Objective: In order to evaluate blood pressure and lifestyle of a stranger population, the medica... more Objective: In order to evaluate blood pressure and lifestyle of a stranger population, the medical staff of the Hypertension Center of the University of Milan observed a random population of Chinese inhabitants of Milan. Design and method: On the tenth anniversary of the world hypertension day we evaluated 139 Chinese subjects on the street (88 male 48 ± 1,39 y and 51 female 51 ± 1,89 y). Each fellow was submitted to a brief interview about his pathological history, smoke habits and pharmacological therapy. We then measured blood pressure (BP) (according ti the ESH rules) and body height and weight Results: The Chinese population of our City showed a 43.9% of hypertensive individuals (72,4% of them male and 27,5 female) surely more than the expected. Even smoking was a male habit with 44% of smokers against only 0,5% of the female population (p = 0,0006). Our population showed a mean BMI increased for the male subjects (26.87 ± 0,83) and a normal one for the female population (24,6 ...
High Blood Pressure & Cardiovascular Prevention, 2007
We aimed to evaluate the intrasubject short-term reproducibility of nocturnal blood pressure (BP)... more We aimed to evaluate the intrasubject short-term reproducibility of nocturnal blood pressure (BP) patterns (dipping/non-dipping) in essential hypertensive patients in relation to age (>50 years) and gender. Methods: A total of 619 never-treated essential grade 1 and 2 hypertensives (383 men, 236 women) underwent the following procedures: 1) repeated clinic BP measurements, 2) routine examinations, 3) ambulatory BP monitoring (ABPM) over two 24-h periods within 4 weeks. Dipping pattern was defined as a 10%, or more, reduction in average SBP/DBP at night compared to daytime values. Results: Of the 407 patients showing a dipping pattern during the first ABPM period, 329 (80.1%) had the same pattern during the second ABPM recording. Of the 211 patients with a non-dipping pattern during the first ABPM period, 140 (65.9%) confirmed the same pattern during the second ABM period. Overall, 149 patients (24.1%) changed their initial nocturnal pattern at the second ABPM recording, without significant age and gender-related differences. Lower reproducibility rates of the non-dipping as compared to the dipping pattern were found in the whole population as well as in men regardless of age and in younger but not in older women. Conclusions: These findings indicate that nocturnal BP patterns have a limited short-term reproducibility in the whole study population as well as in different age and gender subgroups. As variability of nocturnal BP patterns is not predicted by easy available clinical data, such as gender and age, a reliable classification of patients according to circadian BP patterns should be obtained by repeating ABPM.
Objective: Although it is generally acknowledged that the health of migrants differs from that of... more Objective: Although it is generally acknowledged that the health of migrants differs from that of not- migrants, only few epidemiological studies have specifically investigated the prevalence of cardiovascular (CVR) factors and hypertension in migrant populations, In particular, NON studies show on Chinese migrants. The aim of this study is to provide an epidemiological profile of the Chinese community healthcare condition in Milan City. Design and method: Sample selected by Multicenter General Clinic check-up population in Chinese immigrants in Milan. To describe to prevalence of major CVR factors and to evaluate hepatic condition of steatosis in general Chinese community living in Milan. Mean outcome measures of adverse CVR factors were defined by using the Chinese Guidelines for metabolic syndrome. Prevalence of hepatic steatosis was independently defined by mean of ultrasonography technic. Screening analyses involved 229 participants who completed the proposed questionnaire, wer...
High Blood Pressure & Cardiovascular Prevention, 2007
We aimed to evaluate the impact of overweight/obesity and nocturnal blood pressure (BP) patterns ... more We aimed to evaluate the impact of overweight/obesity and nocturnal blood pressure (BP) patterns (dipping non dipping)in untreated essential hypertensives. Methods: A total of 658 consecutive outpatients with grade 1 and 2 hypertension (408 men, 250 women) underwent the following procedures: 1) repeated clinic BP measurements, 2) routine examinations 3) ambulatory BP monitoring over two 24-h periods within four weeks. The dipping pattern was defined as a >10% reduction in average systolic and diastolic BP during night-time compared to day time values. The patients have been classified, with reference to the reproducibility or not of the nocturnal pattern: D-D (reproducible dipping), ND-ND (reproducible nondipping) and VD (variable dipping). The relation between body mass index(BMI) and BP patterns has been analysed in the whole population and in a gender-based analysis. Results: In the total population, the prevalence of overweight (BMI >25 > 30 kg/m 2) resulted to be 40% and 12%, respectively and such conditions were associated to higher frequency of patterns ND-ND and VD compared to the pattern D-D (p < 0.05). Among men with a normal BMI (<25 kg/m 2), the prevalence of DD pattern was significantly higher compared to that of subjects with overweight and obesity (58,6% vs 48,6%, p < 0.01); this was the case for lean women (53,3% vs 46,9%, p < 0.05) when compared to their overweight or obese counterpart. Conclusions: Our findings are that prevalence and reproducibility of the dipping pattern profile are significantly higher in lean hypertensive patients, regardless the gender, as compared to their counterpart with an increased BMI. Therefore the phenotype overweight-obesity is a negative predictor for a physiological and stable nocturnal fall in BP.
