Blood pressure variability was studied in 8 "labile" and in 8 "established" hypertensive patients... more Blood pressure variability was studied in 8 "labile" and in 8 "established" hypertensive patients by means of continuous unrestricted blood pressure recording for 24 hours. In 7 of the former and 5 of the latter the effect of atenolol (200 mg/day) was also investigated. Blood pressure variability as judged by circadian rhythm, standard deviation, coefficient of variation, indexes of skewness and kurtosis was similar in the two groups. The only significant difference consisted in the mean arterial pressure which was higher in the established than in the labile hypertensives. Atenolol produced in all subjects a fall in blood pressure but no significant changes in the standard deviation, coefficient of variation and index of skewness. On the contrary the index of kurtosis significantly increased suggesting a more stable blood pressure after treatment.
The association between obesity and all-cause mortality is controversial and may differ according... more The association between obesity and all-cause mortality is controversial and may differ according to subjects' characteristics. Blood pressure variability (BPV) may be increased in obese individuals and thus impair prognosis. The purpose of this study was to evaluate whether the relationship between obesity and mortality is influenced by short-term ambulatory BPV. The analysis was performed in 8724 participants (54% men) aged 51 ± 15 years enrolled in 8 prospective studies in Australia, Italy, Japan, and U.S.A. The predictive power of obesity (BMI >=30 kg/m2) for mortality was evaluated from multivariable Cox models in the subjects stratified by high or low nocturnal BPV (above or below the median). Obese participants (N = 1286) had higher age-and-sex adjusted systolic and diastolic BPV than the non-obese participants (p = 0.002/<0.001). Obese subjects with high systolic or diastolic BPV had higher nocturnal heart rate (p = 0.01/<0.001) than obese subjects with low BPV and were more frequently diabetic (p<0.001) and heavy alcohol drinkers (p < 0.001). During a median follow-up of 6.4 years there were 361 deaths, 4.7% in the obese and 4.0% in the non-obese individuals (P = NS). However, the risk of mortality among the obese subjects greatly differed according to BPV level. In Cox models including age, sex, mean ambulatory BP, smoking, alcohol use, diabetes, cholesterol, creatinine, and nocturnal heart rate, the obese group with high systolic BPV had a doubled risk of mortality compared to the non-obese group (HR,2.0, 95%CI,1.4-2.9, p < 0.001), whereas the risk was not increased in the obese group with low BPV (P = 0.81). Similar results were found for diastolic BPV, with a HR of 1.7 (1.2-2.5, p = 0.002) in the high BPV group and no association at all with mortality (p = 0.87) in the low BPV group. Inclusion of night-time BP dipping in the regressions did not change the strength of the associations. These data show that high nocturnal BPV greatly increases the risk of mortality related to obesity. High BPV is accompanied by increased heart rate and may reflect the influence of transient BP elevations related to sleep apnea and/or baroreflex dysfunction.
Myocytolysis and muscular involvement associated with endurance exercise are particularly pronoun... more Myocytolysis and muscular involvement associated with endurance exercise are particularly pronounced when the effort is performed in altitude. The skeletal muscle lesion is proven by the release of enzymes and other muscular components into the bloodstream and this is proportional to the amount and length of effort. The hypothesis that the heart muscle can be involved as well has not been unequivocally proven. The aim of this study, whose experimental model is that of a long-lasting endurance race in mountain, was to correlate hemodynamic variations with circulating and systemic modifications. Twenty-two well-trained endurance athletes (mean age 37.6 ± 8.4 years) performed a 30-km race at 869-2522 m. The day before and immediately after the race, each athlete underwent blood letting, echocardiogram, blood pressure measurement in triplicate, and leg and forearm strain-gauge plethysmography. Creatine kinase and its MB fraction, myoglobin and cardiac troponin I increased significantly after the run. Cardiac tropanin T also increased, not reaching statistical significance. Alkaline phosphatase increased but the alkaline/hematocrit ratio was unchanged. Lactate dehydrogenase and aspartate aminotransferase were increased after the race, while alanine aminotransferase and gamma glutamyltransferase did not change. Systolic and diastolic blood pressure decreased by 9.9% and 16.5%, respectively, while heart rate was 33% higher. No echocardiographic variation was found, so that cardiac output increase (+31.6%) entirely depended on heart rate increase. Leg resistance decreased after the race by 30%, together with a 49% increase in arterial flow. Forearm flow resistance trends paralleled those of leg. In the multiple regression adjusted for confounders, exercise-related leg flow increase directly correlated with creatine kinase increase. In conclusion, long-lasting endurance exercise in altitude produces a release of great amount of myocytolysis enzymes and a blood pressure reduction completely attributable to peripheral vasodilation.
