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Palatini P, Kollias A, Saladini F, Asmar R, Bilo G, Kyriakoulis KG, Parati G, Stergiou GS, Grassi G, Kreutz R, Mancia G, Jordan J, Biaggioni I, de la Sierra A. Assessment and management of exaggerated blood pressure response to standing and orthostatic hypertension: consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2024; 42:939-947. [PMID: 38647124 DOI: 10.1097/hjh.0000000000003704] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.
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Affiliation(s)
- Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Francesca Saladini
- Cardiology Unit, Cittadella Town Hospital, Padova. Department of Medicine, University of Padova, Padova, Italy
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Grzegorz Bilo
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Monza, Italy
| | | | | | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Linder Hoehe
- Medical Faculty, University of Cologne, Cologne, Germany
| | - Italo Biaggioni
- Autonomic Dysfunction Center and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alejandro de la Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
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Kyriakoulis KG, Kollias A, Bilo G, Soranna D, Liu CY, Pengo MF, Zambon A, Zhang W, Destounis A, Wang JG, Stergiou GS, Parati G. Blood pressure variability assessed by office, home, and ambulatory measurements before and during antihypertensive drug treatment: a sub-analysis of the REVERENT randomized trial. J Hypertens 2024:00004872-990000000-00446. [PMID: 38690937 DOI: 10.1097/hjh.0000000000003730] [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: 05/03/2024]
Abstract
OBJECTIVES Blood pressure (BP) variability (BPV) can be assessed using office (OBP), home (HBP), or ambulatory BP (ABP) measurements. This analysis investigated the association and agreement between OBP, HBP, and ABP measurements for BPV assessment at baseline and 10 weeks after initiating antihypertensive drug therapy. METHODS Untreated hypertensive patients with elevated BPV were randomized to receive an angiotensin-converting enzyme inhibitor (ramipril) or a calcium channel blocker (nifedipine GITS) in a 10-week, open-label, blinded-end point study. BPV was assessed using standard deviation (SD) and coefficient of variation (CV) (reading-to-reading analyses). RESULTS Data from 146 participants from three research centers (Athens/Greece; Milan/Italy; Shanghai/China) were analyzed [mean age 53 ± 10 (SD) years, male individuals 60%, baseline systolic OBP, HBP, and 24 h ABP 144 ± 9, 138 ± 10, and 143 ± 10 mmHg, respectively]. Post-treatment minus pre-treatment systolic CV difference was: OBP: 0.3%, P = 0.28; HBP: -0.2%, P = 0.20; 24 h ABP: 1.1%, P < 0.001. Home and ambulatory (not office) BPV indices presented weak-to-moderate correlation, both before and during treatment (range of coefficients 0.04-0.33). The correlation coefficient between systolic HBP CV and awake ABP CV was 0.21 and 0.28 before and during treatment, respectively (P < 0.05/< 0.001, respectively). Home and ambulatory (not office) BPV indices presented slight to fair agreement (range 64-73%) in detecting participants with high systolic BPV (top quartile of respective distributions) both before and during treatment (kappa range 0.04-0.27). CONCLUSION These data showed a weak-to-moderate association between out-of-office (but not office) BPV indices both before and during BP-lowering treatment, with reasonable agreement in detecting individuals with high BPV. Out-of-office BP measurements provide more similar and consistent BPV information than office measurements.
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Affiliation(s)
- Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Grzegorz Bilo
- IRCCS, Istituto Auxologico Italiano, Department of Cardiology, San Luca Hospital
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - Davide Soranna
- IRCCS, Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Chang-Yuan Liu
- Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension
- Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Martino F Pengo
- IRCCS, Istituto Auxologico Italiano, Department of Cardiology, San Luca Hospital
- Department of Medicine and Surgery, University of Milano-Bicocca
| | - Antonella Zambon
- IRCCS, Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
- Department of Statistics and quantitative methods, University of Milano-Bicocca, Milan, Italy
| | - Wei Zhang
- Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension
- Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Antonios Destounis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Center for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension
- Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Department of Cardiology, San Luca Hospital
- Department of Medicine and Surgery, University of Milano-Bicocca
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Parati G, Croce A, Bilo G. Blood pressure variability: no longer a mASCOT for research nerds. Eur Heart J 2024; 45:1170-1172. [PMID: 38315171 DOI: 10.1093/eurheartj/ehae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 2, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Croce
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 2, 20149 Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 2, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Stopa M, Zięba K, Tofilska A, Bilo G, Rajzer M, Olszanecka A. Unattended automatic blood pressure measurements versus conventional office readings in predicting hypertension-mediated organ damage. Pol Arch Intern Med 2024:16699. [PMID: 38501381 DOI: 10.20452/pamw.16699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Hypertension is a leading cardiovascular risk factor. Accurate blood pressure measurement is pivotal in hypertension diagnosis and management. Conventional office measurements (OBP) are error-prone, exacerbated by the white coat effect. Unattended automated office blood pressure measurement (UAOBP) is emerging as an alternative, mitigating the white coat effect. However, its ability to predict hypertension-mediated organ damage (HMOD) remains disputable. OBJECTIVES This study compares UAOBP with OBP in terms of their association with various HMODs, including left ventricular hypertrophy, left atrial enlargement, left ventricular systolic and diastolic dysfunction, intima-media complex thickening, microalbuminuria and abnormal pulse wave velocity. PATIENTS AND METHODS A total of 219 hypertensive patients were recruited, interviewed, and examined. Subsequently, blood pressure measurements were conducted in a randomized manner: 1) UAOBP: after 5 minutes of solitary rest in the examination room, the patient's blood pressure was automatically measured three times at 1-minute intervals. 2) OBP: after 5 minutes of rest, a physician performed three consecutive blood pressure measurements at 1-minute intervals. Subsequent evaluations aimed to detect HMODs, including echocardiography, carotid artery ultrasound, pulse wave velocity assessment, and laboratory tests. RESULTS The blood pressure values in UAOBP were significantly lower than those in OBP (mean (SD) 124.7 (14.4) vs. 128.2 (14.2) mmHg, P <0.001 for systolic, and 73.3 (10.2) vs. 75.2 (10.6) mmHg, P <0.001 for diastolic). Correlation and ROC curve analyses revealed no method's superiority in predicting HMOD. CONCLUSIONS The UAOBP did not prove superior in predicting HMOD compared to OBP, Further research is warranted to determine the role of UAOBP in clinical practice.
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Wojciechowska W, Rajzer M, Weber T, Prejbisz A, Dobrowolski P, Ostrowska A, Bilo G, Mancia G, Kreutz R, Januszewicz A. Ambulatory blood pressure monitoring in treated patients with hypertension in the COVID-19 pandemic - The study of European society of hypertension (ESH ABPM COVID-19 study). Blood Press 2023; 32:2161998. [PMID: 36694963 DOI: 10.1080/08037051.2022.2161998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/26/2023]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The established risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. This study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes as assessed with 24-hour ambulatory BP monitoring (ABPM). MATERIALS AND METHODS This is a multi-centre, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data and office BP, ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e. after March 2020, and the first one 9-15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within a similar 9-15 month interval between the recordings. Within each group, we will analyse and compare BP variables and phenotypes (including averaged daytime and night-time BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the two groups. The target sample size will amount to least 590 participants in each of the study groups, which means a total of at least 2360 ABPM recordings overall. EXPECTED OUTCOMES As a result, we expect to identify the impact of a COVID-19 pandemic on blood pressure control and the quality of medical care in order to develop the strategy to control cardiovascular risk factors during unpredictable global events.
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Affiliation(s)
- Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Thomas Weber
- Cardiology Department Klinikum Wels-Grieskirchen, Wels, Austria
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Aleksandra Ostrowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Bilo
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, Università Milano-Bicocca, Milano, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, Università Milano-Bicocca, Milano, Italy
| | - Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
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Stergiou GS, Parati G, Kollias A, Schutte AE, Asayama K, Asmar R, Bilo G, de la Sierra A, Dolan E, Filipovsky J, Head G, Kario K, Kyriakoulis KG, Mancia G, Manios E, Menti A, McManus RJ, Mihailidou AS, Muntner P, Niiranen T, Ohkubo T, Omboni S, Protogerou A, Saladini F, Sharman J, Shennan A, Shimbo D, Topouchian J, Wang J, O'Brien E, Palatini P. Requirements for design and function of blood pressure measuring devices used for the management of hypertension: Consensus Statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and STRIDE BP. J Hypertens 2023; 41:2088-2094. [PMID: 37303225 DOI: 10.1097/hjh.0000000000003482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To develop scientific consensus recommendations for the optimal design and functions of different types of blood pressure (BP) measuring devices used in clinical practice for the detection, management, and long-term follow-up of hypertension. METHODS A scientific consensus meeting was performed by the European Society of Hypertension (ESH) Working Group on BP Monitoring and Cardiovascular Variability and STRIDE BP (Science and Technology for Regional Innovation and Development in Europe) during the 2022 Scientific Meeting of the ESH in Athens, Greece. Manufacturers were also invited to provide their feedback on BP device design and development. Thirty-one international experts in clinical hypertension and BP monitoring contributed to the development of consensus recommendations on the optimal design of BP devices. STATEMENT International consensus was reached on the requirements for the design and features of five types of BP monitors, including office (or clinic) BP monitors, ambulatory BP monitors, home BP monitors, home BP telemonitors, and kiosk BP monitors for public spaces. For each device type "essential" requirements (must have), and "optional" ones (may have) are presented, as well as additional comments on the optimal device design and features. CONCLUSIONS These consensus recommendations aim at providing manufacturers of BP devices with the requirements that are considered mandatory, or optional, by clinical experts involved in the detection and management of hypertension. They are also directed to administrative healthcare personnel involved in the provision and purchase of BP devices so that they can recommend the most appropriate ones.
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Affiliation(s)
- George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Grzegorz Bilo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Catalonia, Spain
| | - Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland
| | - Jan Filipovsky
- 2nd Department of Internal Medicine, Medical Faculty of Charles University & University Hospital, Pilsen, Czech Republic
| | - Geoffrey Head
- Neuropharmacology Laboratory, Baker Heart and Diabetes Institute, Monash University, Melbourne, Australia
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | | | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Ariadni Menti
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anastasia S Mihailidou
- Cardiovascular & Hormonal Research Laboratory, Department of Cardiology and Kolling Institute, Royal North Shore Hospital, Macquarie University, Sydney, Australia
| | - Paul Muntner
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Teemu Niiranen
- National Institute for Health and Welfare, and Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
| | - Athanasios Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - James Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, FoLSM, Kings College London, UK
| | - Daichi Shimbo
- Columbia Hypertension Center and Lab, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Hotel Dieu Hospital, Paris, France
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Eoin O'Brien
- The Conway Institute, University College Dublin, Ireland
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padova, Padua, Italy
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Pengo MF, Oscullo G, Gomez-Olivas JD, Bilo G, Parati G, Martinez-Garcia MA. Nocturnal BP Profile Predicts CPAP Effect on BP in Patients With OSA and Resistant Hypertension. Chest 2023; 164:1302-1304. [PMID: 37364854 DOI: 10.1016/j.chest.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/03/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Martino F Pengo
- Istituto Auxologico Italiano IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grace Oscullo
- Pneumology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | - Grzegorz Bilo
- Istituto Auxologico Italiano IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Miguel Angel Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias, Madrid, Spain.
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Vignati C, Contini M, Salvioni E, Lombardi C, Caravita S, Bilo G, Swenson ER, Parati G, Agostoni P. Exercise in hypoxia: a model from laboratory to on-field studies. Eur J Prev Cardiol 2023; 30:ii40-ii46. [PMID: 37819224 DOI: 10.1093/eurjpc/zwad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 10/13/2023]
Abstract
Clinical outcome and quality of life of patients with chronic heart failure (HF) have greatly improved over the last two decades. These results and the availability of modern lifts allow many cardiac patients to spend leisure time at altitude. Heart failure per se does not impede a safe stay at altitude, but exercise at both simulated and real altitudes is associated with a reduction in performance, which is inversely proportional to HF severity. For example, in normal subjects, the reduction in functional capacity is ∼2% every 1000 m altitude increase, whereas it is 4 and 10% in HF patients with normal or slightly diminished exercise capacity and in HF patients with markedly diminished exercise capacity, respectively. Also, the on-field experience with HF patients at altitude confirms safety and shows overall similar data to that reported at simulated altitude. Even 'optimal' HF treatment in patients spending time at altitude or at hypoxic conditions is likely different from optimal treatment at sea level, particularly with regard to the selectivity of β-blockers. Furthermore, high altitude, both simulated and on-field, represents a stimulating model of hypoxia in HF patients and healthy subjects. Our data suggest that spending time at altitude (<3500 m) can be safe even for HF patients, provided that subjects are free from comorbidities that may directly interfere with the adaptation to altitude and are stable. However, HF patients experience a reduction of exercise capacity directly proportional to HF severity and altitude. Finally, HF patients should be tested for functional capacity and must undergo a specific 'hypoxic-tailored treatment' to avoid pharmacological interference with altitude adaptation mechanisms, particularly with regard to the selectivity of β-blockers.
