OBJECTIVE:It has been suggested that measurement of “unattended” or “automated oscillatory (AOBP)” blood pressure values may provide advantages over conventional BP measurement; some hypertension ...guidelines now suggest this approach as the preferred one for measuring office BP. Data on the relationship between AOBP and cardiovascular events are much less solid as compared to those obtained with the standard BP measurement; on the other hand, some study suggested that AOBP might be more strictly correlated with hypertensive target organ damage than “attended” BP.The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and target organ damage in 261 subjects attending the outpatient clinic of an ESH Excellence Centre.
DESIGN AND METHOD:BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest; thereafter, the patient was left alone and unattended BP was measured automatically after 5 minutes (3 measurements at 1 minute interval).
RESULTS:Patientʼs mean age was 61 ± 16 yrs, mean BMI 26.1 ± 4.2, 60% were female, 88 % had a previous diagnosis of hypertension (64% treated). Systolic unattended BP was lower as compared to attended SBP (130.1 ± 15.7vs138.6 ± 17.2 mmHg). Left ventricular mass index (LVMI) was similarly correlated with unattended and attended SBP (r = 0.132 and r = 0.133, p < 0.05, respectively). LVMI was similarly correlated with unattended and attended pulse pressure (PP) (r = 0.277 and r = 0.299, p < 0.05, respectively). Carotid IMT was significantly and similarly correlated with both attended and unattended BP values (CBMaxIMTr = 0.172 and r = 0.153 for attended and unattended SBP, p < 0.05 andr = 0.459 and r = 0.436 for attended and unattended PP, p < 0.001). The differences between correlations were not statistically significant.
CONCLUSIONS:Measurement of BP “unattended” or “unattended” provides different values, being unattended BP lower as compared to attended BP. Our results suggest that attended and unattended BP values are similarly related with cardiac and vascular hypertensive target organ damage.
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: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:A non-invasive approach for the estimation of mechanical efficiency through the calculation of the ratio between stroke work and HR–pressure product has been recently proposed by de Simone ...et al. 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.The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) in a large general population sample in Northern Italy.
DESIGN AND METHOD:We evaluated 478 subjects participating in a general population study in Northern Italy (Studio Vobarno). All subjects underwent a physical examination with measurement of clinic blood pressure (BP). In all subjects laboratory examinations, 24 hours blood pressure measurement, echocardiography, and assessment of carotid-femoral pulse wave velocity (PWV) were performed.
RESULTS:Subjects had a mean age of 58 ± 10 years, a BMI of 26 ± 4, 44% were males, 69% had arterial hypertension (55% treated). MEEi was lower in males and in patients with increased PWV. MEEi was inversely correlated with age, BMI, waist circumference, clinic and 24 hours BP, glucose, uric acid, triglycerides and directly correlated with HDL. MEEI was also inversely correlated with relative wall thickness (RWT) and PWV. At linear regression multivariate (?) analysis MEEi remained independently related to male gender (β = 0.16, p < 0.001), BMI (β = −0.13, p < 0.005), RWT (β = −0.56, p < 0.001) and PWV (β = −0.10, p < 0.05).
CONCLUSIONS:In a large sample of general population in Northern Italy myocardial mechanoenergetic efficiency was inversely correlated with arterial stiffness, independently of multiple possible confounders.
OBJECTIVE:The recent results of the SPRINT study suggest that “intensive” reduction of systolic blood pressure (BP) (to less than 120 mmHg) might provide greater cardiovascular protection as compared ...to less intensive (<140 mmHg) reduction of BP, at least in some subsets of patients. Only few studies, have investigated the possible effect of tight blood pressure control on indices of left ventricular hypertrophy, and have been mainly based on electrocardiography.Aim of our studywas to evaluate cardiac organ damage according to “on treatment” blood pressure values in a large cohort of hypertensive patients undergoing echocardiography (2D, M-mode with conventional and tissue Doppler analysis) at the echo-lab of an ESH Excellence Centre in Italy.
DESIGN AND METHOD:The analysis included 976 treated hypertensive patients (43% female, age 59 ± 12 yrs, age range 15–90). Patients were subdivided in three groups according to BP values at the time of the echocardiogram, defined as followsuncontrolled (UC; SBP >or equal to 140 mmHg), controlled <140 (C140; SBP between 139 and 120 mmHg) and controlled <120 (C120; SBP <120 mmHg).
