OBJECTIVE:2018 ESH guidelines for diagnosis and treatment of hypertension have lowered the blood pressure (BP) targets to be reached with treatment especially for elderly subjects; this suggestion is ...based on the results of recent trials that demonstrate that lower blood pressures reduces the risk of cardiovascular events. However to attain a stricter blood pressure control is not always easy and requires intensified treatment.The purpose of this study was to quantify the impact that new guidelines’ BP targets could have on the clinical practice.
DESIGN AND METHOD:We analyzed 100 patient reports, related to visits performed in our outpatient clinic in a period precedeng the publication of the 2018 guidelines (consecutive patients seen between March and May 2018; from the report we collected the BP values measured during the visit, the physicianʼs evaluation of BP control and decision about treatment and prescribed drug therapy (class of drugs and dose, either full dose or low dose).
RESULTS:20 patients were excluded from subsequent analysis because it was their first visit and they were prescribed an antihypertensive treatment for the first time; in 63 of the remaining 80 patients, according to BP measured during the visit and overall BP control out of office, keeping in mind the target of previous guidelines, the physician decided to confirm the ongoing therapy because BP control was deemed satisfactory; in 3 more patients the BP control was partially unsatisfactory but the physician confirmed anyway the current therapy (an example of physicianʼs inertia); in the remaining 14 patients the therapy was modified because of poor BP control. If we were to apply the new targets for BP, therapy should have been modified in 68 patients and that could be done with an increase of dose in 40 cases and with the addition of a new drug in the remaining 28 patients.
CONCLUSIONS:To reach the new targets for BP control is feasible but in many cases increases the number of drugs that have to be taken and this could have negative effects on adherence and therefore paradoxical effects on BP control.
OBJECTIVE:Even though there are no doubts about the convenience of treating high blood pressure in both genders, the available evidence for men and women may not be equal and/or the presence of ...possible differences between genders might not have been systematically investigated. In other words the questions to be answered are1) were both genders equally represented in hypertension researches; 2) Possible differences between genders have been investigated in all studies or not?
DESIGN AND METHOD:To try to find an answer to the above questions we performed a search of scientific literature to check whether women have been underrepresented in epidemiological and controlled clinical trials (CCT) and in which percentage of CCTs a gender specific analysis of the results was performed.
RESULTS:As far as epidemiology both meta-analysis available (that of the Prospective Study Collaboration and that of the Asian Pacific Study Collaboration) included less than 40% of women; in CCTs the percentage of women included has increased from less than 30% in the early trials to almost 50% in the latest ones but large differences still persist among the studies. Moreover a gender-specific analysis of the results is not routinely performed. Among the latest 34 CCTs that were included in our analysis, results were reported separately for men and women only in half of the trials even though when searched some cases between genders were present. The situation is even worse for meta-analysis; of the 17 most relevant meta-analysis published between 1990 and 2018, two were dedicated to sex differences and only 3 others analyzed the presence of potential differences between genders.
CONCLUSIONS:Even though the prevalence of hypertension in women is equal to that in men or even higher in older women, the attention given to the presence of potential differences in epidemiology, physiopathology and treatment is less than optimal and could be improved.
•State of art of management and treatment of hypertension emergency/urgency in Italy.•Good knowledge of definition and treatment.•Fair quality of blood pressure measurement technique.•Lack of ...protocol or fast track for this problem.•Differences in terms of treatment and diagnosis across macro-areas.
Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension. 665 questionnaires were collected from EDs, Emergency and Urgency Medicine, Cardiology or Coronary Units, Internal Medicines, Intensive care, Stroke units. Symptoms considered suspicious of acute organ damage were: chest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%) and epistaxis (34.4%). Exams more frequent prescribed were: electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). The use of intravenous or oral medications to treat HEs was 94.7% and 3.5%, while for HUs 24.4% and 70.8% respectively. Of note, a surprisingly high percentage of physicians (22 % overall, 24.5% in North Italy) used to prescribe sublingual nifedipine. After discharge, home blood pressure monitoring and general practitioner re-evaluation were more frequently suggested, while ambulatory blood pressure monitoring and hypertension specialist examination were less prescribed. The differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration. This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy.