High Blood Pressure & Cardiovascular Prevention, 2007
Whether serum uric acid (SUA) is an independent risk factor for target organ damage (TOD) and car... more Whether serum uric acid (SUA) is an independent risk factor for target organ damage (TOD) and cardiovascular events in human hypertension is still undefined. We sought to investigate the association of SUA with subclinical cardiac, vascular and renal alterations in never treated uncomplicated essential hypertensives. Methods: A total of 580 subjects with recently diagnosed (<1 year) grade 1 and 2 hypertension, categorized by sex and tertiles of SUA levels were considered for this analysis. All subjects underwent extensive clinical, laboratory and ultrasonographic investigations searching for cardiac and extracardiac TOD. Results: Hyperuricemia (SUA >7.0 mg/dl in men and >6 mg/dl in women) was present in 8.3% of the patients. The overall prevalence of left ventricular hypertrophy (LVH), carotid alterations and microalbuminuria was 28%, 27% and 8%, respectively. No differences in the prevalence rates of these TOD markers were present across SUA tertiles in the whole population, as well as in both genders. SUA levels were similar in patients with and without LVH, carotid alterations or MA. When patients were classified according to the number of organs involved, those with multiple TOD (2 or 3 organs) had significantly higher SUA levels (5.1±1.3, 5.2±1.4 mg/dl), as compared to those with a single or no organ involvement (4.9±1.3, 4.9±1.4 mg/dl, p< 0.05). The association, however, between SUA levels and multiple TOD was not confirmed in a logistic regression analysis. Conclusions: Our findings do not support a role of SUA as an independent risk factor for subclinical TOD in a selected population of recently diagnosed uncomplicated hypertensives at low prevalence of hyperuricaemia.
High Blood Pressure & Cardiovascular Prevention, 2008
Aim. We investigated the prevalence of the metabolic syndrome (MS) in hypertensive patients categ... more Aim. We investigated the prevalence of the metabolic syndrome (MS) in hypertensive patients categorized according to the number of markers of organ damage (OD) in order to assess the value of a systematic search for cardiac and extra-cardiac OD in the MS setting. Methods. A total of 3119 untreated and treated essential hypertensive patients included in the Evaluation of Target Organ Damage in Hypertension (ETODH), an observational registry of hypertension-related OD, were considered for this analysis. All patients underwent extensive searching for left ventricular hypertrophy (LVH) or LV concentric remodelling (cardiac OD), carotid plaques and/or intima-media thickening (vascular OD) and microalbuminuria (MA) and/or increased serum creatinine (renal OD). Subjects were classified as: positive for none (group 0), one (group I), two (group II) or three markers (group III) of OD. Results. MS prevalence rates progressively rose across the groups stratified according to the OD score, reaching a 2.3-fold increase in group III as compared to their MS counterparts in group 0. The distribution of subjects with and without the MS across the groups, was 15 vs 29 % (group 0), 32 vs 38% (group I), 39 vs 26% (group II) and 14 vs 7 % (group III), respectively. Thus, subjects having 2 or 3 markers of OD were 53% among those with MS and 33% (p<0.01) among those without it. Conclusions. Our findings indicate a strong association between the MS and OD by showing that a clustering of two or three OD is the prevalent cardiovascular phenotype in MS hypertensive patients referred to a specialist centre and call for a systematic evaluation of cardiac and extra cardiac OD in this setting.
