ABSTRACT
The recent literature reported an inverse correlation between COVID-19 pandemic and hospital admissions for Acute Coronary Syndromes (ACS).
Subject(s)
Acute Coronary Syndrome/epidemiology , COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Heart Arrest/epidemiology , Stroke/epidemiology , Acute Disease , COVID-19/mortality , Call Centers/statistics & numerical data , Chi-Square Distribution , Humans , Italy/epidemiology , PandemicsABSTRACT
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.
Subject(s)
Cardiovascular Diseases/epidemiology , Hyperuricemia/epidemiology , Uric Acid/blood , Adult , Aged , Biomarkers/blood , Cardiovascular Diseases/blood , Cardiovascular Diseases/mortality , Female , Humans , Hyperuricemia/blood , Hyperuricemia/diagnosis , Hyperuricemia/mortality , Italy/epidemiology , Male , Middle Aged , Multicenter Studies as Topic , Observational Studies as Topic , Prognosis , Research Design , Retrospective Studies , Risk Assessment , Risk Factors , Time FactorsABSTRACT
Aging leads to a multitude of changes in the cardiovascular system that include a rise in blood pressure. Age-related changes in blood pressure are mainly attributable to an increase in systolic blood pressure, generally associated with a slight decrease diastolic blood pressure. This leads to a widening in pulse pressure. Ambulatory blood pressure monitoring is a useful tool to understand these processes and to refine cardiovascular risk assessment. In the light of emerging data in this area, we reviewed the main features of ambulatory blood pressure in elderly and discussed the evidence showing that ambulatory blood pressure is superior to clinic blood pressure to reflect the true pattern of blood pressure over time. Furthermore, we discussed the role of weight control obtained by fitness programs to prevent an excessive rise in blood pressure with age. A thorough understanding of these concepts is of paramount importance and has therapeutic implications in the growing population of elderly subjects with increased blood pressure.
Subject(s)
Aging/physiology , Blood Pressure Monitoring, Ambulatory/methods , Aged , Blood Pressure/physiology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Humans , Hypertension/diagnosis , Hypertension/prevention & control , Risk Assessment , Risk FactorsABSTRACT
The purpose of this study is to evaluate the effectiveness of endoscopic dacryocystorhinostomy by the posterior lacrimal sac approach without use of lacrimal stents or harvest of mucosal flaps as a valid surgical procedure for the treatment of an obstruction of the lacrimal pathways. A retrospective evaluation was conducted in a cohort of 75 patients between 2007 and 2011. A total of 78 endoscopic dacryocystorhinostomies were analyzed in 75 patients. After a mean follow-up of 25.7 months (minimum 12 months), 93.3% had a complete relief of symptoms after surgery. Our experience appears to confirm that the endoscopic posterior lacrimal sac approach with no stent insertion or mucosal flaps creation is a good alternative to other known endoscopic procedures.
Subject(s)
Dacryocystorhinostomy/methods , Endoscopy , Nasolacrimal Duct , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , StentsABSTRACT
A 41-year-old male was admitted because of severe systemic hypertension and acute renal failure (ARF) that required hemodialysis (HD). Also present were hemolytic anemia, thrombocytopenia and increased plasmatic levels of aldosterone and reninic activity. The diagnostic tests performed during the recovery led to the conclusion of malignant hypertension. This case dealt with a cause of ARF, which is not currently so common; physicians should be aware of this condition especially when it is present with hemolytic anemia and thrombocytopenia, which are the microangiopathy markers.