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Affiliation(s)
- Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Parea, Milano 20138, Italy
| | - Mauro Contini
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
| | | | - Carolina Lombardi
- Sleep Medicine Center, Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea, Milano 20138, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Parea, Milano 20138, Italy
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9
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Rosa D, Pengo MF, Adorni R, Bilo G, Parati G, Steca P. Psychometric Properties of a Brief Version of the Perception of Risk of Heart Disease Scale in an Italian Sample. High Blood Press Cardiovasc Prev 2023; 30:475-484. [PMID: 37847486 PMCID: PMC10600277 DOI: 10.1007/s40292-023-00603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/20/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION The number of Italian citizens unaware of their risk of cardiovascular disease it is still very high. AIM This study aimed to translate and preliminarily validate a brief Italian version of the Perception of Risk of Heart Disease Scale (PRHDS). METHODS PRHDS was culturally adapted to the Italian context. Then, the scale was administered to 772 healthy adults. By randomly dividing the sample into two subsamples, we tested the scale dimensionality through Exploratory Factor Analysis (EFA) followed by Confirmatory Factor Analysis (CFA). Finally, we evaluated internal consistency. RESULTS Psychometric properties of the scale were appropriate. EFA and CFA evidenced a unidimensional structure of a brief version of the scale, composed of six items. Internal consistency was adequate. CONCLUSIONS Italian version of the brief PRHDS is a promising self-report questionnaire to measure cardiovascular risk perception among Italian adults.
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Affiliation(s)
- Debora Rosa
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Martino Francesco Pengo
- Istituto Auxologico Italiano IRCCS, Milan, Italy.
- University of Milano-Bicocca, Faculty of Medicine, Milan, Italy.
| | - Roberta Adorni
- University of Milano-Bicocca, Department of Psychology, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- University of Milano-Bicocca, Faculty of Medicine, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- University of Milano-Bicocca, Faculty of Medicine, Milan, Italy
| | - Patrizia Steca
- University of Milano-Bicocca, Department of Psychology, Milan, Italy
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10
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Baldassarre D, Iacoviello L, Baetta R, Roncaglioni MC, Condorelli G, Remuzzi G, Gensini G, Frati L, Ricciardi W, Conaldi PG, Uccelli A, Blandini F, Bosari S, Scambia G, Fini M, Di Malta A, Amato M, Veglia F, Bonomi A, Klersy C, Colazzo F, Pengo M, Gorini F, Auteri L, Ferrante G, Baviera M, Ambrosio G, Catapano A, Gialluisi A, Malavazos AE, Castelvecchio S, Corsi-Romanelli MM, Cardani R, La Rovere MT, Agnese V, Pane B, Prati D, Spinardi L, Liuzzo G, Arbustini E, Volterrani M, Visconti M, Werba JP, Genovese S, Bilo G, Invitti C, Di Blasio A, Lombardi C, Faini A, Rosa D, Ojeda-Fernández L, Foresta A, De Curtis A, Di Castelnuovo A, Scalvini S, Pierobon A, Gorini A, Valenti L, Luzi L, Racca A, Bandi M, Tremoli E, Menicanti L, Parati G, Pompilio G. Rationale and design of the CV-PREVITAL study: an Italian multiple cohort randomised controlled trial investigating innovative digital strategies in primary cardiovascular prevention. BMJ Open 2023; 13:e072040. [PMID: 37451717 PMCID: PMC10351259 DOI: 10.1136/bmjopen-2023-072040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Prevention of cardiovascular disease (CVD) is of key importance in reducing morbidity, disability and mortality worldwide. Observational studies suggest that digital health interventions can be an effective strategy to reduce cardiovascular (CV) risk. However, evidence from large randomised clinical trials is lacking. METHODS AND ANALYSIS The CV-PREVITAL study is a multicentre, prospective, randomised, controlled, open-label interventional trial designed to compare the effectiveness of an educational and motivational mobile health (mHealth) intervention versus usual care in reducing CV risk. The intervention aims at improving diet, physical activity, sleep quality, psycho-behavioural aspects, as well as promoting smoking cessation and adherence to pharmacological treatment for CV risk factors. The trial aims to enrol approximately 80 000 subjects without overt CVDs referring to general practitioners' offices, community pharmacies or clinics of Scientific Institute for Research, Hospitalization and Health Care (Italian acronym IRCCS) affiliated with the Italian Cardiology Network. All participants are evaluated at baseline and after 12 months to assess the effectiveness of the intervention on short-term endpoints, namely improvement in CV risk score and reduction of major CV risk factors. Beyond the funded life of the study, a long-term (7 years) follow-up is also planned to assess the effectiveness of the intervention on the incidence of major adverse CV events. A series of ancillary studies designed to evaluate the effect of the mHealth intervention on additional risk biomarkers are also performed. ETHICS AND DISSEMINATION This study received ethics approval from the ethics committee of the coordinating centre (Monzino Cardiology Center; R1256/20-CCM 1319) and from all other relevant IRBs and ethics committees. Findings are disseminated through scientific meetings and peer-reviewed journals and via social media. Partners are informed about the study's course and findings through regular meetings. TRIAL REGISTRATION NUMBER NCT05339841.
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Affiliation(s)
- Damiano Baldassarre
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Varese, Italy
| | | | - Maria Carla Roncaglioni
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Gianluigi Condorelli
- Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Luigi Frati
- IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | - Walter Ricciardi
- Istituti Clinici Scientifici Maugeri IRCCS Pavia, Pavia, Italy
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
| | - Pier Giulio Conaldi
- IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | | | - Fabio Blandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvano Bosari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Mauro Amato
- Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Veglia
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | | | - Catherine Klersy
- Unit of Clinical Epidemiology & Biostatistic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Martino Pengo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, IRCCS-Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Baviera
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Alberico Catapano
- IRCCS Multimedica, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alessandro Gialluisi
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Varese, Italy
| | - Alexis Elias Malavazos
- Endocrinology Unit, Clinical Nutrition and Cardiovascular Prevention Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | | | - Massimiliano Marco Corsi-Romanelli
- UOC SMEL-1, IRCCS POLICLINICO SAN DONATO, San Donato Milanese, Italy
- Department of Health and Biomedical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Rosanna Cardani
- BioCor Biobank, UOC SMEL-1 of Clinical Pathology, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | | | - Valentina Agnese
- IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Bianca Pane
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genoa, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Spinardi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Liuzzo
- Università Cattolica del Sacro Cuore - Campus di Roma, Rome, Italy
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Eloisa Arbustini
- Centro Malattie Genetiche Cardiovascolari - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maurizio Volterrani
- Cardio Pulmonary Department, IRCCS San Raffaele, Rome, Italy
- Exercise Science and Medicine, San Raffaele Open University, Rome, Italy
| | - Marco Visconti
- Co.S. (Consorzio Sanità) Study Center, Italy, Soresina, Italy
| | | | | | - Grzegorz Bilo
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Carolina Lombardi
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Andrea Faini
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Debora Rosa
- Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luisa Ojeda-Fernández
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andreana Foresta
- Laboratory of Cardiovascular Prevention, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy
| | | | | | - Antonia Pierobon
- Istituti Clinici Scientifici Maugeri IRCCS Montescano, Montescano, Italy
| | - Alessandra Gorini
- Istituti Clinici Scientifici Maugeri IRCCS Milano, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Luca Valenti
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Fisiopatologia e Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Livio Luzi
- IRCCS Multimedica, Milan, Italy
- Department of Health and Biomedical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Annarosa Racca
- Federfarma Lombardia & Fondazione Guido Muralti, Milan, Italy
| | - Manuela Bandi
- Federfarma Lombardia & Fondazione Guido Muralti, Milan, Italy
| | - Elena Tremoli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
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11
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Colombo C, Ceruti D, De Leo S, Bilo G, Trevisan M, Giancola N, Moneta C, Parati G, Persani L, Fugazzola L. Management of hypertension during lenvatinib for advanced thyroid cancer: a suggested diagnostic and therapeutic algorithm. Eur Thyroid J 2023; 12:e230047. [PMID: 37097040 PMCID: PMC10308446 DOI: 10.1530/etj-23-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 04/26/2023] Open
Abstract
Background Hypertension (HTN) is the most frequent adverse event during treatment with lenvatinib (LEN), but data on its best management are limited. Aim The objective of this study was to assess incidence, features and best management of LEN-related HTN in a consecutive single tertiary-care centre cohort. Methods Twenty-nine patients were followed up for a mean time of 29.8 months (6-77 months). Results After a mean follow-up of 6.8 months, HTN was recorded in 76% of cases, as a de novo occurrence in half of them. HTN significantly correlated with LEN dose and was of grade 1, grade 2 and grade 3 in 5%, 50% and 45% of patients, respectively. The majority (77%) of patients with HTN developed proteinuria. There was no correlation between HTN and proteinuria or clinical features or best morphological response or any other adverse event (AE), with the exception of diarrhoea. Patients with or without pre-existing HTN or any other cardiovascular disease had a similar incidence of HTN during LEN, thus excluding the impact of this potential predisposing factor. After evaluation by a dedicated cardiologist, medical treatment was introduced in 21/22 patients (polytherapy in 20 of them). The most frequently used drugs were calcium channel blockers (CCBs) due to their effect on vasodilation. In case of poor control, CCBs were associated with one or more anti-hypertensive drug. Conclusion HTN is a frequent and early AE in patients on LEN treatment. We suggest a diagnostic and therapeutic algorithm to be applied in clinical practice to allow efficient HTN control and improve patient compliance, reducing LEN discontinuation.