High Blood Pressure & Cardiovascular Prevention, 2008
Left ventricular hypertrophy (LVH) assessed by echocardiography has a relevant impact in clinical... more Left ventricular hypertrophy (LVH) assessed by echocardiography has a relevant impact in clinical decision making in hypertensive patients. Aim. We investigated the precision and accuracy of hypertensive LVH determination in current clinical practice by a regional-based survey. Methods. The study included 211 patients with essential hypertension consecutively attending six hospital outpatient hypertension clinics in the northern Italian region of Lombardy; all subjects had undergone an echocardiographic examination for hypertension related problems in a non-academic or research ultrasound laboratory within two years. The original echocardiographic report was examined to ascertain whether the diagnosis of LVH was based on calculation of LV mass according to validated formulae and indexed to body size (primary outcome) and whether LV geometrical patterns and indices of diastolic function were provided (secondary outcome). Results. A total of 211 echocardiograms performed by 120 physicians operating in 73 different hospital and out-of-hospital ultrasound laboratories were collected. Absolute LV mass, LV mass index and relative wall thickness were calculated in 45.5 %, 24.6 % and 12.3% of the cases, respectively. Parameters of LV diastolic filling were measured in two-thirds of the cases and estimation of E/A ratio was provided by less than 20% of the examinations. Conclusions. This study shows that a large majority of echocardiographic examinations routinely performed in hypertensive subjects in order to detect cardiac damage, do not report qualifying data on LV mass, LV geometry and diastolic function. These results indicate that a quantitative assessment of LVH and LV function is rarely provided in clinical practice.
High Blood Pressure & Cardiovascular Prevention, 2008
Introduction. We investigated the cluster of cardiac, vascular and renal damages in a large sampl... more Introduction. We investigated the cluster of cardiac, vascular and renal damages in a large sample of treated hypertensive patients in order to assess the value of a systematic search for organ damage (OD) during antihypertensive treatment. Methods. A total of 2213 treated essential hypertensive patients included in the Evaluation of Target Organ Damage in Hypertension (ETODH), an observational registry of hypertension-related OD, were considered for this analysis. All patients underwent extensive investigations searching for left ventricular hypertrophy (LVH) or LV concentric remodelling (cardiac OD), carotid plaques and/or intima-media thickening (vascular OD) and microalbuminuria (MA) and/or increased serum creatinine (renal OD). Results. In the whole population the most common OD was LVH (46.5%) followed by carotid plaque (44.1%), carotid IM thickening (28.8%), MA (19.1%), LV concentric remodelling (10.4%) and increased serum creatinine (3.1%). Over all, the involvement of a single organ was observed in a limited fraction of patients, ranging from 23% for MA to 51% for carotid plaque. Prevalence rates of patients negative for OD (group I) or positive for one (group II), two (group III), or three (group IV) markers of OD were the following: 17.2 %, 36.4%, 33.9 % and 12.5 %, respectively. Conclusions. Our findings show that a cluster of two or three OD is the prevalent cardiovascular phenotype in treated hypertensive patients referred to a specialist centre. These findings call for an extensive evaluation of cardiac and extracardiac OD in all patients attending a specialist setting.
High Blood Pressure & Cardiovascular Prevention, 2007
Introduction: Limited evidence is available about the relationship between ambulatory heart rate ... more Introduction: Limited evidence is available about the relationship between ambulatory heart rate (HR) and target organ damage (TOD) in uncomplicated hypertension. Aim: We sought to investigate the association of ambulatory HR with subclinical cardiac, vascular and renal markers of TOD in never treated essential hypertensives. Methods: A total of 580 subjects with recently diagnosed (<1 year) grade 1 and 2 hypertension, categorized by tertiles of ambulatory 48-hour HR levels and sex or by presence or absence of TOD were considered for this analysis. All subjects underwent two 24-hour ambulatory blood pressure monitoring (ABPM) at 1 to 4 week interval, extensive laboratory and ultrasonographic investigations searching for microalbuminuria (MA), left ventricular hypertrophy (LVH) and carotid atherosclerosis (carotid thickening/plaque). Results: In the whole population, as well as in both genders, LVH, carotid atherosclerosis and MA prevalence rates did not significantly increase with 48-hour HR tertiles increments. When patients were categorized according to the absence or presence of any sign of TOD (i.e. LVH, carotid atherosclerosis or MA) no significant intergroup differences in 48-hour HR were found. Furthermore, average 48-hour HR was similar in patients without organ involvement as in those with one, two or three TOD signs. Finally, in a multivariate analysis age, 48-hour systolic BP and ATP III metabolic syndrome but not HR were independently associated with TOD. Conclusions: Our findings show a lack of association between ambulatory HR and markers of TOD and do not support the view that a faster 48-hour HR may have an additive effect in the development in organ damage in the early phases of essential hypertension.
