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4. Impact of the 2017 Blood Pressure Guidelines by the American Academy of Pediatrics in overweight/obese youth

Author

Di Bonito, Procolo, Valerio, Giuliana, Pacifico, Lucia, Chiesa, Claudio, Invitti, Cecilia, Morandi, Anita, Licenziati, Maria Rosaria, Manco, Melania, Giudice, Emanuele Miraglia Del, Baroni, Marco Giorgio, Loche, Sandro, Tornese, Gianluca, Franco, Francesca, Maffeis, Claudio, de Simone, Giovanni, Di Sessa, A, Gilardini, L, Incani, M, Luciano, R, Moio, N, Pellegrin, Mc, Sanguigno, E, Tomat, M ., Di Bonito, Procolo, Valerio, Giuliana, Pacifico, Lucia, Chiesa, Claudio, Invitti, Cecilia, Morandi, Anita, Licenziati, Maria Rosaria, Manco, Melania, Giudice, Emanuele Miraglia Del, Baroni, Marco Giorgio, Loche, Sandro, Tornese, Gianluca, Franco, Francesca, Maffeis, Claudio, and de Simone, Giovanni

Subjects
Male, Pediatric Obesity, Pediatrics, obesity, Physiology, 030204 cardiovascular system & hematology, Overweight, Left ventricular hypertrophy, 0302 clinical medicine, children, hypertension, left ventricular hypertrophy, obesity, overweight, Risk Factors, Odds Ratio, Prevalence, Mass Screening, Medicine, 030212 general & internal medicine, adolescents, Child, hypertension, children, Ventricular Remodeling, blood pressure, left ventricular hypertrophy, Echocardiography, Practice Guidelines as Topic, Female, Hypertrophy, Left Ventricular, medicine.symptom, Cardiology and Cardiovascular Medicine, Risk assessment, medicine.medical_specialty, Adolescent, Heart Ventricles, Risk Assessment, 03 medical and health sciences, overweight, Internal Medicine, Humans, Ventricular remodeling, Mass screening, business.industry, Blood Pressure Determination, Odds ratio, medicine.disease, United States, Confidence interval, Blood pressure, business
Abstract

OBJECTIVES: The aim of this study was to compare the impact of the European Society of Hypertension Guidelines 2016 (ESHG2016) and the American Academy of Pediatrics Guidelines 2017 (AAPG2017) on the screening of hypertension and classification of abnormal left ventricular geometry (ALVG) in overweight/obese youth. METHODS: This study included 6137 overweight/obese youth; 437 had echocardiographic assessment. Hypertension was defined using either ESHG2016 or AAPG2017. ALVG was defined using 95th percentile for age and sex of left ventricular mass index (LVMi) and/or relative wall thickness (RWT) more than 0.38 (juvenile cut-offs) according to ESHG2016 or LVMi more than 51 g/h and/or RWT more than 0.42 (adult cut-offs) according to AAPG2017. RESULTS: Prevalence of youth at a high risk of hypertension was 13% higher using AAPG2017 than ESHG2016. The increase was larger in overweight youth at least 13 years of age (+43%). Using the juvenile cut-offs for ALVG, youth at a high risk of hypertension by ESHG2016 had an odds ratio [95% confidence interval (95% CI)] of 3.03 (1.31-7.05) for left ventricular concentric remodelling (LVcr) and 2.53 (1.43-4.47) for concentric left ventricular hypertrophy (cLVH) as compared with youth with normal LVG. Similarly, in youth at a high risk of hypertension by AAPG2017, the odds ratio for LVcr was 3.28 (1.45-7.41, P

Published
2019
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8. Prehypertension in outpatient obese children

Author

Di Bonito P, Forziato C, Sanguigno E, Di Fraia T, Saitta F, Iardino MR, Scilla C, Cavuto L, Sibilio G, Moio N, CAPALDO, BRUNELLA, Di Bonito, P, Forziato, C, Sanguigno, E, Di Fraia, T, Saitta, F, Iardino, Mr, Scilla, C, Cavuto, L, Sibilio, G, Moio, N, and Capaldo, Brunella

Subjects
obesity, children, prehypertension
Abstract

Background The aim of the study was to analyze the prevalence of prehypertension (PH) in obese (OB) children and its relation with estimated glomerular filtration rate (eGFR) and left ventricular (LV) function. Methods The study included 447 OB and 131 normal-weight children. PH was defined according to the criteria proposed by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. Insulin sensitivity was evaluated by HOMAIR, and eGFR was calculated by Schwartz’s formula. LV function was analyzed by echocardiography in 165 OB children. Results PH was observed in 79 OB children (17.7%) and in 2 (1.5%) controls. Among OB children, those with PH had greater percentage of males (P < 0.05), higher level of body mass index (BMI) (P < .001), waist circumference (WC) (P < 0.005), and HOMAIR (P < 0.001), compared to PH− children. The two groups did not differ for eGFR and LV function. At logistic regression analysis, PH was independently associated with male gender (P < 0.025) and HOMAIR (P < 0.002). Gender analysis showed that boys with PH presented higher levels of BMI (P < 0.005), WC (P < 0.01), HOMAIR (P < 0.001), and triglycerides (P < 0.005) compared to PH− boys. Females with PH were older and in more advanced postpubertal stage, had higher BMI, WC (P < 0.05, for all), and HOMAIR (P < 0.025), compared to PH− girls. Conclusions In a population of outpatient OB children, the prevalence of PH was 17.7% and boys were more likely than girls to have PH. This condition is characterized by insulin resistance in both sexes but no impairment in glomerular and LV function.

