Age-related changes in blood pressure twenty-four-hour pattern in normotensive subjects of two populations.

OBJECTIVES: This study investigates the systolic (S) and diastolic (D) blood pressure (BP) 24-h pattern in normotensive healthy subjects belonging to two populations characterized respectively by a "non-salt culture" (Italian subjects) and a "salt culture" (Japanese subjects) in their dietary salt intake (4-6 g/day in Italians vs 10-12 g/day in Japanese). The comparison was performed by taking into consideration the within-day variability (WDV) and circadian rhythmicity (CR) of BP with respect to age. MATERIALS AND METHODS: Subjects investigated were 862 normotensive healthy subjects (308 Italians and 554 Japanese), stratified by age from 16 to 75 years, who volunteered for a noninvasive BP monitoring in an ordinary day of their life. The SBP and DBP time series were analyzed via conventional parametric statistics as well as chronobiological procedures. RESULTS: The biometric estimates demonstrate that BP changes in its WDV and CR as a function of age in both populations. Despite the difference in their habitual salt intake, the age-related changes in BP WDV and CR result to be almost comparable at the cross-sectional contrasts, giving origin to age-related trends for SBP and DBP which are significantly parallel. CONCLUSIONS: The comparability of BP WDV and CR in the two populations with a substantial difference in salt intake suggests that the normotensive status in human races is realized despite the difference in their habitual salt intake. This implies the ancestral development of mechanism(s) of adaptation to the possible "sodium luxus consumption". Although the adaptive mechanisms which provide a normotensive regimen under different conditions of sodium intake are almost unexplored, the racial adaptation to dietary salt constitutes, however, the initial condition for the cause-effect nexus between dietary salt intake and hypertension in human populations.

Lower 24-h blood pressure regimen in subjects with a familial genealogy of longevity.

OBJECTIVE: This study investigates the 24-h blood pressure (BP) pattern in longevous subjects and their progeny, in order to validate the hypothesis that the human beings who live beyond their longest expectancy of life should be protected from developing hypertension. Such a characteristic feature is supposed to be a biological aspect of human longevity which can be transmitted to the progeny. MATERIALS AND METHODS: The study was carried out on 92 elderly subjects, (45 M, 47 W, 76-102 years), and 28 firstborn descendants of the first (7 M, 7 W, 36-55 years) and second (7 M, 7 W, 16-26 years) generation, in clinical health. The control subjects were 308 clinically healthy individuals (154 M, 154 F, 16-75 years) of the common population, stratified by age. RESULTS: The longevous subjects were found to show a diastolic daily mean level less pronounced than expected, according to the BP age-related trend in the common population. Both the children and grandchildren of the longevous subjects were seen to show a systolic and diastolic daily mean level significantly less pronounced than in their coeval subjects of the common population. CONCLUSIONS: Because of the unexpected lower diastolic BP daily mean level in the very old subjects, the hypothesis that the longevous subjects might be protected from developing hypertension via the arteriolar vasoconstriction seems to be confirmed. Because of the lower systolic and diastolic BP in young and adult subjects with a positive familiarity for longevity, the hypothesis that the hemodynamic protection from senile hypertension might be an inheritable biological feature of the longevity seems to be acceptable.

Construction of age-related reference limits for 24-h blood pressure pattern.

Blood pressure (BP) is recursively variable during the day-night cycle because of a physiological circadian rhythm. The aim of this study is, therefore, to show how to construct the population reference limits (desms) for BP in its time varying 24-h pattern, starting from a small sample, in order to facilitate their use in a local context. The sample for standardization comprised 427 clinically healthy subjects (211 males and 216 females), ranging in age from 16 to 100 years, attending their routine activities. The procedure begins with the statistical biometry related to the sample, and proceeds with the computation of the BP desms related to (1) the time-qualified discrete values; (2) the parameters of circadian rhythm; (3) the daily pressure load. The pertaining rules are explained step by stop, allowing each one to prepare the proper local desms for BP 24-h pattern. These standards may be useful for validating the individual BP monitoring according to the upper limits of the circadian physiological variability in the diagnostic procedure for identifying hypertensive subjects.

Siesta, night sleep and blood pressure dropping.