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Affiliation(s)
- Carla Colombo
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Daniele Ceruti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Simone De Leo
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Trevisan
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Noemi Giancola
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Claudia Moneta
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Luca Persani
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Laura Fugazzola
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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12
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Parati G, Bilo G, Kollias A, Pengo M, Ochoa JE, Castiglioni P, Stergiou GS, Mancia G, Asayama K, Asmar R, Avolio A, Caiani EG, De La Sierra A, Dolan E, Grillo A, Guzik P, Hoshide S, Head GA, Imai Y, Juhanoja E, Kahan T, Kario K, Kotsis V, Kreutz R, Kyriakoulis KG, Li Y, Manios E, Mihailidou AS, Modesti PA, Omboni S, Palatini P, Persu A, Protogerou AD, Saladini F, Salvi P, Sarafidis P, Torlasco C, Veglio F, Vlachopoulos C, Zhang Y. Blood pressure variability: methodological aspects, clinical relevance and practical indications for management - a European Society of Hypertension position paper ∗. J Hypertens 2023; 41:527-544. [PMID: 36723481 DOI: 10.1097/hjh.0000000000003363] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [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: 02/02/2023]
Abstract
Blood pressure is not a static parameter, but rather undergoes continuous fluctuations over time, as a result of the interaction between environmental and behavioural factors on one side and intrinsic cardiovascular regulatory mechanisms on the other side. Increased blood pressure variability (BPV) may indicate an impaired cardiovascular regulation and may represent a cardiovascular risk factor itself, having been associated with increased all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia incidence. Nonetheless, BPV was considered only a research issue in previous hypertension management guidelines, because the available evidence on its clinical relevance presents several gaps and is based on heterogeneous studies with limited standardization of methods for BPV assessment. The aim of this position paper, with contributions from members of the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability and from a number of international experts, is to summarize the available evidence in the field of BPV assessment methodology and clinical applications and to provide practical indications on how to measure and interpret BPV in research and clinical settings based on currently available data. Pending issues and clinical and methodological recommendations supported by available evidence are also reported. The information provided by this paper should contribute to a better standardization of future studies on BPV, but should also provide clinicians with some indications on how BPV can be managed based on currently available data.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Paolo Castiglioni
- IRCCS Fondazione Don Carlo Gnocchi, Milan
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | | | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Sciences, University of Leuven, and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Enrico G Caiani
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Italy
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Andrea Grillo
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy
| | - Przemysław Guzik
- Department of Cardiology -Intensive Therapy, University School of Medicine in Poznan, Poznan, Poland
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Geoffrey A Head
- Baker Heart and Diabetes Institute, Melbourne Victoria Australia
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Eeva Juhanoja
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Turku
- Department of Oncology; Division of Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Thomas Kahan
- Karolinska Institute, Department of Clinical Sciences, Division of Cardiovascular Medicine, Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | | | | | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Yan Li
- Department of Cardiovascular Medicine, Shanghai Key Laboratory of Hypertension and Medical Genomics, National Research Centre for Translational Medicine
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital Athens, Greece
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paolo Palatini
- Department of Medicine. University of Padova, Padua, Italy
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Athanasios D Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Francesca Saladini
- Department of Medicine. University of Padova, Padua, Italy
- Cardiology Unit, Cittadella Town Hospital, Padova, Italy
| | - Paolo Salvi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, Milan
| | - Franco Veglio
- Internal Medicine Division and Hypertension Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit, 1 Department of Cardiology, Medical School, National & Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Yuqing Zhang
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cattazzo F, Pengo MF, Giontella A, Soranna D, Bilo G, Zambon A, Karalliedde J, Gnudi L, Martinez-Garcia MÁ, Minuz P, Lombardi C, Parati G, Fava C. Effect of Continuous Positive Airway Pressure on Glucose and Lipid Profiles in Patients With Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Arch Bronconeumol 2023:S0300-2896(23)00111-4. [PMID: 37024342 DOI: 10.1016/j.arbres.2023.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND AIM Continuous Positive Airway Pressure (CPAP) is the most effective therapy for symptomatic obstructive sleep apnoea (OSA). However, uncertainty remains about the effectiveness of CPAP in improving OSA-related metabolic dysregulation. This meta-analysis of randomized controlled trials (RCTs) aimed to investigate whether CPAP, compared to other control treatments, could improve glucose or lipid metabolism in OSA patients. METHODS Relevant articles were searched in three different databases (MEDLINE, EMBASE and Web of Science) from inception to 6th Feb 2022 through specific search terms and selection criteria. RESULTS From a total of 5553 articles, 31 RCTs were included. CPAP modestly improved insulin sensitivity as determined by mean fasting plasma insulin and Homeostasis Model Assessment of Insulin Resistance reduction of 1.33mU/L and 0.287, respectively. In subgroup analyses pre-diabetic/type 2 diabetic patients as well as those with sleepy OSA showed a greater response to CPAP. Regarding lipid metabolism, CPAP was associated with a mean total cholesterol reduction of 0.064mmol/L. In subgroup analyses, the benefit was higher in patients that showed more severe OSA and oxygen desaturations at the baseline sleep study as well as in younger and obese subjects. Neither glycated haemoglobin nor triglycerides, HDL- and LDL-cholesterol were reduced by CPAP. CONCLUSION CPAP treatment may improve insulin sensitivity and total cholesterol levels in OSA patients but with low effect size. Our results suggest that CPAP does not substantially improve metabolic derangements in an unselected OSA population, but the effect may be higher in specific subgroups of OSA patients.
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Affiliation(s)
- Filippo Cattazzo
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy
| | - Martino F Pengo
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alice Giontella
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy
| | - Davide Soranna
- IRCCS, Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Grzegorz Bilo
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- IRCCS, Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Janaka Karalliedde
- School of Cardiovascular Medicine & Sciences, Section Vascular Biology and Inflammation, Unit for Metabolic Medicine, King's College London, London, UK
| | - Luigi Gnudi
- School of Cardiovascular Medicine & Sciences, Section Vascular Biology and Inflammation, Unit for Metabolic Medicine, King's College London, London, UK
| | - Miguel Ángel Martinez-Garcia
- Department of Pneumology, Hospital Universitari i Politècnic la Fe, Valencia, Spain; CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - Pietro Minuz
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy
| | - Carolina Lombardi
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cristiano Fava
- Department of Medicine, University of Verona, Section of General Medicine and Hypertension, Verona, Italy.
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14
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Bilo G, Pengo MF, Parati G. New answers to an old question: how many office blood pressure measurements are needed? Eur J Prev Cardiol 2022; 29:2088-2089. [PMID: 35919941 DOI: 10.1093/eurjpc/zwac158] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Grzegorz Bilo
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Martino F Pengo
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Bilo G, Gatterer H, Torlasco C, Villafuerte FC, Parati G. Editorial: Hypoxia in cardiovascular disease. Front Cardiovasc Med 2022; 9:990013. [PMID: 35990947 PMCID: PMC9389445 DOI: 10.3389/fcvm.2022.990013] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Grzegorz Bilo
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- *Correspondence: Grzegorz Bilo
| | - Hannes Gatterer
- Eurac Research, Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Camilla Torlasco
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Francisco C. Villafuerte
- Laboratorio de Fisiología Comparada/Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gianfranco Parati
- Department of Cardiology, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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16
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Rivasi G, Groppelli A, Brignole M, Soranna D, Zambon A, Bilo G, Pengo M, Sharad B, Hamrefors V, Rafanelli M, Testa GD, Rice C, Kenny RA, Sutton R, Ungar A, Fedorowski A, Parati G. Association between hypotension during 24 h ambulatory blood pressure monitoring and reflex syncope: the SynABPM 1 study. Eur Heart J 2022; 43:3765-3776. [PMID: 35766175 PMCID: PMC9553097 DOI: 10.1093/eurheartj/ehac347] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 04/25/2022] [Accepted: 06/15/2022] [Indexed: 01/06/2023] Open
Abstract
AIMS Diagnostic criteria for ambulatory blood pressure monitoring (ABPM) in patients with suspected reflex syncope are lacking. The study hypothesis was that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ABPM. METHODS AND RESULTS ABPM data from reflex syncope patients and controls, matched by average 24 h SBP, age, sex, and hypertension were compared. Patients with constitutional hypotension, orthostatic hypotension, and predominant cardioinhibition during carotid sinus massage or prolonged electrocardiogram monitoring or competing causes of syncope were excluded. Daytime and nighttime SBP drops (<110, 100, 90, 80 mmHg) were assessed. Findings were validated in an independent sample. In the derivation sample, daytime SBP drops were significantly more common in 158 syncope patients than 329 controls. One or more daytime drops <90 mmHg achieved 91% specificity and 32% sensitivity [odds ratio (OR) 4.6, P < 0.001]. Two or more daytime drops <100 mmHg achieved 84% specificity and 40% sensitivity (OR 3.5, P = 0.001). Results were confirmed in the validation sample of 164 syncope patients and 164 controls: one or more daytime SBP drops <90 mmHg achieved 94% specificity and 29% sensitivity (OR 6.2, P < 0.001), while two or more daytime SBP drops <100 mmHg achieved 83% specificity and 35% sensitivity (OR 2.6, P < 0.001). CONCLUSION SBP drops during ABPM are more common in reflex syncope patients than in controls. Cut-off values that may be applied in clinical practice are defined. This study expands the current indications for ABPM to patients with reflex syncope.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Antonella Groppelli
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Michele Brignole
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, 20149 Milan, Italy
| | - Antonella Zambon
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, 20149 Milan, Italy.,Department of Statistics and quantitative methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Grzegorz Bilo
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Martino Pengo
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
| | - Bashaaer Sharad
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden
| | - Martina Rafanelli
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Ciara Rice
- Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland
| | - Rose Anne Kenny
- Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St James's Hospital, Dublin 8, Ireland.,Department of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
| | - Richard Sutton
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden.,Department of Cardiology, National Heart & Lung Institute, Imperial College, Hammersmith Hospital Campus, London W12 0HS, UK
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, and Skåne University Hospital, 50332 Malmö, Sweden.,Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, 171 77 Stockholm, Sweden
| | - Gianfranco Parati
- IRCCS, Istituto Auxologico Italiano, Cardiology Unit and Department of Cardiology, S.Luca Hospital, 20149 Milan, Italy
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17
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Gruszka K, Drożdż T, Wojciechowska W, Jankowski P, Terlecki M, Bijak M, Hering D, Bilo G, Drożdż D, Rajzer M. Effects of uric acid-lowering therapy in patients with essential arterial hypertension. Blood Press Monit 2022; 27:152-160. [PMID: 35120026 DOI: 10.1097/mbp.0000000000000578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/25/2022]
Abstract
OBJECTIVES Asymptomatic hyperuricemia (AHU) is elevated serum uric acid (UA) without symptoms. This study aimed to determine the effects of AHU treatment with allopurinol on selected hypertension-mediated organ damage (HMOD) indices in patients with uncomplicated essential arterial hypertension (AH). METHODS Patients aged 30-70 years with AHU and AH grade 1-2 with adequate blood pressure (BP) control, without previous urate-lowering therapy (ULT), were divided into two groups: (a) ULT (receiving allopurinol) and (b) control (age- and sex-matched patients without ULT). Both received a UA-lowering diet. BP (office, 24 h and central), echocardiographic parameters, carotid intima-media thickness (IMT) and lab tests [high-sensitivity C-reactive protein (hs-CRP)] were measured at baseline and at 6 months follow-up. RESULTS Of 100 participants, 87 (44 ULT, 43 controls) completed the study. At 6 months follow-up, there was a greater reduction in serum UA concentration in the ULT group than in the control group. Patients receiving allopurinol had significant reductions in office systolic and diastolic BP, central systolic BP, pulse pressure, IMT (0.773 ± 0.121 vs. 0.752 ± 0.13 mm, P = 0.044) and hs-CRP (3.36 ± 2.73 vs. 2.74 ± 1.91 mg/L, P = 0.028) compared to controls. Multivariate regression analysis revealed the independent relationship between reduction in IMT and UA lowering (P < 0.026). CONCLUSION In patients with AH and AHU, treatment with allopurinol leads to improvement in BP control and reduction in HMOD intensity, in particular IMT. The decrease in hs-CRP concentration associated with ULT may have a beneficial effect on a patient's long-term prognosis.
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Affiliation(s)
- Krystian Gruszka
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Tomasz Drożdż
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Wiktoria Wojciechowska
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Piotr Jankowski
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Michał Terlecki
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Magdalena Bijak
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Dorota Drożdż
- Jagiellonian University Medical College, Department of Pediatric Nephrology and Hypertension, Krakow, Poland
| | - Marek Rajzer
- Jagiellonian University Medical College, 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Krakow
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18
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Lang M, Mendt S, Paéz V, Gunga HC, Bilo G, Merati G, Parati G, Maggioni MA. Cardiac Autonomic Modulation and Response to Sub-Maximal Exercise in Chilean Hypertensive Miners. Front Physiol 2022; 13:846891. [PMID: 35492599 PMCID: PMC9043845 DOI: 10.3389/fphys.2022.846891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/11/2022] [Indexed: 11/15/2022] Open
Abstract
Cardiac autonomic modulation in workers exposed to chronic intermittent hypoxia (CIH) has been poorly studied, especially considering hypertensive ones. Heart rate variability (HRV) has been proven as valuable tool to assess cardiac autonomic modulation under different conditions. The aim of this study is to investigate the cardiac autonomic response related to submaximal exercise (i.e., six-minute walk test, 6MWT) in hypertensive (HT, n = 9) and non-hypertensive (NT, n = 10) workers exposed for > 2 years to CIH. Participants worked on 7-on 7-off days shift between high altitude (HA: > 4.200 m asl) and sea level (SL: < 500 m asl). Data were recorded with electrocardiography (ECG) at morning upon awakening (10 min supine, baseline), then at rest before and after (5 min sitting, pre and post) the 6MWT, performed respectively on the first day of their work shift at HA, and after the second day of SL sojourn. Heart rate was higher at HA in both groups for each measurement (p < 0.01). Parasympathetic indices of HRV were lower in both groups at HA, either in time domain (RMSSD, p < 0.01) and in frequency domain (log HF, p < 0.01), independently from measurement's time. HRV indices in non-linear domain supported the decrease of vagal tone at HA and showed a reduced signal's complexity. ECG derived respiration frequency (EDR) was higher at HA in both groups (p < 0.01) with interaction group x altitude (p = 0.012), i.e., higher EDR in HT with respect to NT. No significant difference was found in 6MWT distance regarding altitude for both groups, whereas HT covered a shorter 6MWT distance compared to NT (p < 0.05), both at HA and SL. Besides, conventional arm-cuff blood pressure and oxygen blood saturation values (recorded before, at the end and after 5-min recovery from 6MWT), reported differences related to HA only. HA is the main factor affecting cardiac autonomic modulation, independently from hypertension. However, presence of hypertension was associated with a reduced physical performance independently from altitude, and with higher respiratory frequency at HA.