Published
2009

9. PREAMI: Perindopril and remodelling in elderly with acute myocardial infarction: Study rationale and design

Author

Battaglia, A., Ferraro, L., Lo Monaco, M., Palumbo, A., Mariani, M., Biadi, O., Boccalatte, A., Polimeno, S., Rosa, V., Liguori, L., Cuomo, S., Boccanelli, A., Morosetti, P., D Angelo, G., Bottiglieri, P., Brunelli, C., Spallarossa, P., Rolandi, A., Rossettini, Pf, Campa, P., Francesco BARILLA', Biase, L., Biscosi, C., Zampino, D., Capponi, E., Buccolieri, M., Gattobigio, R., Capucci, A., Passerini, F., Piepoli, M., Castello, A., Chiariello, M., Betocchi, S., Ciampi, Q., Losi, M., Corsini, G., Melorio, S., Dalle Mule, J., Mazzella, M., Cristinziani, Gr, Mario, L., Luca, I., Fusco, F., Del Salvatore, B., Sorino, M., Delise, P., Mozzato, Mg, Bilardo, G., Coro, L., Fantinel, M., Zasso, A., Fedele, F., Di Donato, D., Romano, S., Pascale, F., Giasi, M., Ciarcia, L., Lizzardo, A., Mastursi, M., Giordano, A., Benigno, M., Zanelli, E., Campana, M., Giovannini, E., Lacche, A., Pulignano, G., Giuffrida, G., Montana, G., Licciardello, G., L Abbate, A., Carpeggiani, C., Morales, A., Leghissa, R., Mandorla, S., Del Pinto, M., Borgioni, C., Mininni, N., Petrillo, Me, Moretti, G., Bonaglia, M., Zoni, A., Piscicelli, C., Orlandi, M., Panciroli, C., Oddone, A., Caizzi, V., Tartarini, G., Lattanzi, F., Reisenhofer, B., Pascotto, P., Zanocco, A., Dabizzi, Rp, Bini, L., Mondanelli, D., Frascarelli, F., Pitscheider, W., Erlicher, A., Rauhe, W., Bonsante, E., Polimeni, M., Catananti, F., Guerrisi, G., Magnani, B., Rapezzi, C., Ferlito, M., Amati, S., Di Leo, L., Manzo, M., Baldi, C., Cristofaro, M., Citro, R., Raviele, A., Turiano, G., Zuin, G., Rengo, F., Furgi, G., Papa, A., Rotiroti, D., Rosato, G., Siano, F., Pagliuca, MR, Rovelli, G., Heyman, J., Locati, I., Sanguinetti, M., Tomassini, F., Mantovani, R., Sanna, A., Marras, L., Crabu, E., Locci, G., Moio, N., Scilla, C., Tavazzi, L., Magrini, G., Bersano, C., Laudisa, Ml, Trimarco, B., Argenziano, L., Silvestri, S., Valagussa, F., Ciro, E., Cantu, E., Trocino, G., Rossillo, A., Valagussa, L., Finocchi, G., Benvenuto, Gm, Bonanno, C., Ometto, R., Risica, G., Gualandi, G., Facchin, L., Tenderini, P., Nicolosi, Gl, Burelli, C., Macor, F., Bellone, E., Laiso, D., Carvalho, P., Peila, C., Fagiano, A., Gardiol, S., Ganci, B., Presutto, P., Fontanelli, A., Morgera, T., Scarpino, L., Barbuzzi, S., Capogrosso, V., Terrosu, Pf, Contini, Gm, Sabino, G., Pes, R., Uneddu, F., Mecca, D., Tommaso, I., Rusconi, C., Brunazzi, Mc, Codeluppi, P., Pasqualini, M., Gorni, R., Negrelli, M., Paparoni, S., Core, A., Pecce, P., Petrella, L., Zennaro, Rg, Garuti, W., Alfano, G., Bacca, F., Petrucci, G., Paci, Am, Bigalli, G., Mangiameli, S., Gulizia, M., Cardillo, R., Ferrari, G., Tettamanti, F., Butti, E., Picchione, N., Sulla, A., Stroder, P., Perna, Gp, Ricci, S., Generali, Ca, Adornato, E., Ghisio, A., Tidu, M., Ferrari, R., Mele, D., Cicchitelli, G., Merli, E., Russa, O., Azcarate, Jma, Gonzales, Pz, Vilchez, F., Alonso, Lfi, Montero, Jmm, Zarzosa, Cd, Martin, Es, Ros, Jo, Martinez, Mh, Palau, Vm, Carranza, Mst, Mayor, Djlb, Cocina, Eg, Valderrama, Jc, Jimenez, Rp, Pardo, Jam, Cortada, Jb, Lorente, Lj, Guerrero, Jjg, Martinez, A., Coronado, Jlb, Casado, Rs, Cendon, Aa, Cokkinos, D., Maounis, T., Karatasakis, G., Kremastinos, D., Iliodromitis, S., Karatzas, D., Georgiadis, M., Paraskevaidis, I., Toutouzas, P., Antoniadis, P., Angeli, C., Vadas, P., Kaleboubas, M., Stamatelopoulos, S., Nanas, I., Kanakakis, A., Dalianis, A., Zacharoulis, A., Fotiadis, I., Pyrgakis, V., Liata, O., Mazen, B., Kardaras, F., Kardara, D., Krokos, V., Sioras, H., Fousas, S., Stefanidis, A., Papadopoulos, G., Papadopoulos, C., Papagiannis, I., Karidas, I., Zobolos, S., Preami, Investigators, A., Battaglia, L., Ferraro, M. L., Monaco, A., Palumbo, M., Mariani, O., Biadi, A., Boccalatte, S., Polimeno, V. D., Rosa, L., Liguori, S., Cuomo, A., Boccanelli, P., Morosetti, G., D'Angelo, P., Bottiglieri, C., Brunelli, P., Spallarossa, A., Rolandi, P. F., Rossettini, P., Campa, F., Barilla, L. D., Biase, C., Biscosi, D., Zampino, E., Capponi, M., Buccolieri, R., Gattobigio, A., Capucci, F., Passerini, M., Piepoli, A., Castello, M., Chiariello, Betocchi, Sandro, Q., Ciampi, Losi, MARIA