Transient but not sustained blood pressure increments by occupational noise. An ambulatory blood pressure measurement study.

OBJECTIVE: Studies on the effects of chronic exposure to industrial noise on clinic blood pressure (BP) at rest have yielded inconsistent results. The aim of this study was to evaluate the effect of occupational noise exposure on ambulatory blood pressure (ABP) in normotensive subjects. METHODS: We studied 476 normotensive workers, aged 20-50 years (systolic blood pressure (SBP) < 140, diastolic blood pressure (DBP) < 90), at a metallurgical factory; 238 were exposed to high levels of noise (> 85 dB), while 238 were not exposed (< 80 dB). Clinical evaluation included measurements of casual BP (by standard mercury sphygmomanometer, Korotkoff sound phase I and V) and heart rate (HR) (by pulse palpation), body height and weight. All subjects underwent a 24 h non-invasive ABP monitoring (by SpaceLabs 90207 recorder; SpaceLabs, Redmond, Washington, USA) twice within 14 days: one during a normal working day and one during a non-working day. Measurements were performed every 15 min. Computed analysis of individual recordings provided average SBP, DBP and HR values for 24 h, daytime working hours (0800-1700 h), daytime non-working hours (1700-2300 h) and night-time (2300-0800 h). RESULTS: No significant difference in clinic SBP, DBP and HR was observed between exposed and non-exposed subjects. Results obtained by ABP monitoring showed in the exposed workers: (a) a higher SBP (by a mean of 6 mmHg, P < 0.0001 versus controls) and DBP (by a mean of 3 mmHg, P < 0.0001) during the time of exposure and the following 2 or 3 h, whereas no difference between the two groups was found during the non-working day; (b) an increase in HR, which was present not only during the time of exposure to noise (+3.7 beats-per-minute (bpm), P < 0.0001 versus controls), but also during the non-working hours (+2.8 bpm, P < 0.001) and during the day-time hours of the non-working day (+2.8 bpm, P < 0.003); (c) a significant increase in BP variability throughout the working day. CONCLUSIONS: These findings suggest that in normotensive subjects below the age of 50 years, chronic exposure to occupational noise is associated with a transient increase in BP, which is not reflected in a sustained BP elevation. The possible role of repeated BP and HR fluctuations due to frequent and prolonged exposure to noise in accounting for the higher prevalence of hypertension reported in noise-exposed workers above age 50 years, requires longitudinal studies to be clarified.

Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study.

The aim of this study was to compare the effect of antihypertensive treatment with valsartan or cavedilol on sexual activity in hypertensive men who were never treated for hypertension. A total of 160 newly diagnosed hypertensive men (diastolic blood pressure [DBP] > or = 95 mm Hg and < 110 mm Hg), aged 40 to 49 years, all married and without any previous sexual disfunction, were enrolled. After a 4-week placebo period, the patients were divided into two groups: a) 120 patients were randomized to receive carvedilol 50 mg once daily or valsartan 80 mg once daily for 16 weeks according to a double-blind, cross-over design; after another 4-week placebo period, patients were crossed over to the alternative regimen for a further 16 weeks; b) 40 patients were treated with placebo according to a single-blind design for 16 weeks. At the screening visit and every 4 weeks thereafter, blood pressure (BP) was evaluated and patients were interviewed by a questionnaire about their sexual activity. Blood pressure was significantly lowered by both treatments, with a 48% of normalization with valsartan and 45% with carvedilol. During the first month of therapy, sexual activity (assessed as number of sexual intercourse episodes per month) declined with both drugs as compared with baseline, although the decrease was statistically significant in the carvedilol (from 8.2 to 4.4 sexual intercourse episodes, P < .01) but not in the valsartan-treated patients (from 8.3 to 6.6 sexual intercourse episodes, not significant). Ongoing with the treatment the sexual activity further worsened with carvedilol (3.7 sexual intercourse episodes per month) while fully recovered and also improved with valsartan (10.2 sexual intercourse episodes per month). The results were confirmed by the cross-over. Erectile dysfunction was a complaint of 15 patients with carvedilol (13.5%), one patient with valsartan (0.9%), and one patient in the placebo group. These findings suggest that carvedilol induces a chronic worsening of sexual activity, whereas valsartan not only does not significantly worsen sexual activity but may even improve it.

[Evaluation of the occupational exposure risk to non-ionizing radiation in the working environment in a metal mechanical industry]. / Valutazione del rischio per esposizione professionale a radiazioni non ionizzanti nell'ambiente lavorativo di una azienda metalmeccanica.

