Papers by Giovanni de Simone
Italian Journal of Medicine, Sep 11, 2017
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European Heart Journal, Aug 1, 2018
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European Journal of Preventive Cardiology, Jul 6, 2023
Aims In the present study, we assessed correlates and their consistency of ascending aorta (AscAo... more Aims In the present study, we assessed correlates and their consistency of ascending aorta (AscAo) measurement in treated hypertensive patients. Methods and results A total of 1634 patients ≥ 18 years old with available AscAo ultrasound were included. Ascending aorta was measured at end-diastole with leading edge to leading edge method, perpendicular to the long axis of the aorta in parasternal long-axis view at its maximal identifiable dimension. Correlations of AscAo and AscAo normalized for height (AscAo/HT) or body surface area (AscAo/BSA) with demographics and metabolic profile were explored. Multi-variable regression was also used to identify potential confounders influencing univariate correlations. Sensitivity analysis was performed using cardiovascular (CV) outcome. Correlations with age, estimated glomerular filtration rate, systolic blood pressure (BP), and heart rate (HR) were similar among the three aortic measures. Women exhibited smaller AscAo but larger AscAo/BSA than men with AscAo/HT offsetting the sex difference. Obesity and diabetes were associated with greater AscAo and AscAo/HT but with smaller AscAo/BSA (all P < 0.001). In multi-variable regression model, all aortic measure confirmed the sign of their relations with sex and metabolic profile independently of age, BP, and HR. In Kaplan–Mayer analysis, only dilated AscAo and AscAo/HT were significantly associated with increased risk of CV events (both P < 0.008). Conclusions Among patients with long-standing controlled systemic hypertension, magnitude of aortic remodelling is influenced by the type of the measure adopted, with physiological consistency only for AscAo and AscAo/HT, but not for AscAo/BSA.
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Journal of The American Society of Echocardiography, Feb 1, 2023
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Journal of Human Hypertension, Jun 16, 2020
In this issue of Journal of Human Hypertension, two positions face to each other relatively to th... more In this issue of Journal of Human Hypertension, two positions face to each other relatively to the relevant question of target blood pressure to achieve in the very old hypertensive patients under pharmacologic treatment [1, 2]. The two positions present different points of views, substantially reflecting the different approaches of American and European recent guidelines [3, 4]. In general, the differences between European and American guidelines are less than what they appear just focusing on the target levels of blood pressure to be achieved, but clearly there is a different approach for the very old patients (Fig. 1). American guidelines do not make any difference related to age and suggest decreasing systolic blood pressure below 130 mmHg in all hypertensive patients, possibly forcing below 120 mmHg anytime this is made possible by the patient’s conditions. The ESC/ESH 2018 guidelines present a more articulated position on blood pressure targets, according to age strata, and suggest for persons aged >80 years a target range of systolic blood pressure between 130 and 140 mmHg, discouraging to go below 130 mmHg. In addition, the ESC/ESH guidelines recommend paying special attention to frailty and tolerability of treatment. In addition, ESC/ESH guidelines strongly suggest to start with monotherapy in persons aged >80 years while American guidelines only recommend cautions when starting dual therapy. The American position was substantially driven by the results of the SPRINT trial [5], demonstrating a clear prognostic benefit of intensive treatment (with systolic blood pressure target <120 mmHg), compared to standard treatment (with systolic blood pressure target <140 mmHg). The trial was interrupted and, therefore, the follow-up was shorter than was programmed (median= 3.26 years). The success of the intensive treatment arm in the SPRINT had a cost in terms of side effects and serious adverse events, with increased incidence of hypotension, syncope, electrolyte abnormalities (including both hypokalemia and hyponatremia) and even acute kidney injury or acute renal failure (all 0.006 < p < 0.0001) [5]. As also recalled in the Angeli et al. position paper [2], the SPRINT investigators also performed analyses in the sub-population >75 years [6] and found the same protective effect of intensive treatment as in the entire study population, suggesting that aggressive blood pressure reduction may be a winner strategy also in the very old. However, the trend in serious adverse events was exactly the same as in the main study, though the HRs could not achieve statistical significance (Table 1). The lack of such a statistical significance does not affect the biological meaning of the results, especially