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Cazzaniga ME, Giordano M, Bandera M, Cassani C, Bounous V, Lania A, Biasi G, Destro M, Ricci S, Lucini D, Biglia N, Pagani O. Managing Menopausal Symptoms in Young Women With Breast Cancer: When Medicine Is Not All. The Take Care Project. Clin Breast Cancer 2021; 21:e547-e560. [PMID: 33685833 DOI: 10.1016/j.clbc.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/29/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
In the last decade, endocrine therapy strategies in perimenopausal women with hormone-responsive early breast cancer (BC) have changed and now ovarian function suppression (OFS) is recommended for the majority of patients. Side effects of OFS mimic menopausal symptoms, including hot flushes, sweats, weight gain, and sexual dysfunction, which may negatively impact quality of life (QoL). Aims of the Take Care Project are the education of physicians and patients to have all the information (medical and nonmedical) they need to manage menopausal symptoms by distributing educational materials useful to face menopause. Four different areas have been identified by surveys conducted among physicians and young patients: for each area, interventions and tools have been elaborated by a doctor and nonphysician professionals of these identified areas, to offer the widest information available. Clinical and practical suggestions have been provided. Based on the evidence given, we strongly suggest setting up a multidisciplinary team for the treatment planning of young patients with BC, which could help patients to face and manage their new menopause condition. The reduction of side effects and the improvement in QoL should be the best ally to treat young patients with BC.
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Affiliation(s)
- Marina Elena Cazzaniga
- Phase 1 Research Unit & Oncology Unit, Azienda Socio Sanitaria Territoriale Monza & Milano Bicocca School of Medicine and Surgery, Monza, Italy.
| | - Monica Giordano
- Oncology Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Mirko Bandera
- Farmacie Sant'Agata, Pharmacy Group, Bulgarograsso (Como), Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy
| | - Valentina Bounous
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Andrea Lania
- Endocrinology, Diabetology and Andrology Unit, Biomedicine Department, Humanitas University, Milan, Italy
| | - Giovanna Biasi
- Prevention Department, Unità Operativa Complessa Medicine and Sport and Exercise, Treviso, Italy
| | - Maurizio Destro
- Medical Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio (BG) Italy
| | - Sauro Ricci
- Executive Chef, Joja Restaurant, Milan, Italy
| | - Daniela Lucini
- Exercise Medicine Unit, University of Milan BIOMETRA Department, Humanitas Clinical and Research Center, Milan, Italy
| | - Nicoletta Biglia
- Department of Obstetrics and Gynecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Olivia Pagani
- EOC Istituto Oncologico della Svizzera Italiana Ospedale Regionale Bellinzona e Valli 6500, Bellinzona, Switzerland
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2
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Torlasco C, Faini A, Ferri C, Grassi G, Salvetti M, Destro M, Cicero AFG, Galletti F, Ghiadoni L, Carugo S, Sarzani R, Minuz P, Morganti A, Mulatero P, Mulè G, Savoia C, Volpe M, Borghi C, Beaney T, Ster AC, Poulter NR, Xia X, Parati G. May Measurement Month 2018: an analysis of blood pressure screening results from Italy. Eur Heart J Suppl 2020; 22:H70-H73. [PMID: 32884475 PMCID: PMC7455302 DOI: 10.1093/eurheartj/suaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cardiovascular (CV) diseases are burdened by high mortality and morbidity, being responsible for half of the deaths in Europe. Although hypertension is recognized as the most important CV risk factor, hypertension awareness and blood pressure (BP) control are still unsatisfactory. In 2017, 30.6% of a >10 000 individual sample who took part in the May Measurement Month (MMM) campaign in Italy was found to have high BP. To raise awareness on the hypertension issue and to report BP data on a nation-wide scale in Italy. In the frame of the MMM campaign, an opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2018. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screenings were conducted in multiple sites by health care personnel. Among the 5554 people screened (females: 48.3%, mean age 58 ± 17 years) mean BP was 127/77 mmHg, and after imputations, 1462 (26.3%) participants were found to have high BP levels. Body mass index >25 was associated with higher systolic BP and diastolic BP (DBP), while diabetes was associated with high DBP only. Our data provide a nation-wide snapshot of BP control in a sample of individuals participating in a national health care campaign, and confirm the power of this kind of healthcare-related activities in reaching a significant number of people to raise awareness on health topics. The apparent positive trend in BP control compared to available data from other similar campaigns carried out during the past years needs to be confirmed with more methodologically robust studies.
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Affiliation(s)
- Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan 20149, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126 Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan 20149, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, piazza Santa Margherita 2, 67100, L'Aquila, Italy
| | - Guido Grassi
- Policlinico di Monza, Via Amati, 111 - 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126 Milan, Italy
| | - Massimo Salvetti
- Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia, Via Amati, 111 - 20900, Brescia, Italy.,2a Medicina-ASST Spedali Civili Brescia, Piazzale Spedali Civili, 1 25123, Brescia, Italy
| | - Maurizio Destro
- Medical Science, ASST Bergamo Ovest, Piazzale Ospedale 1, 24047, Treviglio, Italy
| | - Arrigo F G Cicero
- Medical and Surgical Sciences Department, University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, Naples, Via Pansini, 5 - 80131, Italy.,"Federico II" University of Naples Medical School, Corso Umberto I 40, Naples, 80138, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Lungarno Antonio Pacinotti, 43, 56121, Italy
| | - Stefano Carugo
- Division of Cardiology, San Paolo University Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy.,Department of Health Sciences, University of Milan, ia Festa del Perdono, 7, 20122, Milan, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS INRCA, Via Festa del Perdono, 7, 20122, Ancona, Italy.,Department of Clinical and Molecular Sciences, University 'Politecnica delle Marche', ia Tronto, 10/a, 60126, Ancona, Italy
| | - Pietro Minuz
- Department of Medicine, Unit of General Medicine for the Study and Treatment of Hypertensive Disease, Policlinico GB Rossi, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Paolo Mulatero
- Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Torino, Via Giuseppe Verdi, 8, 10124, Torino, Italy
| | - Giuseppe Mulè
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy
| | - Carmine Savoia
- Clinical and Molecular Medicine Department, Cardiology Unit Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035/1039, 00189, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa, 1035/1039, 00189, Rome, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan 20149, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126 Milan, Italy
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Cazzaniga M, Lania A, Destro M, Bandera M, Biasi G, Giordano M, Pagani O. The global care of young women with breast cancer: take care from cure to care. A multidisciplinary educational initiative. Breast 2019. [DOI: 10.1016/s0960-9776(19)30439-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Aragona B, De Luca R, Piccolo A, Le Cause M, Destro M, Casella C, Filoni S, Calabrò RS. Is bupropion useful in the treatment of post-stroke thalamic apathy? A case report and considerations. Funct Neurol 2018; 33:213-216. [PMID: 30663968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Post-stroke apathy is considered to be one of the clinical consequences of lesions affecting the structures of the prefrontal cortex, basal ganglia, thalamus and limbic system. However, there is no current consensus on the treatment of post-stroke apathy, which mainly depends on the underlying etiology and comorbidities. A 62-year-old man, affected by hemorrhagic stroke in the left thalamus, presented with mood depression, anhedonia, hyporexia and marked apathy. The patient underwent clinical evaluation before and after receiving two different pharmacological therapies: escitalopram and bupropion. Only after treatment with the latter drug did the patient show changes: high motivation and willingness to pursue activities, greater interest in the external environment and social life activities, and an overall reduction of apathy. On the basis of our observations in this case, we hypothesize that the thalamic lesion resulted in disconnection of the fronto-striatal-thalamic circuits, and that loss of the dopaminergic striatal innervation caused the patient's apathetic state. The resolution of the apathetic disorder may be attributable to the action of the dopaminergic drug bupropion on the mesocortical pathway.
