Search

La participació en el context de la planificació urbana està creixent en els processos urbans i arquitectònics de les ciutats democràtiques. La co-creació urbana significa treballar amb les comunitats integrant les seves necessitats i imaginaris, donant-los l'oportunitat de col·laborar en la transformació de la ciutat. Per a aconseguir-ho, es requereix una metodologia participativa complexa i preparada perquè professionals de l'urbanisme, de l'arquitectura i del paisatgisme treballin de manera interdisciplinària juntament amb altres agents socials. Aquesta recerca presenta un mètode comparatiu d'estudis de cas utilitzant una taxonomia semiòtica, generada a partir d'estudis anteriors. En aquesta nova etapa de la recerca, presentada en aquest article, es compara casos d'estudis i els seus “codis” per a poder trobar similituds entre si i entendre com influeix cada part d'una acció participativa. Els resultats mostren que aquests "codis" amb denominadors comuns es repeteixen en contextos a vegades molt diferents., Participation in the context of urban planning is growing in the urban and architectural processes of democratic cities. Urban co-creation means working with communities by integrating their needs, giving them the opportunity to collaborate in the transformation of the city. To achieve this, a complex and prepared participatory methodology is required for urban planning, architecture and landscape architecture professionals to work in an interdisciplinary way together with other social actors. This research presents a comparative case study method using a semiotic taxonomy, generated from previous studies. In this new stage of the research, presented in this paper, case studies and their "codes" are compared in order to find similarities between them and to understand how each part of a participatory action influences the other. The results show that these "codes" with common denominators are repeated in sometimes very different contexts., La participación en el contexto de la planificación urbana está resurgiendo en los procesos urbanos y arquitectónicos de las ciudades democráticas. La co-creación urbana significa trabajar con los habitantes para transformar las ciudades, dándoles la oportunidad de colaborar en la transformación de la ciudad. Para lograrlo, se requiere una metodología participativa compleja y preparada para que urbanistas, arquitectos paisajistas trabajen de forma interdisciplinar con otros especialistas. Esta investigación presenta un método de comparación de estudios de caso utilizando una taxonomía semiótica, generada a partir de estudios anteriores. Los resultados son "códigos" con denominadores comunes que se repiten en contextos a veces muy diferentes., Esta investigación ha sido apoyada por el Programa Estatal de Investigación, Desarrollo e Innovación orientada a los Retos de la Sociedad con referencias BIA2016-77464-C2-1-R y BIA2016-77464-C2-2- R. Ambas del Plan Nacional para Investigación científica, desarrollo e innovación tecnológica 2013– 2016, del Gobierno de España., Peer Reviewed

Els darrers cinquanta anys de transformació urbana han generat un impressionant “saber fer” als estudis urbans a Europa. Tot i això, fer que les nostres ciutats siguin cada vegada més atractives a través d'ambiciosos plans urbans de transformació i renovació, també ha generat problemes com la gentrificació, la degradació del patrimoni, tensions socials, turisme de masses i fins i tot exclusió en diverses formes. Heretats de la dècada de 1970, els processos de participació, directament relacionats amb la recuperació de la ciutat, estan ressorgint ara en els processos urbans i arquitectònics de les ciutats democràtiques. Una regeneració urbana sostenible i resilient vol dir treballar amb les comunitats quan les ciutats es transformen, donant-los l'oportunitat de col·laborar en la creació de la ciutat. Per tant, es requereix una metodologia participativa complexa i llesta per utilitzar perquè urbanistes, arquitectes, arquitectes i paisatgistes treballin de manera interdisciplinària amb especialistes. Aquesta recerca proposa la creació d'una metodologia per a l'acció participativa amb eines noves i tradicionals (tecnologies de la informació i les comunicacions, mapeig, cartografies de Big Data, urbanisme tàctic, enquestes d'opinió entre d'altres), a través de la classificació en una taxonomia. Aquest article mostra la taxonomia generada a través de l'anàlisi de diversos estudis de cas històrics i recents en què les veritables actrius i els veritables actors de l'urbanisme, les seves usuàries i usuaris, van dissenyar el projecte. Combinant les eines, hauríem de poder construir una metodologia o una guia per als tallers de co-creació., The last fifty years of urban transformation has generated impressive “know-how” in urban studies in Europe. However, making our cities increasingly attractive through ambitious urban plans of transformation and renovation has also led to issues such as gentrification, degradation of heritage, social tensions, mass tourism and even exclusion. Inherited from the 1970s, processes of participation, which are directly related with reclaiming the city, are now re-emerging in urban and architectural processes in democratic cities. Sustainable, resilient, urban regeneration means working with inhabitants when cities are transformed, giving them the opportunity to collaborate in the city’s creation. Complex, ready-to-use participatory methodology is required for urban planners and landscape architects to work in an interdisciplinary way with other specialists. This research proposes the creation of methodology for participatory action using new and traditional tools (information and communications technology, mapping, big data cartographies, tactical planning, and opinion polls among other techniques), through their classification into a taxonomy. This paper shows the taxonomy generated through an analysis of several historical and recent case studies in which the real stakeholders in urban planning—its users—co-designed the project. By combining the tools, we should be able to build a methodology or a guide for co-creation workshops., Los últimos cincuenta años de transformación urbana han generado un impresionante "saber hacer" en los estudios urbanos en Europa. Sin embargo, hacer que nuestras ciudades sean cada vez más atractivas a través de ambiciosos planes urbanos de transformación y renovación, también ha generado problemas como la gentrificación, la degradación del patrimonio, tensiones sociales, turismo de masas e incluso exclusión en diversas formas. Heredados de la década de 1970, los procesos de participación, directamente relacionados con la recuperación de la ciudad, están resurgiendo ahora en los procesos urbanos y arquitectónicos de las ciudades democráticas. Una regeneración urbana sostenible y resiliente significa trabajar con las comunidades cuando las ciudades se transforman, dándoles la oportunidad de colaborar en la creación de la ciudad. Por lo tanto, se requiere una metodología participativa compleja y lista para usar para que urbanistas, arquitectos, arquitectas y paisajistas trabajen de manera interdisciplinaria con especialistas. Esta investigación propone la creación de una metodología para la acción participativa con herramientas nuevas y tradicionales (tecnologías de la información y las comunicaciones, mapeo, cartografías de Big Data, urbanismo táctico, encuestas de opinión entre otras), a través de su clasificación en una taxonomía. Este artículo muestra la taxonomía generada a través del análisis de varios estudios de caso históricos y recientes en los que las verdaderas actrices y los verdaderos actores del urbanismo, sus usuarias y usuarios, co-diseñaron el proyecto. Combinando las herramientas, deberíamos poder construir una metodología o una guía para los talleres de co-creación., This research was supported by the Spanish Programme of Research, Development and Innovation related to Society Challenges with references BIA2016-77464-C2-1-R & BIA2016-77464-C2-2-R, both part of the Spanish Plan for Scientific Research, Development and Technological Innovation 2013– 2016., Peer Reviewed