in some specific adverse side effect, as has been recently highlighted in a consensus document from statisticians [7], especially when applied to subgroup analyses that might be clearly underpowered. Overall, even assuming that in the SPRINT the success of the intensive treatment option is by far better than the traditional approach, the cost that the strategy pays is four serious adverse events for each saved life. Considering these numbers does not mean that in some specific case we cannot try to go further down with blood pressure. The most quoted HYVET study [8] demonstrated a promising success in the aggressive control of blood pressure in elderly, but recruited a study population that was very healthy, virtually without co-morbidities. In contrast, in our daily practice the old hypertensive patients coming to our observation have one and more often more than one co-morbidity, and, especially, they have often isolated systolic blood pressure, with low diastolic blood pressure, how Ruilope and RuizHurtado underline in their position document [1]. The ESC/ESH 2018 Guidelines consider carefully also diastolic blood pressure in their recommendations, indeed. When recommending to maintain systolic blood pressure between 130 and 140 in both age groups, 65–80 and over 80, the European guidelines also recommend to keep * Giovanni de Simone simogi@unina.it
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Monaldi archives for chest disease, Mar 19, 2018
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Journal of Hypertension, Sep 1, 2019
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High blood pressure & cardiovascular prevention, May 2, 2018
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European Journal of Internal Medicine, Jul 1, 2020
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Nutrition Metabolism and Cardiovascular Diseases, Feb 1, 2019
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European heart journal open, Aug 7, 2021
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Cardiovascular Diabetology, May 12, 2017
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Cardiovascular Diabetology, Apr 30, 2019
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Ndt Plus, Jul 19, 2023
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European Heart Journal, Oct 1, 2022
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European Journal of Internal Medicine, Nov 1, 2020
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Journal of Clinical Medicine, Jul 17, 2019
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Hypertension, Jul 1, 2023
Background: Arterial hypertension causes cardiac functional and structural alterations. In hypert... more Background: Arterial hypertension causes cardiac functional and structural alterations. In hypertensive patients without flow-limiting epicardial coronary artery disease, we investigated possible relationships between positron emission tomography/computed tomography–derived myocardial blood flow (MBF) and echocardiographic parameters of left ventricular (LV) performance, including mechano-energetic efficiency indexed for myocardial mass (MEEi). Methods: Seventy-eight hypertensive patients without flow-limiting epicardial coronary artery disease underwent echocardiography, including MEEi computation, and cardiac positron emission tomography/computed tomography with assessment of MBF/mass ratio at rest and after stress and myocardial flow reserve. The lowest MEEi tertile (MEEi&lt;0.031 mL/s/g) was compared to the merged second and third tertiles (MEEi≥0.031). Results: Patients in the lowest MEEi tertile were older, had higher systolic blood pressure and body mass index. They also had higher prevalence of LV hypertrophy, whereas lower resting and stress MBF/mass ratio. MEEi was significantly correlated with both resting (r=0.51; P &lt;0.0001) and hyperemic (r=0.54; P &lt;0.0001) MBF/mass ratios, whereas it was not related to myocardial flow reserve. Delta of MBF/mass ratio was lower in the lowest MEEi tertile than in the highest ( P &lt;0.0001). In separate multiple linear regression models, after adjusting for sex, systolic blood pressure, body mass index, prevalence of LV hypertrophy, left atrial volume index, and diuretic therapy, the association between LV MEEi and both hyperemic (beta coefficient=0.44; P =0.003) and resting (beta coefficient=0.35; P =0.008) MBF/mass ratio remained significant. Conclusions: In hypertensive patients without flow-limiting epicardial coronary artery disease, low values of MEEi could detect an early LV dysfunction involving an impairment of both resting and hyperemic MBF/mass ratios. MEEi has the advantage of simpler detection, cheaper costs than positron emission tomography/computed tomography, and a lack of radiation exposure. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02211365.
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Journal of Hypertension, 2018
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Nutr Metab Cardiovasc Dis, 2013
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Papers by Giovanni de Simone