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De Ciuceis C, Rosei CA, Malerba P, Rossini C, Nardin M, Chiarini G, Famà F, Lemoli M, Baresi M, Petelca A, Bortoluzzi C, Porteri E, Salvetti M, Muiesan ML, Rosei EA, Rizzoni D. Prognostic significance of the wall to lumen ratio of retinal arterioles evaluated by adaptive optics. Eur J Intern Med 2024; 122:86-92. [PMID: 37914655 DOI: 10.1016/j.ejim.2023.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Microvascular structural alterations may be considered an important form of hypertension-mediated organ damage. An increased media-to-lumen ratio of subcutaneous small arteries evaluated with locally invasive techniques (micromyography) predicts the development of cardiovascular (CV) events. However, it is not known whether retinal arteriole structural alterations evaluated with a noninvasive approach (Adaptive Optics) may have a prognostic significance. DESIGN AND METHODS Two-hundred and thirty-seven subjects (mean age 58.7 ± 16.1 years, age range 13-89 years; 116 males) were included in the study: 65 normotensive subjects (27.4 %) and 172 patients with essential hypertension or primary aldosteronism (72.6 %). All subjects underwent a non-invasive evaluation of retinal arteriolar wall-to-lumen ratio (WLR) by Adaptive Optics. Subjects were re-evaluated after an average follow-up time of 4.55 years in order to assess the occurrence of clinical events (non CV and/or CV death or events). RESULTS Fifty-four events occurred in the study population:26 were cardio-cerebrovascular events (ischemic or hemorragic stroke, atrial fibrillation, heart failure, coronary artery disease, peripheral artery disease, cardiac valvular disease) while the remaining were deaths for any cause, or neoplastic diseases. Subjects with events were older and had a WLR of retinal arterioles significantly greater than those without events. The event-free survival was significantly worse in those with a baseline WLR above the median value of the population (0.28) according to Kaplan-Mayer survival curves and multivariate analysis (Cox's proportional hazard model). The evidence was confirmed after restricting the analysis to CV events. CONCLUSIONS Structural alterations of retinal arterioles evaluated by Adaptive Optics may predict total and CV events.
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Affiliation(s)
- Carolina De Ciuceis
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy.
| | - Claudia Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Paolo Malerba
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Claudia Rossini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Matteo Nardin
- Third Division of Medicine, ASST Spedali Civili di Brescia, Italy
| | - Giulia Chiarini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Francesca Famà
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Matteo Lemoli
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Mattia Baresi
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Alina Petelca
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Chiara Bortoluzzi
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Enzo Porteri
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Massimo Salvetti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Enrico Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia 25123, Italy; Division of Medicine, ASST Spedali Civili di Brescia, Montichiari, Brescia, Italy
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Agabiti-Rosei C, Saxton SN, De Ciuceis C, Lorenza Muiesan M, Rizzoni D, Agabiti Rosei E, Heagerty AM. Influence of Perivascular Adipose Tissue on Microcirculation: A Link Between Hypertension and Obesity. Hypertension 2024; 81:24-33. [PMID: 37937425 DOI: 10.1161/hypertensionaha.123.19437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Alterations in microcirculation play a crucial role in the pathogenesis of cardiovascular and metabolic disorders such as obesity and hypertension. The small resistance arteries of these patients show a typical remodeling, as indicated by an increase of media or total wall thickness to lumen diameter ratio that impairs organ flow reserve. The majority of blood vessels are surrounded by a fat depot which is termed perivascular adipose tissue (PVAT). In recent years, data from several studies have indicated that PVAT is an endocrine organ that can produce a variety of adipokines and cytokines, which may participate in the regulation of vascular tone, and the secretory profile varies with adipocyte phenotype and disease status. The PVAT of lean humans largely secretes the vasodilator adiponectin, which will act in a paracrine fashion to reduce peripheral resistance and improve nutrient uptake into tissues, thereby protecting against the development of hypertension and diabetes. In obesity, PVAT becomes enlarged and inflamed, and the bioavailability of adiponectin is reduced. The inevitable consequence is a rise in peripheral resistance with higher blood pressure. The interrelationship between obesity and hypertension could be explained, at least in part, by a cross-talk between microcirculation and PVAT. In this article, we propose an integrated pathophysiological approach of this relationship, in order to better clarify its role in obesity and hypertension, as the basis for effective and specific prevention and treatment.
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Affiliation(s)
- Claudia Agabiti-Rosei
- Department of Medical and Surgical Sciences, University of Brescia, Italy (C.A.-R., C.D.C., M.L.M., D.R., E.A.R.)
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Italy (C.A.R., C.D.C, M.L.M.)
| | - Sophie N Saxton
- Division of Cardiovascular Sciences, The University of Manchester, Core Technology Facility, United Kingdom (S.N.S., A.M.H.)
| | - Carolina De Ciuceis
- Department of Medical and Surgical Sciences, University of Brescia, Italy (C.A.-R., C.D.C., M.L.M., D.R., E.A.R.)
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Italy (C.A.R., C.D.C, M.L.M.)
| | - Maria Lorenza Muiesan
- Department of Medical and Surgical Sciences, University of Brescia, Italy (C.A.-R., C.D.C., M.L.M., D.R., E.A.R.)
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Italy (C.A.R., C.D.C, M.L.M.)
| | - Damiano Rizzoni
- Department of Medical and Surgical Sciences, University of Brescia, Italy (C.A.-R., C.D.C., M.L.M., D.R., E.A.R.)
| | - Enrico Agabiti Rosei
- Department of Medical and Surgical Sciences, University of Brescia, Italy (C.A.-R., C.D.C., M.L.M., D.R., E.A.R.)
| | - Anthony M Heagerty
- Division of Cardiovascular Sciences, The University of Manchester, Core Technology Facility, United Kingdom (S.N.S., A.M.H.)
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Maloberti A, Mengozzi A, Russo E, Cicero AFG, Angeli F, Agabiti Rosei E, Barbagallo CM, Bernardino B, Bombelli M, Cappelli F, Casiglia E, Cianci R, Ciccarelli M, Cirillo M, Cirillo P, Desideri G, D'Elia L, Dell'Oro R, Facchetti R, Ferri C, Galletti F, Giannattasio C, Gesualdo L, Iaccarino G, Lippa L, Mallamaci F, Masi S, Masulli M, Mazza A, Muiesan ML, Nazzaro P, Parati G, Palatini P, Pauletto P, Pontremoli R, Pugliese NR, Quarti-Trevano F, Rattazzi M, Reboldi G, Rivasi G, Salvetti M, Tikhonoff V, Tocci G, Ungar A, Verdecchia P, Viazzi F, Volpe M, Virdis A, Grassi G, Borghi C. The Results of the URRAH (Uric Acid Right for Heart Health) Project: A Focus on Hyperuricemia in Relation to Cardiovascular and Kidney Disease and its Role in Metabolic Dysregulation. High Blood Press Cardiovasc Prev 2023; 30:411-425. [PMID: 37792253 PMCID: PMC10600296 DOI: 10.1007/s40292-023-00602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
The relationship between Serum Uric Acid (UA) and Cardiovascular (CV) diseases has already been extensively evaluated, and it was found to be an independent predictor of all-cause and cardiovascular mortality but also acute coronary syndrome, stroke and heart failure. Similarly, also many papers have been published on the association between UA and kidney function, while less is known on the role of UA in metabolic derangement and, particularly, in metabolic syndrome. Despite the substantial number of publications on the topic, there are still some elements of doubt: (1) the better cut-off to be used to refine CV risk (also called CV cut-off); (2) the needing for a correction of UA values for kidney function; and (3) the better definition of its role in metabolic syndrome: is UA simply a marker, a bystander or a key pathological element of metabolic dysregulation?. The Uric acid Right for heArt Health (URRAH) project was designed by the Working Group on uric acid and CV risk of the Italian Society of Hypertension to answer the first question. After the first papers that individuates specific cut-off for different CV disease, subsequent articles have been published responding to the other relevant questions. This review will summarise most of the results obtained so far from the URRAH research project.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, University of Zurich, Schlieren, Switzerland
| | - Elisa Russo
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy.
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy.
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - Bruno Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Bombelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Internal Medicine, Pio XI Hospital of Desio, ASST Brianza, Desio, Italy
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Rosario Cianci
- Department of Translational and Precision Medicine, University of Rome La Sapienza, Rome, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Massimo Cirillo
- Department of Public Health, ''Federico II'' University of Naples, Naples, Italy
| | - Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Raffaella Dell'Oro
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Rita Facchetti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ''Federico II'' University of Naples, Naples, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, ''Aldo Moro'' University of Bari, Bari, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, ''Federico II'' University of Naples, Naples, Italy
| | - Luciano Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - Francesca Mallamaci
- Reggio Cal Unit, Clinical Epidemiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Maria Masulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Alberto Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - Gianfranco Parati
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Paolo Palatini
- Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | | | - Fosca Quarti-Trevano
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | | | - Gianpaolo Reboldi
- Department of Medical and Surgical Science, University of Perugia, 06100, Perugia, Italy
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico SanMartino, Genoa, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome, Italy
- IRCCS San Raffaele, Rome, Italy
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Group, Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOU S. Orsola di Bologna, Pad. 25 - 1st Floor, Via Massarenti, 9, 40138, Bologna, Italy
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Taddei S, Bernini G, Ghiadoni L, Virdis A, Agabiti Rosei E, Ambrosioni E, Pessina A, Rappelli A, Trimarco B, Volpe M, Mancia G. In Memoriam: professor Antonio Salvetti (1936-2021). J Hypertens 2021; 39:1473-1474. [PMID: 37712404 DOI: 10.1097/hjh.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Giampaolo Bernini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | | | | | | | | | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University Sant'Andrea Hospital, Rome
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Del Pinto R, Desideri G, Ferri C, Agabiti Rosei E. Real-world Antihypertensive Treatment Patterns, Treatment Adherence, and Blood Pressure Control in the Elderly: An Italian Awareness-raising Campaign on Hypertension by Senior Italia FederAnziani, the Italian Society of Hypertension and the Italian Federation of General Practitioners. High Blood Press Cardiovasc Prev 2021; 28:457-466. [PMID: 34185255 PMCID: PMC8484252 DOI: 10.1007/s40292-021-00465-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/13/2021] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Achieving hypertension control is beneficial regardless of age. Fixed-combination pills have the potential of increasing adherence to treatment, improving the benefit/risk ratio, and simplifying therapy, with resulting convenience especially in the elderly. AIM We examined real-world antihypertensive treatment adherence and hypertension control rates in a cohort of Italian elderly individuals, enrolled in a prospective, pragmatic awareness-raising campaign on blood pressure (BP). METHODS 13196 treated hypertensive elderly (mean age 73.2±7.5 years, 55.5% women) were recruited through opportunistic sampling, answered a brief questionnaire on antihypertensive therapy, and were followed-up for 6 months, when BP was measured as per routine care. Controlled hypertension was defined as BP < 140/90 mmHg. Real-world treatment adherence and hypertension control rates were evaluated at 6 months according to different treatment patterns (fixed-dose versus free combinations), using Yates correction for continuity to assess likelihood estimates for differences between treatments. RESULTS 10551 participants (80%) were on a single-pill therapy and 3445 were on a fixed combination therapy of two (24.8%) or three (1.3%) drugs. Individuals on a fixed combination therapy were more adherent to treatment than the counterparts (p < 0.001). Full adherence increased with the number of drugs/pill among single-pill users (47.5%, 68.5%, and 100% with 1, 2, or 3 drugs/pill; p < 0.001). Hypertension control rates were 70% and 65.2% (p = 0.001) according to fixed or free combinations of two drugs and 71% and 63.9% (p = 0.321) for fixed or free combinations of three drugs. CONCLUSIONS Real-world data suggest that simplified treatment strategies and use of fixed combinations improve adherence to antihypertensive therapy and BP control in the elderly.
