«Se l’Australia vista dall’Asia sembra un nano, …, i “Pollicini” insulari la percepiscono come un vero gigante. Quando gli australiani guardano verso est e verso nord-est, vedono di fronte a sé solo ...uno sciame di arcipelaghi sparpagliati nell’immensità dell’oceano» (M. Perez, “L’Oceania alla deriva”, in Limes n. 4, 2000: 27). Lo sciame di sparpagliati «Pollicini» insulari, insistendo sul carattere di marginalità di questi territori, racconta una consolidata visione dell’Oceania radicata in ...
Background:
Vascular Ehlers–Danlos syndrome (vEDS) is an inherited connective tissue disorder characterized by arterial fragility. Celiprolol has been suggested to significantly reduce rates of ...vascular events in this setting, though real-world evidence is limited. The aim of this study was to report our experience with celiprolol therapy in vEDS management.
Methods:
Patients with a genetically confirmed diagnosis of vEDS who were referred for outpatient consultation at the Brescia University Hospital between January 2011 and July 2023 were included. At each visit, patients’ medical history, results of vascular imaging, and office blood pressure measurements were recorded. Celiprolol therapy was progressively titrated to the maximum tolerated dose of up to 400 mg daily, according to the patients’ tolerance.
Results:
Overall, 26 patients were included. Female sex was prevalent (62%). Mean (SD) age was 37 (16) years. Follow-up duration was 72 (41) months. At the last follow-up visit, all patients were on celiprolol therapy, 80% of whom were taking the maximum recommended dose. The yearly risk of symptomatic vascular events was 8.8%, the majority of which occurred after reaching the maximum recommended dose of celiprolol. No significant predictor of symptomatic vascular events was identified among patients’ clinical characteristics.
Conclusion:
In our cohort, rates of celiprolol use were high and the drug was well tolerated overall. Nonetheless, the risk of symptomatic vascular events remained nonnegligible. Future studies should identify reliable predictors of major adverse events and explore additional therapeutic strategies that could further lower the risk of life-threatening events in this population.
Abstract
BACKGROUND
US guidelines on high blood pressure (BP) have recently proposed a new BP stratification.
OBJECTIVE
To evaluate the redistribution of adult outpatients according to 2003 and 2017 ...US hypertension guidelines.
METHODS
We extracted data referred to individuals aged between 40 and 70 years with valid BP assessment from a national, cross-sectional database. The following systolic/diastolic BP strata were considered: (i) 2003 guidelines: 0 = normal (<120/180 mm Hg), 1 = prehypertension (≥120 and ≤139/≥80 and ≤89 mm Hg), 2 = stage 1 (≥140 and ≤159/≥90 and ≤99 mm Hg), 3 = stage 2 (≥160/≥100 mm Hg) and (ii) 2017 American College of Cardiology/American Heart Association guidelines: 0 = normal (<120/80 mm Hg), 1 = elevated (≥120 and ≤129/<80 mm Hg); 2 = stage 1 (≥130 and ≤139/≥80 and ≤89 mm Hg), 3 = stage 2 (≥140/≥90 mm Hg). Cardiovascular (CV) risk profile characterization was based on Framingham, 10-year risk of a first atherosclerotic cardiovascular disease and European score equations.
RESULTS
From an overall population sample of 10,012 individuals, we selected 8,911 (89.0%) with valid clinic BP data (44.4% female, age = 60.7 ± 6.6 years, body mass index = 28.2 ± 4.9 kg/m2, clinic BP = 136.8 ± 14.5/82.1 ± 8.3 mm Hg), among whom 339 (3.8%) were in the normal BP range. According to 2003 guidelines, 3,919 (44.0%) patients had prehypertension, 3,698 (41.5%) had stage-1 and 955 (10.7%) had stage-2 hypertension. According to 2017 guidelines, 635 (3.8%) patients had elevated BP, 3,284 (36.9%) had stage-1 and 4,653 (52.2%) had stage-2 hypertension. New BP classification moved 37% individuals from “pre-hypertension” to “stage 1” and 41% from “stage 1” to “stage 2” hypertension, respectively.