OBJECTIVE:Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Italian Emergency Department (ED), however the diagnostic and therapeutic approach may differ ...across the Italian country. The aim of the study GEAR (Gestione delle Emergenze e urgenze in ARea critica) was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of on-line survey.
DESIGN AND METHOD:The young investigator research group of the Italian Society of Hypertension developed a 23-items questionnaire spread by e-mail invitation to the members of Italian Scientific societies involved in the field of Emergency Medicine and Hypertension.
RESULTS:665 questionnaires were collected59.7% from EDs, 22% from Emergency and Urgency Medicine wards, 8.7% from Cardiology or Coronary Units, 5.7% from Internal Medicines and 3.9% from Intensive care or Stroke units. The definition of HE and HU was correctly identified by 81.2% and 89.3% of the responders respectively. The symptoms considered suspicious of acute organ damage werechest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%), epistaxis (34.4%). Appropriate cuffs, for different arm sizes, were not widely available in all units94% had standard cuffs, 57% small and 75.6 % large cuffs, extra-large only 38.5%. The exams more frequent prescribed to evaluate target organ damage were electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). HEs were treated by 94.7% of the physicians by intravenous medications and by 3.5% by oral drugs, while HUs were treated by intravenous drugs in 24.4% of the cases and by oral drugs in 70.8%. When patients were discharged from ED, 87.5 % of the responders recommended home blood pressure monitoring, 87.5% general practitioner re-evaluation, while ambulatory blood pressure monitoring and hypertension specialist examination were less frequently recommended.
CONCLUSIONS:This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy. Strong unmet needs clearly emerged, especially for educational initiatives, standardized treatment protocols and interrelationship with the chronic care system.
OBJECTIVE:Different wheats contain different amounts of bioactive peptides and with different pharmacological effects. Some wheat peptides as LTP2 have known ACE-inhibitory activity in vitro. Our aim ...was to test the haemodynamic and metabolic effect of two kind of commercial wheat product made by wheat naturally containing a high (Khamut®) or low amount of LTP2.
DESIGN AND METHOD:Methodsin the context of the 7FP EU “Beneficial Effects of Bioactive Compounds in Humans (BACCHUS)” project, we enrolled 60 non-diabetic subjects (age 40–70 years old), at increased estimated CV risk (ESC/EAS SCORE), with SBP 130–139 mmHg and/or DBP 85–90 mmHg (pre-hypertensive/borderline high pressure subjects), in primary prevention for CVD, and we randomized then to the two experimental arms. The trial was a double-blind, cross-over, randomized clinical trial. Each treatment phase had a 4-week duration.
RESULTS:Anthropometric parameters, office blood pressure, cholesterol, liver and renal parameters did not change during both wheat products intake.Diurnal and nocturnal systolic blood pressure significantly improved only after Khamut intake versus baseline and versus control (from 136,3 ± 4,2 to 132,4 ± 4,5 mmHg, p < 0.05, and from 120,8 ± 5,4 to 116,4 ± 4,1 mmHg, p < 0,05, respectively).Pulse volume change (as a marker of endothelial reactivity) significantly improved only after Khamut intake versus baseline and versus control (from 64,3 ± 6,6 to 68,1 ± 4,2, p < 0.05).Pulse wave velocity and augmentation index did not change during both wheat products intake.Plasma fasting triglycerides and glucose significantly improved only after Khamut intake versus baseline and versus control (from 123,5 ± 32,9 to 107,2 ± 21,5 mg/dL, p < 0.05, and from 86,3 ± 8,8 to 84,2 ± 6,3 mg/dL, p < 0,05, respectively).
