WITHDRAWN: Left atrial function and arterial hypertension.

Left atrial enlargement is frequently observed in many cardiac diseases. One of the main determinants of left atrial size is ventricular diastolic function. It has recently been suggested that left atrial volume might be the morphophysiologic expression of long-term modifications induced by diastolic function. Furthermore, left ventricular remodelling, such as it happens in hypertensive patients, is another important determinant of atrial volume. All the volumetric modifications of the left atrium, during cardiac cycle, are involved in hypertensive damage. Therefore, left atrial function impairment represents the result of morphological and haemodynamic alterations observed in hypertension. Actually, many techniques, invasive and non-invasive, are available with the purpose to investigate the real atrial dimensions and provide a suitable assessment of atrial function. Recently, it has been demonstrated that the degree of left atrial enlargement is associated with adverse prognosis in different clinical setting. The predictive value of left atrial volume seems to be independent of left ventricular systolic and diastolic function, but the use of left atrial volume for risk stratification is yet an evolving science: more data are required with respect to the natural history of left atrial remodelling in disease, the degree of left atrial modifiability with therapy and whether regression of left atrial size translates into improved cardiovascular outcome.Journal of Human Hypertension advance online publication, 14 August 2008; doi:10.1038/jhh.2008.96.

Baroreflex sensitivity is impaired in essential hypertensives with central obesity.

Recently, much interest has focussed on the potential interaction between sympathetic nervous system and global cardiovascular risk. We investigated how baroreflex sensitivity (BRS), an index of autonomic function, interacts with central obesity (CO) in an essential hypertensive (EH) population. We selected 170 EHs and 43 normotensives (NT), (median age 47.3+/-11.3 and 49.1+/-13 years, respectively). Anthropometric parameters were measured for each and BRS was evaluated by a non-invasive method using Portapres TNO. The BRS evaluation was made using the sequences method. Systolic blood pressure (SBP) and heart rate were significantly higher in EH (P<0.001 and P=0.007, respectively). BRS was significantly greater in NT (P=0.02), and was associated inversely with waist circumference (WC) (P=0.005), but not with SBP or with other metabolic risk factors. Body mass index, total and high-density lipoprotein cholesterol, age and WC were not significantly different between the two groups. These results were confirmed by age pounded analysis. Finally, a separate analysis of the hypertensive group with CO (n=84) demonstrated a significantly lower BRS compared with the other hypertensive patients (n=86) (P<0.001). BRS is associated with WC but not with arterial pressure values and metabolic risk factors. Hypertensive subjects with CO show an impairment of BRS. Owing to its association with abdominal fat distribution and subsequently insulin resistance, BRS could represent a further and reliable index for evaluation of global cardiovascular risk in hypertensive patients.

Accuracy of the blood pressure measurement.

Blood pressure measurement is the cornerstone for the diagnosis, the treatment and the research on arterial hypertension, and all of the decisions about one of these single aspects may be dramatically influenced by the accuracy of the measurement. Over the past 20 years or so, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white coat hypertension, whereby some individuals with an apparent increase in blood pressure have normal, or reduced, blood pressures when measurement is repeated away from the medical environment, has focused attention on methods of measurement that provide profiles of blood pressure behavior rather than relying on isolated measurements under circumstances that may in themselves influence the level of blood pressure recorded. These methodologies have included repeated measurements of blood pressure using the traditional technique, self-measurement of blood pressure in the home or work place, and ambulatory blood pressure measurement using innovative automated devices. The purpose of this review to serve as a source of practical information about the commonly used methods for blood pressure measurement: the traditional Riva-Rocci method and the automated methods.

Relationship between QT interval and cardiovascular risk factors in healthy young subjects.

