OBJECTIVE:Left atrial (LA) enlargement (LAE) is associated to an increased risk of cardiovascular complications, and in particular of atrial fibrillation. The 2018 ESH/ESC Hypertension guidelines ...suggested the use of LA volume instead of linear dimensions, and for the first time proposed the indexation to height2(h2)The aim of our study was to assess the prevalence of left atrial dilatation in a large sample of patients undergoing an echocardiogram for cardiovascular risk stratification at an ESH excellence centre in Italy.
DESIGN AND METHOD:3872 subjects undergoing a diagnostic work-up for arterial hypertension (known or suspect) were analysed. The mean age was 56 ± 15 years, BMI 26 ± 5, 44% normal weight, 39% overweight, 17% obese, 53% males. Left atrial volume was measured by the area-length method using the apical 4-chamber and 2-chamber views.
RESULTS:The prevalence of left ventricular hypertrophy (LVH) was 11% when indexing for BSA and 12% when indexing for height2.7. LAE was observed in 30% of subjects when indexing for h2 and in 9% when indexing for BSA. In obese or overweight subjects the prevalence of LAE was 38% of subjects when indexing for h2 and in 11% when indexing for BSA. The different prevalence of LAE was particularly evident in extremely obese patients.LAE was very common in patients with LVH62% and 26% when indexing for h2 and for BSA, respectively. Interestingly, it was frequent also in patients without LVH, in particular when the indexation for h2 was used (25% as compared to 7% when indexing for BSA).
CONCLUSIONS:In a large sample of subjects undergoing a diagnostic work-up for arterial hypertension LAE was frequently observed, particularly when the new indexation proposed by the 2018 ESH/ESC hypertension guidelines was used. Even in the absence of clear-cut LVH, LAE was observed in one quarter of subjects. The indexation to BSA leads to an under-recognition of LAE, in particular in patients with overweight and/or obesity.
OBJECTIVE:It has been suggested that measurement of “unattended” or “automated oscillatory(AOBP)” blood pressure values may provide advantages over conventional BP measurement and some hypertension ...guidelines now suggest this approach as the preferred one for measuring office BP. Data on the strength of the relationship between AOBP and cardiovascular events are limited as compared to those obtained with the standard BP measurement; conflicting data are available on the relationship between hypertensive organ damage and “attended” and “unattended” BP.The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and arterial stiffness in 108 subjects undergoing a visit and assessment of arterial stiffness at an ESH Excellence Centre.
DESIGN AND METHOD:Both “unattended” BP (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1 minute intervals, after 5 minutes) and “attended” BP were measured with the same device, on the same day of arterial stiffness assessment, in random order.
RESULTS:Patientʼs mean age was 65 ± 15 yrs, mean BMI 26 ± 4, 43% female, 72 % had hypertension (59% treated). Systolic unattended BP was lower as compared to attended SBP (132.7 ± 17.7vs124.9 ± 15.3 mmHg). A similar correlation was observed between PWV and systolic unattended BP or attended SBP (r = 0.530 and r = 0.535, p < 0.0001, respectively) and between PWV and mean unattended and attended BP (r = 0.408 and r = 0.381, p < 0.0001, respectively). Similar correlations were also observed between PWV and unattended and attended pulse pressure (r = 0.459 and r = 0.480, p < 0.0001). The differences between correlations were not statistically significant (Steigerʼs Z test).No significant difference was observed between the ROC curves of attended and unattended SBP for the presence of increased arterial stiffness (AUC 0.706 vs. AUC 0.730, p for the comparison = ns).
CONCLUSIONS:Measurement of BP “unattended” or “unattended” provides different values, being unattended BP lower as compared to attended BP. Our results suggest that unattended measurement of BP values does not change the relationship with the gold standard measure of arterial stiffness.
OBJECTIVE:Available data indicate that patients with primary aldosteronism (PA) have an increased risk of cardiovascular (CV) events; furthermore, CV risk seems to be, at least in part, independent ...of blood pressure (BP) elevation. Previous studies have shown that patients with PA have a greater prevalence of left ventricular (LV) hypertrophy, which might contribute to the increase in CV risk. Recently, a non-invasive approach for the estimation of LV mechanical efficiency through the calculation of the ratio between stroke work (SW) and heart rate (HR)–pressure product has been proposed by de Simone and coworkers. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography.
