Inappropriate left ventricular mass in normotensive and hypertensive patients.

We evaluated cardiovascular features of normotensive and hypertensive adults with left ventricular (LV) mass values exceeding levels predicted for given stroke work, gender, and height, termed "inappropriate" LV mass. Inappropriate LV mass is associated with overweight, concentric LV geometry, and low myocardial systolic function not only in hypertensive subjects, but also in normotensive subjects.

Left ventricular geometry and arterial function in hypercholesterolemia.

AIMS: To investigate the effect of hypercholesterolemia on total arterial compliance and left ventricular (LV) geometry in the absence of arterial hypertension and diabetes. METHODS: One hundred and fifty-two normotensive, non-diabetic patients (109 men) aged 52 +/- 10 years with plasma cholesterol > 240 mg/100 mL, and 282 normotensive controls (154 men) aged 42 +/- 10 years (p < 0.0001) with plasma cholesterol < 200 mg/100 mL were studied by means of echocardiography. The stroke volume/pulse pressure ratio as a percentage of the value predicted by individual age, body weight and heart rate was used as a prognostically-validated index of total arterial compliance. Central pulse pressure (PP) was estimated using a regression equation obtained in a non-overlapping population. RESULTS: Although within the "normal" range, systolic pressure, PP and estimated central PP were higher in the hypercholesterolemic patients even after controlling for differences in age, body mass index (BMI) and race (all p < 0.0001). After controlling for differences in systolic pressure, age, BMI and race, LV mass and the prevalence of hypertrophy were comparable between the two groups, whereas relative diastolic wall thickness was greater (0.36 + 0.06 vs 0.33 + 0.05) and percent SV/PP (stroke volume/PP) lower in the hypercholesterolemic patients (96 +/- 19% vs 102 +/- 18%; both p < 0.005). After considering the covariates, there was still an independent negative correlation between relative wall thickness and percent SV/PP (r = -0.37, p < 0.0001). CONCLUSIONS: Hypercholesterolemia in normotensive non-diabetic adults is independently associated with a mildly concentric LV geometry and a reduced index of total arterial compliance.

[Absence of an association of the D allele of the ACE gene with arterial pressure in mild-moderate essential arterial hypertension]. / Assenza di associazione tra allele D del gene dell'ACE e pressione arteriosa nell'ipertensione arteriosa essenziale lieve-moderata.

To assess the relationship between the angiotensin converting enzyme (ACE) gene I/D polymorphism, blood pressure (BP) and family history of hypertension, 133 hypertensive subjects (mean age 50 +/- 9 years, 78 males, 55 females) were selected according to both casual supine BP > 140/90 mmHg and ambulatory BP > 134/88 mmHg. Drug treatment was discontinued 2 weeks before entering the study. Subjects with myocardial ischemia, as well as those with "white coat" hypertension, were excluded. The study population was subclassified according to age < or = 50 years. Polymerase chain reaction was used to detect the I/D polymorphism of the ACE gene, and the DD genotype was analysed twice. The frequencies of the I and D allele were 42 and 58%, and the distribution of the ID+ II and DD genotypes were 69 and 31% respectively. No significant relation was found among ACE genotypes (DD vs ID+ II) and casual systolic or diastolic BP as well as ambulatory BP, both in the whole study population and in the subpopulation < 50 years old. No difference was found also in the distribution of dippers and no dippers, as well as in the distribution of subjects with a positive family history in the whole sample and hypertensives < 50 years old.

Anti-hypertensive effect of manidipine: 24 hours monitoring evaluation and Doppler-echocardiographic remarks.

In order to evaluate the antihypertensive effects of manidipine, at the dosage of 10 or 20 mg once daily, we studied 36 patients (12 males and 24 females, mean age 54.3 years) with mild hypertension. After a wash-out period of 2 weeks and another 2 week run-in period with placebo, all the patients were assigned to a treatment with manidipine 10 mg/ day. After 2 weeks of treatment, the non-normalized (diastolic BP > 90 mmHg) and the non-responders (BP fall < 10 mmHg) received an increase in dosage to 20 mg/day. The drug effects were assessed by casual blood pressure (BP) measurement at baseline and after 4, 8, 12, 24, 36 and 52 weeks. At baseline and after 1 year of treatment a 24-h BP monitoring and a Doppler echocardiogram were performed. Routine laboratory tests were performed at baseline, after 6 months and after 1 year of treatment. At the end of the observation period, both casual systolic (p < 0.01) and diastolic (p < 0.001) BP were significantly reduced; 24-h BP monitoring showed a significant decrease in systolic (p < 0.05) and diastolic (p < 0.01) pressure, systolic and diastolic (p < 0.001) daytime and night-time measurements. The peak to through ratio was 67%. No difference was found in heart rate. Reduced interventricular septum thickness (p < 0.05), increased fractional shortening (p < 0.02), reduced end-systolic stress (p < 0.005) and systemic vascular resistances (p < 0.001), and lower values of atrial filling fraction (AFF) (p < 0.001) after 1 year of treatment have been shown at the Doppler-Echo evaluation. A multilinear regression analysis showed a relation between delta %AFF and delta %24-h systolic BP (R = 0.74; F = 7.5: p < 0.05) and with delta % daytime systolic BP (R = 0.77; F = 9.2; p < 0.02). No abnormal changes were observed in laboratory tests. Three non-responder patients and three patients with adverse effects (1 flushing and 2 ankle oedema) dropped out and were excluded from the final analysis. In conclusion, manidipine at an individualized dose of 10 or 20 mg. was effective and safe in the management of arterial hypertension. Hemodynamic evaluations after 1 year of treatment confirmed an improvement of systolic and diastolic function, with an evident reduction of afterload.

[The SINTESI Project: software in cardiovascular prevention]. / "Progetto SINTESI": un software nella prevenzione cardiovascolare.

Coronary heart disease is the most important cause of mortality in adults. New approaches may reduce the cardiovascular risk in population. "SINTESI" is an original data base designed in collaboration with the Italian Group for the Study of Metabolism Disease and Atherosclerosis to improve the evaluation of the major risk factors in the population and to create a data bank for medical research. It runs in Windows. The software includes the following electronics archives: Demographics; History; Follow-up; ECG; Laboratory; Doppler-echocardiography; Stress test-ECT; Ambulatory blood pressure monitoring; Holter-ECG; Nuclear imaging; Vascular echo-Doppler; Hemodynamics; Radiology. We named the most important file "Main Working Area" (MWA). This displays all the most important information on the clinical status of the patients and represents the "console" for using the software. In fact, in MWA "buttons" are displayed to enter all the electronic archives. The software displays graphics and the flow-chart of clinical history. We implemented "routines" for automatic evaluation of several variables. We also simplify the statistical use of the data implementing functions for "query" that permit the management of data bank. The use of this software may facilitate the correct evaluation and stratification of the cardiovascular risk. In conclusion, "Progetto SINTESI" is an easy, synthetic organization of patient's clinical data and a complete data bank. It is our opinion that the use of this software may promote a standard way of collecting a large number of data to improve the stratification of cardiovascular risk.