Search

Pulmonary hypertension is a not-so-rare complication of connective tissue diseases and is usually related with an inauspicious prognosis. We present the case of a 67-years-old woman hospitalized for progressive dyspnea. Two-dimensional echocardiography showed numerous features related to pulmonary hypertension (PH) with moderate Mitral Regurgitation. The right cardiac catheterization confirmed mixed PH (pre and post capillary) without chest angio-TC evidence of pulmonary thromboembolism. Thanks to optimized medical therapy (B-Blocker, ACE-i and diuretics), there was a significant clinical improvement documented at discharge. After 1 year, due to recurrence of dyspnea, she was admitted to our medical unit. Her clinical examination showed some of the characteristics of a connective tissue disease. Compared to previous echocardiography, a moderate to mild reduction of MR was documented. Chest CT scan revealed interstitial lung disease likely related to patient's underlying pathology. Immunological screening tests detected the presence of antinuclear (ANA) and anti-topoisomerase (ATA) antibodies. Right heart catheterization documented a worsening of PH with only pre-capillary component. On the basis of the above findings, a diagnosis of CREST syndrome complicated with PH was made, and the patient was started on oral combination of macitentan and riociguat. The frequency of this complication in connective tissue disease, the need for screening tests and different treatment approaches of pre and post capillary pulmonary hypertension is discussed.

Background Large cardiovascular (CV) trials enrolling patients with type 2 diabetes showed that sodium glucose co-transporter-2 inhibitors (SGLT2i) significantly decreased heart failure (HF) hospitalization, both in patients with or without a history of HF. Accordingly, DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) demonstrated the efficacy of dapagliflozin, for the reduction of CV death/HF hospitalization in patients with HF with reduced ejection fraction (HFrEF) regardless of type 2 diabetes status. However, there are still few real-word data and it is still not well known how early the clinical benefits are after the introduction of the drug into therapy; consequently, we aimed to evaluate the effect of dapagliflozin three months after its introduction in therapy in our real-world population. Methods From February 2022 to September 2022 we introduced Dapagliflozin in 23 HFrEF patients’ therapy and we collected data of 11 patients (66.78±3.96 years; 89% men) at 3-months-FU. Specifically, on the first visit we collected the clinical, laboratory and echocardiographic parameters and dapagliflozin was added to optimal medical therapy of patients; then, the patients were evaluated after 3 months (follow-up). Results At follow-up, all patients were free from side effects and we did not record statistically significant differences in laboratory parameters and/or blood pressure values. As regards the echocardiographic parameters, there was an improvement in FE (28.11±2.95 vs 37.00±5.71%, p0.17), PAPS (46.89±3.94 vs 37.63±5.27mmHg, p0.17), and LVEDVind (75.34±10.58 vs 57.20±13.55 ml/m2, p0.30), although not statistically significant. Moreover, we observed a statistically significant reduction in the diameter of the inferior vena cava (18.89±1.78 vs 11.5±1.15 mm, p Conclusions Dapagliflozin improved symptoms, and quality of life in patients with HFrEF of our real world population already after 12 weeks, accordingly with previous data of DEFINE-HF trial. Moreover, already after 3 months was possible to record improvements in the echocardiographic parameters, even if they are not statistically significant. Certainly, it will be necessary to continue with the study to evaluate these results on a larger sample.