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Affiliation(s)
- Morin Lang
- Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
- Network for Extreme Environment Research (NEXER), University of Antofagasta, Antofagasta, Chile
| | - Stefan Mendt
- Charité—Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Valeria Paéz
- Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
| | - Hanns-Christian, Gunga
- Charité—Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Grzegorz Bilo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giampiero Merati
- Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
- IRCCS Don C. Gnocchi Foundation, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Martina Anna Maggioni
- Charité—Universitätsmedizin Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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19
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Parati G, Stergiou GS, Bilo G, Kollias A, Pengo M, Ochoa JE, Agarwal R, Asayama K, Asmar R, Burnier M, De La Sierra A, Giannattasio C, Gosse P, Head G, Hoshide S, Imai Y, Kario K, Li Y, Manios E, Mant J, McManus RJ, Mengden T, Mihailidou AS, Muntner P, Myers M, Niiranen T, Ntineri A, O’Brien E, Octavio JA, Ohkubo T, Omboni S, Padfield P, Palatini P, Pellegrini D, Postel-Vinay N, Ramirez AJ, Sharman JE, Shennan A, Silva E, Topouchian J, Torlasco C, Wang JG, Weber MA, Whelton PK, White WB, Mancia G. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension. J Hypertens 2021; 39:1742-1767. [PMID: 34269334 PMCID: PMC9904446 DOI: 10.1097/hjh.0000000000002922] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Cristina Giannattasio
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Cardiology IV, ‘A. De Gasperis” Department, ASTT GOM Niguarda Ca’ Granda
| | - Philippe Gosse
- Cardiology/Hypertension Unit Saint André Hospital. University Hospital of Borfeaux, France
| | - Geoffrey Head
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yan Li
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Mengden
- Kerckhoff Clinic, Rehabilitation, ESH Excellence Centre, Bad Nauheim, Germany
| | - Anastasia S. Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Paul Muntner
- Hypertension Research Center, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Myers
- Schulich Heart Program, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Teemu Niiranen
- Department of Medicine, Turku University Hospital and University of Turku
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - José Andres Octavio
- Experimental Cardiology, Department of Tropical Medicine Institute, Universidad Central de Venezuela, Venezuela
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paul Padfield
- Department of Medical Sciences, University of Edinburgh, Edinburgh, UK
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua
| | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Agustin J. Ramirez
- Arterial Hypertension and Metabolic Unit, University Hospital, Fundacion Favaloro, Argentina
| | - James E. Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, FoLSM, Kings College London, UK
| | - Egle Silva
- Research Institute of Cardiovascular Diseases of the University of Zulia, Venezuelan Foundation of Arterial Hypertension. Maracaibo, Venezuela
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Paris-Descartes University, AP-HP, Hotel Dieu, Paris, France
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Ji Guang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael A. Weber
- Division of Cardiovascular Medicine, Downstate College of Medicine, State University of New York, Brooklyn, New York, USA
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, Lousiana
| | - William B. White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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20
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Lang M, Paéz V, Maj G, Silva-Urra J, Labarca-Valenzuela C, Caravita S, Faini A, Cantuarias J, Perez O, Bilo G, Parati G. Blood Pressure Response in Miners Exposed to Chronic Intermittent Hypoxia in Chile. Front Cardiovasc Med 2021; 8:701961. [PMID: 34458335 PMCID: PMC8387657 DOI: 10.3389/fcvm.2021.701961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/28/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction: Limited information is available on blood pressure (BP) behavior in workers exposed to chronic intermittent hypoxia (CIH), and even less is known regarding effects of CIH on 24-h ambulatory BP in those affected by arterial hypertension at sea level (SL). The aims of this study were to assess clinic and 24-h ambulatory BP at SL and at high altitude (HA; 3,870 m above SL) in workers exposed to CIH, and to compare BP response to HA exposure between normotensive and hypertensive workers. Methods: Nineteen normotensive and 18 pharmacologically treated hypertensive miners acclimatized to CIH were included, whose work was organized according to a “7 days-on−7 days-off” shift pattern between SL and HA. All measurements were performed on the second and seventh day of their HA shift and after the second day of SL sojourn. Results: Compared to SL, 24-h systolic BP (SBP) and diastolic BP (DBP) increased at HA [+14.7 ± 12.6 mmHg (p < 0.001) and +8.7 ± 7.2 mmHg (p < 0.001), respectively], and SBP nocturnal fall decreased consistently (−4.1 ± 9.8%; p < 0.05) in all participants, with hypertensives showing higher nocturnal DBP than normotensives (p < 0.05) despite the current therapy. Also, heart rate (HR) nocturnal fall tended to be reduced at HA. In addition, the 24-h SBP/DBP hypertension threshold of ≥130/80 mmHg was exceeded by 39% of workers at SL and by 89% at HA. Clinic HR, SBP, and DBP were significantly higher on the second day of work at HA compared with SL, the increase being more pronounced for SBP in hypertensives (p < 0.05) and accompanied by, on average, mild altitude sickness in both groups. These symptoms and the values of all cardiovascular variables decreased on the seventh day at HA (p < 0.05) regardless of CIH exposure duration. Conclusion: Long history of work at HA according to scheduled CIH did not prevent the occurrence of acute cardiovascular changes at HA during the first days of exposure. The BP response to HA tended to be more pronounced in hypertensive than in normotensive workers despite being already treated; the BP changes were more evident for 24-h ambulatory BP. Twenty-four-hour ABP monitoring is a useful tool for an appropriate evaluation of BP in CIH workers.
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Affiliation(s)
- Morin Lang
- Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
| | - Valeria Paéz
- Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
| | - Giacomo Maj
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Juan Silva-Urra
- Biomedical Department, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile
| | | | - Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Oscar Perez
- Compañia Minera Doña Inés de Collahuasi, Iquique, Chile
| | - Grzegorz Bilo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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21
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Kreutz R, Dobrowolski P, Prejbisz A, Algharably EAEH, Bilo G, Creutzig F, Grassi G, Kotsis V, Lovic D, Lurbe E, Modesti PA, Pappaccogli M, Parati G, Persu A, Polonia J, Rajzer M, de Timary P, Weber T, Weisser B, Tsioufis K, Mancia G, Januszewicz A. Lifestyle, psychological, socioeconomic and environmental factors and their impact on hypertension during the coronavirus disease 2019 pandemic. J Hypertens 2021; 39:1077-1089. [PMID: 33395152 DOI: 10.1097/hjh.0000000000002770] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 02/07/2023]
Abstract
SUMMARY The coronavirus disease 2019 (COVID-19) pandemic considerably affects health, wellbeing, social, economic and other aspects of daily life. The impact of COVID-19 on blood pressure (BP) control and hypertension remains insufficiently explored. We therefore provide a comprehensive review of the potential changes in lifestyle factors and behaviours as well as environmental changes likely to influence BP control and cardiovascular risk during the pandemic. This includes the impact on physical activity, dietary patterns, alcohol consumption and the resulting consequences, for example increases in body weight. Other risk factors for increases in BP and cardiovascular risk such as smoking, emotional/psychologic stress, changes in sleep patterns and diurnal rhythms may also exhibit significant changes in addition to novel factors such as air pollution and environmental noise. We also highlight potential preventive measures to improve BP control because hypertension is the leading preventable risk factor for worldwide health during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Engi A E-H Algharably
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Felix Creutzig
- Mercator Research Institute on Global Commons and Climate Change
- Technical University Berlin, Berlin, Germany
| | - Guido Grassi
- Clinica Medica, University Milano Bicocca, Milan, Italy
| | - Vasilios Kotsis
- 3rd Department of Internal Medicine Aristotle University Thessaloniki, Hypertension-24 h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, Thessaloniki, Greece
| | - Dragan Lovic
- Cardiology Department, Clinic for Internal Disease Intermedica, Singidunum University, School of Medicine, Nis, Serbia
| | - Empar Lurbe
- Pediatric Department, Consorcio Hospital General, University of Valencia
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Valencia, Spain
| | - Pietro A Modesti
- Department of Experimental and Clinical Medicine, Universita' degli Studi di Firenze, School of Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze
| | - Marco Pappaccogli
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jorge Polonia
- Department of Medicine and CINTESIS, Faculty of Medicine, Porto University, Porto, Portugal
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension Jagiellonian University Medical College, Kraków, Poland
| | - Philippe de Timary
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc and Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Giuseppe Mancia
- Università Milano-Bicocca, Milan
- Policlinico di Monza, Monza, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
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22
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Lang M, Bilo G, Caravita S, Parati G. [Blood pressure and high altitude: physiological response and clinical management]. Medwave 2021; 21:e8194. [PMID: 34037579 DOI: 10.5867/medwave.2021.04.8194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/11/2020] [Accepted: 04/19/2021] [Indexed: 11/27/2022] Open
Abstract
High altitude is an extreme environment that challenges human beings exposed because of work, recreational activities, or habitat. Exposure to hypobaric hypoxia results in physiological adaptations in response to the geography and the associated extreme environmental conditions. These acclimatization responses can be diverse and result from evolutionary changes and comorbidities. In this context, this review aims to identify the available evidence on the effects of high altitude on blood pressurefrom the physiological to clinical aspects at rest and during exerciseand the underlying mechanisms and possible clinical implications of acute and chronic intermittent hypoxia.
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Affiliation(s)
- Morin Lang
- Department of Rehabilitation Sciences and Human Movement, Faculty of Health Sciences, University of Antofagasta, Antofagasta, Chile. Address: Avenida Angamos 601, Antofagasta, Chile. . ORCID: 0000-0002-8465-5471
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ORCID: 0000-0002-5104-9176
| | - Sergio Caravita
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine, Italy. ORCID: 0000-0002-3003-6499
| | - Gianfranco Parati
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ORCID: 0000-0001-9402-7439
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23
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Pengo M, Albini F, Guglielmi G, Mollica C, Soranna D, Zambra G, Zambon A, Bilo G, Parati G. Home blood pressure during COVID-19 related lockdown in patients with hypertension. Eur J Prev Cardiol 2021. [PMCID: PMC8227353 DOI: 10.1093/eurjpc/zwab061.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Funding Acknowledgements Type of funding sources: None. Abstract COVID-19 pandemic has induced governments to promote strict containment measures which
inevitably altered patients’ lifestyle with potential effects on blood pressure (BP)
control. We aimed to evaluate the changes in home BP (HBP) during the COVID-19 related
lockdown in a cohort of hypertensive patients. Consecutive adult patients with arterial hypertension and stable medical treatment were
recruited. HBP values were recorded before and after lockdown in March 2020. An
additional set of HBP measurements, recorded one year before the pre-lockdown period,
were also considered as reference because of similar environmental temperature. A total of 126 patients were included: 47% males, mean age 66 [58-72], reference HBP
124.78 (9.90)/76.19 (8.10) mmHg. In the whole group, patients during lockdown exhibited
lower systolic and diastolic HBP values compared to the pre-lockdown period [123.23 vs
125.05 mmHg, p = 0.008 and 74.45 vs 75.28 mmHg, p = 0.023, respectively]. Patients with
uncontrolled HBP showed the most consistent drop of systolic HBP [136.06 (8.36) and
138.0 (2.08) vs 130 (9.35) p = 0.001 and p < 0.001] and diastolic [81.30 (6.75) and
84.9 (1.85) vs 78.78 (9.25), p = 0.018 and p = 0.002] from pre-lockdown to lockdown and
when considering reference values taken one year before, respectively. (Figure 1: Mean
values at baseline, pre-lockdown and during lockdown in the 3 groups for systolic (A)
and diastolic (B) blood pressure (dotted line = uncontrolled BP group, solid
line = unstable BP control, dashed line = controlled BP group). *p<.001 (one year
before lockdown vs lockdown SBP), #p = 0.001 (pre-lockdown vs lockdown SBP), $p = 0.002
(one year before lockdown vs lockdown DBP), §p = 0.018 (pre-lockdown vs lockdown DBP).