It is still undefined whether serum uric acid (SUA) is an independent risk factor for target orga... more It is still undefined whether serum uric acid (SUA) is an independent risk factor for target organ damage (TOD) and cardiovascular events in human hypertension. We sought to investigate the association of SUA with subclinical cardiac, vascular, and renal alterations in never-treated uncomplicated essential hypertensives. A total of 580 subjects with recently diagnosed (<1 year) grade 1 and 2 hypertension, categorized by sex and tertiles of SUA levels, were considered for this analysis. All subjects underwent extensive clinical, laboratory, and ultrasonographic investigations searching for cardiac and extracardiac TOD. Hyperuricemia (SUA >7.0 mg/dL in men and >6 mg/dL in women) was present in 8.3% of the patients. The overall prevalence of left-ventricular hypertrophy (LVH), carotid alterations, and microalbuminuria was 28%, 27%, and 8%, respectively. No differences in the prevalence rates of these TOD markers were present across all SUA tertiles in the entire population, as...
Little information is available on the reproducibility of nocturnal variations in blood pressure ... more Little information is available on the reproducibility of nocturnal variations in blood pressure in type 2 diabetic hypertensive patients. We aimed to compare the intrasubject short-term reproducibility of a nocturnal non-dipping pattern and the prevalence of cardiac and extracardiac signs of target organ damage, in a group of type 2 diabetic hypertensive patients and in an age/gender-matched group of non-diabetic hypertensive subjects. Thirty-six treated hypertensive patients with long-lasting type 2 diabetes (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 10 years duration) consecutively attending our hospital out-patient hypertension clinic (group I; mean age, 65 +/- 9 years), and 61 untreated non-diabetic subjects with grade 1 and grade 2 uncomplicated essential hypertension, matched for age and gender, and chosen from patients attending an outpatient clinic (group II; mean age, 65 +/- 5 years), were considered for this analysis. All patients underwent blood sampling for routine blood chemistry, 24-h urine collection for microalbuminuria, two 24-h periods of ambulatory blood pressure monitoring (ABPM) within a 4-week period, echocardiography, and carotid ultrasonography. A dipping pattern was defined as a greater than 10% reduction in the average systolic and diastolic blood pressure at night compared with average daytime values. A reproducible nocturnal dipping and non-dipping profile was found in 11 (30.6%) and 21 (58.3%) diabetic patients, respectively; while only in four (11.1%) patients was a variable dipping profile observed. Of the 23 patients with a non-dipping pattern during the first ABPM period, 21 (91.3%) also had this type of pattern during the second ABPM recording. In group II (non-diabetic hypertensive patients), 30 patients (49.2%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) had a dipping pattern, 13 patients (21.3%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) had a non-dipping profile pattern and 18 patients (29.5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) had a variable dipping pattern. Of the 20 patients with a non-dipping pattern during the first ABPM period, 13 (65.0%) confirmed this type of pattern during the second ABPM recording. Finally, the prevalence of left ventricular hypertrophy (77.7 versus 41.4%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), carotid plaques (80.5 versus 38.3%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), carotid intima-media thickening (54.3 versus 44.0%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and microalbuminuria (11.1 versus 2.0%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) was significantly higher in group I than in group II. According to a logistic regression analysis, diabetes, left ventricular hypertrophy and carotid plaques were the main independent predictors of the non-dipping (pattern in the overall population. These findings indicate that intrasubject variability of non-dipper pattern is lower in diabetic than in non-diabetic hypertensive patients, that classification of diabetic hypertensive patients as dipper or non-dipper on the basis of a single ABP recording is more reliable than in non-diabetic patients, and that the more frequent and reproducible non-dipping (pattern in diabetic patients is associated with a more prominent cardiac and extracardiac target organ damage.
One of the challenges for public-private R&D collaborations in emerging scientific fields is to a... more One of the challenges for public-private R&D collaborations in emerging scientific fields is to actively include the demand side. Insight in how to facilitate learning between stakeholders is, however, lacking. In this paper we present an approach to facilitate and analyse learning processes in multi-stakeholder interactions within public-private research consortia working on new science and technologies. The learning processes that took place during dialogue meetings within the framework of the Dutch Ecogenomics Consortium were analysed, including a reflection on the actual effects. The results show that a carefully structured dialogue method facilitates learning between researchers, users and policy-related participants, and that this learning to some extent is anchored within the Ecogenomics Consortium. At the same time, the results point to the challenges of translating learning into action.
