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BackgroundCardiac outcome in patients with atherosclerotic renal artery stenosis (ARAS) undergoing percutaneous transluminal renal angioplasty (PTRA) or medical therapy is not yet completely clear. The aim of this study was to perform a meta-analysis of randomized controlled trials to compare the effect of PTRA and medical therapy on nonfatal myocardial infarction in patients with ARAS.MethodsWe searched for articles reporting cardiovascular outcome, including nonfatal myocardial infarction, in patients with renal artery stenosis randomized to PTRA with/without stenting or medical therapy.ResultsFive studies were identified. The pooled population consisted of 1,159 subjects who experienced 56 nonfatal myocardial infarctions. When compared with medical therapy, the overall relative risk (RR) was 0.85 (95% confidence interval (CI) 0.51-1.42), P = 0.55, for PTRA. There was no significant difference between PTRA and medical therapy according to procedural characteristics (with/without stent placement), mean serum creatinine at follow-up (higher or lower than 2.0 mg/dl), and maximum follow-up length (> or <2 years).ConclusionsIn patients with ARAS and hypertension, there is a lack of evidence supporting the superiority of PTRA over medical therapy in prevention of nonfatal myocardial infarction. Awaiting for results of ongoing trials, our data and previous data suggest that PTRA and drug therapy have a similar impact on cardiovascular risk reduction in patients with renal artery stenosis and hypertension.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.110 [ABSTRACT FROM AUTHOR]

BackgroundMetabolic syndrome (MetS) is a cluster of risk factors, related to visceral adiposity, which is frequently observed in overweight patients. However, it has also been reported in normal weight subjects. Epicardial adipose tissue (EAT) is a visceral fat. The aim of the study was to evaluate whether EAT is associated with MetS in hypertensive patients with normal weight and waist.MethodsWe studied 174 Caucasian hypertensive patients, aged ≥40 years, with body mass index (BMI) <25 kg/m2 and waist circumference <102 cm in men and 88 cm in women. MetS was defined according to NCEP ATP III criteria, not including waist circumference. EAT was measured by echocardiography above the free wall of the right ventricle, at end diastole.ResultsMetS was present in 21 (12%) patients. EAT was significantly higher in patients with MetS than in those without MetS, 4.0 ± 0.8 vs 2.5 ± 0.9 mm, P < 0.01, respectively, but BMI and waist circumference were not. Multivariate analysis showed that EAT was independently associated with MetS. Receiver operating characteristic (ROC) curve analysis showed that EAT significantly improved prediction of MetS when added to BMI and waist circumference. Indeed, the area under the curve improved from 0.63 (0.50-0.76) to 0.91 (0.87-0.96), and resulted significantly higher (P < 0.01). ROC curve for EAT alone indicated that the cutoff value of 3.1 mm had the best performance in predicting MetS, that is, 100% sensitivity and 79% specificity.ConclusionEAT thickness is associated with MetS in hypertensive patients with normal weight and waist.American Journal of Hypertension (2011). doi:10.1038/ajh.2011.134 [ABSTRACT FROM AUTHOR]

BackgroundThe prognostic relevance of white-coat hypertension (WCH) and masked hypertension (MH) is controversial. The aim of this study was to perform an updated meta-analysis on the prognostic value of WCH and MH diagnosed by ambulatory monitoring in initially untreated subjects.MethodsWe searched for articles evaluating cardiovascular outcome in WCH or MH or sustained hypertension (SH) in comparison with normotension, investigating untreated subjects at baseline or performing separate analysis for untreated or treated subjects, and reporting adjusted hazard ratio (HR) and 95% confidence interval (CI).ResultsEight studies were identified. Five whole studies and untreated groups of three others were included in the meta-analysis. The pooled population consisted of 7,961 subjects who experienced 696 events. When compared with normotension, the overall adjusted HR was 0.96 (95% CI 0.65-1.42) for WCH (P = 0.85), 2.09 (1.55-2.81) for MH (P = 0.0001), and 2.59 (2.0-3.35) for SH (P = 0.0001). There was no significant difference between WCH and normotension according to normotensive subjects source (same or different study population) and follow-up length. Where reported, prevalence of drug therapy was higher in subjects with WCH than in those with normotension at follow-up.ConclusionsCardiovascular risk is not significantly different between WCH and normotension, regardless of normotensive population type and follow-up length. However, at follow-up drug therapy was more frequent in WCH than in normotension and its possible impact on outcome should be evaluated in future studies. MH shows significantly higher risk than normotension, although the best way for its detection and treatment remains to be established.American Journal of Hypertension (2011). doi:10.1038/ajh.2010.203 [ABSTRACT FROM AUTHOR]