Background Heart failure (HF) alternates phases of stability and phases of exacerbation, with a progressive decline in the patient's functional capacity and quality of life; the need to anticipate and improve the effectiveness of management of HF exacerbation has led to the development of several remote monitoring tools. We report our experience with CardioMEMS HF system (implantable device to monitor changes in pulmonary artery diastolic pressure (PAPd) as early indicator of the onset of worsening HF) in order to optimize the pharmaceutical treatments strategy (e.g. Levosimendan infusion) and to assess the impact on hospital resources consumption and costs. Methods We enrolled 7 patients (69.00±4.88 years; 30% female) with end-stage HF, implanted with CardioMEMS and daily monitored remotely, in order to optimize both tailored adjustment of home therapy and infusions of Levosimendan. More in detail, if the cardiologist detected a tendency for PAPd to rise, patients were contacted for home therapeutic changes. If no further changes were possible, the patient was hospitalized for the infusion of Levosimendan. In order to calculate the impact of this remote monitoring strategy on resources consumption, we collected data on hospitalizations (e.g. causes, numbers, length, high-cost drugs and costs) taking into account the same number of months pre and post-CardioMEMS implant for each patient. Results Following the implantation of CardioMEMS we observed a 45% reduction in the total number of hospitalizations and a 62% reduction in the days of hospitalization (from a total of 421 days before implantation to a total of 159 days post implantation in the observation period). From an economic point of view, a significant hospital cost reduction was recorded in terms of both hospitalization costs (HF related re-hospitalization and CardioMEMS's implant related cost) and drugs infusion costs (hospital stay and drug costs); more specifically, the total savings for the 7 patients are around € 236,000 and total days of hospitalization avoided are around 500 days including the hospitalizations avoided for drugs infusion. Accordingly, was recorded an improvement in patients’ quality of life measured with EQ5D (pre-implantation 75.17±2.06 vs post-implantation 108.60±8.70, p 0.0078). Conclusions Our preliminary results support the usefulness of this system in the remote management of the HF patients and in the re-hospitalization reduction both for exacerbation and drug management. In fact, the parameters’ monitoring through the CardioMEMS device allows a personalized management of drug therapy; more precisely, considering the drug Levosimendan, instead of a periodic standard timing for infusion, a patient-tailored timing of infusion was applied. In conclusion, our innovative strategy contributes to achieve the organizational efficiency of the healthcare facilities, as well as to the adequate use and allocation of financial and human resources with a better outcome for HF patients.

Background: In the real world, medical practice is changing hand in hand with the development of new Artificial Intelligence (AI) systems and problems from different areas have been successfully solved using AI algorithms. Specifically, the use of AI techniques in setting up or building precision medicine is significant in terms of the accuracy of disease discovery and tailored treatment. Moreover, with the use of technology, clinical personnel can deliver a very much efficient healthcare service. Objective: This article reviews AI state-of-the-art in cardiovascular disease management, focusing on diagnostic and therapeutic improvements. Methods: To that end, we conducted a detailed PubMed search on AI application from distinct areas of cardiology: heart failure, arterial hypertension, atrial fibrillation, syncope and cardiovascular rehabilitation. Particularly, to assess the impact of these technologies in clinical decision-making, this research considers technical and medical aspects. Results: : On one hand, some devices in heart failure, atrial fibrillation and cardiac rehabilitation represent an inexpensive, not invasive or not very invasive approach to long-term surveillance and management in these areas. On the other hand, the availability of large datasets (big data) is a useful tool to predict the development and outcome of many cardiovascular diseases. In summary, with this new guided therapy, the physician can supply prompt, individualised, and tailored treatment and the patients feel safe as they are continuously monitored, with a significant psychological effect. Conclusion: Soon, tailored patient care via telemonitoring can improve clinical practice because AI-based systems support cardiologists in daily medical activities, improving disease detection and treatment. However, the physician-patient relationship remains a pivotal step.

Sacubitril/valsartan (Sac/Val) reduces mortality in patients with heart failure with reduced ejection fraction (HFrEF) compared to enalapril. However, its effects on functional capacity remain uncertain; consequently, we sought to compare Sac/Val vs. standard medical therapy, in terms of effects on prognostically significant CPET parameters, in HFrEF patients during a long follow-up period. We conducted a single-center, observational study in an HF clinic; specifically, we retrospectively identified that 12 patients switched to Sac/Val and 13 patients that managed with standard, optimal medical therapy (control group). At each visit, baseline, and follow-up (median time: 16 months; IQ range: 11.5–22), we collected demographic information, medical history, vital signs, cardiopulmonary exercise testing, standard laboratory data, pharmacological treatment information, and echocardiographic parameters. The study’s primary end-point was the change from baseline in peak VO2 (adjusted to body weight). We did not observe significant differences between the two study groups at baseline. Similarly, we did not observe any significant differences during the follow-up in mean values of peak VO2 corrected for body weight: Sac/Val baseline: 12.2 ± 4.6 and FU: 12.7 ± 3.3 vs. control group: 13.1 ± 4.2 and 13.0 ± 4.2 mL/kg/min; p = 0.49. No significant treatment differences were observed for changes in VE/VCO2 slope: Sac/Val baseline: 35.4 ± 7.4 and FU: 37.2 ± 13.1 vs. control group: 34.6 ± 9.1 and 34.0 ± 7.3; p = 0.49. In conclusion, after a median follow-up period of 16 months, there was no significant benefit of Sac/Val on peak VO2 and other measures of CPET compared with standard optimal therapy in patients with HFrEF.

