Search

Introduction: This study aims to investigate how image settings affect carotid Intima-Media-Thickness (IMT) and diameter estimation performed with Carotid Studio (Quipu-Srl). Methods: Fourteen healthy volunteers (24.4 ± 4.4 years; eight men) were recruited. Longitudinal scans 3-cm-deep of common-carotid-arteries with the same region-of-interest were obtained by expert operator, starting from a “default-setup” (central Time Gain Compensation-TGC; gain: 50 dB; no persistence filter) and adjusting one parameter at a time (oblique TGC; gain: 10 dB increments from 30 to 70 dB; persistence filter). The acquisition was performed twice, and repeatability was expressed for each setup as Coefficient of Variation (CV). Significant changes (p ≤ 0.05) compared with the “default-setup” were analysed by Wilcoxon signed-rank-test. Results: Sixty and 70 dB gain resulted in overestimating IMT (from 0.460 ± 0.001 to 0.506 ± 0.030 mm and 0.538 ± 0.011 mm, p = 0.002 and 0.023 respectively vs. default-50 dB), underestimating the mean diameter (from 6.044 ± 0.040 mm to 5.763 ± 0.004 mm, p = 0.008 and to 5.698 ± 0.225 mm, p = 0.002), and for 70 dB, increasing IMT CV from 2.14 ± 1.92% to 6.85 ± 5.23% (p = 0.01) and diameter CV from 1.79 ± 1.22% to 4.77 ± 4.71% (p = 0.05). Distension CV increased from 5.71 ± 4.31% to 10.84 ± 5.91% (p = 0.041) and to 12.59 ± 7.97% (p = 0.021) for 60 and 70 dB respectively. Persistence and TGC did not affect repeatability, whereas diameter (5.955 ± 0.033 mm, p = 0.005) and distension (from 0.816 ± 0.019 mm to 0.655 ± 0.018 mm, p = 0.002) values were underestimated when persistence filter was active. Discussion: Precision and reproducibility of carotid parameters, automatically assessed by Carotid Studio, are affected by high gain levels, due to image grey-level saturation. Persistence filter activation leads to underestimate diameter and distension, possibly due to mathematical operator behaviour and image temporal filtering. Since ultrasound setup significantly affects carotid parameter assessment, it should be reported and replicated in follow-up scans. HIGHLIGHTS •We investigated how ultrasound imaging setup may affect carotid parameters. •Carotid parameters’ reproducibility was lower with high-gain values. •Persistence filter leads to underestimation of diameter and distension. •The scan projection seems to influence carotid parameter estimation. •Image depth should be kept at the lowest attainable value for best repeatability.

Background and aim Spontaneous coronary artery dissection (SCAD) is a major cause of acute coronary syndrome in women aged 50 years or less (22–43%). Its etiology is still unknown, though an association with systemic diseases such as fibromuscular dysplasia and collagenopathies has been found. This study is aimed at investigating the presence of subclinical structural and functional alterations in extracoronary districts in SCAD patients. Methods The design was a case-control study. Carotid, radial and digital arteries were scanned by standard or ultrahigh frequency ultrasound; clips were analyzed by automated image analysis software for diameter, intima-media thickness (IMT) and local distensibility. Applanation tonometry was used to obtain carotid-femoral pulse wave velocity, a measure of regional, aortic stiffness, and carotid pressure waveform. Results 30 patients previously diagnosed with SCAD (27 women, age 51±10 years, 8 treated hypertensives, 4 smokers, mean BP 83±11mmHg, BMI 25±5kg/mq) and 30 controls, matched for age, sex and CV risk factors by propensity score, were enrolled. 18 SCAD patients underwent PTCA and 6 had a diagnosis of extracoronary fibromuscular dysplasia. In the left radial artery, wall thickness, cross-sectional area (2.96±1.07 vs 1.79±1.41mm2, p=0.008), and wall inhomogeneity were increased, especially in the outer layer, whereas diameter, wall/lumen ratio and distensibility were comparable to controls. In the left common carotid artery, an increased carotid stiffness was shown in SCAD (5.99±0.89 m/s vs 5.6±0.85, 0.03), while IMT tended to be increased bilaterally (0.63±0.12 vs 0.59±0.10mm, p=0.08). Aortic stiffness was similar in the two groups (7.0±1.9 vs 6.7±1.7m/s, p=0.60). Carotid (20.4±14.2 vs 11.9±15.0%, p=0.03), but not aortic augmentation index, was increased bilaterally. Conclusions SCAD patients showed a peculiar pattern of alterations in vascular remodeling and stiffness in extracoronary arterial segments such as the carotid and radial arteries, supporting the hypothesis that a systemic susceptibility is present even in the absence of systemic diseases.