ANGELA, G., Corsini, S., Melorio, J. D., Mule, M., Mazzella, G. R., Cristinziani, L., Mario, I. D., Luca, F., Fusco, B. D., Salvatore, M., Sorino, P., Delise, M. G., Mozzato, G., Bilardo, L., Coro', M., Fantinel, A., Zasso, F., Fedele, D. D., Donato, S., Romano, F. D., Pascale, M., Giasi, L., Ciarcia, A., Lizzardo, M., Mastursi, A., Giordano, M., Benigno, E., Zanelli, M., Campana, E., Giovannini, A., Lacche, G., Pulignano, G., Giuffrida, G., Montana, G., Licciardello, A., L'Abbate, C., Carpeggiani, A., Morale, R., Leghissa, S., Mandorla, M. D., Pinto, C., Borgioni, N., Mininni, M. E., Petrillo, G., Moretti, M., Bonaglia, A., Zoni, C., Piscicelli, M., Orlandi, C., Panciroli, A., Oddone, V., Caizzi, G., Tartarini, F., Lattanzi, B., Reisenhofer, P., Pascotto, A., Zanocco, R. P., Dabizzi, L., Bini, D., Mondanelli, F., Frascarelli, W., Pitscheider, A., Erlicher, W., Rauhe, E., Bonsante, M., Polimeni, F., Catananti, G., Guerrisi, B., Magnani, C., Rapezzi, M., Ferlito, S., Amati, L. D., Leo, M., Manzo, C., Baldi, M. D., Cristofaro, R., Citro, A., Raviele, G., Turiano, G., Zuin, F., Rengo, G., Furgi, A., Papa, D., Rotiroti, G., Rosato, F., Siano, M. R., Pagliuca, G., Rovelli, J., Heyman, I., Locati, M., Sanguinetti, F., Tomassini, R., Mantovani, A., Sanna, L., Marra, E., Crabu, G., Locci, N., Moio, C., Scilla, L., Tavazzi, G., Magrini, C., Bersano, M. L., Laudisa, Trimarco, Bruno, L., Argenziano, S., Silvestri, F., Valagussa, E., Ciro, E., Cantu, G., Trocino, A., Rossillo, L., Valagussa, G., Finocchi, G. M., Benvenuto, C., Bonanno, R., Ometto, G., Risica, G., Gualandi, L., Facchin, P., Tenderini, G. L., Nicolosi, C., Burelli, F., Macor, E., Bellone, D., Laiso, P., Carvalho, C., Peila, A., Fagiano, S., Gardiol, B., Ganci, P., Presutto, A., Fontanelli, T., Morgera, L., Scarpino, S., Barbuzzi, V., Capogrosso, P. F., Terrosu, G. M., Contini, G., Sabino, R., Pe, F., Uneddu, D., Mecca, I. D., Tommaso, C., Rusconi, M. C., Brunazzi, P., Codeluppi, M., Pasqualini, R., Gorni, M., Negrelli, S., Paparoni, A., Core, P., Pecce, L., Petrella, R. G., Zennaro, W., Garuti, G., Alfano, F., Bacca, G., Petrucci, A. M., Paci, G., Bigalli, S., Mangiameli, M., Gulizia, R., Cardillo, G., Ferrari, F., Tettamanti, E., Butti, N., Picchione, A., Sulla, P., Stroder, G. P., Perna, S., Ricci, C. A., Generali, E., Adornato, A., Ghisio, M., Tidu, R., Ferrari, D., Mele, G., Cicchitelli, E., Merli, O., Russa, J. M., A., P. Z., Gonzale, F., Vilchez, L. F. I., J. M. M., C. D., Zarzosa, E. S., Martin, J. O., De, M. H., Martinez, V. M., Palau, M. S. T., D. J. L., E. G., Cocina, J. C., Valderrama, R. P., Jimenez, J. A., M., J. B., Cortada, L. J., Lorente, J. J., G., A., Martinez, J. L., B., R. S., Casado, A. A., Cendon, D., Cokkino, T., Maouni, G., Karatasaki, D., Kremastino, S., Iliodromiti, D., Karatza, M., Georgiadi, I., Paraskevaidi, P., Toutouza, P., Antoniadi, C., Angeli, P., Vada, M., Kalebouba, S., Stamatelopoulo, I., Nana, A., Kanakaki, A., Daliani, A., Zacharouli, I., Fotiadi, V., Pyrgaki, O., Liata, B., Mazen, F., Kardara, D., Kardara, V., Kroko, H., Siora, S., Fousa, A., Stefanidi, G., Papadopoulo, C., Papadopoulo, I., Papagianni, I., Karida, and S., Zobolos

