rome and Hypertension

Although hypertension guidelines highlight the benefits of achieving the recommended blood pressure (BP) targets, hypertension control rate is still insufficient, mostly in high or very high cardiovascular (CV) risk patients. Thus, we aimed to estimate BP control in a cohort of patients at high CV risk in both primary and secondary prevention.. A single-center, cross-sectional study was conducted by extracting data from a medical database of adult outpatients aged 40-75 years, who were referred to our Hypertension Unit, Rome (IT), for hypertension assessment. Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: a)<130/80 mmHg in individuals aged 40-65 years; b)<140/80 mmHg in subjects aged >65 years. Primary prevention patients with SCORE <5% were considered to be at low-intermediate risk, whilst individuals with SCORE ≥5% or patients with comorbidities were defined to be at very high risk. Among 6354 patients (47.2% female, age 58.4 ± 9.6 years), 4164 (65.5%) were in primary prevention with low-intermediate CV risk, 1831 (28.8%) in primary prevention with high-very high CV risk and 359 (5.6%) in secondary prevention. In treated hypertensive outpatients, uncontrolled hypertension rate was significantly higher in high risk primary prevention than in low risk primary prevention and secondary prevention patients (18.4% vs 24.4% vs. 12.5%, respectively; P < 0.001). In high risk primary prevention diabetic patients only 10% achieved the recommended BP targets.. Our data confirmed unsatisfactory BP control among high-risk patients, both in primary and secondary prevention, and suggest the need for a more stringent BP control policies in these patients.

Topics: Adult; Aged; Antihypertensive Agents; Blood Pressure; Comorbidity; Cross-Sectional Studies; Databases, Factual; Female; Heart Disease Risk Factors; Humans; Hypertension; Male; Middle Aged; Outpatients; Prevalence; Primary Prevention; Risk Assessment; Rome; Secondary Prevention; Time Factors; Treatment Outcome

Despite hypertension guidelines suggest that the most effective treatment strategy to improve blood pressure (BP) target achievement is to implement the use of combination treatment, monotherapy is still widely used in the clinical practice of hypertension.. To investigate BP control under monotherapy in the setting of real-life.. We extracted data from a medical database of adult outpatients who were referred to the Hypertension Unit, Sant'Andrea Hospital, Rome (IT), including anthropometric data, CV risk factors and comorbidities, presence or absence of antihypertensive therapy and concomitant medications. Among treated hypertensive patients, we identified only those under single antihypertensive agent (monotherapy). Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: (a) < 130/80 mmHg in individuals aged 18-65 years; (b) < 140/80 mmHg in those aged > 65 years.. Our data showed a persistent use of monotherapy in the clinical practice, though with unsatisfactory BP control, especially in light of the BP treatment targets suggested by the last hypertension guidelines.

Topics: Adolescent; Adult; Aged; Antihypertensive Agents; Blood Pressure; Cross-Sectional Studies; Databases, Factual; Female; Humans; Hypertension; Male; Middle Aged; Rome; Treatment Outcome; Young Adult

Nowadays there are more than 5 millions of immigrants (8.3% of general adult population) in Italy.. To evaluate the potential impact of immigration and the possession of a permanent residence on blood pressure (BP) levels and control in a low income population of immigrants from different countries.. We evaluated clinical characteristics and social status of adult individuals with known diagnosis of hypertension afferent to the Poliambulatorio della Caritas Diocesana in Rome, Italy, between 2010-2016. Subjects were stratified according to their macro-areas of origin (Europe, Asia, Africa, South-America), housing (with or without house), and immigration status (presence or absence of residence permit). BP levels were measured in three consecutive visits according to recommendations from current European Guidelines.. From an overall population sample of 9827 adult individuals, we initially identified 994 patients with a diagnosis of hypertension (10.1%), among whom 536 (5.4%) had valid BP data. Among these, 50.6% came from Europe, 21.6% from Africa, 24.1% from Asia, and 3.7% from South-America. They were predominantly male (54.7%), middle aged (42.8 ± 12.1 years at arrival and 51.6 ± 10.6 years at first visit) and untreated (72.8%) individuals with baseline systolic/diastolic BP levels of 156.9 ± 22.2/97.3 ± 12.4 mmHg). BP levels remained higher in homeless than in housed people at both visit 2 (150.0 ± 21.8/92.6 ± 12.9 mmHg vs. 142.9 ± 19.3/89.9 ± 11.6 mmHg; P < 0.001) and visit 3 (147.9 ± 22.2/91.7 ± 12.5 mmHg vs. 141.8 ± 19.4/89.2 ± 12.0 mmHg; P = 0.013). We also observed reductions of both systolic and diastolic BP levels compared to baseline values in immigrants stratified according to residence permit, although without relevant differences among groups.. Beyond conventional risk factors, socio-economic issues, including lack of residence permit or habitation, may affect BP levels and control in frail populations of immigrants, which have been marginally considered before.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Blood Pressure; Databases, Factual; Emigrants and Immigrants; Emigration and Immigration; Female; Housing; Humans; Hypertension; Ill-Housed Persons; Male; Middle Aged; Prevalence; Retrospective Studies; Risk Assessment; Risk Factors; Rome; Social Determinants of Health; Socioeconomic Factors; Undocumented Immigrants; Young Adult