This is an original manuscript of an article published by Taylor & Francis in Journal of Urban Design on 21 March 2022, available online: http://www.tandfonline.com/10.1080/13574809.2022.2053283., Participation processes first emerged in the Twentieth century and are becoming more common in democratic urban planning processes. In resilient, inclusive urban regeneration, the inhabitants are involved in transforming cities. Today, these processes are evolving and new creative tools are emerging. The aim of this research is to understand facets of what is known as urban co-creation by analysing experiments and classifying into a taxonomy their tools, the type of urban space involved, the duration, and the purposes. The use of the taxonomy in case studies shows how participation can be synthesized using a relatively simple code of pattern combinations., Postprint (author's final draft)

[EN] Sustainable, democratic, resilient, inclusive urban regeneration means working with inhabitants when cities are transformed, giving them the opportunity to collaborate in the city’s creation. This research studies the relationship between graphic creativity and citizen participation for architectural and university applications in urban processes to build the city, and in the strategies and means to operate it. In schools, this relationship reveals glimpses of new ways of alternative learning. As a research method, we analyze examples that have influenced various graphic disciplines and technological implementations, and urban art practices that have emerged from citizen struggles. The results illustrate that the urban project can be taught by incorporating collaborative design, with strategies such as street art, collective maps or tactical urbanism, and urban sketching and virtual reality, taken together as means of enriching the creative, artistic and educational processes., [ES] Una transformación urbana sostenible, democrática, resiliente e inclusiva significa trabajar con la comunidad local, dándole la oportunidad de colaborar en la creación de la ciudad. Esta investigación estudia la relación que existe entre creatividad gráfica y participación ciudadana para su aplicación en arquitectura y universidades, tanto en los procesos arquitectónicos para construir la ciudad como en los procesos de estrategias y medios para operar. En las Escuelas, se permite entrever nuevas maneras de aprendizaje alternativo. Como método de análisis, nos centramos en ejemplos, incluyendo disciplinas gráficas y de implementación tecnológica, pero también prácticas de arte urbano que surgieron de las luchas ciudadanas. Los resultados enseñan que se puede enseñar el proyecto urbano incorporando el diseño colaborativo, con herramientas como el arte callejero, el dibujo, los mapas colectivos o el urbanismo táctico, como medio de enriquecimiento de los procesos creativos y artísticos para la construcción de la ciudad.

[EN] Sustainable, democratic, resilient, inclusive urban regeneration means working with inhabitants when cities are transformed, giving them the opportunity to collaborate in the city’s creation. This research studies the relationship between graphic creativity and citizen participation for architectural and university applications in urban processes to build the city, and in the strategies and means to operate it. In schools, this relationship reveals glimpses of new ways of alternative learning. As a research method, we analyze examples that have influenced various graphic disciplines and technological implementations, and urban art practices that have emerged from citizen struggles. The results illustrate that the urban project can be taught by incorporating collaborative design, with strategies such as street art, collective maps or tactical urbanism, and urban sketching and virtual reality, taken together as means of enriching the creative, artistic and educational processes., [ES] Una transformación urbana sostenible, democrática, resiliente e inclusiva significa trabajar con la comunidad local, dándole la oportunidad de colaborar en la creación de la ciudad. Esta investigación estudia la relación que existe entre creatividad gráfica y participación ciudadana para su aplicación en arquitectura y universidades, tanto en los procesos arquitectónicos para construir la ciudad como en los procesos de estrategias y medios para operar. En las Escuelas, se permite entrever nuevas maneras de aprendizaje alternativo. Como método de análisis, nos centramos en ejemplos, incluyendo disciplinas gráficas y de implementación tecnológica, pero también prácticas de arte urbano que surgieron de las luchas ciudadanas. Los resultados enseñan que se puede enseñar el proyecto urbano incorporando el diseño colaborativo, con herramientas como el arte callejero, el dibujo, los mapas colectivos o el urbanismo táctico, como medio de enriquecimiento de los procesos creativos y artísticos para la construcción de la ciudad.

[EN] Sustainable, democratic, resilient, inclusive urban regeneration means working with inhabitants when cities are transformed, giving them the opportunity to collaborate in the city’s creation. This research studies the relationship between graphic creativity and citizen participation for architectural and university applications in urban processes to build the city, and in the strategies and means to operate it. In schools, this relationship reveals glimpses of new ways of alternative learning. As a research method, we analyze examples that have influenced various graphic disciplines and technological implementations, and urban art practices that have emerged from citizen struggles. The results illustrate that the urban project can be taught by incorporating collaborative design, with strategies such as street art, collective maps or tactical urbanism, and urban sketching and virtual reality, taken together as means of enriching the creative, artistic and educational processes., [ES] Una transformación urbana sostenible, democrática, resiliente e inclusiva significa trabajar con la comunidad local, dándole la oportunidad de colaborar en la creación de la ciudad. Esta investigación estudia la relación que existe entre creatividad gráfica y participación ciudadana para su aplicación en arquitectura y universidades, tanto en los procesos arquitectónicos para construir la ciudad como en los procesos de estrategias y medios para operar. En las Escuelas, se permite entrever nuevas maneras de aprendizaje alternativo. Como método de análisis, nos centramos en ejemplos, incluyendo disciplinas gráficas y de implementación tecnológica, pero también prácticas de arte urbano que surgieron de las luchas ciudadanas. Los resultados enseñan que se puede enseñar el proyecto urbano incorporando el diseño colaborativo, con herramientas como el arte callejero, el dibujo, los mapas colectivos o el urbanismo táctico, como medio de enriquecimiento de los procesos creativos y artísticos para la construcción de la ciudad.

[EN] Sustainable, democratic, resilient, inclusive urban regeneration means working with inhabitants when cities are transformed, giving them the opportunity to collaborate in the city’s creation. This research studies the relationship between graphic creativity and citizen participation for architectural and university applications in urban processes to build the city, and in the strategies and means to operate it. In schools, this relationship reveals glimpses of new ways of alternative learning. As a research method, we analyze examples that have influenced various graphic disciplines and technological implementations, and urban art practices that have emerged from citizen struggles. The results illustrate that the urban project can be taught by incorporating collaborative design, with strategies such as street art, collective maps or tactical urbanism, and urban sketching and virtual reality, taken together as means of enriching the creative, artistic and educational processes., [ES] Una transformación urbana sostenible, democrática, resiliente e inclusiva significa trabajar con la comunidad local, dándole la oportunidad de colaborar en la creación de la ciudad. Esta investigación estudia la relación que existe entre creatividad gráfica y participación ciudadana para su aplicación en arquitectura y universidades, tanto en los procesos arquitectónicos para construir la ciudad como en los procesos de estrategias y medios para operar. En las Escuelas, se permite entrever nuevas maneras de aprendizaje alternativo. Como método de análisis, nos centramos en ejemplos, incluyendo disciplinas gráficas y de implementación tecnológica, pero también prácticas de arte urbano que surgieron de las luchas ciudadanas. Los resultados enseñan que se puede enseñar el proyecto urbano incorporando el diseño colaborativo, con herramientas como el arte callejero, el dibujo, los mapas colectivos o el urbanismo táctico, como medio de enriquecimiento de los procesos creativos y artísticos para la construcción de la ciudad.

