Observational study of hypertension and snoring in Northeastern Italy (Limana Hypertension Study).

Objective: To evaluate through an observational study on volunteers some important cardiovascular disease risk factors such as hypertension and snoring in a population from Limana, a town of a subalpine zone of northeastern Italy.

Design: Limana residents were informed by post and at a public meeting and then attended an outpatient clinic set up by the town of Limana for clinical history, measurement of blood pressure, weight and height.

Patients: Of 202 subjects (94 men and 108 women), 92.

Prognostic value of elevated white blood cell count in hypertension.

Background: Chronic low-grade inflammation may contribute to vascular injury and atherogenesis, and has been described in association to high blood pressure (BP). However, as yet the prognostic significance of white blood cell (WBC) count in the setting of uncomplicated hypertension has not been investigated.

Methods: In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, 1617 white patients with essential hypertension (aged 49 +/- 12 years, 55% men) without prevalent cardiovascular or renal disease underwent off-treatment baseline clinical evaluation and were then followed up for 11 years (average 4.

Day-to-day variability of electrocardiographic diagnosis of left ventricular hypertrophy in hypertensive patients. Influence of electrode placement.

Objective: Although electrocardiography (ECG) is recommended in all subjects with hypertension, no information is available on the influence exerted by random changes in the placement of electrodes on the day-to-day variability of ECG criteria for diagnosis of left ventricular hypertrophy (LVH).

Methods: In a multicentre, randomized study, two standard 12-lead ECG were recorded, 24 h apart, from 276 consecutive hypertensive patients (mean age 65 +/- 12 years, 49.6% men).

Prognostic impact of prolonged ventricular repolarization in hypertension.

Background: QT interval prolongation on the surface electrocardiogram (ECG) predicts cardiovascular complications in high-risk subjects, but its prognostic role in uncomplicated hypertension has been understudied.

Methods: For up to 13 years (average, 5.3 years), we followed up 2110 white patients with initially untreated essential hypertension (mean +/- SD age, 49 +/- 12 years; 55% men) without prevalent cardiovascular or renal disease who underwent 12-lead ECG before therapy.

Angiotensin-converting enzyme inhibitors and calcium channel blockers for coronary heart disease and stroke prevention.

We investigated whether protection from coronary heart disease (CHD) and stroke conferred by angiotensin-converting enzyme inhibitors (ACEIs) and calcium channel blockers (CCBs) in hypertensive or high-risk patients may be explained by the specific drug regimen. We extracted summary statistics regarding CHD and stroke from 28 outcome trials that compared either ACEIs or CCBs with diuretics, beta-blockers, or placebo for a total of 179,122 patients, 9509 incident cases of CHD, and 5971 cases of stroke. CHD included myocardial infarction and coronary death.

Asymptomatic left ventricular systolic dysfunction in essential hypertension: prevalence, determinants, and prognostic value.

Prevalence, determinants, and prognostic value of asymptomatic left ventricular systolic dysfunction (LVSD) in uncomplicated subjects with essential hypertension are still incompletely known. We studied 2384 initially untreated subjects with hypertension, no previous cardiovascular disease, and no symptoms or physical signs of congestive heart failure (CHF). These subjects were studied at entry and followed for up to 17 years (mean 6.

Prognostic value of lipoprotein fractions in essential hypertension.

Background: To evaluate distribution and prognostic value of total cholesterol and lipoprotein fractions in essential hypertension.

Methods: In a prospective cohort study, 2649 initially untreated subjects with essential hypertension (aged 51, 46.5% women) were investigated at entry and followed for a mean of 5.

Regression of left ventricular hypertrophy and cardiovascular risk changes in hypertensive patients.

Hypertensive left ventricular hypertrophy (LVH) may be detected in about one third of people with hypertension. When an individual with elevated blood pressure develops LVH, the risk of adverse cardiovascular events in the ensuing years almost doubles even in the absence of symptoms. Because of this high added risk, hypertension and other modifiable risk factors should be managed aggressively with lifestyle measures and drugs.

Calcium channel blockade to prevent stroke in hypertension: a meta-analysis of 13 studies with 103,793 subjects.

Background: The possibility that specific antihypertensive treatments may prevent the occurrence of stroke more effectively than other treatments remains unproved. We undertook a meta-analysis to assess whether calcium channel blockers (CCBs) are associated with a lesser risk of stroke as compared with other antihypertensive drugs.

Methods: Through Medline we identified 13 major studies conducted in hypertensive subjects for a total of 103,793 subjects.

Validation of the A&D UA-774 (UA-767Plus) device for self-measurement of blood pressure.

Objectives: To determine the accuracy of the UA-774 (UA-767Plus) blood pressure monitor developed by the A&D Company.

Methods: Device evaluation was performed according to the modified British Hypertension Society (BHS) protocol released in 1993. Eighty-five subjects with characteristics outlined in the BHS protocol were recruited among those attending the outpatient clinic of the Department of Cardiovascular Disease, Hospital 'R.

Prognostic value of the metabolic syndrome in essential hypertension.

Objectives: We sought to determine the prognostic significance of the metabolic syndrome in hypertension.

Background: Increased cardiovascular risk in hypertensive patients might be partially attributable to metabolic disturbances.

Methods: We prospectively followed for up to 10.

Prognostic significance of isolated, non-specific left ventricular repolarization abnormalities in hypertension.

Objective: Clinicians are often confronted with the incidental finding of isolated minor, non-specific repolarization changes on the electrocardiogram (ECG) in hypertensive patients. The aim of this study was to investigate the prognostic significance of such changes.