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Dognini G, Petrelli F, Destro M, Ghilardi M, Borgonovo K, Cabiddu M, Barni S. Sunitinb, hypertension and renal function: a monocentric experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx435.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Borgonovo K, Cabiddu M, Petrelli F, Ghilardi M, De Giuseppe A, Brizzi L, Silva S, Destro M, Dognini G, Invernizzi L, Ghedi A, Barni S. Long-lasting strategy of pain management: the “comitato ospedale senza dolore”. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx437.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ruiz V, Kriston A, Adanouj I, Destro M, Fontana D, Pfrang A. Degradation Studies on Lithium Iron Phosphate - Graphite Cells. The Effect of Dissimilar Charging – Discharging Temperatures. Electrochim Acta 2017. [DOI: 10.1016/j.electacta.2017.03.126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Barni S, Dognini GP, Petrelli F, Borgonovo K, Ghilardi M, Cabiddu M, Destro M. Antiangiogenetic-induced hypertension and improved outcome in cancer patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e21651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21651 Background: Hypertension (HTN) is one of the most common adverse events observed during treatment with antiangiogenetic drugs (AAG) inhibiting the Vascular Endothelial Growth Factor Pathway. It may rise few days after anti-AAG starting, is dose dependent and reversible after its withdrawal. Some reports seem to suggest an improved outcome in patients (pts) developing HTN after AAG initiation (AAG-HTN). The aim of this study was to evaluate the impact of AAG-HTN on ORR, OS and EFS in pts receiving AAG, particularly tyrosine kinase inhibitors. Methods: All consecutive pts referred to ASST Bergamo Ovest between March 2012 and January 2017, and receiving sunitinib, sorafenib, regorafenib, pazopanib or axitinib, were evaluated. AAG- HTN was defined either as ex novo HTN or worsening of a pre-existing and pharmacologically controlled HTN, arising after AAG starting, and graded according to the NCI CTCAE 4.03. Overall survival was estimated using the Kaplan-Meyer method and hazard ratio with 95% CI was calculated, the primary endpoint was analyzed with a stratified log-rank test. Overall response rates were compared applying the chi-square test. Results: Overall 43 pts (male/female = 30/13, median age = 65yrs, range: 49-84) were evaluated. The AAG used were: sunitinib (n = 20), sorafenib (14), regorafenib (4), axitinib (3), pazopanib (2). Hypertension was present and pharmacologically controlled before AAG in 35 pts. Antiangiogenetic-related hypertension was developed in 27 pts (62.8%). Thirty-four pts were evaluable for ORR, which was observed in 44% of pts developing AAG-HTN versus 9% of those not developing AAG-HTN (p = 0.045). A trend to improved OS (hazard ratio [HR] 0.71 95%CI 0.33-1.5; P = 0.33) and EFS (HR 0.7, 95%CI 0.33-1.49; P = 0.29) in pts developing HTN was observed too. Conclusions: the development of AAG-HTN is related to an increased ORR. An improvement in OS and EFS has been postulated too, but the small number of this series did not allow to find a statistical correlation. For its potential impact on pts’ prognosis, further studies to better explore this issue should be performed and, importantly, AAG-HTN should be early recognized and properly managed.
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Affiliation(s)
- Sandro Barni
- Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
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9
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Cagnoni F, Destro M, Bontempelli E, Locatelli G, Hering D, Schlaich MP. Central Sympathetic Inhibition: a Neglected Approach for Treatment of Cardiac Arrhythmias? Curr Hypertens Rep 2016; 18:13. [PMID: 26781253 DOI: 10.1007/s11906-015-0619-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Overactivation of the sympathetic nervous system (SNS) plays an important role in the pathogenesis of comorbidities related to AF such as hypertension, congestive heart failure, obesity, insulin resistance, and obstructive sleep apnea. Methods that reduce sympathetic drive, such as centrally acting sympatho-inhibitory agents, have been shown to reduce the incidence of spontaneous or induced atrial arrhythmias, suggesting that neuromodulation may be helpful in controlling AF. Moxonidine acts centrally to reduce activity of the SNS, and clinical trials indicate that this is associated with a decreased AF burden in hypertensive patients with paroxysmal AF and reduced post-ablation recurrence of AF in patients with hypertension who underwent pulmonary vein isolation (PVI). Furthermore, device-based approaches to reduce sympathetic drive, such as renal denervation, have yielded promising results in the prevention and treatment of cardiac arrhythmias. In light of these recent findings, targeting elevated sympathetic drive with either pharmacological or device-based approaches has become a focus of clinical research. Here, we review the data currently available to explore the potential utility of sympatho-inhibitory therapies in the prevention and treatment of cardiac arrhythmias.
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Affiliation(s)
- Francesca Cagnoni
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy.,Dobney Hypertension Centre School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Maurizio Destro
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy
| | - Erika Bontempelli
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy
| | - Giovanni Locatelli
- Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy
| | - Dagmara Hering
- Dobney Hypertension Centre School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia.
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Cagnoni F, Sganzerla P, Bontempelli E, Masserini AB, Cavalleri C, Negrini P, Maccagni G, Destro M. RDN in Hypertensives: Results from a Novel Anatomical Approach. J Am Soc Hypertens 2016; 10 Suppl 1:e5. [PMID: 27677139 DOI: 10.1016/j.jash.2016.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- F Cagnoni
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
| | - P Sganzerla
- Cardiology Ward and Cath Lab, ASST Bergamo Ovest, Treviglio, Italy
| | - E Bontempelli
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
| | | | - C Cavalleri
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
| | - P Negrini
- Cardiology Ward and Cath Lab, ASST Bergamo Ovest, Treviglio, Italy
| | - G Maccagni
- Sport Medicine, Minerva Medica Sport Medicine Center, Cassano D'Adda, Italy
| | - M Destro
- Medical Science, ASST Bergamo Ovest, Treviglio, Italy
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Bossi AC, Veronesi G, Poerio CS, Braus A, Madaschi S, Destro M, Ferraro B, Gilberti L, Sganzerla P, Davis EM. A Prospective Study for Introducing Insulin Pens and Safety Needles in a Hospital Setting. The SANITHY Study. Curr Diabetes Rev 2016; 12:460-467. [PMID: 26245310 PMCID: PMC5112762 DOI: 10.2174/1573399811666150806150210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND to assess costs and safety of insulin pen devices and safety needles as compared to vial/syringes in hospitalized patients requiring insulin therapy in a General Hospital in Northern Italy. MATERIALS AND METHODS in a prospective 9-month study, consecutive patients admitted to three Hospital Units received insulin therapy through either a traditional disposable syringe method, or pen/safety needles with dual-ended protection, or disposable safety syringes. We compared the median direct (insulin and devices) and indirect (insulin supply at discharge, insulin wastage) costs of a 10-day in-hospital insulin treatment in the 3 study groups, additionally accounting for the costs related to the observed needlestick injury rate. Patients' safety during in-hospital stay (hypo- and hyperglycemia episodes) and satisfaction were also assessed. RESULTS N=360 patients (55% men, mean age 75.6 years, 57% with DM since ≥10 years) were recruited in the study. Insulin pens had higher median direct cost than both traditional syringes (43 vs. 18 ε/patient, p<.0001) and safety syringes (21.5 ε/patient, p<.0001). However, when also indirect and injuries costs were taken into account, the estimated savings for using pens over traditional syringes were as high as 32 ε/patient (45.8 vs. 77.6 ε/patient, p-value <.0001). No differences in patients' safety were observed. 74% and 12% of patients using pens and syringes would like to continue the method at home, respectively (p<0.0001). DISCUSSION A selective use of individual pre-filled pens/safety needles for patients who are likely to continue insulin therapy at home may strongly reduce hospital diabetes treatment related costs.