Effective and sustained blood pressure (BP) control in hypertensive patients with moderate-to-severe obesity is often difficult to achieve. We evaluated clinic, 24h, day-time and night-time systolic/diastolic BP levels and control in a large cohort of adult outpatients with different classes of obesity. A single center, prospective, cohort study was conducted at Hypertension Unit, Division of Cardiology, Sant'Andrea Hospital, Rome Italy. All BP measurements were performed and BP thresholds were set according to guidelines. Study population was stratified according to BMI. We included 4,766 individuals (women 48.6%, age 60.3 ± 11.6 years, clinic BP 143.8 ± 18.2/90.9 ± 12.3 mmHg, 24h BP 130.2 ± 13.3/79.1 ± 9.5 mmHg), among whom 36.0% had normal weight, 43.5% were overweight, 15.7% had class I, and 4.8% class II/III obesity. Obese outpatients had higher prevalence of risk factors, and were treated more frequently and with more antihypertensive drugs than those with normal body weight. Obese outpatients showed higher systolic BP levels at all BP measurements, mostly 24h and night-time periods, than those observed in normal weight outpatients. BMI resulted significantly related with clinic (r = 0.053; P < 0.001), 24h (r = 0.098; P < 0.001) and night-time systolic BP (r = 0.126; P < 0.001), and left ventricular mass indexed by height^2.7 (r = 0.311; P < 0.001). BMI was also negatively and independently associated with predefined BP goals at all types of BP measurements. Obesity was associated with higher systolic BP levels during the entire 24h period and increased left ventricular mass. These effects were independently observed, even after correction for major cardiovascular risk factors and comorbidities, as well as the number and type of antihypertensive drug classes.

Topics: Aged; Antihypertensive Agents; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Comorbidity; Female; Humans; Hypertension; Male; Middle Aged; Obesity; Outpatients; Predictive Value of Tests; Prevalence; Retrospective Studies; Risk Assessment; Risk Factors; Rome; Severity of Illness Index; Time Factors; Treatment Outcome

The aim of the present study was to evaluate the prevalence, determinants, and clinical management of systemic hypertension in a large cohort of competitive athletes: 2,040 consecutive athletes (aged 25 ± 6 years, 64% men) underwent clinical evaluation including blood test, electrocardiogram, exercise test, echocardiography, and ophthalmic evaluation. Sixty-five athletes (3%) were identified with hypertension (men = 57; 87%) including 5 with a secondary cause (thyroid dysfunction in 3, renal artery stenosis in 1, and drug induced in 1). The hypertensive athletes had greater left ventricular hypertrophy and showed more often a concentric pattern than normotensive ones. Moreover, they showed a mildly reduced physical performance and were characterized by a higher cardiovascular risk profile compared with normotensive athletes. Multivariate logistic regression analysis showed that family hypertension history (odds ratio 2.05; 95% confidence interval 1.21 to 3.49; p = 0.008) and body mass index (odds ratio 1.32; 95% confidence interval 1.23 to 1.40; p <0.001) were the strongest predictors of hypertension. Therapeutic intervention included successful lifestyle modification in 57 and required additional pharmacologic treatment in 3 with essential hypertension. Secondary hypertension was treated according to the underlying disorder. After a mean follow-up of 18 ± 6 months, all hypertensive athletes had achieved and maintained optimal control of the blood pressure, without restriction to sport participation. In conclusion, the prevalence of hypertension in athletes is low (3%) and largely related to family history and overweight. In the vast majority of hypertensives, lifestyle modifications were sufficient to achieve an optimal control of blood pressure values.

