[Hemodynamic assessment at rest and during dynamic physical exercise in young subjects with and without hypertensive parents]

The aim of this research was to identify any early cardiovascular changes that may be predictive of future hypertension in young subjects with family history of hypertension. The study was conducted on 25 offspring of hypertensive parents, mean age 17 years (22 with hypertension only in 1 parent and 3 with both hypertensive parents) and 20 offspring of both normotensive parents, matched by age. Subjects were divided into children (7-13 years) and young adults (19 years on). All subjects underwent three office blood pressure measurements with a mercury sphygmomanometer. On the third control, BoMed thoracic electrical bioimpedance at rest and during upright bicycle exercise was performed. Physical characteristics were similar in subjects matched by age in the two groups. Systolic blood pressure was similar in offspring of normotensives and hypertensives, both at rest and during exercise; diastolic blood pressure was greater in offspring of hypertensive parents at rest (73.1 +/- 10.5 vs 63.5 +/- 7.1 mmHg, p < 0.05), during the first minutes of exercise and during the recovery phase (p < 0.05). Moreover, at the third blood pressure measurement at rest, diastolic blood pressure decreased, with respect to the first measurement, only in children and young adult offspring of normotensive parents, while systolic blood pressure decreased in the two groups of child subjects. No differences in heart rate were observed, both at rest and during physical exercise, between offspring of normotensives and hypertensives. Left ventricular end-diastolic volume, stroke volume, ejection fraction, cardiac output and systemic vascular resistance at rest and their response to decubitus changes and exercise were normal and similar in offspring of normotensive and hypertensive parents both in children and young adults. In conclusion, a different behavior of diastolic blood pressure was found in offspring of hypertensive parents compared to that of normotensive parents, both in children and, to a higher degree, in young adults. This may be an expression of early vascular change in subjects with a genetic predisposition to hypertension.

[Clinical and echocardiographic evaluation of thalassemic cardiomyopathy]

To evaluate the reliability of the echocardiographic examination in assessment of adult patient with thalassemia major, in comparison with clinical, electrocardiographic and/or chest x ray exams, 103 patients with thalassemia major, mean age 20 years (range 14 to 30 years), were studied and compared with 30 age matched normal subjects. All patients were receiving transfusions regularly to maintain hemoglobin levels above 11 g/dl and subcutaneous infusions of desferrioxamine (about 40 mg/kg/day) to reduce hemosiderosis. The patients were divided into three groups according to their cardiac impairment, deduced by clinical history, electrocardiography (ECG) and/or chest x ray. Group I (36 patients) showed no signs or symptoms of cardiac impairment. Group II (38 patients) had only signs of cardiac impairment by ECG and/or chest x ray. Group III (29 patients) had both symptoms and signs of cardiac failure. In comparison to normal controls, Group I showed an increase in left ventricular (LV) dimension (EDD) and mass (p < 0.001), Group II and III showed a decrease in LV fractional shortening (FS; p < 0.001) too. In comparison to Group I, Group II showed a decrease in LV FS (p < 0.05), Group III showed an increase in LV EDD and mass (p < 0.001) too. In comparison to Group II, Group III showed an increase in LV EDD and mass (p < 0.001), and a decrease in LV FS (p < 0.001). In conclusion, echocardiographic examination appears a tool more reliable than clinical, electrocardiographic and/or chest x ray examination in assessment of adult patient with thalassemia major.(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronology of regression of hypertensive ventricular hypertrophy during antihypertensive therapy with beta blockers]

To define the time course of regression of left ventricular hypertrophy (LVH) during antihypertensive therapy with beta-blocking agents, 73 hypertensive patients were serially studied by echocardiography during 12-months therapy with beta-blockers. Blood pressure decreased significantly after 1 month and further on after 12 months (from 164 +/- 18/110 +/- 9 to 139 +/- 14/94 +/- 7 mmHg, p < 0.001). Left ventricular (LV) end-diastolic dimension increased significantly after 1 month (from 51.2 +/- 3.9 to 52.2 +/- 4.7 mm, p < 0.01) and decreased after 12 months (50.4 +/- 4.0 mm, p < 0.05). Septal and posterior wall thickness decreased progressively after 1 month and 3 months, respectively. LV mass index decreased significantly after 3 months, and further on after 12 months (from 164 +/- 42 to 145 +/- 33 g/m2, p < 0.001). LV fractional shortening did not significantly change throughout the study. Thus, a reduction of hypertensive LVH occurred after 3 months of therapy with beta-blocking agents and went on during the subsequent months without impairment of LV systolic function.