Subject(s)
Acute Kidney Injury/etiology , Hemolysis , Thrombocytopenia/complications , Adult , Humans , MaleABSTRACT
Epidemiological studies have established that left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular and cerebrovascular morbidity and mortality. In turn, hypertension is a well-established risk factor for LVH. Ambulatory blood pressure monitoring has shown that 24-h mean ambulatory blood pressure is a particularly powerful predictor of LVH, being superior to casual clinic blood pressure measurements. The magnitude of the rise in blood pressure in the early morning correlates with the extent of LVH. Prospective studies have shown the advantageous effects of antihypertensive therapy on LVH in terms of regression of left ventricular mass (LVM) and subsequent reduction in overt cardiovascular disease. Meta-analysis has identified differences in the ability of different classes of anti-hypertensive agents to bring about regression of LVH, with agents that target the renin angiotensin system (RAS) appearing superior to other agents, such as beta-blockers and diuretics. The distinct pharmacological features of telmisartan suggest that it may be a suitable agent for managing hypertensive patients because it provides sustained control of blood pressure and appears to be very effective in reversing cardiac remodelling. Pre-clinical evaluation has demonstrated that telmisartan suppresses angiotensin II-induced collagen production and secretion by cultured fibroblasts, and reduces left ventricular weight in different animal models. Several clinical studies have demonstrated that, as well as reducing blood pressure (including 24-h mean ambulatory values), telmisartan brings about LVM regression in patients with hypertension, and improves left ventricular and left atrial function. Comparative studies have shown telmisartan's superiority compared with both hydrochlorothiazide and carvedilol in regressing LVM, the additional activity probably being explained by the sustained blood pressure control and the non-haemodynamic effects of targeting the RAS. The ultimate proof of the clinical value of telmisartan will be provided by the outcome trials ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) currently being conducted in high-risk patients.
Subject(s)
Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Benzimidazoles/therapeutic use , Benzoates/therapeutic use , Clinical Trials as Topic , Drug Evaluation, Preclinical , Ventricular Remodeling/drug effects , Animals , Humans , TelmisartanABSTRACT
An elevated urinary albumin excretion (UAE) below the proteinuric level, i.e. microalbuminuria (MAU), has long been recognized as a marker of kidney disease and increased cardiovascular risk in both types of diabetes mellitus. Subsequent clinical evidence documented an association between MAU and other cardiovascular risk factors, target organ damage and risk of cardiovascular disease in the general population and in specific clinical contexts including essential hypertension. This article reviews the available evidence on the clinical value of MAU in subjects with essential hypertension. In these subjects, the reported prevalence of MAU ranges from about 4% to 46% across different studies and these differences may be explained by the huge intraindividual variability in UAE, age and ethnicity, discrepancies in the technique of measurement and different definitions of MAU. A direct and continuous association between UAE and blood pressure (BP) and left ventricular mass has been found in most studies. In contrast, it is not yet clear whether the association between UAE and other factors including age, gender, smoking, ethnicity, insulin resistance, lipids and obesity is independent or due to confounders, particularly BP. Several prospective studies disclosed an association between MAU and the risk of future cardiovascular disease. Of particular note, in some of these studies the incidence of major cardiovascular events progressively increased with UAE starting below the conventional MAU thresholds. Thus, besides being a direct risk factor for progressive renal damage, MAU can be considered a marker which integrates and reflects the long-term level of activity of several other detrimental factors on cardiovascular system. Antihypertensive treatment reduces UAE and such effect may be detected after just a few days of treatment. Among available antihypertensive drugs, angiotensin converting enzyme (ACE) inhibitors and the angiotensin II receptor antagonists seem to be superior to other antihypertensive drugs in reducing UAE. The dual blockade of the renin angiotensin system with an ACE inhibitor and an angiotensin II receptor antagonist is a new and promising approach to control UAE in hypertensive patients. Determination of MAU is recommended in the initial work-up of subjects with essential hypertension as suggested in the most recent European hypertension guidelines, even though, as upcoming evidence suggest, the periodic evaluation of this simple, inexpensive and predictive marker might be valuable and cost-effective.