BACKGROUND: The drop in blood pressure during the night sleeping hours is well documented. Less is known about the drop in blood pressure during daytime sleep. The objective of this survey is to describe the dropping during conventional and referred sleeping hours of night and afternoon sleep, and the relation of the dropping to individual characteristics.METHODS: One hundred and seven consecutive patients, who had undergone blood pressure monitoring between February 1993 and October 1994, were studied. Takeda automatic monitors programmed to provide readings at 0.5 h intervals during a period of 24 h were used. For each patient the following information was recorded: age, sex, height and weight, creatinine, and actual sleeping hours recorded on a diary. RESULTS: There was a clinically important decline both in diastolic (12 mmHg) and in systolic (15 mmHg) blood pressure during night sleep compared with awake time blood pressure. A greater decline was observed among untreated hypertensive individuals. No difference in the average blood pressure during the night sleep was observed between conventional sleeping hours and sleeping hours as recorded by the patient. Among patients with afternoon nap, a similar blood pressure was recorded during the sleeping hours (night and afternoon). No association was found between body mass index, estimated creatinine clearance and awake-asleep differences in blood pressure; only a weak correlation was found between age and blood pressure differences. CONCLUSION: Our findings confirm that a substantial decline of blood pressure occurs during night and afternoon sleep compared with that during awake time. We did not find a clinically relevant difference in blood pressure between conventional day-periods and awake and sleeping hours as reported by the patients.

[The Campodimele study: 24-hour blood pressure in rural life style subjects]. / Studio di Campodimele: la pressione arteriosa di 24 ore in soggetti con stile di vita rurale.

The present paper is aimed at investigating the daily blood pressure in subjects with a rural style of life with the purpose of detecting whether or not the blood pressure regimen is influenced as expected because of the stress less prominent in the non-urban areas. Control data were obtained by the study of age- and sex-matching subjects with a metropolitan style of life. The results indicate the blood pressure has a lower daily level in rural subjects as compared to urban subjects. The daily baric impact is also lower, suggesting that the blood pressure regimen is really less pronounced in those who live according to a rural style of life. Such a lower magnitude allows us to experimentally suggest that the rural life is concrete in protecting the hemodynamic system from the higher level of blood pressure which are observable in subjects who live according to a metropolitan style of life. Interestingly, the expected phase anticipation in blood pressure circadian rhythm of rural subjects was not detected, as the wake up time was not so anticipated to act as a synchronizer.

Campodimele study: blood pressure and heart rate pattern in clinically healthy elderly subjects.

Noninvasive ambulatory blood pressure (BP) monitoring is a developing method in clinical practice. Its interpretation needs reference standards stratified by age and gender. This study addresses ambulatory BP monitoring in elderly people with the purpose of quantifying the discrete and periodic variability of BP pattern over a 24-h period. The ABPM was performed in 92 clinically healthy subjects (45 men and 47 women) ranging in age from 76 to 102 years. The results refer to the time-qualified mean values with their dispersion, to the circadian rhythm with its parameters, and to the daily baric impact (BI) with its variability. The conclusion is drawn that BP preserves its nychtohemeral variability and circadian rhythmicity despite old age. The daily BP mean level and BI in older people in good health are comparable with those of young subjects, suggesting that humans surviving into old age are characterized by a eugenic control of their pressure regimen.

[Chronobiological standards of 24-hour arterial blood pressure validated by bayesian criteria]. / Standard cronobiologici della pressione arteriosa di 24-h stimati con criteri bayesiani.

The monodiagnosis of hypertension via ambulatory (A) blood pressure (BP) monitoring (M) is erroneous by definition. Its use has to be substituted by the chronodiagnosis. Because of the lack of an international standardization, the BP chronobiologic reference limits have to be computed on a small sample size. For this compilation, it is, however, unavoidable the recruitment of normotensive subjects using the WHO's fixed limits. These chronobiologic standards are by principle contaminated by false negatives and need a bayesian validation. Such a depuration has been made by reclassifying each subject using the BP time-qualified standards. A secondary sample was constituted on the true normotensive reclassified. This sample provided the a posteriori reference standards for BP. The bayesian chronobiologic reference standards seem to be the limits with which the chronodiagnosis of hypertension can be suitably done via ABPM.

[A 24-hour blood pressure and heart rate pattern in healthy persons over 70 years of age. A Campodimele study]. / Comportamento di 24-h della pressione arteriosa e della frequenza cardiaca in vecchi sani ultrasettuagenari. Studio di Campodimele.

The present report is aimed at studying the 24-h pattern of blood pressure in elderly subjects (45 men and 47 women, aged from 76 to 102 years), recruited in Campodimele, a small city where the population of ultra septuagenaries is very dense. The investigation has been performed by mean of ambulatory non-invasive monitoring combined with chronobiometric estimates. The computation has been performed on raw data, rhythmic series and integral profiles. The analysis has been stratified according to sex. The tabulated estimates constitute an index of reference for blood pressure 24-h pattern in aged people.

Hürthle cell hyperplasia and sarcoidosis of the thyroid.

We report of a case of Hürthle cell hyperplasia of the thyroid that was correctly identified preoperatively by fine-needle aspiration cytology but was unexpectedly associated with sarcoid granulomas. To our knowledge, the association has not been previously reported. The rarely described thyroid involvement by sarcoidosis is briefly reviewed.

[24-hour blood pressure: effects of sports in aged subjects]. / La pressione arteriosa di 24-h: effetto dello sport in soggetti anziani.