The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan (Sac/Val) demonstrated to be superior to enalapril in reducing hospitalizations, cardiovascular and all-cause mortality in patients with ambulatory heart failure and reduced ejection fraction (HFrEF), in particular when it is maximally up-titrated. Unfortunately, the target dose is achieved in less than 50% of HFrEF patients, thus undermining the beneficial effects on the outcomes. In this study, we aimed to evaluate the role of Sac/Val and its titration dose on reverse cardiac remodelling and determine which echocardiographic index best predicts the up-titration success.From January 2020 to June 2021, we retrospectively identified 95 patients (65.6 [59.1-72.8] years; 15.8% females) with chronic HFrEF who were prescribed Sac/Val from the HF Clinics of 5 Italian University Hospitals and evaluated the tolerability of Sac/Val high dose (the ability of the patient to achieve and stably tolerate the maximum dose) as the primary endpoint in the cohort. We used a multivariable logistic regression analysis, with a stepwise backward selection method, to determine the independent predictors of Sac/Val maximum dose tolerability, using, as candidate predictors, only variables with a P-value0.1 in the univariate analyses. Candidate predictors identified for the multivariable backward logistic regression analysis were age, sex, body mass index (BMI), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), dyslipidaemia, atrial fibrillation, systolic blood pressure (SBP), baseline tolerability of ACEi/ARBs maximum dose, left ventricle global longitudinal strain (LVgLS), LV ejection fraction (EF), tricuspid annulus plane systolic excursion (TAPSE), right ventricle (RV) fractional area change (FAC), RV global and free wall longitudinal strain (RVgLS and RV-FW-LS). After the multivariable analysis, only one categorical (ACEi/ARBs maximum dose at baseline) and three continuous (younger age, higher SBP, and higher TAPSE), resulted significantly associated with the study outcome variable with a strong discriminatory capacity (area under the curve 0.874, 95% confidence interval (CI) (0.794-0.954) to predict maximum Sac/Val dose tolerability.Our study is the first to analyse the potential role of echocardiography and, in particular, of RV dysfunction, measured by TAPSE, in predicting Sac/Val maximum dose tolerability. Therefore, patients with RV dysfunction (baseline TAPSE16 mm, in our cohort) might benefit from a different strategy to titrate Sac/Val, such as starting from the lowest dose and/or waiting for a more extended period of observation before attempting with the higher doses.

Arterial hypertension (AH) is a progressive issue that grows in importance with the increased average age of the world population. The potential role of artificial intelligence (AI) in its prevention and treatment is firmly recognized. Indeed, AI application allows personalized medicine and tailored treatment for each patient. Specifically, this article reviews the benefits of AI in AH management, pointing out diagnostic and therapeutic improvements without ignoring the limitations of this innovative scientific approach. Consequently, we conducted a detailed search on AI applications in AH: the articles (quantitative and qualitative) reviewed in this paper were obtained by searching journal databases such as PubMed and subject-specific professional websites, including Google Scholar. The search terms included artificial intelligence, artificial neural network, deep learning, machine learning, big data, arterial hypertension, blood pressure, blood pressure measurement, cardiovascular disease, and personalized medicine. Specifically, AI-based systems could help continuously monitor BP using wearable technologies; in particular, BP can be estimated from a photoplethysmograph (PPG) signal obtained from a smartphone or a smartwatch using DL. Furthermore, thanks to ML algorithms, it is possible to identify new hypertension genes for the early diagnosis of AH and the prevention of complications. Moreover, integrating AI with omics-based technologies will lead to the definition of the trajectory of the hypertensive patient and the use of the most appropriate drug. However, AI is not free from technical issues and biases, such as over/underfitting, the “black-box” nature of many ML algorithms, and patient data privacy. In conclusion, AI-based systems will change clinical practice for AH by identifying patient trajectories for new, personalized care plans and predicting patients’ risks and necessary therapy adjustments due to changes in disease progression and/or therapy response.