Subject(s)
Albuminuria/complications , Hypertension/urine , Albuminuria/prevention & control , Cardiovascular Diseases/etiology , Humans , Hypertension/complications , Hypertrophy, Left Ventricular/etiology , Prognosis , Risk FactorsABSTRACT
Systolic blood pressure (SBP) is an important determinant of the development and regression of left ventricular hypertrophy (LVH) in hypertensive humans. However, comparative assessments with other BP components are scarce and generally limited in size. As part of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA), 743 hypertensive subjects underwent echocardiography and 24-h ambulatory BP monitoring before and after an average of 3.9 years of treatment. The changes in left ventricular mass showed a significant direct association with the changes in 24-h SBP (r=0.40), diastolic blood pressure (DBP) (r=0.33) and pulse pressure (PP) (r=0.35). Weaker associations were found with the changes in clinic BP (r=0.32, 0.31 and 0.16, respectively). In a multivariate linear regression analysis, the changes in 24-h SBP were the sole independent determinants of the changes in left ventricular mass (LVM) according to the following equation: percentage changes in LVM=0.73 x (percentage changes in 24-h SBP) -0.48 (P<0.0001). For any given reduction in 24-h SBP, the reduction in LVM did not show any association with the changes in DBP and PP, either clinic or ambulatory. These data indicate that SBP is the principal determinant of LVH regression in hypertensive humans.
Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/physiology , Hypertension/drug therapy , Hypertrophy, Left Ventricular/drug therapy , Blood Pressure Monitoring, Ambulatory , Echocardiography , Electrocardiography , Female , Follow-Up Studies , Humans , Hypertension/complications , Hypertension/physiopathology , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Linear Models , Male , Middle Aged , Treatment OutcomeABSTRACT
Introducción: El gold standard en el tratamiento de cáncer de próstata clinicamente localizado en pacientes con expectativa de vida de más de 10 años es la proatatectomía radical. Evaluamos los factores pronósticos prequirúrgicos y patológicos y su incidencia en la progresión de la enfermedad. Material y Métodos: Se realizó un estudio retrospectivo de 59 pacientes tratados con prostatectomía radical por cáncer de próstata clinicamente localizado durante los últimos 10 años Resultados: 69 por ciento de los pacientes fueron cáncer órgano confinado, 10 por ciento tuvieron extensión extracapsular, 12 por ciento compromiso de vesículas seminales, 3 por ciento invasión de cuello vesical y 3 por ciento compromiso ganglionar. Se registró un 29 por ciento de márgenes quirúrgico positivos. El estadío clíunico T2 tuvo 50 por ciento más riesgo de presentar penetración capsular que el T1. 32 por ciento presentaron recaída bioquímica; en el 27 por ciento los T2, 50 por ciento de los T3a y 57 por ciento de los pT3b.(RR=2,2); 23 por ciento de los pacientes con Gleason patológico 5-6 y 39 por ciento con Gleason patológico 7 mostraron recaída de PSA. En el grupo de bajo riesgo (PSA<=10, Gleason <=6, T1c) 18 por ciento mostraron progresión bioquímica. En el grupo de alto riesgo (PSA>10, Gleason >=7, T2-b) 71 por ciento tuvieron recaída de PSA (p=0,04) (RR-3,9). Conclusiones: Una correcta selección de los pacientes se asocia con un alto porcentaje de cáncer órgano confinado y menor probabilidad de recaída bio química, no obstante la subestadificación en grado y estadío es frecuente. El estadio patológico y los márgenes quirúrgicos positivos son factores oronósticos más poderosos de progresión de la enfermedad(AU)
Subject(s)
Humans , Male , Prostatectomy , Prognosis , Prostatic Neoplasms , Prostatic Neoplasms/therapy , Retrospective StudiesABSTRACT
