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BACKGROUND AND PURPOSE Hypertension is known to be highly prevalent among patients with diabetes and associated with an increased risk of cardiovascular damage. In contrast, relatively few investigations have addressed the prevalence of diabetes among patients with hypertension. The purpose of the present study was to examine the prevalence of type 2 diabetes, the effectiveness of hypertension and diabetes control and the association with other cardiovascular risk factors and previous cardiovascular diseases in a cohort of patients with hypertension referred to 30 hospital outpatient clinics for the treatment of hypertension. METHODS AND PATIENTS Patients were considered as having diabetes if they were already on an antidiabetic treatment either with diet or medications. All other patients had fasting plasma glucose measured on two separate occasions and were classified as having diabetes if both values were at least 140 mg/dl (7.8 mmol/l) and as not having diabetes if both values were less than 110 mg/dl (6.1 mmol/l). In patients with a single determination of at least 110 mg/dl, the final diagnosis of diabetes was established according to the result of an oral glucose tolerance test. A secondary definition of diabetes was also used, that is two fasting plasma glucose values of at least 126 mg/dl (7.0 mmol/l). In all patients, serum total, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, fasting serum triglycerides, serum creatinine and urinary albumin were also evaluated. RESULTS AND CONCLUSION Among the 1397 recruited patients, 242 (17.3%) were diagnosed as having diabetes according to the primary definition and 244 (17.5%) according to the secondary definition. In 195 out of the 242 (14%), the diagnosis was already known whereas, in the remaining 47 (3.3%), it was made de novo. In 61.4% of those already having diabetes, plasma glucose was at least 140 mg/dl (7.8 mmol/l), whereas only in 8.4% of them was it less than 110 mg/dl (6.1 mmol/l). Patients with diabetes were older, heavier and with a greater familiar predisposition. Patients with diabetes had higher values of systolic blood pressure than individuals without diabetes (150 +/- 17 vs. 144 +/- 16 mmHg, respectively; P < 0.001), lower high-density lipoprotein cholesterol and higher triglycerides and microalbuminuria. Overall, among patients with hypertension and diabetes, only 3% had blood pressure and HbA1c within the recommended limits. The prevalence of previous cardiovascular disorders was two to three times higher than among individuals without diabetes.

In the course of a general population survey in Mirano (Venice), Northern Italy, a random sample of 1,903 subjects (50.1% men) aged 20-59 was examined. Fifty-five were diabetic (fasting plasma glucose greater than or equal to 140 mg/dl or diagnosed by a physician) and 1,670 non-diabetic subjects (fasting plasma glucose below 110 mg/dl). In this paper an assessment was made on the more frequent occurrence of coronary risk factors (serum cholesterol and triglycerides, body mass index (BMI), systolic blood pressure, cigarette smoking) and, in particular, of their aggregation in diabetic patients as compared to non-diabetic controls. The occurrence of any one of the coronary risk factors studied was more frequent in diabetic subjects and significantly so for triglyceridemia in both sexes and for systolic blood pressure and BMI in men. The aggregation of two or more risk factors was also more frequent in diabetic subjects than controls. Finally, the combined score of coronary risk as calculated by multiple logistic function showed higher values for diabetic subjects. These results confirm the need for a systematic search for coronary risk factors in diabetic subjects in order to prevent cardiovascular complications.

In 1978 a random sample (367 men and 568 women aged 18-65 years) taken from the general population of a north-eastern Italian town was screened for cardiovascular risk; 16 years later, the women were invited to a second screening. Three groups were identified at the initial screening (fertile, naturally menopausal and surgically menopausal) and four in the longitudinal study (137 remained fertile during the whole study, 205 became naturally menopausal, 56 were ovariectomised and 127 were already going through the menopause). The protocol included a questionnaire, blood pressure (BP) measurement, and blood exams. Continuous variables were adjusted for confounders. Systolic BP, prevalence of hypertension, cholesterol, glycaemia and uricaemia were similar, whereas diastolic and triglycerides (TG) were lower in surgically-menopausal than in fertile women (P0.001). No significant difference in 16 years' variation from baseline was observed between the four groups, although women who remained fertile showed the smallest increases. In particular, neither systolic or diastolic BP increases differed between the women who were oophorectimised and those who remained fertile. 'Fertile status' was rejected from the logistic equation of incidence of hypertension, and 'age of menopause' was also rejected when this analysis was repeated in ovariectomised women. New coronary artery disease (angina pectoris or myocardial infarction) was observed in one ovariectomised woman, in three naturally menopausal, and in 13 already menopausal women which seemed to reflect the age trend. No new cases were observed in women who remained fertile. In conclusion, in Italian women surgical menopause, similarly to natural menopause, is devoid of any negative prognostic effect. Journal of Human Hypertension (2000) 14, 799-805