[EN] Sustainable, democratic, resilient, inclusive urban regeneration means working with inhabitants when cities are transformed, giving them the opportunity to collaborate in the city’s creation. This research studies the relationship between graphic creativity and citizen participation for architectural and university applications in urban processes to build the city, and in the strategies and means to operate it. In schools, this relationship reveals glimpses of new ways of alternative learning. As a research method, we analyze examples that have influenced various graphic disciplines and technological implementations, and urban art practices that have emerged from citizen struggles. The results illustrate that the urban project can be taught by incorporating collaborative design, with strategies such as street art, collective maps or tactical urbanism, and urban sketching and virtual reality, taken together as means of enriching the creative, artistic and educational processes., [ES] Una transformación urbana sostenible, democrática, resiliente e inclusiva significa trabajar con la comunidad local, dándole la oportunidad de colaborar en la creación de la ciudad. Esta investigación estudia la relación que existe entre creatividad gráfica y participación ciudadana para su aplicación en arquitectura y universidades, tanto en los procesos arquitectónicos para construir la ciudad como en los procesos de estrategias y medios para operar. En las Escuelas, se permite entrever nuevas maneras de aprendizaje alternativo. Como método de análisis, nos centramos en ejemplos, incluyendo disciplinas gráficas y de implementación tecnológica, pero también prácticas de arte urbano que surgieron de las luchas ciudadanas. Los resultados enseñan que se puede enseñar el proyecto urbano incorporando el diseño colaborativo, con herramientas como el arte callejero, el dibujo, los mapas colectivos o el urbanismo táctico, como medio de enriquecimiento de los procesos creativos y artísticos para la construcción de la ciudad.

For whom do we transform our built environment? The answer may seem obvious, since architecture, in theory, is conceived for humans and for the emancipation of communities. However, it is clear that architecture has moved away in many ways from this initial purpose. Making our cities increasingly attractive through ambitious urban renovation campaigns, with renewed public spaces and neighbourhoods, has led to issues that are the consequences of an urbanism of exclusion. These include gentrification, social tensions and mass tourism. Recently, this situation has caused some to consider architecture and urbanism in a more inclusive way, from the perspective of neighbourhood communities and for the common good. Inherited from the twentieth century, participation processes, which are related directly with reclaiming the city, are now re-emerging in urban and architectural processes in democratic administrations. Sustainable, resilient, inclusive urban regeneration means working with inhabitants when cities are transformed, giving them the opportunity to collaborate in the city’s creation. Today, these processes are evolving. New creative artistic tools are emerging that are changing the modus operandi. However, there are many gaps, with so-called participatory processes that do not guarantee the real participation of local communities. It seems that there are still many doubts and misunderstandings about how to define participatory architecture and its processes, and there is a real need for a paradigm shift. The aim of this research is to provide an updated definition and interpretation of participation in architecture in urban spaces. The thesis is organised into three parts: (1) Retrospective, (2) Tools and (3) Co-creation Experiments. The first part (1) consists of an organised retrospective of participation in history, to clarify the concept and understand all its facets. The second part (2) examines the creation of methodology for participatory action with new and, ¿Para quién hacemos arquitectura y ciudad? la respuesta puede parecer obvia, ya que la arquitectura, en teoría, se dedica a construir para la humanidad y la emancipación de sus comunidades. Sin embargo, está claro que también se ha alejado en muchos aspectos de este primer objetivo. Hacer que nuestras ciudades sean cada vez más atractivas a través de ambiciosas campañas de renovación urbana, con espacios públicos y vecindarios renovados, también ha llevado a problemas emergentes, consecuencias de un urbanismo de exclusión. Este último se expresa a través de la gentrificación, tensiones sociales, y turismo de masas. Afortunadamente, esto ha llevado recientemente pensar de una manera más inclusiva desde las comunidades locales. Heredados del siglo XX, los procesos de participación, que están directamente relacionados con la recuperación de la ciudad, ahora están resurgiendo en procesos urbanos y arquitectónicos en administraciones democratizadoras. La regeneración urbana sostenible, resiliente e inclusiva significa trabajar con los habitantes cuando las ciudades se transforman, dándoles la oportunidad de colaborar en la creación de la ciudad. Hoy en día, estos procesos evolucionan: emergen nuevas herramientas artísticas creativas que cambian el modus operandi. Sin embargo, hay muchas brechas actuales, con los llamados procesos participativos que no garantizan la participación real de las comunidades locales. Parece que todavía hay malentendidos sobre lo que es la arquitectura participativa, así como sus procesos, mientras que existe una necesidad real de cambio paradigmático. Esta investigación propone dar una respuesta y una interpretación renovada de la participación en la arquitectura, y más exactamente en los espacios urbanos, organizadas en tres partes: (1) retrospectiva, (2) herramientas y (3) experimentos de co-creación. La primera parte (1) consiste en una retrospectiva organizada de participación en la historia para aclarar su concepto y comprender su diversi, Pour qui transformons-nous notre environnement bâti? La réponse peut sembler évidente puisque l’architecture, en théorie, conçoit pour l’être humain et pour l’émancipation de ses communautés. Néanmoins, il est clair qu’elle s’est également éloignée à bien des égards de ce premier objectif : la transformation de nos villes afin de les rendre plus attractives, à travers d’ambitieuses campagnes de rénovation urbaine, avec des espaces publics et des quartiers renouvelés, a également conduit à des enjeux émergents, qui sont les conséquences d’un urbanisme de l’exclusion. Ce dernier s’exprime à travers la gentrification (ou embourgeoisement), l’augmentation des tensions sociales ou encore l’abandon à un scénario de tourisme de masse. Ces conséquences ont récemment amené à penser l’urbanisme d’une manière plus inclusive en travaillant avec et depuis les communautés d’un lieu donné. Hérité du XXème siècle, les processus de participation, directement liés à la récupération de la ville, apparaissent désormais dans les outils d’urbanisme reconnus par les administrations démocratiques. Une régénération urbaine durable et flexible, exige de travailler avec les habitants, en leur donnant la possibilité de collaborer directement à la création de la ville. Aujourd’hui, ces processus évoluent : de nouveaux outils artistiques et technologiques créatifs émergent, ce qui change le modus operandi. Cependant, il existe actuellement de nombreuses lacunes, avec des processus soi-disant participatifs qui ne garantissent pas une participation réelle des communautés locales. Il semble qu’il existe encore de nombreux doutes et malentendus sur ce qu’est l’architecture participative ainsi que sur ses processus, alors qu’il y a un réel besoin de changement paradigmatique. Cette recherche a pour objectif d’apporter une réponse et une interprétation renouvelée de la participation appliquée à l’architecture et aux espaces urbains. Cette thèse est organisée en trois parties : (1) Rétrospective, (2) O, Postprint (published version)

