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Nodal conduction is usually studied by tracing the H1 H2 on function of A1 A2 curves. If one interpolates a PVC before A1, there is a decrease in H1 H2. This might be explained by an A1 H1 interval lengthening (delta A1 H1). This study was done on 14 consecutive patients in whom a PVC can be interpolated (blocked at the A-V junction). In the majority of these patients, there is a downward and a right hand shift in the curve after an interpolated PVC. On other hand, the curves representing the sum H1 H2 + delta A1 H1 on function of A1 A2 were shifted upward and to the right in 12 of the 14 patients. This indicates inhibition which manifests itself not only by an ERP increase but also by an A2 H2 increase.

Coronary angiography by the percutaneous femoral approach is widely used. This technique is potentially dangerous or impossible in patients with advanced arterial disease of the lower limbs, whether or not surgically treated. In these cases, percutaneous left or right axillary approach is an alternative to brachial approach. In this article, we report our multicenter experience involving 120 patients. The left axillary artery was used in 94 cases (78%) and the right in 26 cases (22%). We used performed coronary catheters usually associated with the femoral approach. The left axillary artery was used preferentially since this avoids catheterization of the innominated trunk and allows easier catheterization of the coronary ostia and aortic ends of aorto-coronary bypass grafts. The routine use of a sheath (arterial introducer) avoided arterial compression during catheterization, prevented hemorrhagic suffusion when the catheters were exchanged, and reduced the risk of thrombosis or laceration of the axillary artery. There were no failures in the catheterization of the axillary artery and no complication was observed during or after the procedure. Axillary percutaneous technique appears to have the following advantages over the brachial arteriotomy: 1) Investigation time is equivalent to the time needed for the femoral percutaneous approach. 2) There is the possibility of lateral and simultaneous bi-plane angiograms. 3) Arterial puncture is preferable to arteriotomy. The axillary approach could also be used for percutaneous transluminal coronary angioplasty.

The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30mL/min/1.73m(2) and 60mL/min/1.73m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities.

Plasma aldosterone concentrations (PACs) are often increased in the advanced stages of chronic kidney disease (CKD); however, PAC has not been fully investigated in early CKD. Moreover, little is known about the relationship between aldosteronemia and left ventricular (LV) mass in subjects with mild-to-moderate CKD. The study objectives were to analyze PAC, LV mass (LVM), LV geometry and their relationships, in a group of hypertensive patients with stage I-III CKD. One hundred ninety-five hypertensive patients with stage I-III CKD were enrolled and compared with a control group of 82 hypertensive patients without renal dysfunction. LVM was higher in subjects with CKD than in the control group and increased progressively with advancing stages of CKD (P=0.004). A similar trend was observed for PAC (P

Background and Aims In experimental investigations conducted in rats, raising serum uric acid (SUA) levels resulted in the stimulation of intrarenal renin expression. Studies in humans exploring the association of SUA with plasma renin activity (PRA) yielded conflicting results. Moreover, little is known about the relationship of SUA with plasma aldosterone concentration (PAC). The study aimed to assess the relationship between SUA levels, PRA, and PAC and the influence of age, gender, body mass index (BMI), and hyperuricemia on these relationships in subjects with essential hypertension (EH). Methods and Results We enrolled 372 hypertensive patients (mean age 45±12 years, men 67%) with uncomplicated EH that was not pharmacologically treated. The study population was divided in tertiles according to SUA levels. While PRA did not differ significantly across the three tertiles, PAC was higher in subjects belonging to the uppermost tertile of SUA than those in the lower ones (p=0.0429); however, this difference lost statistical significance after adjustment for age, sex, BMI, and serum creatinine. Univariate correlation analyses showed significant associations of SUA with PRA (r=0.137; p=0.008) and PAC (r=0.179; p&nbsp

