The new European Society of Hypertension/European Society of Cardiology (ESH/ESC) Guidelines

The 2007 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) [Mancia et al. 2007] differ for several aspects from the previous hypertension guidelines issued by the two Societies in 2003 [Guidelines Committee ESH/ESC, 2003]. In some instances the difference mainly consists in a reinforcement or extension of what was only suggested by the previous guidelines, based on the increased amount of data obtained in the last four years. In other instances, however, it consists in an actual change from what was recommended in 2003 because of the new data provided by trials and other types of studies. In this paper we will report on some of these differences and discuss their rationale

Blood Pressure Non-Dipping and Obstructive Sleep Apnea Syndrome: A Meta-Analysis

AIM: We examined the reduced blood pressure (BP) nocturnal fall in patients with obstructive sleep apnea (OSA) by a meta-analysis including studies that provided data on prevalence rates of non-dipping (ND) pattern during 24-h ambulatory blood pressure monitoring (ABPM). DESIGN: The PubMed, OVID-MEDLINE, and Cochrane CENTRAL literature databases were searched for appropriate articles without temporal restriction up to April 2019 through focused and sensitive search methods. Studies were identified by crossing the search terms as follows: "obstructive sleep apnea", "sleep quality", "non dipping", "reduced nocturnal BP fall", "circadian BP variation", "night-time BP", and "ambulatory blood pressure monitoring". RESULTS: Meta-analysis included 1562 patients with OSA from different clinical settings and 957 non-OSA controls from 14 studies. ND pattern prevalence in patients with OSA widely varied among studies (36.0-90.0%). This was also the case for non-OSA controls (33.0% to 69.0%). Overall, the ND pattern, assessed as an event rate in the pooled OSA population, was 59.1% (confidence interval (CI): 52.0-65.0%). Meta-analysis of the seven studies comparing the prevalence of ND pattern in participants with OSA and controls showed that OSA entails a significantly increased risk of ND (Odds ratio (OR) = 1.47, CI: 1.07-1.89, p < 0.01). After the exclusion of patients with mild OSA, OR increased to 1.67 (CI: 1.21-2.28, p < 0.001). CONCLUSIONS: The present meta-analysis, extending previous information on the relationship between OSA and impaired BP dipping, based on single studies, suggests that this condition increases by approximately 1.5 times the likelihood of ND, which is a pattern associated with a greater cardiovascular risk than normal BP dipping

Tropical SST Preconditioning of the SH Polar Vortex during Winter 2002

Abstract The response of the Southern Hemisphere (SH) polar atmosphere to the tropical sea surface temperature (SST) during the 2002 winter–spring season is investigated by using a general circulation model (GCM). The SH stratospheric winter of 2002 was particularly unusual, characterized by a weaker-than-normal polar vortex during the whole season. It also registered, at the end of September, the first major warming yet observed in the SH. This event is unexpected in the SH, and it is supposed to be induced by a "preconditioning" of the polar vortex starting at the beginning of the winter. Atmospheric GCM experiments with prescribed SST boundary conditions are performed. The sensitivity of the Antarctic dynamics to the tropical SST of 2002 (a year characterized by an El Niño event of moderate intensity) is studied, and the uniqueness of the 2002 tropical oceanic condition is investigated through the comparison of the simulated response of the climatic system to 2002 and 1997 tropical SST (1997 being a year with a strong El Niño event). Model results highlight a primary role played by the tropical SST of 2002 in the development of the peculiar characteristics of the Antarctic dynamics during the winter months that appears to be a necessary condition for the generation of the anomalous destabilization of the polar vortex during the following spring. Results for June 2002 show a strong generation of vertically propagating waves resulting from the tropical SST that, through the perturbation of the westerly jet at middle latitudes, produces a preconditioning of the polar vortex by affecting the wave refraction index. The particular structure of the tropical SST anomalies during the winter of 2002 is thought to have influenced the subsequent preconditioning of the stratospheric vortex

Arctic Sea Ice Reduction and Extreme Climate Events over the Mediterranean Region

Abstract During the last decade, Arctic sea ice cover has experienced an accelerated decline that has been suggested to drive the increased occurrence of extremely cold winter events over continental Europe. Observations and modeling studies seem to support the idea that Mediterranean climate is also changing. In this work, the authors estimate potential effects on the Mediterranean Basin, during the winter period, of Arctic sea ice reduction. Two sets of simulations have been performed by prescribing different values of sea ice concentrations (50% and 20%) on the Barents–Kara Seas in the NCAR Community Atmosphere Model, version 3 (CAM3), as representative of idealized present and future sea ice conditions. Global model simulations have then been used to run the Abdus Salam International Centre for Theoretical Physics (ICTP) Regional Climate Model, version 4 (RegCM4), over central Europe and the Mediterranean domain. Simulations provide evidence for a large-scale atmospheric circulation response to sea ice reduction, resembling the negative phase of the Arctic Oscillation (AO) and characterized by a wave activity flux from the North Atlantic toward the Mediterranean Basin, during winter months. An increase in the occurrence and intensity of extreme cold events, over continental Europe, and extreme precipitation events, over the entire Mediterranean Basin, was found. In particular, simulations suggest an increased risk of winter flooding in southern Italy, Greece, and the Iberian Peninsula