Grey box refers to the lockdown period. SBP = systolic blood pressure, DBP = diastolic
blood pressure.) In conclusion, this study reports for the first time the occurrence of no changes or
even a reduction in home BP of treated hypertensive patients during lockdown due to
COVID-19. These results may have implications for the management of patients with high
blood pressure not only during the current pandemic but also in case of future lockdown
conditions. Abstract Figure 1 ![]()
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Affiliation(s)
- M Pengo
- Ospedale St. Luca - Istituto Auxologico Italiano, Milan, Italy
| | - F Albini
- Ospedale St. Luca - Istituto Auxologico Italiano, Milan, Italy
| | - G Guglielmi
- Ospedale St. Luca - Istituto Auxologico Italiano, Milan, Italy
| | - C Mollica
- Ospedale St. Luca - Istituto Auxologico Italiano, Milan, Italy
| | - D Soranna
- Ospedale St. Luca - Istituto Auxologico Italiano, Milan, Italy
| | - G Zambra
- Ospedale St. Luca - Istituto Auxologico Italiano, Milan, Italy
| | - A Zambon
- University of Milan-Bicocca, Milan, Italy
| | - G Bilo
- University of Milan-Bicocca, Milan, Italy
| | - G Parati
- University of Milan-Bicocca, Milan, Italy
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24
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Maiolino G, Bisogni V, Soranna D, Pengo MF, Pucci G, Vettor R, Fava C, Colussi GL, Bilo G, Lombardi C, Parati G, Rossi GP, Silvani A. Effects of insomnia and restless legs syndrome on sleep arterial blood pressure: A systematic review and meta-analysis. Sleep Med Rev 2021; 59:101497. [PMID: 34044356 DOI: 10.1016/j.smrv.2021.101497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Hypertension and blunted blood pressure (BP) dipping during nighttime sleep are associated with increased cardiovascular risk. Chronic insomnia and restless legs syndrome (RLS) may affect the 24-h BP profile. We systematically reviewed the association of insomnia and RLS with BP values during nighttime sleep and the relative BP dipping pattern. We searched relevant articles in any language with selection criteria including enrolment of subjects with insomnia or RLS and with obstructive sleep apnea comorbidity assessment. Of the 872 studies originally retrieved, seven were selected. Four studies enrolled subjects with insomnia. One study relied on sleep diaries to classify nighttime sleep BP, whereas three relied only on clock time. At meta-analysis, subjects with insomnia displayed an attenuated dipping of systolic BP (-2.00%; 95% confidence interval (CI): -3.61 - -0.39%) and diastolic BP (-1.58%; 95% CI: -2.66 ̶ -0.49%) during nighttime sleep compared to controls. Three studies enrolled subjects with RLS. One study relied on polysomnography to classify nighttime sleep BP, whereas two relied only on clock time. Subjects with RLS showed increases in nighttime sleep systolic BP (5.61 mm Hg, 95% CI 0.13̶-11.09 mm Hg) compared to controls. In conclusion, the limited available data suggest that insomnia and RLS are both associated with altered BP control during nighttime sleep. There is need for more clinical studies to confirm these findings, specifically focusing on measurements of BP during objectively defined sleep, on causal roles of leg movements during sleep and alterations in sleep architecture, and on implications for cardiovascular risk. PROSPERO ACKNOWLEDGEMENT OF NUMBER: CRD42020217947.
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Affiliation(s)
- Giuseppe Maiolino
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Valeria Bisogni
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistic Unit, Milan, Italy
| | - Martino F Pengo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy.
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University of Padova, Italy
| | - Cristiano Fava
- Section of General Medicine and Hypertension, Dept of Medicine, University of Verona, Verona, Italy
| | | | - Grzegorz Bilo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carolina Lombardi
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gian Paolo Rossi
- Hypertension Clinic, Department of Medicine - DIMED, University of Padova, Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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25
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Czepiel J, Rajzer M, Bilo G, Parati G, BIesiada G, Cibor D, Pitera E, Wołkow P, Michalak M, Garlicki A. The Association Between Chronic Hepatitis B, Chronic Hepatitis C, Sustained Liver Damage, and Features of Increased Cardiovascular Risk. Folia Biol (Praha) 2021. [DOI: 10.3409/fb_69-1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It is thought that chronic liver disease affects a person's risk of cardiovascular disease (CVD) development. The aim of this study was to assess the effect of Chronic Hepatitis B (HBV) infection, Chronic Hepatitis C (HCV) infection, and liver damage on cardiovascular risk and selected
vascular parameters contributing to CVD risk. This case-control study included a group of 114 patients composed of 34 patients with HBV, 35 patients with HCV, and 45 patients as the control group. Cardiovascular risk was assessed by analyzing classic risk factors, and the SCORE system. The
following arterial properties were analyzed using applanation tonometry with SphygmoCor Vx technology: central systolic blood pressure (cSBP), central pulse pressure, augmentation pressure, augmentation index, and carotid-femoral pulse wave velocity (PWV). Asymmetric dimethyloarginine (ADMA)
blood levels were analyzed using ELISA as a marker of vascular function. In a univariable analysis we found no significant differences between the hepatitis B, hepatitis C, and control groups in terms of PWV (respectively: median 7.2 [Q25-Q75 6.4-8.5], 7.3 [6.9-8.7], 7.8 [6.5-8.9]), cSBP (115
[109-126], 118 [107-123], 116 [107-129]), ADMA (0.52 [0.47-0.60], 0.53 [0.45-0.62], 0.58 [0.51-0.63]), SCORE (0 [0-1], 0 [0-2], 0 [0-2]). No significant differences in cardiovascular variables were observed between cirrhotic and non-cirrhotic patients. A multivariable analysis confirmed the
above findings. (PWV, p=0 . 29; cSBP, p=0.26; ADMA, p=0.19). We concluded that chronic hepatitis B or C was not independently associated with an adverse cardiovascular risk profile nor with an unfavorable pattern of vascular parameters contributing to CVD risk in our study population, even
in the case of liver cirrhosis. The same was true for blood ADMA levels.
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26
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Pengo MF, Albini F, Guglielmi G, Mollica C, Soranna D, Zambra G, Zambon A, Bilo G, Parati G. Home blood pressure during COVID-19-related lockdown in patients with hypertension. Eur J Prev Cardiol 2021; 29:e94-e96. [PMID: 33899916 PMCID: PMC8135487 DOI: 10.1093/eurjpc/zwab010] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/23/2020] [Accepted: 01/11/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Martino F Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy
| | | | - Giulia Guglielmi
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy
| | - Chiara Mollica
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy
| | - Davide Soranna
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Gaia Zambra
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Antonella Zambon
- IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy.,Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, 20149, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
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27
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Parati G, Lombardi C, Pengo M, Bilo G, Ochoa JE. Current challenges for hypertension management: From better hypertension diagnosis to improved patients' adherence and blood pressure control. Int J Cardiol 2021; 331:262-269. [PMID: 33548384 DOI: 10.1016/j.ijcard.2021.01.070] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/09/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
Hypertension control still remains a largely unmet challenge for public health systems. Despite the progress in blood pressure (BP) measurement techniques, and the availability of effective and safe antihypertensive drugs, a large number of hypertensive patients are not properly identified, and a significant proportion of those who receive antihypertensive treatment fail to achieve satisfactory control of their BP levels. It is thus not surprising that hypertension is still a major contributor to disease burden and disability worlwide, even in developed countries. This paper will address current challenges in hypertension management and potential strategies for an improvement in this field. In its first part relevant issues related to hypertension diagnosis will be addressed, in particular how to improve identification of sustained BP elevation and specific BP phenotypes such as white coat and masked hypertension trough the combined use of office and out-of-office BP monitoring techniques. In its second part focus will be on how to improve achievement of hypertension control in treated patients by optimization and simplification of medication regimens, including more efficient selection and titration of antihypertensive drugs and their combinations, aimed at achieving a more consistent 24hBP control; and by favoring a more active patients' and physicians' involvement in hypertension management also through BP telemonitoring and mobile health technologies.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Milan, Italy
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28
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Bilo G, Acone L, Anza-Ramírez C, Macarlupú JL, Soranna D, Zambon A, Vizcardo-Galindo G, Pengo MF, Villafuerte FC, Parati G. Office and Ambulatory Arterial Hypertension in Highlanders: HIGHCARE-ANDES Highlanders Study. Hypertension 2020; 76:1962-1970. [PMID: 33175629 DOI: 10.1161/hypertensionaha.120.16010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/14/2022]
Abstract
Millions of people worldwide live at high altitude, being chronically exposed to hypobaric hypoxia. Hypertension is a major cardiovascular risk factor but data on its prevalence and determinants in highlanders are limited, and systematic studies with ambulatory blood pressure monitoring are not available. Aim of this study was to assess the prevalence of clinic and ambulatory hypertension and the associated factors in a sample of Andean highlanders. Hypertension prevalence and phenotypes were assessed with office and ambulatory blood pressure measurement in a sample of adults living in Cerro de Pasco, Peru (altitude 4340 m). Basic clinical data, blood oxygen saturation, hematocrit, and Qinghai Chronic Mountain Sickness score were obtained. Participants were classified according to the presence of excessive erythrocytosis and chronic mountain sickness diagnosis. Data of 289 participants (143 women, 146 men, mean age 38.3 years) were analyzed. Office hypertension was present in 20 (7%) participants, while ambulatory hypertension was found in 58 (20%) participants. Masked hypertension was common (15%), and white coat hypertension was rare (2%). Among participants with ambulatory hypertension, the most prevalent phenotypes included isolated nocturnal hypertension, isolated diastolic hypertension, and systodiastolic hypertension. Ambulatory hypertension was associated with male gender, age, overweight/obesity, 24-hour heart rate, and excessive erythrocytosis. Prevalence of hypertension among Andean highlanders may be significantly underestimated when based on conventional blood pressure measurements, due to the high prevalence of masked hypertension. In highlanders, ambulatory hypertension may be independently associated with excessive erythrocytosis.
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Affiliation(s)
- Grzegorz Bilo
- From the Department of Cardiovascular, Neural and Metabolic Sciences (G.B., M.F.P., G.P.), University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Milan, Italy Department of Medicine and Surgery (G.B., L.A., G.P.), University of Milano-Bicocca, Milan, Italy
| | - Lorenzo Acone
- Istituto Auxologico Italiano, IRCCS, Milan, Italy Department of Medicine and Surgery (G.B., L.A., G.P.), University of Milano-Bicocca, Milan, Italy
| | - Cecilia Anza-Ramírez
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - José Luis Macarlupú
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - Davide Soranna
- Biostatistics Unit (D.S., A.Z.), University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Biostatistics Unit (D.S., A.Z.), University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods (A.Z.), University of Milano-Bicocca, Milan, Italy
| | - Gustavo Vizcardo-Galindo
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - Martino F Pengo
- From the Department of Cardiovascular, Neural and Metabolic Sciences (G.B., M.F.P., G.P.), University of Milano-Bicocca, Milan, Italy
| | - Francisco C Villafuerte
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - Gianfranco Parati
- From the Department of Cardiovascular, Neural and Metabolic Sciences (G.B., M.F.P., G.P.), University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Milan, Italy Department of Medicine and Surgery (G.B., L.A., G.P.), University of Milano-Bicocca, Milan, Italy
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29
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Pengo MF, Soranna D, Giontella A, Perger E, Mattaliano P, Schwarz EI, Lombardi C, Bilo G, Zambon A, Steier J, Parati G, Minuz P, Fava C. Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis. Eur Respir J 2020; 55:13993003.01945-2019. [PMID: 32079643 DOI: 10.1183/13993003.01945-2019] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/06/2020] [Indexed: 11/05/2022]
Abstract
The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of -2.09 (95% CI -2.78- -1.40) mmHg for systolic BP and -1.92 (95% CI -2.40- -1.43) mmHg for diastolic BP and -1.27 (95% CI -2.34- -0.20) mmHg for systolic BP and -1.11 (95% CI -1.82- -0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged <60 years (systolic BP -2.93 mmHg), with uncontrolled BP at baseline (systolic BP -4.14 mmHg) and with severe oxygen desaturations (minimum arterial oxygen saturation measured by pulse oximetry <77%) at baseline (24-h systolic BP -7.57 mmHg).Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of BP control. These findings should be interpreted with caution; however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.
