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Background: The purpose of the present study was to assess whether systemic arterial hypertension is associated with abnormal right ventricular (RV) structure and function as assessed by three-dimensional speckle tracking echocardiography and how those changes are related to left ventricular (LV) strain, left ventricular hypertrophy (LVH) and aortic (Ao) function. Methods: We examined 115 hypertensive (mean age, 65±16 years; 52% male) and 115 healthy adults (mean age, 68±13 years; 54% male). Patients were divided into two groups: patients with LVH (Group I, LVMI>115g/m 2 men, LVMI>95g/m 2 women) and patients without LVH (group II). LV longitudinal (LS), circumferential, radial and area (GAS) strains were calculated by three-dimensional speckle tracking echocardiography (3DSTE). RV free-wall longitudinal strain (LS) was determined by 3DSTE. Aortic (Ao) distensibility and stiffness index (SI) were calculated using accepted formulae. The corrected aortic strain (Ao-S) by two-dimensional speckle tracking echocardiography was calculated as the global aortic strain /pulse pressure. Data analysis was performed offline (GE EchoPAC). Results: Overall, Ao-SI was increased (r=0.74, p=0.003) and Ao-S was decreased (r=0.79, p=0.002) in hypertensive patients compared with controls. Ao-SI had a negative correlation with Ao-S (r=-0.76, p Conclusions: In systemic hypertension there is a complex interaction between LV strain, RV strain and Ao strain. Reduced RV strain can occur even in the absence of LV hypertrophy.

Introduction Proper control of blood pressure reduces the risk of developing cardiovascular and cerebrovascular complications in hypertensive people. However, this control remains mostly unsatisfactory. Although alexithymia has been associated with essential hypertension, no study has analysed the relationship between alexithymia and blood pressure control in drug-treated hypertension. This research aimed to analyse the presence and the characteristics of this relationship, considering both the pharmacological treatment and the achievement of adequate maintenance of blood pressure in a physiological range. Method One thousand two hundred and forty-one people participated in the study. Eight hundred and ten were hypertensive patients, and four hundred and thirty-one were normotensive people. The Toronto Alexithymia Scale-20 was used to assess alexithymia. Results Results show that hypertensive people are more alexithymic than normotensive people. According to the presence of pharmacological treatment, treated hypertensive patients are more alexithymic than normotensive and not treated hypertensive patients. Considering the blood pressure control associated with the drug-therapy, people with uncontrolled hypertension are more alexithymic than normotensive and untreated hypertensive people. Conclusions These findings confirm a relationship between alexithymia and essential arterial hypertension, but they also highlight that alexithymia appears to be associated with higher severity of hypertension. Alexithymia could be a facet of uncontrolled hypertension.

Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience.Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring.Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience.Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.

IntroductionThere is growing interest in lipid-lowering nutraceuticals; however, there are a relative scarcity of data on combined compounds. This study was aimed to assess the efficacy and tolerability of a combined nutraceutical (CARDIOL® Forte – CF) containing polyunsaturated fatty acids, hydroxytyrosol, Coenzyme Q10, folic acid, B12 and E vitamins, piperine, and red yeast rice in patients with mild-to-moderate hypercholesterolaemia.Material and methodsIn this single-centre, double-blinded, placebo-controlled study enrolled subjects who were randomised to receive the tested combined nutraceutical for 16 weeks (CF group) or placebo (control group), in association with a low-fat diet. After 8 weeks of treatment, all patients underwent a 15-day washout period; then, a further 8 weeks of treatment was planned.ResultsOf 80 enrolled subjects, 37 completed the study in the CF group and 38 in the control group. After 8 weeks of treatment, low-density lipoprotein cholesterol levels were reduced by 17% in the CF group and by 6.4% in the control group, compared to baseline (p = 0.0001); these changes were improved at the end of study. Total cholesterol and triglyceride levels significantly decreased during treatment; high-density lipoprotein cholesterol did not change. In the CF group, flow-mediated dilation increased by 18.8% after 8 weeks and by 39.3% at the end of treatment. No adverse events or musculoskeletal disorders were reported in either group.ConclusionsThe tested combined nutraceutical, in association with a controlled diet, can reduce cholesterol levels and improve endothelial function, thus reducing the cardiovascular risk in patients with mild-to-moderate hypercholesterolaemia.

Objective To assess the findings of contrast-enhanced ultrasound (CEUS) of carotid arteries in patients with large vessel vasculitis (LVV) and to compare them with those observed using 18F-fluorodeoxyglucose–positron emission tomography (18FDG-PET). Methods A total of 31 consecutive patients with LVV (14 with Takayasu arteritis, 17 with giant cell arteritis with large vessel involvement) underwent both PET/computed tomography and carotid artery color Doppler ultrasound (CDUS) for a total of 35 combined assessments. Right carotid artery CEUS was performed after CDUS in all assessments. Kerr's criteria, a complete clinical examination, and acute phase reactants were simultaneously evaluated. The intensity of vascular uptake and vascularization of the carotid artery wall were compared. Results Ten 18F-FDG/PET scans showed active vascular 18F-FDG uptake (visual grade ≥2) in the right carotid artery. CEUS demonstrated severe vascularization (grade 2) within the right carotid artery wall in 12 examinations. The carotid CEUS vascularization grade significantly correlated with vascular 18F-FDG uptake (P

Background Given that in patients with cardiac amyloidosis (CA), deposition of amyloid protein is not restricted to the left ventricular (LV) myocardium, it can be hypothesized that the diagnostic value of deformation mechanics would be enhanced by considering right ventricular (RV) strain measures. The aim of the present study was to examine the potential utility of left ventricular (LV) and right ventricular (RV) deformation and rotational parameters derived from three-dimensional speckle-tracking echocardiograph (3DSTE) to diagnose cardiac amyloidosis and differentiate this disease from other forms of myocardial hypertrophy. Methods Twenty-three patients with biopsy-proven light-chain (AL) amyloidosis, 23 patients with systemic arterial hypertension (HTN), 23 patients with hypertrophic cardiomyopathy (HCM), 23 athletes and 23 normal controls were prospectively studied by conventional echocardiography and 3DSTE. LV longitudinal strain (LV LS), LV circumferential strain (LV CS), RV global longitudinal strain and RV free-wall longitudinal strain (RV FW LS) were obtained by 3DSTE, as well as LV rotation and rotational velocities. Results LV and RV longitudinal strains were reduced in cardiac amyloidosis (CA) patients compared to controls. By multivariate analysis, LV basal LS (p = 0.002), LV peak basal rotation (p = 0.003), and RV basal FW LS (p = 0.014) were independently associated with CA in the overall population. A significant improvement in global χ2 value was noted with RV 3D-strain parameters over only LV-3DSTE + conventional indices for detection of CA (p Conclusions Three-dimensional speckle tracking echocardiography reveals regional and global biventricular dysfunction in CA. Assessment of RV ventricular dysfunction has an additive value in differentiating CA from other causes of myocardial wall thickening.

