G Cesana

Ambulatory blood pressure normality : results from the PAMELA study

Objective To determine ambulatory and home blood pressure means and distributions in relation to clinic blood pressure in a general population. Methods We obtained a random sample of 2400 subjects stratified by sex and 10 year age groups to be representative of residents aged 25–64 years of the city of Monza. Participation rate was 69% (1651 subjects). Blood pressure measurements consisted of clinic blood pressure (average of three measurements, sphygmomanometry), home blood pressure (average of morning and evening measurements, semiautomatic device) and ambulatory blood pressure (automatic readings at 20 min intervals, Space labs 90207). Clinic blood pressure was obtained both before and after home and ambulatory blood pressures. Data analysis did not include 213 subjects receiving antihypertensive drug treatment and was therefore limited to 1438 participants. Results: In the 1438 subjects, clinic, home and ambulatory blood pressure showed a normal-like distribution, with a taller peak and a narrower base for ambulatory than for home and clinic values. Clinic, home and ambulatory blood pressures were significantly related to each other (P always < 0.001). The means of the two clinic blood pressures obtained on consecutive days were superimposable (127.4 ± 17.0/82.3 ± 9.8 and 128.2 ± 16.5/81.9 ± 9.9 mmHg) and both were markedly higher than home and 24 h average blood pressures (8.2 mmHg), which were similar to one another. The differences between clinic and home or 24 h average blood pressure were similar in both sexes but increased with increasing age and clinic blood pressure values. The influence of clinic blood pressure values on the clinic-ambulatory or clinic–home blood pressure differences was more important than age. Although higher than the 24 h average value, daytime average blood pressure was also lower than clinic blood pressure. Night-time blood pressure was markedly lower than the daytime value in both sexes and at all ages. Conclusion Data from a large and unbiased sample of a general population show that home and 24 h or daytime average blood pressures are much lower than clinic blood pressure. The relatively close correlation between blood pressure values measured with the different methods used has allowed calculation of home and ambulatory blood pressure values corresponding to the accepted upper limit of normality of clinic blood pressure (140/90 mmHg). The upper limit of normality for the population was for both home and ambulatory blood pressures in the range 120–130 and 75–81 mmHg for systolic and diastolic values, respectively, with slight differences depending on sex and age. Taking 140/90 mmHg as the upper normal limit of the population is therefore an error that leads to individuals whose home or ambulatory blood pressures are high being considered as normotensive.

Comparison of Active Stretching Technique and Static Stretching Technique on Hamstring Flexibility

Objectives:To compare a passive and an active stretching technique to determine which one would produce and maintain the greatest gain in hamstring flexibility. To determine whether a passive or an active stretching technique results in a greater increase in hamstring flexibility and to compare whether the gains are maintained. Design:Randomized controlled trial. Setting:Institutional. Participants:Sixty-five volunteer healthy subjects completed the enrollment questionnaire, 33 completed the required 75% of the treatment after 6 weeks, and 22 were assessed 4 weeks after the training interruption. Intervention:A 6-week stretching program with subjects divided into 2 groups with group 1 performing active stretching exercises and group 2 performing passive stretching exercises. Main Outcome Measures:Range of motion (ROM) was measured after 3 and 6 weeks of training and again 4 weeks after the cessation of training and compared with the initial measurement. Results:After 3 weeks of training, the mean gain in group 1 (active stretching) on performing the active knee extension range of motion (AKER) test was 5.7°, whereas the mean gain in group 2 (passive stretching) was 3° (P = .015). After 6 weeks of training, the mean gain in group 1 was 8.7°, whereas the mean gain in group 2 was 5.3° (P = .006). Twenty-two subjects were reassessed 4 weeks after the cessation of the training with the maintained gain of ROM in group 1 being 6.3°, whereas the maintained gain in group 2 was 0.1° (P = .003). Conclusions:Active stretching produced the greater gain in the AKER test, and the gain was almost completely maintained 4 weeks after the end of the training, which was not seen with the passive stretching group. Active stretching was more time efficient compared with the static stretching and needed a lower compliance to produce effects on flexibility.