A prolongation of QT interval increases the risk for coronary heart disease, ventricular arrhythmias, and sudden death in diabetic patients, after myocardial infarction, and in the elderly. An association between QT prolongation and cardiovascular risk factors has been demonstrated in middle-aged and elderly subjects. Aims of this study were to evaluate the prevalence of a prolonged corrected QT interval (QTc) in a healthy young population (n=170, age 22-25 years, 84 males) and to investigate the association of QTc and QT dispersion (QTd) with cardiovascular risk factors (body mass index, blood pressure, fasting blood glucose and cholesterol, smoking habits, and hypertensive familiarity). A prolonged QTc was observed in 10% of female and 5% of male subjects; in multiple regression analysis, QTc showed a significant positive relationship with blood glucose in females (P=0.04) and systolic blood pressure in male subjects (P=0.03), while QTd was not significantly related with any of the factors. In conclusion, the association between QTc length, glucose levels, and blood pressure is present also in young healthy subjects. QT measurement may represent a useful marker in the screening of young subjects for cardiovascular prevention. Journal of Human Hypertension (2005) 19, 623-627. doi:10.1038/sj.jhh.1001874; published online 19 May 2005.

Recent advances in diagnosis and treatment of pheochromocytoma.

Pheochromocytomas are rare tumours of catecholamine-producing chromaffin cells leading to hypertension and symptoms of catecholamine excess. They can be benign or malignant, sporadic or familial tumours. Genetic syndromes associated with pheochromocytoma are MEN II, VHL disease and neurofibromatosis type 1. Usually, pheochromocytomas occur in the adrenal medulla. Clinical manifestations include hypertension (which can be intermittent, stable or in the form of hypertensive peaks) and symptoms related to catecholamine excess such as headache, palpitations and tachycardia, pallor, anxiety and nervousness, nausea, vomiting, weight loss. This clinical syndrome can be mimicked by various hyperkinetic and hyperadrenergic states. When pheochromocytoma is suspected, the first diagnostic step is represented by the measurement of catecholamines and their metabolites (metanephrines) in urine and plasma. Chro-mogranin A measurement can be useful. The clonidine suppression test may be helpful in ruling out other conditions that may elevate catecholamines and metanephrines. Localiza-tion and staging of pheochromocytoma is based on MRI, which is more sensitive than CT scan, and (131)I-MIBG scintiscan. The best therapeutic option for pheochromocytoma is surgery with a laparoscopic approach. An appropriate pre-, intra- and postoperative medical management of the patient is mandatory. In the absence of optimal medical treatment, intraoperative mortality reaches 50%.

Pulse rate in childhood: reference limits.

BACKGROUND AND AIM: Systematic quantitative resting pulse rate measurements may represent an additional parameter for the study of cardiovascular risk factors in youth as well as in adulthood. The aim of this study was to evaluate resting pulse rate and its distribution curve in order to define reference limits in a sample of adolescents from Turin, Italy. METHODS AND RESULTS: The study population consisted of 2230 children aged 12-18 years, who were randomly enrolled from Turin Junior High Schools. All of the participants underwent pulse rate, blood pressure and height measurements. The 5th and 95th percentiles of the pulse rate in boys and girls are reported by age and height. The pulse rate was higher in the girls, but progressively decreased with age and somatic growth in both genders. CONCLUSIONS: The present study provides reference blood pressure values by age, gender and height in a sample of male and female adolescents.

Human infections tick-transmitted.

In this monograph are analysed the principal infections transmitted by ticks and particularly those interesting Europe and North America. Besides the main species of these arthropods are described in consideration of their characteristics and geographic diffusion. In particular the infections caused by Borrelia genus and tick born encephalitis virus are treated more exhaustively in consideration of their potential severity and because the diagnosis of these infections is sometimes difficult. However also the main rickettsial infections transmitted by ticks are reported together the hemorragic fevers transmitted by such arthropods. In particular it is exhaustively analysed the Mediterranean tick fever in consideration of its presence in some regions of Italy and of the wrong opinion of considering this pathology not very severe. Lastly has been included a treatment about some emergent infections transmitted by ticks, like as the ehrlichiosis and babesiasis, but also the mention of tularaemia that can be considered a re-emergent infection, also in consideration of the epidemic focus now present in Kossovo. The above-mentioned pathologies are analysed also as regards the laboratory diagnosis (direct and serologic methods), the therapeutic treatment and the prophilaxis, both directed against the arthropods vectors and that of individual type, employing also some vaccines, when disposable.