OBJECTIVE: Sound evidence indicates that aldosterone has a fundamental role in determining functional and structural changes in the heart. Moreover, it has been observed that high plasma aldosterone concentration (PAC) is related to the development of congestive heart failure and to cardiovascular mortality. However, previous studies on the association between circulating aldosterone levels and left ventricular (LV) mass (LVM) and LV geometry, in subjects without primary aldosteronism yielded conflicting results. The aim of our study was to evaluate in patients with essential hypertension the relationships of PAC with LV mass and geometry, and to asses the influence of gender on these relationships. DESIGN AND METHOD: A total of 478 subjects (men: 63%; mean age 44 ± 12 years) with untreated essential hypertension were enrolled.The measurements included 24-h blood pressure (BP) readings, plasma renin activity (PRA) and PAC, obtained by radioimmunoassay and an echocardiogram.For its skewed distribution PAC was log transformed and expressed as median value and interquartile range. RESULTS: PAC was significantly lower (p

Introduction: The prevalence of systemic arterial hypertension in young adults is increasing worldwide in association with modifiable risk factors. Aim: To assess the prevalence of high blood pressure (BP) in young adults participating to a screening campaign during the World Hypertension Day (17/05/2014), and to determine the possible association with lifestyle factors. Methods: 493 individuals aged 18–35 years were selected in 13 Italian cities. All participants underwent BP measurement together with the administration of a questionnaire exploring: medical and drug history; traditional cardiovascular risk factors and diseases; dietary pattern; salt intake; sleep habits; mood disorders. Results: High BP (≥140/90 mmHg) was found in 54 individuals, with a prevalence of 11 % and awareness of 28 %. Those with high BP values were more frequently men, reported a higher BMI and a greater use of corticosteroids and non-steroidal anti-inflammatory drugs, and had a lower anxiety score. Concerning dietary habits, they were more likely to eat cheese/cold cuts ≥3 times/week, to have their meals out ≥1/day and to eat in fast foods ≥1/week. In the multiple logistic regression analysis, male sex [OR 3.19, 95 % CI (1.33–7.63)], BMI [OR 1.14 95 % CI (1.04–1.25)], eating in fast foods [OR 3.10 95 % CI (1.21–7.95)], and anxiety [OR 0.85 95 % CI (0.75–0.97)], were independently associated with high BP. Conclusions: High BP values were found in 11 % young adults. Male sex, adiposity and alimentary habits were the main determinants of high BP values, indicating that young men are a suitable target for healthy lifestyle interventions.

Objective: Experimental studies documented that the mechanical injury of intravascular pressure on the vessel wall, which results in vascular remodelling and atherosclerosis, may be more closely associated to oscillatory than to steady laminar shear stress This suggests that the hypertensive patient's prognosis may depend not only on average BP level but also on the degree and rate of BP variation. Little is known about the relationships between early renal abnormalities and the rate of BP changes assessed by intermittent 24-h ambulatory BP monitoring (ABPM). Our study was aimed to analyse the relationships between subclinical renal damage (SRD), defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30-60 ml/min/1.73 m2 and the maximum speed of BP rise (Max Slope BP) during a 24-h BP recording Design and method: The study population consisted of 389 untreated essential hypertensives (mean age: 49 +/- 13 years; males 58%), which underwent 24-h ABPM, 24-h albumin excretion rate (AER) measurement and GFR estimation, using the CKD-EPI equation. The Max Slope BP was calculated as the first derivative of the curve obtained by fitting partial Fourier series to raw BP data recorded by discontinuous 24-h ABPM. Results: The Max Slope of systolic BP (SBP) was higher in subjects with SRD (n = 117) than in those without SRD (n = 272) .