[Effects of verapamil on left ventricular mass and diastolic function in hypertensive patients]

To evaluate the effects of antihypertensive therapy with verapamil on left ventricular (LV) mass, systolic and diastolic function, 12 hypertensive patients, mean age 44 years, were studied during 12 months of treatment with verapamil, in a gradual release from (240-480 mg/day), by serial recordings of ECG, blood pressure (BP) and echocardiogram. In pretreatment conditions, 8 patients showed LV hypertrophy and 2 patients impaired LV diastolic function. Blood pressure decreased significantly after 1 month of therapy, septal and LV posterior wall thickness after 3 months and LV mass after 6 months. No significant changes were observed in LV fractional shortening and diastolic transmitral flow. At the end of the study BP normalized in 8 patients and LV mass in 1 patient. Left ventricular diastolic function was normalized in 1 patient but became worse in another, in spite of the reduction in BP and LV mass. Thus, verapamil was an effective antihypertensive drug and was able to revert hypertensive LV hypertrophy. However, the behaviour of LV diastolic function seems to be independent of the effects of the drug on BP and LV mass. Further studies are necessary to clarify this problem.

[The effect of nifedipine in hypertensive cardiopathy. An echocardiographic and electrocardiographic study]

To assess whether antihypertensive therapy by nifedipine can reverse left ventricular (LV) hypertrophy, 15 hypertensive patients, mean age 47 years, were serially studied during 12 months of treatment with nifedipine in slow release (40-60 mg/day), by recordings of blood pressure (BP), ECG and echocardiogram. Blood pressure decreased from 161 +/- 6/104 +/- 3 mmHg to 131 +/- 3/89 +/- 1 mmHg, p < 0.001, and this fall first became statistically significant at 1 month. From the hemodynamic view point, BP decreased for a reduction in total peripheral resistance. The Sokolow-Lyon voltage decreased significantly after 6 months (from 33.5 +/- 2.7 to 28.1 +/- 2.1 mm, p < 0.01) without further changes in the subsequent months. Left ventricular mass, by echocardiography, decreased after 6 months (from 189 +/- 15 to 176 +/- 13 g/m2, p < 0.05) and further after 12 months (169 +/- 13 g/m2, p < 0.001). The reduction in LV mass was secondary to the decrease in wall thickness, particularly in posterior wall thickness. No significant changes were observed in LV fractional shortening throughout the study. Thus, nifedipine was an effective antihypertensive agent and reverted LV hypertrophy secondary to arterial hypertension without impairment of LV systolic function.

[The effect of nifedipine on arterial pressure and exercise tolerance in hypertensive patients]

The aim of this research was to assess whether the antihypertensive therapy with nifedipine, a dihydropyridine calcium-antagonist, is able to control hypertension not only at rest but also during exercise. So, 20 male hypertensive patients, mean age 48 years, were evaluated by symptom limited bicycle exercise (10 W/min) before and after 6 and 12 months of therapy with nifedipine in a slow releasing form (40-60 mg/day). Exercise tolerance significantly increased after 12 months of antihypertensive therapy with nifedipine (from 146 +/- 5 to 153 +/- 4 W, p < 0.05). Systolic and diastolic blood pressure decreased after 6 and 12 months both at rest (from 160 +/- 6/109 +/- 9 mmHg to 132 +/- 3/91 +/- 3 and 135 +/- 4/93 +/- 1 mmHg, respectively, both p < 0.001) and during exercise (at end exercise: from 238 +/- 7/121 +/- 5 mmHg to 216 +/- 6/106 +/- 3 and 213 +/- 6/107 +/- 3 mmHg, respectively, both p < 0.001). No significant changes in heart rate were observed during antihypertensive therapy both at rest and during exercise test. In conclusion, long-term antihypertensive therapy with nifedipine was effective in the control of hypertension both at rest and during physical stress. Moreover, an improvement in effort tolerance was observed in hypertensive patients.

