Vito Volpe

Influence of metabolic syndrome on hypertension‐related target organ damage

Objectives.  The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage.

Value of Home Blood Pressures as Predictor of Target Organ Damage in Mild Arterial Hypertension

Background Home blood pressure measurement has gained increasing importance for the management of hypertensive patients. The aim of our study was to compare levels of clinic (CBP), ambulatory (ABP), and home blood pressure (HBP) measurements, and their relationships with various indexes of target organ damage in I–II grade essential hypertension. Design and methods Thirty-eight essential hypertensives underwent evaluation of clinic, ambulatory and home blood pressures. Each patient recorded HBP for 2 days with a digital BP monitor three times daily, the first time on the same day during which ABP monitoring was simultaneously performed. Moreover, in all subjects electrocardiogram recording, echocardiographic study, microalbuminuria assay and fundus oculi examination were obtained. Results The average HBPs obtained on the first day, in particular systolic values, were quite similar to mean daytime ambulatory BP recorded on the same day. Clinic BP, both systolic and diastolic, showed no significant correlation with left ventricular mass index (LVMI) and with albumin excretion rate (AER), whereas a correlation barely significant was observed with an index of global target organ damage (GTODi), including cardiac, renal and retinal parameters. On the contrary, home blood pressures, especially those recorded on the second day, correlated significantly, and more tightly than clinic BP, with LVMI, AER and GTODi. Conclusions Our study seems to justify the adoption of home BP monitoring in the management of hypertensive patients, as a useful complement to clinical readings, and may provide additional prognostic information.

Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients.

Objectives.  To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid‐femoral pulse wave velocity (PWV), as an index of aortic stiffness.

White-coat hypertension and cardiovascular risk.

Objective: To compare cardiovascular risk in white-coat hypertensives, normotensives and established hypertensives. Methods: We studied 61 hypertensive individuals, 27 of whom were white-coat hypertensives, and 35 normotensives. All subjects underwent 24 h noninvasive blood pressure monitoring and Doppler echocardiographic examination of the heart; urine was tested for microalbuminuria and the fundi of the eyes examined for retinopathy. Results: The 24 h as well as the day- and night-time mean systolic blood pressure (SBP) was slightly but significantly higher in white-coat hypertensives than in normotensives; no significant difference was observed in diastolic blood pressure (DBP) between these groups. In white-coat hypertensives, 24 h SBP and DBP were lower than in established hypertensives (P <0.001). The echocardiographic study showed higher values of posterior wall thickness, left ventricular mass index (LVMI), and ventricular septum thickness (P <0.05) in white-coat hypertensives than in normotensives; fractional shortening and ejection fraction were similar. The E:A ratio, obtained from the Doppler study, was lower in white-coat hypertensives than in normotensives (1.14 ± 0.3 versus 1.24 ± 0.25; P <0.05). LVMI values were smaller in white-coat hypertensives than in established hypertensives (P <0.05), and both ejection fraction and fractional shortening were similar in the two groups. Among white-coat hypertensives, eight out of 27 showed hypertensive retinal damage; microalbuminuria values were similar to those obtained in normotensives. Conclusions: The results of this cross-sectional and therefore limited study lead us to hypothesize that white-coat hypertensives are at higher risk than normotensives and lower risk than established hypertensives for developing cardiovascular damage.

Sympathetic Overactivity and 24-Hour Blood Pressure Pattern in Hypertensives with Chronic Renal Failure

In order to assess the activity of the sympathetic system and to evaluate the 24-h blood pressure pattern in hypertensives with chronic renal failure (CRF), 12 CRF patients and 16 essential hypertensives (EHs) were studied. In all subjects, plasma samples for catecholamines and renin activity were obtained both in the basal condition and after standing, and 24-h blood pressure monitoring (ABPM) was performed. The 24-h mean blood pressure results were quite similar between CRFs and EHs. In 50% of the CRFs, ABPM showed a nighttime decrease in diastolic BP (DBP) greater than 10%, while in the remaining 50% the ABPM indicated a nondipper blood pressure pattern. Of the 16 EHs, 4 had a nighttime decrease in DBP < 10%, that is, nondippers. The study of circulating catecholamines showed no significant differences in plasma epinephrine between CRFs and EHs, while plasma norepinephrine (NE) was significantly higher in hypertensives with CRF than in EHs, both at rest and after standing (p < 0.05 and 0.02, respectively). Among dipper hypertensives, subjects with CRF showed greater values of basal plasma NE than EHs (535 +/- 67 vs. 412 +/- 24.5 pg/mL, p < 0.05); the comparison between dipper and nondipper CRFs showed no differences in circulating NE levels (535 vs. 516 pg/mL). The present study shows that CRFs are characterized by higher values of plasma NE than EHs, and that there are no differences in sympathetic activity between dipper and nondipper hypertensives with CRF.