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Affiliation(s)
- Rita Del Pinto
- Department of Life, Health and Environmental Sciences, Division of Internal Medicine and Nephrology, Hypertension and Cardiovascular Prevention Unit, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, Division of Geriatrics, University of L'Aquila, SS. Filippo and Nicola Hospital, Avezzano, AQ, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, Division of Internal Medicine and Nephrology, Hypertension and Cardiovascular Prevention Unit, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, Clinica Medica Generale, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy. .,Department of Medicine, Azienda Spedali Civili di Brescia, Brescia, Italy.
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Agabiti Rosei E, Muiesan ML, Salvetti M, Paini A, Agabiti Rosei C, Aggiusti C, Bertacchini F, Castellano M, Giacchè M. The Vobarno study. Panminerva Med 2021; 63:458-463. [PMID: 33988330 DOI: 10.23736/s0031-0808.21.04433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The Vobarno study represents the first observational study aimed to assess in a general population sample the relationship between parameters of cardiac and vascular structure (and function) and blood pressure values, measured in the clinic and during the 24 hours. EVIDENCE ACQUISITION AND SYNTHESIS In the frame of the Vobarno study blood samples for hematochemistry and DNA extraction, clinic and 24-hour blood pressure measurements, cardiac and carotid ultrasound, and aortic stiffness were measured in all subjects, living in a small town (Vobarno) between Brescia and the Garda lake, and randomly selected from electoral roles. In this sample of a general population an extensive evaluation of organ damage, including left ventricular (LV) mass and hypertrophy, LV systolic function, left atrial dimensions and aortic root diameters, carotid intima media thickness (IMT) and carotid plaques, carotid and aortic stiffness were performed. In this study subjects were included in a long follow-up, lasting 25 years, and cardiovascular morbility and mortality were assessed up to 2019. This will allow to update the information related to cardiovascular morbidity and mortality in the study cohort. CONCLUSIONS The present paper will report the results of some analyses performed, exploring epidemiological and clinical aspects of target organ damage.
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Affiliation(s)
- Enrico Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy - .,Medicina Generale 2, ASST Spedali Civili, Brescia, Italy -
| | - Maria L Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Medicina Generale 2, ASST Spedali Civili, Brescia, Italy
| | - Massimo Salvetti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Anna Paini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Medicina Generale 2, ASST Spedali Civili, Brescia, Italy
| | - Claudia Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Carlo Aggiusti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Medicina Generale 2, ASST Spedali Civili, Brescia, Italy
| | - Fabio Bertacchini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Medicina Generale 2, ASST Spedali Civili, Brescia, Italy
| | - Maurizio Castellano
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mara Giacchè
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Muiesan ML, Rosei EA, Borghi C, De Luca N, Ghiadoni L, Grassi G, Perlini S, Pucci G, Salvetti M, Volpe M, Ferri C. The UrgeRe (Urgenze Ipertensive: Un Progetto Educazionale Fondato Sulla Vita Reale, Hypertensive Urgencies: A Project in the Real World) Project. High Blood Press Cardiovasc Prev 2021; 28:151-157. [PMID: 33544372 PMCID: PMC7952352 DOI: 10.1007/s40292-021-00433-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/04/2021] [Indexed: 12/04/2022] Open
Abstract
The approach to hypertensive emergiencies (HE) and urgencies (HU) may be different according to local clinical practice, despite recent guidelines and position papers recommendations. The Italian Society of Hypertension (Società Italiana della Ipertensione Arteriosa, SIIA) developed an online survey, in order to explore the awareness, management and treatment of HU in Italy, sending by e mail a 12 items questionnaire to the members of the SIIA. The results show that the definition of HU was correctly identified by 62% of the responders. Most physicians identified the role of pharmacological therapy or legal/illegal substances abuse as possible cause of BP elevation; the use of a benzodiazepine drugs was considered worthwhile by 65% of responders. The prescription of diagnostic test and drug administration significantly differed from guidelines recommendations and only 57% of the physicians reported to treat HU with oral drug administration. Sub-lingual nifedipine was prescribed by 13% or responders. This survey shows the need to further spread the updated scientific information on the management and treatment of HE and HU, along with the improvement of the interrelationship with the general practitioner health system in Italy.
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Affiliation(s)
- Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy.
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Science, Hypertension Research Center, Federico II University Hospital, Naples, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Stefano Perlini
- Department of Emergency, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Giacomo Pucci
- Internal Medicine, Department of Medicine, University of Perugia, Terni University Hospital, Perugia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Massimo Volpe
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, IS, Italy
| | - Claudio Ferri
- Department of Internal Medicine and Public Health, University of Aquila, L'Aquila, Italy
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Abstract
Arterial blood pressure (BP) is a continuous variable, with a physiology characterized by significant variability stemming from the complex interaction among haemodynamic factors, neuronal reflexes, as well as hormonal, behavioural, and environmental stimuli. The homoeostatic response accounts for the physiologic variability in BP in normotensive individuals, which is more evident in hypertensive patients. Blood pressure variability is a complex phenomenon, which could be classified in various types: very short term (beat to beat), short term (during 24 h), mid-term (day by day), long term (<5 years), and very long term (>5 years). Accurate measurement of BP variability represents a complex and often controversial endeavour, despite several methodological approaches are available. Albeit a prognostic significance has been demonstrated for some indicators of BP variability, the clinical significance of this measurement is still uncertain. In fact, none of the indicators presently available for BP variability, including early morning BP rise, substantially affects, and redefines, the cardiovascular risk of the hypertensive patient, over and beyond the mere BP values. Accordingly, in defining the cardiovascular risk, the focus should be on the absolute BP values, which remain the most relevant risk factor, and the one more susceptible to modification with both non-pharmacologic and pharmacologic treatment.
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Affiliation(s)
- Enrico Agabiti Rosei
- Clinica Medica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia
| | - Giulia Chiarini
- Clinica Medica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia
| | - Damiano Rizzoni
- Clinica Medica, Dipartimento di Scienze Cliniche e Sperimentali, Università degli Studi di Brescia
- Divisione di Medicina, Istituto Clinico Città di Brescia
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9
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Maloberti A, Giannattasio C, Bombelli M, Desideri G, Cicero AFG, Muiesan ML, Rosei EA, Salvetti M, Ungar A, Rivasi G, Pontremoli R, Viazzi F, Facchetti R, Ferri C, Bernardino B, Galletti F, D'Elia L, Palatini P, Casiglia E, Tikhonoff V, Barbagallo CM, Verdecchia P, Masi S, Mallamaci F, Cirillo M, Rattazzi M, Pauletto P, Cirillo P, Gesualdo L, Mazza A, Volpe M, Tocci G, Iaccarino G, Nazzaro P, Lippa L, Parati G, Dell'Oro R, Quarti-Trevano F, Grassi G, Virdis A, Borghi C. Hyperuricemia and Risk of Cardiovascular Outcomes: The Experience of the URRAH (Uric Acid Right for Heart Health) Project. High Blood Press Cardiovasc Prev 2020; 27:121-128. [PMID: 32157643 DOI: 10.1007/s40292-020-00368-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/04/2020] [Indexed: 12/17/2022] Open
Abstract
The latest European Guidelines of Arterial Hypertension have officially introduced uric acid evaluation among the cardiovascular risk factors that should be evaluated in order to stratify patient's risk. In fact, it has been extensively evaluated and demonstrated to be an independent predictor not only of all-cause and cardiovascular mortality, but also of myocardial infraction, stroke and heart failure. Despite the large number of studies on this topic, an important open question that still need to be answered is the identification of a cardiovascular uric acid cut-off value. The actual hyperuricemia cut-off (> 6 mg/dL in women and 7 mg/dL in men) is principally based on the saturation point of uric acid but previous evidence suggests that the negative impact of cardiovascular system could occur also at lower levels. In this context, the Working Group on uric acid and CV risk of the Italian Society of Hypertension has designed the Uric acid Right for heArt Health project. The primary objective of this project is to define the level of uricemia above which the independent risk of CV disease may increase in a significantly manner. In this review we will summarize the first results obtained and describe the further planned analysis.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy. .,Health Science Department, Milano-Bicocca University, Milan, Italy.