Disease activity assessment in large vessel vasculitis (LVV) is often challenging for physicians. In this study, we compared the assessment of disease activity based on inflammatory markers, clinical indices (Indian Takayasu Activity Score [ITAS] and the Kerr/National Institute of Health indices [Kerr/NIH]), and 18F-Fluorodesossiglucose (FGD) vascular uptake at positron emission tomography (Pet). We found that Pet results did not statistically correlate with the clinical indices ITAS and Kerr/NIH, because FDG uptake was increased (grade>2 on a 0-3 scale in at least one evaluated vascular segment) in many patients with inactive disease according to clinical and laboratory parameters (i.e., negative ITAS and Kerr/NIH indices as well as normal erythrocyte sedimentation rate (ESR) and C-reactive protein (PCR)). Similarly, interleukin- 6 and its soluble receptor did not statistically correlate with disease activity. In contrast, clinical indices showed a significant correlation between each other and with inflammatory markers (VES and PCR). These data suggest that while clinical indices and inflammatory markers may be useful to assess disease activity, Pet may be more sensitive.

Aortic stiffness may be associated with an increased incidence of cardiovascular events and has been reported to be related to arterial wall motion velocities as measured by tissue Doppler imaging.To investigate the potential clinical application of tissue Doppler imaging (TDI) for assessment of aortic function parameters in healthy and hypertensive adults.110 hypertensive and 80 healthy adults were examined. Pulse wave velocity (PWV) and augmentation index (Aix) were measured as standard parameters of arterial stiffness by an oscillometric system. Aortic M-mode and TDI parameters were measured. Aortic distensibility (D) and aortic stiffness index (SI) were calculated using accepted formulae. Anterior wall aortic expansion velocity (S(Ao)), acceleration time (AT(Ao)), early (E(Ao)) and late (A(Ao)) diastolic retraction velocity and peak systolic radial strain (epsilon(Ao)) were determined. Comprehensive echocardiography was performed for the assessment of left ventricular (LV) systolic/diastolic function.S(Ao), E(Ao) and e(Ao) were significantly lower in hypertensive subjects (p.001, p.001, and p.0001, respectively). Reduced D (p.05 vs controls) and increased PWV (p.05 vs controls) and SI (p.01 vs controls) were consistent with evidence of increased aortic stiffness in both male and female hypertensive patients. PWV and Aix increased and D decreased with increasing age or systolic blood pressure. Multivariate analysis showed epsilon(Ao) to be independently related (R2 = 0.63) to pulse pressure, LV mass index and diastolic function.Ascending aorta TDI provides wall velocity and strain data differentiating hypertensive from healthy adults and reflecting aortic compliance changes related to age and sex and LV diastolic function.

Three professional devices for office blood pressure (BP) measurement, using three different algorithms to determine BP, were evaluated according to the International Protocol of the European Society of Hypertension. The Omron BP10 uses the oscillometric method, the Omron HBP T105 (module HBP-M3600) uses the smart inflation mode and high-speed measurement and the Pic Indolor Professional check is a hybrid sphygmomanometer.The International Protocol of the European Society of Hypertension is divided into two phases and includes a total number of 33 participants on whom the validation is performed. In each study and for each participant, four BP measurements were performed simultaneously by two observers using mercury sphygmomanometers alternately with three measurements by the tested device. The difference between the observers and the device BP values was calculated for each measure. The 99 pairs BP differences were classified into three categories (or=5,or=10 andor=15 mmHg).All three tested devices passed the first and the second phase of the validation process. The mean differences between the device and mercury readings were -0.02 +/- 3.7 and -2.2 +/- 3.9 mmHg for SBP and DBP, respectively, for the Omron BP10 device; 1.5 +/- 5.7 and -0.6 +/- 3.8 mmHg for the Omron HBP T105 device; and -0.6 +/- 1.7 and -0.4 +/- 1.5 mmHg for the Pic Indolor Professional device.Readings of the Omron BP10, the Omron HBP T105 and the Pic Professional check, fulfill the criteria of the International Protocol of the European Society of Hypertension. Therefore, these devices can be used in the clinic.

In this report, we describe the clinical results of ivabradine use in a patient with a serious form of unstable angina. For this patient, it was proposed that no other therapeutic, pharmacologic or surgical, option was available. The patient is a 75-year-old woman who presented with repeated episodes of retrosternal chest pain. She notably had a history of type II diabetes mellitus treated by insulin for several years and complicated by diabetic macro-angiopathy. ECG tracings recorded during these episodes showed abnormalities of the lateral repolarization phase of ischaemic nature. There was no measured increase in cardiac enzymes. She was transferred to our CCU with a diagnosis of unstable angina. In our CCU, the patient was treated with nitrates, metoprolol, aspirin, clopidogrel and atorvastatin at maximal sustainable doses. Following persistent clinical-instrumental instability, she was subjected to coronary angiography. This study revealed severe multi-vessel coronary artery disease not amenable to surgery or angioplasty revascularization. In addition to the therapy already provided, a beta-blocker (metoprolol 50 mg x 2/die) and diltiazem (30 mg x 2/die) were added despite their potentially dangerous and adverse chronotropic effects. Despite this treatment, the patient's heart rate remained high (between 80 and 100 beats/min). This heart rate appeared to be the main driving cause of her anginal symptoms. At this point, the use of ivabradine seemed the only option, even though use would be ‘off-label’ compared to current indications for the drug's use. We started with a low dose of 2.5 mg/b.i.d. and titrated up to 5 mg b.i.d. As we titrated, we witnessed a gradual reduction in heart rate. A consequent stabilization of her clinical pattern progressed into an almost unexpected asymptomatic state. After about a week of clinical observation, the patient recovered. After three months, she remains asymptomatic.