DESIGN AND METHOD:The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as SV/HR and indexed to LV mass (MEEi = MEE/LVM) in a large group of patients with primary aldosteronism and in a control group of essential hypertensives (EH). PA was diagnosed in the presence of a positive aldosterone to renin ratio (>30) and post saline aldosterone > 100ng/ml). Ninety-nine patients with PA were compared with 99 EH patients matched for age and BP values.
RESULTS:No differences between groups were observed for age, gender, BMI, BP values, glucose, lipid profile and renal function. LV mass index was greater in PA vs EH (101 ± 34 vs 84 ± 20, gr/m2, p < 0,05); also relative wall thickness was greater in PA vs EH (0.36 ± 0.1 vs 0.32 ± 0.4, p < 0,05). Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in PA vs EH (40 ± 7 vs 43 ± 6, and 18 ± 3 vs 21 ± 2 both p < 0,05). MEEI was lower in PA vs EH (0.44 ± 0.14 vs 0.52 ± 0.10, p < 0,05). A negative correlation was observed between MEEI and aldosterone levels (r = −0.20, p < 0.05).
CONCLUSIONS:In patients with primary aldosteronism MEEI is lower as compared to EH. These findings may contribute to explain the increased risk of CV events in patients with PA.
OBJECTIVE:BackgroundThe CHA2DS2-VASc score is used in patients with atrial fibrillation (AF) for stroke risk stratification. Recent studies have shown that CHA2DS2-VASc is also predictive of ...cardiovascular (CV) events and mortality, whether or not AF is present. Few data are available on the relationship between CHA2DS2-VASc and preclinical organ damage (OD) in the general population.
DESIGN AND METHOD:Aim of our studywas to evaluate the relationship between CHA2DS2-VASc and 10 years Framingham risk scores and preclinical cardiac and vascular organ damage in subjects from a general population.MethodsA total of 478 subjects underwent clinical examination with blood pressure measurement (clinic and 24 hours), and laboratory examinations. Left ventricular (LV) and carotid artery structure were assessed by ultrasound and carotid-femoral PWV was measured. OD was defined according to ESH ESC 2013 Guidelines. CHA2DS2-VASc was calculated as recommended by current AF Guidelines. The Framingham risk score for cardiovascular events (FRS CVD), for stroke (FRS stroke) and for coronary heart disease (FRS CHD) were also calculated.
RESULTS:Resultsmean age was 58 ± 10 (range 43–74 yrs), 44% were males, 69% hypertensives (37% treated). Left ventricular mass index, meanmax IMT and carotid-femoral pulse wave velocity (PWV) were significantly correlated with all the Framingham risk scores as well as with CHA2DS2-VASc (table).(Figure is included in full-text article.)The simultaneous inclusion of CHA2DS2-VASc and FRS (for CVD or Stroke or CHD) in linear regression analysis showed that the relationship between CHA2DS2-VASc and OD is independent of FRS.
CONCLUSIONS:ConclusionsCHA2DS2-VASc score is significantly correlated to preclinical organ damage in patients from a general population.
OBJECTIVE:Epidemiological studies have suggested that even mild enlargement of the ascending aorta may have independent prognostic significance for cardiovascular events. Therefore, some Authors have ...proposed that dilatation of the ascending aorta could be considered as a form of preclinical vascular damage in hypertensive patients. Aim of our studywas to assess the correlation between clinic and 24 hours BP values and the dimensions of the aorta, measured at level of the sinuses of Valsalva (Val), at the left ventricular outflow tract (LVOT), and at the level of the proximal ascending aorta (AscAO) in subjects from a general population.
DESIGN AND METHOD:250 subjects (43% males, mean age 56 ± 4 years, 42% hypertensives-HT) underwent laboratory examinations, clinic and 24 hours BP measurement, cardiac and carotid ultrasound, carotid-femoral pulse wave velocity measurement (AoPWV).