Cardiovascular diseases (CVDs) are the leading cause of death and illness in Europe and worldwide, responsible for a staggering 47% of deaths in Europe. Over the past few years, there has been increasing evidence pointing to bioactive sphingolipids as drivers of CVDs. Among them, most studies place emphasis on the cardiovascular effect of ceramides and sphingosine-1-phosphate (S1P), reporting correlation between their aberrant expression and CVD risk factors. In experimental in vivo models, pharmacological inhibition of de novo ceramide synthesis averts the development of diabetes, atherosclerosis, hypertension and heart failure. In humans, levels of circulating sphingolipids have been suggested as prognostic indicators for a broad spectrum of diseases. This article provides a comprehensive review of sphingolipids’ contribution to cardiovascular, cerebrovascular and metabolic diseases, focusing on the latest experimental and clinical findings. Cumulatively, these studies indicate that monitoring sphingolipid level alterations could allow for better assessment of cardiovascular disease progression and/or severity, and also suggest them as a potential target for future therapeutic intervention. Some approaches may include the down-regulation of specific sphingolipid species levels in the circulation, by inhibiting critical enzymes that catalyze ceramide metabolism, such as ceramidases, sphingomyelinases and sphingosine kinases. Therefore, manipulation of the sphingolipid pathway may be a promising strategy for the treatment of cardio- and cerebrovascular diseases.