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Affiliation(s)
- Martino F Pengo
- Dept of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Davide Soranna
- Dept of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,These authors are joint co-authors
| | - Alice Giontella
- Section of General Medicine and Hypertension, Dept of Medicine, University of Verona, Verona, Italy.,These authors are joint co-authors
| | - Elisa Perger
- Dept of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Paola Mattaliano
- Dept of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Esther Irene Schwarz
- Dept of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Zurich, Switzerland
| | - Carolina Lombardi
- Dept of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Grzegorz Bilo
- Dept of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Antonella Zambon
- Dept of Statistics and Quantitative Methods, Università di Milano-Bicocca, Milan, Italy
| | - Joerg Steier
- CHAPS, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Gianfranco Parati
- Dept of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Dept of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pietro Minuz
- Section of General Medicine and Hypertension, Dept of Medicine, University of Verona, Verona, Italy
| | - Cristiano Fava
- Section of General Medicine and Hypertension, Dept of Medicine, University of Verona, Verona, Italy
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Torlasco C, Bilo G, Giuliano A, Soranna D, Ravaro S, Oliverio G, Faini A, Zambon A, Lombardi C, Parati G. Effects of acute exposure to moderate altitude on blood pressure and sleep breathing patterns. Int J Cardiol 2020; 301:173-179. [DOI: 10.1016/j.ijcard.2019.09.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/11/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022]
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Parati G, Agostoni P, Basnyat B, Bilo G, Brugger H, Coca A, Festi L, Giardini G, Lironcurti A, Luks AM, Maggiorini M, Modesti PA, Swenson ER, Williams B, Bärtsch P, Torlasco C. Clinical recommendations for high altitude exposure of individuals with pre-existing cardiovascular conditions: A joint statement by the European Society of Cardiology, the Council on Hypertension of the European Society of Cardiology, the European Society of Hypertension, the International Society of Mountain Medicine, the Italian Society of Hypertension and the Italian Society of Mountain Medicine. Eur Heart J 2019; 39:1546-1554. [PMID: 29340578 PMCID: PMC5930248 DOI: 10.1093/eurheartj/ehx720] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 12/15/2017] [Indexed: 01/22/2023] Open
Abstract
Adapted from Bärtsch and Gibbs2 Physiological response to hypoxia. Life-sustaining oxygen delivery, in spite of a reduction in the partial pressure of inhaled oxygen between 25% and 60% (respectively at 2500 m and 8000 m), is ensured by an increase in pulmonary ventilation, an increase in cardiac output by increasing heart rate, changes in vascular tone, as well as an increase in haemoglobin concentration. BP, blood pressure; HR, heart rate; PaCO2, partial pressure of arterial carbon dioxide. ![]()
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Affiliation(s)
- Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Piergiuseppe Agostoni
- Department of Cardiology, Heart Failure Unit, Centro Cardiologico Monzino, via Parea 4, 20138 Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, via Festa del Perdono 7, 20122 Milan, Italy
| | - Buddha Basnyat
- Nuffield Department of Clinical Medicine, Oxford University Clinical Research Unit-Nepal and Centre for Tropical Medicine and Global Health, University of Oxford, Old Road campus, Roosevelt Drive, Headington, Oxford OX3 7FZ, UK
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine at the EURAC Research, viale Druso 1, 39100 Bolzano, Italy.,Medical University, Christoph-Probst-Platz 1, Innrain 52 A - 6020 Innsbruck, Austria
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Luigi Festi
- Surgery Department, Ospedale di Circolo Fondazione Macchi, viale Luigi Borri, 57, 21100 Varese, Italy.,University of Insubria, via Ravasi 2, 21100 Varese, Italy
| | - Guido Giardini
- Department of Neurology, Neurophysiopathology Unit, Valle d'Aosta Regional Hospital, via Ginevra, 3, 11100 Aosta, Italy
| | - Alessandra Lironcurti
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy
| | - Andrew M Luks
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, 98195 WA, USA
| | - Marco Maggiorini
- Medical Intensive Care Unit, University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Pietro A Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134 Florence, Florence, Italy
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, 98195 WA, USA.,Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, 98108 WA, USA
| | - Bryan Williams
- University College London (UCL) and NIHR UCL Hospitals Biomedical Research Centre, NHS Foundation Trust, University College, Gower St, Bloomsbury, London WC1E 6BT, UK
| | - Peter Bärtsch
- Department of Internal Medicine, University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, S. Luca Hospital, Piazzale Brescia, 20, 20149 Milan, Italy
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Bilo G, Dolan E, O'Brien E, Facchetti R, Soranna D, Zambon A, Mancia G, Parati G. The impact of systolic and diastolic blood pressure variability on mortality is age dependent: Data from the Dublin Outcome Study. Eur J Prev Cardiol 2019; 27:355-364. [DOI: 10.1177/2047487319872572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Twenty-four-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but limited and conflicting evidence is available on the relative prognostic importance of systolic and diastolic BPV. The aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 h with cardiovascular mortality in untreated subjects is affected by age. Design and methods The study included 9154 untreated individuals assessed for hypertension between 1982 and 2002 in the frame of the Dublin Outcome Study, in which 24 h ambulatory blood pressure monitoring was obtained (age 54.1 ± 14.3 years, 47% males). The association of short-term systolic and diastolic blood pressure variability with cardiovascular and all-cause mortality in the entire sample and separately in younger and older age subgroups was assessed over a median follow-up period of 6.3 years. Results Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for daytime standard deviation 1.16 (95% confidence interval 1.08–1.26)) with no significant differences among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for daytime standard deviation 1.72 (95% confidence interval 1.33–2.23)), superseding the predictive value of diastolic BPV in this group. Conclusions Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application.
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Affiliation(s)
- Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Eoin O'Brien
- Conway Institute, University College, Dublin, Ireland
| | - Rita Facchetti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Davide Soranna
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Mancia
- University of Milano-Bicocca, Milan, Italy
- Policlinico di Monza, Monza, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Parati G, Ochoa JE, Bilo G. White Coat and Masked Hypertension in Chronic Kidney Disease: Importance of the Difference Between Office and Out-of-Office Blood Pressure Measurements. J Am Heart Assoc 2019; 8:e012299. [PMID: 31014172 PMCID: PMC6512095 DOI: 10.1161/jaha.119.012299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
See Article Ku et al
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Affiliation(s)
- Gianfranco Parati
- 1 Chair of Cardiovascular Medicine Department of Medicine and Surgery University of Milano-Bicocca Milan Italy.,2 Istituto Auxologico Italiano IRCCS Department of Cardiovascular, Neural and Metabolic Sciences S. Luca Hospital Milan Italy
| | - Juan Eugenio Ochoa
- 2 Istituto Auxologico Italiano IRCCS Department of Cardiovascular, Neural and Metabolic Sciences S. Luca Hospital Milan Italy
| | - Grzegorz Bilo
- 1 Chair of Cardiovascular Medicine Department of Medicine and Surgery University of Milano-Bicocca Milan Italy.,2 Istituto Auxologico Italiano IRCCS Department of Cardiovascular, Neural and Metabolic Sciences S. Luca Hospital Milan Italy
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Torlasco C, Faini A, Makil E, Bilo G, Pengo M, Beaney T, Xia X, Borghi C, Poulter NR, Tocci G, Galletti F, Desideri G, Veglio F, Ferri C, Parati G. Nation-wide hypertension screening in Italy: data from May Measurements Month 2017-Europe. Eur Heart J Suppl 2019; 21:D66-D70. [PMID: 31043882 PMCID: PMC6479437 DOI: 10.1093/eurheartj/suz058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2019] [Indexed: 12/20/2022]
Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative organized by the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. A similar approach has been used in Italy since 2012, showing inadequate awareness of the consequences of hypertension, a generally increased cardiovascular risk and unsatisfactory BP control in 36% of interviewed individuals. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017, during the joint MMM and World Hypertension Day events. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screenings were conducted both in cities and villages, indoor and outdoor, by health personnel. Eighty-five sites, involving approximately 300 investigators, took part in MMM17/World Hypertension Day in Italy, screening 10 076 individuals during a month-long period. After multiple imputation, 3099 participants were found (30.8%) to have high BP levels. This was the biggest opportunistic BP screening in a single time-point ever reported in Italy. A significant proportion of individuals had high BP, although it was not possible to differentiate between known treated hypertensive patients with inadequate BP control and as yet undiagnosed hypertensive individuals. Opportunistic screening can reach a significant number of individuals, being a powerful tool for raising awareness and carrying out BP screening.
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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, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, , Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, , Milan, Italy
| | - Elhassan Makil
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, , Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, , Milan, Italy
| | - Martino Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan, Italy
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, UK
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, Council of the Italian Society of Hypertension, University of Bologna, Via Zamboni 33, Bologna, Italy
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, UK
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza" Piazzale Aldo Moro 5, Roma, Italy; Sant'Andrea Hospital, IRCCS Neuromed, Pozzilli (IS), Council of the Italian Society of Hypertension, Rome, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, ESH Excellence Center of Hypertension, "Federico II" University of Naples Medical School, Corso Umberto I 40, Naples, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, piazza Santa Margherita 2, 67100 L'Aquila, Italy; Council of the Italian Society of Hypertension, L'Aquila, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Via Giuseppe Verdi 8, 10124 Turin, Italy; Council of the Italian Society of Hypertension; and
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, piazza Santa Margherita 2, L'Aquila, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Piazzale Brescia 20, Milan, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, , Milan, Italy
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Styczkiewicz K, Spadacini G, Tritto M, Perego GB, Facchini M, Bilo G, Kawecka-Jaszcz K, Czarnecka D, Malfatto G, Parati G. Cardiac autonomic regulation in patients undergoing pulmonary vein isolation for atrial fibrillation. J Cardiovasc Med (Hagerstown) 2019; 20:297-305. [PMID: 30921268 DOI: 10.2459/jcm.0000000000000791] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Ablation procedures for the treatment of atrial fibrillation lead to changes in autonomic heart control; however, there are insufficient data on the possible association of these changes with atrial fibrillation recurrence. The study aim was to assess the effects of pulmonary vein isolation (PVI) on cardiac autonomic modulation and atrial fibrillation recurrence. METHODS We screened 52 patients with atrial fibrillation referred for PVI, of whom 20 patients met inclusion and exclusion criteria, and were enrolled in the study and followed over 6 months. Beat-to-beat blood pressure monitoring was performed 1-2 days before PVI, 1 and 6 months after PVI. We estimated pulse interval variability and spontaneous baroreflex sensitivity (BRS) both in the time and frequency domains, and performed the Valsalva manoeuvre assessing the Valsalva ratio. RESULTS During 6 months after PVI, atrial fibrillation recurrence was observed in six patients. One month after PVI, pulse interval variability and BRS (sequence method) significantly decreased in all patients, returning to preintervention values by 6 months. Patients without atrial fibrillation recurrence at 1 month showed a transient reduction in pulse interval variability (frequency domain) and in BRS (both methods) in contrast to those with atrial fibrillation recurrence. A significant decrease in the Valsalva ratio observed at 1 month was maintained at 6 months after PVI in both groups. CONCLUSION Successful PVI may lead to transient autonomic alterations reflected by a reduction in pulse interval variability and BRS, with more prolonged changes in the Valsalva ratio. The efficacy of PVI in preventing atrial fibrillation recurrence seems to be related to transient parasympathetic atrial denervation.