| | - C Giannattasio
- Cardiology IV, "A.De Gasperis" Department, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - M Bombelli
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - G Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A F G Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - E A Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - M Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - G Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - R Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico SanMartino, Genoa, Italy
| | - F Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico SanMartino, Genoa, Italy
| | - R Facchetti
- Health Science Department, Milano-Bicocca University, Milan, Italy
| | - C Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - B Bernardino
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - F Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - L D'Elia
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
| | - P Palatini
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - E Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, Padua, Italy
| | - V Tikhonoff
- Department of Medicine, University of Padua, Padua, Italy
| | - C M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
| | - P Verdecchia
- Hospital S. Maria della Misericordia, Perugia, Italy
| | - S Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Mallamaci
- Reggio Cal Unit, CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - M Cirillo
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - M Rattazzi
- Department of Medicine, University of Padua, Padua, Italy.,Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - P Pauletto
- Medicina Interna I, Ca' Foncello University Hospital, Treviso, Italy
| | - P Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - L Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - A Mazza
- Department of Internal Medicine, Santa Maria della Misericordia General Hospital, AULSS 5 Polesana, Rovigo, Italy
| | - M Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - G Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - G Iaccarino
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - P Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
| | - L Lippa
- Italian Society of General Medicine (SIMG), Avezzano, L'Aquila, Italy
| | - G Parati
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - R Dell'Oro
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - F Quarti-Trevano
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - G Grassi
- Health Science Department, Milano-Bicocca University, Milan, Italy.,Clinica Medica, San Gerardo Hospital, Monza, Italy
| | - A Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy
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10
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Paini A, Aggiusti C, Bertacchini F, Stassaldi D, Capellini S, Rosei EA, Muiesan ML, Salvetti M. P111 Arterial Stiffness and Unattended and Attended BP Values. Artery Res 2020. [DOI: 10.2991/artres.k.191224.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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11
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Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. [2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)]. G Ital Cardiol (Rome) 2019; 19:3S-73S. [PMID: 30520455 DOI: 10.1714/3026.30245] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Salvetti M, Paini A, Aggiusti C, Bertacchini F, Stassaldi D, Capellini S, de Ciuceis C, Rizzoni D, Gatta R, Agabiti Rosei E, Muiesan ML. Response to Letter to the Editor Regarding Article "Unattended Versus Attended Blood Pressure Measurement: Relationship With Preclinical Organ Damage". Hypertension 2019; 73:e86. [PMID: 31030608 DOI: 10.1161/hypertensionaha.119.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Carlo Aggiusti
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Fabio Bertacchini
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Deborah Stassaldi
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Sara Capellini
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Carolina de Ciuceis
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Roberto Gatta
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
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13
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Salvetti M, Paini A, Aggiusti C, Bertacchini F, Stassaldi D, Capellini S, De Ciuceis C, Rizzoni D, Gatta R, Agabiti Rosei E, Muiesan ML. Unattended Versus Attended Blood Pressure Measurement. Hypertension 2019; 73:736-742. [DOI: 10.1161/hypertensionaha.118.12187] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo Salvetti
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Anna Paini
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Carlo Aggiusti
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Fabio Bertacchini
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Deborah Stassaldi
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Sara Capellini
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Carolina De Ciuceis
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Damiano Rizzoni
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Roberto Gatta
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Enrico Agabiti Rosei
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
| | - Maria Lorenza Muiesan
- From the Department of Clinical and Experimental Sciences, University of Brescia, 2a Medicina ASST Spedali Civili di Brescia, Italy
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14
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Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. [2018 ESC/ESH Guidelines for the management of arterial hypertension]. Kardiol Pol 2019; 77:71-159. [PMID: 30816983 DOI: 10.5603/kp.2019.0018] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Bryan Williams
- Institute of Cardiovascular Science, University College London, Maple House, 1st Floor, Suite A, 149 Tottenham Court Road, W1T 7DN London, United Kingdom.
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15
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement D, Coca A, De Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen S, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder R, Shlyakhto E, Tsioufis K, Aboyans V, Desormais I. 2018 Practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Press 2018; 27:314-340. [DOI: 10.1080/08037051.2018.1527177] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Bryan Williams
- University College London, London UCL, London, United Kingdom of Great Britain and Northern Ireland
| | - Giuseppe Mancia
- IRCCS Instituto Auxologico Italiano, University of Milano-Bicocca, Milano, Italy
| | - Wilko Spiering
- Department of Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Enrico Agabiti Rosei
- Universita degli Studi di Brescia Aree Disciplinari Medicina e Chirurgia, Brescia, Italy
| | | | - Michel Burnier
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Antonio Coca
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Giovanni De Simone
- Hypertension Research Center (CIRIAPA), Department of Translational Medical Sciences, Federico II University Hospital, Napoli, Italy
| | - Anna Dominiczak
- University of Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | | | | | - Josep Redon
- Servicio de Medicina Interna del Hospital Clínico de Valencia, Catedrático de Medicina de la Universidad de Valencia, Valencia, Spain
| | | | | | | | - Sverre Kjeldsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Reinhold Kreutz
- Institut für Klinische Pharmakologie und Toxikologie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Gregory Y. H. Lip
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Richard McManus
- Nuffield Department of Primary Care, Nuffield, United Kingdom of Great Britain and Northern Ireland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Frank Ruschitzka
- Department of Cardiology, University of Zurich, Zurich, Switzerland
| | - Roland Schmieder
- Abteilung für Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Evgeny Shlyakhto
- Almazov Federal Heart, Blood and Endocrinology Centre, St Petersburg, Russian Federation
| | - Konstantinos Tsioufis
- Hippokration Hospital, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France
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16
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van den Born BJH, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E, Mahfoud F, Amraoui F, Persu A, Kahan T, Agabiti Rosei E, de Simone G, Gosse P, Williams B. ESC Council on hypertension position document on the management of hypertensive emergencies. European Heart Journal - Cardiovascular Pharmacotherapy 2018; 5:37-46. [DOI: 10.1093/ehjcvp/pvy032] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/31/2022]
Abstract
Abstract
Hypertensive emergencies are those situations where very high blood pressure (BP) values are associated with acute organ damage, and therefore, require immediate, but careful, BP reduction. The type of acute organ damage is the principal determinant of: (i) the drug of choice, (ii) the target BP, and (iii) the timeframe in which BP should be lowered. Key target organs are the heart, retina, brain, kidneys, and large arteries. Patients who lack acute hypertension-mediated end organ damage do not have a hypertensive emergency and can usually be treated with oral BP-lowering agents and usually discharged after a brief period of observation.
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Affiliation(s)
- Bert-Jan H van den Born
- Department of Internal Medicine, Division of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Jana Brguljan-Hitij
- Hypertension Division, University Medical Centre Ljubljana, Department of Internal Medicine, Dr. Peter Držaj Hospital, Ljubljana, Slovenia
| | - Antoine Cremer
- Hypertension Unit, Department of Cardiology, Hopital Saint André and University Hospital of Bordeaux, Bordeaux, France
| | - Julian Segura
- Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - Enrique Morales
- Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain
| | - Felix Mahfoud
- Department for Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Fouad Amraoui
- Department of Internal Medicine, Division of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Kahan
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Enrico Agabiti Rosei
- Clinica Medica Generale, Department of Clinical and Experimental Sciences, University of Brescia, and Department of Medicine, Azienda Spedali Civili di Brescia, Brescia, Italy
| | - Giovanni de Simone
- Hypertension Research Center, Department of Translational Medical Sciences, Federico II University Hospital, Naples, Italy
| | - Philippe Gosse
- Hypertension Unit, Department of Cardiology, Hopital Saint André and University Hospital of Bordeaux, Bordeaux, France
| | - Bryan Williams
- University College London (UCL) and UCL Hospitals, London, UK
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17
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5359] [Impact Index Per Article: 893.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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18
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Paini A, Bertacchini F, Stassaldi D, Aggiusti C, Maruelli G, Arnoldi C, De Ciuceis C, Agabiti Rosei C, Rizzoni D, Gatta R, Agabiti Rosei E, Muiesan ML, Salvetti M. Unattended versus attended blood pressure measurement: Mean values and determinants of the difference. Int J Cardiol 2018; 274:305-310. [PMID: 29945805 DOI: 10.1016/j.ijcard.2018.06.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Anna Paini
- ASST Spedali Civili di Brescia, Clinica Medica-2 Medicina, Italy
| | | | | | - Carlo Aggiusti
- ASST Spedali Civili di Brescia, Clinica Medica-2 Medicina, Italy
| | - Giulia Maruelli
- ASST Spedali Civili di Brescia, Clinica Medica-2 Medicina, Italy
| | - Chiara Arnoldi
- ASST Spedali Civili di Brescia, Clinica Medica-2 Medicina, Italy
| | | | | | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; Società Italiana dell'Ipertensione, Italy; Istituto Clinico Città di Brescia, Divisione of Medicine, Brescia, Italy
| | - Roberto Gatta
- ASST Spedali Civili di Brescia, Clinica Medica-2 Medicina, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; Società Italiana dell'Ipertensione, Italy
| | - Maria Lorenza Muiesan
- ASST Spedali Civili di Brescia, Clinica Medica-2 Medicina, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy; Società Italiana dell'Ipertensione, Italy
| | - Massimo Salvetti
- ASST Spedali Civili di Brescia, Clinica Medica-2 Medicina, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy; Società Italiana dell'Ipertensione, Italy.
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19
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Paini A, Salvetti M, Bertacchini F, Aggiusti C, Cappellini S, Agabiti Rosei E, Muiesan ML. P123 UNATTENDED AND ATTENDED BP VALUES AND VASCULARE AND CARDIAC ORGAN DAMAGE. Artery Res 2018. [DOI: 10.1016/j.artres.2018.10.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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20
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De Ciuceis C, Salvetti M, Paini A, Rossini C, Muiesan ML, Duse S, Caletti S, Coschignano MA, Semeraro F, Trapletti V, Bertacchini F, Brami V, Petelca A, Agabiti Rosei E, Rizzoni D, Agabiti Rosei C. Comparison of lercanidipine plus hydrochlorothiazide vs. lercanidipine plus enalapril on micro and macrocirculation in patients with mild essential hypertension. Intern Emerg Med 2017. [PMID: 28647890 DOI: 10.1007/s11739-017-1696-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Dihydropyridine calcium channel blockers may possess antioxidant properties, and might improve micro and macrovascular structure and function. Combination treatment with an ACE inhibitor may have additional advantages, compared with a thiazide diuretic. The aim of the present study is to investigate the effects of a short-term treatment with lercanidipine, and to compare two combination treatments: lercanidipine + enalapril vs. lercanidipine + hydrochlorothiazide on structural alterations in retinal arterioles, on skin capillary density and on large artery distensibility. Thirty essential hypertension patients are included in the study, and treated for 4 weeks with lercanidipine 20 mg per day orally. Then, they were treated for 6 months with lercanidipine + enalapril (n = 15) or lercanidipine + hydrochlorothiazide (n = 15) combinations. Investigations were performed on basal condition, after appropriate wash out of previous treatments, after 4 weeks of lercanidipine monotherapy treatment, and at the end of the combination treatment. Non-invasive measurements of wall-to-lumen ratio (WLR) and other morphological parameters of retinal arterioles were performed using either scanning laser Doppler flowmetry or adaptive optics. Capillary density was evaluated by capillaroscopy, while pulse wave velocity was measured, and central blood pressures were assessed by pressure waveform analysis. A significant improvement of WLR and other indices of retinal artery structure is observed with both technical approaches after treatment with lercanidipine alone, with a further improvement after treatment with lercanidipine + enalapril, while after treatment with lercanidipine + hydrochlorothiazide, the improvement is partially blunted. Central systolic and diastolic blood pressures are similarly reduced by both therapeutic strategies. Capillary density is increased only after treatment with lercanidipine + enalapril. In conclusion, lercanidipine both in monotherapy and in combination with enalapril but not with hydrochlorothiazide is able to improve microvascular structure; on the other hand, a decrease in central blood pressure is observed with both therapeutic combinations.