Several allometric methods for indexing cardiac structures to body size have been proposed but th... more Several allometric methods for indexing cardiac structures to body size have been proposed but the optimal way for normalization of cardiac structures is still controversial. We aimed to estimate the allometric exponents that best describe the relationships between cardiac dimensions and body size, propose normative values, and analyze how the different scaling metrics influence the prevalence of left ventricular hypertrophy (LVH) and chambers enlargement as well as predictive models for cardiovascular outcome in the community. We measured left ventricular end-diastolic dimension, end-diastolic volume, left ventricular mass, and left atrial volume in randomly recruited population cohorts (n = 1509; 52.8% women; mean age, 47.8 years). In a healthy subgroup (n = 656), the allometric exponents that described the relationships between left ventricular end-diastolic dimension and body size were 1, 0.5, and 0.33 for body height, body surface area (BSA), and estimated lean body mass, respectively. With regard to left ventricular end-diastolic volume, left ventricular mass, and left atrial volume the allometric exponents for body height were 2.9, 2.7, and 2.0, respectively; for BSA, they ranged from 1.7 to 1.8; for estimated lean body mass all exponents were around 1. These exponents were used to appropriately scale the cardiac dimensions to body size and derived sex-specific cut-off limits for different indexed cardiac dimensions. The hazard ratios of cardiovascular outcome were highest for LVH defined by left ventricular mass/height. Our study resulted in a proposal for thresholds for various indexed cardiac dimensions. Left ventricular mass indexed to height was sensitive in detection of LVH associated with obesity and slightly better predicted outcome.
Objective: Although the relationship between hyperuricemia and cardiovascular events has been ext... more Objective: Although the relationship between hyperuricemia and cardiovascular events has been extensively examined, data on the role of diuretic-related hyperuricemia are still scanty. The present study was designed to collect information on the relationship between diuretic-related hyperuricemia and cardiovascular events. Methods: The URic acid Right for heArt Health (URRAH) study is a nationwide, multicentre, observational cohort study involving data on individuals recruited from all the Italy territory under the patronage of the Italian Society of Hypertension with an average follow-up period of 122.3 ± 66.9 months. Patients were classified into four groups according to the diuretic use (yes vs. no) and serum uric acid (SUA) levels (higher vs. lower than the median value of 4.8 mg/dl). All-cause death, cardiovascular deaths and first cardiovascular event were considered as outcomes. Results: Seventeen thousand, seven hundred and forty-seven individuals were included in the analys...
Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is... more Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is still unknown. By utilizing a large population-based database, we assessed the threshold of SUA that increases the risk of total mortality and cardiovascular mortality (CVM). The URRAH study (Uric Acid Right for Heart Health) is a multicentre retrospective, observational study, which collected data from several large population-based longitudinal studies in Italy and subjects recruited in the hypertension clinics of the Italian Society of Hypertension. Total mortality was defined as mortality for any cause, CVM as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. A total of 22 714 subjects were included in the analysis. Multivariate Cox regression analyses identified an independent association between SUA and total mortality (hazard ratio, 1.53 [95% CI, 1.21–1.93]) or CVM (hazard ratio, 2.08 [95% CI, 1.146–2.97]; P <0.001). Cutoff values of SUA...
Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to c... more Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61–70, 71–80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0–4.7) to 86.3 (76.1–96.5) for all-cause mortality and from 4.1 (3.9–4.6) to 59.8 (51.0–68.7) for ca...