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Affiliation(s)
- Katarzyna Styczkiewicz
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Giammario Spadacini
- Electrophysiology and Cardiac Pacing Operative Unit, Humanitas Mater Domini Hospital, Castellanza (VA)
| | - Massimo Tritto
- Electrophysiology and Cardiac Pacing Operative Unit, Humanitas Mater Domini Hospital, Castellanza (VA)
| | - Giovanni B Perego
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Mario Facchini
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Grzegorz Bilo
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy
| | - Kalina Kawecka-Jaszcz
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Danuta Czarnecka
- The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Gabriella Malfatto
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Gianfranco Parati
- IRCCS Istituto Auxologico Italiano, Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano- Bicocca, Milan, Italy
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Głuszewska A, Gryglewska B, Gąsowski J, Bilo G, Zarzycki B, Dzieża-Grudnik A, Major P, Budzyński A, Faini A, Parati G, Grodzicki T. Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension. Eur J Intern Med 2019; 60:39-45. [PMID: 30420135 DOI: 10.1016/j.ejim.2018.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/23/2018] [Accepted: 10/25/2018] [Indexed: 12/24/2022]
Abstract
UNLABELLED Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability. AIM To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension. MATERIALS & METHODS A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ± 11.3, BMI = 46.7 ± 5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention. RESULTS Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status. CONCLUSIONS Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension.
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Affiliation(s)
- Anna Głuszewska
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland.
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Grzegorz Bilo
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Bartosz Zarzycki
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Anna Dzieża-Grudnik
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
| | - Piotr Major
- Department of General Surgery, Jagiellonian University, Medical College, Krakow, Poland
| | - Andrzej Budzyński
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Andrea Faini
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, Università di Milano-Bicocca, Milan, Italy
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University, Medical College, Krakow, Poland
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Parati G, Agabiti-Rosei E, Bakris GL, Bilo G, Branzi G, Cecchi F, Chrostowska M, De la Sierra A, Domenech M, Dorobantu M, Faria T, Huo Y, Jelaković B, Kahan T, Konradi A, Laurent S, Li N, Madan K, Mancia G, McManus RJ, Modesti PA, Ochoa JE, Octavio JA, Omboni S, Palatini P, Park JB, Pellegrini D, Perl S, Podoleanu C, Pucci G, Redon J, Renna N, Rhee MY, Rodilla Sala E, Sanchez R, Schmieder R, Soranna D, Stergiou G, Stojanovic M, Tsioufis K, Valsecchi MG, Veglio F, Waisman GD, Wang JG, Wijnmaalen P, Zambon A, Zanchetti A, Zhang Y. MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol. BMJ Open 2018; 8:e021038. [PMID: 30573476 PMCID: PMC6303603 DOI: 10.1136/bmjopen-2017-021038] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. METHODS AND ANALYSIS MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed. ETHICS AND DISSEMINATION MASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER NCT02804074; Pre-results.
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Affiliation(s)
- Gianfranco Parati
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Centro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milan, Milan, Italy
| | - Enrico Agabiti-Rosei
- Department of Medicine, Azienda Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - George L Bakris
- Department of Medicine, University of Chicago, Chicago, USA
- ASH Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and metabolism, Chicago, USA
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giovanna Branzi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Franco Cecchi
- Department of Cardiology, Università di Firenze, Florence, Italy
| | - Marzena Chrostowska
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Alejandro De la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Monica Domenech
- Department of Cardiovascular, Nutrition and Aging, Hospital Clinic of Barcelona, University of Barcelona, Insitut d’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Dorobantu
- Department of Cardiology, Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Thays Faria
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bojan Jelaković
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
- Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Alexandra Konradi
- Hypertension Department, Almazov Federeal North-Werst Medical Research Centre, St.Petersburg, Russian Federation
| | - Stéphane Laurent
- Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 and University Paris Descartes, Paris, France
| | - Nanfang Li
- The Center of Hypertension of the Peoples Hospital, Urumqi, China
| | - Kushal Madan
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Pietro Amedeo Modesti
- Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - José Andrés Octavio
- Fundacion Venezolana de Hipertensión Arterial, Instituto de investigaciones de Enfermedades Cardiovasculares de LUZ, Maracaibo, Venezuela, Bolivarian Republic of
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
| | - Paolo Palatini
- Dipartimento di Medicina DIMED, University of Padova, Padua, Italy
| | | | - Dario Pellegrini
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Sabine Perl
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Cristian Podoleanu
- Department of Cardiology, County Clinical Hospital, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania
| | - Giacomo Pucci
- Department of Medicine, University of Perugia, Perugia, Italy
- Hypertension Clinic, Unit of Internal Medicine, “S.Maria” Hospital, Terni, Italy
| | - Josep Redon
- University of Valencia and INCLIVA Research Institute, Valencia, Spain
- Hypertension Clinic, Hospital Clinico de Valencia, Valencia, Spain
| | - Nicolas Renna
- Department of Cardiology, Hospital Español de Mendoza, Mendoza, Argentina
| | - Moo Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si/Gyeonggi-do, Korea (the Republic of)
| | - Enrique Rodilla Sala
- Department of Hypertension, Hospital de Sagunto and University CEU Cardenal Herrera, Ciencias de la Salud, Valencia, Spain
| | - Ramiro Sanchez
- Metabolic Unit, Hypertension section, Favaloro Foundation, Buenos Aires, Argentina
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Davide Soranna
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Statistics and Quantitative methods, University of Milan-Bicocca, Milan, Italy
| | - George Stergiou
- School of Medicine, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Athens, Greece
- Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Milos Stojanovic
- Excellence Centre for Hypertension, Department of Endocrinology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Maria Grazia Valsecchi
- School of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Milan, Italy
| | - Franco Veglio
- Department of Medical Sciences, Internal Medicine and Hypertension Division, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriel Dario Waisman
- Department of Internal Medicine, Hypertension Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ji Guang Wang
- School of Medicince, The Shanghai Institute of Hypertension, Ruijin Hospital; Shanghai Jiaotong University, Shanghai, China
- Department of Hypertension, Centre For Epidemiological Studies And Clinical Trials, Shanghai Key Laboratory Of Hypertension, Shanghai, China
| | - Paulina Wijnmaalen
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Antonella Zambon
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Statistics and Quantitative methods, University of Milan-Bicocca, Milan, Italy
| | - Alberto Zanchetti
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Yuqing Zhang
- Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical Colleges, Beijing, China
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Parati G, Stergiou GS, Dolan E, Bilo G. Blood pressure variability: clinical relevance and application. J Clin Hypertens (Greenwich) 2018; 20:1133-1137. [DOI: 10.1111/jch.13304] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Gianfranco Parati
- Department of Medicine and Surgery; University of Milano-Bicocca; Milano Italy
- Cardiology Unit and Department of Cardiovascular; Neural and Metabolic Sciences; Istituto Auxologco Italiano; S. Luca Hospital; Milano Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7; School of Medicine; Third Department of Medicine; Sotiria Hospital, National and Kapodistrian University of Athens; Athens Greece
| | - Eamon Dolan
- Stroke and Hypertension Unit; Connolly Hospital; Dublin Ireland
| | - Grzegorz Bilo
- Department of Medicine and Surgery; University of Milano-Bicocca; Milano Italy
- Cardiology Unit and Department of Cardiovascular; Neural and Metabolic Sciences; Istituto Auxologco Italiano; S. Luca Hospital; Milano Italy
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Caravita S, Faini A, Baratto C, Bilo G, Macarlupu JL, Lang M, Revera M, Lombardi C, Villafuerte FC, Agostoni P, Parati G. Upward Shift and Steepening of the Blood Pressure Response to Exercise in Hypertensive Subjects at High Altitude. J Am Heart Assoc 2018; 7:JAHA.117.008506. [PMID: 29886423 PMCID: PMC6220550 DOI: 10.1161/jaha.117.008506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute exposure to high-altitude hypobaric hypoxia induces a blood pressure rise in hypertensive humans, both at rest and during exercise. It is unclear whether this phenomenon reflects specific blood pressure hyperreactivity or rather an upward shift of blood pressure levels. We aimed at evaluating the extent and rate of blood pressure rise during exercise in hypertensive subjects acutely exposed to high altitude, and how these alterations can be counterbalanced by antihypertensive treatment. METHODS AND RESULTS Fifty-five subjects with mild hypertension, double-blindly randomized to placebo or to a fixed-dose combination of an angiotensin-receptor blocker (telmisartan 80 mg) and a calcium-channel blocker (nifedipine slow release 30 mg), performed a cardiopulmonary exercise test at sea level and after the first night's stay at 3260 m altitude. High-altitude exposure caused both an 8 mm Hg upward shift (P<0.01) and a 0.4 mm Hg/mL/kg per minute steepening (P<0.05) of the systolic blood pressure/oxygen consumption relationship during exercise, independent of treatment. Telmisartan/nifedipine did not modify blood pressure reactivity to exercise (blood pressure/oxygen consumption slope), but downward shifted (P<0.001) the relationship between systolic blood pressure and oxygen consumption by 26 mm Hg, both at sea level and at altitude. Muscle oxygen delivery was not influenced by altitude exposure but was higher on telmisartan/nifedipine than on placebo (P<0.01). CONCLUSIONS In hypertensive subjects exposed to high altitude, we observed a hypoxia-driven upward shift and steepening of the blood pressure response to exercise. The effect of the combination of telmisartan/nifedipine slow release outweighed these changes and was associated with better muscle oxygen delivery. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830530.
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Affiliation(s)
- Sergio Caravita
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Baratto
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Josè Luis Macarlupu
- Laboratorio de Fisiologia Comparada, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Morin Lang
- Department de Ciencias de la Rehabilitación y del Movimiento Humano, Universidad de Antofagasta, Chile
| | - Miriam Revera
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carolina Lombardi
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francisco C Villafuerte
- Laboratorio de Fisiologia Comparada, Facultad de Ciencias y Filosofia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital IRCCS Istituto Auxologico Italiano, Milan, Italy .,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Abstract
Morning hours are the period of the day characterized by the highest incidence of major cardiovascular events including myocardial infarction, sudden death or stroke. They are also characterized by important neurohormonal changes, in particular, the activation of sympathetic nervous system which usually leads to a rapid increase in blood pressure (BP), known as morning blood pressure surge (MBPS). It was hypothesized that excessive MBPS may be causally involved in the pathogenesis of cardiovascular events occurring in the morning by inducing hemodynamic stress. A number of studies support an independent relationship of MBPS with organ damage, cerebrovascular complications and mortality, although some heterogeneity exists in the available evidence. This may be due to ethnic differences, methodological issues and the confounding relationship of MBPS with other features of 24-hour BP profile, such as nocturnal dipping or BP variability. Several studies are also available dealing with treatment effects on MBPS and indicating the importance of long-acting antihypertensive drugs in this regard. This paper provides an overview of pathophysiologic, methodological, prognostic and therapeutic aspects related to MBPS.
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Affiliation(s)
- Grzegorz Bilo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Grillo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Valentina Guida
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology Unit, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Corante N, Anza-Ramírez C, Figueroa-Mujíca R, Macarlupú JL, Vizcardo-Galindo G, Bilo G, Parati G, Gamboa JL, León-Velarde F, Villafuerte FC. Excessive Erythrocytosis and Cardiovascular Risk in Andean Highlanders. High Alt Med Biol 2018; 19:221-231. [PMID: 29782186 PMCID: PMC6157350 DOI: 10.1089/ham.2017.0123] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 12/11/2022] Open
Abstract
Corante, Noemí, Cecilia Anza-Ramírez, Rómulo Figueroa-Mujíca, José Luis Macarlupú, Gustavo Vizcardo-Galindo, Grzegorz Bilo, Gianfranco Parati, Jorge L. Gamboa, Fabiola León-Velarde, and Francisco C. Villafuerte. Excessive erythrocytosis and cardiovascular risk in Andean highlanders. High Alt Med Biol. 19:221–231, 2018.—Cardiovascular diseases are the main cause of death worldwide. Life under high-altitude (HA) hypoxic conditions is believed to provide highlanders with a natural protection against cardiovascular and metabolic diseases compared with sea-level inhabitants. However, some HA dwellers become intolerant to chronic hypoxia and develop a progressive incapacitating syndrome known as chronic mountain sickness (CMS), characterized by excessive erythrocytosis (EE; Hb ≥21 g/dL in men, Hb ≥19 g/dL in women). Evidence from HA studies suggests that, in addition to CMS typical signs and symptoms, these highlanders may also suffer from metabolic and cardiovascular disorders. Thus, we hypothesize that this syndrome is also associated to the loss of the cardiometabolic protection observed in healthy highlanders (HH), and therefore to a higher cardiovascular risk (CVR). The aim of the present work was to evaluate the association between EE and CVR calculated using the Framingham General CVR Score and between EE and CVR factors in male highlanders. This cross-sectional study included 342 males from Cerro de Pasco, Peru at 4340 m (HH = 209, CMS = 133). Associations were assessed by multiple logistic regressions adjusted for potential confounders (BMI, pulse oxygen saturation and age). The adjusted models show that the odds of high CVR (>20%) in highlanders with EE was 3.63 times the odds in HH (CI 95%:1.22–10.78; p = 0.020), and that EE is associated to hypertension, elevated fasting serum glucose, insulin resistance, and elevated fasting serum triglycerides. Our results suggest that individuals who suffer from EE are at increased risk of developing cardiovascular events compared with their healthy counterparts.