BackgroundThe prognostic relevance of echocardiographic left ventricular hypertrophy (LVH) regression in hypertension is uncertain. The aim of this study was to perform an updated meta-analysis about the impact of LVH regression on the occurrence of cardiovascular events in hypertensive patients.MethodsWe searched for studies on echocardiographic LVH regression and prognosis in hypertension that compared patients with or without LVH regression or groups including subjects with or without LVH regression and reported adjusted hazard ratio (HR) for calculating the overall effect size.ResultsFive studies were identified (3,149 patients, mean age range 48–66 years, 58% men). Follow-up echocardiography was performed after a mean period ranging from 1 to 5 years. Entire follow-up duration ranged from 3 to 9 years. Globally, 333 cardiovascular events occurred. Three whole studies and subgroups of two others were included in the meta-analysis, comprising 2,449 patients, 1,900 (78%) with baseline LVH and 969 (51%) with LVH regression, who experienced 304 events. The overall adjusted HR of total cardiovascular events was 0.54, 95% confidence interval (CI) 0.35–0.84, P = 0.007, for LVH regression/persistent normal left ventricular (LV) mass vs. LVH persistence/LVH development. Heterogeneity was found between studies. Higher baseline prevalence of comorbid conditions and Japanese ethnicity seemed to be associated with lower benefit from LVH regression.ConclusionsThis meta-analysis indicates that regression of echocardiographic LVH in hypertension, even after adjustment for various confounders, is associated with reduction of cardiovascular events. However, future studies are needed to evaluate whether LVH regression is of benefit for all hypertensive patients and ethnic groups.American Journal of Hypertension 2010; doi:10.1038/ajh.2010.80 [ABSTRACT FROM AUTHOR]

BackgroundThe independent prognostic significance of different indices of blood pressure (BP) variability is not clear. We investigated the prognostic value of BP variability estimated as s.d. or average real variability (ARV) of daytime and night time BP, in hypertensive patients.MethodsThe occurrence of fatal and nonfatal cardiovascular events was evaluated in 1,280 sequential hypertensive patients (550 initially untreated and 730 initially treated) aged ≥40 years. Subjects with s.d. or ARV of daytime or night time systolic or diastolic BP below or above the median were classified as having low or high BP variability.ResultsDuring the follow-up (4.75 ± 1.8 years), 104 cardiovascular events occurred. The event rate per 100 patient-years was 1.71 in the global population. After adjustment for other covariates, Cox regression analysis showed that cardiovascular risk was higher in subjects with high ARV of daytime systolic BP in initially untreated, initially treated, and all the subjects (high vs. low ARV, hazard ratio (HR) 2.29 (1.06–4.94), HR 1.90 (1.06–3.39), and HR 2.07 (1.31–3.28), respectively). ARV of daytime diastolic BP and night time BP, and s.d. of daytime and night time BP were not significantly associated with risk or were not independent predictors of outcome.ConclusionsIn this study, high ARV of daytime systolic BP resulted in an independent predictor of cardiovascular risk in hypertensive patients, while high s.d. did not. Our data suggest that, in comparison to s.d., ARV could be a more appropriate index of BP variability and a more useful predictor of outcomes.American Journal of Hypertension 2009; doi:10.1038/ajh.2009.103American Journal of Hypertension 2009; 22, 8, 842–847. doi:10.1038/ajh.2009.103 [ABSTRACT FROM AUTHOR]