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Affiliation(s)
- Antonio C Bossi
- Metabolic Diseases and Diabetes Unit, Treviglio General Hospital, P.le Ospedale, 1 - 24047 Treviglio - BG - Italy.
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Dognini G, Destro M, Petrelli F, Cagnoni F, Locatelli G, Colombelli P, Valabrega E, Barni S. The role of medical department in the management of Breast Cancer patients: a series review. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv346.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Borgonovo K, Cabiddu M, Petrelli F, Coinu A, Ghilardi M, De Giuseppe A, Destro M, Dognini G, Locatelli G, Sgroi G, Turati L, Steccanella F, Invernizzi L, Ghedi A, Ercole C, Barni S. “Comitato ospedale senza dolore”: a successful strategy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv346.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Destro M, Dognini G, Cagnoni F, Colombelli P, Barni S. Antiangiogenetics-related hypertesion: a class-effect adverse event or therapy response mark? an emerging topic. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Parati G, Omboni S, Compare A, Grossi E, Callus E, Venco A, Destro M, Villa G, Palatini P, Rosei EA, Scalvini S, Taddei S, Manfellotto D, Favale S, De Matteis C, Guglielmi M. Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study). Trials 2013; 14:22. [PMID: 23343138 PMCID: PMC3576326 DOI: 10.1186/1745-6215-14-22] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 12/03/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient's therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated. METHODS/DESIGN The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension--both in the office and in ambulatory conditions over 24 h--and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n = 84) or HBPT (n = 168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (< 135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome). DISCUSSION The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients. TRIAL REGISTRATION Clinical Trials.gov: NCT01541566.
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Affiliation(s)
- Gianfranco Parati
- Department of Cardiology, IRCCS Ospedale San Luca, Istituto Auxologico Italiano and Department of Clinical Medicine and Prevention, University of Milano Bicocca, Milano, Italy
| | | | - Angelo Compare
- Department of Human Sciences, University of Bergamo, Bergamo, Italy
| | - Enzo Grossi
- Scientific Advisor, Centro Diagnostico Italiano, Milan, Italy
| | - Edward Callus
- Department of Pediatric Cardiology & Adult with Congenital Heart Centre, IRCCS Policlinico San Donato, Milan, Italy
| | - Achille Venco
- Medicina Generale II, Centro Ipertensione, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maurizio Destro
- General Medicine Unit, Treviglio-Caravaggio Hospital, Medical Department AO, Treviglio, Italy
| | - Giuseppe Villa
- Divisione di Nefrologia ed Emodialisi, IRCCS Fondazione Salvatore Maugeri, Istituto Scientifico di Pavia, Pavia, Italy
| | - Paolo Palatini
- Istituto di Clinica Medica IV, Policlinico Universitario, University of Padova, Padova, Italy
| | - Enrico Agabiti Rosei
- Clinica Medica, University of Brescia, II Medicina Generale, A.O. Spedali Civili di Brescia, Brescia, Italy
| | - Simonetta Scalvini
- Servizio Autonomo di Telemedicina, IRCCS Fondazione Salvatore Maugeri, Lumezzane, Brescia, Italy
| | - Stefano Taddei
- Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria di Santa Chiara, University of Pisa, Pisa, Italy
| | | | - Stefano Favale
- U.O. Cardiologia, Azienda Ospedaliera Policlinico, University of Bari, Bari, Italy
| | - Carmine De Matteis
- U.O.S.D. Servizio di Prevenzione e Riabilitazione Cardiopatico, Centro di Prevenzione Malattie Cardiovascolari, Presidio Ospedaliero San Felice a Cancello, San Felice a Cancello, Caserta, Italy
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Lamberti A, Destro M, Bianco S, Quaglio M, Chiodoni A, Pirri C, Gerbaldi C. Facile fabrication of cuprous oxide nanocomposite anode films for flexible Li-ion batteries via thermal oxidation. Electrochim Acta 2012. [DOI: 10.1016/j.electacta.2012.11.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nair JR, Destro M, Gerbaldi C, Bongiovanni R, Penazzi N. Novel multiphase electrode/electrolyte composites for next generation of flexible polymeric Li-ion cells. J APPL ELECTROCHEM 2012. [DOI: 10.1007/s10800-012-0492-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Destro M, Cagnoni F, Dognini GP, Galimberti V, Taietti C, Cavalleri C, Galli E. Telmisartan: just an antihypertensive agent? A literature review. Expert Opin Pharmacother 2012; 12:2719-35. [PMID: 22077832 DOI: 10.1517/14656566.2011.632367] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The modulation of the renin angiotensin aldosterone system (RAAS) is an important pathway in managing high blood pressure, and its overexpression plays a key role in target end-organ damage. Telmisartan is an angiotensin II receptor blocker (ARB) with unique pharmacologic properties, including the longest half-life among all ARBs; this leads to a significant and 24-h sustained reduction of blood pressure. Telmisartan has well-known antihypertensive properties, but there is also strong clinical evidence that it reduces left ventricular hypertrophy, arterial stiffness and the recurrence of atrial fibrillation, and confers renoprotection. AREAS COVERED This paper reviews telmisartan's pharmacological properties in terms of efficacy for hypertension control and, importantly, focuses on its new therapeutic indications and their clinical implications. EXPERT OPINION ONTARGET (ongoing telmisartan alone and in combination with ramipril global endpoint trial) demonstrated, that telmisartan confers cardiovascular protective effects similar to those of ramipril, but with a better tolerability. Moreover, recent investigations focused on the capability of telmisartan to modulate the peroxisome proliferator-activated receptor-gamma (PPAR-γ), an established target in the treatment of insulin resistance, diabetes and metabolic syndrome, whose activation is also correlated to anti-inflammatory and, finally, anti-atherosclerotic properties. Telmisartan shows peculiar features that go beyond blood pressure control. It presents promising and unique protective properties against target end-organ damage, potentially able to open a scenario of new therapeutic approaches to cardiovascular disease.
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Affiliation(s)
- Maurizio Destro
- General Medicine Unit, Treviglio-Caravaggio Hospital, Medical Department, A.O. Treviglio, 24047 Treviglio (BG), Italy.