Subjects
Male, Ventricular Remodeling, Myocardial Infarction, Angiotensin-Converting Enzyme Inhibitors, Electrocardiography, ace inhibitors, elderly, heart rate variability, left ventricular remodeling, myocardial infarction, perindopril, Double-Blind Method, Echocardiography, Research Design, Perindopril, Electrocardiography, Ambulatory, Humans, Female, Aged
Abstract

Angiotensin-converting enzyme (ACE) inhibitors reduce mortality, the development of remodeling, left ventricular (LV) dysfunction, and ischemic events, both when administered alone as long-term treatment in patients with impaired LV function and/or heart failure (HF) and as short-term treatment, early after acute myocardial infarction (AMI) and/or HF. The few data available on the use of ACE inhibitors in the elderly after AMI are conflicting. Nothing is known about the effects of ACE inhibitors in elderly postinfarction patients with preserved LV function: these patients have a remarkable medium- to long-term mortality and HF incidence after infarction. The aim of this study is to evaluate, in patients with AMI agedor =65 years, the effects of Perindopril on the combined outcome of death, hospitalization for HF, and heart remodeling, considered to be aor =8% increase in LV end-diastolic volume (LVEDV). Secondary objectives include the same factors listed in the primary end points but considered separately. In addition, safety of the drug, ventricular remodeling, and adaptation are being evaluated. A total of 1100 patients with AMI (first episode or reinfarction), agedor =65 years, and preserved or only moderately depressed LV (LV ejection fractionor =40%), are to be enrolled and randomly assigned to treatment (8 mg for 12 months of Perindopril or placebo, in double-blind conditions). Clinical assessment is performed at fixed times, and periodic evaluations of (1) ventricular shape, dimensions, and function by quantitative 2-D echocardiography, and (2) heart rate variability and arrhythmias by ambulatory electrocardiographic monitoring are anticipated. The results and conclusions will be available by 2002 year.

Published
2000

10. Prehypertension in Outpatient Obese Children

Author

Di Bonito, P., primary, Forziato, C., additional, Sanguigno, E., additional, Di Fraia, T., additional, Saitta, F., additional, Iardino, M. R., additional, Scilla, C., additional, Cavuto, L., additional, Sibilio, G., additional, Moio, N., additional, and Capaldo, B., additional

Published
2009
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15. Elevated blood pressure, cardiometabolic risk and target organ damage in youth with overweight and obesity

Author

Claudia Forziato, Lucia Pacifico, Anita Morandi, Melania Manco, Giuseppina Campana, Claudio Maffeis, Emanuele Miraglia del Giudice, Giuliana Valerio, Giovanni de Simone, Claudio Chiesa, Sandro Loche, Marco Giorgio Baroni, Maria Rosaria Licenziati, Luisa Gilardini, Nicola Moio, Gianluca Tornese, Procolo Di Bonito, Anna Di Sessa, Di Bonito, P., Pacifico, L., Licenziati, M. R., Maffeis, C., Morandi, A., Manco, M., del Giudice, E. M., Di Sessa, A., Campana, G., Moio, N., Baroni, M. G., Chiesa, C., De Simone, G., Valerio, G., Forziato, C., Gilardini, L., Loche, S., and Tornese, G.

Subjects
Carotid Artery Diseases, Male, Pediatric Obesity, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Left ventricular ma, Liver steatosis, Medicine (miscellaneous), Blood Pressure, 030204 cardiovascular system & hematology, Overweight, Adolescents, Body Mass Index, Left ventricular mass, Prehypertension, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, Risk Factors, Carotid intima media thickness, Prevalence, Child, Children, Carotid intima media thickne, education.field_of_study, Nutrition and Dietetics, Age Factors, Left Ventricular, Italy, Cardiovascular Diseases, Child, Preschool, Liver steatosi, Elevated blood pressure, Obesity, Adolescent, Cross-Sectional Studies, Female, Humans, Hypertrophy, Left Ventricular, Insulin Resistance, Risk Assessment, medicine.symptom, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Population, 030209 endocrinology & metabolism, 03 medical and health sciences, Insulin resistance, Internal medicine, medicine, Preschool, education, business.industry, Hypertrophy, medicine.disease, Blood pressure, business, Body mass index
Abstract

Background and aim: To compare cardiometabolic risk profile and preclinical signs of target organ damage in youth with normal and elevated blood pressure (BP), according to the American Academy of Pediatrics (AAP) guidelines. Methods and results: This cross-sectional multicenter study included 2739 youth (5-17 year-old; 170 normal-weight, 610 overweight and 1959 with obesity) defined non hypertensive by the AAP guidelines. Anthropometric, biochemical and liver ultrasound data were available in the whole population; carotid artery ultrasound and echocardiographic assessments were available respectively in 427 and 264 youth. Elevated BP was defined as BP >= 90th to = 120/80 to

Published
2020
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16. Cardiovascular comorbidities and pharmacological treatments of covid-19 patients not requiring hospitalization

Author

Michele Del Guercio, Pierpaolo Di Micco, Nicola Moio, Gaetano Piccinocchi, Roberta Trotta, Vincenzo Mandaliti, Sergio Severino, Giovanni Cimmino, Emilio Attena, Vincenzo Russo, Saverio Annunziata, Russo, V., Piccinocchi, G., Mandaliti, V., Annunziata, S., Cimmino, G., Attena, E., Moio, N., Di Micco, P., Severino, S., Trotta, R., and Del Guercio, M.