Objective To evaluate rates of major bleeding (mBleed) associated with anticoagulant treatments in patients (pts) with age ≥75 years (y), referred to hospital in northwest Tuscany. Methods We analysed 4-y survey; 302,687 visits; catchment area 197,722 inhabitants, of whom 15,267 on Warfarin (W) and 10,397 on direct oral anticoagulants (DOACs). DOACs were available in the catchment area since 4 y (dabigatran and rivaroxaban), 3 y (apixaban), and 2 y (edoxaban). Overall, 3,373 pts received dabigatran, 4,046 rivaroxaban, 2,141 apixaban, and 839 edoxaban. Pts with hemorrhage were submitted to propensity score matching for mBleed and stratified according to age ≥75 y, and W or DOACs. Primary endpoint was one-month death in pts with age ≥75 y. Results Out of 1,919 mBleed enrolled, those of pts aged ≥75 y were 1,127 (59%) versus (vs) 792 (41%) aged Patients on W showed higher rate of mBleed (n=175; 9.1%) compared to DOACs (n=53; 2.8%); p Warfarin or DOACs and outcomes Major Bleeding (pts ≥75 y) p value versus pts Patients with age >75 years and bleeding Conclusion In pts with age ≥75 y, rate of mBleed and short-term mortality were significantly higher than in pts aged

Objective To look for outcomes of patients (pts) with major gastrointestinal haemorrhage (mGIH) and ongoing anticoagulants out of four-year survey of community hospital with catchment area 197,722 inhabitants, of whom 15,267 with Warfarin (W) and 10,397 with direct oral anticoagulants (DOACs). DOACs were available for prescription in the catchment area since 4 years (dabigatran and rivaroxaban), 3 years (apixaban), and 2 years (edoxaban). Methods Haemorrhage (n=1,919) were submitted to propensity score matching for major bleeding; mGIH were enrolled and stratified according to ongoing W or DOACs. Primary endpoint was one-month death. Results Out of 476 mGIH, 73 pts received anticoagulants; 22 DOACs and 51 W; p=0.0006. Of note mGIH on W accounted for 2.7% (51/1,919) per year of pts, and 0.08% (51/15,267) of the catchment area. Conversely, mGIH on DOACs accounted as follows: dabigatran (n=10/476) 0.53%, rivaroxaban (n=6/476) 0.32%, apixaban (n=5/476) 0.35%, and edoxaban (n=1/476) 0.11% per year of pts; p=0.117. Rate of mGIH and DOACs versus (vs) rate of mGIH and W as follows: less than (−) 5 fold (2.7x100/0.53) of dabigatran vs W, p=0.004; −8 fold (2.7x100/0.32) of rivaroxaban vs W, p=0.0002; −7 fold (2.7x100/0.35) of apixaban vs W; p=0.ehz745.10188, and −25 fold (2.7x100/0.11) of edoxaban vs W; p=0.ehz745.101801. However no difference versus the catchment area per year (0.723): 0.07% (10/3,373) dabigatran, 0.04% (6/4,046) rivaroxaban, 0.08% (5/2,141) apixaban, 0.06% (1/839) edoxaban. Overall, one-month death accounted for 10/476 (2.1%). Of note 236 mGI were from the upper tract and 240 from the lower tract. Among upper tract, 10 pts received DOACs (4 dabigatran, 4 rivaroxaban, 2 apixaban, and 0 edoxaban) and 21 received W. One-month death was 0/10 DOACs versus 1/21 W, p=0.483. Among lower tract, 12 pts received DOACs (6 dabigatran, 2 rivaroxaban, 3 apixaban, and 1 edoxaban) and 30 pts received W; one-month death was 0 for every groop. Anticoagulant reversal treatment was given to 6/22 (27%) pts with DOACs versus 18/51 (35%) with W, p=0.014; transfusion to 6/22 (27%) versus 11/51 (22%), respectively, p=0.306; admission 19/22 (86%) versus 42/51 (82%), respectively, p=0.004. Sensitivity/specificity ratio of variables and biomarkers for aggressive pharmacological approach were obtained by area under ROC curve (AUC) >0.50. PTT value >37 sec (AUC 0.57) showed sensitivity 15%, specificity 90%; INR value >1.4 (0.50), sens 15%, spec 80%. In addition, warfarin (0.49) sens 15%, spec 80%; age ≥75 years (0.48) sen 60%, spec 40%. Gastrointestinal bleeding: flow-chart. Conclusion Out of four-year survey, pts with ongoing DOACs were less likely to have mGIH when compared to W. Patients with W were more likely to receive reversal tratment; pts with DOACs were more likely to undergo admission. Short-term mortality of pts with W was higher than DOACs. Aggressive pharmacological approach should be driven by PTT, INR, ongoing warfarin, and older age.