Design: Prospective, observational study.

Adverse prognostic significance of new diabetes in treated hypertensive subjects.

Diabetes may develop in nondiabetic hypertensive subjects during treatment, but the long-term cardiovascular implications of this phenomenon are not clear. We determined the prognostic value of new diabetes in hypertensive subjects. In a long-term cohort study, 795 initially untreated hypertensive subjects, 6.

Ambulatory blood pressure monitoring and prognosis in the management of essential hypertension.

Over the past decade, several prospective outcome studies have demonstrated that ambulatory blood pressure measurements provide a better prediction of major cardiovascular events compared with clinic blood pressure measurements. This review summarizes the advantages of ambulatory blood pressure over clinic blood pressure to predict outcome in untreated and treated hypertensive subjects. Based on available evidence, an operational flow-chart in order to interpret results of ambulatory blood pressure for a better management of these subjects is suggested.

Meta-Analysis of effectiveness or lack thereof of angiotensin-converting enzyme inhibitors for prevention of heart failure in patients with systemic hypertension.

We undertook a meta-analysis of large, randomized controlled trials in hypertensive subjects that compared angiotensin-converting enzyme (ACE) inhibitors with different classes of antihypertensive drugs. Compared with subjects randomized to drugs different from ACE inhibitors, those treated with ACE inhibitors did not show a different risk of congestive heart failure (CHF) (odds ratio 1.03, 95% confidence interval 0.

Changes in cardiovascular risk by reduction of left ventricular mass in hypertension: a meta-analysis.

Background: Some studies have suggested that serial changes in left ventricular (LV) mass in hypertensive subjects predict the subsequent risk of cardiovascular disease. The aim of this meta-analysis was to evaluate the prognostic impact of LV hypertrophy regression in hypertension.

Methods: We undertook a meta-analysis of studies that reported echocardiographic LV mass before and during antihypertensive therapy, with subsequent assessment of cardiovascular events.

Improved cardiovascular risk stratification by a simple ECG index in hypertension.

Background: We determined the prognostic value of the Cornell/strain [C/S] index, a simple electrocardiographic (ECG) index for left ventricular hypertrophy (LVH) defined by the presence of either a classic strain pattern or a Cornell voltage (sum of R in aVL + S in V(3)) >2.0 mV in women or 2.4 mV in men, or both.

Effect of body weight changes on 24-hour blood pressure and left ventricular mass in hypertension: a 4-year follow-up.

Background: Few data are available on the long-term effects of weight loss on 24-h blood pressure (BP) and left ventricular mass in overweight hypertensive patients.

Methods: A total of 181 never-treated overweight hypertensive subjects (body mass index, 25 to 39 kg/m(2), office BP 145/94 +/- 12/7 mm Hg) had 24-h BP monitoring and echocardiography twice, at baseline and after 3.8 +/- 2 years (minimum 1 year).

Combination of lisinopril and nifedipine GITS increases blood pressure control compared with single drugs in essential hypertensive patients.

The present study was designed to evaluate the effect of combination therapy using the angiotensin-converting enzyme-inhibitor lisinopril and the dihydropyridine calcium antagonist nifedipine GITS on the degree and homogeneity of 24-hour blood pressure reduction in essential hypertensive patients. After a 4-week placebo run-in period, 51 patients (mean age, 54.4 +/- 9.

Atrial fibrillation in hypertension: predictors and outcome.

Incidence, determinants, and outcome of atrial fibrillation in hypertensive subjects are incompletely known. We followed for up to 16 years 2482 initially untreated subjects with essential hypertension. At entry, all subjects were in sinus rhythm.

Switching from ACE inhibitors, beta-blockers, calcium antagonists or diuretics to candesartan improves efficacy and tolerability.

Objective: To evaluate the efficacy and safety of candesartan in patients previously treated with, but displaying adverse reactions to, ACE inhibitors, beta-blockers, calcium antagonists or thiazide diuretics.

Methods: 968 mild to moderate essential hypertensive patients (aged 18-74 years) entered an 8-week treatment period with candesartan 8 or 16 mg according to a multicenter, randomized, open-label, parallel-group design. After the first 4 weeks of treatment, candesartan was doubled in 33.

Change in cardiovascular risk profile by echocardiography in low- or medium-risk hypertension.

Background: Clinical decision-making in hypertensive patients is largely based upon assessment of total cardiovascular risk. World Health Organization-International Society of Hypertension (WHO-ISH) guidelines suggest delaying or withholding drug treatment in individuals assessed as at low risk on the basis of a suggested work-up that does not include echocardiography.

Objective: To assess the impact of echocardiography on risk stratification in never-treated individuals classified as at low cardiovascular risk.

Prognostic significance of left ventricular diastolic dysfunction in essential hypertension.

Objectives: We sought to assess the prognostic value of alterations in left ventricular (LV) diastolic function in patients with essential hypertension.

Background: Alterations in LV diastolic function are frequent in patients with hypertension, even in the absence of LV hypertrophy, but their prognostic significance has never been investigated.

Methods: In the setting of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, we followed, for up to 11 years (mean: 4.

Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects.

Objective: We investigated the prognostic impact of 24-h blood pressure control in treated hypertensive subjects.

Background: There is growing evidence that ambulatory blood pressure improves risk stratification in untreated subjects with essential hypertension. Surprisingly, little is known on the prognostic value of this procedure in treated subjects.