Subjects
Male, Health, Toxicology and Mutagenesis, lcsh:Medicine, Comorbidity, 030204 cardiovascular system & hematology, Azithromycin, 0302 clinical medicine, Retrospective Studie, risk factors, 030212 general & internal medicine, Low molecular weight heparin, Diabetes Mellitu, Middle Aged, Cardiovascular disease, Hospitalization, Italy, Hypertension, Population study, Female, medicine.drug, Venous thromboembolism, Human, Adult, medicine.medical_specialty, medicine.drug_class, Article, 03 medical and health sciences, Anticoagulation, Internal medicine, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Retrospective Studies, Experimental drug, Aged, business.industry, experimental drugs, Risk Factor, lcsh:R, Public Health, Environmental and Occupational Health, COVID-19, Retrospective cohort study, medicine.disease, COVID-19 Drug Treatment, cardiovascular diseases, Outpatient’s setting, Concomitant, Relative risk, business
Abstract

Introduction: The Coronavirus disease 2019 (COVID-19) outbreak is a whole Earth health emergency related to a highly pathogenic human coronavirus responsible for severe acute respiratory syndrome (SARS-CoV-2). Despite the fact that the majority of infected patients were managed in outpatient settings, little is known about the clinical characteristics of COVID-19 patients not requiring hospitalization. The aim of our study was to describe the clinical comorbidity and the pharmacological therapies of COVID-19 patients managed in outpatient settings. Materials and Methods: We performed an observational, retrospective analysis of laboratory-confirmed COVID-19 patients managed in outpatient settings in Naples, Italy between March 9 and May 1, 2020. Data were sourced from the prospectively maintained Health Search (HS)/Thales database, shared by 128 primary care physicians (PCPs) in Naples, Italy. The clinical features and pharmacological therapies of COVID-19 patients not requiring hospitalization and managed in outpatient settings have been described. Results: A total of 351 laboratory-confirmed COVID-19 patients (mean age 54 &plusmn, 17 years, 193 males) with outpatient management were evaluated. Hypertension was the most prevalent comorbidity (35%). The distribution of cardiovascular comorbidities showed no gender-related differences. A total of 201 patients (57.3%) were treated with at least one experimental drug for COVID-19. Azithromycin, alone (42.78%) or in combination (27.44%), was the most widely used experimental anti-COVID drug in outpatient settings. Low Molecular Weight Heparin and Cortisone were prescribed in 24.87% and 19.4% of the study population, respectively. At multivariate regression model, diabetes (risk ratio (RR): 3.74, 95% CI 1.05 to 13.34, p = 0.04) and hypertension (RR: 1.69, 95% CI 1.05 to 2.7, p = 0.03) were significantly associated with the experimental anti-COVID drug administration. Moreover, only diabetes (RR: 2.43, 95% CI 1.01 to 5.8, p = 0.03) was significantly associated with heparin administration. Conclusions: Our data show a high prevalence of hypertension, more likely treated with renin&ndash, angiotensin&ndash, aldosterone system (RASS) inhibitors, among COVID-19 patients not requiring hospitalization. Experimental COVID-19 therapies have been prescribed to COVID-19 patients considered at risk for increased venous thromboembolism based on concomitant comorbidities, in particular diabetes and hypertension.

Published
2021

17. The American Academy of Pediatrics hypertension guidelines identify obese youth at high cardiovascular risk among individuals non-hypertensive by the European Society of Hypertension guidelines

Author

Di Bonito, Procolo, Licenziati, Maria Rosaria, Baroni, Marco G., Maffeis, Claudio, Morandi, Anita, Manco, Melania, del Giudice, Emanuele Miraglia, Di Sessa, Anna, Campana, Giuseppina, Moio, Nicola, Gilardini, Luisa, Chiesa, Claudio, Pacifico, Lucia, de Simone, Giovanni, Valerio, Giuliana, Driul, D., Forziato, C., Loche, S., Tornese, G., Bonito, P. D., Licenziati, M. R., Baroni, M. G., Maffeis, C., Morandi, A., Manco, M., Miraglia del Giudice, E., Sessa, A. D., Campana, G., Moio, N., Gilardini, L., Chiesa, C., Pacifico, L., Simone, G. D., Tornese, G, and Valerio, G.

Subjects
Male, Pediatric Obesity, Pediatrics, medicine.medical_specialty, Consensus, hypertension, Adolescent, Epidemiology, paediatric obesity, Blood Pressure, 030204 cardiovascular system & hematology, Left ventricular hypertrophy, Risk Assessment, Childhood obesity, Decision Support Techniques, 03 medical and health sciences, 0302 clinical medicine, Paediatric obesity, Predictive Value of Tests, Humans, Medicine, 030212 general & internal medicine, Child, Cardiometabolic risk factor, business.industry, Age Factors, medicine.disease, cardiometabolic risk factors, left ventricular hypertrophy, Cross-Sectional Studies, Italy, Heart Disease Risk Factors, Practice Guidelines as Topic, Female, Cardiology and Cardiovascular Medicine, business
Abstract

Background Two different systems for the screening and diagnosis of hypertension (HTN) in children currently coexist, namely, the guidelines of the 2017 American Academy of Pediatrics (AAP) and the 2016 European Society for Hypertension (ESH). The two systems differ in the lowered cut-offs proposed by the AAP versus ESH. Objectives We evaluated whether the reclassification of hypertension by the AAP guidelines in young people who were defined non-hypertensive by the ESH criteria would classify differently overweight/obese youth in relation to their cardiovascular risk profile. Methods A sample of 2929 overweight/obese young people (6–16 years) defined non-hypertensive by ESH (ESH–) was analysed. Echocardiographic data were available in 438 youth. Results Using the AAP criteria, 327/2929 (11%) young people were categorized as hypertensive (ESH–/AAP+). These youth were older, exhibited higher body mass index, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), triglycerides, total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio, blood pressure, left ventricular mass index and lower HDL-C (p Conclusions The reclassification of hypertension by the AAP guidelines in young people overweight/obese defined non-hypertensive by the ESH criteria identified a significant number of individuals with high blood pressure and abnormal cardiovascular risk. Our data support the need of a revision of the ESH criteria.

