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Masked hypertension (MH) is defined as normal office blood pressure (BP) and elevated ambulatory BP (ABP) or home BP or both. This study assessed the association of MH (ie, isolated home, isolated ABP and dual MH) with echocardiographic left ventricular hypertrophy (LVH). The present analysis of the PAMELA study included 1087 untreated and treated participants with normal office BP and a measurable LV mass (LVM). A total of 193 individuals (17.7%) had any MH (ie, normal office BP, elevated ABP or home BP or both), 48 had dual MH (25%), 62 isolated ambulatory MH (32%), and 83 isolated home MH (43%). Average LVM indexed to body surface area was superimposable in the three MH phenotypes (being the largest difference between groups

The study by Triantafyllidi et al. supports the view that regression of subclinical cardiac damage requires an effective 24‐hour blood pressure (BP) control along with a reduction in BP variability and suggests that the assessment of BPV and its modifications during the course of therapy may be an useful approach in predicting the beneficial effects of treatment on cardiac structure. However, some aspects and limitations of this study require caution in drawing firm conclusions. So, further investigation is needed to determine if reduction of BPV is actually associated with a regression in cardiac and extracardiac organ damage to identify which which classes of antihypertensive drugs are most effective in reducing BPV, and to elucidate whether those treatments provide additional clinical benefit, independent of the conventional BP targets.

We sought to assess functional capacity in recently diagnosed untreated hypertensive patients with different 24-hour blood pressure (BP) patterns (dipping, non-dipping, extreme dipping, and reverse dipping). This cross-sectional study involved 164 untreated hypertensive patients who underwent 24-hour ambulatory BP monitoring and cardiopulmonary exercise testing. Our findings showed that 24-hour and daytime BP values did not differ between four groups. Nighttime BP significantly and gradually increased from extreme dippers to reverse dippers. There was no significant difference in BPs at baseline and at the peak of exercise among four observed groups. Peak oxygen consumption (peak VO2) was significantly lower in reverse dippers than in dippers and extreme dippers. Heart rate recovery was significantly lower among reverse dippers than in dippers and extreme dippers. Ventilation/carbon dioxide slope (VE/VCO2) was significantly higher in reverse dippers and non-dippers in comparison with dippers and extreme dippers. Non-dipping BP pattern (non-dippers and reverse dippers together) was independently and negatively associated lower heart rate recovery in the first minute and peak VO2. Reverse dipping BP pattern was independently associated not only with heart rate recovery in the first minute and peak VO2, but also with VE/VCO2. In conclusion, untreated hypertensive patients with reverse dipping BP patterns showed significantly worse functional capacity than those with dipping and extreme dipping BP patterns. Circadian BP rhythm is related with functional capacity and should be taken into account in the risk assessment of hypertensive patients.

The present study was aimed at assessing the relationships between absolute and individual residual blood pressure (BP) variability and cognitive function in a general population. This cross‐sectional study evaluated cognitive function using minimental state evaluation (MMSE) in 471 subjects enrolled in the PAMELA study. MMSE was calculated 10 years after initial enrollment of the subjects in the PAMELA study. Measurements included office, home, and 24‐hour ambulatory BP monitoring. BP variability was obtained by calculating: (a) 24‐hour standard deviation (SD) for systolic and diastolic BP and (b) individual residual BP variability. Mean age (±SD) of the subjects enrolled was 63 ± 5.7 years at the initial evaluation, with a 10‐year increase when MMSE was performed. There was no significant difference in BP or heart rate values measured at office, home, or during 24‐h BP monitoring between subjects with MMSE

Obesity is significantly associated with uncontrolled blood pressure and resistant hypertension (RH). There are limited studies on the prevalence and determinants of RH in patients with higher body mass index (BMI) values. Since the hypertension guidelines changed in 2017, the prevalence of RH has become unknown and now is subject to be estimated by further studies. We conducted a cross‐sectional study in an urban Federally Qualified Health Center in New York City aiming to estimate the prevalence of RH in high‐risk overweight and obese patients based on the new hypertension definition, BP threshold ≥130/80 mm Hg, and also to describe the associated comorbid conditions in these patients. We identified 761 eligible high‐risk overweight and obese subjects with hypertension between October 2017 and October 2018. Apparent treatment‐RH was found in 13.6% among the entire study population. This represented 15.4% of those treated with BP‐lowering agents. True RH confirmed with out‐of‐office elevated BP was found in 6.7% of the study population and 7.4% among patients treated with BP‐lowering agents. Prevalence was higher with higher BMI values. Those with true RH were more likely to be black, to have diabetes mellitus requiring insulin, chronic kidney disease stage 3 or above and diastolic heart failure. In conclusion, obesity is significantly associated with RH and other significant metabolic comorbid conditions.