OBJECTIVE To evaluate whether there are histopathologic features of negative temporal artery biopsy (TAB) that allow differentiation between patients with giant cell arteritis (GCA) and those without. METHODS All consecutive patients with negative TAB seen between January 2009 and December 2012 were selected retrospectively. Demographic, clinical, and laboratory data at presentation and at each followup visit were collected. A pathologist with expertise in vasculitis and blinded to clinical data and final diagnosis reviewed all negative TABs. Histopathologic features evaluated were the presence of a focal mediointimal scar, medial attenuation, intimal hyperplasia, fragmentation of inner elastic lamina, calcification, adventitial fibrosis, and neoangiogenesis. RESULTS After a median (interquartile range [IQR]) followup period of, respectively, 19 months (9.2-31.2) and 26.3 months (4.9-36.7) (P = 0.041), 38 (55%) of 69 patients had a final diagnosis of TAB-negative GCA, while in the remaining 31 (45%) of 69 patients GCA was excluded. The American College of Rheumatology classification criteria for GCA were satisfied by 31 (81.6%) of 38 patients and 2 (6.5%) of 31 patients (P < 0.0001). Compared to non-GCA patients, those with TAB-negative GCA had more frequent cranial manifestations and higher erythrocyte sedimentation rates and C-reactive protein levels. The frequency of patients receiving prednisone, the mean dose, and the duration of prednisone treatment at TAB were similar in the 2 groups. There were no significant differences between TAB-negative GCA and non-GCA patients in the frequencies of all the histologic features evaluated. CONCLUSION The histologic features of negative TABs evaluated in this study do not allow for the differentiation between GCA and non-GCA patients. In the absence of an inflammatory infiltrate, other histologic changes of the temporal artery wall are not specific for GCA.

Background Enhanced oxidative stress has been observed in hypertension, but the underlying mechanism has not been fully clarified. Objective To study the relationship between oxygen free radicals and hypertension, using platelets as a tool to measure the cellular production of superoxide anion (O 2 -). Design Forty patients with hypertension were allocated randomly to groups to receive either irbesartan, an inhibitor of angiotensin II type 1 (AT 1 ) receptors (n = 20), or a diuretic (hydrochlorothiazide) (n = 20). In each patient, collagen-induced production of O 2 - by platelets was studied before and after 4 weeks of treatment. Forty sex-and age-matched healthy individuals were studied as controls. Methods Platelet-produced O 2 - was measured using lucigenin chemiluminescence and hydroethidine cytofluorimetric analysis. Results Compared with healthy individuals, patients with hypertension showed a greater production of O 2 - by platelets (P

Objective The aim of this study was to assess the usefulness of colour duplex sonography (CDS)-guided temporal artery biopsy (TAB) for the diagnosis of GCA in patients with suspected GCA. Methods From September 2009 through December 2012, 112 consecutive patients with suspected GCA were randomized to undergo CDS-guided TAB or standard TAB. All patients underwent temporal artery physical examination and temporal artery CDS prior to TAB. CDS of the temporal artery was performed by the same ultrasonographer, who was unaware of the patient's clinical data, and all TABs were evaluated by the same pathologist. Seven patients in whom biopsy failed to sample temporal artery tissue were excluded from the analysis. Results Fifty patients were randomized to undergo CDS-guided TAB and 55 patients to standard TAB. Except for a younger age in patients who underwent standard TAB (P = 0.026), no significant differences were observed between the two groups. There were no significant differences in the frequencies of positive TAB for classic transmural inflammation (28% vs 18.2%) or for periadventitial small vessel vasculitis and/or vasa vasorum vasculitis (6% vs 14.5%) between the two groups. No significant differences in the frequency of positive TAB in the two groups were observed when we excluded the patients treated with glucocorticoids and when we stratified the patients of the two groups for the presence or absence of the halo sign. Conclusion Our study showed that CDS-guided TAB did not improve the sensitivity of TAB for diagnosing GCA.

Overweight and obesity are estimated at high prevalence and progression in adults; they are major contributors to chronic diseases and a major public health challenge. An obese habitus changes body-surface electrocardiograms (ECGs). Obesity is responsible for geometric changes to the heart and torso, as well as for deleterious electrophysiological changes of the heart. Common ECG changes, reduced voltages in the precordial leads, and axis deviation have made the search for left ventricular hypertrophy (LVH) even more problematic. Identification of LVH by ECG is difficult and time consuming but ECG is fundamental to reveal abnormalities of clinical relevance associated with obesity. The QTc dispersion assessment and the comparison with magnetic resonance imaging are the frontiers to clarify the connection between ECG LVH signs and overweight and obesity.

Systemic hypertension is highly prevalent in stable coronary artery disease, a pervasive comorbidity complicating the diagnostic performance and interpretation of non-invasive provocative tests in chest pain patients because of the ischaemic signals generated, despite normal or near normal coronary arteries, by hearts structurally readapted by long-term exposure to raised systemic blood pressure. Additional and unresolved problems posed by arterial hypertension in patients with stable coronary artery disease regard the benefits of antihypertensive treatment due to reports of irrelevant, if not detrimental, effect of blood pressure (BP) lowering in averting coronary relapses as well as the lack of association between BP levels and incident coronary events in survivors from acute myocardial infarction. Uncertainties extend to BP-independent cardioprotective effects of antihypertensive drugs, although the efficacy of renin-angiotensin system blockers in the long-term prevention of cardiovascular events in stable coronary artery disease patients has been shown by several studies, particularly when combined with amlodipine, a dihydropiridine calcium channel blocker. In contrast, the long-term effect of beta-blockers, the antihypertensive class most used in that clinical category, is not supported by strong evidence except that generated in patients with systolic dysfunction and early postmyocardial infarction recovery periods.

