Hypertension in pregnancy and endothelial activation: An emerging risk factor for cardiovascular disease.

Objective: There is emerging evidence suggesting that women who develop hypertensive disorders of pregnancy should be considered at risk for cardiovascular disease (CVD). Our objective was to determine whether persistent endothelial activation, which represents the earliest step in atherogenesis, is present after delivery in women with a history of hypertensive pregnancies compared to women with normal pregnancies.

Study Design: Two matched case-control studies were conducted.

Benefits in cognitive function, blood pressure, and insulin resistance through cocoa flavanol consumption in elderly subjects with mild cognitive impairment: the Cocoa, Cognition, and Aging (CoCoA) study.

Flavanol consumption is favorably associated with cognitive function. We tested the hypothesis that dietary flavanols might improve cognitive function in subjects with mild cognitive impairment. We conducted a double-blind, parallel arm study in 90 elderly individuals with mild cognitive impairment randomized to consume once daily for 8 weeks a drink containing ≈990 mg (high flavanols), ≈520 mg (intermediate flavanols), or ≈45 mg (low flavanols) of cocoa flavanols per day.

Nonmodulation as the mechanism for salt sensitivity of blood pressure in individuals with hypertension and type 2 diabetes mellitus.

Context: It is assumed that in individuals with type 2 diabetes mellitus (T2DM), blood pressure sensitivity to salt intake and the frequency of a low renin state are both increased compared with the nondiabetic population. However, studies supporting these assumptions may have been confounded by participant inclusion criteria, and study results may reflect target organ damage.

Objective: The objective of this study was to examine in a cohort of T2DM 1) the frequency of salt sensitivity of blood pressure and 2) whether alterations of the renin-angiotensin-aldosterone system (RAAS) contribute to salt sensitivity in this population.

Protective effects of flavanol-rich dark chocolate on endothelial function and wave reflection during acute hyperglycemia.

Nitric oxide plays a pivotal role in regulating vascular tone. Different studies show endothelial function is impaired during hyperglycemia. Dark chocolate increases flow-mediated dilation in healthy and hypertensive subjects with and without glucose intolerance; however, the effect of pretreatment with dark chocolate on endothelial function and other vascular responses to hyperglycemia has not been examined.

Different polymorphisms of the mineralocorticoid receptor gene are associated with either glucocorticoid or mineralocorticoid levels in hypertension.

Objective: Both aldosterone and cortisol can activate the mineralocorticoid receptor (MR). Polymorphisms in the MR gene have been inconsistently shown to be associated with risk of hypertension and aldosterone and cortisol levels. The purpose of this project was to investigate the association of MR gene variants with serum aldosterone and a previously identified hypertension subgroup with higher urinary free cortisol (UFC) levels (high-mode UFC) in a rigorously phenotyped Caucasian hypertensive cohort.

Are physicians underestimating the challenges of hypertension management? Results from the Supporting Hypertension Awareness and Research Europe-wide (SHARE) survey.

Aims: The Supporting Hypertension Awareness and Research Europe-wide (SHARE) survey aimed to qualify the key challenges that physicians face when trying to get patients to recommended blood pressure (BP) goals.

Methods And Results: The survey was open to physicians involved in the treatment of hypertension, was anonymous, and included 45 questions covering: physicians' demographic information, familiarity with BP treatment guidelines, views on the BP targets recommended by the 2007 European Society of Hypertension and European Society of Cardiology (ESH-ESC) guidelines, and perceptions on the proportion of 'challenging patients' in hypertension management (defined as patients not achieving the BP goal, where the BP goal is at least <140/90 mm Hg, and <130/80 mm Hg for patients with co-morbidities or high CV risk). Physicians significantly underestimated the proportions of their 'challenging patients' with hypertension compared with their perceptions of the proportions achieving 2007 ESH-ESC BP targets (p < 0.

Blood pressure control in Italy: analysis of clinical data from 2005-2011 surveys on hypertension.

Introduction: Blood pressure (BP) control is poorly achieved in hypertensive patients, worldwide.