BACKGROUND The prognostic impact of masked hypertension is not yet completely clear. The aim of this study was to evaluate the prognostic relevance of masked hypertension in subjects with prehypertension. METHODS The occurrence of fatal and nonfatal cardiovascular events was evaluated in 591 subjects with prehypertension defined as clinic blood pressure (BP) in the range of 120-139 mm Hg for systolic BP and 80-89 mm Hg for diastolic BP. Among them, 471 were classified as having true prehypertension (clinic BP <140/90 mm Hg and daytime BP <135/85 mm Hg) and 120 as having masked hypertension (clinic BP <140/90 mm Hg and daytime BP ≥135 or 85 mm Hg). RESULTS During the follow-up (6.6 ± 4.3 years, range 0.5-15.5 years), 29 cardiovascular events occurred. In subjects with true prehypertension and masked hypertension the event-rates per 100 patient-years were 0.57 and 1.51, respectively. Event-free survival was significantly different between the groups (P < 0.005). After adjustment for other covariates, including clinic BP (forced into the model), Cox regression analysis showed that cardiovascular risk was significantly higher in masked hypertension than in true prehypertension (masked vs. true prehypertension, relative risk 2.65, 95% confidence interval 1.18-5.98, P = 0.018). CONCLUSIONS Among subjects with prehypertension, those with masked hypertension are at higher cardiovascular risk than those with true prehypertension. Out-of-office BP should be known in individuals with prehypertension, preferably by ambulatory BP monitoring or alternatively by home BP measurement, to obtain a better prognostic stratification. [ABSTRACT FROM AUTHOR]

BACKGROUND There is still ambiguity about the prognostic relevance of regression of left ventricular hypertrophy (LVH) (as revealed by echocardiography) in a large population of subjects with hypertension, with and without evidence of LVH in their electrocardiograms (ECGs). This holds true even after adjusting for various confounders including in treatment ambulatory blood pressure (BP). The most suitable time point for a follow-up echocardiography also remains a matter for debate. In this study, we investigated the prognostic relevance of regression of LVH after 2 years of therapy, in a large population of subjects with hypertension, and possessing the aforesaid characteristics. METHODS The occurrence of adverse cardiovascular events was evaluated in 387 patients with LVH shown by echocardiography at baseline, and these patients were studied again after 2 years of therapy. At the second examination, 245 subjects showed regression of LVH, whereas 142 did not. RESULTS During the time period before the subsequent follow up (6.2 ± 3 years, range 1.9-12.9 years), 59 first adverse events (26 cardiac and 33 cerebrovascular) had occurred among these subjects. The event rates per 100 patient-years in patients with and without LVH regression were 1.06 and 4.4, respectively. After adjusting for several covariates at the 2-year visit, including in treatment ambulatory BP, Cox regression analysis showed that cardiovascular risk was significantly lower in patients with LVH regression than in those without (RR 0.36, 95% CI 0.19-0.68, P = 0.002). When left ventricular (LV) mass index reduction was analyzed instead of LVH status, it was found to be significantly associated with reduced risk (RR 0.62 per 1-s.d. decrease, 95% CI 0.44-0.88, P = 0.01). CONCLUSIONS Regression of LVH, as revealed by echocardiography after 2 years of therapy, is associated with reduced cardiovascular risk in patients with hypertension, whether or not LVH was revealed in their ECGs. This holds true even after adjusting for various confounders including in treatment ambulatory BP. [ABSTRACT FROM AUTHOR]

: BackgroundTransforming growth factor-β1 (TGF-β1) has been demonstrated to be overexpressed in hypertension. Leptin, an adipocyte product, has been shown to play a role in obesity-related hypertension and in vitro studies demonstrated a biologic interaction between leptin and TGF-β1. Thus, we evaluate a possible in vivo association between TGF-β1, body mass index (BMI), and leptin circulating levels in hypertensive subjects.: MethodsBlood samples for fasting leptin and TGF-β1, were evaluated in 29 overweight, 46 obese, and 29 nonobese hypertensive patients before and after a 12-week calorie-restricted diet. Monocyte cultures were used for in vitro experiments.: ResultsTransforming growth factor-β1 was significantly elevated in hypertensive obese patients (n = 46) as compared with TGF-β1 levels of hypertensive patients with normal BMI (n = 29) (8. 9 ± 3 ng/mL v 4.4 ± 2; P < .001). The circulating levels of TGF-β1 were associated with BMI and leptin levels in an univariate analysis (r = 0.59, P < .0001; r = 0.62, P < .0001, respectively) and these associations were still present after stepwise multivariate analysis. Weight loss of 10% produced a parallel decrease in TGF-β1 (from 8.9 ± 3 ng/mL to 5.3 ± 2.8 ng/mL; P < .01) and leptin levels (from 30 ± 24 ng/mL to 17 ± 14; P < .05). In vitro experiments showed that leptin is able to induce a dose-dependent increase in TGF-β1 production and mRNA expression in human monocyte cultures.: ConclusionsOur data indicate that TGF-β1 levels are positively associated with BMI and leptin levels in hypertensive patients and suggest that adipose tissue may be an important determinant of TGF-β1 levels possibly by a leptin-dependent pathway. [Copyright &y& Elsevier]

