F. Santi

Leisure-time physical activity and cardiovascular disease mortality: the Brisighella Heart Study.

Objective The aim of this study is to describe the relationship between self-rated physical activity during leisure time and cardiovascular disease mortality in 2936 individuals of the cohort of the Brisighella Heart Study, a prospective, population-based, longitudinal, epidemiological survey. Methods Long-term (1988–2000) prognostic significance of physical activity was determined after adjustments for age, sex, smoking habits, low-density lipoprotein-cholesterol and history of type 2 diabetes. Results At baseline, 377 (25.3%) male and 496 (34.3%) female participants reported scarce-null physical activity, whereas 1112 (74.7%) men and 951 (65.7%) women reported medium-intense physical activity. In the entire population, cardiovascular mortality was three times higher in participants with sedentary physical activity than in those with medium-intense physical activity (P = 0.0001). These results have been confirmed in both men (P = 0.0001) and women (P = 0.0028). A categorical distribution of the population according to age showed a higher risk of cardiovascular death associated with sedentary physical activity only in the younger male particupants (P = 0.0032). Conclusion On the basis of our data, physical activity is inversely related to cardiovascular mortality in a sample of the rural Mediterranean population with a highest risk in inactive men aged less than 65 years.

Hemodynamic and neurohumoral profile in patients with different types of hypertension in pregnancy

Hypertension in pregnancy is a frequent disorder that includes a spectrum of conditions. We aimed at comparatively evaluating the hemodynamic, echocardiographic and biohumoral profile of a sample of pregnant Caucasian women with different form of pregnancy-related hypertension. We enrolled 39 non-hypertensive pregnant women (NP), 26 with Chronic HBP in pregnancy (CH), 24 with gestational hypertension (G-PIH), and 33 with pre-eclampsia. We recorded and compared blood pressure (BP), echocardiographic parameters, resting plasma renin activity (PRA) and plasma aldosterone (PA), Plasma levels of atrial (ANP) and brain natriuretic peptide (BNP). PE patients had a significantly higher BP than either G-PIH or NP patients. PE patients had also significantly lower cardiac output than NP, G-PIH and CH. In comparison to NP patients, the total peripheral vascular resistance was 61% higher in PE women and 38% higher in CH patients. All echographic parameters were significantly more altered in PE patients when compared with NP, in respect to any other form of hypertension. Either ANP (+35%) and BNP (+40%) were significantly higher in PE patients than in controls. The PRA was reduced in PE and CH patients when compared either with NP (−38 and −35%, respectively) or G-PIH (−47 and −43%, respectively). On the basis of our data, we can conclude that PE is the gestation associated hypertension with the largest anatomical, functional and biohumoral involvement, and so it has to be involved in a more intensive monitoring and evaluation.

Relationship between blood pressure, cholesterolemia and serum apolipoprotein B in a large population sample: the Brisighella Heart Study.

Objective: The objective is to evaluate the relationship between cholesterolemia, serum apolipoprotein B (apoB) level and blood pressure in a large sample of general population. Methods: The Brisighella Heart Study (BHS) is a prospective, population-based longitudinal epidemiological investigation. For this study, we analysed the data sampled in the 2008 BHS population survey, excluding those participants treated with antihypertensive and/or lipid lowering drugs (N: 2473). Results: In a sex, BMI, smoking habit, physical activity level and serum creatinine adjusted model, low-density lipoprotein-cholesterol (LDL-C) appears to be significantly related to SBP (P < 0.001), DBP (P = 0.026), and pulse pressure (PP) (P < 0.001). In individuals aged less than 52 years, LDL-C was significantly associated to SBP and DBP (P < 0.001), but not PP. In the same model, apoB appears to be mildly but significantly related to SBP (P < 0.001), DBP (P < 0.001), and PP (P < 0.001). In individuals aged less than 52 years, apoB was significantly associated to SBP (P < 0.001), DBP (P < 0.001), and PP (P < 0.001). In individuals aged 52 or more, nor LDL-C neither apoB were significantly associated to blood pressure. Including in the same model LDL-C and apoB, apoB excluded the predicting role of LDL-C as it regards the blood pressure either in the whole population sample and in the younger individuals. Conclusion: On the basis of our observation, either serum LDL-C and apoB are significantly related to the blood pressure level in a large sample of individuals untreated with antihypertensive and lipid-lowering drugs. This association is stronger in younger individuals than in elderly. ApoB seems to be a stronger predictor of either SBP, DBP and PP than LDL-C.