The present study deals with the blood pressure (BP) and heart rate (HR) 24-h pattern in aged people of both sexes ranging in age from 66 to 75 years. 20 subjects were active in agonistic sports (running and swimming), 20 others had sedentary habits. BP and HR were studied by non-invasive monitoring along with chronobiometric analysis. The BP and HR 24-h pattern was seen to preserve its circadian rhythm in both aged athletes and sedentary elderly. The analysis reveals that the aged athletes show a higher mesor for systolic BP and a lower mesor for diastolic BP and HR. The daily pressure load, as the integral of the BP 24-h values multiplied by the HR mesor, is lower in aged people practising sport as compared to age-matched individuals with sedentary habits. The spectral analysis reveals that physical exercise acts to change the time structure of BP and HR 24-h patterns. The conclusion is drawn that active sport plays beneficial effects in aged people because of a lower pressure load.

[Influenza vaccination and polyradiculoneuritis of the Guillain-Barré type]. / Vaccinazione antinfluenzale e poliradicoloneurite a tipo sindrome di Guillan-Barré.

The Authors present a Guillain-Barré like case of polyradiculoneuritis occurring two weeks after the 1988-89 influenza vaccination. The existence of similar cases recently reported in the literature and their frequent association with swine influenza vaccination suggest the opportunity of a better epidemiological survey of similar cases.

Pernicious anemia, vitiligo and positive antiglobulin test: an unusual association.

The authors present the case of a patient with concomitant pernicious anemia and positive antiglobulin test. After discussing previous cases in the literature and pointing out the probably simultaneous occurrence of the two, the authors comment on the persistence of a positive antiglobulin test after remission of the pernicious anemia and the association with vitiligo, which has been sometimes described as associated with autoimmune hemolytic anemia and more often with pernicious anemia, but not with both. The patient also had diabetes mellitus and a persistently false positive test for syphilis.

An unusually severe subacute motor neuronopathy in Hodgkin's disease.

A patient in whom an unusually severe Hodgkin's disease was complicated by subacute motor neuronopathy is described. This is a syndrome involving the lower motor neurons, recently described in patients with Hodgkin's disease and other lymphomas; its course is more often benign, and independent from that of the underlying lymphoma. In our patient it was unusually severe. Its pathological features are described. We found only 13 cases of subacute motor neuronopathy reported in current literature, with pathological documentation in 5 of these. A brief discussion and review of the literature follow.

Influenza vaccination with live-attenuated and inactivated virus-vaccines during an outbreak of disease.

Immunization procedures with live attenuated and inactivated vaccines were carried out on a group of young recruits at the beginning of an outbreak of infection due to an A/Victoria/3/75-related virus strain, which occurred in February 1977 in a military camp. A retrospective investigation on protection from clinical influenza was then performed in order to investigate whether immunization with live virus vaccines, administered at the beginning of an epidemic, could provide early protection from the disease. In the course of the two weeks following vaccination, laboratory-confirmed clinical influenza cases occurred in 4 subjects among the 110 volunteers of the control group which received placebo, and in 8, 7 and 4 subjects respectively of the 3 groups of about 125 individuals, each of which received one of the following vaccine preparations: (a), live attenuated A/Victoria/3/75 influenza virus oral vaccine, grown on chick embryo kidney culture; (b), live attenuated nasal vaccine, a recombinant of A/Puerto Rico/8/34 with A/Victoria/3/75 virus; and (c), inactivated A/Victoria/3/75 virus intramuscular vaccine. These data do not support the hypothesis that, during an epidemic of infection, early protection from clinical influenza can be achieved through immunization with live attenuated or inactivated influenza virus vaccines, in spite of the high immunizing capability of the vaccine preparations.

Protection from natural infection after live influenza virus immunization in an open population.

Live attenuated influenza vaccine containing the recombinant of A/Victoria/3/75 with A/PR/8/34 virus was administered to healthy adults in a field trial aimed at evaluating protection provided by immunization. The study was designed to measure the effect of vaccination on absenteeism from respiratory disease during a natural influenza epidemic. A total of 2115 male employees of the public transport service of Rome volunteered to participate in the trial, 1050 and 1065 receiving vaccine and placebo respectively, in a randomized blind fashion. Vaccination procedure was completed by the end of December 1976. A small-sized outbreak of influenza, due to a viral strain antigenically homologous to the vaccine, occurred during the month of February 1977. Analysis of absenteeism data, classified according to medical certificate, indicated that morbidity from respiratory disease was reduced in vaccinees compared with controls during the epidemic month; the rate of increase of morbidity compared with that of the preceding month was then three times lower in vaccinees than in controls and the difference in absenteeism between the two groups greatly exceeded the ordinary fluctuation that was observed during non-epidemic periods.