Diabetes and coronary risk factors, relative risk for single factors and aggregation of more factors in a general population sample from northern Italy.

In the course of a general population survey in Mirano (Venice), Northern Italy, a random sample of 1,903 subjects (50.1% men) aged 20-59 was examined. Fifty-five were diabetic (fasting plasma glucose greater than or equal to 140 mg/dl or diagnosed by a physician) and 1,670 non-diabetic subjects (fasting plasma glucose below 110 mg/dl). In this paper an assessment was made on the more frequent occurrence of coronary risk factors (serum cholesterol and triglycerides, body mass index (BMI), systolic blood pressure, cigarette smoking) and, in particular, of their aggregation in diabetic patients as compared to non-diabetic controls. The occurrence of any one of the coronary risk factors studied was more frequent in diabetic subjects and significantly so for triglyceridemia in both sexes and for systolic blood pressure and BMI in men. The aggregation of two or more risk factors was also more frequent in diabetic subjects than controls. Finally, the combined score of coronary risk as calculated by multiple logistic function showed higher values for diabetic subjects. These results confirm the need for a systematic search for coronary risk factors in diabetic subjects in order to prevent cardiovascular complications.

Electrocardiographic findings in hypertensive patients of a population sample. Role of sex, age, and antihypertensive treatment.

During the initial phase of the World Health Organization (WHO) "Community Control Program of Hypertension" in Italy, 1190 subjects with high blood pressure derived from a general population random sample (5856 people of both sexes, aged 20 to 64 years) were enrolled in a hypertension register. At the registration visit (RV), each of them gave case history details and underwent a complete clinical examination, blood and urine tests, and a standard 12-lead electrocardiogram (ECG). All the ECGs were read by a single coder, using the second version of the Minnesota Code (MC). We calculated the prevalence of electrocardiographic codes according to sex, age, and the state of antihypertensive treatment. The overall prevalence of electrocardiographic abnormalities (i.e., all codes except 1:0 and isolated 9:4) was 40.8% with a slightly higher prevalence in males than in females: 42.4% versus 39.4%. Codes related to left ventricular hypertrophy (LVH) (3:1 or 3:3) were also more frequent in males (21.2%) than in females (14.5%) but not those related to ischemia (4:1-4:3 or 5:1-5:3). In fact, group 4 codes were present in 4.0% of males and 16.1% of females; group 5 codes, in 5.7% of males and 18.1% of females. Abnormal codes generally increased with increasing age, but those related to LVH did not follow this general rule in males. In fact, in the age class 20-29 years, codes 3:1 were found in 11.1% and codes 3:3 in 17.5% of the subjects, whereas the corresponding frequencies in the oldest age group (60-64 years) were 15.2% and 12.4%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Captopril-stimulated renin in the diagnosis of restenosis after percutaneous transluminal renal angioplasty.

Recurrence of hypertension is reported in a considerable percentage of renovascular hypertensive patients treated by percutaneous transluminal angioplasty (PTRA); among the possible mechanisms for these failures, restenosis of the renal artery is the only correctable one. Since captopril stimulates renin secretion to a greater extent in renovascular than in essential hypertensive patients, we determined if it could be used to unmask significant restenosis in the patients with hypertension recurring after PTRA. Follow-up study was performed in 28 patients treated with PTRA. We found that captopril caused a greater increase in peripheral plasma renin activity in 8 of 8 cases who had recurrence of hypertension and restenosis than in 13 of 15 of the patients who did not. We suggest that the determination of captopril-stimulated renin may provide a useful, simple and economical tool for the detection of restenosis after PTRA.

Intra-erythrocytic sodium content in normotensive offspring of normotensive and hypertensive subjects: an epidemiological study.

An increase in intra-erythrocytic sodium (IENa) content has been proposed as a genetic marker of essential hypertension. Intra-erythrocytic sodium was studied using hypotonic lysis and flame photometry after four washings with isotonic MgCl2 in 240 normotensive subjects (aged 10-45 years) on a free diet with (F+, 121 patients) or without (F-, 119 patients) hypertensive parents, recruited from a random sample of the general population. Systolic blood pressure was significantly higher in males F+ than in males F- (130 +/- 2 versus 125 +/- 2 mmHg, mean +/- s.e.m., P < 0.05), while IENa did not differ. In contrast, intra-erythrocytic potassium content (IEK) was significantly lower and red cell sodium potassium (Na:K) ratio significantly higher in F+ than F-. This might reflect decreased NaK pump activity, or increased membrane permeability to cations which causes increased K leakage. No differences in blood pressure, IENa or IEK showed in female F+ versus F-. It is concluded that IENa is not a genetic marker of hypertension, and that it is probably influenced by exogenous factors. Being associated with differences in blood pressure, the abnormalities of IEK and Na:K ratio might be pathogenetically linked to an early increase in blood pressure.

[Psychological effects in the drug treatment of arterial hypertension. A study during a community preventive program]. / Effetti psicologici del trattamento farmacologico dell'ipertensione arteriosa. Uno studio durante un programma di prevenzione comunitario.

The possibility that antihypertensive drug treatment may induce neurotic symptoms was investigated in a random sample of 114 hypertensives enrolled in an "Hypertension Register" by means of the Kellner and Sheffield Symptom Rating Test (S.R.T.). Of them 73 were on antihypertensive treatment; 41 untreated subjects constituted the control group. Covariance analysis adjusting for age and diastolic blood pressure was used as a statistical test. The comparison between treated and not treated hypertensive subjects did not show any significant difference either for total S.R.T. score (12.6 vs 10.6 in M, 11.6 vs 14.6 in F), or for the partial scores of anxiety (3.5 vs 3.0 in M, 3.1 vs 3.4 in F), depression (2.4 vs 2.2 in M, 2.7 vs 3.5 in F), somatization (4.2 vs 3.2 in M, 3.9 vs 5.6 in F), inadequacy (2.4 vs 2.1 in M, 1.9 vs 2.1 in F). Taking into account the total group (M + F) of treated hypertensives, no significant differences were observed between different treatments (reserpine, alphamethyldopa, clonidine; beta-blockers, diuretics). However beta-blockers and clonidine showed the highest scores for total S.R.T. score (17.3 and 13.2 respectively). The study suggests that the antihypertensive drugs taken into consideration, at least at the given regime, do not induce such psychological side effects as to prevent them being used in a programme of secondary prevention of hypertension.

Psychological effects of hypertension labelling during a community survey. A two-year follow-up.

The possibility that subjects examined during a population screening programme may develop psychological disturbances as a consequence of being labelled as hypertensives has been investigated. The Symptom Rating Test (SRT) for the assessment of neurotic symptoms was completed by 210 screenees. Aware hypertensives were excluded from the study. It was subsequently found that 81 subjects had raised BP (systolic greater than or equal to 160 or diastolic greater than or equal to 95 mmHg; group 1), and 129 subjects were 'normotensive' (group 2). The total SRT score was significantly higher in group 2 than in group 1. After screening, all subjects were returned to their GPs, and 82% of them were re-examined 2 years later. SRT scores were significantly lower than the initial ones in both groups. At re-examination 35% of 'hypertensives', were found to have 'normal' BP values. The SRT scores of these falsely-labelled subjects were similar to those of the subjects found still to be hypertensive. These findings suggest that subjects with raised BP at screening have lower neuroticism scores than normotensives. More importantly still, hypertension labelling, whether 'true' or 'false', does not have any negative long-term psychological consequences.