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Affiliation(s)
- Carolina De Ciuceis
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Massimo Salvetti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Anna Paini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Claudia Rossini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Sarah Duse
- Chair of Ophthalmology, University of Brescia, Brescia, Italy
| | - Stefano Caletti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Maria Antonietta Coschignano
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | | | - Valentina Trapletti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Fabio Bertacchini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Valeria Brami
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Alina Petelca
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Enrico Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy.
- Division of Medicine, Istituto Clinico Città di Brescia, Brescia, Italy.
| | - Claudia Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2ª Medicina, Spedali Civili, 25100, Brescia, Italy
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Torlasco C, Faini A, Makil E, Ferri C, Borghi C, Veglio F, Desideri G, Agabiti Rosei E, Ghiadoni L, Pauletto P, Pontremoli R, Stornello M, Tocci G, Galletti F, Trimarco B, Parati G. Cardiovascular risk and hypertension control in Italy. Data from the 2015 World Hypertension Day. Int J Cardiol 2017; 243:529-532. [PMID: 28571620 DOI: 10.1016/j.ijcard.2017.03.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) are the first cause of death and disability in western countries. Despite therapeutic advances, their prevalence is constantly increasing. Detailed assessment of modifiable CV risk factors could improve CVD prevention and management. METHODS to assess CV risk and hypertension control in a sample of the Italian population, individuals participating to the 2015 "World Hypertension Day" were interviewed in 62sites all over Italy. Blood pressure was measured with a validated auscultatory or oscillometric device and information on demography and prevalence of CVD risk factors was collected by an anonymous questionnaire. An ad-hoc modified version of the Systematic COronary Risk Evaluation (SCORE) system was then applied. RESULTS 8657 recruited individuals (43%women, aged 56.68±16years) were subdivided into 3 age groups (40-49y, 50-59y, 60-69y) for analysis. CV risk was low in 62.4%, 18.0% and 0%; moderate in 26.0%, 66.0% and 62.5%; high/very high in 11.6%, 16% and 37.4%, respectively. Smoking was mainly responsible for increased CV risk among those aged 40-49y (26%smokers), while hypertension was the main factor in the whole sample and in subjects over 50y (36% and 42% respectively). Overall, BP control was unsatisfactory in 36% of individuals (28%, 48% and 31% of those who declared to be normotensive, hypertensive on treatment or unaware of their BP condition, respectively). CONCLUSIONS In this sample of the Italian population, CV risk was alarmingly high, irrespectively of age, mostly due to presence of modifiable risk factors, including hypertension, which should thus be better addressed, especially in the youngsters.
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Affiliation(s)
- Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy
| | - Elhassan Makil
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy
| | - Claudio Ferri
- Department of Medicine, Life and Environmental Sciences, L'Aquila University, Coppito, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili di Brescia, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Pauletto
- Department of Medicine, University of Padova, Padova, Italy; Medicina I, Ospedale Ca' Foncello, Treviso, Italy
| | - Roberto Pontremoli
- Università degli Studi di Genova and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Michele Stornello
- Centro per la Diagnosi, la Cura e la Prevenzione delle Cardio e Cerebrovasculopatie - Ospedale "Umberto I" - ASP Siracusa, Italy
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Ferruccio Galletti
- Department of Medicine and Surgery, Federico II University of Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy.
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22
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De Ciuceis C, Rossini C, Airò P, Scarsi M, Tincani A, Tiberio GAM, Piantoni S, Porteri E, Solaini L, Duse S, Semeraro F, Petroboni B, Mori L, Castellano M, Gavazzi A, Agabiti Rosei C, Agabiti Rosei E, Rizzoni D. Relationship Between Different Subpopulations of Circulating CD4+ T-lymphocytes and Microvascular Structural Alterations in Humans. Am J Hypertens 2017; 30:51-60. [PMID: 27653031 DOI: 10.1093/ajh/hpw102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Different components of the immune system, including innate and adaptive immunity (T-effector lymphocytes and T-regulatory lymphocytes-TREGs) may be involved in the development of hypertension. In addition, it was demonstrated in animal models that TREGs may prevent angiotensin II-induced hypertension and vascular injury/inflammation. However, no data are presently available in humans about possible relationships between T-lymphocyte subtypes and microvascular structural alterations. METHODS For this purpose, in the present study, we enrolled 24 normotensive subjects and 12 hypertensive patients undergoing an elective surgical intervention. No sign of local or systemic inflammation was present. All patients underwent a biopsy of subcutaneous fat during surgery. Subcutaneous small resistance arteries were dissected and mounted on a wire myograph and the media to lumen ratio (M/L) was calculated. In addition, retinal arteriolar structure was evaluated noninvasively by scanning laser Doppler flowmetry. Capillary density in the nailfold, dorsum of the finger, and forearm were evaluated by videomicroscopy. A peripheral blood sample was obtained before surgery for assessment of T-lymphocyte subpopulations by flow cytometry. RESULTS Significant negative correlations were observed between indices of microvascular structure (M/L of subcutaneous small arteries and wall to lumen ratio of retinal arterioles) and circulating TREG lymphocytes. A direct correlation was observed between M/L of subcutaneous small arteries and circulating Th17 lymphocytes. In addition, total capillary density was correlated with a TREG effector memory subpopulation. CONCLUSION Our data suggest that some lymphocyte subpopulations may be related to microvascular remodeling, confirming previous animal data, and opening therapeutic possibilities.
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Affiliation(s)
- Carolina De Ciuceis
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Rossini
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Airò
- Clinica Chirurgica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Mirko Scarsi
- Clinica Chirurgica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Tincani
- Clinica Chirurgica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Silvia Piantoni
- Clinica Chirurgica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Enzo Porteri
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Leonardo Solaini
- Institute of Rheumatology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sarah Duse
- Institute of Ophthalmology, University of Brescia, Brescia, Italy
| | | | - Beatrice Petroboni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luigi Mori
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maurizio Castellano
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alice Gavazzi
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Enrico Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy;
- Istituto Clinico Città di Brescia, Division of Medicine, Brescia, Italy
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23
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Rosei EA. The fixed-dose combination of lercanidipine and enalapril: more than mere blood pressure reduction. Curr Med Res Opin 2016; 32:1-2. [PMID: 27779453 DOI: 10.1080/03007995.2016.1247687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Enrico Agabiti Rosei
- a Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
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24
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Kjeldsen SE, Stenehjem A, Os I, Van de Borne P, Burnier M, Narkiewicz K, Redon J, Agabiti Rosei E, Mancia G. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press 2016; 25:333-336. [PMID: 27644446 DOI: 10.1080/08037051.2016.1236329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The European Society of Hypertension recommend the following main rules for treatment of hypertension in elderly and octogenarians: 1) In elderly hypertensives with SBP ≥ 160 mmHg there is solid evidence to recommend reducing SBP to between 140 mmHg and 150 mmHg. 2) In fit elderly patients less than 80 years old treatment may be considered at SBP ≥ 140 mmHg with a target SBP < 140 mmHg if treatment is well tolerated. 3) In fit individuals older than 80 years with an initial SBP ≥ 160 mmHg it is recommended to reduce SBP to between 150 mmHg and 140 mmHg. 4) In frail elderly patients, it is recommended to base treatment decisions on comorbidity and carefully monitor the effects of treatment. 5) Continuation of well-tolerated antihypertensive treatment should be considered when a treated individual becomes octogenarian. 6) All hypertensive agents are recommended and can be used in the elderly, although diuretics and calcium antagonists may be preferred in isolated systolic hypertension.
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Affiliation(s)
- Sverre E Kjeldsen
- a Departments of Cardiology and Nephrology , Oslo University Hospital , Ullevål.,b Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Aud Stenehjem
- a Departments of Cardiology and Nephrology , Oslo University Hospital , Ullevål
| | - Ingrid Os
- a Departments of Cardiology and Nephrology , Oslo University Hospital , Ullevål.,b Faculty of Medicine , University of Oslo , Oslo , Norway
| | | | - Michel Burnier
- d Service of Nephrology and Hypertension , Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
| | - Krzysztof Narkiewicz
- e Department of Hypertension and Diabetology , Medical University of Gdansk , Poland
| | - Josep Redon
- f Department of Internal Medicine , Hospital Clinico, University of Valencia , Valencia , Spain
| | - Enrico Agabiti Rosei
- g Clinica Medica, Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
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Agabiti Rosei E, Salvetti M. Management of Hypercholesterolemia, Appropriateness of Therapeutic Approaches and New Drugs in Patients with High Cardiovascular Risk. High Blood Press Cardiovasc Prev 2016; 23:217-30. [PMID: 27567901 PMCID: PMC5014894 DOI: 10.1007/s40292-016-0155-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/25/2016] [Indexed: 01/14/2023] Open
Abstract
Control of lipid levels is one of the most effective strategies for cardiovascular (CV) event prevention. In fact, many clinical trials have clearly demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering, primarily with statins, reduces major CV events and mortality. The evidence from these trials has been useful in designing the cholesterol treatment guidelines, which are mainly aimed at preventing and managing cardiovascular disease (CVD). However, available data indicate that a large proportion of patients fail to achieve lipid goals, and this is particularly frequent in patients at high or very high CV risk. Furthermore, owing to side effects, a significant percentage of patients cannot tolerate statin treatment. Hence, researchers have focused their attention on novel LDL-C-lowering agents that act via mechanisms distinct from that of statins. Among the new compounds under investigation, the monoclonal antibodies to proprotein convertase subtilisin/kexin type 9 (PCSK9) seem particularly promising, having recently been shown to be well tolerated and highly effective at lowering LDL-C, with a possible effect on the occurrence of CV events. Currently, alirocumab is approved by the US Food and Drug Administration (FDA) as an adjunct to diet and maximally tolerated statin therapy for use in adults with heterozygous familial hypercholesterolemia (FH) or those with atherosclerotic CV disease who require additional LDL-C lowering; it has also been recently approved by the European Medicines Agency (EMA) for use in patients with heterozygous FH, non–familial hypercholesterolemia or mixed dyslipidemia in whom statins are ineffective or not tolerated. Evolocumab is approved by the FDA as an adjunct to diet and maximally tolerated statins for adults with hetero- and homozygous FH and those with atherosclerotic CV disease who require additional lowering of LDL-C, and by the EMA in adults with primary hypercholesterolemia or mixed dyslipidemia, as an adjunct to diet, in combination with a statin or a statin with other lipid lowering therapies in patients unable to reach LDL-C goals with the maximum tolerated dose of a statin; alone or in combination with other lipid lowering therapies in patients who are statin-intolerant, or those for whom a statin is contraindicated. Evolocumab is also indicated in adults and adolescents aged 12 years and over with homozygous familial hypercholesterolemia in combination with other lipid-lowering therapies.