Blood pressure variability was studied in 8 "labile" and in 8 "established" hypertensive patients... more Blood pressure variability was studied in 8 "labile" and in 8 "established" hypertensive patients by means of continuous unrestricted blood pressure recording for 24 hours. In 7 of the former and 5 of the latter the effect of atenolol (200 mg/day) was also investigated. Blood pressure variability as judged by circadian rhythm, standard deviation, coefficient of variation, indexes of skewness and kurtosis was similar in the two groups. The only significant difference consisted in the mean arterial pressure which was higher in the established than in the labile hypertensives. Atenolol produced in all subjects a fall in blood pressure but no significant changes in the standard deviation, coefficient of variation and index of skewness. On the contrary the index of kurtosis significantly increased suggesting a more stable blood pressure after treatment.
The association between obesity and all-cause mortality is controversial and may differ according... more The association between obesity and all-cause mortality is controversial and may differ according to subjects&amp;amp;#39; characteristics. Blood pressure variability (BPV) may be increased in obese individuals and thus impair prognosis. The purpose of this study was to evaluate whether the relationship between obesity and mortality is influenced by short-term ambulatory BPV. The analysis was performed in 8724 participants (54% men) aged 51 ± 15 years enrolled in 8 prospective studies in Australia, Italy, Japan, and U.S.A. The predictive power of obesity (BMI &amp;amp;gt;=30 kg/m2) for mortality was evaluated from multivariable Cox models in the subjects stratified by high or low nocturnal BPV (above or below the median). Obese participants (N = 1286) had higher age-and-sex adjusted systolic and diastolic BPV than the non-obese participants (p = 0.002/&amp;amp;lt;0.001). Obese subjects with high systolic or diastolic BPV had higher nocturnal heart rate (p = 0.01/&amp;amp;lt;0.001) than obese subjects with low BPV and were more frequently diabetic (p&amp;amp;lt;0.001) and heavy alcohol drinkers (p &amp;amp;lt; 0.001). During a median follow-up of 6.4 years there were 361 deaths, 4.7% in the obese and 4.0% in the non-obese individuals (P = NS). However, the risk of mortality among the obese subjects greatly differed according to BPV level. In Cox models including age, sex, mean ambulatory BP, smoking, alcohol use, diabetes, cholesterol, creatinine, and nocturnal heart rate, the obese group with high systolic BPV had a doubled risk of mortality compared to the non-obese group (HR,2.0, 95%CI,1.4-2.9, p &amp;amp;lt; 0.001), whereas the risk was not increased in the obese group with low BPV (P = 0.81). Similar results were found for diastolic BPV, with a HR of 1.7 (1.2-2.5, p = 0.002) in the high BPV group and no association at all with mortality (p = 0.87) in the low BPV group. Inclusion of night-time BP dipping in the regressions did not change the strength of the associations. These data show that high nocturnal BPV greatly increases the risk of mortality related to obesity. High BPV is accompanied by increased heart rate and may reflect the influence of transient BP elevations related to sleep apnea and/or baroreflex dysfunction.
Myocytolysis and muscular involvement associated with endurance exercise are particularly pronoun... more Myocytolysis and muscular involvement associated with endurance exercise are particularly pronounced when the effort is performed in altitude. The skeletal muscle lesion is proven by the release of enzymes and other muscular components into the bloodstream and this is proportional to the amount and length of effort. The hypothesis that the heart muscle can be involved as well has not been unequivocally proven. The aim of this study, whose experimental model is that of a long-lasting endurance race in mountain, was to correlate hemodynamic variations with circulating and systemic modifications. Twenty-two well-trained endurance athletes (mean age 37.6 ± 8.4 years) performed a 30-km race at 869-2522 m. The day before and immediately after the race, each athlete underwent blood letting, echocardiogram, blood pressure measurement in triplicate, and leg and forearm strain-gauge plethysmography. Creatine kinase and its MB fraction, myoglobin and cardiac troponin I increased significantly after the run. Cardiac tropanin T also increased, not reaching statistical significance. Alkaline phosphatase increased but the alkaline/hematocrit ratio was unchanged. Lactate dehydrogenase and aspartate aminotransferase were increased after the race, while alanine aminotransferase and gamma glutamyltransferase did not change. Systolic and diastolic blood pressure decreased by 9.9% and 16.5%, respectively, while heart rate was 33% higher. No echocardiographic variation was found, so that cardiac output increase (+31.6%) entirely depended on heart rate increase. Leg resistance decreased after the race by 30%, together with a 49% increase in arterial flow. Forearm flow resistance trends paralleled those of leg. In the multiple regression adjusted for confounders, exercise-related leg flow increase directly correlated with creatine kinase increase. In conclusion, long-lasting endurance exercise in altitude produces a release of great amount of myocytolysis enzymes and a blood pressure reduction completely attributable to peripheral vasodilation.
