Abstract Introduction Data regarding prevalence and clinical management of hypertensive emergencies and urgencies are lacking and heterogeneous. Our goal is to characterize patients with hypertensive ...emergencies and urgencies admitted to the Emergency Department (ED) of Niguarda hospital and Pio XI Hospital of Desio. In this population we also want to evaluate factors associated with organ damage, adherence to guidelines and the impact of Blood Pressure (BP) management on in–hospital mortality. Method We performed a multi–centre retrospective study collecting data about all adult patients with systolic BP ≥ 180 mmHg and/or diastolic BP ≥120 mmHg admitted to our hospitals‘ ED during 2017 and 2019. Results Admission to ED for BP elevation were 1838 (0.95% of total admission to ED), of whom 38% were hypertensive emergencies and 62% were hypertensive urgencies. Patients with hypertensive emergencies were older, mainly male, with more comorbidities and more symptomatic at ED admission. In the emergencies group, we observe a SBP mean reduction of 39.50 mmHg (±26.35) and a DBP mean lowering of 16.28 mmHg (±17.57); the most used drugs were furosemide, nitroglycerin and parenteral labetalol. In the urgencies group, the mean reduction was 39.09 mmHg (±22.46) for SBP and 15.34 mmHg (±16.07) for DBP. The most used drug was short–acting nifedipine benzodiazepine and amlodipine in this group. Age, sex, clinical history of heart failure and chronic obstructive pulmonary disease, symptoms at ED admission ad eGFR have been recognised as factors associated with organ damage. Instead, BP at ED admission and its management didn’t appear to have a significant impact on outcomes. Conclusions Our study demonstrated better adherence to guidelines in the treatment of hypertensive emergency than of hypertensive urgencies. Furthermore, no significant association were found between the BP management in the ED and in–hospital mortality.
Objective: Hyperuricemia can be both determined by overproduction (due to xanthine oxidase hyperactivity) or renal hypoexcretion. In this latter case, also diuretic use (particularly ...hydrochlorotiazhide) can be involved. While the relationship between hyperuricemia and CardioVascular (CV) events has been definitively linked in many studies, data on diuretic related hyperuricemia are still lacking. The objective of this analysis is to assess the relationship between diuretic induced hyperuricemia and CV events. Design and method: The URic acid Right for heArt Health study is a nationwide, multicentre, observational cohort study involving data on individuals aged 18–95 years recruited on a regional community basis from all the territory of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 122 ± 66.9 months. Patients were classified into four groups accordingly to the diuretic use (yes vs no) and Uric Acid (UA) levels (higher or lower than the median value of 4.9 mg/dL). All cause death, CV deaths and CV events were consiedered as outcomes. Results: A total of 17747 individuals were included in the analysis. Mean age was 57.1 ± 15.2 years, males were 45.3%, SBP/DBP were 144.1/85.2 ± 24.6/13.2. 17.2% of the subjects use diuretic of whom 58% presents UA higher than median values. As showed in figure 1, patients with Hpeuricemia without diuretic use served as reference group. In multivariate adjusted analysis (for sex, age, SBP, BMI, glycemia, total cholesterol and creatinine) subjects without hyperuricemia and without diuretic show a significant lower risk for the three outcomes. Subjects without hyperuricemia with diuretic use have lower risk of all cause death but similar risk of CV death and events. Finally subjects with hyperuricemia and diuretic use exhibit a similar risk for the three outcomes as compared with the reference group. Conclusions: Our study showed that diuretic related hyperuricemia is related to CV events similarly to the subjects that present hyperuricemia without diuretics.
The prevalence and clinical significance of isolated office (or white coat) hypertension is controversial, and population data are limited. We studied the prevalence of this condition and its ...association with echocardiographic left ventricular mass in the general population of the PAMELA (Pressione Arteriose Monitorate E Loro Associazioni) Study.
The study involved a large, randomized sample (n=3200) representative of the Monza (Milan) population, 25 to 74 years of age. Participants in the study (64% of the sample) underwent measurements of office, home, 24-hour ambulatory blood pressure, and echocardiography. Isolated office hypertension was defined as systolic or diastolic values >/=140 mm Hg or >/=90 mm Hg, respectively. Home and ambulatory normotension were defined according to criteria previously established from the PAMELA Study, for example, <132/83 mm Hg (systolic/diastolic) for home and 125/79 mm Hg for 24-hour average blood pressure. Treated hypertensive subjects were excluded from analysis that was made on a total of 1637 subjects. Depending on normotension being established on systolic or diastolic blood pressure measured at home or over 24 hours, the prevalence of isolated office hypertension ranged from 9% to 12%. In these subjects, left ventricular mass index was greater (P<0.01) than in subjects with normotension both in and outside the office. This was the case also for prevalence of left ventricular hypertrophy. Left ventricular mass index and hypertrophy were similarly greater in subjects found to have normal office but elevated home or ambulatory blood pressure ( approximately 10% of the population).
