271 research outputs found
EFFETTO DELLO SPORT E DELL'ESERCIZIO FISICO NELLA SINDROME METABOLICA: TERAPIA FARMACOLOGICA E NON FARMACOLOGICA
The referral centers for the diagnosis and treatment of hypertension in adolescents
Primary hypertension in adolescence was felt to be quite
rare. However, the worldwide childhood obesity epidemic
has had a profound impact on the frequency of
high blood pressure (BP) with the result that primary
hypertension should now be viewed as one of the most
common health conditions in the young (estimated prevalence
1–5%).
Therefore, current guidelines recommend that all children
and adolescents seen in a medical setting should
have their BP measured. The availability of BP tables
with normal BP percentiles for age, sex and height has
improved BP values classification.
Studies conducted at referral clinics for evaluation of
hypertension have indicated that as many as 30 to 40%
of adolescents may actually have in a clinical setting
white-coat hypertension. This may lead to a misdiagnosis
of “true” hypertension in a considerable number of
cases. The usefulness of out-of-office BP evaluation
using ambulatory or home monitoring is well established.
These measurements allow the detection of the
white-coat and masked hypertension, the opposite of
white-coat hypertension, and are more closely associated
with organ damage and cardiovascular risk than office
measurements. A thorough familial and personal history
is of primary importance as well as the physical examination
that should be focused on the search for signs
suggestive for an underlying cause and/or for the severity
of hypertension.
Following investigations must be tailored to the child’s
age, anamnesis and clinical examination and to the
severity of BP elevation, in order to investigate not only
the possible cause of hypertension, but also associated diseases and target organs damage. Therapeutic
approach should firstly include non-pharmacological
measures, and the use of medications when indicated.
A key role in the management of the adolescents with
hypertension may be attributed to the hypertension
referral center
Renal involvement in psychological eating disorders
Psychological eating disorders--anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder--are an increasing public health problem with severe clinical manifestations: hypothermia, hypotension, electrolyte imbalance, endocrine disorders and kidney failure; they are of interest to nephrologists, but pathophysiological mechanisms in determining the renal involvement are still unclear. We describe pathophysiology, histological features and clinical manifestations of the most frequent psychological eating disorders: AN and BN. Regarding AN, we analyze the recent literature, and identify 3 principal pathways towards renal involvement: chronic dehydration-hypokalemia, nephrocalcinosis and chronic rhabdomyolysis. Regarding BN, we describe the correlation between obesity and many proinflammatory cytokines, chemokines, growth factors and adipokines, having potential metabolic and hemodynamic effects on the kidney and an important role in the pathogenesis of obesity-related renal injury, independently of hypertension and diabetes
Electrocardiography for Assessment of Hypertensive Heart Disease: A New Role for an Old Tool
Left ventricular (LV) hypertrophy (LVH), detected
either by electrocardiography (ECG) or echocardiography
(ECHO), has long been recognized as a powerful
predictor of serious cardiovascular (CV) sequelae.A
very large and highly consistent body of evidence
indicates that LVH is not only an adaptation to
increased hemodynamic load in hypertension, but is
also independently associated with an enhanced risk for
myocardial infarction, cardiac sudden death, congestive
heart failure, and stroke in the general population, as
well as in patients with systemic hypertension, coronary
heart disease, chronic kidney disease, and atrial fibrillation. Intriguingly, the cumulative incidence of
cardiovascular events increases progressively with
increasing LV mass (LVM), without evidence of any
threshold separating the postulated “compensatory”
from “pathological” LVH. In other words, patients
with LVM in the upper-normal range already have
increased risk for CV events
Prevalence and predictors of left ventricular hypertrophy in patients with hypertension and normal electrocardiogram
Background: Electrocardiography (ECG) has low sensitivity for detecting left ventricular hypertrophy (LVH), while
echocardiography cannot be routinely performed.
Design/methods: In this study we evaluate the prevalence of LVH and diastolic dysfunction in hypertensive patients
with normal ECG. We excluded patients with cardiovascular (CV) diseases, diabetes, chronic kidney disease, or presenting
ECG-LVH or other ECG anomalies. The enrolled 440 hypertensive patients underwent echocardiographic
examination (Acuson Sequoia 512); LV mass was indexed by body surface area (LVMI) and LVH was defined as LVMI
>125 g/m2 in men and >110 g/m2 in women. Diastolic function was evaluated by mitral inflow and tissue Doppler imaging
(TDI).