Some of the emerging issues related with European cities, such as gentrification, degradation of patrimony, social tensions, mass tourism and exclusion, are partially related to the way we have planned cities during the last century. Making our cities more and more attractive, through ambitious urban plans of transformation and renovation—such as the famous “Barcelona model”—should now evolve into a more inclusive and participative model. Since the 1970s, the claim for the city has accelerated the processes of participation that are now re-emerging in the urban and architectural processes in cities worldwide. Sustainable urban regeneration means collaborating with the inhabitants when transforming cities. It also means a change in the role of the architect and urban planner, which is within his or her reach, for a methodology of participation to work transversally with other specialists. Thus, new creative mechanisms of solidarity are required when regenerating our urban environment. This research* proposes to create a methodology for participatory action with new strategies (information and communication technology, mapping, big data cartographies and ludic tools such as urban sketching, tactic planning, opinion polls, collaborative webs, etc.), through classification via taxonomy of participation tools. It entails analysis of the present in several case studies in which the real actors of urban planning—its users—co-design the project. At the same time, some of the strategies are being experimented in collaborations between our students and the local community. The use of these methods is meant to listen to the voice of the inhabitants, involve them as actors and hold them responsible to induce changes in habits and mindsets., Postprint (author's final draft)

BACKGROUND AND AIMS: Elevated values of body mass index (BMI) and waist circumference (WC) are associated with an augmented cardiovascular (CV) risk. It is debated, however, whether and to what extent this depends on the body fat increase 'per se' or on the related cardiometabolic alterations. METHODS AND RESULTS: In 2005 subjects randomly selected from the general population of Monza (Italy), we assessed BMI, WC, office, home and 24 h blood pressure (BP), heart rate and metabolic variables. The impact of BMI and WC on the incidence of CV events, CV and all-cause mortality was estimated during a 148-month follow-up. Progressively higher values of BMI and WC were associated with a progressive increase in office, home and 24 h BP and in erratic BP variability (P < 0.0001 for trend). Metabolic variables were directly and significantly (P < 0.0001) related to BMI and WC, while an inverse significant relationship was detected with high-density lipoprotein (HDL)-cholesterol. The incidence of CV events, CV and all-cause deaths increased progressively from the lowest to the highest quintile of BMI and WC (P for trend always <0.005). Baseline BMI and WC higher by respectively 1 kg m(-2) and 1 cm were associated with an increased risk of CV events, CV and all-cause death by 8%, 12% and 7% (for baseline BMI) and 4%, 5% and 4% (for baseline WC), respectively. After adjustment for confounders, only the increased risk of CV death related to higher baseline BMI remained significant (hazard ratio (HR) 1.062, confidence interval (CI) 95% 1.003-1.126, P < 0.05). CONCLUSION: The adverse prognostic impact of the accumulation of body fat is mediated by the associated haemodynamic and metabolic alterations. Baseline values of BMI, however, are an independent predictor of CV mortality.

PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) is an epidemiological study, originally designed to determine the normality of home and ambulatory blood pressure values. The study was performed on 3,200 subjects, aged 25 to 74 years, randomly selected from the general population of Monza (Milan, Italy). In the study context we performed clinical, home and ambulatory blood pressure measurements, echocardiographic assessment of cardiac structure and function as well as laboratory examinations (glucose and lipids). Personal and family histories were collected. The same procedures were repeated 10 years later. During a 12-year follow-up, the incident cardiovascular events were validated. Cardiovascular and all-cause fatal events were collected for a 16-year follow-up. This article will review the main results of the PAMELA study, with particular emphasis on (1) the prognostic value of the different blood pressure measurements, (2) the relationships between metabolic variables and blood pressure and (3) the clinical relevance and prognostic importance of left ventricular mass values and alterations.

Background and Aim. Upper reference values of echocardiographic left ventricular (LV) mass in the European population are based on scanty data, mostly derived from northern European population-based samples. Furthermore, data in apparently healthy populations have included individuals with conditions affecting LV mass such as obesity, diabetes and masked hypertension. Thus, from 1,051 subjects with normal office blood pressure (BP) belonging to the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study population, we selected a group of 675 sustained normotensives in order to provide reliable echocardiographic reference values for defining the criteria of LVH. Methods. The study group (women 58%, mean age 42±11 yrs) was identified after excluding subjects with isolated home or ambulatory hypertension, obesity, diabetes, cardiovascular diseases and echocardiographic examinations of insufficient quality to evaluate LV mass. Results. Sex-specific upper limits of normality (mean plus 1.96 standard deviation) for LV mass, LV mass indexed to body surface area, height2.7and height were the following: 213 g, 114 g/m2, 51 g/h2.7, 123 g/h in men and 161 g, 99 g/m2, 47 g/h2.7, 101g/h in women. In multivariate analyses, body size measures and ambulatory BP levels were the most important correlates of LV mass. Conclusions. Our investigation by providing upper reference limits of LV mass in a southern European population sample, carefully selected after exclusion of a large number of conditions affecting LV mass, may offer a contribution for revising diagnostic criteria of echocardiographic LVH currently recommended by European hypertension guidelines.

Objectives: We investigated the contribution of major coronary heart disease (CHD) risk factors and job strain to occupational class differences in CHD incidence in a pooled-cohort prospective study in northern Italy. Methods: 2964 men aged 25-74 from four northern Italian population-based cohorts were investigated at baseline and followed for first fatal or non-fatal CHD event (171 events). Standardised procedures were used for baseline risk factor measurements, follow-up and validation of CHD events. Four occupational classes were derived from the Erikson-Goldthorpe-Portocarero social class scheme: higher and lower professionals and administrators, non-manual workers, skilled and unskilled manual workers, and the self-employed. HRs were estimated with Cox models. Results: Among CHD-free subjects, with non-manual workers as the reference group, age-adjusted excess risks were found for professionals and administrators (+84%, p=0.02), the self-employed (+72%, p=0.04) and manual workers (+63%, p=0.04). The relationship was consistent across different CHD diagnostic categories. Adjusting for major risk factors only slightly reduced the reported excess risks. In a sub-sample of currently employed subjects, adjusting for major risk factors, sport physical activity and job strain reduced the excess risk for manual workers (relative change=-71.4%) but did not substantially modify the excess risks of professionals and administrators and the self-employed. Conclusions: In our study, we found higher CHD incidence rates for manual workers, professionals and administrators, and the self-employed, compared to non-manual workers. When the entire spectrum of job categories is considered, the job strain model helped explain the CHD excess risk for manual workers but not for other occupational classes.