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Affiliation(s)
- Enrico Agabiti Rosei
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Massimo Salvetti
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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26
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Cerini C, Casari S, Donato F, Porteri E, Rodella A, Terlenghi L, Compostella S, Apostoli A, Brianese N, Urbinati L, Salvi A, Rossini A, Agabiti Rosei E, Caruso A, Carosi G, Castelli F. Trigger-oriented HIV testing at Internal Medicine hospital Departments in Northern Italy: an observational study (Fo.C.S. Study). Infect Dis (Lond) 2016; 48:838-43. [PMID: 27622515 DOI: 10.3109/23744235.2016.1169551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection of undiagnosed HIV infected patients is of paramount importance. The attitude of Italian hospital-based Internal Medicine physicians to prescribe HIV testing following the detection of HIV-associated signs, symptoms and behaviours (triggers) has been reported to be poor. The aim of the study is to quantify the extent of the missed opportunities for early HIV diagnosis in Internal Medicine Departments (IMD). METHODS Patients admitted to IMD of a General University Hospital in Italy in March-June 2013 were interviewed using a structured questionnaire investigating the presence of triggers for HIV testing, including patient's characteristics, symptoms and conditions associated with HIV infection. HIV tests performed during hospitalisation were recorded. RESULTS HIV testing was performed in 73 (6.6%) out of 1113 hospitalisations (1072 patients), providing positive results in three cases (4.1%). All of them presented ≥1 triggers. Conversely, 853 triggers were identified in 528 hospitalisations with at least one trigger (47.4%). The proportion of hospitalisations where an HIV testing was prescribed was 3.1%, 9.5% and 16.0% in the presence of zero, one-to-two or more triggers, respectively. Age <70 years, female gender, length of hospital stay, haematological disease, HBV infection, multiple sexual partners and lymphadenopathy were predictors of HIV testing by logistic regression analysis. CONCLUSIONS Although chances of an HIV test being performed in patients hospitalised in IMD increases along with the number of triggers, the number of tests being performed in people presenting with triggers is unacceptably low and requires educational interventions in order to obtain individual and public health advantages.
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Affiliation(s)
- Carlo Cerini
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Salvatore Casari
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Francesco Donato
- b Institute of Hygiene, Epidemiology and Public Health , University of Brescia , Italy
| | - Enzo Porteri
- c Internal Medicine Unit , University of Brescia , Italy
| | - Anna Rodella
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | - Luigina Terlenghi
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | | | | | | | - Lucia Urbinati
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Andrea Salvi
- e Internal Medicine Unit 3 , Spedali Civili General Hospital , Brescia , Italy
| | - Angelo Rossini
- f Hepatology Unit , Spedali Civili General Hospital , Brescia , Italy
| | | | - Arnaldo Caruso
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | | | - Francesco Castelli
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy ;,h Training and empowering human resources for health development in resource-limited countries , University of Brescia , Brescia , Italy
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27
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Affiliation(s)
- Enrico Agabiti Rosei
- From the Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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28
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Tocci G, Muiesan ML, Parati G, Agabiti Rosei E, Ferri C, Virdis A, Pontremoli R, Mancia G, Borghi C, Volpe M. Trends in Prevalence, Awareness, Treatment, and Control of Blood Pressure Recorded From 2004 to 2014 During World Hypertension Day in Italy. J Clin Hypertens (Greenwich) 2016; 18:551-6. [PMID: 26459236 PMCID: PMC8031560 DOI: 10.1111/jch.12711] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/12/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022]
Abstract
Estimates of blood pressure (BP) control in real life are not systematically collected in Italy. We evaluated trends in systolic/diastolic BP levels, as well as prevalence, awareness, treatment, and control rates of hypertension among adult individuals visiting open checkpoints during the 2004 to 2014 annual editions of World Hypertension Day. Hypertension was defined as BP level ≥140/90 mm Hg or use of antihypertensive medication, whereas BP control was defined as BP level <140/90 mm Hg. We included 10,051 individuals (53.2% female, age 56.2±16.8 years, body mass index 25.7±7.6 kg/m(2) , systolic/diastolic BP 131.9±18.6/79.1±10.5 mm Hg). Hypertension prevalence and treatment were substantially unchanged, whereas awareness appears to increase over time. Controlled hypertension in diagnosed treated patients increased from 50.0% in 2004-2010 to 55.5% in 2011-2012 towards 57.6% in 2013-2014. This analysis provides real-life snapshots of hypertension over the years in the occasion of World Hypertension Day, showing increased awareness and improved control rates among treated hypertensive patients attending open checkpoints during 2004 to 2014 in Italy.
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Affiliation(s)
- Giuliano Tocci
- Department of Clinical and Molecular MedicineDivision of CardiologyFaculty of Medicine and PsychologySant'Andrea HospitalUniversity of Rome SapienzaRomeItaly
- IRCCS NeuromedPozzilli (IS)Italy
| | - Maria L. Muiesan
- Department of Medical and Surgical SciencesUniversity of BresciaBresciaItaly
| | - Gianfranco Parati
- Department of Health SciencesUniversity of Milan‐BicoccaMilanItaly
- Department of CardiovascularNeural and Metabolic SciencesSan Luca HospitalIstituto Auxologico ItalianoMilanItaly
| | - Enrico Agabiti Rosei
- Clinica Medica GeneraleDepartment of Clinical and Experimental SciencesUniversity of BresciaAzienda Spedali CiviliBresciaItaly
| | - Claudio Ferri
- Department MeSVADivision of Internal Medicine and NephrologySan Salvatore HospitalUniversity of L'AquilaL'AquilaItaly
| | - Agostino Virdis
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Roberto Pontremoli
- Department of Internal MedicineUniversity of Genova and IRCCS Azienda Ospedaliera Universitaria San Martino‐ISTGenoaItaly
| | - Giuseppe Mancia
- Istituto Auxologico Italiano and Centro di Fisiologia Clinica e IpertensioneUniversity of Milano MilanMilanItaly
| | - Claudio Borghi
- Chair of Internal MedicineUniversity of BolognaBolognaItaly
| | - Massimo Volpe
- Department of Clinical and Molecular MedicineDivision of CardiologyFaculty of Medicine and PsychologySant'Andrea HospitalUniversity of Rome SapienzaRomeItaly
- IRCCS NeuromedPozzilli (IS)Italy
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29
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Benetos A, Bulpitt CJ, Petrovic M, Ungar A, Agabiti Rosei E, Cherubini A, Redon J, Grodzicki T, Dominiczak A, Strandberg T, Mancia G. An Expert Opinion From the European Society of Hypertension–European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects. Hypertension 2016; 67:820-5. [DOI: 10.1161/hypertensionaha.115.07020] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Athanase Benetos
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Christopher J. Bulpitt
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Mirko Petrovic
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Andrea Ungar
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Enrico Agabiti Rosei
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Antonio Cherubini
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Josep Redon
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Tomasz Grodzicki
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Anna Dominiczak
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Timo Strandberg
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
| | - Giuseppe Mancia
- From the Department of Geriatrics and FHU CARTAGE, CHU de Nancy and INSERM 1116, Université de Lorraine, Nancy, France (A.B.); Department of Medicine Imperial College, London, United Kingdom (C.J.B.); Department of Geriatrics, Ghent University Hospital, and Ghent University, Ghent, Belgium (M.P.); Geriatric Cardiology and Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Firenze, Italy (A.U.); Clinica Medica, Department of Clinical and Experimental Sciences, University
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Modesti PA, Perticone F, Parati G, Agabiti Rosei E, Prisco D. Chronic disease in the ethnic minority and migrant groups: time for a paradigm shift in Europe. Intern Emerg Med 2016; 11:295-7. [PMID: 27021388 DOI: 10.1007/s11739-016-1444-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Pietro Amedeo Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, Catanzaro, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Health Sciences, University of Milan Bicocca, Milan, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Azienda Spedali Civili, Brescia, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Muiesan ML, Salvetti M, Amadoro V, di Somma S, Perlini S, Semplicini A, Borghi C, Volpe M, Saba PS, Cameli M, Ciccone MM, Maiello M, Modesti PA, Novo S, Palmiero P, Scicchitano P, Rosei EA, Pedrinelli R. An update on hypertensive emergencies and urgencies. J Cardiovasc Med (Hagerstown) 2016; 16:372-82. [PMID: 25575271 DOI: 10.2459/jcm.0000000000000223] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Severe acute arterial hypertension is usually defined as 'hypertensive crisis', although 'hypertensive emergencies' or 'hypertensive urgencies', as suggested by the Joint National Committee and the European Society of Hypertension, have completely different diagnostic and therapeutic approaches.The prevalence and demographics of hypertensive emergencies and urgencies have changed over the last four decades, but hypertensive emergencies and urgencies are still associated with significant morbidity and mortality.Different scientific societies have repeatedly produced up-to-date guidelines; however, the treatment of hypertensive emergencies and urgencies is still inappropriate, with potential clinical implications.This review focuses on hypertensive emergencies and urgencies management and treatment, as suggested by recent data.