Isolated office hypertension has a noticeable prevalence in the population and is accompanied by structural cardiac alterations, suggesting that it is not an entirely harmless phenomenon. This is the case also for the opposite condition, that is, normal office but elevated home or ambulatory blood pressure, which implies that limiting blood pressure measurements to office values may not suffice in identification of subjects at risk.
OBJECTIVEThe increase in blood pressure that accompanies the obese state is almost invariably associated with alterations in metabolism (insulin resistance and dyslipidaemia) and the neurohumoral ...profile (activation of the renin–angiotensin system, sympathetic overactivity), which potentiate the cardiovascular risk associated with hypertension. However, debate remains as to the antihypertensive drug on which treatment of obesity-related hypertension should be based. The CROSS (Candesartan Role on Obesity and on Sympathetic System) study was undertaken to examine the antihypertensive, neuroadrenergic, and metabolic effects of an angiotensin II receptor blocker in comparison with a diuretic in obese hypertensive individuals.
METHODSIn 127 obese hypertensive individuals aged 50.7 ± 5.1 years (mean ± SD), we measured clinic blood pressure, heart rate, plasma glucose, and insulin at rest and during an oral glucose load before and 12 weeks after treatment with either candesartan cilexetil (8–16 mg once daily) or hydrochlorothiazide (HCTZ, 25–50 mg once daily), administered orally in accordance with a double-blind, randomized, placebo-controlled, two-parallel-groups study design. Insulin sensitivity was expressed as insulin resistance index (IRI), calculated as the ratio of the area under the curve (AUC) for glucose to that for insulin. In a subgroup of patients, measurements also included direct microneurographic recording of muscle sympathetic nerve activity (MSNA) in the peroneal nerve.
RESULTSCandesartan cilexetil caused a significant (P < 0.01) reduction in both mean blood pressure (from 114.2 ± 5.1 to 99.6 ± 6.0 mmHg) and MSNA (from 51.0 ± 12.3 to 40.4 ± 12.5 bursts per 100 heart beats), and a significant (P < 0.02) increase in insulin sensitivity (AUC IRIfrom −23.2 ± 22.1 to −17.6 ± 12.2). In contrast, HCTZ did not significantly affect MSNA and worsened insulin sensitivity, while achieving blood pressure reductions similar to those produced by candesartan cilexetil.
CONCLUSIONSThese data provide evidence that, in obese hypertensive individuals, treatment with candesartan cilexetil has an antihypertensive effect similar to that of HCTZ. Unlike diuretic treatment, however, treatment with candesartan cilexetil improves insulin sensitivity and exerts sympathoinhibitory effects.
The single-incision minimally invasive anterior approach to the hip with complete preservation of the musculotendinous structures offers excellent surgical exposure of both the acetabulum and the ...femur for the purpose of total hip replacement. Acetabular exposure corresponds to a modified and limited Smith-Petersen approach with intrinsic peculiarities. Femoral exposure in external rotation, adduction and extension of the leg is unusual for replacement purposes and is accomplished by the use of a traction table and a specially designed hook. Anterior single-incision exposure combines the advantage of intrinsic articular stability of anterior approaches with the advantages of preservation of lateral pelvitrochanteric and posterior myotendinous structures. An adequate learning curve must be overcome due to peculiar adaptations during the course of operation. A large variety of femoral components may be implanted by this approach; metaphyseal anchoring stems and femoral neck-preserving stems are particularly suited to this technique, combining both issues of minimally invasive surgery in total hip replacement: bone preservation and minimal surgical invasiveness. This article describes the surgical technique that we adopted in 2003 and compares it to other minimally invasive surgical techniques.PUBLICATION ABSTRACT
OBJECTIVE:To compare the prevalence of metabolic syndrome (MS) in HIV-positive patients with that from a sample of a general Italian population.
DESIGN:Cross-sectional study.
METHODS:A total of 1263 ...HIV-infected patients 18 years of age or older were recruited in 18 centers for infectious diseases in northern and central Italy. Controls were 2051 subjects aged 25 to 74 years representative of the residents of Monza, a town in Milan province, who were enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study.
RESULTS:The prevalence of MS in the HIV group was 20.8%, whereas in the control group, it was only 15.8%, with the difference being statistically significant. The age- and gender-adjusted risk of having MS in HIV-infected patients was twice as great as that in controls. Compared with controls, HIV-infected patients had a greater prevalence of the impaired fasting glucose, increased plasma triglycerides, and reduced high-density lipoprotein cholesterol components. MS prevalence was similar in treated and never-treated HIV-infected patients, and so were the various MS components.
CONCLUSIONS:The risk of MS is greater in HIV-infected patients compared with the general population because of a greater prevalence of lipid and glucose abnormalities. The prevalence of MS and its components is similar in treated and untreated HIV-positive patients.
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