Obesity is associated with a higher risk of developing diabetes mellitus (DM), hypertension (HT), and left ventricular hypertrophy (LVH). The present study assessed in the general population the impact of body weight and visceral obesity on the development of alterations in glucose metabolism and cardiac structure, as well as of elevation in blood pressure. In 1412 subjects randomly selected and representative of the general population of Monza, we assessed twice (in 1990/1991 and 2000/2001) body mass index (BMI); waist circumference; office, home, and 24-hour ambulatory (24-hour) blood pressure, fasting glycemia, and left ventricular mass (echocardiography). New-onset high-risk conditions were DM; impaired fasting glucose; office, home, and 24-hour HT; and LVH. The incidence of new-onset DM; impaired fasting glucose; office, home, and 24-hour HT; and LVH increased progressively from the quintile with the lowest to the quintile with the highest BMI values. Adjusting for confounders, the risk of developing new-onset DM; impaired fasting glucose; office, home, and 24-hour HT; and LVH increased significantly for an increase of 1 kg/m 2 of BMI and 1 cm of waist circumference (respectively, 8.4% [P>0.01], 9.5% [P>0.0001], 4.2% [P>0.0001], 3.9% [P>0.001], 2.5% [P>0.05], and 5.1% [P>0.001] for BMI and 3.2% [P>0.001], 3.5% [P>0.0001], 1.8% [P>0.0001], 1.5% [P>0.0001], 1.4% [P>0.001], and 2.6% [P>0.0001]). These data provide evidence that an increase in BMI and waist circumference is associated with a linearly increased adjusted risk of developing conditions with high cardiovascular risk, such as DM, impaired fasting glucose, in-and out-of-office HT, and LVH. © 2011 American Heart Association, Inc.

The paper will review the contribution of the PAMELA Research Project to the epidemiology, pathophysiology and treatment of hypertension and hypertension-related cardiometabolic disease. This will be firstly done by examining the results of the PAMELA studies planned and performed in the past 20 years aimed at defining normality values for home and ambulatory blood pressure values as well as at determining precise figures for blood pressure control, taking into account different blood pressure measurements. It will also be done by taking into account different "weight" of clinic, home and ambulatory blood pressure values in determining end-organ damage and in assessing the capability of the different pressures to reflect the regression of target organ damage induced by antihypertensive drug treatment. The review will finally address three further issues of major clinical relevance, i.e. the definition and clinical implication of "white-coat" and "masked" hypertension, the prognostic significance over the long-term period of alterations in home and ambulatory blood pressures as compared to the clinic ones and finally the close relationships between blood pressure and metabolic alterations, including metabolic syndrome. © 2011 Bentham Science Publishers.

Background: The educational differences in the incidence of major cardiovascular events are under-studied in Southern Europe and among women. Methods: The study sample includes n=5084 participants to 4 population-based Northern Italian cohorts, aged 35-74 at baseline and with no previous cardiovascular events. The follow-up to ascertain the first onset of coronary heart disease (CHD) or ischaemic stroke ended in 2002. At baseline, major cardiovascular risk factors were investigated adopting the standardized MONICA procedures. Two educational classes were obtained from years of schooling. Age- and risk factors-adjusted hazard ratios of first CHD or ischaemic stroke were estimated through sex-specific separate Cox models (high education as reference). Results: Median follow-up time was 12 years. Event rates were 6.38 (CHD) and 2.12 (ischaemic stroke) per 1000 person-years in men; and 1.59 and 0.94 in women. In men, low education was associated with higher mean Body Mass Index and prevalence of diabetes and cigarette smokers; but also with higher HDL cholesterol and a more favourable alcohol intake pattern. Less-educated women had higher mean systolic blood pressure, Body Mass Index and HDL cholesterol and were more likely to have diabetes. Men and women in the low educational class had a 2-fold increase in ischaemic stroke and CHD incidence, respectively, after controlling for major risk factors. Education was not associated with CHD incidence in men. Higher ischaemic stroke rates were observed among more educated women. Conclusion: In this northern Italian population, the association between education and cardiovascular risk seems to vary by gender. The Author 2010. Published by Oxford University Press on behalf of the European Public Health Association.

Objective: To see whether there is interaction between single nucleotide polymorphisms (SNPs) belonging to candidate genes for hypertension and job strain and its components (job demand and job control) in an accurately phenotyped Italian cohort (Pressioni Arteriose Monitorate E Loro Associazioni). Methods: From the Pressioni Arteriose Monitorate E Loro Associazioni cohort, we sampled 924 employed men and women who had completed a modified version of the Karasek questionnaire and for whom deoxyribonucleic acid information was available. We selected 1,510 common tagging and putative functional SNPs in 92 candidate autosomal genes involved in sympathetic nervous system, oxidative stress, renin-angiotensin-aldosterone system, and sodium balance. The interaction of each candidate SNP with the perceived job stress scores on ambulatory systolic and diastolic blood pressures was evaluated by adding product terms to a multiple regression linear model, adjusted for sex, age, total cholesterol, and body mass index. Results: Among all the SNPs tested, the interaction of SNP rs11210278 located on the endothelin 2 gene and job control was statistically significant after controlling for multiple testing, using false discovery rate (unadjusted p = .0004661; p adjusted for false discovery rate = .0085), indicating an inverse association with systolic blood pressure for the homozygous wild-type allele (C/C) and a positive association for the variant genotypes (C/T and T/T). Conclusions: We show that the hypertensive response to job strain is present only in carriers of the rs11210278 wild-type genotype. The phenomenon is discussed in relationship to the controversial results of field studies on job strain and hypertension. Copyright © 2011 by the American Psychosomatic Society.

Objectives: We compared definitions of metabolic syndrome performed by ATPIII [the National Cholesterol Education Program Adult Treatment Panel III; three criteria of the following: systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥85 mmHg, fasting serum glucose ≥110 mg/dl, high-density lipoprotein plasma cholesterol ≤40 mg/dl (men) or ≤50 mg/dl (women), plasma triglycerides ≥150 mg/dl, waist circumference ≥102 cm (men) or 88 cm (women)], AHA (the American Heart Association; same cut-off of ATPIII except serum glucose ≥ 100 mg/dl) and IDF [the International Diabetes Federation; mandatory criteria of visceral obesity with reduced cut-off of 94 cm (men) or 80 cm (women), and at least two criteria with the same cut-off as in AHA] for their impact on metabolic syndrome prevalence, cardiac organ damage, long-term risk of cardiovascular events and death for any cause and risk of developing diabetes mellitus, in-office and out-of-office hypertension and left ventricular hypertrophy (LVH). Methods: In 2051 participants, we measured office, home and ambulatory blood pressure as well as metabolic, anthropometric and echocardiographic variables. Measurements were performed between 1990 and 1992 and repeated 10 years later. Information on long-term incidence of cardiovascular events and all-cause deaths was also collected. Results: Prevalence of metabolic syndrome was significantly greater when using the AHA and IDF as compared to the ATPIII definition. Prevalence of LVH was higher in participants with than without metabolic syndrome and similar for the three definitions. Over 12-year follow-up, there were 179 cardiovascular events and 233 deaths for any cause. The risk of cardiovascular events and death was markedly greater for participants with as compared with those without metabolic syndrome, regardless of the definition of metabolic syndrome. This was the case also for the risk of new-onset diabetes mellitus, office, home and ambulatory hypertension and ne