We performed a meta‐analysis of population studies reporting data on carotid intima‐media thickness and plaque in patients with and without metabolic syndrome (MetS) to provide a new piece of information on the relationship of MetS with both phenotypes of vascular damage. The Ovid MEDLINE, PubMed, and Cochrane CENTRAL databases were searched without time restriction up to December 31, 2016. Overall, 19 696 patients (22.2% with MetS) were included in eight studies. Common carotid intima‐media thickness was greater in patients with MetS compared with those without it (788 ± 47 μm vs 727 ± 44 μm), with a standard means difference of 0.28 ± 0.06 (P = .00003). Increased intima‐media thickness in patients with MetS was paralleled by a higher prevalence of plaques. The present meta‐analysis shows that MetS is associated with both ultrasonographic phenotypes of carotid damage. This finding is consistent with the view of MetS as a cluster of hemodynamic and nonhemodynamic factors promoting vascular hypertrophy and plaque.

BACKGROUND A large number of chemotherapy-induced cardiovascular complications were discovered in studies over the last several decades. The focus of the majority of these studies was left ventricular (LV) remodeling. The aim of this article was to provide a comprehensive overview of potential mechanisms of chemotherapy-induced right ventricular (RV) remodeling and summarize clinical studies on this topic. HYPOTHESIS Chemotherapy induces RV structural, functional, and mechanical changes. METHODS We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 1990 up to September 2016 in the English language using the following keyword "chemotherapy," "heart," "right ventricle," "anthracyclines," and "trastuzumab." RESULTS The existing research show that RV remodeling occurs simultaneously with LV remodeling, which is why RV remodeling should not be neglected in the overall cardiac assessment of patients treated with chemotherapy, and especially those protocols that involve anthracyclines and trastuzumab. Investigations showed that these agents could significantly impact RV structure, function, and mechanics. These medications induce fibrosis of the RV myocardium, RV dilatation, decline in RV systolic function, worsening of its diastolic function, and finally impairment of RV mechanics (strain). The mechanisms of chemotherapy-induced RV remodeling are still not entirely clear, but it is considered that direct destructive influence of chemotherapy on myocardium, oxidative stress, endothelial dysfunction, and negative impact on pulmonary circulation could significantly contribute to RV impairment. CONCLUSIONS Chemotherapy induces the impairment of RV structure, function, and mechanics by different complex mechanisms.

Dual‐energy X‐ray absorptiometry (DXA) is a low‐cost, minimal radiation technique commonly used to assess bone density and body composition that can also provide a measure of abdominal aortic calcification (AAC). We examined the association between pulse pressure (PP) and DXA‐derived AAC in a nationally representative sample of US adults. Analyses were performed in 2,478 adults from the 2013‐2014 NHANES cycle. AAC scores were calculated using a validated 24‐point scale from thoraco‐lumbar spine images (scored 1‐6 across four vertebral heights from L1‐L4 for both anterior and posterior aortic walls). We examined PP as a predictor of both the presence (dichotomous) and magnitude (continuous) of AAC in age‐stratified analyses (

Aim: Information on left atrium (LA) enlargement, as assessed by LA volume (LAV) instead of LA diameter, in the athletic population is scanty. To expand current knowledge on this issue, we performed an updated meta-analysis of echocardiographic studies. Design: The Ovid MEDLINE, PubMed, and Cochrane CENTRAL databases were searched for English language articles without time restriction up to February 2018 through focused, high sensitive search strategies. Studies were identified by crossing the following search terms: “athletes,” “physical training,” “left atrial size,” “left atrial volume,” “atrial function,” and “echocardiography.”. Results: Overall, 3145 subjects (2425 elite athletes and 720 active but not trained healthy controls) were included in 16 studies. Average LAV indexed to BSA (LAVI) was 37% higher in athletes as compared to nonathletic controls (31.0 ± 1.4 mL/m2 vs 22.2 ± 0.9 mL/m2), the standard means difference (SMD) being 1.12 ± 0.13 (CI: 0.86-1.89, P

To evaluate the impact of blood pressure variability (BPV) on cardiovascular outcomes in patients with acute coronary syndrome, short‐term BPV was estimated by using weighted standard deviation of 24‐hour ambulatory blood pressure monitoring readings. The primary outcome was in‐hospital major adverse cardiac events (MACE). Overall, 200 patients (mean age, 58.6 years; 27.5% women; 38% with diabetes mellitus; and 47% smokers) were divided into low and high BPV groups based on the median value (9.45). Patients in the high BPV group were more likely to have in‐hospital MACE compared with patients with low BPV (47% vs 27%, P = .003). Multivariate binary logistic regression analysis of incidence of MACE showed that BPV (odds ratio, 2.4; confidence interval, 1.2–4.5 [P = .008]) and presence of type II diabetes mellitus (odds ratio, 2.6; confidence interval, 1.2–5.3 [P = .008]) were the only independent predictors of in‐hospital MACE derived mainly by hypertensive emergencies. BPV could be an important risk factor for in‐hospital MACE in patients with acute coronary syndrome.

