12.17 Flow Dependent Vasodilation of Brachial Artery: Effect of Treatment with a Calcium Antagonist or Thiazide Diuretic in the Essential Hypertensive Patient

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2.8 In Patients with Isolated Ambulatory Hypertension Central Blood Pressure and Augmentation Index are Increased: the VOBARNO Study

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COVID-19 pneumonia: Three thoracic complications in the same patient

The most dreaded thoracic complications in patients with coronavirus disease 2019 (COVID-19) are acute pulmonary embolism and pulmonary fibrosis. Both the complications are associated with an increased risk of morbidity and mortality. While acute pulmonary embolism is not a rare finding in patients with COVID-19 pneumonia, the prevalence of pulmonary fibrosis remains unclear. Spontaneous pneumothorax is another possible complication in COVID-19 pneumonia, although its observation is rather uncommon. Herein, we present interesting computed tomography images of the first case of COVID-19 pneumonia that initially developed acute pulmonary embolism and subsequently showed progression toward pulmonary fibrosis and spontaneous pneumothorax

WALL-TO-LUMEN RATIO OF RETINAL ARTERIOLES IS RELATED WITH CLINIC AND 24 HOURS BLOOD PRESSURE

Objective: Wall-to-lumen ratio of retinal arterioles might be an in-vivo marker of small arteries damage. Aim of this study was to analyze retinal arteriolar structure in patients with essential hypertension and to test whether clinic and 24 h blood pressure values associated with an increased wall-to-lumen ratio of retinal arterioles. Methods: In 102 patients with essential hypertension (mean age 54 + 9.5, 38 females, 59% treated) and in 32 untreated normotensive individuals (mean age 55 + 3.3 years, 22 females, all untreated) 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 h blood pressure (BP) values were measured. Results: In patients with essential hypertension a higher wall-to-lumen ratio (0.37 + 0.19 vs. 0.30 + 0.13, p = 0.05), wall thickness (11.2 + 4.6 vs. 9.3 + 3.4, p = 0.04) and wall cross-sectional area of retinal arterioles (2,747 + 1,367 vs. 2,122 + 578, p = 0.025) was observed in comparison with normotensive individuals; no differences were observed between treated and untreated hypertensive patients. Wall to lumen ratio of retinal arterioles was significantly related to clinic systolic BP (r = 0.18, p = 0.05) and diastolic BP (r = 0.19, p = 0.04) as well as to 24 h systolic BP (r = 0.24, p = 0.009) and diastolic BP (r = 0.22, p = 0.02). A significant correlation was observed between wall to lumen ratio of retinal arterioles and daytime systolic and diastolic BP (r = 0.26, p = 0.004 and r = 0.20, p = 0.026); no correlation was observed between wall to lumen ratio and mean nighttime BP or with standard deviation of 24 h, daytime and nighttime systolic and diastolic BP. Multiple regression analysis including known cardiovascular risk factors showed that 24 h, but not clinic BP is independently associated with an increased wall-to-lumen ratio of retinal arterioles

Hypertensive emergencies and urgencies: A single-centre experience in Northern Italy 2008-2015

Background: An increasing attention is given to emergency departments (EDs) admissions for an acute and severe rise in blood pressure (BP). Data on epidemiology and treatment of hypertensive emergencies and urgencies admitted to ED are still limited. The aim of our study was to evaluate the prevalence, clinical presentation and treatment of patients admitted for hypertensive emergencies or hypertensive urgencies. Methods: Medical records of consecutive patients aged at least 18 years, admitted to the ED of the Spedali Civili in Brescia in 2008 and in 2015 and presenting with SBP at least 180mmHg and/or DBP at least 120mmHg were prospectively collected and analysed. Results: The prevalence of patients admitted with acute BP rise was 2.0% (n¼1551, age 7014 years) in 2008 and 1.75% (n¼1214, age 69.715 years) in 2015. According to the clinical presentation and the presence of acute organ damage, patients were defined hypertensive emergencies (20.4 and 15.4%, respectively, in 2008 and 2015) or as hypertensive urgencies (79.6 and 84.5%, respectively, in 2008 and 2015). SBP and DBP values were higher in patients with emergencies than in those with urgencies (BP 19315/10215 vs. 18913/ 9613mmHg in 2008 and 19217/9815 vs. 18912/ 9415mmHg in 2015, P<0.001 for both). Among hypertensive emergencies, the different forms of organ damage were 25% acute coronary syndromes and 1% aortic dissection in both periods, 34 and 38% acute heart failure, 40 and 37% stroke. Conclusion: Admission to the ED for hypertensive emergencies and hypertensive urgencies is still high. Diagnosis and treatment are still not appropriate and require the rapid application of recently published guideline