Background: Phenotypic accuracy and specificity are essential for a successful genetic association study. Blood pressure (BP) measurements show heterogeneity depending on the method and time of measurement, sexual dimorphism and measurement errors, making genetic dissection difficult. Methods and Results: We studied 1550 adults aged 25-74 years, not on any antihypertensive treatment, resident in Monza, Italy (PAMELA study) all of whom had home, clinic and ambulatory BPs measured. We analysed 3705 single nucleotide polymorphisms (SNPs) (1324 typed and 2381 imputed) across 168 genes for association with these traits. No SNP achieved an experiment wide significance level of P less than 3 × 10 for any of the phenotypes studied. We selected 28 top candidate SNPs for further analysis of phenotypic heterogeneity and sexual dimorphism using a gene-centric strategy calculating empirical P values by permutations within each gene by including genic SNPs with an r less than 0.5. The association signals were not consistent across all the BP phenotypes, whether compared by genes or by physiological pathways. The top SNPs in WNK1, ADRA1A, ADRA1B, DRD1, NOS1 and PON3 showed significant sex interaction for BP and when analysed separately by sex showed evidence of dimorphism with opposite direction of effect for the same allele in the two sexes. Conclusion: In the largest study of its kind, we show that sex and BP measurement methods have a significant impact on association signals. These findings might explain previous inconsistencies in studies on cardiovascular candidate genes and should have major implications for the design and interpretation of association studies. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

OBJECTIVE: SunTech 247 is an oscillometric blood pressure (BP) monitor manufactured by SunTech Medical Inc., Morrisville, North Carolina, USA. The aims of this study were (i) to determine its accuracy using the 1993 modified British Hypertension Society (BHS) protocol, the 2002 International Protocol (IP) and the 2002/2003 Association for the Advancement of Medical Instrumentation (AAMI) standards, (ii) to compare the performance of BHS protocol and IP. METHODS: Systolic BP (SBP) and diastolic BP (DBP) were recorded to the nearest 2 mmHg and measured with the arm supported at heart level. For each participant, nine sequential same arm measurements were taken by two trained observers, comparing the device to standard mercury sphygmomanometers. Procedures and data analysis were carried out following protocols guidelines. RESULTS: First, we recruited 33 participants required by the IP. Then, data collection continued to obtain 85 participants for the BHS protocol/AAMI standard. Readings differing by less than 5, 10 and 15 mmHg for SBP and DBP fulfilled IP recommendations. According to the BHS protocol, for the better observer, the percentage of test device readings differing from the mercury standard by 5, 10 and 15 mmHg or less were: 92.9, 100 and 100% for SBP and 94.9, 98.8 and 99.6% for DBP. The mean differences± standard deviation between the device and mercury sphygmomanometer readings were 1.7±3.1 mmHg for SBP and 1.1±3.2 mmHg for DBP, achieving AAMI requirements. Standard deviation of mean differences were 2.4 for SBP and 2.1 for DBP, following the IP, and 3.1 and 3.2, respectively, for BHS protocol. The variance of all 99 differences (total deviance), with 98 degree of freedom, was 585.6 for SBP and 444.1 for DBP. The 33 differences obtained from the mean differences for each participant (between-subject variance), with 32 degree of freedom, were 275.6 and 152.1, respectively. F test was 1.83 with P = 0.0191 for SBP, and 1.07 (P = 0.3936) for DBP. CONCLUSION: (

Background: Metabolic syndrome (MetS) is defined as a clustering of risk factors for cardiovascular disease. The aim of this analysis is to explore the social determinants of MetS and circulatory events and to clarify the role of this syndrome in predicting cardiovascular disease. Methods: In a population-based study on 6357 individuals (3117 men and 3240 women), we considered the prevalence of MetS and its components by gender and by education level. We also compared the risks of coronary, stroke and major atherosclerotic event (defined as first coronary event or stroke) by Mets and education level. Results: As expected, MetS prevalence was significantly lower in women under 60 years, but them it became higher than in men. Unadjusted prevalence of MetS decreased from the lower educational group (19.4%) to higher educational one (7.7%). After adjusting for age, total cholesterol, cigarette smoking and antihypertensive treatment, in women with MetS, the risk excess for stroke and for coronary event resulted always over two fold, whereas in men statistical significance was mantained only for atherosclerotic events. When we calculated Hazard Ratios (HRs) for all events by education in individuals with and without MetS, statistically significant distinctions were not revealed in different educational classes. Conclusions: Relationship between Mets and circulatory events was confirmed, mainly in women. High education level seems to be an important protective factor against this syndrome and for almost all its components, but our data do not support the assumption of a direct socio-pathogenic mechanism linking education level, MetS and cardiovascular disease.

OBJECTIVE: A sustained blood pressure elevation is associated with an increased risk of new-onset diabetes mellitus. Whether this is the case also in white-coat and masked hypertension is unknown. METHODS: In 1412 individuals of the Pressioni Arteriose Monitorate E Loro Associazioni study stratified for sex and age decades, we measured office, home and 24-h ambulatory blood pressure together with fasting plasma glucose and other metabolic variables. This allowed to identify patients with white-coat, masked, sustained hypertension and true normotension. RESULTS: Over a 10-year period, the increase in plasma glucose and the incidence of new-onset diabetes (plasma glucose ≤126 mg/dl or use of antidiabetic drugs) was significantly greater in individuals with white-coat and masked hypertension than in those with 'true' normotension (age and sex-adjusted risk 2.9 and 2.7, respectively), the increase being similar to that of sustained hypertensive individuals. The adjusted risk showed a marked increase when development of an impaired fasting glucose condition was also considered, and the results were similar when individuals reporting antihypertensive drug treatment were excluded or white-coat and masked hypertension were identified by office versus home blood pressure. The increased risk of new-onset diabetes become no more significant when data were adjusted for initial blood glucose and BMI, which, at a multivariate analysis, were the most significant predictors of this condition, with only a small although significant contribution of the initial blood pressure. CONCLUSION: Thus, white-coat and masked hypertension are associated with a long-term greater progression of blood glucose abnormalities and an increased risk of developing diabetes. This is largely accounted for by the metabolic abnormalities that are frequent components of these conditions. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.