[The effect of antihypertensive therapy on the seasonal variations in arterial pressure in hypertensive patients]

To evaluate the influence of antihypertensive therapy (AHT) on blood pressure (BP) seasonal variations, we have analyzed the systolic and diastolic BP values in 145 hypertensives, 112 males and 33 females, aged 23-65 years, in the 10-year period 1981-1990. All patients received medical treatment and were examined for at least 5-7 consecutive years. The year was divided in 2 (cold and warm months) and 4 periods in relation to mean monthly environmental temperature (10 degrees C, 13 degrees C, 18 degrees C and 23 degrees C). Systolic and diastolic BP was higher in cold months (142/93 vs 137/88 mmHg, p less than 0.05). In cold periods AHT was increased in 11% of patients and decreased in 8%. In the warm periods AHT was decreased in 11% of patients and increased in 6%. The AHT reduction in the warm months was not significantly different in comparison to that of cold months. Vice versa, the AHT increase in cold months was greater than that of warm periods (p less than 0.001). In the 10-year period considered, 18% of patients reduced AHT in the warm period and increased it in the cold period. It was also found a small correlation between diastolic blood pressure and wind, which is, in our country, mostly the mistral. Betablockers, calcium-antagonists and the association betablocker-diuretics showed a seasonal BP variation, while patients treated by diuretic had the same BP both in winter and in summer. A small negative correlation was observed between systolic and diastolic BP and temperature in patients treated by all antihypertensive drugs except the diuretics.(ABSTRACT TRUNCATED AT 250 WORDS)

[Arterial blood pressure behavior during progressive muscular exercise in subjects with stable arterial hypertension]

To assess the behaviour of blood pressure (BP) during exercise in hypertensive patients (H), 103 males aged 21 to 59 years (mean 43 years) with essential hypertension WHO class I-II were studied. All H, without antihypertensive therapy for at least 15 days, underwent sitting bicycle exercise (10 W/min). BP was measured on the left arm by a standard mercury sphygmomanometer. The fifth Korotkoff phase was taken as the diastolic pressure. Heart rate was measured by electrocardiogram. Subjects were studied at rest in sitting position, during exercise every 3 min and during recovery at 1, 3 and 5 min. As controls we took 100 normotensive (N) males aged 20 to 59 years (mean 39 years). The results were analyzed also by decades. Systolic (S) and diastolic (D) blood pressure were higher in H in comparison with N at rest, in sitting position, (N 119 +/- 10/79 +/- 7 mmHg; H 162 +/- 21/112 +/- 11 mmHg; p less than 0.01), during exercise and recovery. SBP and, to a lesser extent DBP, progressively increased during exercise both in N and in H patients (at peak exercise: N 192 +/- 20/85 +/- 13 mmHg; H 239 +/- 25/121 +/- 13 mmHg, p less than 0.01). The mean increase of SBP during exercise was 77 mmHg in H and 73 mmHg in N (NS). DBP increment was about 6 mmHg in N and 9 mmHg in H (NS). Within the age decades, SBP during exercise was higher in the age group of 50 to 59 in comparison with 20 to 29 in N and H (p less than 0.05) and DBP in the age group of 40 to 49 and 50 to 59 in comparison with 20 to 29 and 30 to 39 (p less than 0.01). The fall of SBP and DBP was greater at 1 min of recovery both in H and N and became progressively smaller thereafter. At a same workload (90 and 120 W) 60% of H had SBP and 85% had DBP higher than BP in N (above 200/104 mmHg--mean + 2 SD--at 90 W and 215/106 mmHg at 120 W). No difference was observed in heart rate at rest and during exercise between N and H. In conclusion, H had SBP and DBP higher at rest, during exercise and recovery in comparison with N. However, a parallel increase of BP was found in the 2 groups during exercise. Ergometric test showed that 60-85% of H had also excessive increase of systolic and diastolic blood pressure during exercise.