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Affiliation(s)
- Maria Lorenza Muiesan
- aDepartment of Clinical and Experimental Sciences University of Brescia, 25100 Spedali Civili, Brescia bDepartment of Medical-Surgery Sciences and Translational Medicine, Emergency Department, University La Sapienza, Sant'Andrea Hospital Rome, Rome cDepartment of Internal Medicine and Therapeutics, University of Pavia, Lombardy dDepartment of Internal Medicine 1, USL12 Veneziana, Venice eDepartment of Medicine, University of Padua, Padova fDepartment of ScienzeMediche e Chirurgiche, S.Orsola-Malpighi University Hospital, Bologna gDivision of Cardiology, Department of Medicina Clinica e Molecolare, University Roma 'Sapienza' - Azienda Ospedaliera Sant'Andrea, and IRCCS Neuromed, Rome hDivision of Cardiology, AOU Sassari, Sassari iDepartment of Cardiovascular Diseases, University of Siena, Tuscany jCardiovascular Disease Section, Department of Emergency and Organ Tranplantation, University of Bari, Bari kAS Department of Cardiology, Brindisi District, Brindisi lDepartment of Clinical and Experimental Medicine, University of Florence, Florence mDepartment of Internal Medicine and Cardiovascular Diseases, University of Palermo, Palermo nDipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Pisa, Italy
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Cappelli C, Pirola I, Daffini L, Formenti A, Iacobello C, Cristiano A, Gandossi E, Agabiti Rosei E, Castellano M. A Double-Blind Placebo-Controlled Trial of Liquid Thyroxine Ingested at Breakfast: Results of the TICO Study. Thyroid 2016; 26:197-202. [PMID: 26586610 DOI: 10.1089/thy.2015.0422] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Levothyroxine (LT4) is the recommended treatment for millions of hypothyroid patients. Current guidelines recommend that LT4 tablets be taken in a fasting state, but inability to adhere to this often leads to poor therapy compliance. METHODS A randomized, double-blind, placebo-controlled, crossover trial was conducted in previously untreated hypothyroid patients randomly assigned to receive an oral solution of LT4 either at least 30 minutes before breakfast or directly at breakfast time. Each patient completed two six-week treatment periods, with different timing of active LT4 administration: placebo before breakfast and active LT4 at breakfast, or vice versa. At the end of each period, thyrotropin (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) were measured. The primary endpoint was to verify any difference in serum TSH levels whether consuming liquid LT4 at breakfast or 30 minutes prior to breakfast. RESULTS A total of 77 patients (64 females; median age 45.4 ± 3.7 years) completed the study. No statistically significant differences in serum TSH, fT4, or fT3 levels were observed whether LT4 was taken at breakfast or 30 minutes before, in a fasting state. No significant effect from the sequence of regimens, breakfast composition, and/or concomitantly administered drugs was observed on the dose of LT4 administered, or on the post-treatment serum TSH values. CONCLUSIONS The TICO study suggests that a liquid LT4 formulation can be ingested directly at breakfast, thus potentially improving therapeutic compliance. This observation is of considerable clinical relevance, since non-adherence to LT4 therapy requirements is more likely to cause variability in serum TSH concentrations.
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Affiliation(s)
- Carlo Cappelli
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Ilenia Pirola
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Linda Daffini
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Annamaria Formenti
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Carmelo Iacobello
- 2 Department of Molecular and Translational Medicine, University of Brescia , Brescia, Italy
| | - Alessandra Cristiano
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Elena Gandossi
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Enrico Agabiti Rosei
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
| | - Maurizio Castellano
- 1 Department of Medical and Surgical Sciences, Endocrine and Metabolic Unit, University of Brescia , Brescia, Italy
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De Ciuceis C, Rossini C, Muiesan ML, Salvetti M, Porteri E, Gavazzi A, Paini A, Pileri P, Agabiti Rosei E, Rizzoni D. Abstract P256: Structural Alterations of Subcutaneous Small Resistance Arteries in Resistant Hypertension. Hypertension 2015. [DOI: 10.1161/hyp.66.suppl_1.p256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
It is was suggested that, in resistant hypertension, the presence of particularly pronounced microvascular alterations may contribute to explain the relative lack of response to treatment
Patients and Methods:
We investigated a population of 94 treated essential hypertensive patients. Secondary forms of hypertension were excluded, and in all patients a 24-hour blood pressure monitoring was performed in order to exclude a white coat effect. In all patients, we evaluated small resistance arteries morphology by a wire micromyographic approach. Subcutaneous tissue was obtained by local biopsy or during election surgery and subcutaneous small resistance arteries were dissected and mounted on a myograph; the media to lumen ratio (M/L) was then measured. We subdived our patents according to the presence or not of resistant hypertension (clinic blood pressure values above 140/90 mm Hg despite administration of three antihypertensive agent including a diuretic and 24-hour blood pressure values >130/80 mm Hg). Sixteen patients had true resistant hypertension, and were compared with the remaining 78 patients with non-resistant hypertension.
Results:
are summarized in the Table, The two groups were also different in terms of mean age (57±12 vs. 67±7 years, p=0.016 and pulse pressure/stroke volume, a rough index of large artery distensibility: 0.63±0.31 vs. 0.90±0.33, p=0.02).
Conclusion:
Hypertensive patients with true resistant hypertension have greater microvascular structural alterations compared with non-resistant hypertensive patients. This could partly explain the resistance to treatment and the high cardiovascular risk observed in these patients.
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Affiliation(s)
| | - Claudia Rossini
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | | | - Massimo Salvetti
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | - Enzo Porteri
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | - Alice Gavazzi
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | - Anna Paini
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | - Paola Pileri
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | | | - Damiano Rizzoni
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
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De Ciuceis C, Rossini C, Agabiti Rosei C, Porteri E, Gavazzi A, Pileri P, Caletti S, Agabiti Rosei E, Rizzoni D. Abstract P255: Age and Structural Alterations in Subcutaneous Small Resistance Arteries of Hypertensive Patients. Hypertension 2015. [DOI: 10.1161/hyp.66.suppl_1.p255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
It was proposed that early vascular ageing may be an important mechanism of vascular damage in large conductance arteries. However it is not known whether aging may also affect small resistance artery morphology.
Patients and Methods:
For this reason, we investigated 100 patients with essential hypertension. Secondary forms of hypertension were excluded according to standard clinical evaluations and biochemical or instrumental assessments. In all patients, an evaluation of small resistance arteries morphology was performed by a wire micromyographic approach (Mulvany’s technique). A small amount of subcutaneous tissue was obtained by local biopsy or during election surgery and subcutaneous small resistance arteries were dissected and mounted on a myograph; the media to lumen ratio (M/L) was then measured.
Results:
The age range of our populaton was 22-81 years, with a mean value of 57±12 years; 14% of them were current smokers, 32% had alterations in lipid patterns, none of them had diabetes mellitus, 58 were males and average blood pressure values were 156/95±19/12 mmHg.
We found a significant correlation between M/L and age (r=0.30, p=0.002): the statistical significance of the correlation persisted after correction for counfounding variables (gender, serum cholesterol, smoking status, serum glucose, systolic or diastolic blood pressure values). A statistically significant inverse correlation was also observed between internal diameter and age (r=-0.20, p=0.046), while the correlation beween age and media thickness did not reach statistical significance (r=0.09, p=0.37).
Conclusion:
Our data suggest that age may affect microvascular structure in hypertensive patients. It is also possible that hypertension may anticipate the effects of physiological aging, and this should be explored in a relatively large population of normotensive subjects.
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Affiliation(s)
| | - Claudia Rossini
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | | | - Enzo Porteri
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | - Alice Gavazzi
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | - Paola Pileri
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | - Stefano Caletti
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
| | | | - Damiano Rizzoni
- Univ of Brescia, Dept of Clinical and Experimental Sciences, Brescia, Italy
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Paini* A, Salvetti M, Rosei CA, Bertacchini F, Maruelli G, Rubagotti G, Colonetti E, Donini C, Casella E, Rosei EA, Muiesan ML. P6.12 AORTIC AND LOCAL CAROTID STIFFNESS: RELATIONSHIP WITH CARDIAC AND VASCULAR ORGAN DAMAGE IN A GENERAL POPULATION SAMPLE IN NORTHERN ITALY. Artery Res 2015. [DOI: 10.1016/j.artres.2015.10.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Muiesan ML, Salvetti M, Paini A, Agabiti Rosei C, Rubagotti G, Negrinelli A, Gregorini G, Cancarini G, Calabresi L, Franceschini G, Obici L, Perlini S, Merlini G, Agabiti Rosei E. Vascular alterations in apolipoprotein A-I amyloidosis (Leu75Pro). A case-control study. Amyloid 2015; 22:187-93. [PMID: 26193960 DOI: 10.3109/13506129.2015.1066771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Among hereditary amyloidoses, apolipoprotein A-I (APO A-I) amyloidosis (Leu75Pro) is a rare, autosomal dominant condition in which renal, hepatic, and testicular involvement has been demonstrated. OBJECTIVE To investigate vascular structural as well as functional alterations. METHODS In 131 carriers of the amyloidogenic Leu75Pro APO A-I mutation (mean age 52 + 16 years, 56 women) and in 131 subjects matched for age, sex, body mass index and clinic blood pressure (BP), arterial stiffness (pulse wave velocity, PWV) and carotid intima-media thickness (IMT) were measured. RESULTS By definition no differences for age, sex, body mass index, and BP were observed. Meanmax IMT (Mmax-IMT) in the common (CC), bifurcation (BIF) and internal (ICA) carotid artery were comparable in the two groups. After adjustment for high-density lipoprotein cholesterol and renal function differences between the two groups, a lower meanmax-IMT was observed in APO A-I Leu75Pro mutation carriers than in controls (CC Mmax-IMT 0.87 ± 0.21 versus 0.93 ± 0.2 mm, p = 0.07; BIF Mmax-IMT 1.19 ± 0.48 versus 1.36 ± 0.46 mm, p = 0.025; ICA Mmax-IMT 0.9 ± 0.37 versus 1.02 ± 0.35 mm, p = 0.028). On the other hand, aortic stiffness was significantly greater in patients with APO A-I amyloidosis than controls (PWV 11.5 ± 2.9 and 10.7 ± 2.3 m/s, p < 0.05), even after adjusting for confounders. CONCLUSIONS In carriers of the amyloidogenic Leu75Pro APO A-I mutation, a significant increase in arterial stiffness is observed; on the contrary, carotid artery IMT is comparable to that of control subjects. These results may add significant information to the clinical features of this rare genetic disorder.
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Affiliation(s)
- Maria Lorenza Muiesan
- a Internal Medicine, Department of Clinical and Experimental Sciences , University of Brescia and Spedali Civili , Brescia , Italy
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De Ciuceis C, Savoia C, Arrabito E, Porteri E, Mazza M, Rossini C, Duse S, Semeraro F, Agabiti Rosei C, Alonzo A, Sada L, La Boria E, Sarkar A, Petroboni B, Mercantini P, Volpe M, Rizzoni D, Agabiti Rosei E. Effects of a Long-Term Treatment With Aliskiren or Ramipril on Structural Alterations of Subcutaneous Small-Resistance Arteries of Diabetic Hypertensive Patients. Hypertension 2014; 64:717-24. [DOI: 10.1161/hypertensionaha.114.03380] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Structural alterations of subcutaneous small-resistance arteries are associated with a worse clinical prognosis in hypertension and non–insulin-dependent diabetes mellitus. The effects of the direct renin inhibitor aliskiren on microvascular structure were never previously evaluated. Therefore, we investigated the effects of aliskiren in comparison with those of an extensively used angiotensin-converting enzyme inhibitor, ramipril, on peripheral subcutaneous small-resistance artery morphology, retinal arteriolar structure, and capillary density in a population of patients with non–insulin-dependent diabetes mellitus. Sixteen patients with mild essential hypertension and with a previous diagnosis of non–insulin-dependent diabetes mellitus were included in the study. Patients were then randomized to 1 of the 2 active treatments (aliskiren 150 mg once daily, n=9; or ramipril 5 mg once daily, n=7). Each patient underwent a biopsy of the subcutaneous fat from the gluteal region, an evaluation of retinal artery morphology (scanning laser Doppler flowmetry), and capillary density (capillaroscopy), at baseline and after 1 year of treatment. Subcutaneous small arteries were dissected and mounted on a pressurized micromyograph, and the media-to-lumen ratio was evaluated. A similar office blood pressure–lowering effect and a similar reduction of the wall-to-lumen ratio of retinal arterioles were observed with the 2 drugs. Aliskiren significantly reduced media-to-lumen ratio of subcutaneous small-resistance arteries, whereas ramipril-induced reduction of media to lumen ratio was not statistically significant. No relevant effect on capillary density was observed. In conclusion, treatment with aliskiren or ramipril was associated with a correction of microvascular structural alterations in patients with non–insulin-dependent diabetes mellitus.