Smooth muscle function is explored by sublingual glyceryl trinitrate (GTN) administration to compare with endothelium-dependent vasodilation of the brachial artery by flow-mediated-dilation (FMD). This study compared the hemodynamic and autonomic effects of the two most often used GTN dosages. In 80 essential hypertensive patients (HT) and 60 normotensive subjects (NT), FMD of the brachial artery and endothelium-independent response to sublingual GTN (25 μg and 400 μg) were evaluated by high-resolution ultrasound and automated image analysis. In 10 HT, muscle sympathetic nerve activity (MSNA) was also assessed by microneurography. HT showed significantly (p .01) lower FMD (5.5 ± 3.3%) compared to NT (6.9 ± 2.2%). The response to GTN 25 μg tended to be lower (HT:7.2 ± 3.3%; NT:7.9 ± 2.9%; p = .06), whereas response to GTN 400 μg was similar (HT:14.3 ± 4.8%, NT:14.5 ± 4.7%, p = ns). Blood pressure (BP) reduction induced by GTN 400 μg (systolic-BP:-3.2 ± 7.7 mm Hg, diastolic-BP:-4.7 ± 5.0 mm Hg) was greater (p .001) compared to GTN 25 μg (systolic-BP:-0.7 ± 5.8 mm Hg, diastolic-BP:-0.7 ± 4.4 mm Hg). Changes in heart rate were also greater (+5.6 ± 6.4 bpm versus -0.2 ± 5.4 bpm, p .001). This behaviour was similar in either NT or HT. MSNA was significantly increased by GTN 400 μg (31 ± 7bursts/min to 41 ± 6bursts/min, p .001) but not by 25 μg (33 ± 9bursts/min to 37 ± 11bursts/min, p = .19). In conclusion, the administration of low-dose GTN allows exploring endothelium-independent vasodilation in FMD protocols, inducing only modest hemodynamic and sympathetic responses.

To study whether adolescents with the classical form of polycystic ovary syndrome (PCOS) have alterations in metabolic and vascular structure and function. The effect of metformin was evaluated.Controlled study.University outpatient clinic.Eighteen nonobese adolescents with PCOS were enrolled. Seventeen healthy age-matched adolescents were recruited as control subjects.The metabolic profile and the endothelial structure and function were evaluated.Hormonal and lipid profile, blood pressure (BP) measurement, fasting glucose and insulin levels, C-reactive protein (CRP), homocysteine, tissue-type plasminogen activator, plasminogen activator inhibitor-1 (PAI-1), and plasmin-antiplasmin complexes (PAP) were measured. Flow mediated dilation (FMD), central pulse wave velocity (PWV), radial artery pulse wave, and common carotid intima-media thickness (IMT) were also assessed. Girls with PCOS were also studied 6 months after treatment with metformin (850 mg twice per day).Adolescents with PCOS were insulin resistant and/or hyperinsulinemic and they had higher BP values and levels of CRP and PAI-1 than the control subjects. The levels of tissue-type plasminogen activator and PAP were similar in both groups. FMD, PWV, and IMT were also similar. Metformin significantly (P .05) reduced insulin, BP, CRP, and PAI-1 levels. The PAP levels significantly (P .05) increased. Radial artery pulse wave was significantly reduced after metformin treatment. No modifications in FMD, PWV, and IMT were observed.Adolescents with classical PCOS have alterations in some surrogate markers of cardiovascular risk and they are ameliorated by metformin. No deterioration of vascular structure and function has been detected, probably because of the short duration of exposure to the disease.

Out-of-office blood pressure (BP) measurement is encouraged by recent hypertension guidelines for assessing BP phenotypes. These showed acceptable reproducibility in the short term, but few data exist about long-term reproducibility, particularly for chronic kidney disease (CKD) patients. We evaluated changes of the BP phenotypes at 6 and 12 months in 280 consecutive non-dialysis CKD outpatients (186 males, age 71 ± 12 years, eGFR 38 ± 13 ml/min/1.73), without any change in drug therapy. Elevated BP is defined as office BP > 140/90 and home BP > 135/85 mmHg for defining the following BP phenotypes: sustained uncontrolled hypertension (SUCH); white-coat uncontrolled hypertension (WUCH); masked uncontrolled hypertension (MUCH); and controlled hypertension (CH). At baseline, the prevalence of the phenotypes was SUCH 36.6%, CH 30.1%, WUCH 25.4% and MUCH 7.9%, and it was similar at 6 months and 12 months. On the other hand, individual phenotype reproducibility at 12 months was poor both overall (38.0%) and across the different phenotypes (SUCH 53.9%, WUCH 32.4% and CH 32.1%, MUCH 9.1%). Patients who were not maintaining the same phenotype (non-concordant) were not distinguished by age, sex, BMI, eGFR, presence of diabetes or cardiovascular disease, or pharmacological therapy. When reproducibility of BP phenotypes both at 6 months and at 12 months was assessed, it was very low (19.6%), particularly for MUCH (0%), CH (14%) and WUCH (15.5%), while it was 31% for SUCH. In a CKD cohort, the overall prevalence of the different BP phenotypes defined by office and home BP remains constant over time. However, only 38% of patients maintained the same phenotype at 12 months, suggesting a poor reproducibility over time for the BP phenotypes.