Aim: We evaluated clinic BP levels and the rate of BP control in hypertensive patients included in observational studies and clinical surveys published between 2005 and 2011 in Italy.

Methods: We reviewed the medical literature to identify observational studies and clinical surveys on hypertension between January 2005 and June 2011, which clearly reported information on clinic BP levels, rates of BP control, proportions of treated and untreated patients, who were followed in different clinical settings (mostly in general practice, and also in outpatient clinics and hypertension centres).

Lysine-specific demethylase 1: an epigenetic regulator of salt-sensitive hypertension.

Background: Hypertension (HTN) represents a complex heritable disease in which environmental factors may directly affect gene function via epigenetic mechanisms. The aim of this study was to test the hypothesis that dietary salt influences the activity of a histone-modifying enzyme, lysine-specific demethylase 1 (LSD-1), which in turn is associated with salt-sensitivity of blood pressure (BP).

Methods: Animal and human studies were performed.

Endothelium/nitric oxide mechanism mediates vasorelaxation and counteracts vasoconstriction induced by low concentration of flavanols.

Purpose: At relatively low concentrations, flavanols induce inconsistent effects on isolated arterial tone, sometimes explained as being due to a structure-activity relationship. The aim of our study was to investigate the effects of two flavanols at different doses on arterial functional state.

Methods: The effects of two catechins, (-)-epigallocatechin-3-gallate (EGCG) and (-)-epicatechin (EP), on rat-isolated aorta tone were investigated on resting tension and on precontracted preparations, both in the presence and in the absence of endothelium.

Cognitive decline as a consequence of essential hypertension.

Hypertension is a leading cardiovascular risk for cardiovascular morbidity and mortality. Age is the strongest risk factor for dementia and with the increasing life expectancy the number of patients living with dementia worldwide is estimated to progressively rise. A number of studies support an association between hypertension, particularly in midlife, and the development of cognitive disorders and dementia, including Alzheimer's disease.

Physician attitudes to blood pressure control: findings from the Supporting Hypertension Awareness and Research Europe-wide survey.

Objectives: The Supporting Hypertension Awareness and Research Europe-wide (SHARE) physician survey aimed to qualify the key challenges that physicians face when trying to get patients to blood pressure (BP) goal.

Methods: The SHARE survey was open to physicians involved in the treatment of patients with hypertension, was anonymous, and was designed to take 15 min to complete. The survey included 45 questions covering physicians' demographic information, views on the BP targets recommended by the European Society of Hypertension-European Society of Cardiology guidelines, opinions on acceptable levels of BP control, and perceptions about the challenges associated with getting patients to BP goal.

Renin gene polymorphism: its relationship to hypertension, renin levels and vascular responses.

The renin gene has been previously reported to be associated with essential hypertension in a variety of ethnic groups. However, no studies have systematically evaluated the relationship between single nucleotide polymorphisms (SNPs) representing coverage of the entire renin gene and hypertension risk. To evaluate the association between renin gene variation and hypertension we investigated data on HyperPATH cohort with 570 hypertensive and 222 normotensive Caucasian subjects.

The role of Doppler ultrasound in the diagnosis of vasculogenic impotence.

Objective: Many authors have demonstrated that cardiovascular diseases (CVD) and their related risk factors can predict erectile dysfunction (ED). The penile Doppler ultrasonography is a method to evaluate the cavernous blood flow in people with suspected vasculogenic impotence. The goal of our study was to evaluate if erectile dysfunction is associated to a vascular disease and which is the role of penile Doppler investigation.

Soluble CD40 ligand is predictive of combined cardiovascular morbidity and mortality in patients on haemodialysis at a relatively short-term follow-up.

Background: We tested the hypothesis that soluble CD40 ligand (sCD40L), a biomarker of proatherogenic inflammation, may be predictive of cardiovascular (CV) events in a subgroup of patients from the RISCAVID study, an observational and prospective study in patients on haemodialysis (HD).