Several allometric methods for indexing cardiac structures to body size have been proposed but th... more Several allometric methods for indexing cardiac structures to body size have been proposed but the optimal way for normalization of cardiac structures is still controversial. We aimed to estimate the allometric exponents that best describe the relationships between cardiac dimensions and body size, propose normative values, and analyze how the different scaling metrics influence the prevalence of left ventricular hypertrophy (LVH) and chambers enlargement as well as predictive models for cardiovascular outcome in the community. We measured left ventricular end-diastolic dimension, end-diastolic volume, left ventricular mass, and left atrial volume in randomly recruited population cohorts (n = 1509; 52.8% women; mean age, 47.8 years). In a healthy subgroup (n = 656), the allometric exponents that described the relationships between left ventricular end-diastolic dimension and body size were 1, 0.5, and 0.33 for body height, body surface area (BSA), and estimated lean body mass, respectively. With regard to left ventricular end-diastolic volume, left ventricular mass, and left atrial volume the allometric exponents for body height were 2.9, 2.7, and 2.0, respectively; for BSA, they ranged from 1.7 to 1.8; for estimated lean body mass all exponents were around 1. These exponents were used to appropriately scale the cardiac dimensions to body size and derived sex-specific cut-off limits for different indexed cardiac dimensions. The hazard ratios of cardiovascular outcome were highest for LVH defined by left ventricular mass/height. Our study resulted in a proposal for thresholds for various indexed cardiac dimensions. Left ventricular mass indexed to height was sensitive in detection of LVH associated with obesity and slightly better predicted outcome.
Objective: Although the relationship between hyperuricemia and cardiovascular events has been ext... more Objective: Although the relationship between hyperuricemia and cardiovascular events has been extensively examined, data on the role of diuretic-related hyperuricemia are still scanty. The present study was designed to collect information on the relationship between diuretic-related hyperuricemia and cardiovascular events. Methods: The URic acid Right for heArt Health (URRAH) study is a nationwide, multicentre, observational cohort study involving data on individuals recruited from all the Italy territory under the patronage of the Italian Society of Hypertension with an average follow-up period of 122.3 ± 66.9 months. Patients were classified into four groups according to the diuretic use (yes vs. no) and serum uric acid (SUA) levels (higher vs. lower than the median value of 4.8 mg/dl). All-cause death, cardiovascular deaths and first cardiovascular event were considered as outcomes. Results: Seventeen thousand, seven hundred and forty-seven individuals were included in the analys...
Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is... more Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is still unknown. By utilizing a large population-based database, we assessed the threshold of SUA that increases the risk of total mortality and cardiovascular mortality (CVM). The URRAH study (Uric Acid Right for Heart Health) is a multicentre retrospective, observational study, which collected data from several large population-based longitudinal studies in Italy and subjects recruited in the hypertension clinics of the Italian Society of Hypertension. Total mortality was defined as mortality for any cause, CVM as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. A total of 22 714 subjects were included in the analysis. Multivariate Cox regression analyses identified an independent association between SUA and total mortality (hazard ratio, 1.53 [95% CI, 1.21–1.93]) or CVM (hazard ratio, 2.08 [95% CI, 1.146–2.97]; P <0.001). Cutoff values of SUA...
Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to c... more Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61–70, 71–80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0–4.7) to 86.3 (76.1–96.5) for all-cause mortality and from 4.1 (3.9–4.6) to 59.8 (51.0–68.7) for ca...
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