Introducción: El gold standard en el tratamiento de cáncer de próstata clinicamente localizado en pacientes con expectativa de vida de más de 10 años es la proatatectomía radical. Evaluamos los factores pronósticos prequirúrgicos y patológicos y su incidencia en la progresión de la enfermedad. Material y Métodos: Se realizó un estudio retrospectivo de 59 pacientes tratados con prostatectomía radical por cáncer de próstata clinicamente localizado durante los últimos 10 años Resultados: 69 por ciento de los pacientes fueron cáncer órgano confinado, 10 por ciento tuvieron extensión extracapsular, 12 por ciento compromiso de vesículas seminales, 3 por ciento invasión de cuello vesical y 3 por ciento compromiso ganglionar. Se registró un 29 por ciento de márgenes quirúrgico positivos. El estadío clíunico T2 tuvo 50 por ciento más riesgo de presentar penetración capsular que el T1. 32 por ciento presentaron recaída bioquímica; en el 27 por ciento los T2, 50 por ciento de los T3a y 57 por ciento de los pT3b.(RR=2,2); 23 por ciento de los pacientes con Gleason patológico 5-6 y 39 por ciento con Gleason patológico 7 mostraron recaída de PSA. En el grupo de bajo riesgo (PSA<=10, Gleason <=6, T1c) 18 por ciento mostraron progresión bioquímica. En el grupo de alto riesgo (PSA>10, Gleason >=7, T2-b) 71 por ciento tuvieron recaída de PSA (p=0,04) (RR-3,9). Conclusiones: Una correcta selección de los pacientes se asocia con un alto porcentaje de cáncer órgano confinado y menor probabilidad de recaída bio´química, no obstante la subestadificación en grado y estadío es frecuente. El estadio patológico y los márgenes quirúrgicos positivos son factores oronósticos más poderosos de progresión de la enfermedad
Subject(s)
Humans , Male , Prognosis , Prostatectomy , Prostatic Neoplasms , Retrospective StudiesABSTRACT
El diagnóstico y tratamiento del tumor primario en el cáncer de pene, no ofrece dificultad para el urólogo. Sin embargo, mientras los ganglios inguinales positivos deben ser tratados inmediatamente, el manejo de los ganglios inguinales clínicamente negativos es controvertido y debería considerarse: vigilancia y tratamiento conservador, biopsia guiada por ecografía, biopsia dinámica del ganglio centinela o biopsia escisional y eventual linfadenectomía, según las características del tumor primario. Realizamos un estudio retrospectivo de 20 pacientes tratados en nuestra institución entre enero de 1981 y julio de 2002 con diagnóstico de cáncer de pene. Los tumores indiferenciados comúnmente se asocian con la presencia de metástasis en los ganglios inguinales. La presentación con ganglios inguinales negativos (NO) está vinculada con menor incidencia de metástasis inguinales, al igual que el ganglio solitario (N1). Sin embargo, las metástasis son frecuentes en el estadio N2 (ganglios múltiples inguinales). La radioterapia inguinal no cumple con las expectativas de control y curación de la enfermedad. (AU)
Subject(s)
Humans , Male , Penile Neoplasms/diagnosis , Penile Neoplasms/therapy , Neoplasm Staging , Retrospective StudiesABSTRACT
El diagnóstico y tratamiento del tumor primario en el cáncer de pene, no ofrece dificultad para el urólogo. Sin embargo, mientras los ganglios inguinales positivos deben ser tratados inmediatamente, el manejo de los ganglios inguinales clínicamente negativos es controvertido y debería considerarse: vigilancia y tratamiento conservador, biopsia guiada por ecografía, biopsia dinámica del ganglio centinela o biopsia escisional y eventual linfadenectomía, según las características del tumor primario. Realizamos un estudio retrospectivo de 20 pacientes tratados en nuestra institución entre enero de 1981 y julio de 2002 con diagnóstico de cáncer de pene. Los tumores indiferenciados comúnmente se asocian con la presencia de metástasis en los ganglios inguinales. La presentación con ganglios inguinales negativos (NO) está vinculada con menor incidencia de metástasis inguinales, al igual que el ganglio solitario (N1). Sin embargo, las metástasis son frecuentes en el estadio N2 (ganglios múltiples inguinales). La radioterapia inguinal no cumple con las expectativas de control y curación de la enfermedad.