ContextMechanisms mediating the cardiovascular and renal protection exerted by SGLT2 inhibitors are still partially unknown. We investigated whether dapagliflozin modulates systemic and renal vascular function and structure, and induces epigenetic modifications.Subjects and MethodsForty hypertensive patients with type 2 diabetes were randomly assigned to 4-week treatment with dapagliflozin 10 mg or hydrochlorothiazide (HCT) 12.5 mg. Routine analyses; plasma renin activity; aldosterone, catecholamine, and 24-hour urinary electrolyte levels; flow-mediated dilation (FMD) of the brachial artery; carotid-femoral pulse-wave velocity (PWV); augmentation index; and resistive index and dynamic renal resistive index (DRIN) were measured at baseline and after treatment. Circulating miRNAs (miRs) related to heart failure (miR30e-5p, miR199a-3p), endothelial dysfunction (miR27b and miR200b), and renal function (miR130b-3p, miR21-5p) were assessed and related to the effects of treatments.ResultsDapagliflozin and HCT marginally lowered blood pressure. Fasting glucose was lowered, whereas 24-hour diuresis, glycosuria, and osmolar clearance were increased by dapagliflozin (P < 0.001 for all), without affecting sodium excretion and glomerular filtration rate. Magnesium levels significantly increased after dapagliflozin treatment (P = 0.02). Neither dapagliflozin nor HCT modified FMD or PWV. DRIN did not vary in the dapagliflozin group, whereas it increased in the HCT group (P = 0.047 for time by treatment interaction). Both treatments induced variations in the expression of some miRs; dapagliflozin, but not HCT, significantly up-regulated miR30e-5p and downregulated miR199a-3p.ConclusionA putative epigenetic regulation of the protecting cardiovascular effect exerted by SGLT2 inhibitors was found. Dapagliflozin might exert nephroprotection by preserving renal vasodilating capacity.

Purpose/Background/Objectives: This study aims to investigate how image settings affect carotid Intima-Media-Thickness (IMT) and diameter estimation performed with CarotidStudio (Quipu Srl). Methods: 14 healthy volunteers (24.4 ± 4.4 years; 8 men) were recruited. Longitudinal scans 3cm deep of common-carotid-arteries with the same region-of-interest were obtained by expert operator, starting from a “default” setup (central Time Gain Compensation-TGC; gain:50 dB; no persistence filter) and adjusting one parameter at a time (oblique TGC; gain:10 dB increments from 30 to 70 dB; persistence filter). The acquisition was performed twice and repeatability was expressed for each setup as coefficient of variation (CV). Significant changes (p < 0.05) with respect to the “default” setup were analysed by paired Student-t-test. Results: A 70 dB gain results in overestimating IMT (from 0.46 mm ± 0.01 mm to 0.54 mm ± 0.01 mm), underestimating diameter (from 6.04 mm ± 0.04 mm to 5.70 mm ± 0.23 mm), increasing their CVs (from 2.14% ± 1.92% to 6.85% ± 5.23% for IMT, from 1.79% ± 1.22% to 4.77% ± 4.71% for diameter) and in 4/14 cases the estimation wasn’t possible. Distension CV increases also with 60 dB (from 5.71% ± 4.31% to 10.84% ± 5.91% and to 12.59% ± 7.97%). Persistence and TGC do not affect repeatability, whereas diameter (5.96 mm ± 0.03 mm) and distension (from 0.82 mm ± 0.02 mm to 0.66 mm ± 0.02 mm) values are influenced by persistence. Conclusions: CarotidStudio precision does not show significant alterations except from 70 dB gain, which, due to the image grey-level saturation, results in poor image quality and modified values. Persistence does not affect precision but leads to reduced diameter and distension, possibly for the intrinsic behaviour of mathematical operator and image temporal filtering. Gain and persistence influence ultrasound biomarker estimation; the chosen setup should be documented and replicated in follow-up scans.