Objective: In order to evaluate blood pressure and lifestyle of a stranger population, the medica... more Objective: In order to evaluate blood pressure and lifestyle of a stranger population, the medical staff of the Hypertension Center of the University of Milan observed a random population of Chinese inhabitants of Milan. Design and method: On the tenth anniversary of the world hypertension day we evaluated 139 Chinese subjects on the street (88 male 48 ± 1,39 y and 51 female 51 ± 1,89 y). Each fellow was submitted to a brief interview about his pathological history, smoke habits and pharmacological therapy. We then measured blood pressure (BP) (according ti the ESH rules) and body height and weight Results: The Chinese population of our City showed a 43.9% of hypertensive individuals (72,4% of them male and 27,5 female) surely more than the expected. Even smoking was a male habit with 44% of smokers against only 0,5% of the female population (p = 0,0006). Our population showed a mean BMI increased for the male subjects (26.87 ± 0,83) and a normal one for the female population (24,6 ...
High Blood Pressure & Cardiovascular Prevention, 2007
We aimed to evaluate the intrasubject short-term reproducibility of nocturnal blood pressure (BP)... more We aimed to evaluate the intrasubject short-term reproducibility of nocturnal blood pressure (BP) patterns (dipping/non-dipping) in essential hypertensive patients in relation to age (>50 years) and gender. Methods: A total of 619 never-treated essential grade 1 and 2 hypertensives (383 men, 236 women) underwent the following procedures: 1) repeated clinic BP measurements, 2) routine examinations, 3) ambulatory BP monitoring (ABPM) over two 24-h periods within 4 weeks. Dipping pattern was defined as a 10%, or more, reduction in average SBP/DBP at night compared to daytime values. Results: Of the 407 patients showing a dipping pattern during the first ABPM period, 329 (80.1%) had the same pattern during the second ABPM recording. Of the 211 patients with a non-dipping pattern during the first ABPM period, 140 (65.9%) confirmed the same pattern during the second ABM period. Overall, 149 patients (24.1%) changed their initial nocturnal pattern at the second ABPM recording, without significant age and gender-related differences. Lower reproducibility rates of the non-dipping as compared to the dipping pattern were found in the whole population as well as in men regardless of age and in younger but not in older women. Conclusions: These findings indicate that nocturnal BP patterns have a limited short-term reproducibility in the whole study population as well as in different age and gender subgroups. As variability of nocturnal BP patterns is not predicted by easy available clinical data, such as gender and age, a reliable classification of patients according to circadian BP patterns should be obtained by repeating ABPM.
Objective: Although it is generally acknowledged that the health of migrants differs from that of... more Objective: Although it is generally acknowledged that the health of migrants differs from that of not- migrants, only few epidemiological studies have specifically investigated the prevalence of cardiovascular (CVR) factors and hypertension in migrant populations, In particular, NON studies show on Chinese migrants. The aim of this study is to provide an epidemiological profile of the Chinese community healthcare condition in Milan City. Design and method: Sample selected by Multicenter General Clinic check-up population in Chinese immigrants in Milan. To describe to prevalence of major CVR factors and to evaluate hepatic condition of steatosis in general Chinese community living in Milan. Mean outcome measures of adverse CVR factors were defined by using the Chinese Guidelines for metabolic syndrome. Prevalence of hepatic steatosis was independently defined by mean of ultrasonography technic. Screening analyses involved 229 participants who completed the proposed questionnaire, wer...
High Blood Pressure & Cardiovascular Prevention, 2007
We aimed to evaluate the impact of overweight/obesity and nocturnal blood pressure (BP) patterns ... more We aimed to evaluate the impact of overweight/obesity and nocturnal blood pressure (BP) patterns (dipping non dipping)in untreated essential hypertensives. Methods: A total of 658 consecutive outpatients with grade 1 and 2 hypertension (408 men, 250 women) underwent the following procedures: 1) repeated clinic BP measurements, 2) routine examinations 3) ambulatory BP monitoring over two 24-h periods within four weeks. The dipping pattern was defined as a >10% reduction in average systolic and diastolic BP during night-time compared to day time values. The patients have been classified, with reference to the reproducibility or not of the nocturnal pattern: D-D (reproducible dipping), ND-ND (reproducible nondipping) and VD (variable dipping). The relation between body mass index(BMI) and BP patterns has been analysed in the whole population and in a gender-based analysis. Results: In the total population, the prevalence of overweight (BMI >25 > 30 kg/m 2) resulted to be 40% and 12%, respectively and such conditions were associated to higher frequency of patterns ND-ND and VD compared to the pattern D-D (p < 0.05). Among men with a normal BMI (<25 kg/m 2), the prevalence of DD pattern was significantly higher compared to that of subjects with overweight and obesity (58,6% vs 48,6%, p < 0.01); this was the case for lean women (53,3% vs 46,9%, p < 0.05) when compared to their overweight or obese counterpart. Conclusions: Our findings are that prevalence and reproducibility of the dipping pattern profile are significantly higher in lean hypertensive patients, regardless the gender, as compared to their counterpart with an increased BMI. Therefore the phenotype overweight-obesity is a negative predictor for a physiological and stable nocturnal fall in BP.