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Affiliation(s)
- Carolina De Ciuceis
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Carmine Savoia
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Emanuele Arrabito
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Enzo Porteri
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Monica Mazza
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudia Rossini
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Sarah Duse
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesco Semeraro
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudia Agabiti Rosei
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandro Alonzo
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Lidia Sada
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elisa La Boria
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Annamaria Sarkar
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Beatrice Petroboni
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Mercantini
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Volpe
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Damiano Rizzoni
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Enrico Agabiti Rosei
- From the Clinica Medica, Department of Clinical and Experimental Sciences (C.D.C., E.P., M.M., C.R., C.A.R., E.L.B., A.S., B.P., D.R., E.A.R.) and Division of Ophthalmology (S.D., F.S.), University of Brescia, Brescia, Italy; and Division of Cardiology, Department of Clinical and Molecular Medicine (C.S., E.A., A.A., L.S., M.V.) and Surgical Department of Clinical Sciences (P.M.), Biomedical Technologies and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
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De Ciuceis C, Cornali C, Porteri E, Mardighian D, Pinardi C, Fontanella MM, Rodella LF, Rezzani R, Rizzoni D, Boari GEM, Rosei EA, Gasparotti R. Cerebral small-resistance artery structure and cerebral blood flow in normotensive subjects and hypertensive patients. Neuroradiology 2014; 56:1103-11. [PMID: 25204449 DOI: 10.1007/s00234-014-1423-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this study was to prospectively investigate whether the structure of cerebral small-resistance arteries is related to cerebral perfusion parameters as measured with dynamic susceptibility-weighted contrast magnetic resonance imaging (DSC-MRI) in a selected cohort of hypertensive and normotensive patients. METHODS Ten hypertensive and 10 normotensive patients were included in the study. All patients underwent neurosurgical intervention for an intracranial tumor and were investigated with DSC-MRI at 1.5 T. Cerebral small-resistance arteries were dissected from a small portion of morphologically normal cerebral tissue and mounted on an isometric myograph for the measurement of the media-to-lumen (M/L) ratio. A quantitative assessment of cerebral blood flow (CBF) and volume (CBV) was performed with a region-of-interest approach. Correlation coefficients were calculated for normally distributed variables. The institutional review board approved the study, and informed consent was obtained from all patients. RESULTS Compared with normotensive subjects, hypertensive patients had significantly lower regional CBF (mL/100 g/min) in the cortical grey matter (55.63 ± 1.90 vs 58.37 ± 2.19, p < 0.05), basal ganglia (53.34 ± 4.39 vs 58.22. ± 4.33, p < 0.05), thalami (50.65 ± 3.23 vs 57.56 ± 4.45, p < 0.01), subcortical white matter (19.32 ± 2.54 vs 22.24 ± 1.9, p < 0.05), greater M/L ratio (0.099 ± 0.013 vs 0.085 ± 0.012, p < 0.05), and lower microvessel density (1.66 ± 0.67 vs 2.52 ± 1.28, p < 0.05). A statistically significant negative correlation was observed between M/L ratio of cerebral arteries and CBF in the cortical grey matter (r = -0.516, p < 0.05), basal ganglia (r = -0.521, p < 0.05), thalami (r = -0.527 p < 0.05), and subcortical white matter (r = -0.612, p < 0.01). CONCLUSION Our results indicate that microvascular structure might play a role in controlling CBF, with possible clinical consequences.
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Affiliation(s)
- Carolina De Ciuceis
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Salvetti M, Agabiti Rosei C, Paini A, Aggiusti C, Cancarini A, Duse S, Semeraro F, Rizzoni D, Agabiti Rosei E, Muiesan ML. Relationship of Wall-to-Lumen Ratio of Retinal Arterioles With Clinic and 24-Hour Blood Pressure. Hypertension 2014; 63:1110-5. [DOI: 10.1161/hypertensionaha.113.03004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo Salvetti
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Claudia Agabiti Rosei
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Anna Paini
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Carlo Aggiusti
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Anna Cancarini
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Sarah Duse
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Francesco Semeraro
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Damiano Rizzoni
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Enrico Agabiti Rosei
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
| | - Maria Lorenza Muiesan
- From Clinica Medica, Department of Clinical and Experimental Sciences (M.S., C.A.R., A.P., C.A., D.R., E.A.R., M.L.M.), and Ophthalmology (A.C., S.D., F.S.), University of Brescia, Brescia, Italy
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De Ciuceis C, Flati V, Rossini C, Rufo A, Porteri E, Di Gregorio J, Petroboni B, La Boria E, Donini C, Pasini E, Agabiti Rosei E, Rizzoni D. Effect of antihypertensive treatments on insulin signalling in lympho-monocytes of essential hypertensive patients: A pilot study. Blood Press 2014; 23:330-8. [DOI: 10.3109/08037051.2014.901021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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De Ciuceis C, Rossini C, La Boria E, Porteri E, Petroboni B, Gavazzi A, Sarkar A, Rosei EA, Rizzoni D. Immune mechanisms in hypertension. High Blood Press Cardiovasc Prev 2014; 21:227-34. [PMID: 24446309 DOI: 10.1007/s40292-014-0040-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/09/2014] [Indexed: 01/11/2023] Open
Abstract
Low grade inflammation may have a key role in the pathogenesis of hypertension and cardiovascular disease. Several studies showed that both innate and adaptive immune systems may be involved, being T cells the most important players. Particularly, the balance between Th1 effector lymphocytes and Treg lymphocytes may be crucial for blood pressure elevation and related organ damage development. In the presence of a mild elevation of blood pressure, neo-antigens are produced. Activated Th1 cells may then contribute to the persistent elevation of blood pressure by affecting vasculature, kidney and perivascular fat. On the other hand, Tregs represent a lymphocyte subpopulation with an anti-inflammatory role, being their activity crucial for the maintenance of cardiovascular homeostasis. Indeed, Tregs were demonstrated to be able to protect from blood pressure elevation and from the development of organ damage, including micro and macrovascular alterations, in different animal models of genetic or experimental hypertension. In the vasculature, inflammation leads to vascular remodeling through cytokine activity, smooth muscle cell proliferation and oxidative stress. It is also known that a consistent part of ischemia-reperfusion-induced acute kidney injury is mediated by inflammatory infiltration and that Treg cell infusion have a protective role. Also the central nervous system has an important role in the maintenance of cardiovascular homeostasis. In conclusion, hypertension development involves chronic inflammatory process. Knowledge of cellular and molecular players in the progression of hypertension has dramatically improved in the last decade, by assessing the central role of innate and adaptive immunity cells and proinflammatory cytokines driving the development of target organ damage. The new concept of role of immunity, especially implicating T lymphocytes, will eventually allow discovery of new therapeutic targets that may improve outcomes in hypertension and cardiovascular or renal disease in humans and uncover an entirely novel approach in the treatment of hypertension and vascular disease.
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Affiliation(s)
- Carolina De Ciuceis
- Clinica Medica, Department of Clinical and Experimental Sciences, c/o 2a Medicina Spedali Civili di Brescia, University of Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy
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Rossini C, De Ciuceis C, Flati V, Rufo A, Porteri E, Di Gregorio J, Petroboni B, La Boria E, Sarkar A, Agabiti Rosei C, Rizzoni D, Agabiti Rosei E. Abstract 380: Short-term Treatment with Lercanidipine May Modulate Insuling Signalling and Oxidative Stress in Hypertensive Patients. Hypertension 2013. [DOI: 10.1161/hyp.62.suppl_1.a380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the effects of antihypertensive treatment with two drug combinations on insulin signalling and oxidative stress.
Twenty essential hypertensive patients were included in the study and treated for 4 weeks with lercanidipine orally. Then they were treated for 6 months with lercanidipine+enalapril (n=10) or lercanidipine+hydrochlorothiazide (n=10). Investigations were performed in basal condition, after 4 weeks of monotherapy with lercanidipine, and at the end of the combination treatment. Insulin signalling was evaluated in mononuclear cells by Wester-Blot. Circulating levels of C-reactive protein (CRP), proinflammatory cytokines interleukin-6 and interleukin-18 (IL-18), macrophage chemotactic factor-1 (MCP-1), soluble vascular cell adhesion molecule 1 and soluble inter-cellular adhesion molecule 1, malonyldialdehyde and lipid peroxidation were measured in plasma.
Results are summarized in the Table (*P<0.05, **p<0.01 vs. Basal; #p<0.05 vs. lercanipine alone). An increased expression of insulin receptor, GLUT-4 and an increased activation of p70S6K1 were observed during treatment with lercanidipine+enalapril but not with lercanidipine+hydrochlorothiazide. A reduction in circulating levels of IL 18, CRP and MCP-1 was observed after treatment with lercanidipine alone, which persisted or further improved after treatment with lercanidipine+enalapril but not with lercanidipine+hydrochlorothiazide.
Therefore the combination treatment lercanidipine+enalapril seems more effective than lercanidipine+hydrochlorothiazide in activating insulin signalling, possibly due to a more marked antioxidant/antiinflammatory effect.
