Subtyping of Primary Aldosteronism in the AVIS-2 Study: Assessment of Selectivity and Lateralization.

Context: Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism (PA), but its interpretation varies widely across referral centers and this can adversely affect the management of PA patients.

Objectives: To investigate in a real-life study the rate of bilateral success and identification of unilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS.

Design And Settings: In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index (SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateral aldosteronism, and blood pressure outcomes.

Sex differences in hypertension-related renal and cardiovascular diseases in Italy: the I-DEMAND study.

Aim: The aim of this study is to evaluate the differences in the prevalence of chronic kidney disease (CKD) and of cardiovascular risk factors and diseases between men and women participating in the Italy Developing Education and awareness on MicroAlbuminuria in patients with hyperteNsive Disease (I-DEMAND) study.

Methods: This is an observational, cross-sectional, multicenter study aimed at assessing prevalence and correlates of CKD among Italian hypertensive patients attending out-patient referral clinics. CKD was defined as glomerular filtration rate (GFR) less than 60 ml/min per 1.

Hyperparathyroidism can be useful in the identification of primary aldosteronism due to aldosterone-producing adenoma.

Hyperparathyroidism represents as a novel feature of primary aldosteronism (PA). Its occurrence in patients with the surgically correctable aldosterone-producing adenoma (APA) and not in those with bilateral adrenal hyperplasia suggested that the measurement of parathyroid hormone could help in differentiating between these subtypes of PA. To test this hypothesis we measured the plasma levels of intact parathyroid hormone, Ca(2+), and several markers of calcium/phosphorus metabolism in 132 hypertensive patients, including 74 with primary (essential) hypertension and 58 consecutive PA patients.

The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism.

Context: In patients who seek surgical cure of primary aldosteronism (PA), The Endocrine Society Guidelines recommend the use of adrenal vein sampling (AVS), which is invasive, technically challenging, difficult to interpret, and commonly held to be risky.

Objective: The aim of this study was to determine the complication rate of AVS and the ways in which it is performed and interpreted at major referral centers.

Design And Settings: The Adrenal Vein Sampling International Study is an observational, retrospective, multicenter study conducted at major referral centers for endocrine hypertension worldwide.

Metabolic syndrome and chronic kidney disease in high-risk Italian hypertensive patients: the I-DEMAND study.

Background: Metabolic syndrome (MS) and chronic kidney disease (CKD) are well-known, independent predictors of increased cardiovascular risk. Both conditions are fairly prevalent in the general population. The aim of this study was to assess the relationship between MS or its individual components and CKD in an Italian population of hypertensive patients with normal or mildly to moderately impaired renal function under specialist care.

Comparison of methods for determination of glomerular filtration rate in hypertensive subjects with normal serum creatinine.

Background: Glomerular filtration rate (GFR) measured through technetium-99m diethyl triamine penta-acetic acid (Tc(99m)DTPA) renal scintigraphy (rsGFR) was compared with that estimated (eGFR) from 24-h creatinine clearance (CrCl) and, using both the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas, in a population of hypertensive subjects (HTs) with normal serum creatinine (SCr) levels.

Patients And Methods: In 200 normoalbuminuric (<30 mg/24 h) HTs 55-75 years old, without diabetes and history of coronary and cerebrovascular diseases, Pearson's correlation assess the relationship between rsGFR and eGFR. The Bland-Altman method was used to assess the agreement between rsGFR and eGFR, separately in subjects with low (<60 ml/min/1.

Within-patient reproducibility of the aldosterone: renin ratio in primary aldosteronism.

The plasma aldosterone concentration:renin ratio (ARR) is widely used for the screening of primary aldosteronism, but its reproducibility is unknown. We, therefore, investigated the within-patient reproducibility of the ARR in a prospective multicenter study of consecutive hypertensive patients referred to specialized centers for hypertension in Italy. After the patients were carefully prepared from the pharmacological standpoint, the ARR was determined at baseline in 1136 patients and repeated after, on average, 4 weeks in the patients who had initially an ARR > or =40 and in 1 of every 4 of those with an ARR <40.

Association of renal damage with cardiovascular diseases is independent of individual cardiovascular risk profile in hypertension: data from the Italy - Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease study.

Objectives: In the past years, several risk charts have been created to increase the accuracy of cardiovascular risk stratification. The most widely used and validated algorithms do not included target organ damage as risk prediction. The aim of the present study was to evaluate whether preclinical renal damage is associated with cardiovascular diseases independently of individual risk profile assessed by risk charts.

Independent association of ECG abnormalities with microalbuminuria and renal damage in hypertensive patients without overt cardiovascular disease: data from Italy-Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease study.

Objectives: Renal abnormalities are strongly associated with cardiac damage in essential hypertension. Detection of preclinical cardiac and renal abnormalities is a key clinical step in hypertension management. This study investigated the relationship between ECG abnormalities and microalbuminuria (MAU) in hypertensive patients without overt cardiovascular disease.

Primary aldosteronism: an update on screening, diagnosis and treatment.

Background: Primary aldosteronism is much more common than previously held; it implies an excessive organ damage to the heart, vessels and kidney, which translates into an excess of cardiovascular events. These two features, along with the fact that the arterial hypertension and the hypokalemia can be corrected with a timely diagnosis and an appropriate therapy, warrant an aggressive diagnostic approach in hypertensive patients.

Objectives: To provide updated information on the screening and exclusion tests for primary aldosteronism and to illustrate the strategy that can be followed for primary aldosteronism subtype differentiation.

Target organs of individuals with diabetes caught between arterial stiffness and damage to the microcirculation.