Results: The prevalence of LVH was 8.18% (95% confidence interval [CI] 5.97–11.1%). Multiple regression analysis
showed that the only variable independently associated with LVH was duration of hypertension (p<0.001). The receiver
operating characteristic (ROC) curve showed that duration of hypertension was a powerful predictor of LVH, with an
area under the curve (AUC) of 0.878 and p<0.0001. Further, in patients with LVH the mean difference of LVMI from the
cut-off value for LVH was 12.3 9.19 g/m2. Diastolic dysfunction, defined as early diastolic myocardial velocity (Em)
<0.08 m/s, was detected only in 3.2% of patients.
Conclusions: The prevalence of LVH among hypertensive patients with normal ECG, free of diabetes and of CV
diseases is low; moreover, patients with echocardiographic LVH presented LVMI values that identified mild LVH. Few
cases of impaired diastolic function were registered.
We suggest that in hypertensive patients with such characteristics the echocardiographic examination should be reserved
to those who present with higher duration of hypertension
Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients
OBJECTIVES:
To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness.
DESIGN:
Cross-sectional study.
SETTING:
Outpatient hypertension clinic.
SUBJECTS:
Seventy patients with mild-to-moderate essential hypertension, aged 42 +/- 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotid-femoral PWV, by means of a computerized method, and AER.
RESULTS:
Microalbuminuric patients (AER > or = 20 microg min(-1); n = 19), when compared with normoalbuminuric subjects, showed more elevated 24-h BP (136/88 +/- 10/10 vs. 128/83 +/- 7/6 mmHg; P < 0.001 and P = 0.013, for systolic and diastolic BP respectively) and higher values of carotid-femoral PWV (10.4 +/- 2 m s(-1) vs. 9.2 +/- 1.3; P = 0.006). This latter difference remained statistically significant, even after correction by ancova for 24-h systolic and diastolic BP, and body mass index (BMI, P = 0.016). Univariate regression analysis disclosed a tight correlation between AER and carotid-femoral PWV (r = 0.42; P = 0.0003). This association was confirmed in a multiple regression model (beta = 0.35; P = 0.009) in which, as independent variables, besides PWV, 24-h BP, age, serum glucose values, smoking status, gender and BMI, were added.
CONCLUSIONS:
Our results seem to confirm that microalbuminuria may represent the early renal manifestation of a widespread vascular dysfunction, and therefore it is an integrated marker of cardiovascular risk
Influence of metabolic syndrome on hypertension-related target organ damage
OBJECTIVES:
The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage.
DESIGN:
Cross-sectional study.
SETTING:
Outpatient hypertension clinic.
SUBJECTS AND METHODS:
A total of 353 young and middle-aged hypertensives, free from cardiovascular and renal diseases (and 37% of whom had MS), underwent echocardiographic examination, microalbuminuria determination and non-mydriatic retinography.
RESULTS:
When compared with subjects without MS, hypertensive patients with MS exhibited more elevated left ventricular (LV) mass (either normalized by body surface area or by height elevated by a power of 2.7), higher myocardial relative wall thickness, albumin excretion rate (AER) and a greater prevalence of LV hypertrophy (57.7% vs. 25.1%; P < 0.00001), of microalbuminuria (36.2% vs. 19.3%; P = 0.002) and of hypertensive retinopathy (87.7% vs. 48.4%; P < 0.00001). These results held even after correction for age, 24-h blood pressures, duration of hypertension, previous antihypertensive therapy, and gender distribution. The independent relationships between LV mass and MS, and between AER and MS, were confirmed in multivariate regression models including MS together with its individual components.
CONCLUSIONS:
MS may amplify hypertension-related cardiac and renal changes, over and above the potential contribution of each single component of this syndrome. As these markers of target organ damage are well-known predictors of cardiovascular events, our results may partly explain the enhanced cardiovascular risk associated with MS
INVERSE RELATIONSHIP BETWEEN AORTIC ROOT DIAMETER AND RENAL FUNCTION IN HYPERTENSIVE SUBJECTS
Recent studies suggest that enlarged aortic root diameter (ARD) may predict cardiovascular events in absence of aneurysmatic alterations. Little is known about the influence of renal function on ARD. Our study was aimed to assess the relationships between glomerular filtration rate (GFR) and ARD in hypertensive subjects
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