Subject(s)
Humans , Male , Neoplasm Staging , Penile Neoplasms , Retrospective StudiesABSTRACT
Introducción: El transplante renal de donante vivo resulta en una opción válida para mitigar la creciente escasez de órganos. Sin embargo, la potencial morbimortalidad quirúrgica desalienta los donantes. La aplicación de técnicas minimamente invasivas puede revertir esta situación. La nefrectomía laparoscópica de donante vivo constituye un desafío de la cirugía urológica actual Objetivo: Presentar caso inicial y técnica quirúrgica de nefrectomía laparoscópica en donante vivo Paciente y método: En agosto de 2001 se realizó la primera nefrectomía laparoscópica de donante vivo. Se evaluaron antecedentes y criterios de selección. Se analizó tiempo de isquemia caliente tiempo operatorio, complicaciones, sangrado y necesidad de transfusiones. También requerimientos analgésicos y estadía hospitalaria. Control de función renal en el receptor hasta la actualidad Técnica: Decúbito lateral izquierdo modificado. Por vía transperitoneal, colocación de tres trocares en mesogastrio, supraumbilical y fosa ilíaca derecha. Incisión transversa en idéntica fosa para disección con asistencia manual y extracción del órgano. Utilización de clips LT 400 para he mostasia de arteria y vena. Preservación del uréter con su meso. Resultados: Se seleccionó una paciente de 47 años para nefrectomía laparoscópica derecha asistencia manual. Tiempo operatorio de 2,5 horas. Isquemia caliente de 2,5 minutos. No presento complicaciones ni requirió transfusiones. Buena respuesta con analgésicos por vía oral en 2 días. Alta hospitalaria al tercer día. Conclusiones: La nefrectomía laparoscópica en donante vivo es un procedimiento reproducible el entrenamiento adecuado y factible de realizar con nuestros recursos. Podría en el futuro incrementar la tasa de donantes vivos. (AU)
Subject(s)
Humans , Adult , Female , Nephrectomy/adverse effects , Nephrectomy/statistics & numerical data , Laparoscopy , Kidney TransplantationABSTRACT
Introducción: El transplante renal de donante vivo resulta en una opción válida para mitigar la creciente escasez de órganos. Sin embargo, la potencial morbimortalidad quirúrgica desalienta los donantes. La aplicación de técnicas minimamente invasivas puede revertir esta situación. La nefrectomía laparoscópica de donante vivo constituye un desafío de la cirugía urológica actual Objetivo: Presentar caso inicial y técnica quirúrgica de nefrectomía laparoscópica en donante vivo Paciente y método: En agosto de 2001 se realizó la primera nefrectomía laparoscópica de donante vivo. Se evaluaron antecedentes y criterios de selección. Se analizó tiempo de isquemia caliente tiempo operatorio, complicaciones, sangrado y necesidad de transfusiones. También requerimientos analgésicos y estadía hospitalaria. Control de función renal en el receptor hasta la actualidad Técnica: Decúbito lateral izquierdo modificado. Por vía transperitoneal, colocación de tres trocares en mesogastrio, supraumbilical y fosa ilíaca derecha. Incisión transversa en idéntica fosa para disección con asistencia manual y extracción del órgano. Utilización de clips LT 400 para he mostasia de arteria y vena. Preservación del uréter con su meso. Resultados: Se seleccionó una paciente de 47 años para nefrectomía laparoscópica derecha asistencia manual. Tiempo operatorio de 2,5 horas. Isquemia caliente de 2,5 minutos. No presento complicaciones ni requirió transfusiones. Buena respuesta con analgésicos por vía oral en 2 días. Alta hospitalaria al tercer día. Conclusiones: La nefrectomía laparoscópica en donante vivo es un procedimiento reproducible el entrenamiento adecuado y factible de realizar con nuestros recursos. Podría en el futuro incrementar la tasa de donantes vivos.
Subject(s)
Humans , Adult , Female , Laparoscopy , Nephrectomy , Kidney TransplantationABSTRACT
BACKGROUND: Elevated pulse pressure, an index of increased large artery stiffness, has been associated with increased left ventricular mass. It is unknown whether this relation is independent or mediated by other blood pressure components. METHODS AND RESULTS: We examined data in 2545 untreated hypertensive subjects (45% women) who underwent echocardiography and 24-h ambulatory blood pressure monitoring. Left ventricular mass increased with all blood pressure components and all associations were closer with ambulatory than with office blood pressure. In a multiple regression analysis, after adjustment for the significant association with age, gender, body weight and duration of hypertension, the proportion of variability of left ventricular mass explained by systolic blood pressure was greater than that explained by other blood pressure components. When different blood pressure components were forced into the same model, the same degree of left ventricular mass variability was accounted for by models including 24-h systolic blood pressure alone, or 24-h mean blood pressure plus 24-h pulse pressure, or 24-h diastolic blood pressure plus 24-h pulse pressure. When 24-h systolic blood pressure and 24-h pulse pressure were forced into the same model, 24-h pulse pressure lost statistical significance. CONCLUSIONS: The association between pulse pressure and left ventricular mass is explained by systolic blood pressure, which is the main pressure determinant of left ventricular mass in essential hypertension.