CONCLUSIONS
Redistribution of hypertensive patients according to 2017 US hypertension guidelines compared with previous ones may help to better identify uncontrolled hypertensive patients with high CV risk profile.
Abstract
The effect of metabolic syndrome (MetS) and clusters of its components on central blood pressure (CBP) has not been well characterized. We aimed to describe the effect of MetS and clusters ...of its components on CBP in a large population and to identify whether this effect differs in men and women. We studied 15,609 volunteers (43% women) from 10 cohorts worldwide who participated in the Metabolic syndrome and Artery REsearch Consortium. MetS was defined according to the NCEP-ATP III criteria (
GHTBW
, glucose, high-density lipoprotein cholesterol, triglyceride, blood pressure, waist circumference). CBP was measured noninvasively and acquired from pulse wave analysis by applanation tonometry. MetS was associated with a 50% greater odds of having higher CSBP. After controlling for age, male sex, non HDL cholesterol, diabetes mellitus, and mean arterial pressure, only specific clusters of MetS components were associated with a higher CSBP; and some of them were significant in women but not in men. We identified “risky clusters” of MetS variables associated with high CSBP. Future studies are needed to confirm they identify subjects at high risk of accelerated arterial aging and, thus, need more intensive clinical management.
Left ventricular (LV) mass and geometry predict risk for cardiovascular events in hypertension. Regression of LV hypertrophy (LVH) may imply an important prognostic significance. The relation between ...changes in LV geometry during antihypertensive treatment and subsequent prognosis has not yet been determined. A total of 436 prospectively identified uncomplicated hypertensive subjects with a baseline and follow-up echocardiogram (last examination 72+/-38 months apart) were followed for an additional 42+/-16 months. Their family doctor gave antihypertensive treatment. After the last follow-up echocardiogram, a first cardiovascular event occurred in 71 patients. Persistence of LVH from baseline to follow-up was confirmed as an independent predictor of cardiovascular events. Cardiovascular morbidity and mortality were significantly greater in patients with concentric (relative wall thickness > or =0.44) than in those with eccentric geometry (relative wall thickness <0.44) in patients presenting with LVH (P=0.002) and in those without LVH (P=0.002) at the follow-up echocardiogram. The incidence of cardiovascular events progressively increased from the first to the third tertile of LV mass index at follow-up (partition values 91 and 117 g/m2), but for a similar value of LV mass index it was significantly greater in those with concentric geometry (OR: 4.07; 95% CI: 1.49 to 11.14; P=0.004 in the second tertile; OR: 3.45; 95% CI: 1.62 to 7.32; P=0.001 in the third tertile; P<0.0001 in concentric versus eccentric geometry). Persistence or development of concentric geometry during follow-up may have additional prognostic significance in hypertensive patients with and without LVH.
ABSTRACT
Bridewealth in Lifou cannot be discussed on its own; rather it should be considered within the plurality of ceremonial acts which are needed to legitimize a marriage as customary. What do ...these transactions mean? Where does women's agency lie? Through a longitudinal analysis of ethnographic materials from my fieldwork in Lifou, Loyalty Islands, I consider how Kanak women are engaged in and perceive these ceremonial and cultural processes through a declared women's perspective that highlights their ability to make autonomous choices in an open ended historical context. I argue that it is a case of ‘positive agency’. I emphasize that local categories (june hmala and wenehleng) which define specific moments in this process can be subsumed under the anthropological term ‘bridewealth’. Further, I examine the meaning of money in bridewealth and the fact that the monetary contribution keeps increasing, raising local concerns about the need to regulate the amount circulating in marriage exchanges and its dispersion. Furthermore in Lifou there is no indication that the assembling of the bridewealth by the grooms implies a commoditization and (later) exploitation of women.