Purpose/Background/Objectives: Recently great attention has been placed on innovative cardiovascular biomarkers obtained from wave separation (WS), wave intensity analysis (WIA) and the reservoir-wave (RW) concept. Pressure waveforms needed to implement these techniques can be obtained in different ways. Aim of this study was to evaluate differences in WS, WIA and RW parameters obtained deriving pressure curves in different ways. Methods: Twenty-two individuals (49 ± 17 years, 59% males) were examined. Common carotid blood flow waveforms were obtained from Pulsed-Wave Doppler images. Carotid pressure waveforms were obtained in four different ways: 1) standard method, i.e., with applanation tonometry; 2) linear scaling from ultrasound (US)-derived diameter curve; 3) exponential scaling from US-derived diameter curve; 4) linear scaling from an accelerometric-derived diameter signal. In each case, reflection magnitude (RM) and reflection index (RI) were obtained from WS. The amplitude of the first positive peak (W1), of the second positive peak (W2) and of the negative one (Wb) were calculated from WIA; the maximum of the reservoir (maxPr) and the excess (maxPex) pressure were achieved from RW. Results: According to the intra-class coefficient values, the agreement between the standard method and all the others was excellent in case of RM, RI, maxPrand maxPex(0.82–0.97), while reached only a fair/good level in case of W1, W2and Wb(0.44–0.82). Conclusions: The use of alternative carotid pressure waveforms does not influence the cardiovascular parameters obtained by WS and RW, while those derived by WIA are affected by the carotid pressure curve employed.

Item does not contain fulltext OBJECTIVES: Brachial artery flow-mediated dilation (FMD) is a popular technique to examine endothelial function in humans. Identifying volunteer and methodological factors related to variation in FMD is important to improve measurement accuracy and applicability. METHODS: Volunteer-related and methodology-related parameters were collected in 672 volunteers from eight affiliated centres worldwide who underwent repeated measures of FMD. All centres adopted contemporary expert-consensus guidelines for FMD assessment. After calculating the coefficient of variation (%) of the FMD for each individual, we constructed quartiles (n = 168 per quartile). Based on two regression models (volunteer-related factors and methodology-related factors), statistically significant components of these two models were added to a final regression model (calculated as beta-coefficient and R). This allowed us to identify factors that independently contributed to the variation in FMD%. RESULTS: Median coefficient of variation was 17.5%, with healthy volunteers demonstrating a coefficient of variation 9.3%. Regression models revealed age (beta = 0.248, P < 0.001), hypertension (beta = 0.104, P < 0.001), dyslipidemia (beta = 0.331, P < 0.001), time between measurements (beta = 0.318, P < 0.001), lab experience (beta = -0.133, P < 0.001) and baseline FMD% (beta = 0.082, P < 0.05) as contributors to the coefficient of variation. After including all significant factors in the final model, we found that time between measurements, hypertension, baseline FMD% and lab experience with FMD independently predicted brachial artery variability (total R = 0.202). CONCLUSION: Although FMD% showed good reproducibility, larger variation was observed in conditions with longer time between measurements, hypertension, less experience and lower baseline FMD%. Accounting for these factors may improve FMD% variability. 01 september 2016

PURPOSE OF REVIEW To provide an overview of available evidence of the relationship between birth weight and future hypertension development. RECENT FINDINGS Fetal programming plays a significant role in future hypertension. Both low and high birth weight are able to influence weight gain during childhood, adult weight and blood pressure values during childhood and adulthood. To date, an increasing amount of evidence is available especially for the relationship between low birth weight and hypertension, supported also by pathophysiological studies. SUMMARY In the era of personalized medicine, the possibility to reduce cardiovascular risk before or soon after birth and intervene on risk factors during childhood is appealing and promising for the future.

Several foods and nutrients have been independently associated with systolic (SBP) and diastolic (DBP) blood pressure values. This study aimed to evaluate the effects of combined dietary habits on SBP and DBP values in a large cohort of healthy adults, with a cross-sectional design. Adherence of participants to four a priori dietary patterns was considered: the Healthy Eating Index 2010 (HEI-2010); the Dietary Approaches to Stop Hypertension (DASH); the Greek Mediterranean Diet Score (MDS); and the Italian Mediterranean Index (IMI). Overall, 13,597 volunteers (35–64 years) were enrolled in 1993–1998 in the EPIC-Florence cohort. Information on dietary habits, anthropometry, smoking status, education, physical activity habits, previous diagnosis of hypertension and SBP and DBP measurements were collected at baseline. Multivariate regression models were performed on 10,163 individuals (7551 women) after excluding subjects with prevalent hypertension. IMI, DASH and HEI-2010 were significantly and inversely associated with SBP and DBP values in the total population. The strongest association emerged between IMI and SBP (β − 1.80 excellent adherence vs low adherence, 95% CI − 2.99; − 0.61, p trend 0.001) and DBP (β − 1.12, 95% CI − 1.869; − 0.39, p trend 0.001) values. In sub-group analyses, an inverse association also emerged between IMI and SBP and DBP values among females and between DASH and DBP among males. MDS was not associated with SBP or DBP. Overall, this study, carried out in a large cohort of healthy adults from Tuscany (Central Italy), showed inverse significant associations between specific a priori dietary patterns, identifying general models of health-conscious diet, and blood pressure values.