Topics: Adult; Athletes; Blood Pressure; Disease Management; Echocardiography; Electrocardiography; Exercise Test; Female; Follow-Up Studies; Humans; Hypertension; Male; Prevalence; Rome; Time Factors; Young Adult

This study was designed to evaluate the results of unilateral laparoscopic adrenalectomy in patients with subclinical hypercortisolism (SH) due to adrenal incidentaloma (AI) concerning the main cardiometabolic disorders.. We have studied between January 2000 to December 2015, 645 patients with AI (283 males and 362 females; mean age 61.9 ± 10 years) and we found 70 patients with SH (27 males and 43 females; mean age 61.9 ± 8.4 years). Twenty-six (37%) SH patients (6 males and 20 females; mean age 58.7 ± 7.1 years) underwent unilateral laparoscopic adrenalectomy, whereas 44 SH patients (21 males and 23 females; mean age 63.9 ± 9.9 years) performed a conservative treatment. All SH patients were evaluated at diagnosis and after follow-up (mean 12 months; range 9-15 months).. In only SH patients undergoing unilateral adrenalectomy we found a statistical significant reduction of the arterial hypertension and metabolic syndrome (p < 0.05, respectively). In particular we observed a reduction of 24-h systolic blood pressure and "non-dipper" pattern (p < 0.05, respectively) evaluated with ambulatory blood pressure monitoring (ABPM).. Our study confirm the high prevalence of SH in AI, and the unilateral laparoscopic adrenalectomy seemed to have a beneficial effect on some cardiometabolic disorders.

Topics: Adrenal Gland Diseases; Adrenalectomy; Aged; Antihypertensive Agents; Arterial Pressure; Asymptomatic Diseases; Blood Pressure Monitoring, Ambulatory; Circadian Rhythm; Cushing Syndrome; Female; Humans; Hypertension; Incidental Findings; Laparoscopy; Male; Middle Aged; Prevalence; Risk Factors; Rome; Time Factors; Treatment Outcome

Approximately 10%-14% of ischemic strokes occur in young adults.. To investigate risk factors and etiologies of strokes of young adults admitted to the "stroke unit" of Policlinico "Gemelli" of Rome from December 2005 to January 2013.. In all, 150 consecutive patients younger than 50 years diagnosed with ischemic stroke were enrolled. Clinical evaluation consisted of a complete neurologic examination and the National Institutes of Health Stroke Scale. Diagnostic workup consisted of anamnesis, extensive laboratory, radiologic, and cardiologic examination. Stroke etiologies were classified according to the Trial of Org 10172 in Acute Stroke Treatment.. Patients' mean age was 41 ± 8.0 years. The most common risk factors were dyslipidemia (52.7%), smoking (47.3%), hypertension (39.3%), and patent foramen ovale (PFO, 32.8%). Large-artery atherosclerosis was diagnosed as the cause of stroke in 17 patients (11.3%). Cardioembolism was presumed in 36 patients (24%), most of them presented a PFO at transesophageal echocardiography. Small-vessel occlusion was diagnosed in 12 patients (8%); all of them were hypertensive and most of them presented additional risk factors. Forty-one patients (27.3%) presented a stroke of other determined etiology and 44 (29.3%) presented a stroke of undetermined etiology. The 3-year survival was 96.8% and recurrent strokes occurred in only 3 cases.. Traditional vascular risk factors are also very common in young adults with ischemic stroke, but such factors increase the susceptibility to stroke dependent to other causes as atherosclerosis and small-artery occlusion represent less than 20% of cases. Prognosis quoadvitam is good, being characterized by low mortality and recurrence rate.

Topics: Adult; Age Factors; Atherosclerosis; Brain Ischemia; Dyslipidemias; Embolism; Female; Foramen Ovale, Patent; Humans; Hypertension; Male; Middle Aged; Prognosis; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Rome; Smoking; Stroke; Survival Rate; Time Factors

A study was conducted on children from a junior high school in Rome, Monteverde district, to observe data on hypertension and obesity. Data were compared with results from the study carried on two years ago in the same school by the same working group.. The study enrolled 336 students, 52% males and 48% females. Blood pressure was measured with Omron 2 automatic monitor, with child cuffs. Weight and height were measured with Seca scale with stadiometer. We assessed hypertension by means of recent Task Force Tables, overweight and obesity with the tables by Cole et al.. A proportion of 5% of screened children presented hypertension, 13.9% overweight, 2.3% obesity.. Prevalence of hypertension, overweight and obesity was lower than prevalence observed two years ago in the same school, thanks to a change in eating habits which included breakfast promotion, adoption of correct food choices for lunch and dinner, and most of all an increase in extracurricular sports activity, currently performed by 92% of students.