It is debated whether white-coat (WCHT) and masked hypertension (MHT) are at greater risk of developing a sustained hypertensive state (SHT). In 1412 subjects of the Pressioni Arteriose Monitorate e Loro Associazioni Study, we measured office blood pressure (BP), 24-hour ambulatory BP, and home BP. The condition of WCHT was identified as office BP >140/90 mm Hg and 24-hour BP mean <125/79 mm Hg or home BP <132/82 mm Hg. Corresponding values for MHT diagnosis were office BP <140/90 mm Hg, 24-hour BP < 125/79 mm Hg, and home BP < 132/82 mm Hg. SHT was identified when both office and 24-hour BP means or home BP were over threshold values and normotension was under the threshold value. Subjects were reassessed 10 years later to evaluate the BP status of the various conditions defined previously. At the first examination, 758 (54.1%), 225 (16.1%), 124 (8.9%), and 293 (20.9%) subjects were normotensive, WCHT, MHT, and SHT subjects, respectively. At the second examination, 136 normotensives (18.2%), 95 WCHT (42.6%), and 56 MHT (47.1%) subjects became SHT. As compared with normotensives, adjusting for age and sex, the risk of becoming SHT was significantly higher for WCHT and MHT subjects (odds ratio: 2.51 and 1.78, respectively; P<0.0001). Similar results were obtained when the definition of the various conditions was based on home BP. Independent contributors of worsening of hypertension status were not only baseline BP, but also, although to a lesser extent, metabolic variables and age. Subjects with WCHT and MHT are at increased risk of developing SHT. This may contribute to their prognosis that appears to be worse as compared with that of normotensive subjects. © 2009 American Heart Association, Inc.

OBJECTIVES:Previous studies have shown that left ventricular hypertrophy (LVH) represents a cardiovascular risk factor independently of clinic blood pressure (BP). The present study was aimed at determining the impact of LVH on the incidence of cardiovascular morbid and fatal events taking into account not only classical risk factors but also home and ambulatory BP values, which have been shown to have an important independent prognostic impact. METHODS: In 1716 patients belonging to the 'Pressioni Arteriose Monitorate E Loro Associazioni' population of Monza, we quantified left ventricular mass index and identified LVH by standard cutoff values. We also measured clinic, home and 24-h ambulatory BPs together with serum glucose and lipids. RESULTS: During a follow-up of 148 months, the rate of fatal and nonfatal (hospitalizations) cardiovascular events as well as of all-cause death was markedly greater (four-fold to five-fold) in patients as compared with those without LVH. In LVH individuals, the increased risk remained significant even when data were adjusted for a large number of other confounding factors including home BP, 24-h mean BP and ambulatory BP. Results were similar when left ventricular mass was indexed by height and body surface area. A 10% increase in left ventricular mass index was associated with a significant increase in cardiovascular risk or all-cause deaths. In multivariate analysis, left ventricular mass index was always an independent predictor of cardiovascular events and death for any cause. CONCLUSION: Our data provide evidence that LVH is an important risk factor even when the contribution of different BPs to risk is fully taken into account

Objective: To estimate effects of weight change on incidence of major cardiovascular events in the Italian population-based Progetto CUORE. Methods: Prospective observation in 12 Italian population-based cohorts on etiology of cardiovascular disease. Twenty-thousand six-hundred-forty-seven men and women aged 35-69 years without previous CVD, examined at baseline between 1984 and 1993 and followed for median time 8.5 years, with validated first cardiovascular events. Standardised anthropometric variables, lifestyle and biochemical risk factors for CVD; major cardiovascular events as end-points. Results: Linear regression between BMI and major CVD risk factors was combined with Cox coefficients from a prediction model of CVD, CHD and stroke using major risk factors as dependent variables. Estimated cardiovascular risk reductions with BMI lowered by 1 to 3 U were: for men 3.8% to 10.9% for all cardiovascular events, 4.2% to 12.1% for CHD, and 2.3% to 6.9% for stroke; for women 2.8% to 8.1% for all cardiovascular events, 3.4% to 9.8% for CHD, and 2.1% to 6.2% for stroke. Conclusions: Body weight level influences cardiovascular disease risk in the Italian population. © 2008 Elsevier Inc. All rights reserved.

OBJECTIVE: Blood pressure (BP) 'Cardiette BP one' system (BP one) is an oscillometric ambulatory BP monitor manufactured in Italy in conformity to current regulations for medical devices. We decided to determine the accuracy of measures made with BP one, using the protocol of the British Hypertension Society published in 1990, and revised in 1993, for evaluating the accuracy of BP measurement devices. METHODS: The evaluation included before-use calibration, in-use assessment, after-use calibration, and static device validation that involved 85 participants. RESULTS: The mean difference between manual readings with sphygmomanometer and automatic ones with the device were -0.36±5.74 (mean±SD) for systolic values and 2.52±4.87 for diastolic values. On the basis of the percentages of measurements differing from the mercury sphygmomanometer standard by ≤5, ≤10, and ≤15 mmHg, the device was graded 'A' for systolic and diastolic BP, for low, median, and high BP values. CONCLUSION: On the basis of the standards indicated by the 1993 modified British Hypertension Society protocol, the BP one recorder can be classified as 'A' grade both for systolic and diastolic pressure. © 2008 Lippincott Williams & Wilkins, Inc.

The prevalence of the metabolic syndrome (National Cholesterol Education Program Adult Treatment Panel III criteria) and its relationships with daily life blood pressures, cardiac damage, and prognosis were determined in 2013 subjects from a Northern Italian population aged 25 to 74 years. Home blood pressure, 24-hour blood pressure, and left ventricular mass index (echocardiography) were also measured. Cardiovascular and noncardiovascular deaths were registered over 148 months. Metabolic syndrome was found in 16.2% of the sample, an office blood pressure elevation being the most frequent (95.4%) and the blood glucose abnormality the least frequent (31.5%) component. There was in metabolic syndrome a frequent elevation in home and/or 24-hour average blood pressure, as well as a greater left ventricular mass index and prevalence of left ventricular hypertrophy, which was manifest even when data were adjusted for between-group differences, including blood pressure. The adjusted risk of cardiovascular and all-cause mortality was greater in metabolic syndrome subjects (+71.0% and +37.0%; P<0.05), a further marked increase being observed with left ventricular hypertrophy or "in-office" and "out-of-office" blood pressure elevations. The increased risk was related to the blood pressure and the blood glucose component of metabolic syndrome, with no contribution of the remaining components. Thus, metabolic syndrome is common in a Mediterranean population in which it significantly increases the long-term risk of death. Cardiac abnormalities and increases in home and 24-hour blood pressure are common in metabolic syndrome, and their occurrence further enhances the risk. The contribution of metabolic syndrome components to the risk, however, is unbalanced and mainly related to blood pressure and glucose abnormalities.