Published
2019
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18. Cardiometabolic Phenotype in Children with Obesity

Author

Nicola Moio, Procolo Di Bonito, Eduardo Sanguigno, Giovanni de Simone, Luigi Cavuto, Claudia Forziato, Brunella Capaldo, Gerolamo Sibilio, Di Bonito, P, Moio, N, Sibilio, G, Cavuto, L, Sanguigno, E, Forziato, C, DE SIMONE, Giovanni, and Capaldo, Brunella

Subjects
Blood Glucose, Male, medicine.medical_specialty, Waist, Heart Ventricles, Blood Pressure, Left ventricular hypertrophy, Body Mass Index, Internal medicine, medicine, Humans, Obesity, cardiovascular diseases, Child, Ultrasonography, Waist-to-height ratio, Waist-Height Ratio, Ventricular Remodeling, medicine.diagnostic_test, business.industry, Anthropometry, medicine.disease, Phenotype, Blood pressure, Endocrinology, Child, Preschool, Obesity, Abdominal, Pediatrics, Perinatology and Child Health, Female, Hypertrophy, Left Ventricular, Waist Circumference, Lipid profile, business, Body mass index
Abstract

To investigate the anthropometric and metabolic correlates of different patterns of left ventricular (LV) geometry in a cohort of outpatient children with high prevalence of obesity.Anthropometric measures, lipid profile, blood pressure (BP), fasting plasma glucose (FPG), and echocardiographic variables were evaluated in 281 white children (6-16 years), of whom 105 were obese and 105 were morbidly obese. Patterns of LV geometry were defined as follows: normal geometry, eccentric LV hypertrophy (LVH), concentric LV remodeling, and concentric LVH.One hundred forty-eight children exhibited normal LV geometry, 53 eccentric LVH, 36 concentric LV remodeling, and 44 concentric LVH. The 4 groups differed in body mass index, waist circumference, waist-to-height ratio, triglycerides/high-density lipoprotein cholesterol ratio (Tg/HDL-C), and BP (P.05-.0001). A statistically significant impairment of diastolic function (expressed as greater E/E', P.002) was observed across patterns of LV geometry. Among anthropometric measures, waist-to-height ratio showed better performance in relation to LVH, with an optimal cut-point of 0.58, compared with body mass index and waist circumference. Children with concentric LVH exhibited the worst metabolic risk profile, with greater prevalence of visceral obesity, high Tg/HDL-C, high BP, and high-normal FPG, than children with normal LV geometry.In children with high levels of obesity, an unfavorable "cardiometabolic phenotype" can be identified, which includes concentric LVH, visceral obesity, high BP, high Tg/HDL-C, and high-normal FPG.

Published
2014
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19. Diastolic Dysfunction in Patients with Non-insulin-dependent Diabetes Mellitus of Short Duration

Author

D. Sabatini, Brunella Capaldo, P. Di Bonito, S. Quattrin, G. Sibilio, S. Cuomo, Nicola Moio, DI BONITO, P, Cuomo, S, Moio, N, Sibilio, G, Sabatini, D, Quattrin, S, and Capaldo, Brunella

Subjects
medicine.medical_specialty, Heart disease, business.industry, Endocrinology, Diabetes and Metabolism, Microangiopathy, Diastole, Cardiomyopathy, medicine.disease, Coronary artery disease, Endocrinology, Diabetes mellitus, Internal medicine, Diabetic cardiomyopathy, Heart failure, Internal Medicine, medicine, Cardiology, business
Abstract

with the control group (p

Published
1996
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21. Association of HDL-Cholesterol, hypertension and left ventricular hypertrophy in youths with overweight or obesity.

Author

Di Bonito P, Morandi A, Licenziati MR, Di Sessa A, Miraglia Del Giudice E, Faienza MF, Corica D, Wasniewska M, Mozzillo E, Maltoni G, Franco F, Calcaterra V, Moio N, Maffeis C, and Valerio G

Subjects
Adolescent, Humans, Child, Hypertrophy, Left Ventricular diagnostic imaging, Hypertrophy, Left Ventricular epidemiology, Cross-Sectional Studies, Obesity diagnosis, Obesity epidemiology, Cholesterol, HDL, Overweight, Hypertension diagnosis, Hypertension epidemiology
Abstract

Background and Aim: To evaluate the relationship between HDL-Cholesterol (HDL-C), hypertension, and left ventricular hypertrophy (LVH) in a large sample of Caucasian youths with overweight/obesity (OW/OB)., Methods and Results: A cross-sectional multicenter study was performed in 1469 youths (age 6-16 years) with OW/OB observed in the period 2016-2020. An additional independent sample of 244 youths with an echocardiographic evaluation, observed in a single center was analyzed. The sample was divided in six quantiles (Q) of HDL-C: Q1: >56, Q2: ≤56 > 51, Q3: ≤51 > 45, Q4: ≤45 > 41, Q5: ≤41 > 39, Q6: <39 mg/dL. The nadir of the relationship was identified in youths in the first quantile. Among HDL-Cholesterol quantiles the distribution of hypertension was non-linear with a percentage of 25.0%, 40.1%, 33.6%, 31.3%, 35.2% and 39.7% in the six quantiles, respectively. The percentage of LVH was 21.8%, 43.6%, 48.8%, 35.5%, 38.5% and 52.0% in the six quantiles, respectively. The highest odds [95%Cl] of hypertension were 2.05 (1.33-3.16) (P < 0.01) in Q2, 1.67 (1.10-2.55) (P < 0.05) in Q3 and 1.59 (1.05-2.41) (P < 0.05) in Q6 vs Q1. The odds of LVH were 3.86 (1.15-10.24) (P < 0.05) in Q2, 4.16 (1.58-10.91) (P < 0.05) in Q3 and 3.60 (1.44-9.02) (P < 0.05) in Q6 vs Q1, independently by centers, age, sex, prepubertal stage, and body mass index., Conclusion: Contrary to the common belief, the present study shows that high levels of HDL-C may be not considered a negative predictor of hypertension and LVH, two risk factors for future CV disease., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2024
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22. Static cutoffs or tables for the diagnosis of hypertension? Effect on identification of organ damage in youths with obesity.