Several studies analyzed 25-hydroxyvitamin D (25[OH]D) and blood pressure (BP) relationship with mixed results. Moreover, a relationship between the risk of hypertension and vitamin D receptor (VDR) gene polymorphisms, FokI and BsmI, was reported. This study was aimed to analyze these relationships in essential hypertensive (EH) patients. Seventy-one EH patients, 18-75 years old, were enrolled. Patients underwent clinical BP, 24-h ambulatory BP monitoring, 25[OH]D and plasma renin activity (PRA) evaluations. FokI and BsmI VDR polymorphisms were analyzed and compared with those of 72 healthy controls. In EH patients, the median 25[OH]D levels were lower than 30 ng ml(-1). We found a significant negative correlation between 25[OH]D and 24-h systolic BP (r = -0.277, P = 0.043). This correlation persisted in backward stepwise multivariate analyses (β = -0.337; P = 0.022), after adjustment for age, gender, body mass index, glomerular filtration rate, and PRA. We did not observe statistically significant correlation between 25[OH]D and PRA. We compared the allelic frequencies and genotype distribution between patients and controls, and FokI and BsmI VDR polymorphisms were not associated either with hypertensive status or with PRA. Further wide studies are needed to clarify this relationship.

Background and aims: Clinical studies exploring the relationship between serum uric acid (SUA) and arterial stiffness yielded conflicting results. Only in a few of these studies, arterial distensibility was examined by measuring aortic pulse wave velocity (PWV), which is considered the gold standard for evaluating arterial stiffness. In none of the previous investigations was the influence of SUA on aortic distensibility assessed, taking into account the effect of albuminuria. The purpose of our study was to comprehensively analyse the relationships between SUA and aortic PWV in a group of essential hypertensive patients. Methods and results: We enrolled 222 untreated and uncomplicated hypertensive subjects (mean age: 44 ± 10 years; 60% males), without gout. In all patients, SUA and urinary albumin excretion rate (AER) were determined. Moreover, carotid-femoral (c-f) PWV was measured. C-f PWV was significantly higher in hypertensive patients belonging to the uppermost tertile of SUA distribution, compared to subjects of the lowest tertiles (10.9 ± 2.2 vs. 10 ± 1.8 vs. 9.9 ± 1.7 m s-1; p = 0.001). In univariate analysis, SUA correlated with c-f PWV (r = 0.24; p < 0.001). This association disappeared when AER was added in a multiple regression model, including SUA, age, mean arterial pressure, gender, metabolic syndrome components and glomerular filtration rate. Conclusion: The results of our study showed that, in essential hypertensive subjects, there is a positive relationship between mild hyperuricaemia and aortic stiffness. This association weakened after adjustment for covariates and lost statistical significance after further correction for albuminuria.

Background and aim: Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. Methods and results: We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtained. In the overall population we observed no significant correlation of SUA with LV mass indexed for height2.7 (LVMH2.7) (r = 0.074). When the same relationship was analysed separately in men and women, we found a statistically significant correlation in female gender (r = 0.27; p < 0.001), but not in males (r = 0.042; p = NS). When we grouped the study population in sex-specific tertiles of SUA, an increase in LVMH2.7 was observed in the highest tertiles in women (44.5 ± 15.6 vs 47.5 16 vs 55.9 ± 22.2 g/m2.7; p < 0.001), but not in men. The association between SUA and LVMH2.7 in women lost statistical significance in multiple regression analyses, after adjustment for age, 24 h systolic BP, body mass index, serum creatinine and other potential confounders. Conclusions: Our findings do not support an independent association between SUA and LV mass in Caucasian men and women with arterial hypertension.

OBJECTIVE: Left ventricular hypertrophy is common in hypertensive patients. In these subjects increased oxidative stress has been observed. Our aim was to evaluate the association of biomarkers of both oxidative stress and inflammation with markers of cardiovascular damage in a large group of hypertensives with different stages of renal function. DESIGN AND METHOD: In 517 hypertensives we analyzed left ventricular mass indexed for body surface area, and we assayed plasma levels of 8-isoprostaglandin F2alpha and high sensitivity C reactive protein. RESULTS: Multivariate analysis carried out considering left ventricular mass as dependent variable, and including 8-isoprostaglandin F2alpha, high sensitivity C reactive protein, age, sex, body mass index, estimated glomerular filtration rate, serum glucose, (log)triglycerides, hemoglobin, pulse pressure or systolic blood pressure, mean or diastolic blood pressure, and antihypertensive treatment showed that in hypertensives plasma levels of 8-isoprostaglandin F2alpha were correlated with left ventricular mass (beta=0.269, p