Topics: Adolescent; Body Mass Index; Diet Surveys; Feeding Behavior; Female; Humans; Hypertension; Male; Obesity; Overweight; Prevalence; Risk Factors; Rome; Schools; Socioeconomic Factors; Students; Weight Loss

The Cardioversion of Atrial Fibrillation in Emergency (CAFE) study was an observational, retrospective, multicenter study focusing on patients with recent onset atrial fibrillation (AF) seen in six different Emergency Departments (ED) of Rome, Italy.. The aim of this study was to present the baseline characteristics and risk factors of the patients enrolled to the CAFE study.. We retrospectively reviewed 3085 eligible patients diagnosed with recent onset AF in any of the EDs between January 2008 and December 2009. Inclusion criteria required documented ICD-9 primary discharge/admission diagnosis of AF in the ED and stable hemodynamic conditions at presentation (systolic blood pressure > 90 mmHg). Exclusion criteria were permanent AF or an ongoing acute coronary syndrome.. Median age was 71 years (interquartile ranges, 62-78 years) and 50.8% were men. Palpitations was the most common symptom at ED presentation and was present in 73.5% of the study subjects. Hypertension was the most prevalent comorbidity, affecting 59.3% of the patients evaluated, and the presence of previous episode(s) of AF was also common (52.3%). Regarding home treatment, the drugs most prescribed were antiplatelets (31.2%) and diuretics (25.2%). A CHADS2 score of 0 was found in 814 patients (26.4%), while a CHADS2 score of 1 was reported in 1114 patients (36.1%). Finally, a CHADS2 score ≥ 2 was reported in 1157 patients (37.5%).. The present study represents an important snapshot of demographics, comorbidities, risk factors and anticoagulation management about patients with recent onset AF. Disparities were noted in anticoagulation management, suggesting that this is still a main problem among patients with AF.

Topics: Aged; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Chi-Square Distribution; Comorbidity; Diuretics; Emergency Service, Hospital; Female; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Platelet Aggregation Inhibitors; Predictive Value of Tests; Prevalence; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Rome

This study aims to investigate prevalence of hypertension and cardiovascular risk factor clustering in children and adolescents attending a lipid clinic as well as the relationship of their hypertensive status with indicators of fat distribution and parental fat distribution and blood pressure (BP). In this cross-sectional primary prevention study, data on indicators of fat distribution (waist, hip, and middle-upper arm circumferences), body mass index (BMI), BP, high-sensitivity C-reactive protein (hsCRP), lipid and glucose profile of 370 children and adolescents (180 M, 190 F, mean age 9.5 years, (range 6-14 years)) were collected. Parents (502, 251 M, 251 F, age range 28-36 years), who gave their informed consent, underwent BMI, fat distribution, and BP measurements. There were 131 (35.4 %) hypercholesterolemic subjects and 72 (19.5 %) hypertensives. Using tests on medians, in comparison with 298 normotensives, the 72 hypertensives had higher levels of insulin (p<0.005) and no differences in cholesterol levels, age, and height. BMI and all the indicators of fat distribution were significantly higher (all p<0.01) in hypertensives than normotensives. BMI and waist circumferences were higher (both p<0.05) in the mothers of hypertensives, but not in the fathers. Hypertensive subjects' BMI was related to mothers' hip and waist circumferences (r=0.28 and 0.21, respectively).. In this study, children's hypertension was a component of the metabolic syndrome, but uric acid and hsCRP levels were not contributive. This hemodynamic and metabolic disorder was related to maternal fat distribution and BMI suggesting an epigenetic etiology.

Topics: Adiposity; Adolescent; Blood Pressure; Body Mass Index; C-Reactive Protein; Child; Cross-Sectional Studies; Female; Humans; Hypercholesterolemia; Hypertension; Male; Metabolic Syndrome; Obesity; Parents; Prevalence; Risk Factors; Rome

Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary atherosclerosis, there are few data appraising gender-specific features of carotid plaques. We aimed to systematically compare the pathology and inflammatory features of carotid plaques in men vs women.. Carotid plaque specimens were collected from patients undergoing surgical endarterectomy for asymptomatic or symptomatic carotid stenosis. Histologic analysis was performed, as well as measurements of plaque composition and inflammation.. A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia, hypertension, and former smoking status in women, despite a higher Framingham Heart Score in men (all P < .05). Women had a lower prevalence of thrombotic plaques, smaller percentage area of necrotic core, and hemorrhage extension (all P < .05). Plaque inflammation analysis showed a lower concentration of inflammatory and, in particular, of macrophage foam cells in the plaque cap of women (both P < .05). These differences were, however, no longer significant at multivariable analysis, including several baseline features, such as symptom status and stenosis severity.. Carotid plaques seem significantly different in women and men, but the main drivers of such pathologic differences are baseline features, including stenosis severity and symptom status.