Author

Di Bonito P, Valerio G, Licenziati MR, Di Sessa A, Miraglia Del Giudice E, Manco M, Chiesa C, Pacifico L, Moio N, and de Simone G

Subjects
Humans, Adolescent, Child, Obesity diagnosis, Obesity epidemiology, Obesity complications, Blood Pressure, Echocardiography, Hypertrophy, Left Ventricular diagnostic imaging, Hypertrophy, Left Ventricular epidemiology, Hypertension diagnosis, Hypertension epidemiology, Hypertension complications, Kidney Diseases
Abstract

Background and Aim: Recently, the European Society of Cardiology task force released a Consensus document (ESC-CD) on pediatric hypertension (HTN) supporting the use of normative tables (age range 6-16 years) for the diagnosis of HTN, while the Hypertension Canada Guidelines (HTN-CGs) proposed static cutoffs. We aimed to assess the prevalence of HTN by ESC-CD or HTN-CGs and their association with glomerular function and left ventricular (LV) geometry in youths with overweight/obesity (OW/OB)., Methods and Results: Data of 3446 youths were analyzed. HTN by was defined using normative tables (ESC-CD) or static cutoffs of BP ≥ 120/80 in children (age <12 years) and ≥130/85 mmHg in adolescents (age ≥12 years) (HTN-CGs). Mildly reduced glomerular filtration rate was defined by GFR <90 ≥ 60 mL/min/1.73 m 2 . Concentric LV hypertrophy (cLVH) was assessed in 500 youths and defined by LVH and high relative wall thickness as proposed by ESC-CD. Prevalence of HTN was 27.9% by ESC-CD and 22.7% by HTN-CGs. The association with mildly reduced glomerular filtration rate was significant only in hypertensive adolescents classified by HTN-CGs [Odds Ratio (OR), 95%Cl] 2.16 (1.44-3.24), whereas the association with cLVH was significant using both criteria: children OR 2.18 (1.29-3.67) by ESC-CD and 2.27 (1.32-3.89) by HTN-CGs; adolescents OR 2.62 (1.17-5.84) by ESC-CD and 2.83 (1.14-7.02) by HTN-CGs., Conclusion: Although static cutoffs may represent a simplification for HTN identification, tables by ESC-CD detect a higher number of hypertensive youths before a clear appearance of glomerular impairment, which offers advantages in terms of primary cardiovascular prevention., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Published
2023
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23. Cardiovascular Comorbidities and Pharmacological Treatments of COVID-19 Patients Not Requiring Hospitalization.

Author

Russo V, Piccinocchi G, Mandaliti V, Annunziata S, Cimmino G, Attena E, Moio N, Di Micco P, Severino S, Trotta R, and Del Guercio M

Subjects
Adult, Aged, Diabetes Mellitus, Female, Hospitalization, Humans, Hypertension complications, Italy epidemiology, Male, Middle Aged, Retrospective Studies, Risk Factors, COVID-19 complications, Cardiovascular Diseases complications, Comorbidity, COVID-19 Drug Treatment
Abstract

Introduction: The Coronavirus disease 2019 (COVID-19) outbreak is a whole Earth health emergency related to a highly pathogenic human coronavirus responsible for severe acute respiratory syndrome (SARS-CoV-2). Despite the fact that the majority of infected patients were managed in outpatient settings, little is known about the clinical characteristics of COVID-19 patients not requiring hospitalization. The aim of our study was to describe the clinical comorbidity and the pharmacological therapies of COVID-19 patients managed in outpatient settings., Materials and Methods: We performed an observational, retrospective analysis of laboratory-confirmed COVID-19 patients managed in outpatient settings in Naples, Italy between 9 March and 1 May 2020. Data were sourced from the prospectively maintained Health Search (HS)/Thales database, shared by 128 primary care physicians (PCPs) in Naples, Italy. The clinical features and pharmacological therapies of COVID-19 patients not requiring hospitalization and managed in outpatient settings have been described., Results: A total of 351 laboratory-confirmed COVID-19 patients (mean age 54 ± 17 years; 193 males) with outpatient management were evaluated. Hypertension was the most prevalent comorbidity (35%). The distribution of cardiovascular comorbidities showed no gender-related differences. A total of 201 patients (57.3%) were treated with at least one experimental drug for COVID-19. Azithromycin, alone (42.78%) or in combination (27.44%), was the most widely used experimental anti-COVID drug in outpatient settings. Low Molecular Weight Heparin and Cortisone were prescribed in 24.87% and 19.4% of the study population, respectively. At multivariate regression model, diabetes (risk ratio (RR): 3.74; 95% CI 1.05 to 13.34; p = 0.04) and hypertension (RR: 1.69; 95% CI 1.05 to 2.7; p = 0.03) were significantly associated with the experimental anti-COVID drug administration. Moreover, only diabetes (RR: 2.43; 95% CI 1.01 to 5.8; p = 0.03) was significantly associated with heparin administration., Conclusions: Our data show a high prevalence of hypertension, more likely treated with renin-angiotensin-aldosterone system (RASS) inhibitors, among COVID-19 patients not requiring hospitalization. Experimental COVID-19 therapies have been prescribed to COVID-19 patients considered at risk for increased venous thromboembolism based on concomitant comorbidities, in particular diabetes and hypertension.