Subject(s)
Blood Pressure/physiology , Hypertension/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Adult , Blood Pressure Monitoring, Ambulatory , Circadian Rhythm/physiology , Cross-Sectional Studies , Female , Heart Ventricles/physiopathology , Humans , Hypertension/complications , Hypertension/epidemiology , Hypertrophy, Left Ventricular/complications , Hypertrophy, Left Ventricular/epidemiology , Italy/epidemiology , Male , Middle Aged , Multivariate Analysis , Observer Variation , Prevalence , Sex FactorsABSTRACT
A relation between left ventricular (LV) hypertrophy and depressed midwall systolic function has been described in hypertensive subjects. However, a strong confounding factor in this relation is concentric geometry, which is both a powerful determinant of depressed midwall systolic function and a correlate of LV mass in hypertension. To evaluate the independent contribution of LV mass to depressed systolic function, 1827 patients with never-treated essential hypertension (age 48 +/- 12 years, men 58%) underwent M-mode echocardiography under two-dimensional guidance. Relative wall thickness was the strongest determinant of low midwall fractional shortening (r = -0.63, P < 0.0001). The significant inverse relation observed between LV mass and midwall fractional shortening (r = -0.43, P < 0.0001) persisted after taking into account the effect of relative wall thickness (partial r = -0.27, P < 0.0001). Within each sex-specific quintile of relative wall thickness, prevalence of subnormal afterload-corrected midwall systolic function was greater in subjects with, than in subjects without, LV hypertrophy (P < 0.05 for the first, third, fourth and fifth quintile). In a multiple linear regression analysis, both LV mass (P < 0.0001) and relative wall thickness (P < 0.0001) were independent predictors of a reduced midwall fractional shortening. In conclusion, the inverse association between LV mass and midwall systolic function is partly independent from the effect of relative wall thickness. LV hypertrophy is a determinant of subclinical LV dysfunction independently of the concomitant changes in chamber geometry.
Subject(s)
Hypertension/epidemiology , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/epidemiology , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/epidemiology , Adult , Age Distribution , Aged , Blood Pressure Determination , Case-Control Studies , Cohort Studies , Comorbidity , Confidence Intervals , Confounding Factors, Epidemiologic , Echocardiography , Female , Heart Function Tests , Humans , Hypertension/diagnosis , Italy/epidemiology , Male , Middle Aged , Prevalence , Reference Values , Risk Assessment , Risk Factors , Severity of Illness Index , Sex Distribution , Systole/physiologyABSTRACT
OBJECTIVES: This study investigated the prognostic value of left ventricular (LV) mass at echocardiography in uncomplicated subjects with essential hypertension. BACKGROUND: Only a few single-center studies support the prognostic value of LV mass in uncomplicated hypertension. METHODS: The MAssa Ventricolare sinistra nell'Ipertensione study was a multicenter (45 centers) prospective study. The prespecified aim was to explore the prognostic value of LV mass in hypertension. Admission criteria included essential hypertension, no previous cardiovascular events, and age > or =50. There was central reading of echocardiographic tracings. Treatment was tailored to the single subject. RESULTS: Overall, 1,033 subjects (396 men) were followed for 0 to 4 years (median, 3 years). Mean age at entry was 60 years, and systolic/diastolic blood pressure was 154/92 mm Hg. The rate of cardiovascular events (x100 patient-years) was 1.3 in the group with normal LV mass and 3.2 in the group (28.5% of total sample) with LV mass > or =125 g/body surface area (p = 0.005). After adjustment for age (p < 0.01), diabetes (p < 0.01), cigarette smoking (p < 0.01) and serum creatinine (p = 0.03), LV hypertrophy was associated with an increased risk of events (RR [relative risk] 2.08; 95% CI [confidence interval]: 1.22 to 3.57). For each 39 g/m(2) (1 SD) increase in LV mass there was an independent 40% rise in the risk of major cardiovascular events (95% CI: 14 to 72; p = 0.0013). CONCLUSIONS: Our findings show a strong, continuous and independent relationship of LV mass to subsequent cardiovascular morbidity. This is the first study to extend such demonstration to a large nationwide multicenter sample of uncomplicated subjects with essential hypertension.