Topics: Aged; Asymptomatic Diseases; Carotid Arteries; Carotid Stenosis; Chi-Square Distribution; Endarterectomy, Carotid; Female; Foam Cells; Hemorrhage; Humans; Hypercholesterolemia; Hypertension; Inflammation; Linear Models; Male; Middle Aged; Multivariate Analysis; Necrosis; Plaque, Atherosclerotic; Prevalence; Risk Assessment; Risk Factors; Rome; Severity of Illness Index; Sex Factors; Smoking; Thrombosis

Hearing impairment (HI) remains a problem among dentists Hearing loss at speech frequencies was recently reported among dentists and dental hygienists. This study aimed to investigate prevalence and factors associated with perceived HI among dentists.. In 2009-2010, 100 general dental practitioners (GDPs) and 115 general (medical) practitioners (GPs) (mean ages, 43.7 and 44.4 years) from Rome (Italy), who commenced practice ≥ 10 years ago, were interviewed on a series of occupation- and recreation-related HI risk factors and on HI-associated symptoms (tinnitus, sensation of fullness, hypoacusis). Prevalence of presumptive HI (≥ 1 symptom perceived during workdays and weekends) was assessed and factors associated with presumptive HI were investigated.. Prevalence was 30.0% (95% confidence interval, 21.0-39.0%) and 14.8% (95% confidence interval, 8.3-21.3%) among GDPs and GPs, respectively. Occupation (GDP vs. GP), family history of hypoacusis, hypertension, ear diseases and smoking were significantly associated with presumptive HI. Within GDPs alone, significant associations were found for frequent use of ultrasonic scalers, use of dental turbines aged≥1 year and prosthodontics as prevalent specialty.. GDPs experienced HI risk than GPs. Such a risk was not generalized to all dentists, but was specific for those who frequently used noisy equipment (aged turbines, ultrasonic scalers) during their daily practice.. GDPs with 10 or more years of practice who routinely use potentially noisy equipment, could be at risk of HI. In order to prevent such condition, daily maintenance and periodical replacement of dental instruments is recommended.

Topics: Adult; Dental High-Speed Equipment; Dental Scaling; Dentists; Ear Diseases; Female; General Practice, Dental; General Practitioners; Hearing Loss; Humans; Hypertension; Male; Noise, Occupational; Occupational Diseases; Occupational Exposure; Prevalence; Recreation; Risk Factors; Rome; Smoking; Surveys and Questionnaires; Tinnitus; Ultrasonics

A study was carried out on students of a middle school with a medium-high social level in a southern zone of Rome, to assess the current situation regarding obesity and arterial hypertension in subjects with a parental environment favouring correct eating habits.. We considered 693 students, mean age 11.2 + 0.6. Hypertension was defined according to blood pressure (BP) tables for children and adolescents of the NIH - Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force. Dietary habits and life-style were investigated by specific questionnaires.. The prevalence of overweight and obesity was respectively 23.1% and 3.3% of the subjects studied. Moreover, 5.2% of them showed BP values between 90th and 95th percentile and 7.8% was hypertensive. Food habits of the current students were fairly correct, favouring the Mediterranean diet and with the proper number of daily meals.. A justification for the high number of hypertensive could be due to the elevated consumption of salt added to food (60% of young people), the elevated frequency of those who often eat fast food (43%) and a family history of hypertension in the parents (24%). Only 24.5% of males and 22.9% of females used to practice physical activity; whereas 40% of males and 41% of females used to spend more than 3 hours a day in front of the TV and/or computer.