[Effects of antihypertensive therapy with selective and non-selective beta blocking agents on dimensions and function of the left ventricle]

The influence of cardioselectivity and/or intrinsic sympathomimetic activity (ISA) of betablockers on hemodynamic antihypertensive effect and on left ventricular (LV) dimensions and function was studied by echocardiography in 72 hypertensive patients, mean age 43 years. After 15 days of placebo, active therapy was given for 1 month: acebutolol (ACEB, n: 16, 400-800 mg/day), atenolol (ATEN, n: 16, 50-100 mg/day), pindolol (PIND, n: 13, 15-30 mg/day), timolol (TIMO, n: 15, 10-20 mg/day) and nadolol (NADO, n: 12, 80-160 mg/day). All betablockers showed effective antihypertensive activity. Betablockers without ISA (ATEN, TIMO, NADO) reduced cardiac output (p less than 0.05), those with ISA (ACEB, PIND) decreased total peripheral resistance (p less than 0.01 and p less than 0.05 respectively). Independently from ISA, cardioselective betablockers (ATEN, ACEB) increased LV end diastolic dimension and stroke volume (p less than 0.05). LV mass was not changed, although interventricular septum thickness decreased after TIMO and NADO (p less than 0.05). LV function, as assessed by fractional shortening, was not impaired by any betablocker.

[Electrocardiographic and echocardiographic changes during antihypertensive therapy]

To investigate the changes of electrocardiographic and echocardiographic indexes of left ventricular hypertrophy (LVH) during antihypertensive therapy, 100 hypertensive patients, mean age 46 years, were studied in pretreatment condition and during 12 months of antihypertensive therapy. In pretreatment condition, 83 patients showed LVH by echocardiography (echo; left ventricular mass index greater than 130 g/m2) and 30 patients had LVH by electrocardiography (ECG) (Sokolow index greater than 35 mm). In comparison to echo index of LVH, Sokolow index showed a sensibility of 34% and a specificity of 88%. Both LV mass echo index and ECG index significantly decreased after 3 months but in different way. LV mass index mainly decreased after 12 months, whereas Sokolow index particularly decreased after 6 months, with no further changes in the subsequent months. After 12 months of therapy, the LV mass echo index normalized in 19% of the patients (16/83) and Sokolow index normalized in 57% (17/30). ECG sensibility and specificity, in comparison to LV mass echo, was 20% and 100%, respectively. Thus, ECG appears less sensitive than echo in the detection of LVH. During antihypertensive therapy ECG index of LVH normalized more precociously and to a greater extent than the echo index. However, the normalization of LVH by ECG does not necessarily mean that a complete anatomic regression of LVH has occurred.

[Effects of indenolol on left ventricular mass in patients with essential arterial hypertension]

This study evaluated the effect of long-term antihypertensive therapy with indenolol, a beta blocking agent with beta 2 stimulating activity, its antihypertensive hemodynamic mechanism and its effect on hypertensive left ventricular (LV) hypertrophy. Fourteen hypertensive patients, mean age of 48 years, were serially studied during 12- month therapy with indenolol (60-120 mg daily), by recording blood pressure, electrocardiogram and echocardiogram. Blood pressure, heart rate and cardiac output significantly decreased after 1 months of therapy, LV posterior wall thickness decreased after 6 months, interventricular septum thickness and LV mass decreased after 12 months. LV fractional shortening did not change throughout the study. Blood pressure normalized (less than or equal to 140/90 mmHg) in 50% of the patients; LV mass normalized in 40% of the patients. In conclusion, indenolol was an effective antihypertensive agent, also in the long-term treatment. Its antihypertensive hemodynamic effect seems to be due mainly to a reduction in cardiac output. Indenolol caused a regression of LV hypertensive hypertrophy without impairment of LV systolic function.

