Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: Data from the general population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study).

Background: The prevalence and clinical significance of isolated office (or white coat) hypertension is controversial, and population data are limited. We studied the prevalence of this condition and its association with echocardiographic left ventricular mass in the general population of the PAMELA (Pressione Arteriose Monitorate E Loro Associazioni) Study.

Methods And Results: The study involved a large, randomized sample (n=3200) representative of the Monza (Milan) population, 25 to 74 years of age.

Progression of large artery structural and functional alterations in Type I diabetes.

Aims/hypothesis: Type I (insulin-dependent) diabetes mellitus is accompanied by reduced arterial distensibility and increased arterial wall thickness even in normotensive subjects with no micro-macrovascular complications. It is not known whether, and how fast, these subclinical markers of vascular damage develop over time.

Methods: We measured arterial wall distensibility in radial, common carotid artery and abdominal aorta in 60 normotensive patients (aged 35.

Effects of physical training of the dominant arm on ipsilateral radial artery distensibility and structure.

Background: Exercise training induces cardiovascular changes that are both generalized and restricted to the microcirculation of the tissues more actively involved in the exercise itself. Whether the local effect of exercise extends to larger arteries is unknown, however.

Methods: In the right and left upper limb of 17 right-handed subjects performing an asymmetric training of the upper limbs (hammer throwers and baseball players) and 16 age-matched sedentary controls, we continuously measured radial artery diameter, distensibility and wall thickness by an echotracking and a beat-to-beat finger blood pressure device.

Radial artery wall alterations in genetic hemochromatosis before and after iron depletion therapy.

Iron overload is believed to have an adverse influence on the cardiovascular system and animal studies have shown that iron may be involved in the events that lead to atherosclerosis via an enhancement of smooth muscle cell proliferation, lipid oxidation, and free radical production. There are no data on the effect of iron overload on arterial structural and mechanical properties in humans. We measured wall thickness and distensibility (D) by ultrasonography of the radial artery in 12 patients with uncomplicated genetic hemochromatosis (GH) who were normotensive and without atherosclerotic plaques.

Systolic blood pressure and pulse pressure: role of 24-h mean values and variability in the determination of organ damage.

An increasing amount of data suggests that systolic blood pressure (SBP) and pulse pressure (PP) may more closely relate to and thus favour the atherogenic process than does diastolic blood pressure (DBP). The baseline data from the ongoing European Lacidipine Study on Atherosclerosis (ELSA) recently indicated that carotid artery atherosclerosis in normocholesterolaemic patients with mild or moderate essential hypertension is more closely related to SBP and more so PP than to DBP and lipid variables. Other new data point to the effects of hypertension on arterial compliance, as well as the effects of 24-h blood pressure variability on arterial compliance and distensibility.

Current antihypertensive treatment: can we do better?

Results of various randomized, controlled clinical trials have shown that antihypertensive treatment is accompanied by reductions in morbidity and mortality caused by cardiovascular, cerebrovascular, and renal disease. Treatment confers a protective benefit against stroke, coronary artery disease, and heart failure, as well as against conditions previously considered unrelated to elevated blood pressure (eg, loss of cognitive function and dementia). Overall benefits of antihypertensive treatment are probably even greater than those shown in clinical trials.

Sympathetic activation in the pathogenesis of hypertension and progression of organ damage.

Although animal models of hypertension have clearly shown that high blood pressure is associated with and is probably caused by an increase in sympathetic cardiovascular influences, a similar demonstration in humans has been more difficult to obtain for methodological reasons. There is now evidence, however, of increased sympathetic activity in essential hypertension. This article will review this evidence by examining data showing that plasma norepinephrine is increased in essential hypertension and that this is also the case for systemic and regional norepinephrine spillover, as well as for the sympathetic nerve firing rate in the skeletal muscle nerve district.

Pharmacological improvement of large arteries properties.

Arterial distensibility reflects mechanical properties of the arterial wall and have, thus a clearcut clinical relevance. This because an arterial distensibility reduction is associated with an increased pulse pressure, an increased cardiac work and a reduced diastolic vital organ perfusion. In recent years it has been demonstrated that arterial distensibility is reduced in marked and mild hypercholesterolemia, in a manner independent from arterial blood pressure values.

Early impairment of large artery structure and function in type I diabetes mellitus.

Aims/hypothesis: Diabetes mellitus is associated with an increased incidence of atherosclerosis. How early functional and structural alterations of large arteries that may preceded atherosclerosis occur in the course of this disease has, however, never been conclusively documented.

Methods: We evaluated arterial wall distensibility in the radial artery, common carotid artery and abdominal aorta in 133 patients (aged 35.

Baroreflex and non-baroreflex modulation of vagal cardiac control after myocardial infarction.

Vagal control of sinus node exerted by arterial baroreceptors is markedly impaired 48 hours after acute myocardial infarction (AMI), but it recovers 10 days later. However, it is unknown whether this recovery is peculiar to baroreceptor vagal control or reflects normalization of the overall vagal modulation of heart rate. In 21 untreated patients (aged 51+/-3 years, mean +/- SEM) studied 10+/-1 and 21+/-1 days after an AMI and in 13 healthy controls (aged 47+/-2 years), we examined the increases in RR interval (electrocardiogram) induced by carotid baroreceptor stimulation via a neck chamber and by immersion of the face in iced water for 15 seconds (diving reflex).

Sympathetic tone restrains arterial distensibility of healthy and atherosclerotic subjects.