Aims The definition of pulmonary hypertension (PH) requires the documentation of mean pulmonary arterial pressure (PAPm) ≥20 mmHg at rest, assessed by right cardiac catheterization. This condition can characterize multiple clinical conditions with different pathophysiological and haemodynamic aspects. Specifically, in pulmonary arterial hypertension (IAP) (Group 1), the increase in PAP is due to an intrinsic pathology of the pulmonary microcirculation; Group 2 includes the forms of IP associated with a pathology of the left heart; Group 3 includes all pathologies of the pulmonary parenchyma and/or hypoxic conditions that lead to a secondary impairment of the small circulation; Group 4 identifies patients with chronic thromboembolic pulmonary heart (CPCTE); finally, Group 5 includes rare clinical conditions in which IP is linked to direct involvement or ab extrinsic compression of the pulmonary vessels. Methods and results To examine the number of deaths and the differences between the various subgroups, we analyzed the follow-up of approximately 76 patients (64.30 ± 13.20 years, 37% male) enrolled in the Pulmonary Hypertension Clinic of the San Giovanni AOU Dio and Ruggi d’Aragona of Salerno from 2014 to 2020 excluding patients with IP under definition and those ‘screened’ who did not show pulmonary hypertension at rest. At each visit, the patients were subjected to anamnestic data collection, physical examination, measurement of blood pressure, heart rate, arterial saturation, transthoracic cardiac echo color Doppler at rest, attribution of the functional class NYHA, evaluation of functional capacity by performing the test of the 6-min walk test (6MWT) and possible programming of right cardiac catheterization. From the data analysis it was found that 26 patients (34.21%, 55.81 ± 13.90 years, 27% males) were affected by IP group 1; 15 patients (19.48%, 74.12 ± 6.26 years, 20% male) were affected by IP group 2; 14 patients (18.18%, 63.34 ± 11.52 years, 71% male) were affected by IP group 3; 12 patients (15.58%, 67.22 ± 11.53 years, 33% male) were affected by IP group 4; 2 patients (2.60%, 71.57 ± 12.48 years, 0% male) were affected by IP group 5; 7 patients (9.09%, 70.07 ± 8.27 years, 57% male) were affected by group 2–3 mixed IP. Analysing the number of deaths, of the 76 patients, 17 deaths were recorded in total (22.37%). All patients in group 1 had been treated with specific therapy and survival was 88% at 3 years. Of the three deaths (12%) in this group, one patient had idiopathic PAH non-responder to pulmonary vasoreactivity test, one patient belonged to the IAP subgroup associated with congenital heart shunt but with concomitant lung disease, and the third patient belonged to the IAP subgroup associated with connective tissue disease (specifically Takayasu’s arteritis). From the analysis of the idiopathic IAP subgroup it emerged that the patients were all women, with an average age of 50.81 ± 3.98 years, and that the deceased patient was distinguished at the first visit from the other patients for: a history of arterial hypertension, dysthyroidism, and obesity; worst NYHA class (III vs. II), elevated heart rate (102 vs. 70.00 ± 7.07 b.p.m.) and blood pressure (SBP: 150.00 vs. 127.50 ± 10.61; DBP 90.00 vs. 75.00 ± 7.07 mmHg) at rest at the clinic visit. Transthoracic echocardiography revealed elevated PAPs values (100.00 vs. 42.50 ± 20.51 mmHg), low TAPSE values (20.00 vs. 26.50 ± 3.54 mm), reduced pulmonary acceleration time (ACT 60 ms), enlargement of the right atrium (area 22 cm2), worst exercise tolerance parameters (6MWT 300 m and 86% final SO2 vs. 427.50 ± 74.25 m and 96.50 ± 0.71% final SO2). Conclusions The percentage of deaths in the different groups appears very heterogeneous, especially if we consider the six deaths (42.86%) in group 3 and three deaths (42.86%) in patients with mixed IP groups 2 and 3. In these two groups, age and advanced NYHA class were the most representative prognostic factors. On the other hand, analysing patients belonging to the idiopathic IAP subgroup, a worse prognosis is entrusted to the negativity of the vasoreactivity test, to the presence of cardiovascular comorbidities (arterial hypertension and dysthyroidism in our case), to worse echocardiographic values (PAPs, TAPSE, ACT, atrial area right) and reduced functional capacity at the 6MWT. However, early treatment and innovative drugs together with a careful strategy have been allowed.

Aims Left ventricular global longitudinal strain (GLS) detects subtle systolic abnormalities in various cardiovascular conditions, which represent significant risk factors for cognitive impairment and stroke. Specifically, GLS has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). This study investigated the relationship of GLS with mild cognitive impairment (MCI) in hypertensive patients. Methods and results From February 2020 to October 2021 were enrolled hypertensive patients without atrial fibrillation and/or cerebrovascular and/or neurodegenerative diseases. Complete demographic, clinical characteristics, laboratory analyses, conventional echocardiographic parameters were collected. Finally, MCI was defined by accurate the Quick Mild Cognitive Impairment (QMCI) Screen corrected for age and education. This score explores spatial and temporal orientation, registration, delayed recall, clock design, logical memory, and verbal fluency in a brief time (5 min—score 0–100); a compliance questionnaire (Morisky medication adherence scale); a questionnaire on nutritional status (MNA). 81 hypertensive patients [66 ± 7.27 years; 9 (11%) female] were included in the study. Concerning echocardiographic evaluation, LVEF was 50.47 ± 9.95% and mean GLS was −16.00 ± 3.66. Mean QMCI corrected for age and education was 56.45 ± 9.37, and MCI was detected in 21 patients (26%). When comparing the patients with MCI (QMCItot 49.4), a statistically significant difference of GLS values was detected (no MCI: −16.52 ± 3.66 vs. MCI: −14.18 ± 3.23; P = 0.032); on the other hand, the two groups did not differ in LVEF (no MCI: 50.58 ± 9.70 vs. MCI: 48.86 ± 11.93; P = 0.864). Furthermore, excluding patients with FE ≥ 45% from the analysis, a statistically significant linear regression was observed between QMCI (corrected for age and education) and the GLS (P = 0.014) (Figure 1). Conclusions Compromised GLS, but not LV EF, is related to MCI in hypertensive patients who are free of clinical dementia, stroke, and neurodegenerative disease. Moreover, our study demonstrates for the first time the existence of a significant association between the QMCI and GLS; consequently, GLS could be an additional parameter in clinical practice for early recognition of MCI. However, studies on a larger population will be needed to confirm this association.