Among the various sources of risk present in a metal engineering industry, it is important to take into account the risk related to non ionizing radiations. New technologies, in fact, use radiations in different equipment to an ever increasing extent. It is therefore important, on the basis of the current regulations, to carry out a census, since the frequencies used in the workplaces vary widely. It is also important to measure exposure, in order to limit access areas, but, above all, to measure personal doses, since it is useful to record the personal doses in view of the uncertain regulation and in connection with exposure levels lower than the reference in order to limit non-stochastic effects, as was shown in our study. Information and training of personnel, health surveillance and the specific observation of critical groups of workers, are also of fundamental importance.

The epidemiology of resting heart rate in a male working population: association with blood pressure, age, smoking habits and other cardiovascular risk factors.

AIM: To evaluate heart rate and its relationship with some established cardiovascular risk factors in normotensive and hypertensive individuals. METHODS: We studied 881 1 men, 696 with essential hypertension and 8115 with normal blood pressure, stratified in four age groups: 20-29, 30-39, 40-49 and 50-59 years. Clinical evaluation included measures of heart rate (by pulse palpation), blood pressure (by mercury sphygmomanometer), total cholesterol, triglycerides, blood glucose and fibrinogen, and details of medical history and personal habits, with particular regard to smoking habits. RESULTS: Heart rate, which was significantly higher in hypertensive than in normotensive individuals, showed no significant change with age in the normotensive group, but a slight decline with increasing age in those with hypertension. In the normotensive group, heart rate was significantly higher in smokers than in non-smokers and ex-smokers, and showed no significant variation with increasing age, independently of smoking habits. Among those with hypertension, heart rate was not statistically different in smokers, non-smokers and ex-smokers, and showed a moderate decrease with age in non-smokers and ex-smokers, but did not change with age in smokers. CONCLUSIONS: Both ageing and smoking habits have different effects on heart rate in normotensive and hypertensive individuals.

Comparative study of acipimox and pravastatin in patients with combined hyperlipidemia.

The aim of this study was to evaluate the lipid-lowering effect of acipimox as compared to pravastatin in patients with combined hyperlipidemia. One hundred and six subjects, all males, aged 18-60 years, with total cholesterol (TC) > or = 200 mg/dl, TC/HDL-C ratio > or = 5, triglycerides (TG) > or = 200 and > or = 350 mg/dl were randomized to receive acipimox 250 mg thrice daily or pravastatin 20 mg once daily for 3 months, according to a double-blind, double-dummy design. After a 1-month wash-out period patients were crossed to the alternative regimen for further 3 months. Prior to and at the end of each treatment period, TC, LDL-C, HDL-C, TG, blood glucose, and fibrinogen were evaluated. Both acipimox and pravastatin significantly decreased TC, LDL-C, TC/HDL-C ratio and TG and increased HDL-C, without affecting plasma glucose. However, at the dosages employed in the study acipimox was more effective in reducing TG and increasing HDL-C levels, whereas pravastatin was more efficient in decreasing TC and LDL-C. There was no difference between the 2 treatments in their effects on TC/HDL-C ratio. Unlike pravastatin acipimox caused a slight but significant reduction in fibrinogen plasma levels. No serious adverse event was observed with either drug, but a major incidence of side-effects was reported during treatment with acipimox. Our findings suggest that, although both drugs at the standard dose employed in the study were effective in improving the lipid profile; in the treatment of combined hyperlipidemia acipimox might be preferable in the presence of more pronounced hypertriglyceridemia with low levels of HDL-C, whereas pravastatin might be more useful when hypercholesterolemia is predominant.

Cigarette smoking and blood pressure in a worker population: a cross-sectional study.

