The clinical significance of white-coat and masked hypertension.

Objective: Self-measured blood pressure (BP) and 24-hour ambulatory blood pressure (ABP) monitoring are used to define the arbitrary clinical categories of masked hypertension (MH) and white-coat hypertension (WCH). Severity of target organ damage and incidence of major cardiovascular events are greater in patients with MH than in patients whose BP is normal both inside and outside the doctor's office.

Methods: We reviewed studies that addressed the prognostic impact of MH and WCH.

Prognostic value of serial electrocardiographic voltage and repolarization changes in essential hypertension: the HEART Survey study.

Background: The interpretation of serial electrocardiographic (ECG) changes in hypertensive subjects is uncertain. We tested the hypothesis that serial changes in repolarization and voltage are independent determinants of outcome.

Methods: The Hypertrophy at ECG And its Regression during Treatment (HEART) Survey was a prospective observational study performed at 61 centers.

[Antihypertensive therapy and cardiovascular prevention. The role of angiotensin II receptor blockers].

Angiotensin II receptor blockers (ARBs) are widely used in patients with hypertension, heart failure, diabetic nephropathy, and other conditions. Over-stimulation of AT2 receptor as a result of AT1 blockade may contribute to the beneficial effects of ARBs through vasodilation and inhibition of cardiac and vascular hypertrophy and fibrosis. Some experimental studies, however, suggested that AT, receptor overstimulation, in addition to beneficial effects, might trigger inhibition of angiogenesis and apoptosis.

Estimate of white-coat effect and arterial stiffness.

Objectives: Blood pressure (BP) measured in the office is usually higher than the average ambulatory BP, a difference generally taken as an estimate of the white-coat effect. This study was designed to assess whether such a difference is associated with impairment of the conduit arterial system.

Methods: We calculated the difference between office and average daytime peak systolic blood pressure (DeltaSBP) in 2778 hypertensive participants (1240 women) of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale cohort.

Ambulatory blood pressure and cardiovascular outcome in relation to perceived sleep deprivation.

Sleep deprivation induced by cuff inflations during overnight blood pressure (BP) monitoring might interfere with the prognostic significance of nighttime BP. In 2934 initially untreated hypertensive subjects, we assessed the perceived quantity of sleep during overnight BP monitoring. Overall, 58.

Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension.

Background: The independent prognostic value of daytime and night-time blood pressure (BP) variability estimated by noninvasive 24-h BP monitoring is unclear.

Methods: We followed 2649 initially untreated subjects with essential hypertension for up to 16 years (mean, 6). Variability of BP was estimated by the standard deviation of daytime or night-time systolic BP (SBP) and diastolic BP (DBP).

Regression of left ventricular hypertrophy and prevention of stroke in hypertensive subjects.

Background: Left ventricular hypertrophy (LVH) is a risk marker for stroke and its regression confers protection from stroke. The relationship between serial LVH changes and risk of stroke has never been investigated in a mixed population of hypertensive subjects with and without LVH.

Methods: In this study, 880 initially untreated hypertensive subjects (mean age 48 years, office blood pressure (BP) 155/98 mm Hg; 24-h BP 137/87 mm Hg) underwent tests including echocardiography and 24-h ambulatory BP monitoring at entry and after a median of 3.

Patients with hibernating myocardium show altered left ventricular volumes and shape, which revert after revascularization: evidence that dyssynergy might directly induce cardiac remodeling.

Objectives: The purpose of this study was to investigate whether post-ischemic left ventricular (LV) remodeling might be induced by regional contractile dysfunction per se (i.e., in the absence of transmural necrosis) and whether this phenomenon is potentially reversible after contractile recovery.

White-coat hypertension in adults.

White-coat hypertension is defined by the coexistence of persistently high office blood pressure (BP) with normal self-measured or ambulatory blood pressure. The prognostic impact of white-coat hypertension is a subject of debate. Cardiovascular morbidity seems to be lower in white-coat hypertension than in ambulatory hypertension, and, according to some but not all studies, is not dissimilar between white-coat hypertension and clinical normotension.

Is the development of diabetes with antihypertensive therapy a problem?--Pro.

Some questions about new-onset diabetes (NOD) must still be completely addressed: 1) its incidence; 2) the possible association between NOD and some classes of antihypertensive drugs; and 3) its prognostic impact. It is well known that diuretics and beta blockers can increase plasma glucose and, in available hypertension trials, diuretics and beta blockers caused a higher incidence of NOD than new antihypertensive drugs. NOD heralds a high risk of major cardiovascular events, but the absolute difference between old and new drugs was too small to significantly drive the differences in cardiovascular event rates between the two groups of treatment.

Microalbuminuria and hypertension.

An elevated urinary albumin excretion (UAE) below the proteinuric level, i.e. microalbuminuria (MAU), has long been recognized as a marker of kidney disease and increased cardiovascular risk in both types of diabetes mellitus.

Do angiotensin II receptor blockers increase the risk of myocardial infarction?

Aims: The uncertainty surrounding safety of angiotensin receptor blockers (ARBs) increased after publication of experimental and clinical studies which suggested an excess risk of myocardial infarction (MI) in people treated with ARBs.

Methods And Results: We performed a meta-analysis of randomised clinical trials, which compared ARBs with either a placebo or active drugs different from ARBs. Overall, ARBs were not associated with an excess risk of MI [odds ratio (OR): 1.

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.

New-onset diabetes in treated hypertensive patients.

Interpretation of some recent trials in hypertension opened a debate on the clinical value of new-onset diabetes in treated hypertensive patients. It is not completely clear whether certain antihypertensive drug classes are associated with a higher risk for developing type 2 diabetes when compared with other classes. Some longitudinal studies suggest that new-onset diabetes in treated hypertensive subjects carries a risk for subsequent cardiovascular disease similar to that of previously known diabetes.

Short- and long-term incidence of stroke in white-coat hypertension.

White-coat hypertension (WCH) has been associated with a low risk for stroke, but long-term data are scanty. We analyzed individual data from 4 prospective cohort studies from the United States, Italy, and Japan that used comparable methodology for 24-hour noninvasive ambulatory blood pressure monitoring (ABPM). Overall, 4406 subjects with essential hypertension and 1549 healthy normotensive controls who were untreated at the time of initial ABPM were followed for a median of 5.

Hypertension and microalbuminuria: the new detrimental duo.

Excretion of albumin with urine (UAE) in small amounts, i.e. microalbuminuria (MAU), also referred to as "incipient nephropathy", has long been considered a marker of early nephropathy and increased cardiovascular risk in the specific setting of diabetes mellitus.

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.

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 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.

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.