MEDIUM TERM ANTIHYPERTENSIVE THERAPY MAY WORSEN BLOOD FLOW IN PATIENTS WITH PERIPHERAL ARTERY DISEASE

Descrizione degli effetti collaterali emidinamici di alcuni antipertensivi in pazienti arteriopatici

Frequency of bicuspid aortic valve in young male conscripts by echocardiogram

IF JCR 2007: 3.60

Is menopause an independent cardiovascular risk factor? Evidence from population based studies

The question on whether menopause is an independent cardiovascular risk factor is still under debate. The results of four studies conducted by our staff in North East Italy, including > 11,000 subjects from the general population and covering a range of ages from 18 to 95 years, have been employed. We found apparently higher blood pressure (BP) values in naturally menopausal than in fertile women, but this difference disappeared after age-correction, or after identifying fertile and menopausal age-matched women. Significantly higher levels of serum lipids were also observed in menopausal than in fertile women but, in this case too, any difference disappeared after age-correction/matching. In a 16-year longitudinal analysis we found that BP increase and incidence of hypertension were the same in the women who remained fertile, in those becoming naturally menopausal and in those already menopausal at baseline; going through the menopause period, therefore, has no effect on BP. A mild and transitory BP increase was only observed during the climacterium. The BP increase during a follow-up and the incidence of new cases of hypertension were also similar in the women who remained fertile and in those who underwent bilateral ovariectomy, indicating no direct effect on BP for surgical menopause. In contrast, vectorial analysis demonstrated an excess increment of serum lipids among the women who underwent oophorectomy. In our populations, menopause had no predictive role and was rejected from the multivariate equations of risk, cardiovascular risk being completely explained by age and BP (both higher in menopausal then in fertile women)

[Drug-induced orthostatic hypotension can be useful in antihypertensive therapy].

The evaluation of the efficacy of antihypertensive therapy may be misleading if it is based on office blood pressures which are usually higher than ambulatory or home pressures. An erroneous evaluation may also derive from the presence of orthostatic hypotension induced by antihypertensive therapy. In seven patients with moderate to severe hypertension who were treated with different antihypertensive agents and who presented drug-induced orthostatic hypotension we studied 24 hour blood pressures by means of the Oxford system. The mean of the blood pressures recorded with the patients up and about were lower than with the patients in the supine position. Consequently the physiological fall in blood pressure which is present in untreated patients during sleep was not observed. The following conclusions may be drawn: a) drug-induced orthostatic hypotension may be useful in antihypertensive therapy; b) drugs which are capable of reducing blood pressure particularly in the supine position should be preferred during the night; c) for the evaluation of antihypertensive therapy it is necessary to take into account both supine and standing blood pressure

Diet and the kidney

Abstract: This is a short synopsis of the importance of nutrition and disease, which is especially centered on the achievements concerning renal diseases. With regard to renal nutrition, the paper analyzes the contributions of Beale, Peters and van Slyke, Addis, and Borst, and discusses the advent of the Giordano-Giovannetti diet and its modification

Blood pressure variability in 'labile' and 'established' hypertension.

Experimental evaulation of a method to detect variability of arterial blood pressure via intra-arterial monitoring in men

Premenopausal women have increased risk of hypertensive target organ damage compared with men of similar age.

BACKGROUND: The impact of high blood pressure (BP) on target organs (TO) in premenopausal women is not well known. The purpose of this study was to describe gender differences in TO involvement in a cohort of young-to-middle-aged subjects screened for stage 1 hypertension and followed for 8.2 years. METHODS: Participants were 175 women and 451 men with similar age (range 18-45 years). Ambulatory BP at entry was 127.5\ub112.5/83.7\ub17.2 mm Hg in women and 131.9\ub110.3/81.0\ub17.9\u2009mm Hg in men. Ambulatory BP, albumin excretion rate (AER), and echocardiographic data (n=489) were obtained at entry, every 5 years, and before starting antihypertensive treatment. RESULTS: Female gender was an independent predictor of final AER (p=0.01) and left ventricular mass index (LVMI) (p<0.001). At follow-up end, both microalbuminuria (13.7% vs. 6.2%, p=0.002) and left ventricular hypertrophy (LVH) (26.4% vs. 8.8%, p<0.0001) were more common among women than men. In a multivariable Cox analysis, after adjusting for age, lifestyle factors, body mass, ambulatory BP, heart rate, and parental hypertension, female gender was a significant predictor of time to development of microalbuminuria (p=0.002), with a hazard ratio (HR) of 3.06, (95% confidence interval [CI] 1.48-6.34) and of LVH (p=0.004), with an HR of 2.50 (1.33-4.70). Inclusion of systolic and diastolic BP changes over time in the models only marginally affected these associations, with HRs of 3.13 (1.50-6.55) and 3.43 (1.75-6.70), respectively. CONCLUSIONS: These data indicate that premenopausal women have an increased risk of hypertensive TO damage (TOD) and raise the question about whether early antihypertensive treatment should be considered in these patients