High Blood Pressure & Cardiovascular Prevention, 2007
Whether serum uric acid (SUA) is an independent risk factor for target organ damage (TOD) and car... more Whether serum uric acid (SUA) is an independent risk factor for target organ damage (TOD) and cardiovascular events in human hypertension is still undefined. We sought to investigate the association of SUA with subclinical cardiac, vascular and renal alterations in never treated uncomplicated essential hypertensives. Methods: A total of 580 subjects with recently diagnosed (<1 year) grade 1 and 2 hypertension, categorized by sex and tertiles of SUA levels were considered for this analysis. All subjects underwent extensive clinical, laboratory and ultrasonographic investigations searching for cardiac and extracardiac TOD. Results: Hyperuricemia (SUA >7.0 mg/dl in men and >6 mg/dl in women) was present in 8.3% of the patients. The overall prevalence of left ventricular hypertrophy (LVH), carotid alterations and microalbuminuria was 28%, 27% and 8%, respectively. No differences in the prevalence rates of these TOD markers were present across SUA tertiles in the whole population, as well as in both genders. SUA levels were similar in patients with and without LVH, carotid alterations or MA. When patients were classified according to the number of organs involved, those with multiple TOD (2 or 3 organs) had significantly higher SUA levels (5.1±1.3, 5.2±1.4 mg/dl), as compared to those with a single or no organ involvement (4.9±1.3, 4.9±1.4 mg/dl, p< 0.05). The association, however, between SUA levels and multiple TOD was not confirmed in a logistic regression analysis. Conclusions: Our findings do not support a role of SUA as an independent risk factor for subclinical TOD in a selected population of recently diagnosed uncomplicated hypertensives at low prevalence of hyperuricaemia.
High Blood Pressure & Cardiovascular Prevention, 2008
Aim. We investigated the prevalence of the metabolic syndrome (MS) in hypertensive patients categ... more Aim. We investigated the prevalence of the metabolic syndrome (MS) in hypertensive patients categorized according to the number of markers of organ damage (OD) in order to assess the value of a systematic search for cardiac and extra-cardiac OD in the MS setting. Methods. A total of 3119 untreated and treated essential hypertensive patients included in the Evaluation of Target Organ Damage in Hypertension (ETODH), an observational registry of hypertension-related OD, were considered for this analysis. All patients underwent extensive searching for left ventricular hypertrophy (LVH) or LV concentric remodelling (cardiac OD), carotid plaques and/or intima-media thickening (vascular OD) and microalbuminuria (MA) and/or increased serum creatinine (renal OD). Subjects were classified as: positive for none (group 0), one (group I), two (group II) or three markers (group III) of OD. Results. MS prevalence rates progressively rose across the groups stratified according to the OD score, reaching a 2.3-fold increase in group III as compared to their MS counterparts in group 0. The distribution of subjects with and without the MS across the groups, was 15 vs 29 % (group 0), 32 vs 38% (group I), 39 vs 26% (group II) and 14 vs 7 % (group III), respectively. Thus, subjects having 2 or 3 markers of OD were 53% among those with MS and 33% (p<0.01) among those without it. Conclusions. Our findings indicate a strong association between the MS and OD by showing that a clustering of two or three OD is the prevalent cardiovascular phenotype in MS hypertensive patients referred to a specialist centre and call for a systematic evaluation of cardiac and extra cardiac OD in this setting.