Since we have observed that mo-nounsaturated fatty acids (MUFA) enriched diet modifies red cell membrane lipids and cation transport systems in normotensive subjects, we similarly evaluated a group of hypertensive patients undergoing an analogous dietary modification. In a group of 18 moderately hypertensive women, the diet was supplemented for two months with olive oil (about 45 g/day), which replaced an equal amount of seasoning fats. Before and after this period, red cell fatty acid composition was evaluated by gas-chromatography in order to verify diet compliance: a significant increase in oleic acid was observed, while the content of saturated and polyunsaturated fatty acids remained unchanged. After olive oil, maximal rates of Na-K pump (5580±329 vs 6995±390, plt;0.001) and Na-K cotransport ( Na-COT 544±52 vs 877±46, plt;0.001: K-COT 790±76 vs 1176±66, plt;0.001), cell Na content (9.58+0.4 vs 10.61 ±0.6, plt;0.03) and passive permeability for Na (936±74 vs 1836±102, plt;0.001 ) rose significantly. Although the reduction in maximal rate of the Li-Na CT after olive oil was not significant, it was the only cation transport parameter being correlated with the variations of membrane lipids, namely negatively with UFA (r=-0.528, plt;0.05) and positively with SFA (r=0.482, plt;0.005). The change in maximal rate of Li-Na CT was also correlated with the variation of systolic and diastolic BP (r=0.50, plt;0.03). No changes in membrane lipid composition and ion transport systems were observed in a group of 13 control patients kept on usual diet over the same period. Thus, olive oil supplementation affects the lipid composition of the cell membrane in hypertension. This change is in turn associated with a modification of membrane transport activity; in addition a significant reduction of blood pressure is obtained.

In the Region Veneto, north-eastern Italy, a survey of three random samples of population aged 20-64 has been made during the initial phase of the international cooperative pilot project called "Community Control Programme of Hypertension", promoted by World Health Organization. 15,187 subjects were examined (47.2% males). The prevalence of "isolated" systolic hypertension (ISH: "casual" blood pressure at or above 160 for systolic readings and below 95 for diastolic) was 6.2%, that of "isolated" diastolic (IDH) 9% and that of "simultaneous" systolic diastolic hypertension (SDH) 15.5%. ISH had an awareness rate of 29.4% and a treatment rate of 10.6%, which is less than for SDH but more than IDH. Analysis of the Hypertension Register set up in one of the three areas showed no important differences in heart rate, Body Mass Index, serum sodium or potassium, B.U.N. and total cholesterol between the different forms of hypertension. The assessment of coronary risk by means of Multiple Logistic Function yielded similar figures for ISH and SDH in males, higher figure for SDH in females. Electrocardiographic changes of left ventricular hypertrophy and of ischaemia were more frequent among subjects with ISH than those with SDH and IDH. It is concluded that ISH is present in a substantial proportion of the population and carries with it no less risk of cardiovascular complications than the other forms of hypertension.

In this study, 953 patients (48 percent men) more than 60 years old with mild to moderate hypertension (class I or II) were included. After a two-week wash-out period, a starting dosage of captopril--12.5 mg twice a day--was given. Patients were examined after one and three weeks and, subsequently, at monthly intervals for a total period of four months. The dosage was adjusted to a maximum of 50 mg twice a day plus, when needed, 25 mg of hydrochlorothiazide per day. Thirty-two patients were lost to follow-up, 10 withdrew because of inadequate control of blood pressure, and only 21 (2 percent) dropped out because of side effects. Mean blood pressure decreased from 184/104 to 152/87 mm Hg. The lowest dosage (25 mg a day) was sufficient to control blood pressure in 15 percent of patients, 31 percent needed 50 mg a day, and 24 percent required 100 mg a day. Hydrochlorothiazide was added to the captopril regimen in 30 percent. No substantial changes in biochemical variables or electrocardiographic results were observed. "Quality of life" (judged as physical fitness, positive well being, mood, and sexual desire) remarkably improved.

1. Blood pressure has been measured in a random sample of 5852 subjects (both sexes, 20–64 years old). The prevalence of hypertension (blood pressure ≥ 160 mmHg and/or 95 mmHg; 150 mmHg and/or 90 mmHg under the age of 30 years) was 29·5%. 2. In a cohort of 972 detected hypertensive subjects, longitudinal changes (2 and 5 months after the initial examination) were evaluated. The phenomenon of regression toward the mean value was evident. 3. The implications of the variability of blood pressure in a community control programme of hypertension are discussed.

summary The relationship between body weight and blood pressure, total serum cholesterol, triglycerides, uric acid and glucose was investigated in 203 psoriatic patients in comparison with 904 healthy controls. In the psoriatic patients, these parameters were clearly related to their body weight. Those psoriatic patients of normal weight exhibited lower mean values of all the parameters compared with overweight psoriatic patients while they did not differ from control subjects of normal weight. Our results suggest that only overweight psoriatic patients exhibit the metabolic abnormalities frequently reported in the literature, while psoriatic patients of normal weight do not differ from the general population in this respect.

Spontaneous changes in blood pressure (BP) over a week after admission to the hospital were investigated in 127 patients admitted with diastolic BP at or above 120 mm Hg. Average BP decreased from 205/129 at admission to 174/110 on the 8th day. Regression analysis showed highly significant negative slopes which were related to initial levels but not to the presence or type of target organ involvement. After 1 week, 66% of the subjects attained a diastolic BP lower than 120 mm Hg. More remarkably, 36% attained values lower than 105 mm Hg: 33% of these had BP values less than 95 mm Hg. While not ruling out the importance of very high BP readings, it is concluded that they do not necessarily represent any pattern of either fixed or severe hypertension nor imply a need for urgent antihypertensive treatment.