Topics: Adolescent; Child; Feeding Behavior; Female; Humans; Hypertension; Male; Motor Activity; Obesity; Prevalence; Rome

Left ventricular (LV) hypertrophy (H) and hypertension are prevalent in children with end-stage renal disease (ESRD) and after renal transplantation. Severe hypertension prior to renal transplantation has traditionally been an indication for native kidney nephrectomy. The impact of nephrectomy on cardiovascular disease has not been well documented. We retrospectively evaluated echocardiographic and ambulatory blood pressure monitoring (ABPM) data in 67 young adults who had undergone transplantation in the pediatric age with a mean follow-up of 10.4 years. Unilateral or bilateral nephrectomies had been performed in 32 patients. The number of antihypertensive drugs used prior to transplantation was significantly higher in the nephrectomized groups. At follow-up the amount of antihypertensive medications was similar between groups and no significant differences were observed in mean arterial blood pressure (MAP) or LV mass index (LVMi). LVH was observed in 50% of non-nephrectomized patients, 45.4% of patients with unilateral nephrectomy, and 44.4% of patients without native kidneys (p = n.s.). In conclusion, unilateral or bilateral nephrectomies prior to transplantation do not appear to influence blood pressure control or the prevalence of LVH after renal transplantation. Longitudinal studies with repeated assessment of LVMi, before and after renal transplantation, are needed to assess the impact of residual activity of native kidneys on arterial blood pressure and cardiac structural changes, even in normotensive patients, to evaluate cardiovascular morbidity.

Topics: Adolescent; Antihypertensive Agents; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Child; Child, Preschool; Echocardiography; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Kidney Failure, Chronic; Kidney Transplantation; Logistic Models; Male; Nephrectomy; Retrospective Studies; Risk Assessment; Risk Factors; Rome; Time Factors; Treatment Outcome; Young Adult

Topics: Adult; Age Distribution; Aged; Biomarkers; Cardiovascular Diseases; Cholesterol; Cholesterol, HDL; Cohort Studies; Diabetes Complications; Female; Humans; Hypercholesterolemia; Hypertension; Male; Medical Records; Middle Aged; Proportional Hazards Models; Risk Assessment; Risk Factors; Rome; Smoking

The metabolic syndrome (MS) is associated with left ventricular hypertrophy (LVH). Previous evidence has shown that LVH is favoured by low levels of atrial natriuretic peptide (ANP), independently from blood pressure (BP), in hypertension. Although levels of natriuretic peptides are known to be lower in obesity, plasma ANP levels have not yet been assessed in MS. We aimed to assess the ANP levels and their relationship with left ventricular mass (LVM) in patients affected by MS.. One hundred and twenty-eight essential hypertensive patients were included in the study: 51 with MS and 77 without MS. Clinical, echocardiographical and biochemical parameters, and levels of both N-terminal (NT)-proANP and alphaANP were assessed.. Hypertensive patients affected by MS had higher LVM and increased frequency of LVH. NT-proANP levels were significantly lower in MS, independent of waist circumference (WC). Log(NT-proANP) levels were significantly inversely related to left ventricular mass index (LVMI) (beta = -0.360, P < 0.001) and LVM/height (beta = -0.370, P < 0.001) in the whole hypertensive population by multiple linear regression analysis. The relationship of log(NT-proANP) with LVM was more enhanced in patients with MS.. The present study demonstrates that levels of NT-proANP are significantly reduced in hypertensive patients affected by MS, and they are significantly inversely related to the increased LVM observed in these patients. Our findings, while supporting previous experimental and clinical evidence of the antihypertrophic role of ANP in hypertension, may help to identify one of the possible mechanisms directly underlying LVH in MS.

Topics: Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Case-Control Studies; Echocardiography, Doppler; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Linear Models; Male; Metabolic Syndrome; Middle Aged; Predictive Value of Tests; Protein Precursors; Rome; Stroke Volume; Transforming Growth Factor beta

The aim of this research was to evaluate the incidence of hypertension in adolescents by assessing their anthropometric measurements and diet, since recent literature data suggest that 30% of obese adolescents are hypertensive.. The 293 schoolchildren engaged in the study were aged 11-14 years and 54% were male. They attended a Secondary School in Rome with a middle-high class background. Blood pressure, heart rate, weight, height, tricipital and subscapular skinfolds and body mass index (BMI) were measured and dietary patterns assessed through 24-h recall. The findings were then statistically evaluated.. The incidence of hypertension was 6.5%, without distinction between sexes. On the basis of the statistical evaluation of the correlations between hypertension and obesity, familial hypertension, weaning with the addition of salt and bottle-feeding from birth, only obesity was found to be statistically significant (p<0.001). Even though the hypertensive adolescents had a high intake of snacks, salt, meat, sausages and cheese in their daily diet, only the excess of proteins was statistically significant (p<0.05). The incidence of obesity (calculated as being 20% over the ideal weight for a given height) was 17.3%. This finding was confirmed by the mean value of the both skinfolds, whereas BMI, for which obesity and overweight were considered together, showed a slight overestimation of this percentage.. A high number of hypertensive adolescents was found, about 1/3 of the obese adolescents examined. This confirms the findings of an extensive study previously carried out by the Group of Hypertension of the Italian Society of Pediatrics. From a nutritional point of view, the excessive intake of proteins of the 19 hypertensive adolescents was found to be statistically significant. However, a more extensive study could probably provide further data on other nutrients which, in this case, were not quite statistically significant.