Trends of smoking habits in northern Italy (1986-1990) The WHO MONICA Project in Area Brianza, Italy

The trends of age-gender specific prevalence of self-reported smoking habits are presented, observed in two population surveys, performed in 1986–87 and 1989–90 in Area Brianza, a northern Italian industrialized district where a WHO MONICA Centre is located. Methods were internationally standardized to obtain comparable data on two inde pendent random samples, each composed of 1,600 subjects, age-sex stratified and extracted from the 25–64 year old residents. A closed question interview was administered to identify smoking condition (smoker, past-smoker, occasional smoker, never smoker), number of cigarettes consumed per day and attained educational level, categorized in compulsory school and post-compulsory school. Serum thiocyanate was measured as a validation index, using a cutpoint of >100 µmol l−1 to detect false negatives. Trends in smoking prevalence are analyzed taking into account influences of education in the presence of an anti-smoking policy that was started in Italy toward the end of the eighties. Self-reported data, confirmed by serum thiocyanate, show a consistent decline of smokers among males (from 48 to 41%), more evident in younger age groups. In females, smoking prevalence is stable (23–24%), although thiocyanate levels in the whole samples indicate a slight but significant tendency to decrease. Education demonstrates positive influences against smoking, particularly in younger male classes. In females a crossover effect is observable: in the second survey youngest group, education results protective against smoking; the contrary is true in the older groups. Our data, detailing what was initially recognized in previous Italian surveys, may be useful to specify the directions of future preventive actions.

Association between job strain and biomarkers of glucose homeostasis: results from the MONICA–Brianza cohort study

Hypertension is the leading cause of cardiovascular disease and death. Despite increased knowledge of its importance in cardiovascular disease, the worldwide prevalence is still increasing and there is considerable scope for improvement of awareness, treatment and control. In this review, five major issues in hypertension management in secondary prevention of cardiovascular disease will be outlined. The first two issues will address hypertension diagnosis: out-of-office blood pressure measurements and the detection of secondary hypertension. The last three issues will address hypertension treatment: lifestyle modification, medication adherence and blood pressure targets. For each of the five issues, we will outline existing knowledge, gaps in existing knowledge, barriers preventing full implementation of guideline recommendations, and possible solutions to improve management of the current disquieting situation.

Temporal Trends in Ischemic and Hemorrhagic Strokes in Northern Italy: Results from the Cardiovascular Monitoring Unit in Northern Italy Population. Based Register, 1998-2004.

Background: We compared rates and case fatality from a population-based stroke register in Northern Italy between 1998 and 2004 to assess changes over time and to evaluate changes in case diagnosis and management. Methods: The WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease criteria were used to identify suspected fatal or nonfatal events occurring among residents 35–74 years of age. Data on in-hospital treatments, symptoms and diagnostic tools were extracted. Out-of-hospital deaths were also investigated. The annual average relative change (ARC) in death rate, attack rate and case fatality were derived from Poisson models. Results: Death rates due to ischemic stroke (IS) decreased [men: ARC –12.7, 95% confidence interval (CI) –21.3 to –3.2; women: ARC –14.0, 95% CI –23.3 to –3.5]. These reductions are attributable to decreases in case fatality; attack rates of nonfatal IS increased (men: ARC 3.6, 95% CI 0.5–6.7; women: ARC 4.1, 95% CI 0.0–8.2). IS patients showed a higher prevalence of dyslipidemia and hypertension and underwent MRI more frequently in 2004. Both findings may explain the increased proportions of less severe cases. Case fatality and attack rates for hemorrhagic strokes (HS) were stable, with an observed increased prevalence of patients under anticoagulant/antiplatelet treatments. Conclusions: In this low-IS-incidence population, death rates decreased substantially during the investigated period. More accurate diagnostic tools increase the probability of detecting less severe cases. HS remains a frequently fatal disease with a stable incidence.

Worker healthy effect in cardiovascular disease prospective cohorts. Does it still matter? Comparing survival curves of northern Italian population-based and factory-based cohorts

BOOK EuroPRevent 2013 Rome, Italy