Objective Recently great attention has been paid to innovative cardiovascular biomarkers obtained from wave separation (WS), wave intensity (WI) and reservoir-wave (RW) theories. All these approaches share a requirement for pressure information. The aim of this study was to evaluate differences in WS-, WI- and RW-derived parameters obtained achieving pressure waveforms in different ways. Approach Twenty-two individuals (49 ± 17 years, 59% males) were examined. Common carotid blood flow waveforms were obtained from pulsed-wave Doppler images. Carotid pressure waveforms were achieved in four different ways: (1) with applanation tonometry, used as a reference method; (2) linear scaling from an ultrasound (US)-derived diameter curve; (3) exponential scaling from a US-derived diameter curve; and (4) linear scaling from an accelerometric-derived diameter signal. For each case, the reflection magnitude (RM) and index (RI) were obtained from the WS. The amplitude of the first positive peak (W 1), of the second positive peak (W 2) and of the negative peak (W b) were calculated from the WI, while the maximum of the reservoir (maxPr) and the excess (maxPex) pressure were achieved from the RW. Main results According to the intra-class coefficient values, the agreement between the standard method and all the others was excellent for the RM (linear: 0.82; exponential: 0.83; accelerometric: 0.86), RI (linear: 0.84; exponential: 0.85; accelerometric: 0.87), maxPr (linear: 0.97; exponential: 0.96; accelerometric: 0.97) and maxPex (linear: 0.85; exponential: 0.87; accelerometric: 0.89), while only a fair/good level was reached for W 1 (linear: 0.67; exponential: 0.77; accelerometric: 0.52), W 2 (linear: 0.52; exponential: 0.69; accelerometric: 0.83) and W b (linear: 0.60; exponential: 0.44; accelerometric: 0.50). Significance Measuring carotid pressure waveforms with different approaches does not influence the cardiovascular parameters obtained by WS and RW; those derived by WI are affected by the carotid pressure curve employed.

BACKGROUND We examined the relative impact of arterial stiffness on the presence and/or severity of chronic mitral regurgitation (MR) in hypertensive patients. METHODS We prospectively enrolled 141 untreated hypertensive patients (mean age 56.6 ± 11.5 years): 94 with MR, 47 without MR. As a measure of arterial stiffness, pulse wave velocity (PWV) was assessed by applanation tonometry. Assessment of MR severity was obtained through calculation of effective regurgitant orifice area (EROA) and vena contracta by standard two-dimensional transthoracic echocardiography. RESULTS PWV appears to progressively increase according to the presence and severity of MR (no MR = 7.3 ± 1.1 m/s, mild MR = 7.9 ± 1.3 m/s, moderate MR = 9.0 ± 1.7 m/s, severe MR = 13.3 ± 4.1 m/s; P

Background Arterial hypertension is very common in chronic kidney disease (CKD) patients and its prevalence increases with lowering estimated glomerular filtration rate (eGFR). Blood pressure (BP) control is a cornerstone in the treatment of CKD patients but still most treatment decisions are based on office BP measurement (OBPM). The aim of this cross-sectional, retrospective study is to investigate the prevalence of hypertension phenotypes in CKD patients and whether different home (HBPM) or OBPM are associated with a different CKD stage and cardiovascular comorbidities. Methods We analyzed 560 consecutive patients (359 men, age 70±13 years), affected by stage 3-5 CKD, who performed HBPM recording; OBPM during a single visit was also assessed. Uncontrolled hypertension was defined as OBPM values ≥140/90 mmHg and HBPM values ≥135/85 mmHg, respectively. Results Systolic and diastolic HBPM values were lower than OBPM values. A white coat effect (systolic BP +18±12 mmHg) was detected in 62.5%, while a masked effect (systolic BP -14±10 mmHg) was detected in 22.7%. No relationship was found between BP differences and body weight, CKD stage, eGFR or presence of diabetes. Based on OBPM, 18.6% of patients showed controlled systolic and diastolic BP, whereas 37.8% had sustained hypertension. White-coat hypertension was detected in 23.4% and Masked hypertension in 12.1%. The multiple logistic regression model showed that masked uncontrolled hypertensive patients showed a higher probability of having ischemic heart disease (OR=2.54 [1.02-6.36]), while sustained hypertension was associated with an increased prevalence of stroke in comparison to normotensive or true control BP group (OR=4.72 [1.30-17.07]). Age, gender, diabetes or CKD stage, were not different among the four hypertension phenotypes. Conclusions We observed a quite high rate of masked uncontrolled hypertension and of white coat hypertension in stage 3-5ND CKD patients. Office BP measurement, as a single tool, is an inadequate diagnostic procedure in the clinical management of CKD patients. HBPM should be routinely implemented for identifying hypertensive phenotypes and then for avoiding misdiagnosis and mistreatment of pre-dialysis CKD patients in a tertiary care setting.