Topics: Adolescent; Child; Diet; Female; Humans; Hypertension; Incidence; Male; Rome

Determinants of long-term outcome are not well defined in minor stroke patients. This study aims to evaluate which factors are independent long-term predictors of death and major stroke recurrence in a cohort of minor ischemic strokes.. A cohort of 322 patients with first-ever minor ischemic strokes (mean age, 55 years; 89% were treated with antiplatelet or anticoagulant drugs) with minor (Rankin score=2) or no disability (Rankin score <2) were followed for 10 years, with only 6% lost to follow-up. Death and major stroke recurrence rates were evaluated by Kaplan-Meier analysis. Hazard ratios and 95% confidence intervals (CI) of factors with P<.1 at the log-rank test were evaluated by multivariate Cox analysis.. The 10-year mortality rate was 32%, with a relative risk of 1.7 (95% CI, 1.4 to 2.1) compared with the age- and sex-matched general population. The 10-year recurrence rate of major strokes was 14%. The hazard ratio (95% CI) of death was 1.1 (1.05 to 1.09) for age (1-year increments), 3.4 (2.2 to 5.2) for minor disability, 1.8 (1.1 to 3.1) for myocardial infarction (MI), 2.0 (1.1 to 3.7) for nonvalvular atrial fibrillation, and 1.8 (1.2 to 2.7) for hypercholesterolemia. The hazard ratio (95% CI) of major stroke recurrence was 2.8 (1.3 to 6.2) for recurrent minor strokes, 3.1 (1.9 to 4.6) for nonlacunar stroke, 2.9 (1.3 to 6.8) for MI, and 3.0 (1.4 to 6.4) for hypertension.. In minor ischemic strokes, age, minor disability, MI, nonvalvular atrial fibrillation, and hypercholesterolemia increase the risk of death; recurrent minor strokes, nonlacunar stroke, MI, and hypertension increase the risk of major stroke.

Topics: Age Factors; Aged; Anticoagulants; Atrial Fibrillation; Brain Ischemia; Case-Control Studies; Cause of Death; Cerebrovascular Disorders; Cohort Studies; Confidence Intervals; Female; Follow-Up Studies; Humans; Hypercholesterolemia; Hypertension; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Outcome Assessment, Health Care; Platelet Aggregation Inhibitors; Prognosis; Proportional Hazards Models; Recurrence; Risk Factors; Rome

Two-hundred-thirty teenagers of a Roman liceo (specializing in classical studies) have been checked with particular regard to growth, pressure and feeding. The diet of teenagers proved to be particularly unbalanced from the qualitative point of view. There is an excessive intake of fats especially to the detriment of carbohydrates and starches. The incidence of obesity (6.9%) and of hypertension (6%) is not particularly high, probably due to the fact that youngsters at this age "look at themselves in the mirror a lot" for the first case and the second one can be considered as a direct consequence of the first.

Topics: Adolescent; Adolescent Nutritional Physiological Phenomena; Energy Intake; Female; Humans; Hypertension; Incidence; Male; Obesity; Rome; Socioeconomic Factors; Urban Population

Sodium balance plays a primary role in blood pressure regulation. Atrial natriuretic peptide, a recently discovered natriuretic substance, seems to participate in renal sodium handling, but its behavior in essential hypertension has not been fully defined. In our study, to avoid the "contamination" of factors other than hypertension, we evaluated the plasma levels of atrial natriuretic peptide in young men at military draft age. Our main results showed that plasma atrial natriuretic peptide levels are higher in young hypertensives with low plasma renin activity and low urinary excretion of active kallikrein. The influence of a positive genetic background for essential hypertension on plasma atrial natriuretic peptide levels was also investigated. Our data showed slightly elevated levels of the atrial hormone in young normotensives with a family history of hypertension.