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Fogari R, Mugellini A, Destro M, Corradi L, Lazzari P, Zoppi A, Preti P, Derosa G. Losartan and amlodipine on myocardial structure and function: a prospective, randomized, clinical trial. Diabet Med 2012; 29:24-31. [PMID: 21781149 DOI: 10.1111/j.1464-5491.2011.03383.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To compare the effects of losartan and amlodipine on myocardial structure and function in hypertensive patients with Type 2 diabetes and left ventricular hypertrophy. METHODS After a 4-week placebo period, patients were randomized to losartan 50 mg (n = 90) or amlodipine 5 mg (n = 91) for 12 months, with a doubling of the dose in patients who did not respond after 4 weeks. Blood pressure was measured in the clinic every month, while conventional echocardiography and acoustic densitometry (integrated backscatter analysis) were performed at the end of the placebo period and after 12 months of treatment. RESULTS Both drugs reduced systolic/diastolic blood pressure to a comparable extent. Losartan significantly reduced left ventricular mass index (-19%, P < 0.001), interventricular septal thickness (-16.6%, P < 0.01) and left ventricular posterior wall thickness in diastole (-13.7%, P < 0.01). Amlodipine also decreased such measurements (-10%, P < 0.01 for left ventricular mass index, -9.3%, P < 0.05 for interventricular septal thickness in diastole and -10.1%, P < 0.05 for posterior wall thickness in diastole), but to a lesser extent than losartan. Both drugs significantly increased the ratio of peak filling velocity at early diastole to that at atrial contraction (E/A ratio) and decreased isovolumetric relaxation time: +13.7% and -8.5% with losartan,(both P < 0.01), and +7.9% and -4.9%, with amlopidine (both P < 0.05). Losartan, but not amlodipine, significantly reduced the relative integrated backscatter compared to baseline of the intraventricular septum (-10%, P < 0.01), and of the left ventricular posterior wall (-12%, P < 0.01), while increasing the cyclic variation of integrated backscatter of both the intraventricular septum (+35%, P < 0.001) and the left ventricular posterior wall (+32%, P < 0.001). CONCLUSIONS Losartan provided a greater attenuation of left ventricular hypertrophy than amlodipine, seemingly as a result of a greater reduction of myocardial fibrosis.
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Affiliation(s)
- R Fogari
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
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Nair JR, Gerbaldi C, Destro M, Bongiovanni R, Penazzi N. Methacrylic-based solid polymer electrolyte membranes for lithium-based batteries by a rapid UV-curing process. REACT FUNCT POLYM 2011. [DOI: 10.1016/j.reactfunctpolym.2010.12.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fogari R, Mugellini A, Zoppi A, Preti P, Destro M, Lazzari P, Derosa G. Effect of Telmisartan and Ramipril on Atrial Fibrillation Recurrence and Severity in Hypertensive Patients With Metabolic Syndrome and Recurrent Symptomatic Paroxysmal and Persistent Atrial Fibrillation. J Cardiovasc Pharmacol Ther 2011; 17:34-43. [DOI: 10.1177/1074248410395018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Roberto Fogari
- Department of Internal Medicine and Therapeutics, Centro per l’ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy
| | - Amedeo Mugellini
- Department of Internal Medicine and Therapeutics, Centro per l’ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy
| | - Annalisa Zoppi
- Department of Internal Medicine and Therapeutics, Centro per l’ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy
| | - Paola Preti
- Department of Internal Medicine and Therapeutics, Centro per l’ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy
| | - Maurizio Destro
- Department of Internal Medicine and Therapeutics, Centro per l’ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy
| | - Pierangelo Lazzari
- Department of Internal Medicine and Therapeutics, Centro per l’ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy
| | - Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, Centro per l’ipertensione e la fisiopatologia cardiovascolare, University of Pavia, Pavia, Italy
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Destro M, Crikelair N, Yen J, Glazer R. Triple combination therapy with amlodipine, valsartan, and hydrochlorothiazide vs dual combination therapy with amlodipine and hydrochlorothiazide for stage 2 hypertensive patients. Vasc Health Risk Manag 2010; 6:821-7. [PMID: 20859551 PMCID: PMC2941793 DOI: 10.2147/vhrm.s11522] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Indexed: 01/13/2023] Open
Abstract
Objective: This post hoc analysis evaluated the efficacy and safety of triple therapy with amlodipine/valsartan+hydrochlorothiazide (Aml/Val+HCTZ) vs dual therapy with Aml+HCTZ in stage 2 hypertensive patients. Methods: The analysis included patients from an eight-week, multicenter, double-blind study, randomized to Aml/Val 10/160 mg or Aml 10 mg groups, who received add-on HCTZ 12.5 mg at week 4 if mean sitting systolic blood pressure (msSBP) was >130 mmHg. Results: Of the patients receiving Aml/Val+HCTZ and Aml+HCTZ, 98% (N = 133/136) and 96% (N = 200/208) completed the study, respectively. Baseline characteristics were similar across groups (Caucasians, 80.2%; diabetics, 14.8%; age, 58.6 years [28.2% ≥ 65 years]; body mass index, 31 kg/m2; mean sitting blood pressure (msBP), 171.5/95.5 mmHg [18% msSBP ≥ 180 mmHg]). Aml/Val+HCTZ provided significantly greater msBP reductions from baseline to week 8 than Aml+HCTZ (30.5/13.8 vs 24.3/8.3 mmHg, P < 0.0001). The incremental msBP reduction (week 4 to 8) with HCTZ added to Aml/Val was greater than when added to Aml (6.9/3.5 vs 3.1/1.0 mmHg, P < 0.01). Treatments were well tolerated with similar overall incidence of adverse events (Aml/Val+HCTZ: 33.8%, Aml+HCTZ: 33.2%). Conclusion: Aml/Val+HCTZ provided significantly greater BP reductions than Aml+HCTZ in patients with stage 2 hypertension. Aml/Val+HCTZ triple therapy may be a suitable option for patients requiring more than two agents to reach target BP.
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Affiliation(s)
- Maurizio Destro
- Azienda Ospedaliera della Provincia di Pavia, Ospedale Unificato Broni-Stradella, Stradella (PV), Italy.
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Cagnoni F, Njwe CAN, Zaninelli A, Ricci AR, Daffra D, D'Ospina A, Preti P, Destro M. Blocking the RAAS at different levels: an update on the use of the direct renin inhibitors alone and in combination. Vasc Health Risk Manag 2010; 6:549-59. [PMID: 20730071 PMCID: PMC2922316 DOI: 10.2147/vhrm.s11816] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Indexed: 01/13/2023] Open
Abstract
The renin–angiotensin–aldosterone system (RAAS), an important regulator of blood pressure and mediator of hypertension-related complications, is a prime target for cardiovascular drug therapy. Angiotensin-converting enzyme inhibitors (ACEIs) were the first drugs to be used to block the RAAS. Angiotensin II receptor blockers (ARBs) have also been shown to be equally effective for treatment. Although these drugs are highly effective and are widely used in the management of hypertension, current treatment regimens with ACEIs and ARBs are unable to completely suppress the RAAS. Combinations of ACEIs and ARBs have been shown to be superior than to either agent alone for some, but certainly not all, composite cardiovascular and kidney outcomes, but dual RAAS blockade with the combination of an ACEI and an ARB is sometimes associated with an increase in the risk for adverse events, primarily hyperkalemia and worsening renal function. The recent introduction of the direct renin inhibitor, aliskiren, has made available new combination strategies to obtain a more complete blockade of the RAAS with fewer adverse events. Renin system blockade with aliskiren and another RAAS agent has been, and still is, the subject of many large-scale clinical trials and furthermore, is already available in some countries as a fixed combination.