RESULTS:Aortic diameters were greater HT as compared to NT (Val3.41 ± 0.54 vs 3.25 ± 0.41 cm, LVOT 2.10 ± 0.28 vs 2.04 ± 0.26, AscAo 3.39 ± 0.45 vs 3.18 ± 0.38, all p < 0.05). Aortic diameters were all correlated to clinic and 24 hours BP values. The coefficients of correlation were greater for 24 hours BP (Tab). Val, AscAo, LVOT were also significantly correlated with left ventricular mass (r = 0.61, r = 0.48, and r = 0.43, all p < 0.001), meanmax intima media thickness (r = 0.13, r = 0.24, and r = 0.13, all p < 0.05) and with AoPWV (r = 0.16, p < 0.05, r = 0.28 p < 0.001, r = 0.08 p = ns).(Figure is included in full-text article.)
CONCLUSIONS:The dimensions of the proximal ascending aorta are significantly related to BP values in normotensive subjects and in hypertensive patients. Aortic dimension are more strictly related to twenty-four hours BP values than to clinic BP values. In this sample of general population a significant correlation between aortic dimensions and measures of cardiac and vascular organ damage was also observed, confirming the parallelism between different forms of organ damage
Objective
Wall-to-lumen ratio of retinal arterioles might serve as an in-vivo parameter of vascular damage. Previous studies have shown a correlation between retinal arteriolar structure and blood ...pressure values, measured both in the clinic and during 24 hours ambulatory monitoring. We analyzed the impact of brachial clinic blood pressure (BP), of central BP and of 24 hours BP values on wall-to-lumen ratio of retinal arterioles.
Methods
In 267 subjects (129 males, age range 20–72 years; mean 54±7 years) wall-to-lumen ratio of retinal arterioles was assessed in vivo using scanning laser doppler flowmetry (Heidelberg retina flowmeter, Heidelberg Engineering). In addition clinic and 24 hours BP values were measured. Central hemodynamics and augmentation index (Ai) were assessed by pulse wave analysis.
Results
In never treated patients with essential hypertension (n=56) a higher wall-to-lumen ratio (0.37±0.19 vs. 0.30±0.13, P=0.05) was observed in comparison with normotensive individuals (n=115); no significant differences were observed between treated (n=96) and untreated hypertensive patients.
Wall to lumen ratio and wall cross sectional area of retinal arterioles were significantly related to clinic systolic BP(r=0.23, P=0.005) and PP(r=0.18, P=0.005), to 24 hours systolic BP(r=0.28, P=0.0001) and PP(r=0.19, P=0.003) and to central systolic BP(r=0.20, P=0.01) and central PP(r=0.21, P=0.001). Multiple regression analysis including all BP indices revealed that only mean systolic 24 hours BP is independently associated with an increased wall-to-lumen ratio of retinal arterioles.
Conclusion
in this quite large group of hypertensive patients and normotensive individuals 24 hours systolic BP seems to be the strongest determinant of increased WLR of retinal arterioles.
Background
Carotid-femoral pulse wave velocity (cfPWV) is an independent predictor of cardiovascular events and its measurement is recommended by current hypertension guidelines. Few data are ...available on the progression of PWV over time. The aim of the present study was to assess the progression of aortic stiffness over a 5-year period in a general population in Northern Italy (Vobarno Study).
Methods
227 subjects, 42% males(age 50±4 years, hypertension in 51% at baseline visit, BL), underwent a BL and a follow up (FU) visit, after 5.1±0.4 years. In all subjects laboratory examinations, measurement of clinic and 24 hours blood pressure(BP) and of cfPWV were performed at BL and at FU.
Results
In the overall population cfPWV increased from 8.28±1.27 at BL to 8.51±3.2 m/s at FU(p<0.05), change: 0.22±1.25. cfPWV significantly increased from BL to FU in hypertensive subjects (HT)(from 8.61 ±1.41 to 8.90±1.40, p<0.01)but not in normotensives (NT)(from 7.97±1.03 to 8.11±1.11, p n.s). The absolute change in cfPWV from BL to FU progressively increased from -0.052±0.108 in NT, to 0.480±0.163 in treated HT and to 0.483±0.138 in untreated HT(p for trend<0.01);after adjustment for possible confounders(age, gender, BMI, baseline cfPWV and change in mean BP)the difference remained statistically significant. At multivariate analysis the variables independently related to the progression of cfPWV were cfPWV and mean BP at BL (beta −0.55, p<0.01, and beta 0.18, p<0.01, respectively) and the change in mean BP during follow-up (beta 0.20, p = 0.001).
Conclusions
In a general population sample in Northern Italy the main determinants of the increase in arterial stiffness during a 5 years FU were cfPWV and mean BP at BL and change in mean BP over time.