The authors estimated the risk of cardiovascular mortality associated with echocardiographic (ECHO) left ventricular hypertrophy (LVH) and subtypes of this phenotype in patients with and without electrocardiographic (ECG) LVH. A total of 1691 representatives of the general population were included in the analysis. During a follow‐up of 211 months, 89 cardiovascular deaths were recorded. Compared with individuals with neither ECHO LVH nor ECG LVH, fully adjusted risk of cardiovascular mortality increased (hazard ratio [HR], 3.36; 95% confidence interval [CI], 1.51–7.47; P=.003) in patients with both ECHO‐LVH and ECG‐LVH, whereas the risk entailed by ECHO‐LVH alone was of borderline statistical significance (P=.04). Combined concentric nondilated LVH and ECG‐LVH, but not concentric nondilated LVH alone, predicted cardiovascular death (HR, 3.79; 95% CI, 1.25–11.38; P=.01). Similar findings were observed for eccentric nondilated LVH (HR, 3.37; 95% CI, 1.05–10.78; P=.04.). The present analysis underlines the value of combining ECG and ECHO in the assessment of cardiovascular prognosis related to abnormal left ventricular geometric patterns.

Objective The aim of the study was to evaluate right atrial (RA) phasic function in hypertensive patients with different left ventricular (LV) geometric patterns by using two-dimensional (2DE) and three-dimensional (3DE) echocardiography. Methods This cross-sectional study involved 177 hypertensive patients who underwent 2DE and 3DE examination. The updated criteria of LV geometry that included LV mass index, LV end-diastolic diameter, and relative wall thickness were applied. Using this classification, patients were separated into six groups: normal geometry, concentric remodeling, eccentric nondilated LV hypertrophy (LVH), concentric LVH, dilated LVH, and concentric–dilated LVH. Results Two-dimensional echocardiography and 3DE RA volumes were significantly higher in concentric and dilated LVH than in other LV geometric types. RA reservoir function, estimated by total 2DE and 3DE RA emptying fraction (EF), was decreased in subjects with dilated LVH compared with normal geometric and concentric LV remodeling patterns. RA conduit function assessed with 2DE and 3DE RA passive EF, gradually reduced from normal LV geometry to dilated LVH. RA pump function was increased in patients with concentric and dilated LVH than in subjects with normal LV geometry and concentric remodeling. 2DE strain analysis confirmed these findings about RA phasic function. Concentric LVH and dilated LVH were associated with RA enlargement and dysfunction irrespectively of main demographic and clinical parameters. Conclusion Left ventricular geometric patterns have significant impact on RA phasic function in hypertensive patients. Concentric and dilated LVH patterns have the most prominent negative effect on RA morphological and functional remodeling.

Evidence on the association of nocturnal hypertension (NH) with subclinical cardiac and vascular damage is scanty. The authors performed a meta‐analysis to provide comprehensive information on this clinically relevant issue. Full articles providing data on subclinical cardiac and carotid damage as assessed by ultrasonographic methods in patients with NH as compared with patients with nocturnal normotension (NN) were considered. A total of 3657 patients (NH=2083, NN=1574) of both sexes were included in seven studies. Left ventricular mass index was higher in individuals with NH than in those with NN (112±4.7 g/m(2) vs 98±4.8 g/m(2); standard mean difference [SMD], 0.54±0.16; confidence interval [CI], 0.23–0.85; P

From the physiopathological point of view obstructive sleep apnoea (OSA) should be regarded as the phenotype with the highest potential to disrupt the normal circadian blood pressure (BP rhythm). Despite these assumptions, it is surprising, however, to note that the data supporting a link between OSA and paradoxical increase in nighttime BP (ie, the so‐called reverse dipping pattern) are still very limited and in some ways not entirely consistent. Available evidence on the association between OSA and reverse dipping (RD pattern), contrary to what is commonly thought, is still scanty. Given the potential negative synergistic effect of these two conditions, it is essential to have studies targeting this topic available soon.

The influence of type 2 diabetes mellitus on cardiac remodeling has been evaluated for decades; however, the majority of investigations were focused only on the left ventricle. The impact of diabetes on the left atrial (LA) function is less researched. LA enlargement has been shown as an independent predictor of cardiovascular morbidity and mortality in the general and diabetic population; however, LA dysfunction has been proven to be an independent predictor only in the general population. There are not much follow-up data about the influence of diabetes on LA function. New echocardiographic techniques, such as 2-dimensional speckle tracking imaging, provide more accurate, sensitive, and reliable information about LA function than traditional, volumetric methods. The aim of this review was to summarize the most recent reports about the influence of diabetes on LA function, as well as to discuss the possible mechanisms and potential clinical implications of the relationship between diabetes and LA remodeling.