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The treatment of hypertensive patients (HTs) requires a long-term commitment of compliance for the patient and resources by the healthcare system. This poses an economic dilemma in countries where universal healthcare is standard. The aim of this study was to evaluate the costs/health benefit and effectiveness of treatment with angiotensin-II receptor blockers (ARBs) in uncomplicated essential hypertension.The daily and annual economic commitment for treating patients with ARBs was estimated using pharmacy dispensing records and the BP-lowering effects of candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan was evaluated retrospectively. In 114 HTs (mean age 59.4±13.5year, 57.5% men), the BP-lowering effect of ARBs as in monotherapy and in fixed-dose combination (FDC) with hydrochlorothiazide at the doses commonly used in the market to reach BP control (i.e. BP140/90mmHg) was analyzed. The BP lowering-effect was evaluated after an average of 6-month follow-up consulting medical professionals. Analysis of variance for repeated measures was provided.Treatment with candesartan (14.1%) and olmesartan (32,4%) versus other ARBs resulted in a significant decrease in BP as for mono- than for FDC therapy. Our studies suggest that daily (data not shown) and annual costs of olmesartan were higher than candesartan as in mono- (4577.71±1120.55 vs. 894.25±127.75 €) than for FDC therapy (5715.90±459.90 vs. 1580.45±113.15 €).Treatment: of BP with candesartan appears to be the most favorable option in terms of cost-effectiveness coupled with favorable health outcomes. These data have some limitations, but open the question if candesartan should be preferred to olmesartan in BP management. Further prospective studies comparing ARBs based on their effect on BP control in uncomplicated HTs are needed for validation.

In clinical practice, patient characteristics predicting resistant hypertension (RH) include higher blood pressure levels, left ventricular hypertrophy, older age, obesity, chronic kidney disease and diabetes. On the contrary little is known about the role of serum uric acid (SUA) as a risk factor for RH in subjects from general population.580 elderly subjects aged ≥65 years were enrolled in the Risk Of Vascular complications Impact of Genetics in Old people (ROVIGO) study. RH was defined as the failure to maintain blood pressure values below 140mmHg (systolic) and 90mmHg (diastolic) despite therapeutic interventions that include appropriate lifestyle measures plus adherence to treatment with full doses of at least three antihypertensive drugs, including a diuretic. RH was confirmed using 24-h ambulatory blood pressure measurement. Hyperuricemic was defined as the subjects having SUA ≥6.8mg/dl or taking uricosuric drugs. Gender-specific odds ratio (OR) for RH was calculated by logistic regression analysis.The prevalence of RH was 5.7% in the cohort and was higher in women (8.3%) than in men (3.0%, p0.05). Independent of chronic kidney disease (OR 3.89, 95% confidence interval 1.49-10.1), hyperuricemia predicted resistant hypertension in women (odds ratio 3.11, 95% confidence intervals 1.06-9.1, p=0.03) but not in men.In elderly women from the general population, an SUA value of ≥6.8mg/dl triples the risk of RH. SUA assessment should be recommended to better define the pattern of risk associated with RH.

Diaphragm motion in forced expiration can be analyzed using M-mode ultrasound in an anterior subcostal approach. Maximum expiratory diaphragmatic excursion (EDE Max ) and forced expiratory diaphragmatic excursion in the first second (FEDE 1 ) are considered the physiopathological analogues of vital capacity (VC) and forced expiratory volume in the first second (FEV 1 ). As the FEV 1 /VC % ratio is used as a marker of obstruction, our aim was to determine if the ratio FEDE 1 /EDE Max (M-mode index of obstruction [MIO]) differs between healthy subjects and patients with airway obstruction. One hundred twenty-four outpatients were examined by diaphragm ultrasound after spirometry. The MIO, expressed as the mean ± standard deviation (range), was 87.08 ± 6.64 (72.84–100) in the healthy group (N = 61) and 67.09 ± 12.49 (33.33–91.30) in the group with obstructed airways (N = 63). The difference between the two groups was significant ( p 1 /VC ( p

We found the paper by Miglioranza et al. [(1)][1] interesting and useful for routine clinical practice because their purpose is that of simplifying and obtaining from an ultrasound B-line count a measure of lung water, a “measure” of disease, that would be approachable by all, with a short