The primary objective is to verify the relation between job strain and clinic blood pressure in a working population from the Milan municipality (1,909 men, 3,786 women) enrolled from 1992 to 1996. Job strain was investigated through the Karasek model. Clinic blood pressure was evaluated using standard procedures from the MONICA project. The association between the two was calculated controlling for age, education, smoking, body mass index, total and high-density lipoprotein (HDL) cholesterol. Significantly, associations were found for systolic blood pressure in men and for both systolic and diastolic blood pressure in women. However, these results do not reflect biological plausibility. The relationship between job strain and blood pressure is an unfinished business: sample characteristics and measurement methods should be carefully considered.

The PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study represents a major research project aimed at investigating the normality values, prognostic significance and relationships of ambulatory and home blood pressure with end-organ damage and metabolic alterations. This article reviews the background, rationale and main results of the various PAMELA studies published to date. These include studies focused on (i) the normal values of ambulatory and home blood pressure in different age decades; (ii) the relevance of the different blood pressures in predicting the occurrence of end-organ damage; (iii) the prognostic significance of 'white-coat' and 'masked' hypertension; (iv) the 'power' of different blood pressures in predicting cardiovascular and all-cause death; and (v) the main features of the blood pressure control in the population. Altogether, the findings reported in this review emphasise the clinical relevance of ambulatory and home blood pressure and the importance of obtaining information on different blood pressures both in treated and untreated hypertensive patients. © 2007 Adis Data Information BV. All rights reserved

The relationship between hypertension, antihypertensive treatments and the risk of renal-cell cancer (RCC) remains still controversial. To evaluate the strength of the evidence provided by the epidemiological literature, a MEDLINE search of the papers published from 1966 to 2006 was performed. Eighteen studies were included. Pooled estimates of the effects of interest were obtained by fitting random effect models to the original data. The effects of some characteristics of the studies were considered as putative sources of heterogeneity of the estimates. Significant increased risks of RCC associated with hypertension (pooled odds ratio 1.62; 95% confidence interval: 1.24 to 2.12), as well as with the use of both diuretics (1.92; 1.59 to 2.33 in women) and no diuretics (1.51; 1.21 to 1.87) antihypertensive drugs were observed. Allowance for the known risk factors of RCC appreciably modified the effect of no diuretic antihypertensives making its pooled estimate not significant (1.17; 0.94 to 1.46). Although the pooled estimates show that both, hypertension and hypertensive therapy, are statistically associated with increased risk of RCC, experimental data and a closer look on the original data from epidemiologic literature, show that available evidence are still uncertain and need to be further investigated.

The hypothesis has been advanced that cardiovascular prognosis is related not only to 24-hour mean blood pressure but also to blood pressure variability. Data, however, are inconsistent, and no long-term prognostic study is available. In 2012 individuals randomly selected from the population of Monza (Milan), 24-hour ambulatory blood pressure (Spacelabs 90207) was measured via readings spaced by 20 minutes. Systolic and diastolic blood pressure variability was obtained by calculating the following: (1) the SD of 24-hour, day, and night mean values; (2) the day-night blood pressure difference; and (3) the residual or erratic blood pressure variability (Fourier spectral analysis). Fatal cardiovascular and noncardiovascular events were registered for 148 months. When adjusted for age, sex, 24-hour mean blood pressure, and other risk factors, there was no relationship between the risk of death and 24-hour, day, and night blood pressure SDs. In contrast, the adjusted risk of cardiovascular death was inversely related to day-night diastolic BP difference (beta coefficient=-0.040; P<0.02) and showed a significant positive relationship with residual diastolic blood pressure variability (beta coefficient=0.175; P<0.002). Twenty-four-hour mean blood pressure attenuation of nocturnal hypotension and erratic diastolic blood pressure variability all independently predicted the mortality risk, with the erratic variability being the most important factor. Our data show that the relationship of blood pressure to prognosis is complex and that phenomena other than 24-hour mean values are involved. They also provide the first evidence that short-term erratic components of blood pressure variability play a prognostic role, with their increase being accompanied by an increased cardiovascular risk.

OBJECTIVE: To compare the prevalence of metabolic syndrome (MS) in HIV-positive patients with that from a sample of a general Italian population. DESIGN: Cross-sectional study. METHODS: A total of 1263 HIV-infected patients 18 years of age or older were recruited in 18 centers for infectious diseases in northern and central Italy. Controls were 2051 subjects aged 25 to 74 years representative of the residents of Monza, a town in Milan province, who were enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study. RESULTS: The prevalence of MS in the HIV group was 20.8%, whereas in the control group, it was only 15.8%, with the difference being statistically significant. The age- and gender-adjusted risk of having MS in HIV-infected patients was twice as great as that in controls. Compared with controls, HIV-infected patients had a greater prevalence of the impaired fasting glucose, increased plasma triglycerides, and reduced high-density lipoprotein cholesterol components. MS prevalence was similar in treated and never-treated HIV-infected patients, and so were the various MS components. CONCLUSIONS: The risk of MS is greater in HIV-infected patients compared with the general population because of a greater prevalence of lipid and glucose abnormalities. The prevalence of MS and its components is similar in treated and untreated HIV-positive patients.

BACKGROUND: Cardiovascular risk factor research has recently broadened its focus based on new data indicating the benefits of low risk, i.e. favorable levels of all major risk factors. The aims of this study were to assess further the relation of low risk to coronary heart disease risk, and implications for prevention. DESIGN: We conducted a prospective population-based Italian study, of 7438 men and 13 009 women aged 35-69 years, with a mean follow-up of 10.4 years and validated first coronary events. METHODS: Baseline coronary heart disease risk was classified into three categories: low risk; unfavorable but not high risk; and high risk. To analyze the relation of these risk profiles to coronary heart disease incidence, age-adjusted, sex-averaged coronary heart disease incidence was calculated for persons free of coronary heart disease and stroke, stratified as baseline low risk, unfavorable but not high risk or high risk. To assess the independent relationship of individual risk factors to coronary heart disease incidence, multivariate proportional hazards models were computed for combinations of risk factors. RESULTS: Only 2.7% of participants met low risk criteria; 81.4% were high risk. Age-adjusted coronary heart disease incidence for the whole cohort was 37.1 out of 10000 person-years (men 59.0; women 15.3). No coronary heart disease events occurred in low-risk men, only two in low-risk women. For women and men who were not high risk, the age-sex standardized coronary heart disease rate was 62% lower than for high-risk participants. Blood pressure, need for antihypertensive medication, smoking, hyperglycemia, diabetes, total and high-density lipoprotein cholesterol were independently related to coronary heart disease risk. CONCLUSIONS: Favorable levels of all modifiable readily measured risk factors - rare among Italian adults - assure minimal coronary heart disease risk. Population-wide prevention is needed, especially improved lifestyles, to increase the pr