Background
The determinants of aortic stiffness have been elucidated in several studies, while few data are available for carotid stiffness. Aim of the study was to identify the main determinants of ...carotid arterial stiffness parameters in a general population in Northern-Italy(Vobarno Study).
Methods
183subjects(61% female, mean age 55± 4,53% hypertensives,59% treated) underwent laboratory examinations and both clinic and 24 hours BP measurement (Spacelabs 90207). A non-invasive echotracking system was used to measure intima-media thickness, diameter, distension, distensibility (Dist), distensibility coefficient (CDist), compliance coefficient (CC) and elastic modulus (Einc) on 4-cm long common carotid artery segment. Results: correlation coefficient of Dist, CDist and Einc are shown in Table 1.
At multivariate analysis the independent predictor of Dist, CDist and Einc were age (β = -0.22, β = -0.22 and β = 0.18, respectively, all p<0.01), BMI (β = -0.18, β = -0.18 and β = 0.14, respectively, all p<0.05), MBP (β = -0.34, β = -0.33 and β = 0.40, respectively, all p<0.001)and female gender(β = 0.19, β = 0.18 and β = -0.15, respectively, all p<0.05). When carotid arterial stiffness parameters were compared in males and females, a significantly lower values of Dist and CC were observed in females (365±97 vs 427±124 μm, p<0.001 and 0.63±0.24 vs 0.83±0.29 mm
2
/kPa
−1
, p<0.001, respectively). After adjusting for possible confounders in a multivariate model distension(345 vs 456 μm, p<0.001), CDist (23.4 vs 30.3 kPa
−1
*10
−3
, p<0.001) and CC (0.61 vs0.87 mm
2
/kPa
−1
, p<0.001)were significantly lower in females while Einc was significantly higher in females(0.45 vs 0.34 kPa*10
3
, p = 0.007). Conclusion: in a general population sample age, female gender, BMI and clinic and 24 hours BP values are associated to an increase local carotid stiffness.
Abstract
Background
Left atrial (LA) enlargement (LAE) is associated to an increased risk of cardiovascular complications, and in particular of atrial fibrillation. The 2018 ESH/ESC Hypertension ...guidelines suggested the use of LA volume instead of linear dimensions, and for the first time proposed the indexation to height2 (h2)
The aim of our study was to assess the prevalence of left atrial dilatation in a large sample of patients undergoing an echocardiogram for cardiovascular risk stratification at an ESH excellence centre in Italy.
Design and methods 3872 subjects undergoing a diagnostic work-up for arterial hypertension (known or suspect) were analysed. The mean age was 56±15 years, BMI 26±5 kg/m, 44% normal weight, 39% overweight, 17% obese, 53% males. Left atrial volume was measured by the area-length method using the apical 4-chamber and 2-chamber views.
Results
The prevalence of left ventricular hypertrophy (LVH) was 11% when indexing for BSA and 12% when indexing for height2.7. LAE was observed in 30% of subjects when indexing for h2 and in 9% when indexing for BSA. In obese or overweight subjects the prevalence of LAE was 38% of subjects when indexing for h2 and in 11% when indexing for BSA. The different prevalence of LAE was particularly evident in extremely obese patients.
LAE was very common in patients with LVH: 62% and 26% when indexing for h2 and for BSA, respectively. Interestingly, it was frequent also in patients without LVH, in particular when the indexation for h2 was used (25% as compared to 7% when indexing for BSA).
Conclusions
In a large sample of subjects undergoing a diagnostic work-up for arterial hypertension LAE was frequently observed, particularly when the new indexation proposed by the 2018 ESH/ESC hypertension guidelines was used. Even in the absence of clear-cut LVH, LAE was observed in one quarter of subjects. The indexation to BSA leads to an under-recognition of LAE, in particular in patients with overweight and/or obesity
Objective: Background: at present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the ...incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Design and method: Methods: medical records of patients aged > 18 yrs, admitted to the ED with blood pressure values > = 180 mmHg (SBP) and/or > = 120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76 % as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70 + 13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5 + 7 months years. Results: Results: During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22 %) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7 %, chisquare p = 0.0001 and 5.8 vs 1.2% chisquare p < 0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions: Conclusions: admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies.
PDF