Objective. To assess the findings of temporal artery colour duplex sonography (CDS) in GCA characterized by a histological pattern of periadventitial small vessel vasculitis (SVV) and/or vasa vasorum vasculitis (VVV) and compare it with those observed in classic GCA with transmural vasculitis.Methods. We studied 30 patients with SVV and/or VVV, 63 patients with classic GCA and 67 biopsy-negative patients identified over a 9-year period. CDS of the temporal arteries was performed in all patients by one ultrasonographer. Temporal artery biopsy was used as the reference standard. Sensitivities, specificities and likelihood ratios (LRs) were calculated.Results. The frequency of the halo sign on CDS was significantly lower in the patients with SVV and/or VVV compared with those with classic GCA (20% vs 82.5%, P = 0.0001). The halo sign had a sensitivity of only 20% (95% CI 8.4, 39.1%) and a specificity of 80.6% (95% CI 68.7, 88.9%) for the diagnosis of SVV and/or VVV. The negative LR was 0.992 (CI 0.824, 1.195), and the positive LR was 1.030 (CI 0.433, 2.451). The halo sign for the diagnosis of biopsy-proven classic GCA had a higher sensitivity of 82.5% (CI 70.5, 90.5%), the same specificity of 80.6% (CI 68.7, 88.9%) and a higher positive LR (4.253; CI 2.577, 7.021).Conclusion. The halo sign is infrequently found in GCA characterized by a histological pattern of SVV and/or VVV. This limits the sensitivity of CDS in correctly identifying patients with GCA. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Objectives. The prevalence of large-vessel vasculitis (LVV) in newly diagnosed GCA is still debated. The aim of this study was to investigate the prevalence of LVV in newly diagnosed GCA using colour-Doppler sonography (CDS) and to compare the clinical and laboratory findings of GCA patients with and without LVV. Methods. Sixty-two consecutive patients with new-onset GCA underwent CDS of the epiaortic vessels and of the aorta. The identified patients with LVV were randomly matched (1 : 2 ratio) to GCA patients without LVV. Results. In 18 (29%) out of 62 patients, CDS showed the characteristic halo sign indicative of vasculitis in at least one vessel examined. Three patients had insufficient documentation and were excluded from the comparative analysis. Compared with patients without LVV, those with LVV were more frequently female (100 vs 73%), less likely to have cranial manifestations (73 vs 97%) and borderline less likely to have jaw claudication (13 vs 43%, P = 0.05). The two groups had similar ages at diagnosis, prevalence of constitutional manifestations and rates of positive temporal artery biopsies. Conclusions. LVV evidenced by CDS was found in 29% of patients with newly diagnosed GCA. This prevalence is similar to that found in previous studies with a similar design. GCA patients with LVV had less frequent cranial manifestations. Early diagnosis of LVV in GCA can help tailor treatment accordingly and may prevent vascular complications.

History of hypertension is a frequent finding in patients with acute myocardial infarction (AMI) and its recurring association with female sex, diabetes, older age, less frequent smoking and more frequent vascular comorbidities composes a risk profile quite distinctive from the normotensive ischemic counterpart.Antecedent hypertension associates with higher rates of death and morbid events both during the early and long-term course of AMI, particularly if complicated by left ventricular dysfunction and/or congestive heart failure. Renin-angiotensin-aldosterone system blockade, through either angiotensin-converting enzyme inhibition, angiotensin II receptor blockade or aldosterone antagonism, exerts particular benefits in that high-risk hypertensive subgroup.In contrast to the negative implications carried by antecedent hypertension, higher systolic pressure at the onset of chest pain associates with lower mortality within 1 year from coronary occlusion, whereas increased blood pressure recorded after hemodynamic stabilization from the acute ischemic event bears inconsistent relationships with recurring coronary events in the long-term follow-up.Whether antihypertensive treatment in post-AMI hypertensive patients prevents ischemic relapses is uncertain. As a matter of fact, excessive diastolic pressure drops may jeopardize coronary perfusion and predispose to new acute coronary events, although the precise cause-effect mechanisms underlying this phenomenon need further evaluation.

Four oscillometric devices for self-measurement of blood pressure (SBPM) were evaluated according to the International Protocol of the European Society of Hypertension (ESH) in four separate studies. The Pic Indolor Personal Check, Comfort Check and My Check measure blood pressure (BP) at the brachial level; the Travel Check measures radial BP at the wrist level.The International Protocol includes a total number of 33 subjects. In each study and for each subject, four BP measurements were performed simultaneously by two observers using mercury sphygmomanometers alternately with three measurements by the tested device. The difference between the observers and the device BP values (99 pairs) were classified into three categories (or =5,or =10,or =15 mmHg).All four tested devices passed the validation process. The mean differences between the device and mercury readings were 0.1 +/- 2.9 and -0.1 +/- 3.8 mmHg for systolic and diastolic BP respectively for the Personal Check; -1.0 +/- 3.7 and 0.2 +/- 3.2 mmHg for the Comfort Check; -0.6 +/- 4.5 and -1.5 +/- 4.3 mmHg for the My Check; -0.1 +/- 2.0 and 0.6 +/- 1.7 mmHg for the Travel Check.Readings of the Pic Indolor Personal Check, Comfort Check, My Check and Travel Check devices differing by less than 5, 10 and 15 mmHg fulfill the International Protocol requirements and therefore can be used by patients for SBPM.

The aim of our study was to analyse the 24-h periodic pattern of blood pressure (BP) in diabetic patients with abnormal responses to cardiovascular reflexes, in order to evaluate the extent of the initial autonomic damage. We studied 44 patients with diabetes mellitus (14 insulin-dependent, 30 non-insulin-dependent; mean duration of disease 6.5±1.8 years) in good metabolic control (fasting glycaemia

The extent and duration of the antihypertensive effect of enalapril and captopril, both given once daily, were evaluated in 12 mild-to-moderate essential hypertensives by 24-hour noninvasive blood pressure (BP) monitoring (Pressurometer IV-mod 1990-1991, Del Mar Avionics). Patients were randomized to a cross-over regimen either with enalapril, 10-20 mg, followed by captopril, 50-100 mg (first group), or with captopril followed by enalapril (second group). The dose was doubled if, at week 3 of each treatment, the diastolic BP remained at 90 mm Hg. Doubling of the 2 drugs was not required in 4 patients; in 7 patients the dose of both drugs was doubled; and in 1 patient the dose of only captopril was doubled. Two of the 7 patients who required doubling of both drugs were considered nonresponders to enalapril and captopril. The circadian rhythm was not altered by the treatments, and the drugs reduced BP mainly during the waking hours. However, the second peak of systolic BP in the late afternoon did not graphically appear to be modified by captopril administration. A periodic asymmetric model with 3 harmonics analysis carried out on 24-hour BP data justifies only the use of enalapril for once-daily administration.