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Affiliation(s)
- Francesca Cagnoni
- Internal Medicine, Ospedale Unificato Broni-Stradella, Stradella (PV), Italy.
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Parati G, Giglio A, Lonati L, Destro M, Ricci AR, Cagnoni F, Pini C, Venco A, Maresca AM, Monza M, Grandi AM, Omboni S. Effectiveness of barnidipine 10 or 20 mg plus losartan 50-mg combination versus losartan 100-mg monotherapy in patients with essential hypertension not controlled by losartan 50-mg monotherapy: A 12-week, multicenter, randomized, open-label, parallel-group study. Clin Ther 2010; 32:1270-84. [PMID: 20678675 DOI: 10.1016/j.clinthera.2010.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2010] [Indexed: 02/02/2023]
Affiliation(s)
- Gianfranco Parati
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Italy.
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Destro M, Cagnoni F, D'Ospina A, Ricci AR, Zaninelli A, Preti P. New strategies and drugs in the treatment of hypertension: monotherapy or combination? ACTA ACUST UNITED AC 2010; 5:69-81. [PMID: 20015049 DOI: 10.2174/157489010790192629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 11/25/2009] [Indexed: 11/22/2022]
Abstract
Hypertension is one of the major risk factors associated with cardiovascular diseases. A range of blood pressure-lowering agents is available including diuretics, alpha- and beta-blockers, aldosterone antagonists, calcium-channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) and direct renin inhibitors (DRI). Most patients require two or more medications to control their blood pressures within normal ranges. When high blood pressure cannot be controlled by low-dose monotherapy, physicians employ either high-dose monotherapy or combination therapy. High-dose ARB monotherapy is more effective for reducing proteinuria against low-dose ARB monotherapy or CCBs. Combination therapy is recommended for hypertension patients to facilitate prompt maintenance of blood pressure. Single-pill combination therapy simplifies treatment and optimizes long-term compliance. Thiazide diuretics such as hydrochlorothiazide (HCTZ), alone or in combination are still widely used as first-line hypertension treatment. Recent studies have shown that double (CCB+ARBs) or triple (CCB+ARBs+HCTZ) combination therapies have a greater lowering efficacy and are better tolerated. Moreover, the use of DRIs has been patented and proven effective in selected categories of hypertensive patients with or without concomitant target organ damage (TOD).
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Fogari R, Mugellini A, Preti P, Destro M, Lazzari P, Zoppi A. EFFECT OF TELMISARTAN AND RAMIPRIL ON ATRIAL FIBRILLATION EPISODES RECURRENCE AND SEVERITY IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME AND PAROXYSMAL ATRIAL FIBRILLATION: PP.1.41. J Hypertens 2010. [DOI: 10.1097/01.hjh.0000378365.53186.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Destro M, Cagnoni F, D'Ospina A, Ricci AR, Demichele E, Peros E, Zaninelli A, Preti P. Role of valsartan, amlodipine and hydrochlorothiazide fixed combination in blood pressure control: an update. Vasc Health Risk Manag 2010; 6:253-60. [PMID: 20407632 PMCID: PMC2856580 DOI: 10.2147/vhrm.s6805] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Indexed: 12/15/2022] Open
Abstract
The treatment of moderate or severe hypertension in most cases requires the contemporaneous use of multiple antihypertensive agents. The most available two-drug combinations have an agent that addresses renin secretion and another one that is statistically more effective in renin-independent hypertension. The practice of combining agents that counteract different mechanisms is the most likely explanation for the fact that most available two-drug combinations have an agent that addresses renin secretion (beta-blocker, angiotensin converting enzyme inhibitor, angiotensin II receptor blocker or direct renin inhibitor) and another one that is more effective in renin-independent hypertension (diuretic, dihydropyridine or non-dihydropyridine calcium channel blocker). Based on these considerations, addition of hydrochlorothiazide to the combination of an antagonist of the renin-angiotensin system with a calcium channel blocker would constitute a logical approach. Inclusion of a diuretic in the triple combination is based on the evidence that these agents are effective and cheap, enhance the effect of other antihypertensive agents, and add a specific effect to individuals with salt-sensitivity of blood pressure. The benefit of triple combination therapy with amlodipine, valsartan and hydrochlorothiazide over its dual component therapies has been demonstrated, and the use of a single pill will simplify therapy resulting in better blood pressure control.
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Affiliation(s)
- Maurizio Destro
- Internal Medicine, Ospedale Unificato Broni-Stradella, Stradella (PV), Italy.
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Fogari R, Mugellini A, Preti P, Destro M, Corradi L, Derosa G. DIFFERENT EFFECTS OF ALISKIREN/HYDROCHLOROTIAZIDE AND ATENOLOL/HYDROCHLOROTIAZIDE COMBINATIONS ON CENTRAL PRESSURE IN ELDERLY HYPERTENSIVE PATIENTS. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Destro M, Preti P, D'Ospina A, Christian Achiri NN, Ricci AR, Cagnoni F. Olmesartan medoxomil: recent clinical and experimental acquisitions. Expert Opin Drug Metab Toxicol 2009; 5:1149-57. [DOI: 10.1517/17425250903203811] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Destro M, Luckow A, Samson M, Kandra A, Brunel P. Efficacy and safety of amlodipine/valsartan compared with amlodipine monotherapy in patients with stage 2 hypertension: a randomized, double-blind, multicenter study: the EX-EFFeCTS Study. ACTA ACUST UNITED AC 2008; 2:294-302. [DOI: 10.1016/j.jash.2008.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 12/10/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
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Fogari R, Derosa G, Zoppi A, Preti P, Lazzari P, Destro M, Fogari E, Rinaldi A, Mugellini A. Effect of telmisartan-amlodipine combination at different doses on urinary albumin excretion in hypertensive diabetic patients with microalbuminuria. Am J Hypertens 2007; 20:417-22. [PMID: 17386350 DOI: 10.1016/j.amjhyper.2006.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 10/10/2006] [Accepted: 10/12/2006] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Aim of this study was to evaluate the effect of the telmisartan-amlodipine combination at different doses on urinary albumin excretion rate (UAER) in hypertensive diabetic patients with microalbuminuria. METHODS After a 2-week placebo period, 300 hypertensive patients with type 2 diabetes and microalbuminuria were treated with the 40 mg of telmisartan and 2.5 mg of amlodipine combination. After 4 weeks 210 patients whose blood pressure (BP) was not controlled (BP >130/80 mm Hg) were randomized to two-dose titration regimens, one based on increasing doses of telmisartan (up to 160 mg daily) and fixed 2.5-mg dose of amlodipine, the other based on increasing doses of amlodipine (up to 10 mg daily) and fixed 40-mg dose of telmisartan. After 12 weeks the nonresponder patients were given transdermic clonidine (0.1mg/d). After 16 weeks the patients yet not controlled were discontinued, the others were followed for 48 weeks. Office BP, UAER, creatinine clearance, plasma potassium, fasting glycemia, and glycosylated hemoglobin were assessed at the end of the telmisartan (40 mg)/amlodipine (2.5 mg) treatment period and after 48 weeks of treatment. RESULTS Similar decrease in systolic/diastolic BP values were obtained with both regimens (-24/-21, -23/-21, and -24/-21 mm Hg, all P < .001 v baseline, with increasing telmisartan; -25/-22, -25/-21, and -25/-22 mm Hg, all P < .001 v baseline with increasing amlodipine). Reductions of UAER were 47.5% (P < .01), 65.3% (P < .001), and 77% (P < .0001) for telmisartan 80, 120, and 160 mg/amlodipine 2.5 mg daily, respectively, whereas reductions of UAER were 34% (P < .03), 37% (P < .03), and 33% (P < .03) for amlodipine 5, 7.5, and 10 mg/telmisartan 40 mg daily, respectively, The difference between the two regimens was statistically significant (P < .05, P < .01, and P < .001, respectively). CONCLUSIONS These findings indicate that, at comparable levels of BP reduction, UAE decreased more in subjects treated with escalating doses of telmisartan.