The introduction of three-dimensional echography (3D echo) in vascular field is not recent, but it still remains a seldom-used technique because of the costs of ultrasound probe and the need of dedicated laboratories. Therefore, despite significant prognostic implications, the high diagnostic accuracy in plaque definition, and the relative ease of use, 3D echo in vascular field is a niche technique. The purpose of this review is mainly clinical and intends to demonstrate the potential strength of a 3D approach, including technical aspects, in order to present to clinicians and imagers the appealing aspects of a noninvasive and radiation-free methodology with relevant diagnostic and prognostic correlates in the assessment of carotid atherosclerosis. A comprehensive literature search (since 1990s to date) using the PubMed, MEDLINE, and Cochrane libraries databases has been conducted. Articles written in English have been assessed, including reviews, clinical trials, meta-analyses, and interventional/observational studies. Manual cross-referencing was also performed, and relevant references from selected articles were reviewed. The search was limited to studies conducted in humans. Search terms, retrieved also with PubMed Advanced search and AND/OR Boolean operators (mainly in title and abstract), included three-dimensional, echo, stroke/transient ischemic attack, predictors, carotid, imaging, and biomarkers.

Background: A high dietary intake of polyphenols has been associated with a reduced cardiovascular mortality, due to their antioxidant properties. However, growing evidence suggests that counteracting oxidative stress in cardiovascular disease might also reduce sympathetic nervous system overactivity. Methods: This article reviews the most commonly used techniques to measure sympathetic activity in humans; the role of sympathetic activation in the pathophysiology of cardiovascular diseases; current evidence demonstrating that oxidative stress is involved in the regulation of sympathetic activity and how antioxidants and polyphenols might counteract sympathetic overactivity, particularly focusing on preliminary data from human studies. Results: The main mechanisms by which polyphenols are cardioprotective are related to the improvement of vascular function and their anti-atherogenic effect. Furthermore, a blood pressure-lowering effect was consistently demonstrated in randomized controlled trials in humans, when the effect of flavonoid-rich foods, such as tea and chocolate, was tested. More recent studies suggest that inhibition of sympathetic overactivity might be one of the mechanisms by which these substances exert their cardioprotective effects. Indeed, an increased adrenergic traffic to the vasculature is a major mechanism of disease in a number of cardiovascular and extra-cardiac diseases, including hypertension, obesity, metabolic syndrome and heart failure. A considerable body of evidence, mostly from experimental studies, support the hypothesis that reactive oxygen species might exert sympathoexcitatory effects both at the central and at the peripheral level. Accordingly, supplementation with antioxidants might reduce adrenergic overdrive to the vasculature and blunt cardiovascular reactivity to stress. Conclusions: While supplementation with “classical” antioxidants such as ROS-scavengers has many limitations, increasing the intake of polyphenol-rich foods seems to be a promising novel therapeutic strategy to reduce the deleterious effects of increased adrenergic tone, particularly in essential hypertension.

Aim: This case-control study is aimed at identifying radial vascular wall abnormalities in patients with fibromuscular dysplasia (FMD). Methods: High-frequency ultrasound scans of radial arteries were obtained by VevoMD (70 MHz probe, FUJIFILM, VisualSonics). Radial wall showed two echogenic interfaces: the 1st (lumen-media) and the 2nd (media-adventitia). Intima-media (IMT), adventitia (AT), and global thickness (IMAT) and wall cross-sectional area (WCSA) Measured. Vascular wall disarray was assessed calculating the root mean square error (RMSE) between 20 gray-level profiles crossing the two interfaces and the profile obtained averaging them, normalized for the maximum value of the corresponding mean profile (RMSE/mean). Results: 11 treated hypertensive female FMD patients and 8 healthy controls (C) were enrolled (age 52±5 vs 45±13years, p = 0.51; BMI 26±3 vs 23±3kg/mg, p = 0.12; mean BP 97±7 vs 85±10 mmHg, p = 0.01). Radial lumen was similar; IMT (0.166±0.037 vs 0.128±0.022mm, p = 0.03), AT (0.114±0.029 vs 0.083±0.019mm, p = 0.008) and IMAT (0.281±0.042 vs 0.211±0.027mm, p = 0.003) were higher in FMD. Wall/lumen ratio was similar and WCSA increased in FMD. The maximum values of 1st (121±43 vs 157±22, p = 0.09) and 2nd interface 109±44 vs133±18, p = 0.09) tended to be lower, whereas RMSE/mean was higher in FMD (1st 1.31±0.24 vs 0.83±0.32, p = 0.006; 2nd 1.37±0.38 vs 0.94±0.32, p = 0.03). The difference was attenuated for the 1st but not for the 2nd interface when considering age and mean BP as covariates (p = 0.054 and p = 0.016 respectively). Conclusions: The radial artery wall of hypertensive FMD patients shows increased thickness and its ultrastructure is characterized of loss of echogenicity and inhomogeneity of the two echogenic layers.

