Giulia Bruno

Arterial hypertension and cancer.

Arterial hypertension and cancer are two of the most important causes of mortality in the world; correlations between these two clinical entities are complex and various. Cancer therapy using old (e.g., mitotic spindle poisons) as well as new (e.g., monoclonal antibody) drugs may cause arterial hypertension through different mechanisms; sometimes the increase of blood pressure levels may be responsible for chemotherapy withdrawal. Among newer cancer therapies, drugs interacting with the VEGF (vascular endothelial growth factors) pathways are the most frequently involved in hypertension development. However, many retrospective studies have suggested a relationship between antihypertensive treatment and risk of cancer, raising vast public concern. The purposes of this brief review have then been to analyse the role of chemotherapy in the pathogenesis of hypertension, to summarize the general rules of arterial hypertension management in this field and finally to evaluate the effects of antihypertensive therapy on cancer disease.

Left Heart Morphology and Function in Primary Aldosteronism

Primary aldosteronism is the most frequent cause of secondary hypertension, accounting for up to 11% of cases in selected populations. Patients affected by primary aldosteronism have shown higher prevalence of cardiovascular and cerebrovascular events compared with patients with essential hypertension, despite similar blood pressure levels. Several studies have been performed over past years aiming to explain these data; many of these evaluated echocardiographic differences in hypertension-related cardiac organ damage between primary aldosteronism and essential hypertension. This article summarizes the present knowledge about structural and functional alteration of the human left heart in primary aldosteronism.

Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

Introduction Current evidence suggests that aortic blood pressure has a superior prognostic value with respect to brachial pressure for cardiovascular events, but direct measurement is not feasible in daily clinical practice. Aim The aim of the present study is the clinical validation of a multiscale mathematical model for non-invasive appraisal of central blood pressure from subject-specific characteristics. Methods A total of 51 young male were selected for the present study. Aortic systolic and diastolic pressure were estimated with a mathematical model and were compared to the most-used non-invasive validated technique (SphygmoCor device, AtCor Medical, Australia). SphygmoCor was calibrated through diastolic and systolic brachial pressure obtained with a sphygmomanometer, while model inputs consist of brachial pressure, height, weight, age, left-ventricular end-systolic and end-diastolic volumes, and data from a pulse wave velocity study. Results Model-estimated systolic and diastolic central blood pressures resulted to be significantly related to SphygmoCor-assessed central systolic (r = 0.65 p <0.0001) and diastolic (r = 0.84 p<0.0001) blood pressures. The model showed a significant overestimation of systolic pressure (+7.8 (-2.2;14) mmHg, p = 0.0003) and a significant underestimation of diastolic values (-3.2(-7.5;1.6), p = 0.004), which imply a significant overestimation of central pulse pressure. Interestingly, model prediction errors mirror the mean errors reported in large meta-analysis characterizing the use of the SphygmoCor when non-invasive calibration is performed. Conclusion In conclusion, multi-scale mathematical model predictions result to be significantly related to SphygmoCor ones. Model-predicted systolic and diastolic aortic pressure resulted in difference of less than 10 mmHg in the 51% and 84% of the subjects, respectively, when compared with SphygmoCor-obtained pressures.

Accuracy of transthoracic echocardiography in the assessment of proximal aortic diameter in hypertensive patients: comparison with cardiac magnetic resonance

Background: Accurate and reproducible measurements of proximal thoracic aorta diameters are essential in the diagnosis and follow-up of patients with aortic dilatation, a condition particularly common in hypertensive patients. Aim: to evaluate the accuracy of transthoracic echocardiography (TTE) in comparison with cardiac magnetic resonance (CMR) for the assessment of proximal thoracic aorta diameters in a cohort of hypertensive patients. Methods: A total of 75 essential hypertensive outpatients previously evaluated by TTE and than by CMR were included in the study. We specifically compared the two techniques at the level of sinuses of Valsalva (SoV) and ascending aorta (Asc) diameter. For the TTE images, the inner edge-to-inner edge and leading edge-to-leading edge conventions were compared. Results: TTE and CMR diameters were significantly related (SoV: r 0.931, Pu200a<u200a0.001; Asc: r 0.949, Pu200a<u200a0.001) when the leading edge-to-leading edge convention was used. Mean difference between CMR and TTE diameters was 2.49u200a±u200a2.01u200amm at the level of SoV and 1.13u200a±u200a1.77u200amm at the level of Asc. Correlation was good also for the TEE diameters measured by inner edge-to-inner edge convention (SoV: r 0.936, Pu200a<u200a0.001; Asc: r 0.947, Pu200a<u200a0.001). Comparing the two approaches in the evaluation of Asc, inner edge-to-inner edge showed a trend to a better correlation with CMR measurements than leading edge-to-leading edge, with a good interobserver and intraobserver agreement. Conclusion: The results of the current study suggest that TTE could be a reliable tool to assess proximal aorta diameters in hypertensive patients.

Correction: Central Pressure Appraisal: Clinical Validation of a Subject-Specific Mathematical Model

[This corrects the article DOI: 10.1371/journal.pone.0151523.].