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Affiliation(s)
- Roberto Fogari
- Department of Internal Medicine and Therapeutics, Clinica Medica II-IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
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Destro M, Sica D, Gradman A, Lederballe O, Meyers M, Cai J, Keefe DL, Maiocchi G. Aliskiren, a Novel Renin Inhibitor, is Well Tolerated and Has Sustained BP-Lowering Effects Alone or in Combination with HCTZ During Long-Term (52 Weeks) Treatment of Hypertension. High Blood Press Cardiovasc Prev 2007. [DOI: 10.2165/00151642-200714030-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Fogari R, Zoppi A, Mugellini A, Preti P, Destro M, Rinaldi A, Derosa G. Hydrochlorothiazide added to valsartan is more effective than when added to olmesartan in reducing blood pressure in moderately hypertensive patients inadequately controlled by monotherapy. Adv Ther 2006; 23:680-95. [PMID: 17142202 DOI: 10.1007/bf02850307] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 01/13/2023]
Abstract
This study was undertaken to evaluate the effects on blood pressure of hydrochlorothiazide (HCTZ) 12.5 mg added to valsartan 160 mg or to olmesartan 20 mg in hypertensive patients. After a 2-wk placebo period, 130 patients, aged 35 to 75 y, with diastolic blood pressure (DBP) >or=99 and 110 mm Hg were randomly assigned to olmesartan 20 mg once daily or to valsartan 160 mg once daily according to a prospective, parallel-arm study design. After 4 wk of monotherapy, patients whose BP was not controlled (DBP >or=90 mm Hg) were given combination treatment with HCTZ 12.5 mg for an additional 4 wk. At the end of the placebo period and at the end of each treatment period, clinical and ambulatory BP measurements were recorded. At the end of the combination therapy period, venous blood samples were drawn 2, 4, and 24 h after drug intake for evaluation of HCTZ plasma concentrations. Both combinations induced a greater ambulatory BP reduction than monotherapy. However, mean reduction from baseline in the valsartan/HCTZ-treated patients (-21.5)-14.6 mm Hg for 24 h, -21.8/-14.9 mm Hg for daytime, and -20.4/-13.7 mm Hg for nighttime systolic blood pressure [SBP]/DBP) was greater than in the olmesartan/HCTZ-treated patients )-18.8/-12.3 mm Hg for 24 h, -19.3/-12.8 mm Hg for daytime, and 17.4/-10.6 mm Hg for nighttime SBP/DBP). The difference between the effects of the 2 treatments was significant (P<.01). In particular, compared with monotherapy, the add-on effect of HCTZ 12.5 mg was significantly greater in the valsartan group than in those treated with olmesartan; the difference was more evident for nighttime BP values. Plasma concentrations of HCTZ were significantly greater with valsartan than with olmesartan at each determination time (P<.05). These findings suggest that the addition of HCTZ 12.5 mg to valsartan 160 mg monotherapy produces a greater BP reduction than the addition of the same dose of HCTZ to olmesartan 20 mg monotherapy.
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Affiliation(s)
- R Fogari
- Department of Internal Medicine, Clinica Medica II, IRCCS Policlinica San Matteo, University of Pavia, Pavia, Italy
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Abstract
The aim of the study was to evaluate the effect of losartan as compared with amlodipine, both associated with amiodarone, in preventing the recurrence of atrial fibrillation (AF) in hypertensive patients with a history of recent paroxysmal atrial fibrillation. Two hundred and fifty mild hypertensive (SBP > 140 mm Hg and/or DBP > 90 < 100 mm Hg) outpatients in sinus rhythm but with at least two ECG-documented episodes of symptomatic atrial fibrillation in the previous 6 months and in treatment with amiodarone were randomized to losartan or amlodipine and were followed up for 1 year. Clinic blood pressure (BP) and a 24-hour ECG was evaluated every month; the patients were asked to report any episode of symptomatic atrial fibrillation and to perform an ECG as early as possible. Two hundred and thirteen patients completed the study, 107 in the losartan group and 106 in the amlodipine group. After 12 months the SBP/DBP mean values were significantly reduced by both losartan (from 151.4/95.6 to 135.5/83.7 mm Hg, P < 0.001 versus baseline) and amlodipine (from 152.3/96.5 to 135.2/83.4 mm Hg, P < 0.001 versus baseline), with no difference between the two treatments. At least one ECG-documented episode of atrial fibrillation was reported in 13% of the patients treated with losartan and in 39% of the patients treated with amlodipine. The use of losartan in combination with amiodarone seems more effective than amlodipine/amiodarone combination in preventing new episodes of atrial fibrillation in hypertensive patients with recurrent atrial fibrillation. This might be related to possible favorable impact of angiotensin II receptor blockers (ARB) on the atrial electrical and structural remodeling in this type of patients.
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Affiliation(s)
- Roberto Fogari
- Department of Internal Medicine and Therapeuthics, Clinica Medica II, IRCCS Policlinico S.Matteo, University of Pavia, Pavia, Italy.
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Fogari R, Mugellini A, Zoppi A, Lazzari P, Destro M, Rinaldi A, Preti P. Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J Hum Hypertens 2005; 20:177-85. [PMID: 16306998 DOI: 10.1038/sj.jhh.1001964] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [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: 11/09/2022]
Abstract
The aim of this study was to compare the effects of telmisartan/hydrochlorothiazide (HCTZ) vs lisinopril/HCTZ combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. A total of 160 patients, 76 men and 84 women, aged 61-75 years, with sitting diastolic blood pressure (DBP)>90 mmHg and <110 mmHg and systolic blood pressure (SBP)>140 mmHg were randomized to receive temisartan 80 mg/HCTZ 12.5 mg o.d. or lisinopril 20 mg/HCTZ 12.5 mg o.d. for 24 weeks, according to a prospective, open-label, blinded end point, parallel-group design. At the end of a 2-week wash-out period and after 12 and 24 weeks of active treatment, 24-h noninvasive ambulatory BP monitoring (ABPM) was performed and cognitive function was evaluated through six different tests (verbal fluency, Boston naming test, word-list memory, word-list recall, word-list recognition and Trails B). Both treatments significantly reduced ambulatory BP. However, the telmisartan/HCTZ combination produced a greater reduction in 24-h, day-time and night time ABPM values. Lisinopril/HCTZ did not induce significant changes in any of the cognitive function test scores at any time of the study, whereas at both 12 and 24 weeks telmisartan/HCTZ significantly improved the word-list memory score (+17.1 and +15.7%, respectively, P<0.05 vs baseline), the word-list recall score (+13.5 and +16.9%, P<0.05) and the Trails B score (-33 and -30.5%, P<0.05). These results suggest that in elderly hypertensive patients treatment with telmisartan/HCTZ produces a slightly greater reduction in ambulatory BP than lisinopril/HCTZ combination and, unlike this latter, improves some of the components of cognitive function, particularly episodic memory and visuospatial abilities.