BACKGROUND: Cigarette smoking has been reported to cause an acute increase in blood pressure (BP). Nevertheless, many epidemiological studies have found lower average BP values in smokers than in non-smokers. The aim of this study was to evaluate the possible existence of a systematic difference in BP values between smokers and non-smokers in a worker population. METHODS: We studied 7109 employees of a metallurgical factory, all men, aged 18-60 years, 3237 non-smokers and 3872 smokers; of the latter, 816 smoked less than 10 cigarettes per day (light smokers), the others smoked 10 or more cigarettes per day. Clinical examination included measures of resting BP (by mercury sphygmomanometer), heart rate (HR) (by pulse palpation), body weight and height. Data were adjusted for age and body mass index (BMI). Four age groups (18-30, >30, >40 and >50 years) and 3 BMI groups (< 25, 25-30, >30) were considered. RESULTS: In smokers, the adjusted values of systolic BP (SBP) and HR (127.72 mmHg and 75.16 beats/min, respectively) were slightly but significantly higher than in non-smokers (127.1 mmHg, P < 0.05 and 72.64 beats/min, P < 0.001), whereas diastolic BP (DBP) was significantly lower (83.37 versus 84.31 mmHg, P < 0.001). Considering the amount of cigarettes smoked, the mean BP values of light smokers were not significantly different from those of subjects smoking 10 or more cigarettes per day, whereas HR mean values were significantly higher in the latter. The prevalence of hypertension (WHO criteria) was similar in smokers and non-smokers in each age group. CONCLUSIONS: Our data showed slightly but statistically higher SBP and HR, and lower DBP mean values in smokers than in non-smokers; however, the differences in BP, although significant from the statistical point of view, were not of actual clinical significance.

Community control of hypertension at work-site: epidemiological data of the Agusta project.

In order to set up a program of community control of hypertension at the work site, 8811 employees belonging to 12 factories of the same company (Agusta SpA, Italy) were screened. Seven hundred and seventy-two subjects (8%) were found to be hypertensive; 48% of them were hypercholesterolemic, 44% were smokers, 5% presented with hyperglycemia and 4% had left ventricular hypertrophy. Multiple regression analysis showed a significant correlation between hypertension and age, hypercholesterolemia, body mass index, occupational exposure to noise exceeding 80 dB and, below the age of 40 years, the type of job. Seven hundred and twenty-nine hypertensives were assigned to pharmacological treatment. This group of patients will be followed up for 3 years.

Effects of different antihypertensive drugs on plasma fibrinogen in hypertensive patients.

1. In order to evaluate whether treatment with different antihypertensive drugs would affect plasma fibrinogen levels, 118 mild to moderate essential hypertensive subjects, all males, aged 18 to 65 years, were randomly treated with amlodipine 10 mg, atenolol 100 mg, hydrochlorothiazide 25 mg or lisinopril 20 mg, all given once daily for 8 weeks. 2. Before and after 8 weeks' treatment, blood pressure (BP), heart rate (HR), fibrinogen, total cholesterol (TC), HDL-C, LDL-C, triglycerides (TG), plasma glucose, plasma uric acid, serum creatinine and serum potassium were evaluated. 3. All four medications significantly reduced BP values, although the BP lowering effect of lisinopril, amlodipine and atenolol was significantly greater compared with that of hydrochlorothiazide. 4. Plasma fibrinogen levels were unaffected by atenolol, hydrochlorothiazide and amlodipine, whereas they were significantly decreased by lisinopril (-11.2%, P = 0.002). This fibrinogen lowering effect was more evident in smokers (-17.7%) than in non smokers (-7.4%). 5. Atenolol and amlodipine did not significantly affect plasma lipids, hydrochlorothiazide increased TC, LDL-C and TG and reduced HDL-C; lisinopril increased HDL-C and decreased TC and LDL-C. 6. Hydrochlorothiazide increased plasma glucose and uric acid concentrations, which were unaffected by the other drugs. The diuretic also reduced serum potassium. 7. The results of this study indicate that lisinopril reduces levels of plasma fibrinogen and confirm that different antihypertensive drugs may elicit different metabolic effects, which may variously influence the overall risk profile of the hypertensive patients.

Associations between plasma fibrinogen levels and cardiovascular risk factors in hypertensive men.

BACKGROUND: Fibrinogen levels are reported to be elevated in hypertensive patients and tend to cluster with nearly all other established cardiovascular risk factors. The aim of this study was to evaluate the relationship between plasma fibrinogen and a number of other cardiovascular risk factors in patients with essential hypertension. METHODS: We studied 118 men with essential hypertension, aged 18-65 years. The clinical evaluation included measurements of blood pressure (mercury sphygmomanometer, Korotkoff I and V), levels of plasma fibrinogen, total cholesterol, high-density-lipoprotein (HDL) cholesterol, triglycerides and blood glucose and the ratio of total-cholesterol to HDL-cholesterol levels; a detailed history of medical and personal habits was also recorded. RESULTS: As expected, plasma fibrinogen levels were significantly higher in smokers than in non-smokers, with the number of cigarettes smoked correlating positively with the fibrinogen level. Patients with a total-cholesterol level in excess of 220 mg/dl had significantly higher fibrinogen levels, and both univariate and multivariate analyses showed total-cholesterol and fibrinogen levels to be positively correlated. A weaker but significant relationship was noted between the fibrinogen level and triglyceride levels (P = 0.0017) and between the fibrinogen level and the ratio of total-cholesterol to HDL-cholesterol levels (P = 0.0006). Fibrinogen levels were not significantly associated with either systolic or diastolic blood pressures. CONCLUSION: A family history of hypertension appears to potentiate the tendency of fibrinogen to cluster with other cardiovascular risk factors in hypertensive patients.