Background Cryopyrin-associated periodic syndromes (CAPS) are a group of rare autoinflammatory diseases caused by dominantly inherited mutations, or de novo gain-of function mutations within CIAS1/NLRP3 gene. Q703K is a variant of CIAS1/NLRP3 gene with unknown pathogenic significance, being also present with an allele frequency of 5% in Caucasian healthy population. It is still unclear whether Q703K has to be considered a low penetrance mutation or a functional polymorphism, whereas it is detected in patients with clinical manifestations suggestive for CAPS. Methods We describe the cases of two siblings who presented with clinical manifestations suggestive for a periodic auto-inflammatory disorder and brilliantly responded to anti-IL1 treatment with anakinra. Molecular analysis of the CIAS1/NLRP3 gene in the two cases and in their first-degree relatives was performed, and a genotype/phenotype correlation of the carriers of Q703K allele was assessed. Detailed information regarding family history and the genealogical tree was also collected Results A 30-year-old man and a 35-year-old woman siblings came to our attention complaining of periodic clinical manifestations lasting since their infancy and young adult age, respectively. The male patient had been experienced recurrent episodes of high-grade fever (T. max 41°C) associated with morning headache, urticarial rash, and conjunctivitis, lasting from 3-5 days through >7 days. The female patient had been suffered from asthenia and chronic musculoskeletal pain since the age of 21, first diagnosed as fibromyalgia. The symptoms were accompanied by episodic low-grade fever (T. max 37.5°, lasting few days); laboratory tests showed persistent increase of acute phase reactants (APR). Serum amyloid A (SAA) levels were found high in both patients (157 mg/L and 54.7 mg/L, respectively, n.v. Conclusions The phenotypic expression observed in carriers of Q703K variant suggests that other genetic and environmental factors, currently unknown, might contribute to the atypical mild clinical autoinflammatory manifestations observed in such cases. However, the remarkable response to IL-1 blockade in our cases confirms the pivotal role of IL-1 in determining the clinical features. Further larger series are needed in order to investigate whether Q703K variant alone might be responsible for milder “CAPS-like” phenotype. Disclosure of Interest None declared

Early hypertension is associated with left ventricular diastolic dysfunction due to increased end-diastolic pressure. This increase, through the cardiopulmonary reflexes, can influence autonomic cardiovascular control.We assessed autonomic nervous system modulation of cardiovascular signals by power spectral analysis of RR interval and systolic arterial pressure variabilities in subjects with recently diagnosed hypertension with or without diastolic dysfunction and in normotensive control subjects.Both hypertensive groups had higher low-frequency (LF) power expressed in normalized units (NUs) than normotensive controls (p0.05; p0.001) during controlled breathing at rest. The LF spectral index measured after tilt was greater in hypertensive subjects with diastolic dysfunction than in those without (p0.05). LF NUs measured at rest correlated significantly with the E/A wave ratio and after tilt with the E-wave deceleration time.These results seem to indicate that in subjects with recently diagnosed hypertension sympathetic modulation of the sinus node prevails. During tilt, a maneuver designed to stimulate systemic arterial and cardiopulmonary baroreceptor reflexes, hypertensive subjects with diastolic dysfunction, who presumably also have higher end-diastolic pressures, seem to have greater sympathetic modulation of the sinus node than hypertensive subjects without diastolic dysfunction.

Left ventricular hypertrophy is a risk factor for sudden death. Malignant ventricular arrhythmias originate from altered cardiac repolarization. Ample data have described spatial abnormalities in cardiac repolarization [QT interval (QT) dispersion] in subjects with hypertension; more data are needed on temporal changes. This study was designed to assess the QT variability index (QTVI), the slope between QT and the RR interval (QT-RRslope) and spectral QT variability in subjects with arterial hypertension. The results were compared with those from a population at high risk of sudden death, i.e. patients with hypertrophic cardiomyopathy (HCM) who had received an implantable cardioverter/defibrillator (ICD), and those from normotensive control subjects. A total of 44 hypertensive subjects, six patients with HCM and an ICD and 33 control subjects underwent simultaneous short-term recording (256 beats) of QT, RR and systolic blood pressure variability, in the supine position, during controlled breathing. QTVI and spectral components of QT variability in the hypertensive group were significantly higher than in normotensive control subjects (P < 0.001), but significantly lower than in patients with HCM and an ICD (P < 0.001). The severity of left ventricular hypertrophy correlated significantly with QTVI and the ratio of low-frequency (LF) to high-frequency (HF) power obtained from the RR variability spectra (RRLF/HF, slope = 0.24, P < 0.05; QTVI, slope = 4.06, P < 0.0001; intercept, slope = 2.40, P < 0.05; χ2 = 38.8; P < 0.0001). The QT-RR slope was significantly higher only in patients with HCM and an ICD (P < 0.001). In conclusion, the increased QTVI and the correlation of this index with left ventricular hypertrophy indicates that hypertension increases temporal cardiac repolarization abnormalities. At the level of the cardiac sinus node, this alteration is associated with increased sympathetic and reduced vagal modulation. As already noted in patients with HCM, the increased QTVI could be a factor responsible for triggering malignant ventricular arrhythmias in subjects with hypertension.

Background Temporal artery biopsy (TAB) showing transmural inflammation is considered the gold standard for the diagnosis of giant cell arteritis (GCA). In some cases of GCA, inflammation is confined to the periadventitial small vessels, the vasa vasorum and/or the adventitia. These patients seem to closely resemble classic GCA, but the final significance of this more limited inflammation need more confirmation. Objectives To describe and correlate different histological subsets of GCA with demographic and clinical manifestations in a large monocentric cohort of biopsy positive GCA patients. Methods All TABs performed for suspected GCA between 1986 and 2012 were reviewed by a single pathologist. Based on the localization of the inflammation, positive TABs were classified into 4 categories: small vessel vasculitis (SVV), with inflammation limited to small periadventitial vessels devoid of muscular coat; vasa vasorum vasculitis (VVV), with inflammation surrounding the adventitial vasa vasorum; inflammation limited to adventitia (ILA), with inflammation spreading from vasa vasorum to the adventitia without extension to the media; transmural inflammation (TMI), with external elastic lamina disruption and extension of the inflammation to the media. Results 317 TABs were positive for inflammation and were classified as: 253 (79.8%) TMI, 18 (5.7%) ILA, 19 (6.%) VVV and 27 (8.5%) SVV. Compared to patients with TMI, those with SVV and VVV had a significantly lower frequency of headache (55.6% vs 77.9%, p=0.010 for SVV and 57.9% vs 77.9%, p=0.048 for VVV), jaw claudication (7.4% vs 44.7%, p Conclusions The histological spectrum of inflammatory lesions that can be found in TAB is broad and constitutes a continuum, ranging from SVV at one extreme, through VVV and the more spread ILA in the middle, to TMI at the other extreme of the spectrum. Despite the differences in cranial symptoms, halo sign at CDS and levels of acute-phase reactants, it is crucial that clinicians be aware that all different histologic TAB patterns are equally associated with a risk of visual loss, thus requiring prompt glucocorticoid treatment. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5674