Methods: Plasma sCD40L levels were assessed at the time of the enrollment in 300 HD patients (mean age: 65 ± 15 years), recruited in five different centres. During a follow-up of 24 months, overall mortality, CV mortality and CV major nonfatal events (acute myocardial infarction, congestive heart failure and stroke) were registered.

Cardiovascular risk and endothelial dysfunction: the preferential route for atherosclerosis.

The vascular endothelium plays a pivotal role in the maintenance of vessel wall integrity. In this regard, endothelial cells actively regulate vascular reactivity by responding to mechanical forces and neurohormonal mediators by releasing a variety of relaxing and contracting factors. Nitric oxide (NO), an endogenous gas synthesized by NO synthases (NOSs) is the main endothelium-derived vasodilator.

Hypertension and migraine comorbidity: prevalence and risk of cerebrovascular events: evidence from a large, multicenter, cross-sectional survey in Italy (MIRACLES study).

Objectives: To estimate the prevalence of hypertension-migraine comorbidity; to determine their demographic and clinical characteristics versus patients with hypertension or migraine alone; and to see whether a history of cerebrovascular events was more common in the comorbidity group.

Methods: The MIRACLES, multicenter, cross-sectional, survey included 2973 patients with a known diagnosis of hypertension or migraine in a general practitioner setting in Italy.

Results: Five hundred and seventeen patients (17%) suffered from hypertension-migraine comorbidity, whereas 1271 (43%) suffered from hypertension only, and 1185 (40%) from migraine only.

Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy; a prevalence-based model.

Background: The presence of metabolic syndrome in patients with hypertension significantly increases the risk of cardiovascular disease, type 2 diabetes and mortality. Our aim is to estimate the epidemiological and economic burden to the health service of metabolic syndrome in patients with hypertension in three European countries in 2008 and 2020.

Methods: An age, sex and risk group structured prevalence based cost of illness model was developed using the United States Adult Treatment Panel III of the National Cholesterol Education Program criteria to define metabolic syndrome.

The aldosterone-renin ratio based on the plasma renin activity and the direct renin assay for diagnosing aldosterone-producing adenoma.

Background: The screening for primary aldosteronism is based on the aldosterone-renin ratio calculated with the plasma renin activity (PRA) value as denominator. A direct measurement of active renin (DRA) is being used as an alternative to PRA, but its diagnostic performance remains unclear.

Method: We, therefore compared, head-to-head, the aldosterone-renin ratio based on PRA with that based on DRA, at baseline and after captopril administration, for identifying aldosterone-producing adenoma (APA) in 251 patients of the Primary Aldosteronism Prevalence in hYpertension Study (PAPY).

Flavonoids: antioxidants against atherosclerosis.

Oxidative stress results from an imbalance between excessive formation of reactive oxygen species (ROS) and/or reactive nitrogen species and limited antioxidant defences. Endothelium and nitric oxide (NO) are key regulators of vascular health. NO bioavailability is modulated by ROS that degrade NO, uncouple NO synthase, and inhibit synthesis.

Ambulatory monitoring of systolic hypertension in the elderly: Eprosartan/hydrochlorothiazide compared with losartan/hydrochlorothiazide (INSIST trial).

Introduction: Systolic hypertension is very common in the elderly and is strongly associated with the risk of cardiovascular and cerebrovascular events. The control of systolic hypertension is difficult and most patients require combination antihypertensive therapy. Few data are available regarding the efficacy of angiotensin II receptor antagonists on systolic hypertension of the elderly.

Oxidative stress and endothelial dysfunction: say NO to cigarette smoking!

Smoking is a significant independent risk factor for cardiovascular disease and is a leading cause of structural and functional alterations of the cardiovascular system. Increasing evidence supports the hypothesis that oxidative stress and endothelial dysfunction are the fundamental pathophysiological mechanisms linking cigarette smoking to cardiovascular disease. The cardiovascular system is a rich source of NADPH oxidase-derived reactive oxygen species, which under pathological conditions play a fundamental role in vascular damage.