Fibrinogen levels in normotensive and hypertensive men: a cross-sectional study.

BACKGROUND: The aim of this study was to compare plasma fibrinogen levels in hypertensive and normotensive men. Possible confounding factors, such as age, cholesterol levels, body-mass index and smoking habits were also to be considered. METHODS: We studied 708 men with essential hypertension (according to the World Health Organization's criteria) and 944 with normal blood pressures, all of whom had similar lifestyles; the overall age range was 18-60 years. The clinical evaluation included measurements of blood pressure, heart rate, body weight and height as well as a medical examination and personal habits history. After an overnight fast, blood samples were taken in order to measure fibrinogen and total-cholesterol levels. RESULTS: The mean fibrinogen level did not differ between the groups, although the distribution of the levels was different and was J-shaped in the hypertensive group. Plasma fibrinogen levels increased significantly with age in both groups. A significant positive correlation was found between fibrinogen and total-cholesterol levels, but not between fibrinogen and body-mass index or systolic or diastolic blood pressures. Cigarette smokers had significantly higher fibrinogen levels than non-smokers, irrespective of their blood pressure status; ex-smokers had intermediate values, suggesting a direct but reversible effect of tobacco. In cigarette smokers, fibrinogen levels increased with the number of cigarettes smoked, which is indicative of a dose-response relationship. CONCLUSION: This study confirms the strong association between fibrinogen levels and smoking and the weaker association with age and total-cholesterol levels. Mean fibrinogen level was not significantly related to blood pressure, although the distribution of fibrinogen levels appeared to be J-shaped in hypertensive men.

Occupational noise exposure and blood pressure.

OBJECTIVE: To investigate the relationship between occupational noise exposure and blood pressure. METHODS: We studied 8811 workers at a metallurgical factory, who were exposed to different levels of noise at the worksite: < or = 80 dB for 8078 workers and > 80 dB for 733 workers. A clinical examination, including measurements of blood pressure (by mercury sphygmomanometer, Korotkoff phases I and V), heart rate (by pulse palpation), body weight and height, was performed. The subjects were stratified into four age groups (18-30, 31-40, 41-50 and > 50 years) and into two body mass index groups: normal weight (< or = 25 kg/m2) and overweight (> 25 kg/m2). In order to eliminate possible confounding factors and statistical bias, a retrospective case versus control analysis was also carried out. RESULTS: The epidemiologic approach showed that the systolic blood pressure (SBP) but neither the diastolic blood pressure (DBP) nor the heart rate values were statistically higher in the group who were exposed to noise levels of > 80 dB, although the difference could be considered clinically relevant only in the older age group. The prevalence of hypertension (according to World Health Organization criteria) was higher among the workers who were exposed to the higher levels of noise. Stratification for body mass index confirmed the existence of a higher prevalence of hypertension in the exposed group. The results from the case versus control analysis indicated that both the SBP and the DBP levels in the exposed group were significantly higher than those in the reference group, and confirmed the existence of a higher prevalence of hypertension in the exposed group. CONCLUSIONS: The present data suggest that occupational exposure to noise levels exceeding 80 dB may lead to a higher prevalence of hypertension and to increased blood pressure values, although the results appear quantitatively different according to the approach that is taken to the problem (i.e. the epidemiologic or the case versus control approach).

[Use of propofol and buprenorphine for total intravenous anesthesia]. / L'impiego del propofol e della buprenorfina per una anestesia totalmente endovenosa.

A study was carried out in 47 patients undergoing general surgery and elective gynecological surgery under totally endovenous general anesthesia. For this purpose, propofol and buprenorphine were used in controlled ventilation with oxygen and air, totally excluding the use of nitrous oxide and halogenate vapours. The following parameters were measured to evaluate the state and depth of anesthesia: arterial pressure (systolic, mean, diastolic), heart rate, sweating, lacrimation (Evan's PRST). The awakening from anesthesia was evaluated using Steward's test. The results of monitoring show that the method represents a valid alternative to anesthesia using inhalatory techniques. Nonetheless, the Authors underline the need for further research on the subject.