Background Giant cell arteritis (GCA) is a vasculitis that involves large and medium sized arteries in patients older than 50 years. Temporal artery biopsy (TAB) is the gold standard for the diagnosis of GCA. Cranial symptoms are the most common manifestations of the disease, while permanent visual loss is the most feared ischaemic complication of GCA and is reported in 10-20% of patients. Previous study have tried to correlate histological features of TAB with cranial and visual symptoms, but the results reported are not conclusive. Objectives To correlate histological findings of TAB with clinical manifestations in a large single center cohort of consecutive patients with biopsy-proven GCA. Methods A pathologist with expertise in vasculitis and blinded to clinical data and final diagnosis reviewed all TABs performed for suspected GCA at our hospital between January 1986 and December 2012. Positive TABs showing only small vessel vasculitis and/or vasa vasorum vasculitis without transmural inflammation were excluded from the comparison analysis. Histopathologic features evaluated were: the severity of inflammation and intimal hyperplasia, both graded on a semiquantitative scale (mild=1, moderate=2 severe=3), the presence of intraluminal acute thrombosis, calcifications, giant cells, fibrinoid necrosis and laminar necrosis, consisting in a band of coagulative necrosis sometimes bordered by palisading histiocytes and following the internal elastic lamina. Results 271 patients had a final diagnosis of biopsy-proven GCA and were included in the study. More severe inflammation on semiquantitative scale was more frequently seen in patients with any cranial symptoms (88.4% grade 3; 87.5% grade 2 and 74.7% grade 1, p=0.026), headache (80.4% grade 3; 80% grade 2 and 65.3% grade 1, p=0.038), abnormalities of TA at physical examination (82.6% grade 3; 63.5% grade 2 and 56.9% grade 1, p=0.001) and halo at TA colour duplex sonography (CDS) (75.5% grade 3; 78.4% grade 2 and 48.5% grade 1, p=0.011). The presence of laminar necrosis was more frequent in patients with visual symptoms (43.1% vs 24.8%, p=0.005), and in those with abnormalities of TA at physical examination (82.3% vs 65.3%, p=0.012). The presence of calcifications was more frequent in patients with visual symptoms (45.5% vs 25%, p=0.003), and in patients without systemic symptoms (71.3% vs 52.7%, p=0.009). More severe intimal hyperplasia on semiquantitative scale was less frequently seen in patients with polymyalgia rheumatica (PMR) (32.2% grade 3; 53.8% grade 2 and 56.3% grade 1, p=0.008). The presence of giant cells was more frequent in patients with jaw claudication (49.2% vs 30.8%, p=0.006). Fibrinoid necrosis was present only in 2 cases (0,7%), in both sparing the temporal artery and limited to a small branch. Conclusions The data of this large monocentric cohort of biopsy-proven GCA patients evidenced that visual symptoms correlate with the presence of laminar necrosis and calcifications. Cranial symptoms and halo at TA CDS correlate with the severity of mural inflammation. PMR inversely correlates with intimal hyperplasia. Fibrinoid necrosis was not a features of GCA. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5659

Background Temporal artery biopsy (TAB) showing transmural inflammation is considered the gold standard for the diagnosis of giant cell arteritis (GCA). A negative TAB does not rule out GCA, and a diagnosis of biopsy-negative GCA was reported in 5-25% of patients. In the absence of active inflammation (negative TAB), other structural changes in the wall of TA are often present and some of those have been described as “healed” or quiescent arteritis, but if these histological changes are expression of GCA is still debated. Objectives To evaluate if there are histopathological features of negative TAB that allow to differentiate patients with GCA from those without. Methods 42 consecutive patients with negative TAB were retrospectively selected. All patients underwent TAB for suspected GCA between January 2009 and December 2012. Demographic, clinical and laboratory data at presentation and at each follow up visit were collected. A pathologist with expertise in vasculitis blinded to clinical data and final diagnosis reviewed all 42 negative TABs. Histopathologic features evaluated were: the presence of a focal medio-intimal scar with medial attenuation, intimal hyperplasia, fragmentation of inner elastic lamina (IEL), calcification, adventitial fibrosis and neoangiogenesis. Results After a median follow-up period of 177 days (interquartile range 38, 508), 20 of the 42 patients had a final diagnosis of GCA, while in the remaining 22 patients GCA was excluded (9 had polymyalgia rheumatica, 4 non arteritic anterior ischemic optic neuropathy, 3 fibromyalgia, 2 non-specific elevation of inflammatory markers, 1 fever of unknown origin, 1 rheumatoid arthritis, 1 ANCA associated vasculitis, 1 osteoarthitis). 1990 ACR classification criteria for GCA were satisfied in 13 of the 20 patients with GCA (65%) and in none of the 22 non-GCA patients. 12 patients (60%) with GCA and 14 patients (64%) with non-GCA were on steroid therapy when TAB was performed (p>0.05). The mean prednisone dose was (mg± SD) 23.75 ±12.95 for GCA patients and 13.57 ±11.67 for non-GCA patients (p=0.05). Mean duration of prednisone treatment was (days±SD) 30.58±44.23 for GCA patients and 144.36±162.24 for non GCA patients (p 0.05). Intimal hyperplasia was present in 45% vs 59%, fragmentation of IEL in 80% vs 91%, calcification in 30% vs 18%, adventitial fibrosis in 10% vs 5% and neoangiogenesis in 10% vs 9% of GCA vs non-GCA patients respectively (all p NS). 4 patients with GCA had visual loss. A focal medio-intimal scar with medial attenuation was not observed in these 4 patients, intimal hyperplasia was observed in 2, fragmentation of IEL in all 4, calcification in 2, adventitial fibrosis in 1 and neoangiogenesis in 1. Histological findings of GCA patients with visual loss were similar to those of patients with non-GCA. Conclusions The histological features of negative TAB evaluated in this study do not allow to differentiate between GCA and non-GCA patients. These data suggest that in the absence of mural active inflammation, other histological changes of the TA wall are not specific for GCA. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5633