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Affiliation(s)
- R Fogari
- Department of Internal Medicine and Therapeutics, Clinica Medica II, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
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Fogari R, Mugellini A, Zoppi A, Lazzari P, Destro M, Rinaldi A, Preti P. Effect of successful hypertension control by manidipine or lisinopril on albuminuria and left ventricular mass in diabetic hypertensive patients with microalbuminuria. Eur J Clin Pharmacol 2005; 61:483-90. [PMID: 16021438 DOI: 10.1007/s00228-005-0961-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 05/18/2005] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this open-labelled, randomised, parallel-group study was to evaluate the effect of long-term monotherapy with manidipine or lisinopril on albumin excretion rate (AER) and left ventricular mass index (LVMI) in hypertensive patients with type-2 diabetes and microalbuminuria. METHODS After a 4-week wash-out period, 174 patients with essential hypertension [diastolic blood pressure (DBP) >80 mmHg and <100 mmHg], type-2 diabetes and microalbuminuria were randomised to manidipine 10 mg o.d. or lisinopril 10 mg o.d.; after 8 weeks, the dose was doubled in non-responders (DBP >80 mmHg); after 3 months, treatment was discontinued in the non-responder patients and in those complaining of side effects; the remaining 121 patients continued their therapy with manidipine or lisinopril, and 99 completed the 2-year study. At the end of the wash-out period, of the titration period and after 6, 12, 18 and 24 months of treatment, BP was measured, AER, creatinine clearance, glycosylated haemoglobin (HbA1c) and body mass index (BMI) were evaluated and an echocardiographic evaluation was performed. RESULTS The 99 patients who completed the study were statistically analysed according to a per-protocol evaluation. Manidipine and lisinopril significantly reduced systolic blood pressure (SBP) and DBP levels (at 24 months, --22.3/15.5 mmHg, P<0.001 versus baseline and --21.4/15.7 mmHg, P<0.01 versus baseline, respectively). Both drugs provided a significant decrease in AER, but it was significantly more pronounced with lisinopril (at 24 weeks, --37.2 mg/24 h, P<0.001 versus baseline) than with manidipine (--29.9 mg/24 h, P<0.05 versus baseline) and became evident earlier in the lisinopril group (after 3 months versus 6 months of treatment). Manidipine produced a greater reduction of LVMI than lisinopril (--14.9 g/m(2) versus --10.8 g/m(2) at 24 months). The effect was more pronounced in patients with left ventricular hypertrophy at baseline (--19.8 g/m(2) versus --12.8 g/m(2), P<0.05). CONCLUSION These data suggest that, despite similar BP lowering, non-haemodynamic factors play an important role in the pharmacological reduction of AER and LVMI in diabetic hypertensive patients.
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Affiliation(s)
- Roberto Fogari
- Department of Internal Medicine and Therapeutics, Clinica Medica II, University of Pavia, IRCCS Policlinico S. Matteo, 27100, Pavia, Italy.
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Preti P, Mugellini A, Rinaldi A, Destro M, Marasi G, Corradi L, Fogari R. Prevalence of Primary Aldosteronism Among Hypertensive Patients. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Preti P, Mugellini A, Destro M, Corradi L, Pasotti C, Rinaldi A, Zoppi A, Fogari R. Losartan and Prevention of Atrial Fibrillation Recurrence in Hypertensive Patients. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Mugellini A, Derosa G, Preti P, Lazzari P, Zoppi A, Destro M, Fogari R. Effect of Valsartan on Adiponectine, Leptin and Resistine in Hypertensive Obese Patients. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Mugellini A, Corradi L, Destro M, Preti P, Zoppi A, Rinaldi A, Fogari R. Influence of Telmisartan Hydrochlorothiazide Combination on Cognitive Function in Elderly Hypertensive Patients. High Blood Press Cardiovasc Prev 2005. [DOI: 10.2165/00151642-200512030-00130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Destro M, Scabrosetti R, Vanasia A, Mugellini A. Comparative efficacy of valsartan and olmesartan in mild-to-moderate hypertension: results of 24-hour ambulatory blood pressure monitoring. Adv Ther 2005; 22:32-43. [PMID: 15943220 DOI: 10.1007/bf02850182] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 11/28/2022]
Abstract
The aim of this prospective, randomized, open-label, blinded endpoint (PROBE) study was to compare the antihypertensive efficacy of 2 angiotensin II (AII) receptor antagonists with different pharmacologic profiles, valsartan and olmesartan, in patients with mild-to-moderate essential hypertension. After an initial 2-week washout period, 114 patients (64 men, 50 women; aged 35-70 years) were randomly assigned to receive valsartan 160 mg or olmesartan 20 mg once daily for 8 weeks. After the washout period and after 2 and 8 weeks of treatment, 24-hour ambulatory blood pressure monitoring (ABPM) was performed using a noninvasive device, and casual blood pressure (BP) and heart rate were measured. Both olmesartan and valsartan had a clear-cut antihypertensive effect. However, significantly earlier and more pronounced antihypertensive activity was achieved with valsartan than with olmesartan, as demonstrated by (1) significantly lower 24-hour, daytime, and nighttime ABPM values after 2 weeks with valsartan (P<.01); (2) significantly lower percentage of abnormal BP readings with valsartan; (3) significantly higher trough-peak ratio and smoothness index with valsartan, suggesting a more prolonged and homogeneous antihypertensive effect; and (4) lower 24-hour postdose clinic systolic and diastolic BP values versus olmesartan. These findings show that pharmacodynamic and pharmacokinetic differences between AII receptor antagonists, at clinically comparable dosages, may be associated with differences in antihypertensive efficacy.