Topics: Adult; Aldosterone; Atrial Natriuretic Factor; Blood Pressure; Heart; Hospitals, Military; Humans; Hypertension; Kallikreins; Kidney; Male; Military Personnel; Renin; Rome; Sodium

Topics: Adult; Age Factors; Coronary Disease; Dietary Fats; Energy Intake; Health Education; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Obesity; Physical Exertion; Risk; Rome; Smoking Prevention

The investigation carried out on a group of 1221 students (aged 13-19) of an Italian secondary school shows (19.6%) prevalence of high blood pressure. The prevalence was calculated assuming as hypertensive people with blood pressure higher than an arbitrary limit of 140/90 mmHg. The means, standard deviations and 95th percentiles for systolic and diastolic pressure for each age and sex were also calculated. In a follow up of 6 months the percentage of students with BP > 140/90 mmHg decreased from 6.5% to 3.5%. Statistical analysis of 19 items of a questionnaire distributed to be filled to the students shows interesting correlations between BP values, hypertension in relatives and obesity.

Topics: Adolescent; Adult; Humans; Hypertension; Male; Rome; Schools

The role of essential hypertension in the pathogenesis of cerebral vessel disorders (not only hemorrhagic, but also ischemic) is greater than in the pathogenesis of the heart ischemic disease. An analysis of the evidences left by ancient doctors, when compared with statistical data of our time, gives one grounds to believe that cerebral hemorrhages have been a rather common disease, at least, since the time of the antique civilization of Greece and Rome, whereas ischemic heart disease has become a widespread disease among the population of the developed countries only in our time. This makes it possible to assume that the role of essential hypertension and that of atherosclerosis are not equal in the "diseases of civilization", if the diseases of today's developed society are meant.

Topics: Adult; Arteriosclerosis; Asia; Cerebral Hemorrhage; Cerebral Infarction; Cerebrovascular Disorders; Coronary Disease; Egypt; Europe; Female; Greece; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; Humans; Hypertension; Male; Middle Aged; Rome; Sex Factors

Within four middle-aged population groups enrolled in the Rome Project of Coronary Heart Disease Prevention, a theoretic estimation of coronary heart disease (CHD) incidence in 5 years has been made on the basis of some risk factors (age, systolic blood pressure, serum cholesterol, smoking habit, physical activity at work, body mass index), employing four different solutions of the multiple longistic function (MLF) derived from previous population studies and a simple risk score adopted by the WHO European Collaborative Group to which this study belongs. The use of different MLF solutions provides rather different levels of estimated incidence, but the ranking and the relative risk between population groups are substancially constant and little dependent on the different solutions. Moreover, an acceptable similarity has been found in terms of estimated risk between the pool of the treatment and that of the control population groups (ratio between 0.97 and 1.09). A reasonable hypothesis indicates that in the absence of preventive action the annual incidence of severe CHD (hard criteria) should be around 6 per 1,000. The estimation of the relative risk within single population groups allows to identify strata of people with different risk, which suggests, again in the absence of any preventive action, a concentration of 25-30% of all new cases of disease in a 10% of the population and about 40-45% in a 20% of the same.

Topics: Adult; Age Factors; Body Weight; Coronary Disease; Humans; Hypercholesterolemia; Hyperlipidemias; Hypertension; Middle Aged; Occupations; Risk; Rome; Smoking

In the Roman Project of Coronary Heart Disease Prevention two different techniques were employed for the identification of individuals at high coronary risk within the treatment groups of the Project. The "risk score" is a simple additive system developed by the working groups of WHO, while the "multiple logistic function" is a complex mathematical model of multivariate analysis. Both of them consider 5 risk factors (age, systolic blood pressure, serum cholesterol, smoking habits and physical activity at work) and are applied for the identification of individuals belonging to the upper 20% of a risk rank list. The two techniques apparently provide similar predictive performances when applied to epidemiological prospective material collected in other studies where the morbid events are already known. When employed in the study population groups they identify, as high risk individuals, different subgroups of population, which overlap only partially. On the basis of theoretical and practical considerations, it has been decided to employ both techniques and to extend, as a consequence, the proportion of high risk individual, eligible for individual treatment, from 20% to about 30% of the total.

Topics: Adult; Age Factors; Cholesterol; Coronary Disease; Humans; Hypertension; Male; Middle Aged; Occupations; Physical Exertion; Risk; Rome; Smoking

Topics: Adult; Age Factors; Antihypertensive Agents; Body Weight; Cholesterol; Coronary Disease; Humans; Hypertension; Male; Mass Screening; Middle Aged; Occupations; Physical Exertion; Rome; Smoking; Stress, Physiological

Topics: Adolescent; Adult; Age Factors; Female; Humans; Hypertension; Male; Pregnancy; Rome