Long-term vascular complications still represent the main cause of morbidity and mortality in diabetic patients. Although randomized long-term clinical studies comparing the effects of conventional and intensive therapy have demonstrated a clear link between hyperglycemia and the development of complications of diabetes, they have not defined the mechanism through which excess glucose results in tissue damage. Evidence has accumulated indicating that oxidative stress may play a key role in the etiology of diabetic complications. Isoprostanes are emerging as a new class of biologically active products of arachidonic acid metabolism of potential relevance to human vascular disease. Their formation in vivo seems to reflect primarily, if not exclusively, a nonenzymatic process of lipid peroxidation. Enhanced urinary excretion of 8-iso-PGF2α has been described in association with both type 1 and type 2 diabetes mellitus, and correlates with impaired glycemic control. Besides providing a likely noninvasive index of lipid peroxidation in this setting, measurements of specific F2 isoprostanes in urine may provide a sensitive biochemical end point for dose-finding studies of natural and synthetic inhibitors of lipid peroxidation. Although the biological effects of 8-iso-PGF2α in vitro suggest that it and other isoeicosanoids may modulate the functional consequences of lipid peroxidation in diabetes, evidence that this is likely in vivo remains inadequate at this time. [ABSTRACT FROM PUBLISHER]

Objectives: We wished to demonstrate that gastric epithelial cells infiltration by HP is associated with the active inflammatory response and the severity of gastritis in the gastric antrum of patients harboring the bacterium. Methods: We studied 129 patients with HP-associated gastritis and 60 HP-negative controls with gastritis of different origin. Gastric mucosal biopsies were obtained from all subjects at endoscopy and were examined for histological features of active inflammation and type of gastritis, as well as for electronmicroscopical features of invasion and damage, according to a four-degree classification (range 0-3). Results: At entry, the presence of acute inflammatory activity, defined according to the presence of a polymorphonuclear cell infiltrate, was significantly greater in HP-positive patients than in controls (p < 0.00001) and was well related to the depth of mucosal invasion (p < 0.001). Accordingly, the prevalence of chronic atrophic gastritis was higher in HP-positive patients (p < 0.02 vs. controls) and at grade 3 of invasion (p < 0.04 vs. grade 1 and 2). Peptic ulcers were more frequent in grade 3 patients (p < 0.04). Conclusion: Gastric epithelial cell infiltration and damage by HP, as assessed by electron microscopy, is an important feature of HP-associated gastritis due to its histological and clinical correlates. [ABSTRACT FROM AUTHOR]

In this study, we assessed the effect of a 5-yr maintenance program with ranitidine on the natural history of duodenal ulcer disease both during treatment and after drug withdrawal. Two groups of patients with duodenal ulcer were studied. In group A patients (n = 40), ranitidine (150 mg/day) was given continuously for 5 yr; group B patients (n = 40), received seasonal, 8-wk prophylactic treatment with ranitidine (300 mg/day), in spring and fall. Routine endoscopy was performed every year and whenever ulcer symptoms recurred. After the 5-yr study, the drug was discontinued in both groups, and patients underwent endoscopy after 3, 6, 12, and 18 months. The probability of duodenal ulcer recurrence was significantly lower in patients continuously receiving ranitidine (p < 0.001), and ulcer complications were significantly lesser in group A patients (p < 0.03). In the 18 months of follow-up after drug discontinuation, only 15% (4/26) of patients of group A relapsed, whereas ulcer recurrence was diagnosed in 84% (26/32) of group B patients (p < 0.001). We conclude that low-dose continuous treatment with ranitidine is preferable to seasonal prophylaxis for its ability to modify the natural history of duodenal ulcer disease. [ABSTRACT FROM AUTHOR]