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Affiliation(s)
- Maurizio Destro
- Divisione di Medicina Interna, Centro per la Diagnosi e Cura dell'Ipertensione Arteriosa, Ospedale Arnaboldi, Via Emilia, 354, 27043 Broni, PV, Italy
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Fogari R, Zoppi A, Malamani G, Lusardi P, Destro M, Corradi L. Effects of Amlodipine vs Enalapril on Microalbuminuria in Hypertensive Patients with Type II Diabetes. Clin Drug Investig 1997. [DOI: 10.2165/00044011-199700131-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Fogari R, Zoppi A, Mugellini A, Lusardi P, Destro M, Corradi L. Effect of Benazepril plus Amlodipine vs Benazepril Alone on Urinary Albumin Excretion in Hypertensive Patients with Type II Diabetes and Microalbuminuria. Clin Drug Investig 1997. [DOI: 10.2165/00044011-199700131-00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Fogari R, Zoppi A, Malamani GD, Lazzari P, Destro M, Corradi L. Ambulatory blood pressure monitoring in normotensive and hypertensive type 2 diabetes. Prevalence of impaired diurnal blood pressure patterns. Am J Hypertens 1993; 6:1-7. [PMID: 8427656 DOI: 10.1093/ajh/6.1.1] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.7] [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: 01/30/2023] Open
Abstract
To assess the prevalence of an impaired diurnal blood pressure (BP) pattern in a population of both normotensive and hypertensive diabetics, noninvasive ambulatory BP monitoring (SpaceLabs 5200, Redmond, WA) was performed in 96 outpatients with type 2 diabetes (47 normotensives and 48 hypertensives) and in 103 control subjects without diabetes (50 normotensives and 53 hypertensives). Mean 24 h and daytime (06:00 to 22:00) BP and heart rate (HR) were not statistically different in diabetic patients compared to nondiabetic ones. Nighttime (22:00 to 06:00) BP and HR tended to be higher in both normotensive and hypertensive diabetics, although not significantly. Heart rate, diastolic BP (DBP), and especially the nocturnal systolic BP (SBP) decrease, were less marked in both normotensive and hypertensive diabetics, with a consequent increase in rate-pressure. A significant correlation was found between the percent decrease in nighttime SBP and the decrease in orthostatic SBP in casual BP measurements. The analysis of individual recordings allowed us to detect an impaired circadian pattern (the disappearance of the nocturnal BP decrease or a paradoxical BP increase) in 30% of the normotensive and 31% of the hypertensive diabetics (v 6% of the normotensive and 6.4% of the hypertensive nondiabetic subjects). As the absence of a nocturnal BP fall has been associated with the increased prevalence of left ventricular hypertrophy and atherosclerotic cardiovascular disease, its detection by ambulatory monitoring might be of prognostic and therapeutic importance.
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Affiliation(s)
- R Fogari
- Department of Internal Medicine and Therapeutics, University of Pavia, Italy
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Bianco V, Colombo A, Destro M, Remotti G. [Chromo-colposcopic images during oral contraception]. Ann Ostet Ginecol Med Perinat 1992; 113:181-94. [PMID: 1285374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The Authors report chromocolposcopic pictures with AZEA (Azure 2 + alcohol-soluble eosine + ethanol) and related histologic pictures in six women under oral contraception. Columnar epithelium develops violet or blue-violet areas histologically corresponding to endocervicitis. Aceto-white epithelium develops reddish color in case of medium-mature metaplasia, brown-violet in case of mature metaplasia, lilac in case of superficial koilocytosis on metaplasia. Native epithelium appears dark brown, or yellow-brown in case of koilocytosis.
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Affiliation(s)
- V Bianco
- I Clinica Ostetrica e Ginecologica, Università degli Studi di Milano
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Destro M, D'Amico DJ, Gragoudas ES, Brockhurst RJ, Pinnolis MK, Albert DM, Topping TM, Puliafito CA. Retinal manifestations of neurofibromatosis. Diagnosis and management. Arch Ophthalmol 1991; 109:662-6. [PMID: 1902661 DOI: 10.1001/archopht.1991.01080050076033] [Citation(s) in RCA: 95] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Five patients presented with vision-threatening retinal tumors and systemic signs of neurofibromatosis, including neurofibromatosis type 1 (four patients) and familial cafe-au-lait spots (one patient). These tumors included large retinal astrocytic hamartomas, multiple retinal capillary hemangiomas, and combined hamartomas of the retina and retinal pigment epithelium, which resulted in rubeotic glaucoma, vitreous hemorrhage, and retinal detachment. Surgical therapy included retinal cryopexy, xenon and argon photocoagulation, scleral buckling, and pars plana vitrectomy with excisional retinal biopsy. Retinal tumors may result in marked visual loss in patients with neurofibromatosis, and vitreoretinal surgery may restore useful vision in some of these patients.
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Affiliation(s)
- M Destro
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114
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Abstract
Choroidal neovascular membranes often are poorly defined on fluorescein angiography because of rapid or indistinct fluorescein leakage or because of blockage of hyperfluorescence by overlying hemorrhage, lipid, turbid fluid, or pigment. Indocyanine green (ICG) is a high protein-bound dye with peak absorption (805 nm) and peak fluorescence (835 nm) in the near infrared portion of the spectrum. At these wavelengths, penetration through overlying pigments is increased. Using an infrared videoangiography system, the authors obtained ICG angiograms of 32 eyes with suspected choroidal neovascularization. Compared with fluorescein angiography, ICG improved visualization of the choroidal circulation and enhanced visualization of some membranes that were poorly defined with fluorescein. In addition, after clearance of the dye from the retinal and choroidal circulations, ICG remained in and around the neovascular tissue. The authors conclude that ICG videoangiography may aid in the evaluation of selected patients with poorly defined membranes on fluorescein angiography.
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Affiliation(s)
- M Destro
- Laser Research Laboratory, Massachusetts Eye and Ear Infirmary, Boston 02114
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Abstract
We used a pulsed erbium-YAG laser emitting in the midinfrared region (2.94 microns) to cut experimental vitreous membranes in rabbits via an intraocular fiberoptic delivery system. Thirty-four membranes were cut at distances of 500 to 3600 microns from the retina. All 34 of the membranes treated were effectively cut. Sixteen cases had no evidence of retinal injury, including one in which the membrane was only 800 microns from the retina. Retinal injuries in the remaining cases consisted of small (less than 300 microns) retinal burns and hemorrhages. In 94% of the cases with retinal injury, the fiberoptic was within 2000 microns of the retina. We conclude that a pulsed erbium-YAG laser allows near tractionless cutting of vitreous membranes and may have potential for clinical use if further studies show it to be efficacious and safe near the retina.
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Affiliation(s)
- T I Margolis
- Laser Research Laboratory, Massachusetts Eye and Ear Infirmary, Boston 02114
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Abstract
Choroidal neovascularization in rat eyes was induced by krypton laser photocoagulation. Lesions were studied weekly by ophthalmoscopy, fundus photography, and fluorescein angiography. Morphologic correlation was provided by serial sectioning of lesions for light and transmission electron microscopy. In addition, vascular casts were prepared for scanning electron microscopy. Choroidal neovascularization occurred in 25 (60%) of 42 lesions, as evidenced by growth of capillaries through breaks in Bruch's membrane. In addition, 24 (28%) of 86 lesions studied by fluorescein angiography demonstrated leakage. This study provides the most complete angiographic, histologic, and ultrastructural documentation of experimental choroidal neovascularization in the rat. This model may be useful for in vivo studies of choroidal angiogenesis and its modulation via drug therapy.
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Affiliation(s)
- E T Dobi
- Massachusetts Eye & Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston
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Gilardi EM, Faktor J, Destro M, Remotti G. [Computer program (Software) for the automation of colposcopy ambulatory files]. Ann Ostet Ginecol Med Perinat 1988; 109:245-56. [PMID: 3071960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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