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Affiliation(s)
- Claudia Rossini
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Carolina De Ciuceis
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Vincenzo Flati
- Dept of Biotechnological and Clinical Sciences, Univ of L’Aquila, Italy, L'Aquila, Italy
| | - Anna Rufo
- Dept of Biotechnological and Clinical Sciences, Univ of L’Aquila, Italy, L'Aquila, Italy
| | - Enzo Porteri
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Jacopo Di Gregorio
- Dept of Biotechnological and Clinical Sciences, Univ of L’Aquila, Italy, L'Aquila, Italy
| | - Beatrice Petroboni
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Elisa La Boria
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Annamaria Sarkar
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Claudia Agabiti Rosei
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Damiano Rizzoni
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
| | - Enrico Agabiti Rosei
- Clinica Medica, Dept of Med and Surgical Sciences, Univ of Brescia, Italy, Brescia, Italy
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De Ciuceis C, Rossini C, Airò P, Scarsi M, Tincani A, Solaini L, Agabiti Rosei C, La Boria E, Sarkar A, Porteri E, Gavazzi A, Petroboni B, Rizzoni D, Agabiti Rosei E. Abstract 379: Circulating T Regulatory Lymphocytes and Microvascular Structural Alterations in Hypertensive Patients and Normotensive Subjects. Hypertension 2013. [DOI: 10.1161/hyp.62.suppl_1.a379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Methods.
Different components of the immune system, including innate immunity and adaptive immunity (T effector lymphocytes and T regulatory lymphocytes: Tregs) may be involved in the development of hypertension. In addition, it was recently demonstrated that Tregs may prevent angiotensin II-induced vascular injury/inflammation, while Th1, Th2 and Th17 may play a role in the progression of vascular remodeling. However, no data are available in human beings about relationships between T-lymphocyte subtypes and microvascular structure.
In the present, preliminary study, we enrolled 7 normotensive subjects and 3 hypertensive patients undergoing an election surgical intervention. No sign of local or systemic inflammation was present in any subjects or patients. All patients underwent a biopsy of subcutaneous fat during surgery. Subcutaneous small resistance arteries were dissected and mounted on a wire myograph, morphological parameter were measured, in particular media to lumen ratio (M/L) was calculated. A peripheral blood sample was obtained before surgery for assessment of T lymphocytes subpopulations by flow cytometry.
Results are summarized in the Table. RTE: recent thymus emigrant; naïve: no contact with antigens, TDEM: highly antigen-experienced cells that assume pro-apoptotic properties. Additional significant positive correlations were observed between M/L and Th17 effector lymphocytes: r=0.67, p<0.05).
Conclusion
Our data suggest that some lymphocytes subpopulations may be related to microvascular remodeling, and open the possibility to regress small artery remodeling in human by specific drug modulation of lymphocyte subtypes.
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Affiliation(s)
| | | | - Paolo Airò
- Chair of Reumatology, Univ of Brescia, Brescia, Italy
| | - Mirko Scarsi
- Chair of Reumatology, Univ of Brescia, Brescia, Italy
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Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Redon J, Dominiczak A, Narkiewicz K, Nilsson PM, Burnier M, Viigimaa M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Schmieder RE, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Coca A, Gillebert TC, Tendera M, Rosei EA, Ambrosioni E, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Hoes AW, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Olsen MH, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Rydén L, Sirenko Y, Stanton A, Struijker-Boudier H, Tsioufis C, van de Borne P, Vlachopoulos C, Volpe M, Wood DA. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34:2159-219. [PMID: 23771844 DOI: 10.1093/eurheartj/eht151] [Citation(s) in RCA: 3139] [Impact Index Per Article: 285.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Giuseppe Mancia
- Centro di Fisiologia Clinica e Ipertensione, Università Milano-Bicocca, Milano, Italy.
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Muiesan ML, Salvetti M, Rizzoni D, Paini A, Agabiti-Rosei C, Aggiusti C, Agabiti Rosei E. Resistant hypertension and target organ damage. Hypertens Res 2013; 36:485-91. [PMID: 23595044 DOI: 10.1038/hr.2013.30] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiovascular (CV) complications such as myocardial infarction, heart failure, stroke and renal failure are related to both the degree and the duration of blood pressure (BP) increase. Resistant hypertension (RH) is associated with a higher risk of CV complications and a higher prevalence of target organ damage (TOD). The relationship between CV disease and TOD can be bidirectional. Elevated BP in RH may cause CV structural and functional alterations, and the development or persistence of left ventricular hypertrophy, aortic stiffness, atherosclerotic plaques, microvascular disease and renal dysfunction, may render hypertension more difficult to control. Specifically, RH is related to several conditions, including obesity, sleep apnea, diabetes, metabolic syndrome and hyperaldosteronism, characterized by an overexpression of humoral and hormonal factors that are involved in the development and maintenance of TOD. Optimal therapeutic strategies, including pharmacological treatment and innovative invasive methodologies, have been shown to achieve adequate BP control and induce the regression of TOD, thereby potentially improving patient prognosis.
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Affiliation(s)
- Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
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Salvetti M, Zotti D, Bazza A, Paini A, Bertacchini F, Chiari E, Coletti G, Rosei EA, Muiesan ML. Platypnea and orthodeoxia in a patient with pulmonary embolism. Am J Emerg Med 2013; 31:760.e1-2. [DOI: 10.1016/j.ajem.2012.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/02/2012] [Indexed: 11/16/2022] Open
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Volpe M, Rosei EA, Ambrosioni E, Cottone S, Cuspidi C, Borghi C, De Luca N, Fallo F, Ferri C, Morganti A, Muiesan ML, Sarzani R, Sechi L, Virdis A, Tocci G, Trimarco B, Filippi A, Mancia G. 2012 Consensus Document of the Italian Society of Hypertension (SIIA): Strategies to Improve Blood Pressure Control in Italy. High Blood Press Cardiovasc Prev 2013; 20:45-52. [DOI: 10.1007/s40292-013-0007-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 01/13/2023] Open
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Parati G, Omboni S, Compare A, Grossi E, Callus E, Venco A, Destro M, Villa G, Palatini P, Rosei EA, Scalvini S, Taddei S, Manfellotto D, Favale S, De Matteis C, Guglielmi M. Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study). Trials 2013; 14:22. [PMID: 23343138 PMCID: PMC3576326 DOI: 10.1186/1745-6215-14-22] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 12/03/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient's therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated. METHODS/DESIGN The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension--both in the office and in ambulatory conditions over 24 h--and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n = 84) or HBPT (n = 168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (< 135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome). DISCUSSION The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients. TRIAL REGISTRATION Clinical Trials.gov: NCT01541566.
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Affiliation(s)
- Gianfranco Parati
- Department of Cardiology, IRCCS Ospedale San Luca, Istituto Auxologico Italiano and Department of Clinical Medicine and Prevention, University of Milano Bicocca, Milano, Italy
| | | | - Angelo Compare
- Department of Human Sciences, University of Bergamo, Bergamo, Italy
| | - Enzo Grossi
- Scientific Advisor, Centro Diagnostico Italiano, Milan, Italy
| | - Edward Callus
- Department of Pediatric Cardiology & Adult with Congenital Heart Centre, IRCCS Policlinico San Donato, Milan, Italy
| | - Achille Venco
- Medicina Generale II, Centro Ipertensione, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maurizio Destro
- General Medicine Unit, Treviglio-Caravaggio Hospital, Medical Department AO, Treviglio, Italy
| | - Giuseppe Villa
- Divisione di Nefrologia ed Emodialisi, IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Pavia, Pavia, Italy
| | - Paolo Palatini
- Istituto di Clinica Medica IV, Policlinico Universitario, University of Padova, Padova, Italy
| | - Enrico Agabiti Rosei
- Clinica Medica, University of Brescia, II Medicina Generale, A.O. Spedali Civili di Brescia, Brescia, Italy
| | - Simonetta Scalvini
- Servizio Autonomo di Telemedicina, IRCCS Fondazione Salvatore Maugeri, Lumezzane, Brescia, Italy
| | - Stefano Taddei
- Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria di Santa Chiara, University of Pisa, Pisa, Italy
| | | | - Stefano Favale
- U.O. Cardiologia, Azienda Ospedaliera Policlinico, University of Bari, Bari, Italy
| | - Carmine De Matteis
- U.O.S.D. Servizio di Prevenzione e Riabilitazione Cardiopatico, Centro di Prevenzione Malattie Cardiovascolari, Presidio Ospedaliero San Felice a Cancello, San Felice a Cancello, Caserta, Italy
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Rosei EA. Reduction of Cardiovascular Risk through Angiotensin II Type 1 Receptor Antagonism : Focus on Olmesartan Medoxomil. High Blood Press Cardiovasc Prev 2013; 15:231-43. [PMID: 23355126 DOI: 10.2165/0151642-200815040-00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 08/24/2008] [Indexed: 01/13/2023] Open
Abstract
It is well recognized that angiotensin II is involved in the pathogenesis of hypertension. Less well recognized - until recently, at least - is its involvement in the pathogenesis of atherosclerosis. However, it is now evident that angiotensin II promotes oxidative stress, vascular remodelling, inflammation, and the formation of atherosclerotic lesions. These actions, which are mediated almost exclusively by the angiotensin II type 1 (AT(1)) receptor, can be blocked by administration of angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]). Of the seven ARBs currently in clinical use, olmesartan is one of the most effective. The rapid and consistent antihypertensive efficacy of this drug, which allows a high proportion of patients to achieve their target blood pressure (BP), is associated with beneficial effects on oxidative stress, vascular remodelling, inflammation, and atherosclerotic lesion formation. These effects appear to be independent of the BP-lowering activity of olmesartan. In clinical trials, olmesartan has been shown to control microinflammation in hypertensive patients, to reduce oxidative stress in patients with type 2 diabetes mellitus, and to normalize the wall: lumen ratio of small resistance arteries (a measure of vascular remodelling) in patients with hypertension. Moreover, in a 2-year study involving hypertensive patients with carotid atherosclerosis (the MORE [Multicentre Olmesartan atherosclerosis Regression Evaluation] trial), olmesartan reduced the intima-media thickness of the carotid artery and significantly reduced the volume of large atherosclerotic plaques. These data suggest that olmesartan may reduce cardiovascular risk by simultaneously normalizing BP and reversing the proatherogenic effects of angiotensin II.
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Affiliation(s)
- Enrico Agabiti Rosei
- Clinica Medica and Department of Medicine, University of Brescia, Brescia, Italy,
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Volpe M, Rosei EA, Ambrosioni E, Cottone S, Cuspidi C, Borghi C, De Luca N, Fallo F, Ferri C, Mancia G, Morganti A, Muiesan ML, Sarzani R, Sechi L, Tocci G, Virdis A. Renal Artery Denervation for Treating Resistant Hypertension. High Blood Press Cardiovasc Prev 2012; 19:237-44. [DOI: 10.1007/bf03297636] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 10/12/2012] [Indexed: 10/27/2022] Open
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