Background: Sympathetic activation induced by cold pressor test or cigarette smoking is accompanied by a marked reduction of radial artery distensibility. It is not known, however, whether arterial distensibility is under tonic sympathetic restraint, or whether this restraint involves arteries greater than the radial one in both normal and pathological conditions.

Methods: We studied the distensibility of radial artery by continuous ultrasonographic assessment of the changes in arterial diameter over the diasto-systolic pressure range (finger pressure measurement) in eight patients with a Dupuytren disease before and 20 min after ipsilateral brachial plexus anaesthesia.

Fluctuations of radial artery distensibility throughout the menstrual cycle.

Estrogen administration has a number of favorable cardiovascular effects, and recent evidence suggests that these include an increase in arterial distensibility. Whether this is also the case for the physiological changes in estrogen production during the menstrual cycle has never been determined, however. In 21 premenopausal healthy women, we continuously measured radial artery diameter and blood pressure by an echo-tracking device and a beat-to-beat finger device, respectively.

Arterial distensibility and pulse pressure. Measurements and clinical significance in hypertension.

Distensibility of large and middle size arteries is a function of major significance for the cardiovascular system. This paper will describe data obtained by measurements of local distensibility in hypertension and other cardiovascular diseases. Isolated systolic hypertension is characterized by a diffuse reduction of arterial distensibility, while essential hypertension by a reduced distensibility in large elastic arteries, but an unchanged distensibility of middle size arteries.

Arterial distensibility in cardiovascular diseases.

Several pathological conditions affecting the cardiovascular system are characterized by a dysfunction of the viscoelastic properties of the arterial vessels and, in particular, of arterial distensibility and compliance. These alterations have pathophysiological and clinical relevance because both distensibility and compliance play a key role in cardiovascular homeostatic control by modulating a number of important parameters, such as arterial impedence, cardiac afterload and myocardial oxygen consumption. This paper, after briefly mentioning the technical progress recently achieved in the assessment of arterial compliance in man, will examine the alterations in this vascular function which take place in hypertension, hypercholesterolemia, diabetes and congestive heart failure.

Effects of prolonged immobilization of the limb on radial artery mechanical properties.

Physical training is associated with an increase in arterial distensibility. Whether the effect of training on this variable is evident also for ordinary levels of exercise or no exercise is unknown, however. We have addressed this issue by investigating the effect on radial artery distensibility of prolonged monolateral immobilization of the ipsilateral limb versus the following resumption of normal mobility.

Effects of isolated systolic hypertension and essential hypertension on large and middle-sized artery compliance.

Background: Systolic hypertension of the elderly is characterized by a reduction in arterial compliance. Whether and to what extent this involves arteries of various structure and size is not well known.

Objective: To study carotid and radial artery compliance in systolic hypertension of the elderly, compared to essential hypertension and normotension.

Present and future role of combination treatment in hypertension.

Both in clinical practice and in drug trials, combination treatment of hypertension plays a fundamental role. This article reviews the features that make combined therapy with two drugs valuable, i.e.

Regression of radial artery wall hypertrophy and improvement of carotid artery compliance after long-term antihypertensive treatment in elderly patients.

Objectives: The present study was designed to assess whether a diuretic- or an angiotensin-converting enzyme inhibitor-based treatment can reduce arterial wall hypertrophy of a distal muscular medium-sized artery--the radial artery--and the stiffness of a proximal large elastic artery--the common carotid artery.

Background: Large-artery wall thickness and stiffness are increased during sustained essential hypertension and contribute to the increased risk of complications. Whether antihypertensive treatment can normalize the wall hypertrophy of conducting arteries has not yet been determined.

Early and late sympathetic activation in hypertension.

In several experimental animal models of hypertension, sympathetic factors have been shown to be involved in the development and/or maintenance of high blood pressure. Although the information available on this issue in man is more scarce, recent evidence clearly indicates the participation of adrenergic mechanisms in the early and late phases of the hypertensive process. In addition, several cardiovascular risk factors frequently associated with hypertension, such as obesity, insulin-resistance, cigarette smoking, and the atherogenic process, are also characterized by alterations in sympathetic cardiovascular drive.

Differential alterations of common carotid and femoral artery distensibility in 12-week-old spontaneously hypertensive rats.

Objective: In essential hypertension, the mechanical properties of the radial artery have been shown to be largely unaltered, whereas more controversial and less reliable data have been obtained for the common carotid artery. We therefore examined the distensibility/pressure relationships of the predominantly elastic common carotid artery and of the predominantly muscle-type femoral artery in 12-week-old normotensive Wistar-Kyoto (WKY) rats and spontaneously hypertensive rats (SHR).

Methods: Eleven 12-week-old SHR and 10 age-matched WKY rats were anesthetized with sodium pentobarbitone.

Effects of cigarette smoking on carotid and radial artery distensibility.

Objective: Cigarette smoking acutely induces a marked increase of blood pressure and heart rate. This is accompanied by a marked reduction of radial artery distensibility. Whether this reflects an alteration of arterial mechanics of large elastic arteries as well is not established, however.

Large and medium sized artery abnormalities in untreated and treated hypothyroidism.

Background: Hypothyroidism is frequently accompanied by cardiac dysfunction, increased vascular resistance and a greater prevalence of hypertension. Whether this condition is also accompanied by alterations of large artery function and structure is not known, however.

Patients And Methods: We investigated radial artery compliance and wall thickness as well as carotid artery compliance in 11 normotensive recently diagnosed and never treated hypothyroid patients.