Published
2020
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24. Glomerular filtration rate and cardiometabolic risk in an outpatient pediatric population with high prevalence of obesity.

Author

Di Bonito P, Sanguigno E, Forziato C, Di Fraia T, Moio N, Cavuto L, Sibilio G, Iardino MR, Di Carluccio C, and Capaldo B

Subjects
Adolescent, Albuminuria diagnosis, Albuminuria epidemiology, Albuminuria etiology, Biomarkers, Body Mass Index, Cardiovascular Diseases diagnosis, Cardiovascular Diseases epidemiology, Child, Cross-Sectional Studies, Early Diagnosis, Female, Glomerular Filtration Rate, Humans, Hypertension diagnosis, Hypertension epidemiology, Hypertension etiology, Hypertrophy, Left Ventricular diagnosis, Hypertrophy, Left Ventricular epidemiology, Hypertrophy, Left Ventricular etiology, Italy epidemiology, Male, Outpatient Clinics, Hospital, Overweight epidemiology, Pediatric Obesity epidemiology, Prevalence, Renal Insufficiency diagnosis, Renal Insufficiency epidemiology, Renal Insufficiency physiopathology, Risk Factors, Severity of Illness Index, Cardiovascular Diseases etiology, Kidney physiopathology, Overweight physiopathology, Pediatric Obesity physiopathology, Renal Insufficiency etiology
Abstract

Objective: To evaluate the relationship between estimated glomerular filtration rate (eGFR) and cardiometabolic risk factors (CMRF) in an outpatient pediatric population with high prevalence of obesity., Design and Methods: eGFR was evaluated in 901 children unselected for chronic kidney disease of whom 694 were overweight/obese (6-16 years) and 207 were age- and sex-matched normal weight (NW). We generated three categories of eGFR: mild-low eGFR (< 20th percentile), high eGFR (>80th percentile) and intermediate eGFR (20-80th percentile), considered as the reference category, Results: Children with either mild-low or high eGFR category showed a 2-4 fold higher Odds ratio of high blood pressure, left ventricular hypertrophy, and microalbuminuria compared with children of the intermediate eGFR category. In addition, children with mild-low eGFR levels showed a 1.5-2 fold higher Odds ratio of impaired fasting glucose and high white blood cell count compared with children with intermediate eGFR levels., Conclusions: In outpatient children with high prevalence of obesity, children with either mildly reduced or high eGFR have an increased burden of CMRF. Children with eGFR < 97 mL/min/1.73 m² show a worse CMR profile. This finding supports the usefulness to assess eGFR to identify children with unfavorable CMR profile.

Published
2014
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25. [Identification of patients with acute myocardial infarction that may be discharged early: prospective evaluation with simple clinical and instrumental indicators].

Author

Murena E, Molero U, Moio N, Pisani A, Stingone MA, Guardascione A, Grassia V, Scilla C, Marino A, and Sibilio G

Subjects
Aged, Female, Follow-Up Studies, Humans, Incidence, Length of Stay, Male, Middle Aged, Myocardial Infarction complications, Myocardial Infarction mortality, Prospective Studies, Time Factors, Myocardial Infarction therapy, Patient Discharge
Abstract

Background: The hospital stay for "uncomplicated" acute myocardial infarction (AMI) is often too long. A reduction in the length of hospitalization, if proven to be safe, is advantageous in terms of costs and health organization. Accordingly the aims of the present, prospective study, were to evaluate: 1) the patients with AMI eligible for early discharge; 2) the incidence of adverse cardiovascular events within 2 weeks of myocardial infarction; 3) the incidence of cardiovascular mortality at 6-month follow-up., Methods: On the fifth day after AMI, 331 of 526 patients, consecutively admitted to our coronary care unit between March 1997 and August 1999, were assigned to "complicated" and "uncomplicated" AMI groups, according to clinical and non-invasive criteria. Uncomplicated myocardial infarction eligible for early discharge was defined in patients < 75 years, as the absence of a high risk personality, stroke, left bundle branch block, transient myocardial ischemia after the first 24 hours from AMI, clinical signs or echocardiographic evidence of left ventricular dysfunction (ejection fraction < 40%), ventricular fibrillation, sustained ventricular tachycardia, symptomatic bradyarrhythmias after the first 48 hours from AMI, cardioversion or defibrillation (after the first 48 hours) or the need for coronary angioplasty or coronary artery bypass grafting. Uncomplicated patients were discharged on the sixth day after AMI (hospital stay 6.5+/-0.72 days). A symptom-limited ergometric stress test was planned in the uncomplicated group 14 days after AMI. "Hard" (death, reinfarction) and "non-hard" (unstable angina, myocardial revascularization) adverse cardiovascular events were monitored at 2 weeks of follow-up, and cardiovascular mortality at 6-month follow-up., Results: Four (1.2%) hard (0.3% exitus and 0.9% reinfarction) and 7 (2.1%) non-hard adverse events occurred among patients with uncomplicated AMI at 2 weeks of follow-up. Patients with uncomplicated AMI who developed adverse events, presented during the primary coronary event creatine kinase (CK) and CK-MB serum levels which were significantly lower than those observed in patients who did not present adverse events. In the complicated group (hospital stay 9.9+/-1.79 days), from day 6 to 14 after AMI, 65 (33%) hard and non-hard events occurred. A significant reduction in mortality between the uncomplicated and complicated group (2.11 vs 27.17%, p < 0.0001) was observed at 6-month follow-up. Multivariate analysis showed a statistically significant difference for age and thrombolytic treatment., Conclusions: This first Italian prospective study demonstrated the possibility of identifying, 5 days after AMI and on the basis of simple criteria and without a stress test, a low risk population of patients eligible for early discharge.

Published
2001

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