Though the relationship between both “attended” and “unattended” BP and several forms of target organ damage have been evaluated, data on retinal arteriolar alterations are lacking. The aim of our ...study was to evaluate the relationship between “attended” or “unattended” BP values and retinal arteriolar changes in consecutive individuals undergoing a clinical evaluation and assessment of retinal fundus at an ESH Excellence Centre. An oscillometric device programmed to perform 3 BP measurements, at 1 min intervals and after 5 min of rest was used on all individuals to measure BP with the patient alone in the room (“unattended”) or in the presence of the physician (“attended”) in the same day in a random order. The retinal arteriole’s wall thickness (WT) was measured automatically by a localization algorithm as the difference between external (ED) and internal diameter (ID) by adaptive optics (RTX-1, Imagine Eyes, Orsay, Francia). Media-to-lumen ratio (WLR) of the retinal arterioles and cross-sectional area (WCSA) of the vascular wall were calculated. Results: One-hundred-forty-two patients were examined (mean age 57 ± 12 yrs, 48% female, mean BMI 26 ± 4). Among them, 60% had hypertension (84% treated) and 11% had type 2 diabetes mellitus. Unattended systolic BP (SBP) was lower as compared to attended SBP (129 ± 14.8. vs. 122.1 ± 13.6 mmHg, p < 0.0001). WLR was similarly correlated with unattended and attended SBP (r = 0.281, p < 0.0001 and r = 0.382, p < 0.0001) and with unattended and attended diastolic BP (r = 0.34, p < 0.001 and r = 0.29, p < 0.0001). The differences between correlations were not statistically significant (Steiger’s Z test). Conclusion: The measurement of “unattended” or “attended” BP provides different values, and unattended BP is lower as compared to attended BP. In this study a similar correlation was observed between attended and unattended BP values and structural changes of retinal arterioles.
Tides of Innovation in Oceania is directly inspired by Epeli Hau‘ofa’s vision of the Pacific as a ‘Sea of Islands’; the image of tides recalls the cyclical movement of waves, with its unpredictable ...consequences. The authors propose tides of innovation as a fluid concept, unbound and open to many directions. This perspective is explored through ethnographic case studies centred on deeply elaborated analyses of locally inflected agencies involved in different transforming contexts. Three interwoven themes—value, materiality and place—provide a common thread.
The prognostic role of endothelial dysfunction, as evaluated by flow-mediated vasodilatation of the brachial artery, has been demonstrated in patients at very high risk. We aimed to investigate ...whether flow-mediated vasodilatation predicts cardiovascular events in uncomplicated hypertensive patients.
A total of 172 prospectively identified uncomplicated hypertensive patients (age 56 +/- 8 years, 41% women, 48 with diabetes mellitus type 2) were studied. At baseline all patients were untreated and underwent baseline standard laboratory examination. A standard echocardiogram was performed for the evaluation of left ventricular anatomy and function and patients with systolic dysfunction or left ventricular wall motion abnormalities were excluded. Endothelial function was measured as flow-mediated vasodilatation of the brachial artery using high-resolution ultrasound. Patients were followed for 95 +/- 37 months (range 2-136 months). A first nonfatal or fatal cardiovascular event occurred in 32 patients. The incidence of cardiovascular events was 1.4 and 3.1 per 100 patient-years in patients with a flow-mediated vasodilatation below and above the median value (4.7%), respectively (P < 0.005 by the log-rank test). In Cox analysis, controlling for age, sex, glycemia, cholesterol, smoking, BMI, systolic and diastolic blood pressure at baseline and left ventricular mass index, a low flow-mediated vasodilatation conferred an increased risk of cardiovascular events (odds ratio 2.67, 95% confidence interval 1.17 to 6.1, P = 0.02).
The presence of endothelial dysfunction, as evaluated by flow-mediated vasodilatation of the brachial artery, identifies hypertensive patients at increased risk of nonfatal and fatal cardiovascular events.
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