Hypertension and diabetes mellitus occur together frequently. There is general consensus in the literature that in patients with hypertension and diabetes, the heart and kidneys are locked in a vice, between arterial stiffening and damage to the microcirculation, with each condition feeding the other in a vicious cycle of events. Decreased glucose tolerance is associated with increased thickness and stiffness of large blood vessels, which contributes to increased blood pressure, macrovascular complications and impaired renal function.

Homocysteine, left ventricular dysfunction and coronary artery disease: is there a link?

Experimental and observational studies support a role of plasma homocysteine levels (tHcy) in coronary artery disease (CAD). In the GENICA (Genetic and Environmental factors In Coronary Atherosclerosis) study, we found that high tHcy predicted cardiovascular mortality in hypertensive, but not in normotensive, patients independently of CAD and history of myocardial infarction. Moreover, despite not being associated with the coronary atherosclerotic burden, tHcy was inversely associated with left ventricular (LV) ejection fraction.

Prospective evaluation of the saline infusion test for excluding primary aldosteronism due to aldosterone-producing adenoma.

Background: Data on the performance of the tests used to confirm the diagnosis of primary aldosteronism (PA) are limited.

Objective: To prospectively investigate the accuracy of the saline infusion test (SIT).

Methods: Three hundred and seventeen (26.

A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients.

Objectives: We prospectively investigated the prevalence of curable forms of primary aldosteronism (PA) in newly diagnosed hypertensive patients.

Background: The prevalence of curable forms of PA is currently unknown, although retrospective data suggest that it is not as low as commonly perceived.

Methods: Consecutive hypertensive patients referred to 14 hypertension centers underwent a diagnostic protocol composed of measurement of Na+ and K+ in serum and 24-h urine, sitting plasma renin activity, and aldosterone at baseline and after 50 mg captopril.

Renal damage in primary aldosteronism: results of the PAPY Study.

Primary aldosteronism (PA) has been associated with cardiovascular hypertrophy and fibrosis, in part independent of the blood pressure level, but deleterious effects on the kidneys are less clear. Likewise, it remains unknown if the kidney can be diversely involved in PA caused by aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Hence, in the Primary Aldosteronism Prevalence in Italy (PAPY) Study, a prospective survey of newly diagnosed consecutive patients referred to hypertension centers nationwide, we sought signs of renal damage in patients with PA and in comparable patients with primary hypertension (PH).

Expression of telomerase (hTERT) in aldosterone-producing adrenocortical tumors.

Telomerase was found in cancers and immortalized cell lines, but only occasionally in normal tissues, thus suggesting that measurement of its hTERT subunit might help distinguishing benign from malignant tumors. Data on hTERT expression in adrenocortical tumors are scant and mostly confined to non-functioning tumors. Therefore, we investigated whether hTERT expression may predict malignancy in aldosterone producing adrenocortical tumors.

Predictors of congestive heart failure mortality in elderly people from the general population.

Congestive heart failure (CHF) is highly prevalent in the elderly. The aim of this study was to identify the predictors of CHF mortality in patients over 65 years of age who were free of CHF at initial screening. A total of 3,282 elderly subjects were recruited in a population-based frame and 12-year events were recorded.

Therapeutic profile of manidipine and lercanidipine in hypertensive patients.

Manidipine and lercanidipine are considered effective and safe in the treatment of chronic arterial hypertension and are equipotent in reducing blood pressure (BP) levels. Their main side effect is ankle-foot edema. After a 2-week placebo run-in period, these 2 drugs were compared in a controlled parallel-group study lasting 3 months, involving 53 patients with mild-to-moderate essential hypertension (26 assigned to manidipine and 27 to lercanidipine).

Measuring accuracy of discharge diagnoses for a region-wide surveillance of hospitalized strokes.

Background And Purpose: Measuring the impact of stroke through population-based stroke registers is complex and costly. The aim of the present study is to assess the validity of hospital discharge diagnoses (all ages) and to estimate the total number of hospitalized stroke events in the Veneto region (Northeastern Italy, 4,500,000 inhabitants).

Methods: All discharges covering a 1-year period (1999) from Veneto hospitals with International Classification of Diseases, 9th Revision codes 342, 430 to 434, and 436 to 438 were identified.

Prevalence of fetal-type smooth muscle cells in the media of microvessels from hypertensive patients.

Significant structural and functional changes in smooth muscle cells (SMCs) of microvessels (diameter 30 to 300 microm) occur in hypertension. However, in microvessels of hypertensive patients, the differentiation pattern of SMCs underlying such changes remains undefined. To analyze the differentiation pattern of SMCs (adult, postnatal, or fetal), 49 muscle biopsies (rectus abdominis) were analyzed: 16 from children (aged 11 months to 11 years), 15 from normotensive adults (aged 55 to 74 years), 18 from hypertensive adults (aged 55 to 74 years).

Abnormal regulation of G protein alpha(i2) subunit in skin fibroblasts from insulin-resistant hypertensive individuals.

Background: Studies in experimental animals and human cells have demonstrated increased intracellular calcium (Ca(i2) signalling and Galphai signal transduction associated with hypertension. We have recently shown that angiotensin II-induced mobilization of Ca(i2) is enhanced in fibroblasts from hypertensive individuals in comparison with that in normotensive individuals and that it is blunted by insulin and pertussis toxin in insulin-sensitive, but not in insulin-resistant, patients. This suggests that G(i)-mediated signal transduction is reduced in insulin-resistant hypertension.

Under treatment with lipid-lowering drugs of high-risk coronary heart disease patients of the GENICA study.

Objectives: To assess the proportion of high-risk coronary artery disease (CAD) patients who received lipid lowering drug treatment (LLDT) and met the LDL-Cholesterol (LDL-C) goal of 100 mg/dl defined by the third report of the U.S. National Cholesterol Education Program (NCEP).