We assessed the OSCILL-IT ambulatory blood pressure (BP) recorder (FIGI srl, Rome, Italy) according to the performance criteria set out by the British Hypertension Society (BHS) protocol. The OSCILL-IT is a portable, noninvasive recorder that uses a process that correlates systolic, mean, and diastolic areas, identified on the oscillations, to the cuff absolute pressure. According to the recommendations of BHS, a large heterogeneous population (100 subjects: 52 men aged from 19 to 79—median 44 and 48 women from 19 to 74—median 54) was recruited in order to assess accuracy and to analyze, in addition, the effects of observer agreement and BP level on the observer–device differences. With reference to BP level, we suggest also a new graphic approach. Four sets of sequential, same arm, comparative BP measurements were obtained, performed by the OSCILL-IT recorder and two skilled clinicians using a mercury column, for each subject. We used a linear combination for the statistical evaluations. We confirmed the observer agreement through the frequency distribution of BP as a function of the observer and through the differences between observers. We compared OSCILL-IT with sphygmomanometric readings: the differences were not significant. A visual inspection, with the addition of regression lines, showed that there were no variations in differences at the changing of BP level. The difference between observers and OSCILL-IT was 0.2 ± 5.3 mm Hg and 0.2 ± 5.8 mm Hg both for systolic BP (SBP) and diastolic BP (DBP). The level of agreement, according to BHS criteria, showed that 64% of all systolic and 70% of all diastolic readings obtained by the OSCILL-IT were within 5 mm Hg of the sphygmomanometric determinations. Therefore, the grade is C for SBP, even if 93% of SBP and 95% of DBP obtained by the OSCILL-IT were within 10 mm Hg of the sphygmomanometric determinations. These analyses demonstrate that the OSCILL-IT satisfies the accuracy parameters and the additional linear regression yields graphics more immediate.

Background There is increasingly scientific evidence of salivary gland ultrasonography accuracy and usefulness in diagnosing Sjogren Syndrome. [2-3] Objectives To assess the role of salivary gland ultrasound in the diagnostic process of Sjogren Syndrome. Methods 82 patients with suspected Sjogren Syndrome from a single center were evaluated. Demographic (age and sex), clinical (sicca syndrome, artralgia), ultrasonographic (salivary gland ultrasound following the score proposed by Ariji et al) [4], serologic (anti nuclear antibodies – ANA, anti ENA, anti HCV) and histological (salivary glands biopsy with Chisholm-Mason score evaluation) features were analyzed. Patients were classified according to ACR/EULAR criteria for SS (AEC).[1] Results All patients with HCV infection were counted out as well as all the patients with one of the exclusion criteria present in the Primary Sjogren Syndrome classification. Male/female ratio was 1/9; 91.2 % of patients presented xerostomia, 75% xerophthalmia. Schirmer test was positive in 72% of the patients; break up time positive in 65%. The biopsy was positive (Chisholm and Mason score ≥1) in 61% and ultrasound was positive (score ≥2 out of 4) in 40.2%. ENA test (SSA and\or SSB) was positive in 37.4%. The diagnosis of Sjogren Syndrome has been assessed, according to AECG classification criteria, in 36 patients out of 82 (43.9%). 80.6% of patients with positive ultrasound were classified as affected by Sjogren Syndrome, 89.1% of patients with negative ultrasound didn’t fill the classification criteria. The ultrasound score presented a positive likelihood ratio of 4.58 (95% confidence interval 2.34 8.98) and a negative one of 0.135 (0.058 Conclusions In our experience salivary gland ultrasound seems to be an useful tool in the diagnostic process of Sjogren Syndrome due to its good sensibility and specificity. Moreover the exam is simple to perform, fast, incruent and well accepted by patients. References Vitali C, Bombardieri S, Jonsson R, et al. Classifi cation criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002;61:554–8. Cornec D et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjogren’s syndrome: Toward new diagnostic criteria? Arthritis Rheum. 2013 Jan;65(1):216-25. Milic V. et al. Ultrasonography of major salivary glands could be an alternative tool to sialoscintigraphy in the American-European classification criteria for primary Sjogren’s syndrome. Rheumatology (Oxford). 2012 Jun;51(6):1081-5 Ariji Y, Ohki M, Eguchi K, et al. Texture analysis of sonographic features of the parotid gland in Sjogren’s syndrome. AJR Am J Roentgenol 1996;166:935–41. Disclosure of Interest None Declared

Background Temporal artery biopsy (TAB) is the gold standard to diagnose giant cell arteritis (GCA), but is negative in approximately 20% of patients Objectives The study aimed to establish whether Color-doppler-ultrasonography (CDU)-guided TAB might provide a greater yield compared to standard TAB technique in patients with GCA Methods We enrolled 100 consecutive patients suspected of having GCA from September 2009 through December 2011. The average age of patients was 74 years. At randomization mean values of ESR were 54 mm/1st hour, mean CRP were 6 mg/dl (n.v.