Fixed combination of lercanidipine and enalapril in the management of hypertension: focus on patient preference and adherence

Hypertension is one of the most important and widespread risk factors for the development of cardiovascular disease. Once, combination therapy was traditionally reserved as a third-line or fourth-line approach in the management of hypertension. However, several major intervention trials in high-risk patient populations have shown that an average of 2–4 antihypertensive agents are required to achieve effective blood pressure control. Combination treatment should be considered as a first choice in patients at high cardiovascular risk and in individuals for whom blood pressure is markedly above the hypertension threshold (eg, more than 20 mmHg systolic or 10 mmHg diastolic), or when milder degrees of blood pressure elevation are associated with multiple risk factors, subclinical organ damage, diabetes, renal failure, or associated cardiovascular disease. A number of clinical trials have demonstrated that a fixed combination of lercanidipine and enalapril has better efficacy and tolerability than monotherapy with either agents. The fixed-dose formulation of lercanidipine–enalapril was well tolerated in all clinical trials, with an adverse event rate similar to that of the component drugs as monotherapy. The advantages of combination therapy include improved adherence to therapy and minimization of blood pressure variability. In addition, combining two antihypertensive agents with different mechanisms of action may provide greater protection against major cardiovascular events and the development of end-organ damage.

ANTIHYPERTENSIVE EFFICACY OF LACTOTRIPEPTIDES ASSUMED AS FUNCTIONAL FOODS: A META-ANALYSIS OF CURRENT AVAILABLE CLINICAL TRIALS: PP.23.425

Background: It has been suggested that lactotripeptides Valine-Proline-Proline (VPP) and Isoleucine-Proline-Proline (IPP) assumed as nutraceuticals or functional foods are associated to inhibition of ACE. However data derived from clinical trials appear to be contrasting. Objective: To perform a meta-analysis of placebo-controlled clinical trials testing the antihypertensive effect of lactotripeptides assumed as nutraceuticals or functional foods. Design: Trials identified using a defined search strategy in PubMed were included in the meta-analysis, and their pooled effect was estimated with a random effects model. Results: 18 trials have been identified for which all needed data have been clearly reported. The most part of them included a small patient number, but the trials were nearly homogeneous as it regards the methodology applied. Pooled effect of peptides was -3.88 mmHg (95% CI: −6.12, −1.54) for systolic blood pressure (SBP), and −1.97 mmHg (95% CI: −3.85, -0.64) for diastolic blood pressure (DBP). The effect was much more evident in Asian patients [SBP = −7.88 mmHg (95% CI: −9.97, −4.18); DBP = −3.98 mmHg (95% CI: −5.38, −2.44)] than in Caucasian ones [SBP = −1.41 mmHg (95% CI: −3.04, 0.62); DBP = −0.41 mmHg (95% CI: −1.39, 0.59)], and not clearly related to the baseline patients age or blood pressure value, nor to the dose of lactotripeptides assumed or to the duration of the study. Conclusions: VPP and IPP lactotripeptides assumed as functional foods may lead to significantly reduced SBP, particularly in Asian subjects. The relevance of this findings in other ethnicities or associated to different dietary pattern has to be further investigated.

AB0216 Activation of the renin angiotensin sistem in a population of patients with rheumatoid arthritis and low severity comorbidity in therapy with dmards and/or anti-tnf alfha

Background Rheumatoid arthritis(RA) is a chronic autoimmune inflammatory disease. The inflammatory process causes joint destruction and disability. Patients have a shorter life expectancy and a relative risk of cardiovascular (CV) disease ranging from 1.5 to 4.0 with an increase in CV morbidity and mortality of 1.5 fold compared with the general population. The chronic inflammation seen in RA have its main effectors in factor alfa tumor necrosis (TNF) and interleukin 6 (IL-6) that, in addition to playing a key role in the initiation of joint damage and progression of atherosclerotic disease, are also potent inducers of the renin angiotensin system (RAS). The latter could contribute in these patients to the development of an early and accelerated CV damage. Objectives To evaluate the possible presence of hyperactivation of RAS and its association with the activity parameters of RA, with traditional risk factors and premature CV organ damage Methods there were evaluated 17 (F) patients (pts) with RA receiving stable therapy (3 months) with DMARDs or anti-TNF alpha, in the absence of previous CVevents and/or traditional risk factors. All pts underwent a visit with rheumatologic evaluation of patient history, activity of RA (DAS28), pain (VAS), quality of life (HAQ), patient GH. Blood samples were collected for the evaluation of: lipid profile, indices of insulin resistance (HOMA-IR), indices of activity of rheumatoid arthritis (autoantibodies, inflammatory markers) and CV risk according to risk charts based on the Framinghamstudy. The CV organ damage was assessed by imaging techniques such as Pulse Wave Velocity (PWV) and Augmentation Index (AIx), Intima-media thickness (IMT) and ankle-brachial index (ABI). From a sample of the patient’s blood leukocytes were separated and subsequently extracted RNA to perform Real time qPCR to verify the expression of Angiotensin II and AT1 and AT2 receptors. The mean disease duration was 9 ±7 years; the mean age (pts all female) was 55 ± 12 years. FR was positive in 49%, antiCC and ANA respectively in 64% and 59% Results data, though preliminary, showed a statistically significant correlation between the density of receptors for angiotensin II (AT1R and AT2R) and, respectively, the values of ABI(p <0.05, p 0.043), serum uric acid values (p <0,014, p <0016) and the index of insulin resistance (HOMA-IR) (p <0,034, p <0.033). This seems to indicate a very strong correlation between markers of early atherosclerosis and expression of the RAS, although the sample did not have additional CV risk factors. Conclusions The results obtained so far make attractive and plausible the initial assumption and could, if confirmed in further continuation of the study, help to explain the paradoxical development of vascular disease in patients with RA and apparent low CV risk with important therapeutic implications Disclosure of Interest None Declared