RESULTS:In 407 patients (42%) SBP values were >140 mmHg, 449 patients (46%) had SBP was between 139 and 120 mmHg (C140) and in 120 (12%) SBP was <120 mmHg (C120).Left ventricular mass (LVM) and LVM index (LVMI) were progressively lower in UC, C140 and C120 (LVM162 ± 51, 159 ± 47 and 149 ± 44 gr respectively, p for trend <0,001; LVMI40 ± 11,38 ± 10 and 35 ± 9 gr/m2.7 respectively, p for trend <0,001). No significant difference was observed for relative wall thickness. Left atrial volume (LAV) and LAV/BSA were progressively lower in UC, C140 and C120 (LAV/BSA25.6 ± 7.6, 23.7 ± 7.9, 22.7 ± 8.5, respectively, p for trend <0,001). These differences remained significant even after adjusting for possible confounders.
CONCLUSIONS:Lower achieved BP targets are associated with a progressive lower left ventricular mass, left ventricular mass index and left atrial volumes. These findings are in line with previous results indicating a favorable effect of tight BP control on electrocardiographic indices of LV hypertrophy. Prospective studies are needed to confirm the possible favorable effect of tight BP control on echocardiographic indices of LVH, and their relation to CV events.
OBJECTIVE:In patients with systemic lupus erythematosus (SLE) a greater prevalence of structural and functional cardiovascular (CV) alterations has been described, possibly explaining the higher ...incidence of CV events, as compared to subjects matched for age and sex.Aim of this study was to analyze the presence of target organ damage in premenopausal women with SLE and in controls matched not only for demographic characteristics but also for other cardiovascular risk factors.
DESIGN AND METHOD:34 patients with SLE clinically stable (SLEDAI Score 2.5 +/- 1.5) (mean age 32 ± 7 years, range 19–44) and 34 controls matched for sex, age, body mass index (BMI), clinic blood pressure (BP) and antihypertensive treatment (if present), underwent24 hours BP monitoring, echocardiography with tissue Doppler analysis (TDI) for the evaluation of left ventricular (LV) structure and of systolic and diastolic function, carotid ultrasound for intima-media thickness (IMT) and carotid distensibility measurement, and pulse wave velocity measurement for aortic stiffness (PWV).
RESULTS:By definition no difference was observed for age, sex, BMI and clinic BP values and a similar Framingham risk score was observed between SLE and controls (1.3 ± 2.7 vs 1.5 ± 2.3%, p = ns). No significant differences were observed for all echocardiographic parameters except LV longitudinal systolic function (Sm), an early index of LV systolic dysfunction (see Table). Carotid IMT and distensibility, as well as PWV and the prevalence of an abnormal aortic stiffness were both similar in the two groups. At the logistic analysis, PWV was independently associated with LV mass in controls and with the steroid weekly dose in SLE patients.(Figure is included in full-text article.)
CONCLUSIONS:In patients with SLE and low activity index of the disease we did not observe significant vascular alterations as compared to controls with similar cardiovascular risk. The early LV systolic impairment observed in this group of patients needs confirmation in larger cohorts.
Background
In patients with Systemic lupus erythematosus (SLE) a greater prevalence of structural and functional cardiovascular (CV) alterations has been described, possibly explaining the higher ...incidence of CV events, as compared to subjects matched for age and sex.
Aim of this study was to analyze the presence of target organ damage in premenopausal women with SLE and in controls matched not only for demographic characteristics but also for other cardiovascular risk factors.
Subjects and methods
4 patients with SLE clinically stable(SLEDAI Score 2.5±1.5)(age 32±7years, range 19–44) and 34 controls matched for sex, age, BMI, clinic blood pressure(BP) and antihypertensive treatment(if present), underwent:24 hours BP monitoring, echocardiography with tissue Doppler analysis(TDI) for the evaluation of left ventricular(LV)structure and of systolic and diastolic function, carotid ultrasound for intima-media thickness(IMT), carotid distensibility measurement, and pulse wave velocity measurement(PWV).
Results
By definition no difference was observed for age, sex, BMI and clinic BP values and a similar Framingham risk score was observed between SLE and controls(1.3±2.7 vs 1.5±2.3%, p = ns). No significant differences were observed for all echocardiographic parameters except LV longitudinal systolic function(Sm), an early index of LV systolic dysfunction(see Table). Carotid IMT and distensibility, as well as PWV and the prevalence of an abnormal aortic stiffness were both similar in the two groups. At the logistic analysis, PWV was independently associated with LV mass in controls and with the steroid weekly dose in SLE patients.
Conclusions
In patients with SLE and low activity index of the disease we did not observe significant vascular alterations as compare to controls with similar cardiovascular risk. The early LV systolic impairment observed in this group of patients needs confirmation in larger cohorts.
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