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Bombelli M, Macchiarulo M, Facchetti R, Maggiolini D, Cuspidi C, Parati G, Mancia G, Grassi G. Serum uric acid and resistance to antihypertensive treatment: data from the European Lacidipine Study on Atherosclerosis. J Hypertens 2019; 37:844-850. [PMID: 30817467 DOI: 10.1097/hjh.0000000000001951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Whether increased serum uric acid (SUA) favours resistance to antihypertensive drugs is not clear. METHODS The European Lacidipine Study on Atherosclerosis (ELSA) was a randomized, double-blind, multicenter trial comparing the effects of a 4-year treatment with either lacidipine or atenolol on progression of carotid atherosclerosis in patients with moderate hypertension. SUA was assessed at randomization and at the study end, office blood pressure (BP) was measured at each titration visit and every 6 months thereafter, ambulatory BP was measured at randomization and every year thereafter. RESULTS No difference was found in office and ambulatory BP reduction achieved after 1 and 4 years of treatment in baseline SUA tertiles. This was the case for both treatments. The percentage of patients with controlled office BP (<140/90 mmHg) after 1 year (36.5, 34.2 and 33.8%, P = 0.56) and 4 years (39.9, 39.4 and 38%, P = 0.82) was not different in SUA tertiles. Similar results were obtained basing the analysis on the control of ambulatory BP (<130/80 mmHg) or when data were analyzed taking into account SUA extreme values (≥7 and <3.5 mg/dl). The average and percentage changes of SUA (baseline-study end) were not different between patients who achieved or did not achieve office BP control (5.31 ± 1.26 vs. 5.4 ± 1.29 mg/dl, P = 0.22 e 0.13 ± 0.33 vs. 0.13 ± 0.68, P = 0.87, respectively). This was the case also for control of ambulatory BP. CONCLUSION In the ELSA study, SUA levels do not affect the responsiveness to antihypertensive treatment.
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Affiliation(s)
- Michele Bombelli
- Department of Medicine and Surgery
- Clinica Medica, University of Milano-Bicocca
| | | | | | | | - Cesare Cuspidi
- Department of Medicine and Surgery
- IRCCS, Istituto Auxologico Italiano, Milan
| | - Gianfranco Parati
- Department of Medicine and Surgery
- IRCCS, Istituto Auxologico Italiano, Milan
| | - Giuseppe Mancia
- Department of Medicine and Surgery
- Policlinico di Monza, Monza
| | - Guido Grassi
- Department of Medicine and Surgery
- Clinica Medica, University of Milano-Bicocca
- IRCCS Mutlimedica, Sesto San Giovanni, Milan, Italy
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Bombelli M, Fodri D, Toso E, Macchiarulo M, Cairo M, Facchetti R, Dell’Oro R, Grassi G, Mancia G. Relationship Among Morning Blood Pressure Surge, 24-Hour Blood Pressure Variability, and Cardiovascular Outcomes in a White Population. Hypertension 2014; 64:943-50. [DOI: 10.1161/hypertensionaha.114.03675] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiovascular events have their greatest prevalence in the early morning period. Whether this is attributable to an arousal-dependent blood pressure (BP) increase is far from being clear. It is also not clear to what extent this phenomenon reflects overall 24-hour BP variability. In 2051 subjects (aged 25–74 years) representative of the population of Monza (Italy), we measured 24-hour ambulatory systolic BP (SBP) and calculated the difference between the 2-hour average values after morning arousal and the lowest 3 or average 2-hour values before arousal (morning BP surge 1 and 2, respectively). For either measure, we sought the relationship with a variety of indices of 24-hour SBP variability and collected information on (1) the occurrence of cardiovascular and all cause deaths during a follow-up of ≈16 years and (2) the appearance of echocardiographic left ventricular hypertrophy after 10 years from the baseline visit. Morning SBP surge 1 was directly related to indices of 24-hour SBP variability, including those made independent on the magnitude of the day–night SBP difference. There was a weak positive relationship between morning SBP surge 1 and the risk of cardiovascular and all-cause death, which disappeared after adjustment for confounders. This was the case also for development of left ventricular hypertrophy. Morning SBP surge 2 was smaller, inconsistently related to 24-hour SBP variability and not at all related to fatal events or new-onset left ventricular hypertrophy. In a white population, morning BP surge was not found to be an independent predictor of cardiovascular death, all-cause death, or development of high cardiovascular risk (as documented by new-onset cardiac damage) even when appropriately assessed by measures that reflect its association with 24-hour BP variability.
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Affiliation(s)
- Michele Bombelli
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Danilo Fodri
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Elena Toso
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Mario Macchiarulo
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Matteo Cairo
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Rita Facchetti
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Raffaella Dell’Oro
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Guido Grassi
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
| | - Giuseppe Mancia
- From the Clinica Medica, Dipartimento di Scienze della Salute, Università Milano-Bicocca, Milano, Italy (M.B., D.F., E.T., M.M., M.C., R.F., R.D., G.G., G.M.); Istituto di Ricerca a Carattere Scientifico IRCCS Multimedica, Sesto San Giovanni (Milano), Milano, Italy (G.G.); and Istituto Auxologico Italiano, Milano, Italy (G.M.)
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