[Cardiovascular response to dynamic physical exercise in adolescents with casual raised values of arterial blood pressure]

The blood pressure response to dynamic exercise was studied in 90 adolescents (45 males and 45 females) mean age 15 years (range 13-16 years) with casual systolic and/or diastolic hypertension (H) and in 50 matched for age adolescents (26 males and 24 females) with casual blood pressure about the fiftieth percentile for age and sex (N). During the third blood pressure control they underwent a maximal bicycle exercise test in sitting position (10 W/min). During exercise and recovery ECG was recorded every 30 s and blood pressure, with a mercury sphygmomanometer, every 3 min. Adolescents with casual hypertension at rest showed, in comparison to normotensives, an increase in blood pressure (H: 176.1 +/- 18.8 mmHg; N: 167.4 +/- 14.2 mmHg, p less than 0.01 at peak of exercise) and in rate-pressure product (H: 326.8 +/- 40.9 X 10(-2); N: 308.7 +/- 29.4 X 10(-2); p less than 0.01 at peak of exercise) during exercise and recovery. Heart rate was greater at rest in hypertensive adolescents, but there was no difference between the 2 groups during exercise. Exercise tolerance was similar in the 2 groups. Casual transient hypertension at rest and excessive increase of systolic blood pressure during exercise could be expression of early cardiovascular changes preceding sustained hypertension.

[Echocardiographic study at rest and during effort in adult asymptomatic thalassemic patients]

An echocardiographic study was performed in 21 young patients with thalassemia major (TM, age 16-22 years), with no cardiac symptoms, and in 24 age-matched normals (N) at rest and during sitting bicycle exercise (EX). All TM were receiving blood transfusions regularly to maintain hemoglobin level above 11 g/dl and subcutaneous infusion of desferrioxamine (40 mg/Kg/day) to reduce hemosiderosis. At rest, in comparison to N, TM showed a significant increase in LV end-diastolic dimension (EDD), septal, posterior wall thickness and mass, whereas wall thickness to EDD ratio and LV fractional shortening (FS) were not different. Stress echocardiography was recorded with success in 90% of TM and 83% of N. During EX, FS increased progressively with increase of heart rate in both groups, though the increase of FS was lower in TM. Thus, asymptomatic young patients with thalassemia major, under well transfusion-chelation therapy, showed cardiac changes from volume overload. LV systolic function, normal at rest, was moderately impaired during exercise test.

Possible regression of left ventricular hypertrophy during antihypertensive treatment with diuretics and/or beta blockers

The possible regression of left ventricular hypertrophy (LVH) during treatment with diuretics and/or beta blockers was assessed in 78 hypertensive patients by echocardiography. Five groups of patients were treated, respectively, with diuretics alone, chlorthalidone plus SR oxprenolol, acebutolol followed by atenolol, timolol alone, or atenolol alone. All patients, except those receiving acebutolol had a significantly reduced LV mass within 12 months. Acebutolol did not modify LV mass even after 24 months, in spite of its antihypertensive efficacy. The reduction of LV mass was due to a decrease in wall thickness after administration of beta blockers and a decrease in LV dimension after chlorthalidone. Normalization of LV mass (less than 130 g/m2) occurred only in 31% of patients. LV mass was not significantly modified in patients with normal mass in pretreatment condition. The decrease of LV mass correlated with a decrease in cardiac output but not with the reduction in blood pressure. In conclusion, LV systolic function showed a tendency toward improvement after long-term antihypertensive therapy.

Early cardiovascular changes in adolescents with high blood pressure values

To assess the type and degree of cardiovascular involvement in the early phases of hypertension, 46 adolescents with casual blood pressure (BP) greater than the 95th percentile for age and sex (23 males and 23 females, mean age 14 years) were studied by M-mode echocardiography. Twenty-seven adolescents with casual BP about the 50th percentile, 17 males and 10 females, matched for age, were studied as controls. Adolescents with casual high BP values showed an increase in left ventricular mass (P less than 0.01) and wall thickness to radius (h:R) ratio (P less than 0.01) in comparison to controls. Cardiac index was increased and was correlated with left ventricular mass in hypertensive subjects (P less than 0.05). The correlation between cardiac output and left ventricular mass suggests that cardiac output is a factor in the development of left ventricular hypertrophy.