Employing computational approaches the compound was further tested for its affinity against potassium protein structure by molecular docking in addition, bioactivity and ADMET properties were predicted through computer aided programs.
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Affiliation(s)
- V Natchimuthu
- PG & Research Department of Physics, National College (Affiliated to Bharathidasan University), Tiruchirapalli, 620 001 Tamil Nadu, India
| | - Srinivas Bandaru
- Bioinformatics Research Laboratory, Eminent Biosciences, Vijaynagar, Indore 452010 Madhya Pradesh, India
| | - Anuraj Nayarisseri
- Bioinformatics Research Laboratory, Eminent Biosciences, Vijaynagar, Indore 452010 Madhya Pradesh, India
| | - S Ravi
- PG & Research Department of Physics, National College (Affiliated to Bharathidasan University), Tiruchirapalli, 620 001 Tamil Nadu, India.
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Baldo MP, Rodrigues SL, Mill JG. High salt intake as a multifaceted cardiovascular disease: new support from cellular and molecular evidence. Heart Fail Rev 2016; 20:461-74. [PMID: 25725616 DOI: 10.1007/s10741-015-9478-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Scientists worldwide have disseminated the idea that increased dietary salt increases blood pressure. Currently, salt intake in the general population is ten times higher than that consumed in the past and at least two times higher than the current recommendation. Indeed, a salt-rich diet increases cardiovascular morbidity and mortality. For a long time, however, the deleterious effects associated with high salt consumption were only related to the effect of salt on blood pressure. Currently, several other effects have been reported. In some cases, the deleterious effects of high salt consumption are independently associated with other common risk factors. In this article, we gather data on the effects of increased salt intake on the cardiovascular system, from infancy to adulthood, to describe the route by which increased salt intake leads to cardiovascular diseases. We have reviewed the cellular and molecular mechanisms through which a high intake of salt acts on the cardiovascular system to lead to the progressive failure of a healthy heart.
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Affiliation(s)
- Marcelo Perim Baldo
- Department of Physiological Sciences, Federal University of Espírito Santo, Av Marechal Campos 1468, Maruipe, Vitória, ES, 29042-755, Brazil,
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20
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Cardiovascular ultrasound exploration contributes to predict incident atrial fibrillation in arterial hypertension: The Campania Salute Network. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.07.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cardiovascular risk in relation to a new classification of hypertensive left ventricular geometric abnormalities. J Hypertens 2015; 33:745-54; discussion 754. [DOI: 10.1097/hjh.0000000000000477] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Izzo R, de Simone G, Trimarco V, Gerdts E, Giudice R, Vaccaro O, De Luca N, Trimarco B. Hypertensive target organ damage predicts incident diabetes mellitus. Eur Heart J 2013; 34:3419-26. [PMID: 23882068 PMCID: PMC3836008 DOI: 10.1093/eurheartj/eht281] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aims Whether patients with hypertensive preclinical cardiovascular disease (CVD) are at higher risk of incident diabetes has never been studied. Methods and results We assessed incident diabetes in 4176 hypertensive non-diabetic patients (age 58.7 ± 8.9 years, 58% male) with ≥1 year follow-up (median: 3.57 years; inter-quartile range: 2.04–7.25). Left ventricular (LV) hypertrophy (LVH) was defined as LV mass index (LVMi) ≥51 g/m2.7. Carotid atherosclerosis (CA) was defined as intima-media thickness >1.5 mm. During follow-up, diabetes developed in 393 patients (9.4%), more frequently in those with than without initial LVH or CA (odds ratio = 1.97 and 1.67, respectively; both P < 0.0001). In the Cox regression, the presence of either initial LVH or CA was associated with higher hazard of diabetes [hazards ratio (HR) = 1.30 and 1.38, respectively; both P = 0.03], independently of the type and number of anti-hypertensive medications, initial systolic blood pressure (P < 0.001), body mass index, fasting glucose, family history of diabetes (all P < 0.0001), and therapy with β-blockers. The presence of one of the, or both, markers of preclinical CVD increased the chance of incident diabetes by 63 or 64%, respectively (both P < 0.002), independently of significant confounders, a result that was confirmed (HR = 1.70 or 1.93, respectively; both P < 0.0001) using ATPIII metabolic syndrome (HR = 2.73; P < 0.0001) in the Cox model. Conclusion Initial LVH and CA are significant predictors of new onset diabetes in a large population of treated hypertensive patients, independently of initial metabolic profile, anti-hypertensive therapy, and other significant covariates. This sequence may be attributable to risk factors common to preclinical CVD and diabetes, but a vascular origin of diabetes cannot be excluded.
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Affiliation(s)
- Raffaele Izzo
- Department of Translational Medical Sciences, Federico II University Hospital, via S. Pansini 5, 80131 Naples, Italy
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Affiliation(s)
- Giovanni de Simone
- From the Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - Marina De Marco
- From the Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
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Importance of electrocardiographic left ventricular hypertrophy in blood pressure control. J Hypertens 2011; 29:1661-2. [DOI: 10.1097/hjh.0b013e32834904ad] [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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