The new concept of total cardiovascular risk management

Introduction: Cardiovascular risk factors, such as hypertension, hypercholesterolemia, and diabetes mellitus, often cluster together and can also be seen with other pathophysiological conditions that greatly increase an individual's risk for cardiovascular morbidity and death. Aim of the study: This article emphasizes the importance of assessing and managing the total cardiovascular risk in an individual patient. Materials and methods: Suggestions and recommendations from the most current hypertension management guidelines have been integrated with results from the major clinical trials published in the last decade. Results: Based on a review of the epidemiological data on cardiovascular disease, this paper expands the concept of stratification of hypertensive patients according to the approximate added risk of major cardiovascular events in the next 10 years and stresses the importance of subclinical target-organ damage. Conclusions: Although common in clinical practice, high-risk patients are often undiagnosed. Intensive hypertensive therapy is recommended for high-risk patients, and this treatment strategy will require combination therapy to control or reverse subclinical organ damage and prevent the progression of cardiovascular risk in subjects at low risk or medium risk

Personalized medicine—a modern approach for the diagnosis and management of hypertension

The main goal of treating hypertension is to reduce blood pressure to physiological levels and thereby prevent risk of cardiovascular disease and hypertension-associated target organ damage. Despite reductions in major risk factors and the availability of a plethora of effective antihypertensive drugs, the control of blood pressure to target values is still poor due to multiple factors including apparent drug resistance and lack of adherence. An explanation for this problem is related to the current reductionist and ‘trial-and-error’ approach in the management of hypertension, as we may oversimplify the complex nature of the disease and not pay enough attention to the heterogeneity of the pathophysiology and clinical presentation of the disorder. Taking into account specific risk factors, genetic phenotype, pharmacokinetic characteristics, and other particular features unique to each patient, would allow a personalized approach to managing the disease. Personalized medicine therefore represents the tailoring of medical approach and treatment to the individual characteristics of each patient and is expected to become the paradigm of future healthcare. The advancement of systems biology research and the rapid development of high-throughput technologies, as well as the characterization of different –omics, have contributed to a shift in modern biological and medical research from traditional hypothesis-driven designs toward data-driven studies and have facilitated the evolution of personalized or precision medicine for chronic diseases such as hypertension

Preexisting Oral Anticoagulant Therapy Ameliorates Prognosis in Hospitalized COVID-19 Patients

Objective: Altered coagulation parameters in COVID-19 patients is associated with a poor prognosis. We tested whether COVID-19 patients on chronic oral anticoagulants (cOACs) for thromboembolism prophylaxis could receive protection from developing more severe phenotypes of the disease. Approach and Results: We searched the database of the SARS-RAS study (Clinicaltrials.gov: NCT04331574), a cross-sectional observational multicenter nationwide survey in Italy designed by the Italian Society of Hypertension. The database counts 2,377 charts of Italian COVID-19 patients in 26 hospitals. We calculated the Charlson comorbidity index (CCI), which is associated with death in COVID-19 patients. In our population (n = 2,377, age 68.2 ± 0.4 years, CCI: 3.04 ± 0.04), we confirm that CCI is associated with increased mortality [OR: 1.756 (1.628-1.894)], admission to intensive care units [ICU; OR: 1.074 (1.017-1.134)], and combined hard events [CHE; OR: 1.277 (1.215-1.342)]. One hundred twenty-five patients were on cOACs (age: 79.3 ± 0.9 years, CCI: 4.35 ± 0.13); despite the higher CCI, cOACs patients presented with a lower risk of admissions to the ICU [OR 0.469 (0.250-0.880)] but not of death [OR: 1.306 (0.78-2.188)] or CHE [OR: 0.843 (0.541-1.312)]. In multivariable logistic regression, cOACs confirmed their protective effect on ICU admission and CHE. The CCI remains the most important risk factor for ICU admission, death, and CHE. Conclusions: Our data support a mechanism for the continuation of cOAC therapy after hospital admission for those patients who are on chronic treatment. Our preliminary results suggest the prophylactic use of direct cOACs in patients with elevated CCI score at the time of the COVID-19 pandemic even in absence of other risks of thromboembolism

The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling

We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population

Turin's Foodscapes: Exploring Places of Food Consumption Through the Prism of Social Practice Theory

This contribution wishes to propose an addition to the existing toolbox of techniques employed to approach and render explicit the place semantics embedded in geosocial data. Inspired by the notion of relational place introduced by human geographers, we focused on people's experience of the city derived from the aggregation of the points of view of different social groups. We analysed socio-spatial behaviour under the frame of social practice theories, defining social practices as collective social actions performed by groups of people that display a similar behaviour. Applying spatial pattern analysis and clustering on data extracted from TripAdvisor platform, we classified social groups of users depending on our prior knowledge and their spatial behaviours

Effects of the PDO phase on the tropical belt width

Recent studies have shown that the Tropical Belt (TB) has progressively expanded since at least the late 1970´s. This trend has been largely attributed to the radiative forcing due to GHG increase and stratospheric ozone depletion, even if an influence of Sea Surface Temperature (SST) anomalies has been also suggested. In this work we investigate the impact of the Pacific Decadal Oscillation (PDO) on the TB width. The study is performed by using both AMIP (Atmospheric Model Intercomparison Project) and idealized simulations, produced by NCAR/CAM3 GCM, and reanalysis data (ERA-Interim, ERA-40 and MERRA). Reanalysis show that a switch of the PDO from a positive to a negative phase can lead to a significant TB expansion during the equinoxes. This effect, indicating a possible PDO contribution to the widening that characterized the TB width during the last decades, is not correctly reproduced by model simulations. Deficiencies in the sensitivity of model simulated convective processes to SST anomalies are suggested as a possible cause of the TB widening underestimation.Fil: Grassi, Barbara. University of L’Aquila; ItaliaFil: Redaelli, Gianluca. University of L’Aquila; ItaliaFil: Canziani, Pablo Osvaldo. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Visconti, Guido. University of L’Aquila; Itali