Aims Hypertension is a known risk factor for stroke and vascular dementia. Recent studies have also shown that arterial hypertension represents a clear risk factor for mild cognitive decline and its evolution into Alzheimer’s disease. Really, mild cognitive decline significantly compromises the patient’s quality of life, reducing compliance with therapy and increasing mortality and hospitalization. Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype. Currently, this diagnosis is based on the execution of second-level investigations (e.g. neuroimaging), that are expensive and not always available. For this reason, we analysed a population of hypertensive patients without atrial fibrillation and/or cerebrovascular and/or neurodegenerative diseases, with the aim of verifying the existence of an association between cognitive impairment and flows on the middle cerebral artery (MCA). Methods We considered 33 hypertensive patients (age 64.90 co1.40 years; 72% male). Specifically, we considered anthropometric, clinical, laboratory, and echocardiographic parameters. Also, we administered: an accurate, sensitive, and specific screening test (QMCI) for the assessment of intermediate cognitive decline (MCI), which explores spatial and temporal orientation, registration, delayed recall, clock design, logical memory and verbal fluency in a concise time (5 min—score 0–100); a compliance questionnaire (Morisky medication adherence scale); a questionnaire on nutritional status (MNA). Finally, we recorded transcranial Doppler flows on the MCA. Results There is no QMCItot score compatible with dementia ( Conclusions In conclusion, our study demonstrates for the first time the existence of a significant association between the QMCI and the sampling of the MCA at the ultrasound Doppler. Studies on a larger population will be needed to confirm this association and to test the translational relevance, in particular to tailor therapeutic approach in patients with abnormal MCA Doppler.

Serum uric acid (sUA) has been associated with cardiovascular risk. Although the recent mechanistic hypothesis poses the basis for the association between sUA and left ventricular mass index (LVMi), the issue remains poorly investigated in a clinical setup. Through a retrospective analysis of the database of the departmental Hypertension Clinic of University Hospital of Salerno Medical School, we identified 177 essential hypertensives (age 60.3 ± 13.3 years; 85 men), free from uric acid-modulating medications and severe chronic kidney disease, and whose sUA values, anthropometric, clinical, and echocardiographic data were available. In the studied cohort, the average duration of hypertension was 8.4 ± 7.1 years. LVMi associated with classical determinants, such as age, blood pressure, and kidney function, although after multivariate correction, only age remained significant. Also, sUA correlated positively with LVMi, as well as body size, metabolism, and kidney function. In a multivariate analysis, sUA confirmed the independent association with LVMi. Also, levels of sUA >5.6 mg/dl are associated with larger cardiac size. We confirmed our data in a replicate analysis performed in a larger population (1,379 hypertensives) from an independent clinic. Our results demonstrate that sUA increases with LVMi, and a cutoff of 5.6 mg/dl predict larger LV sizes. Our data suggest that hyperuricemia might help to stratify the risk of larger cardiac size in hypertensives.