High Blood Pressure & Cardiovascular Prevention, 2008
Left ventricular hypertrophy (LVH) assessed by echocardiography has a relevant impact in clinical... more Left ventricular hypertrophy (LVH) assessed by echocardiography has a relevant impact in clinical decision making in hypertensive patients. Aim. We investigated the precision and accuracy of hypertensive LVH determination in current clinical practice by a regional-based survey. Methods. The study included 211 patients with essential hypertension consecutively attending six hospital outpatient hypertension clinics in the northern Italian region of Lombardy; all subjects had undergone an echocardiographic examination for hypertension related problems in a non-academic or research ultrasound laboratory within two years. The original echocardiographic report was examined to ascertain whether the diagnosis of LVH was based on calculation of LV mass according to validated formulae and indexed to body size (primary outcome) and whether LV geometrical patterns and indices of diastolic function were provided (secondary outcome). Results. A total of 211 echocardiograms performed by 120 physicians operating in 73 different hospital and out-of-hospital ultrasound laboratories were collected. Absolute LV mass, LV mass index and relative wall thickness were calculated in 45.5 %, 24.6 % and 12.3% of the cases, respectively. Parameters of LV diastolic filling were measured in two-thirds of the cases and estimation of E/A ratio was provided by less than 20% of the examinations. Conclusions. This study shows that a large majority of echocardiographic examinations routinely performed in hypertensive subjects in order to detect cardiac damage, do not report qualifying data on LV mass, LV geometry and diastolic function. These results indicate that a quantitative assessment of LVH and LV function is rarely provided in clinical practice.
High Blood Pressure & Cardiovascular Prevention, 2008
Introduction. We investigated the cluster of cardiac, vascular and renal damages in a large sampl... more Introduction. We investigated the cluster of cardiac, vascular and renal damages in a large sample of treated hypertensive patients in order to assess the value of a systematic search for organ damage (OD) during antihypertensive treatment. Methods. A total of 2213 treated essential hypertensive patients included in the Evaluation of Target Organ Damage in Hypertension (ETODH), an observational registry of hypertension-related OD, were considered for this analysis. All patients underwent extensive investigations searching for left ventricular hypertrophy (LVH) or LV concentric remodelling (cardiac OD), carotid plaques and/or intima-media thickening (vascular OD) and microalbuminuria (MA) and/or increased serum creatinine (renal OD). Results. In the whole population the most common OD was LVH (46.5%) followed by carotid plaque (44.1%), carotid IM thickening (28.8%), MA (19.1%), LV concentric remodelling (10.4%) and increased serum creatinine (3.1%). Over all, the involvement of a single organ was observed in a limited fraction of patients, ranging from 23% for MA to 51% for carotid plaque. Prevalence rates of patients negative for OD (group I) or positive for one (group II), two (group III), or three (group IV) markers of OD were the following: 17.2 %, 36.4%, 33.9 % and 12.5 %, respectively. Conclusions. Our findings show that a cluster of two or three OD is the prevalent cardiovascular phenotype in treated hypertensive patients referred to a specialist centre. These findings call for an extensive evaluation of cardiac and extracardiac OD in all patients attending a specialist setting.
High Blood Pressure & Cardiovascular Prevention, 2007
Introduction: Limited evidence is available about the relationship between ambulatory heart rate ... more Introduction: Limited evidence is available about the relationship between ambulatory heart rate (HR) and target organ damage (TOD) in uncomplicated hypertension. Aim: We sought to investigate the association of ambulatory HR with subclinical cardiac, vascular and renal markers of TOD in never treated essential hypertensives. Methods: A total of 580 subjects with recently diagnosed (<1 year) grade 1 and 2 hypertension, categorized by tertiles of ambulatory 48-hour HR levels and sex or by presence or absence of TOD were considered for this analysis. All subjects underwent two 24-hour ambulatory blood pressure monitoring (ABPM) at 1 to 4 week interval, extensive laboratory and ultrasonographic investigations searching for microalbuminuria (MA), left ventricular hypertrophy (LVH) and carotid atherosclerosis (carotid thickening/plaque). Results: In the whole population, as well as in both genders, LVH, carotid atherosclerosis and MA prevalence rates did not significantly increase with 48-hour HR tertiles increments. When patients were categorized according to the absence or presence of any sign of TOD (i.e. LVH, carotid atherosclerosis or MA) no significant intergroup differences in 48-hour HR were found. Furthermore, average 48-hour HR was similar in patients without organ involvement as in those with one, two or three TOD signs. Finally, in a multivariate analysis age, 48-hour systolic BP and ATP III metabolic syndrome but not HR were independently associated with TOD. Conclusions: Our findings show a lack of association between ambulatory HR and markers of TOD and do not support the view that a faster 48-hour HR may have an additive effect in the development in organ damage in the early phases of essential hypertension.