ECHOCARDIOGRAPHY IN PATIENTS WITH HEART FAILURE: REDUCED AND PRESERVED LEFT VENTRICULAR FUNCTION: PP.1.14

Introduction: Patients (pts) with heart failure (HF) can show reduced (r) or preserved (p) left ventricular ejection fraction (EF) and both these groups share the same morbility and mortality, even if theres still a tendency to consider more at stake pts with reduce EF. Objective: Our aim was to observe if pts with pEF or rEF show different echocardiographic geometric pattern and if there was any difference among E/A ratio, left ventricular isovolumetric time relaxation (IVRT) and deceleration time (DT) of early Doppler mitral valve flow velocity between the two groups. Methods and Results: We evaluated 205 consecutive pts with HF, defined by ACC/AHA guidelines, admitted to our Out-patients Clinic for the Management of Heart Failure after discharge from hospital where they had been admitted for acute HF. Each pts underwent echocardiography performed by the same operator. 119 pts were men and represent the 54% of pts with HF with pEF and the 71% of pts with HF with rEF. Average age was 70 ± 10 years (28–98) without significative differences in pts with or without pEF. HF ethiopathogenesis was due to hypertension in 95% of pts with pEF and 67% in pts with rEF. Figure 1. No caption available. Concentric remodelling is the geometric pattern prevalent in pts with pEF whereas eccentric hypertrophy is more common among pts with rEF. If we analyse echocardiographic data in each different geometric pattern group, we find that in pts with normal geometry, DT is significantly reduced if EF<50 (0,22 ± 0,05 vs 0,16 ± 0,06, p < 0.05). We obtained similar results also when using RWT>0.42 as pathologic cut off value. Conclusions: Even if pts with pEF is mostly NYHA 0 or I in comparison to pts with rEF (mostly in NYHA II or III), they came from the same population of pts discharged from hospital with diagnosis of acute HF. These two different kinds of pts show a different echocardiographic geometric pattern.

EFFECT OF AN INTEGRATED APPROACH TO CARE ON HEART FAILURE PATIENTS WITH HYPERTENSION: PP.1.11

Background: Heart Failure(HF) might represents the conclusive clinical event of hypertensive disease(HBP) and its complications. Considering its increasing prevalence, HF is an important clinical and economic challenge often needing integrated and specialistic management programs. Purpose: Aim of the present study was to assess the effect of 1 year dedicated and integrated program care,comprehensive of systematic assessment and management,counselling,educational,on progression of NYHA class and rate of hospital admissions in patients with hypertension-related HF. Methods: Patients with history of hypertension and clinical,radiological or echocardiographic evidence of HF have been enrolled in the study. At entry and after 12 months we evaluated: physical signs,NYHA class,LV function(LVEF%),neuro-humoral profile,on-going therapy. Main objective was the number of and hospital admissions after 6–12 months of intensive approach compared with those in the previous 12 months. Results: In a 5 year period we evaluated 438 consecutive HF patients, of which 170(75%) had at least 1 year control (108 M and 62 F,mean age 76 years,range 40–90). At entry, 103 pts(32%) had at least 1 hospital admission for HF,and 53 patients(17%) had > = 3 admissions,whereas after 1 year 17 patients(5%) were admitted once and 30 patients(9.1%) had >=3 readmissions (p < .0001);15 patients died. At baseline visit, 57% patients were in NYHA class I,30% in NYHA class II,12,5% in NYHA class III and 0,5% patients were in NYHA class IV. At 12 month of follow up,12 % worsened NYHA class pts,40% unchanged pts and 48% ameliorated pts(p < .001 for improving trend). At entry and after 1 year respectively 44 and 46% of patients received ACE-inhibitors, 32,4 and 60 % Angio II-inhibitors, 51 and 73% B-blockers, 65 and 71% diuretics, 11 and 8% digoxin, 24 and 22% calcium channel blockers, 15 and 21% nitrates and 17 and 21% aldosterone receptor antagonists. Conclusions: The specific care and educational/support intervention program was effective in reducing readmission and ameliorating NYHA class of HF and HBP patients without any significant variation in pharmacological therapy.