The introduction of fixed combination of ACEi+CCB (Fixed) has significantly increased patients compliance and adherence to therapy. At the moment, however, there are no data suggesting the better control of once-daily fixed (Fixed) over free doses in separate administrations combination therapy in hypertensives. In a population of 39 consecutive outpatient patients referred to the departmental Hypertension clinic of the University Hospital of Salerno Medical School with the first diagnosis of arterial hypertension, we tested the hypothesis that the Fixed achieve a better control of blood pressure than the Free combination. Patients were randomized to either strategy and after 3 months patients underwent a clinical assessment to evaluate the antihypertensive effect. The two groups, matched for anthropometric and clinical parameters, received Amlodipine (5–10 mg/daily) and Perindopril (5–10 mg/daily). Perindopril and Amlodipine doses did not significantly differ between the two groups. After 3 months BP control was improved in both groups and BP targets were similarly reached in both groups (SBP; Fixed: 61.54%; Free 69.23%; n.s. DPB; Fixed: 80.77%; Free 84.62%; n.s.). The reduction in systolic blood pressure was similar in both groups (Fixed:7.64±2.49%; Free: 7.81±4.00%, n.s.), while the reduction of diastolic blood pressure was greater in the Fixed group (Fixed: 14.22±2.03%; Free: 4.92±5.00%, p

Difficult-to-control (DTC) hypertension represents a burden in real life that can be partially solved through identification of the characteristics of clinical patterns and tailoring antihypertensive strategies, including ICT-enabled integrated care (ICT-IC). In the quest for clinical predictors of DTC hypertension, we screened 482 hypertensive patients who were consecutively referred to the departmental hypertension clinic. Following a data quality check, patients were divided into controlled (C, 49.37%) and uncontrolled (UC, 50.63%) groups based on their systolic blood pressure (BP) at follow-up. We then performed statistical analysis on the demographic, clinical, laboratory, and ultrasound data and observed that older age, female sex, higher BP levels, and a family history of hypertension were predictors of DTC hypertension. We then developed a pilot service of ICT-IC, including weekly home visits by nurses and patient education on self-monitoring of BP, heart rate, body weight, and oxygen saturation using 3G-connected devices. Self-monitored data were transmitted to the hospital servers on the electronic chart of the patient for remote assessment by the hospital hypertension specialists. A total of 20 UC patients (M/F = 10/10; age: 72.04 ± 2.17 years) were enrolled to verify the efficacy of BP control without changes in medical treatment. After 1 month of the ICT-IC program, BP was reduced both at the office assessment (systolic BP (SBP): 162.40 ± 2.23 mm Hg, beginning of the program vs. 138.20 ± 4.26 mm Hg at 1 month, p < 0.01) and at home (SBP: 149.83 ± 3.44, beginning of the program vs. 134.16 ± 1.67 mm Hg at 1 month, p < 0.01). We concluded that DTC hypertension can be predicted based on the clinical characteristics at the first visit. For these patients, ICT-IC is a feasible therapeutic strategy to achieve BP control.

Introduction: Less than 40% of hypertensive on antihypertensive treatment have pressure Methods: To verify the impact of home care strategy to improve pressure control, from February 1 to March 31 2016 we selected patients who accessed the Outpatient Clinic for Hypertension at the AOU San Giovanni e Ruggi in Salerno, those with 1) poor BP control >140 and/or DBP>90 mmHg) after at least three follow-up visits in the last year, 2) optimal drug therapy, 3) poor adherence to therapy, 4) at least one concurrently treated chronic condition. Patients who signed informed consent received “Beyond Silos” home care program, including a weekly nurse access, for four weeks, and telemonitoring through 3G-connected devices of systolic (SBP) and diastolic (DBP) blood pressure, heart rate (HR) and body weight measuring and Oxygen Saturation. Each patient was instructed to scheduled self-assesment of the above parameters that were stored on the Local Health Authority server of Salerno. Treatment compliance was verified weekly by the nurse through drug blister count. After 4 weeks, patients were evaluated at the hospital premises. Results: We selected seven patients (M/F=5/2; age 73.4 ± 2.3 years). In this population BP control that went from ambulatory SBP/DBP 155±5/74±4mmHg to 111±1.7/95.9±2.7mmHg, p Conclusion: Our data show that patients with a hitory of loose BP control despite optimal therapy can achieve controlled BP through Beyond Silos home care program within a month. This suggest that strategies of ICT based home care might represent a real breackthrough in the management of chronic conditions, in particular for multimorbid, poor compliant patients. Future large scale studies are needed for assessing long term effects on cardiovascular outcome.