It is still undefined whether serum uric acid (SUA) is an independent risk factor for target orga... more It is still undefined whether serum uric acid (SUA) is an independent risk factor for target organ damage (TOD) and cardiovascular events in human hypertension. We sought to investigate the association of SUA with subclinical cardiac, vascular, and renal alterations in never-treated uncomplicated essential hypertensives. A total of 580 subjects with recently diagnosed (<1 year) grade 1 and 2 hypertension, categorized by sex and tertiles of SUA levels, were considered for this analysis. All subjects underwent extensive clinical, laboratory, and ultrasonographic investigations searching for cardiac and extracardiac TOD. Hyperuricemia (SUA >7.0 mg/dL in men and >6 mg/dL in women) was present in 8.3% of the patients. The overall prevalence of left-ventricular hypertrophy (LVH), carotid alterations, and microalbuminuria was 28%, 27%, and 8%, respectively. No differences in the prevalence rates of these TOD markers were present across all SUA tertiles in the entire population, as...
Little information is available on the reproducibility of nocturnal variations in blood pressure ... more Little information is available on the reproducibility of nocturnal variations in blood pressure in type 2 diabetic hypertensive patients. We aimed to compare the intrasubject short-term reproducibility of a nocturnal non-dipping pattern and the prevalence of cardiac and extracardiac signs of target organ damage, in a group of type 2 diabetic hypertensive patients and in an age/gender-matched group of non-diabetic hypertensive subjects. Thirty-six treated hypertensive patients with long-lasting type 2 diabetes (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 10 years duration) consecutively attending our hospital out-patient hypertension clinic (group I; mean age, 65 +/- 9 years), and 61 untreated non-diabetic subjects with grade 1 and grade 2 uncomplicated essential hypertension, matched for age and gender, and chosen from patients attending an outpatient clinic (group II; mean age, 65 +/- 5 years), were considered for this analysis. All patients underwent blood sampling for routine blood chemistry, 24-h urine collection for microalbuminuria, two 24-h periods of ambulatory blood pressure monitoring (ABPM) within a 4-week period, echocardiography, and carotid ultrasonography. A dipping pattern was defined as a greater than 10% reduction in the average systolic and diastolic blood pressure at night compared with average daytime values. A reproducible nocturnal dipping and non-dipping profile was found in 11 (30.6%) and 21 (58.3%) diabetic patients, respectively; while only in four (11.1%) patients was a variable dipping profile observed. Of the 23 patients with a non-dipping pattern during the first ABPM period, 21 (91.3%) also had this type of pattern during the second ABPM recording. In group II (non-diabetic hypertensive patients), 30 patients (49.2%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) had a dipping pattern, 13 patients (21.3%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) had a non-dipping profile pattern and 18 patients (29.5%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) had a variable dipping pattern. Of the 20 patients with a non-dipping pattern during the first ABPM period, 13 (65.0%) confirmed this type of pattern during the second ABPM recording. Finally, the prevalence of left ventricular hypertrophy (77.7 versus 41.4%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), carotid plaques (80.5 versus 38.3%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), carotid intima-media thickening (54.3 versus 44.0%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and microalbuminuria (11.1 versus 2.0%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01) was significantly higher in group I than in group II. According to a logistic regression analysis, diabetes, left ventricular hypertrophy and carotid plaques were the main independent predictors of the non-dipping (pattern in the overall population. These findings indicate that intrasubject variability of non-dipper pattern is lower in diabetic than in non-diabetic hypertensive patients, that classification of diabetic hypertensive patients as dipper or non-dipper on the basis of a single ABP recording is more reliable than in non-diabetic patients, and that the more frequent and reproducible non-dipping (pattern in diabetic patients is associated with a more prominent cardiac and extracardiac target organ damage.
One of the challenges for public-private R&D collaborations in emerging scientific fields is to a... more One of the challenges for public-private R&D collaborations in emerging scientific fields is to actively include the demand side. Insight in how to facilitate learning between stakeholders is, however, lacking. In this paper we present an approach to facilitate and analyse learning processes in multi-stakeholder interactions within public-private research consortia working on new science and technologies. The learning processes that took place during dialogue meetings within the framework of the Dutch Ecogenomics Consortium were analysed, including a reflection on the actual effects. The results show that a carefully structured dialogue method facilitates learning between researchers, users and policy-related participants, and that this learning to some extent is anchored within the Ecogenomics Consortium. At the same time, the results point to the challenges of translating learning into action.
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Papers by M. Maisaidi