Liquid gastric emptying has been evaluated in 17 normal human subjects during basal conditions, after mild physical stress at 50% of the maximum predictable heart rate, and after maximal physical stress at 70% maximum heart rate. Each subject exercised on a tread-mill for 30 min, its speed and inclination varied in order to obtain the desired heart rate. Immediately after the exercise, 400 ml of mineral water were drunk by each subject. Gastric emptying was evaluated by real-time ultrasonography (11 subjects) and scintigraphy (six subjects) through previously described methods. The results show similar data with both techniques. Gastric emptying of the water, considered either as reduction in gastric measurements at ultrasonography or decay in radioactivity in the region of interest corresponding to the stomach at scintigraphy, follows a linear relation-ship under basal conditions and during physical stress. Compared with basal conditions, gastric emptying of water after maximal stress was prolonged; after mild stress, gastric emptying of the water was accelerated. These findings may support the common belief that mild physical activity favors the digestive process. [ABSTRACT FROM AUTHOR]

Mouth-to-cecum transit time was studied in 13 patients affected by chronic idiopathic constipation and 18 control subjects matched with the constipation group for age, sex, and dietary habits, in a preliminary investigation, all patients showed a prolonged whole gut (oroanal) transit time as measured with radiopaque markers. Mouth-to-cecum transit time was studied through the serial determination of breath H2, after administration of 12 g lactulose diluted in 120 ml water. Breath H2 was measured with a gas analyzer and was determined in parts per million (ppm). Breath H2 after lactulose was also determined in the group with constipation after a 10-day diet that included either glucomannan (1 g tid orally) or placebo administered in a double-blind manner. The results show a statistically significant increase in mouth-to-cecum transit time in the group with constipation, compared with controls, and a return to within the normal range after the 10-day treatment with glucomannan. With placebo, no difference in transit time was noted. We therefore suggest that chronic idiopathic constipation is a disease that involves the whole gut. [ABSTRACT FROM AUTHOR]

Dose-response curves for cholecystokinin (CCK), cerulein (CRL), and the effect of atropine on peptide-induced gallbladder evacuation, were evaluated in 13 normal subjects. Gallbladder volume was monitored by means of real-time ultrasonography. After an overnight fast, CCK was infused in six subjects iv, with increasing doses from 0.002 IDU/kg/min for 15 min, and CRL in seven subjects from 0.5 ng/kg/min for 5 min. until maximum gallbladder evacuation (>70% of the fasting volume) was achieved. Forty-eight hours after the first study, CCK and CRL were readministered at the maximum contracting dose in each subject with and without a pretreatment with atropine (1 mg iv as bolus). The results showed maximum gallbladder evacuation at 0.016 IDU for CCK, and at 4 ng for CRL. Atropine significantly blunted the gallhladder response both to CCK and to CRL. It is therefore suggested that the cholinergic system is involved in the gallbladder response to CCK and to CRL. [ABSTRACT FROM AUTHOR]

BACKGROUND The independent prognostic significance of left atrial enlargement is not yet completely clear. We investigated the association between left atrial enlargement and risk of ischemic stroke in elderly treated hypertensive patients. METHODS The occurrence of ischemic stroke was evaluated in 1,191 elderly treated hypertensive patients (age range = 60–90 years). Left atrium diameter (cm) was indexed by body surface area (m2) and subjects were divided into those with normal or enlarged (≥2.4cm/m2) left atrium. RESULTS During the follow-up (9.1±4.9 years; range = 0.4–20 years), 139 ischemic strokes occurred. The event rate per 100 patient-years was 1.28. There were 86 strokes in patients with normal (= 928) left atrium and 53 strokes in patients with enlarged (= 263) left atrium, respectively. Stroke-free survival curves were significantly different between the groups (P < 0.01). After adjustment for various covariables, including clinical variables, left ventricular hypertrophy, and ambulatory blood pressure parameters, Cox regression analysis showed that left atrial enlargement was significantly associated with increased risk of ischemic stroke (hazard ratio = 1.54; 95% confidence interval = 1.05–2.27; P = 0.03). CONCLUSIONS In elderly treated hypertensive patients, left atrial enlargement is an independent predictor of ischemic stroke. [ABSTRACT FROM PUBLISHER]