CONCLUSIONS:Substituting standard wheat products in diet with products rich in LTP2 peptide seems to mildly improve 24-hour systolic blood pressure, endothelial reactivity, fasting triglycerides and glucose level in overall healthy subjects with suboptimal blood pressure control.
OBJECTIVE:Red yeast rice is a well-known lipid-lowering nutraceutical. The aim of this double-blind, randomized, placebo-controlled, clinical trial was to investigate if the known benefits on lipid ...pattern of a 6-month treatment with 10 mg monacolins could be also associated to changes in endothelial function and arterial stiffness.
DESIGN AND METHOD:This double blind, placebo-controlled, randomized clinical trial was carried out on 40 moderately hypercholesterolemic subjects, non smokers, pharmacologically untreated, in primary prevention for cardiovascular diseases (Clinicaltrial.gov ID NCT02492464).After 4 weeks of diet and physical activity, patients were allocated to treatment with an indistinguishable pill of placebo or with an active product containing 10 mg monacolins from Monascus purpureus and 50 mg coenzyme Q10 to be assumed for 6 months.Endothelial reactivity and arterial stiffness have been measured through the validated Vicorder® device.
RESULTS:When compared to the placebo phase, during monacolin treatment patients experienced a more favorable percentage change in LDL-cholesterol (LDL after monacolin treatment−27.7%; LDL after placebo treatment+5.0%, p < 0.05).As it regards the vascular parameters, endothelial reactivity (pulse volume displacement after monacolin treatment+6.0%; pulse volume displacement after placebo treatment+0.5%, p < 0.05), and arterial stiffness (pulse wave velocity after monacolin treatment−0.4%; pulse wave velocity after placebo+0.1%, p < 0.05) also significantly improved after monacolin treatment only.
CONCLUSIONS:Based on our data, the long-term assumption of a red yeast rice dietary supplement containing 10 mg monakolins per daily dose seems to be associated to an improvement of LDL-cholesterolemia, endothelial reactivity and pulse wave velocity in moderately hypercholesterolemic subjects
OBJECTIVE:Proprotein convertase subtilisin kexin type 9 (PCKS9) circulating levels are significantly associated with increased risk of total cardiovascular events. Risk markers for cardiovascular ...diseases (CVD) include parameters relative to arterial structure and function. Our study aimed to evaluate the relationship between circulating levels of PCSK9 and arterial stiffness in a large sample of overall healthy subjects.(Figure is included in full-text article.)
DESIGN AND METHOD:From the historical cohort of the Brisighella Heart Study, four subgroups were selected; pre-menopausal women (n = 227), age-matched men (n = 193), post-menopausal women (n = 460) and age-matched men (n = 416). In these subjects, the correlation between PCSK9 plasma circulating levels and the pulse wave velocity (PWV) was evaluated. Active smokers, participants in secondary prevention for CVD treated with statins or vasodilating agents, were excluded from the analysis.
RESULTS:Post-menopausal women showed higher PCSK9 levels (309.9 ± 84.1 ng/mL) compared to the other groups of subjects (p < 0.001). Elderly men had significant higher levels of PCSK9 than adult men (283.2 ± 75.6 ng/mL vs. 260.9 ± 80.4 ng/mL; p = 0.008) (Figure 1). PWV was mainly predicted by age (B = 0.116, 95%CI 0.96 – 0.127, p < 0.001), PCSK9 (B = 0.014, 95%CI 0.011–0.016, p < 0.001), and serum uric acid (B = 0.313, 05%CI 0.024–0.391, p = 0.026). Physical activity, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and estimated glomerular filtration rate were not associated to the PWV level (p > 0.05). Considering the above described subgroups, age and PCSK9 resulted the main factors associated to PWV; the latter correlates to serum uric acid only in post-menopausal women.
CONCLUSIONS:In the Brisighella Heart Study cohort, circulating PCSK9 are significantly related to the arterial stiffness, independently from gender and menopausal status.
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