Background The classic histological appearance of inflamed temporal arteries (TA) in giant cell arteritis (GCA) is transmural cell infiltration. However, periadventitial small vessel vasculitis (SVV) surrounding uninflamed TA and/or isolated vasculitis of the TA vasa vasorum (VVV) is found in a minority of patients with GCA. These patients have less frequently cranial manifestations and lower inflammatory markers at diagnosis compared to the patients with classic GCA, whereas the frequency of cranial ischemic events is similar (1). Color-doppler-sonography (CDS) can demonstrate a hypoechogenic (inflammatory) halo in the TA from patients with GCA in approximately 70% of cases. A study found a correlation between positive CDS findings and transmural inflammatory cell infiltration in GCA (2). There are no data on the performance of CDS in the diagnosis of SVV and/or VVV. Objectives The aim of this study was to evaluate the prevalence of the characteristic halo sign in the TA from patients with SVV and/or VVV and to compare it with that found in patients with classic GCA. Methods 30 consecutive patients with biopsy-proven SVV and/or VVV GCA who underwent CDS of the TA before TA biopsy were analyzed. Of this 30 patients, 16 had SVV, 11 isolated VVV, and 3 associated SVV and VVV. The identified patients were randomly matched to 30 biopsy-proven classic GCA patients. SVV was defined as aggregates of mononuclear inflammatory cells around capillaries located in the connective tissue surrounding the adventitia. VVV was defined as isolated vasculitis of TA vasa vasorum. A hypoechoic halo >0.4 mm around the TA lumen on CDS was considered diagnostic of GCA. For GCA categorization using the 1990 ACR criteria, SVV or isolated VVV were not considered to represent a positive TA biopsy. Results Of the 30 patients with SVV and/or VVV-GCA 14 (46.6%) satisfied the ACR criteria for the classification of GCA. Table 1 shows the comparisons between the patients with SVV/VVV and classic GCA. Conclusions The prevalence of the halo sign on CDS of the TA is significantly lower in patients with SVV/VVV-GCA compared with those with classic GCA. These results suggest that CDS does not perform well in these two subsets of GCA. TA biopsy is required to confirm the diagnosis of GCA in patients with SVV- and VVV-GCA. References Restuccia G et al. Small-vessel vasculitis surrounding an uninflamed temporal artery and isolated vasa vasorum vasculits of the temporal artery: two subsets of giant cell arteritis. Arthritis Rheum. 2011 Sep 27. Schmidt D et al. Comparison between color duplex ultrasonography and histology of the temporal artery in cranial arteritis (giant cell arteritis). Eur J Med Res. 2003 Jan 28;8(1):1-7. Disclosure of Interest None Declared

This study analyzes some methods of evaluating the effects of antihypertensive drugs on blood pressure circadian rhythm. We reviewed four different approaches: hourly averages, trough-to-peak ratio, cosinor method, and Fourier series applied to the same data to prove the time course of the effects of isradipine administered once daily. A total of 141 patients of both sexes (mean age 53 years, range 30-76) with mild to moderate essential hypertension were enrolled in this multicenter trial after a 2-week placebo run-in. Treatment with isradipine SRO 5 mg/day administered between 8 and 9 AM was started. Each patient underwent ambulatory BP monitoring at the time of entry and after 6 weeks of treatment. Calculation of hourly averages showed decreases after 4 AM, and from about 8-9 AM, when the drug was administered, and the decreases practically did not vary until about 10 PM. Subsequently, the decreases became smaller and indicated reduced drug activity. However, this hypothesis no longer held after 4 AM. The trough-to-peak ratio was calculated including hourly averages after the dose divided by the lowest hourly average. Both systolic and diastolic blood pressure showed constant reduction from 3 PM (time of peak) to 11 PM. However, after 11 PM, higher trough-to-peak ratios paradoxically occurred due to a major reduction obtained with placebo, and the negative percentages just before the next dose cannot be attributed to treatment. Applying the cosinor method, maximal values were greatly underestimated, nocturnal values were overestimated, and the absolute maximum occurred in proximity to the minimum relating to postprandial dip. The generalized cosinor model, known as Fourier partial series, was always curtailed to the third harmonic. Fourier analysis was able to describe the daily trend of BP both before and after isradipine administration. We used statistical tests to determine if the differences described by the models were significant. The tests indicated significant mean level reductions after therapy and no appreciable amplitude and phase-related variations. The nocturnal and periawakening intervals, in which BP changed linearly, oscillated between 3 and 4 hours. Within these intervals BP rose by 13-16 mm Hg or fell by 14-19 mm Hg. The intervals, ranges, and speed differences were tested and were never significant. The medication tested was effective only at the mean level, the variables used to characterize the time course of its effect remaining unchanged. There was no significant phase shift of the curves, and BP rhythm was preserved.

In order to evaluate the effects of atrial natriuretic factor (ANF) infusion on plasma insulin (IRI) in hypertension, 32 essential hypertensives (aged 40 to 62 years) were studied. After 1 week of pharmacologic washout under normal sodium intake (120 mEq of Na+/day), patients were randomly assigned to receive either ANF (0.04 micrograms/kg/min) or its vehicle (50 mL of isotonic saline) over a 60-min period in supine position. Plasma IRI and glucose were measured at -60, 0, 20, 40, 60, 120, 180, and 240 min (infusion time: from 0 to 60 min). Plasma levels of IRI and glucose did not change significantly during ANF infusion. On the contrary, after ANF discontinuation plasma IRI rose from levels of 13.5 +/- 6.4 microU/mL at 60 min to values of 20.1 +/- 11.3 microU/mL at 240 min (P less than .0001 v time 0). Plasma glucose showed a similar behavior, increasing from values of 100.4 +/- 5.0 mg/dL at 60 min to values of 120.0 +/- 5.1 mg/dL at 240 min (P less than .02 v time 0). Our findings suggest that ANF did not influence insulin release in hypertensives. The increase of plasma glucose and IRI observed after ANF discontinuation could be due to the relapse of sympathetic activity, suppressed during ANF infusion.

Our preliminary research has attempted to establish a series of methods to study the complex interactions occurring between pressor reactivity and personality profile. Ten untreated mild hypertensives (age 42.9±8) without damaged target organs were recruited from an outpatient hypertension center along with an equal number of normotensive volunteers (age 38.2±8.1). We performed a sequence of stressor types under laboratory conditions (sensory perceptual activities, psychomotor responses, and cognitive behavior) following an order ranging from inferior levels to superior levels of systemic integration. The subjects also underwent a 24-h automatic noninvasive blood pressure recording which took into account the situational reactivity. They filled in MMPI and STAI questionnaires before and after the stressor batteries. Only the sensory-perceptual test (Stroop color test modified), the arithmetic test, and the psychomotor test provoked a significant increase in blood pressure and, in the latter test, also a significant increase of the heart rate. The test batteries' mean differences were not significant between the two groups. Similarly, the answers to the trait-anxiety questionnaires did not allow us to make a substantial division between normotensive and hypertensive subjects. On the contrary, the situational anxiety questionnaires showed a significant difference in the score reading preceding and following a task performed by the hypertensive subjects. We observed significant differences for both systolic and diastolic 24-h blood pressure data in transition from a working situation to the sleeping period. However, there was not a significant difference in hypertensive blood pressure readings recorded during work and at home. The personality structures did not present remarkable differences between the two groups. With reference to the single personality dimensions, we found a number of higher scores expressing difficulty in adapting to social situations, a low capacity for self-assertion, and a great sense of insecurity.