Relationships Between Ambulatory White Coat Effect and Left Ventricular Mass in Arterial Hypertension

The aim of our study was to analyze, in a group of 296 essential hypertensives, the relationship between left ventricular mass (LVM) and ambulatory white coat effect (WCE); that is the difference between the elevation of the first measurements of ambulatory blood pressure monitoring and the mean daytime pressure. The study population was separated into two groups according to the median of the WCE. The LVM was greater in the groups with higher systolic and diastolic ambulatory WCE. The significant association between ambulatory WCE and LVM was confirmed by the results of multiple regression analysis, suggesting that ambulatory WCE may not be an innocent phenomenon.

P-61: Value of home blood pressure as predictor of target organ damage in mild arterial hypertension

baseline,ns). At baseline the highest correlation to LVMI was shown by ambulatory pulse pressure during nighttime (r 50.6, p50.004) ands-BP (r50.7, p,0.0001). At follow-up LVMI was significantly predicted only by mean nighttime a-BP(r50.564, p50.012) andambulatory pulse pressureduring 24 h (r 50.462, p50.035) and nighttime (r 50.531, p50.013). The regression in LVMI was significantly related only to reduction in mean and diastolic s-BP (r50.428/0.454, p 50.037/0.026 respectively) under therapy. It is concluded that C and F are equally effective in reducing LVMI. The highest predictive power for LVMI was given by ambulatory nighttime and pulse pressure. Changes in LVMI were only predicted by self recorded-BP. These results underline the importance of ambulatory as well as self recorded BP in the management of hypertensives.

INFLUENCE OF THE CALCIUM ANTAGONIST AMLODIPINE ON LEFT VENTRICULAR MASS AND FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

SummaryThis study was conducted to evaluate the influence of antihypertensive treatment with the calcium antagonist amlodipine on left ventricular structure and systolic and diastolic function in patients with essential hypertension.Eleven patients (mean age 50 ± 5 years) with mild to moderate essential hypertension (diastolic blood pressure 95 to 114mm Hg) underwent M-mode echocardiography guided by 2-dimensional echocardiography and pulsed-Doppler examination of transmitral blood flow at baseline and after 1 and 6 months’ treatment with amlodipine (10 mg/day).Blood pressure levels significantly decreased during treatment. Left ventricular mass index also decreased during the study period (from 139 ± 4 g/m2 at baseline to 127 ± 3 g/m2 after treatment; p < 0.001). Fractional shortening was not significantly modified during treatment. The peak velocity of early filling (E) increased progressively (0.57 ± 0.6 vs 0.65 ± 0.5 m/sec; p < 0.01), while the peak velocity of late filling (A) did not change significantly; therefore, the E/A ratio increased from 1.1 ± 0.1 to 1.26 ± 0.1 (p< 0.01).This study demonstrated a significant decrease in left ventricular mass during treatment with the calcium antagonist amlodipine, and maintenance of left ventricular systolic performance after reversal of myocardial hypertrophy. Moreover, the decrease in left ventricular mass was associated with significantly improved diastolic filling.

Pulsatile and steady 24-h blood pressure components as determinants of left ventricular mass in young and middle-aged essential hypertensives

In order to explore the relations between left ventricularmass (LVM) and the pulsatile (pulse pressure) andsteady (mean pressure) components of the bloodpressure (BP) curve, 304 young and middle-agedessential hypertensive patients were studied by meansof 24-h ambulatory BP monitoring and echocardio-graphy. In the overall study population, both the BPcomponents showed significant correlations with LVM.These correlations were unevenly distributed in thesubgroups of subjects younger and in those older than50 years. While in this latter subgroup, in multivariateanalysis, both 24-h mean BP (24-MBP) (b¼0.27;P¼0.008) and 24-h pulse pressure (24-h PP) (b¼0.23;P¼0.02) were associated with LVM, in the subset ofyounger hypertensives only 24-h MBP (b¼0.21;P¼0.009) was related to LVM, independent of othercovariates. The relations observed between 24-h PP andLVM in the entire study population and in the patientsolder than 50 years lost statistical significance when theeffect of 24-h systolic blood pressure (24-h SBP) wastaken into account, in a multiple regression model inwhich 24-h MBP was replaced by 24-h SBP. Our findingsseem to suggest that the association of PP with LVM inmiddle-aged hypertensives may partially explain theincreased cardiovascular risk, documented in subjectswith high PP. However, this relation is not independent,but is mediated by SBP.Journal of Human Hypertension (2003) 17, 231–238.doi:10.1038/sj.jhh.1001542Keywords: pulse pressure; mean blood pressure; ambulatory blood pressure; left ventricular mass