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Affiliation(s)
- Noemí Corante
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Cecilia Anza-Ramírez
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Rómulo Figueroa-Mujíca
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - José Luis Macarlupú
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Gustavo Vizcardo-Galindo
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Grzegorz Bilo
- 2 Department of Medicine and Surgery, University of Milano-Bicocca , Milano, Italy .,3 Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano , Milano, Italy
| | - Gianfranco Parati
- 2 Department of Medicine and Surgery, University of Milano-Bicocca , Milano, Italy .,3 Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano , Milano, Italy
| | - Jorge L Gamboa
- 4 Division of Clinical Pharmacology, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Fabiola León-Velarde
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Francisco C Villafuerte
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
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Stergiou GS, Palatini P, Asmar R, Bilo G, de la Sierra A, Head G, Kario K, Mihailidou A, Wang J, Mancia G, O’Brien E, Parati G. Blood pressure monitoring. Blood Press Monit 2018; 23:1-8. [DOI: 10.1097/mbp.0000000000000301] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Affiliation(s)
- Anastasios Kollias
- From the Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan; and Department of Medicine and Surgery, University of Milano-Bicocca, Italy (A.K., G.B., G.P.); and Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (A.K., G.S.S., K.G.K.)
| | - George S. Stergiou
- From the Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan; and Department of Medicine and Surgery, University of Milano-Bicocca, Italy (A.K., G.B., G.P.); and Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (A.K., G.S.S., K.G.K.)
| | - Konstantinos G. Kyriakoulis
- From the Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan; and Department of Medicine and Surgery, University of Milano-Bicocca, Italy (A.K., G.B., G.P.); and Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (A.K., G.S.S., K.G.K.)
| | - Grzegorz Bilo
- From the Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan; and Department of Medicine and Surgery, University of Milano-Bicocca, Italy (A.K., G.B., G.P.); and Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (A.K., G.S.S., K.G.K.)
| | - Gianfranco Parati
- From the Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan; and Department of Medicine and Surgery, University of Milano-Bicocca, Italy (A.K., G.B., G.P.); and Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (A.K., G.S.S., K.G.K.)
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Parati G, Ochoa JE, Bilo G. Moving Beyond Office Blood Pressure to Achieve a Personalized and More Precise Hypertension Management: Which Way to Go? Hypertension 2017; 70:HYPERTENSIONAHA.117.08250. [PMID: 28760937 DOI: 10.1161/hypertensionaha.117.08250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gianfranco Parati
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., G.B.); and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.).
| | - Juan Eugenio Ochoa
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., G.B.); and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.)
| | - Grzegorz Bilo
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., G.B.); and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.)
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Revera M, Salvi P, Faini A, Giuliano A, Gregorini F, Bilo G, Lombardi C, Mancia G, Agostoni P, Parati G. Renin–Angiotensin–Aldosterone System Is Not Involved in the Arterial Stiffening Induced by Acute and Prolonged Exposure to High Altitude. Hypertension 2017; 70:75-84. [DOI: 10.1161/hypertensionaha.117.09197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 02/17/2017] [Accepted: 04/29/2017] [Indexed: 11/16/2022]
Abstract
This randomized, double-blind, placebo-controlled study was designed to explore the effects of exposure to very high altitude hypoxia on vascular wall properties and to clarify the role of renin–angiotensin–aldosterone system inhibition on these vascular changes. Forty-seven healthy subjects were included in this study: 22 randomized to telmisartan (age, 40.3±10.8 years; 7 women) and 25 to placebo (age, 39.3±9.8 years; 7 women). Tests were performed at sea level, pre- and post-treatment, during acute exposure to 3400 and 5400-m altitude (Mt. Everest Base Camp), and after 2 weeks, at 5400 m. The effects of hypobaric hypoxia on mechanical properties of large arteries were assessed by applanation tonometry, measuring carotid–femoral pulse wave velocity, analyzing arterial pulse waveforms, and evaluating subendocardial oxygen supply/demand index. No differences in hemodynamic changes during acute and prolonged exposure to 5400-m altitude were found between telmisartan and placebo groups. Aortic pulse wave velocity significantly increased with altitude (
P
<0.001) from 7.41±1.25 m/s at sea level to 7.70±1.13 m/s at 3400 m and to 8.52±1.59 m/s at arrival at 5400 m (
P
<0.0001), remaining elevated during prolonged exposure to this altitude (8.41±1.12 m/s;
P
<0.0001). Subendocardial oxygen supply/demand index significantly decreased with acute exposure to 3400 m: from 1.72±0.30 m/s at sea level to 1.41±0.27 m/s at 3400 m (
P
<0.001), remaining significantly although slightly less reduced after reaching 5400 m (1.52±0.33) and after prolonged exposure to this altitude (1.53±0.25;
P
<0.001). In conclusion, the acute exposure to hypobaric hypoxia induces aortic stiffening and reduction in subendocardial oxygen supply/demand index. Renin–angiotensin–aldosterone system does not seem to play any significant role in these hemodynamic changes.
Clinical Trial Registration—
URL:
https://www.clinicaltrialsregister.eu/
. Unique identifier: 2008-000540-14.
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Affiliation(s)
- Miriam Revera
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Paolo Salvi
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Andrea Faini
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Andrea Giuliano
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Francesca Gregorini
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Grzegorz Bilo
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Carolina Lombardi
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Giuseppe Mancia
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Piergiuseppe Agostoni
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Gianfranco Parati
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
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47
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Gajjala PR, Jankowski V, Heinze G, Bilo G, Zanchetti A, Noels H, Liehn E, Perco P, Schulz A, Delles C, Kork F, Biessen E, Narkiewicz K, Kawecka-Jaszcz K, Floege J, Soranna D, Zidek W, Jankowski J. Proteomic-Biostatistic Integrated Approach for Finding the Underlying Molecular Determinants of Hypertension in Human Plasma. Hypertension 2017; 70:412-419. [PMID: 28652472 DOI: 10.1161/hypertensionaha.116.08906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/14/2016] [Revised: 01/03/2017] [Accepted: 05/07/2017] [Indexed: 01/08/2023]
Abstract
Despite advancements in lowering blood pressure, the best approach to lower it remains controversial because of the lack of information on the molecular basis of hypertension. We, therefore, performed plasma proteomics of plasma from patients with hypertension to identify molecular determinants detectable in these subjects but not in controls and vice versa. Plasma samples from hypertensive subjects (cases; n=118) and controls (n=85) from the InGenious HyperCare cohort were used for this study and performed mass spectrometric analysis. Using biostatistical methods, plasma peptides specific for hypertension were identified, and a model was developed using least absolute shrinkage and selection operator logistic regression. The underlying peptides were identified and sequenced off-line using matrix-assisted laser desorption ionization orbitrap mass spectrometry. By comparison of the molecular composition of the plasma samples, 27 molecular determinants were identified differently expressed in cases from controls. Seventy percent of the molecular determinants selected were found to occur less likely in hypertensive patients. In cross-validation, the overall R2 was 0.434, and the area under the curve was 0.891 with 95% confidence interval 0.8482 to 0.9349, P<0.0001. The mean values of the cross-validated proteomic score of normotensive and hypertensive patients were found to be -2.007±0.3568 and 3.383±0.2643, respectively, P<0.0001. The molecular determinants were successfully identified, and the proteomic model developed shows an excellent discriminatory ability between hypertensives and normotensives. The identified molecular determinants may be the starting point for further studies to clarify the molecular causes of hypertension.
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Affiliation(s)
- Prathibha R Gajjala
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Vera Jankowski
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Georg Heinze
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Grzegorz Bilo
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Alberto Zanchetti
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Heidi Noels
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Elisa Liehn
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Paul Perco
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Anna Schulz
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Christian Delles
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Felix Kork
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Erik Biessen
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Krzysztof Narkiewicz
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Kalina Kawecka-Jaszcz
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Juergen Floege
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Davide Soranna
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Walter Zidek
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.)
| | - Joachim Jankowski
- From the Universitätsklinikum RWTH Aachen, Institute for Molecular Cardiovascular Research, Germany (P.R.G., V.J., H.N., E.L., F.K., E.B., J.J.); Experimental Vascular Pathology, Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands (P.R.G., E.B., J.J.); Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Austria (G.H.); Departments of Medicine and Surgery (G.B.) and Statistics and Quantitative Methods (D.S.), University of Milano-Bicocca, Italy; Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan, Italy (G.B.); Istituto Auxologico Italiano, IRCCS, Milan, Italy (A.Z., D.S.); Università degli Studi di Milano, Italy (A.Z.); Department of Internal Medicine IV, Medical University Innsbruck, Austria (P.P.); Charité-Universitätsmedizin Berlin (CBF), Germany (A.S., W.Z.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK (C.D.); Department of Hypertension and Diabetology, Medical University of Gdansk, Poland (K.N.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.-J.); and Internal Medicine II, Universitätsklinikum RWTH Aachen, Germany (J.F.).
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Gajjala PR, Jankowski V, Heinze G, Bilo G, Zanchetti A, Jankowski J. SP045A PROTEO-BIOSTATISTIC APPROACH FOR FINDING THE UNDERLYING MOLECULAR DETERMINANTS OF HYPERTENSION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx139.sp045] [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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Bilo G, Parati G, Kawecka-Jaszcz K. Breath holding as a specific type of breathing training from the viewpoint of Avicenna. Authors' reply. Pol Arch Intern Med 2017; 127:215. [DOI: 10.20452/pamw.3991] [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: 11/23/2022]
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Kawecka-Jaszcz K, Bilo G, Drożdż T, Dębicka-Dąbrowska D, Kiełbasa G, Malfatto G, Styczkiewicz K, Lombardi C, Bednarek A, Salerno S, Czarnecka D, Parati G. Effects of device‑guided slow breathing training on exercise capacity, cardiac function, and respiratory patterns during sleep in male and female patients with chronic heart failure. Pol Arch Intern Med 2017; 127:8-15. [PMID: 28075423 DOI: 10.20452/pamw.3890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Slow breathing training (SBT) has been proposed as a new nonpharmacologic treatment in patients with chronic heart failure (CHF). OBJECTIVES The aim of this study was to assess the effects of SBT on exercise capacity, hemodynamic parameters, and sleep respiratory patterns in a relatively large sample of CHF patients. PATIENTS AND METHODS A crossover open study was conducted. Patients completed, in a random order, 10- to 12‑week SBT, with 2 15‑minute sessions of device‑guided SBT each day, reaching 6 breaths/ min, and a 10- to 12‑week follow‑up under standard care. Clinical data collection, polysomnography, echocardiography, 6‑minute walk test (6MWT), and laboratory tests were performed. RESULTS A total of 96 patients (74 men, 22 women) in New York Heart Association classes I-III, with an average age of 65 years and an ejection fraction (EF) of 31%, completed the study. Home‑based SBT was safe. After training, EF and 6MWT distance improved (EF: 31.3% ±7.3% vs 32.3% ±7.7%; P = 0.030; 6MWT: 449.9 ±122.7 m vs 468.3 ±121.9 m; P <0.001), and the apnea-hypopnea index decreased (5.6 [interquartile range (IQR), 2.1; 12.8] vs. 5.4 [IQR, 2.0; 10.8]; P = 0.043). CONCLUSIONS SBT improved physical capacity and systolic heart function; it also diminished sleep disturbances. The results support the benefits of SBT as a novel component of cardiorespiratory rehabilitation programs in patients with CHF.
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