Subject(s)
Cardiovascular Diseases/diagnostic imaging , Echoencephalography , Hypertension/diagnostic imaging , Hypertrophy, Left Ventricular/diagnostic imaging , Aged , Cardiovascular Diseases/mortality , Cause of Death , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Female , Humans , Hypertrophy, Left Ventricular/mortality , Italy/epidemiology , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/mortality , Prognosis , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVE: The proportion of left ventricular (LV) mass variability explained by blood pressure in essential hypertension is small, and several non-haemodynamic determinants of LV mass have been identified or hypothesized. This study examines the possible relation between blood lipids and LV mass in hypertension. DESIGN: Never-treated non-diabetic hypertensive patients. SETTING: Hospital hypertension outpatient clinics in Umbria, Italy. PATIENTS: We investigated the association between high-density lipoprotein (HDL)-cholesterol and echocardiographic LV mass in 1306 never-treated subjects with essential hypertension. Subjects with previous cardiovascular events, diabetes and current or previous antihypertensive or lipid-lowering therapy were excluded. RESULTS: HDL-cholesterol showed an inverse association with LV mass (r = -0.30, P < 0.001). No association was found between LV mass and total or low-density lipoprotein cholesterol. With multiple linear regression analysis we tested the independent contribution of several potential determinants of LV mass in women and in men. Average 24 h blood pressure (both pulse and mean), body mass index, height, stroke volume, age (all P < 0.01) and low HDL-cholesterol (P < 0.0001 in women, P < 0.001 in men) were associated with a greater LV mass in both sexes. Triglycerides showed a weak univariate association with LV mass in women (r = 0.11, P < 0.02), which did not hold in a multivariate analysis. CONCLUSIONS: Low HDL-cholesterol is an independent predictor of LV mass in untreated hypertensive subjects. Common hormonal and metabolic mechanisms, including insulin resistance, could explain this association, which may contribute to the adverse prognostic significance of low HDL-cholesterol levels.
Subject(s)
Cholesterol, HDL/blood , Hypertension/blood , Hypertension/complications , Hypertrophy, Left Ventricular/etiology , Adult , Blood Pressure , Body Mass Index , Echocardiography , Female , Humans , Hypertension/diagnostic imaging , Hypertrophy, Left Ventricular/diagnostic imaging , Lipids/blood , Male , Middle Aged , Multivariate Analysis , Sex Characteristics , Stroke VolumeABSTRACT
Large artery intima-media thickness (IMT) is considered an integrated marker for the total individual burden of arteriosclerosis, and a graded index for cardiovascular risk. However, several different aggregate indexes of IMT on B-mode ultrasound have been used by various investigators, and the optimal number of IMT readings is currently unsettled. In 128 newly diagnosed, never treated, uncomplicated hypertensive subjects aged <55 years (43 +/- 9 years, blood pressure [BP] 152/99 mm Hg), we measured left ventricular mass (M-mode echocardiography, average of five or more measurements) and IMT of common carotid and common femoral arteries. For each segment, 12 IMT measurements were performed, and the average of 1 and 3 readings (right far wall), 6 readings (right side), and 12 readings (right and left side, far and near wall, 3 sampling points) was analyzed. The relation of IMT with left ventricular mass increased progressively with increasing number of readings, from 0.35 (1 reading) to 0.51 (12 readings) for common carotid artery, and from 0.31 to 0.56 for common femoral artery (both P <.001). For each 0.2-mm increase in common femoral IMT, the age-adjusted relative risk of having left ventricular hypertrophy was 1.31 for 1 reading, and increased up to 3.59 for the average of 12 readings. In summary, the association of IMT with left ventricular mass depends strongly on the number of IMT readings. The average of several readings in each segment, including right and left side and far and near wall, carries the closest association to left ventricular mass, and should be preferred for clinical purposes in hypertensive subjects.