Background: Dementia has been recently viewed as a predominantly vascular disorder. Indeed, reduced brain NO availability causes increased ß-amyloid deposition by several mechanisms, including hypoperfusion. Purpose: To investigate the relationship between cerebral blood flow in the hippocampal and parahippocampal regions (CBF-hipp and CBF-parahipp), crucial areas for memory and processing of non-verbal/spatial information, and systemic endothelial function in individuals with mild cognitive impairment (MCI), a subclinical condition predisposing to dementia. Methods: CBF-hipp and CBF-parahipp were evaluated by magnetic resonance imaging (arterial spin labeling, GE HDxt 1.5 T Signa Neuro-optimized System) and systemic endothelial function by flow-mediated dilation (FMD) in the brachial artery. Results: Complete data about CBF and FMD at enrollment were available for 66 individuals with MCI and 32 without (non-MCI). The two groups were matched for age (75 ± 5 vs 74 ± 5 years, p = 0.22), sex (men 45 vs 50%, p = 0.18) and mean BP (96 ± 10 vs 97 ± 9 mmHg, p = 0.41). FMD was significantly lower in MCI than in non-MCI (2.93 ± 2.18 vs 3.74 ± 2.03%, p = 0.02); CBF-hipp (64.3 ± 9.43 vs 69.5 ± 7.03 ml/100 gr/min, p = 0.002) and CBF-parahipp (66.3 ± 8.02 vs 70.0 ± 8.12 ml/100 gr/min, p = 0.002) were significantly lower in MCI as well. Among MCI, FMD was significantly correlated with CBF-parahipp (r = 0.26, p = 0.03) and CBF-hipp (r = 0.32, p = 0.009). In multiple regression models, including age, sex, mean BP, BMI, brachial artery diameter as confounders, FMD remained an independent determinant of CBF-parahipp (beta = 0.93, r2 = 0.063, p = 0.04) and CBF-hipp (beta = 1.31, r2 = 0.089, p = 0.01). Nor CBF-parahipp (r = −0.13, p = 0.48) neither CBF-hipp (r = 0.05, p = 0.80) were correlated with FMD in non-MCI group. Conclusions: An independent association between hippocampal and parahippocampal CBF and systemic endothelial function is present in individuals with MCI.

Background/Aim: Smooth muscle function is explored by sublingual glyceryl trinitrate (GTN) administration in vascular function protocols, in order to compare with endothelium- dependent vasodilation of the brachial artery by flow-mediated dilation (FMD). The aim of this study is to evaluate the hemodynamic and autonomic effects of the two most often used GTN dosages. Methods: In 80 essential hypertensive patients (HT) and 60 normotensive subjects (NT), we evaluated FMD of the brachial artery and endothelium-independent response to 25 and 400 mg of sublingual GTN by high-resolution ultrasound and automated image analysis. In a subgroup of 10 HT, muscle sympathetic nerve activity (MSNA) was also assessed by microneurography. Results: NT showed significantly (p < 0.01) lower FMD (5.5±3.3%) as compared to healthy controls (6.9±2.2%). The response to GTN 25μg also tended to be lower (HT 7.2±3.3%; NT 7.9±2.9%; p = 0.06), whereas response to GTN 400μg was similar (HT 14.3±4.8%, NT 14.5±54.7%, p = ns). In the whole population, changes in blood pressure (BP) induced by GTN 400μg (systolic BP −3.2±7.7, diastolic BP −4.7±5.0 mmHg) were significantly higher (

Background: Spontaneous coronary dissection (SCAD) may represent a manifestation of fibromuscular dysplasia (FMD); thus, preclinical lesions might be found in extracoronary vessels with similar size and wall ultrastructure, such as the radial artery. Methods: Two 5′-clips from the left radial artery were obtained by Vevo MD (70 MHz probe, FUJIFILM, VisualSonics). Radial wall showed two echogenic interfaces: the 1st (lumen-media) and the 2nd (media-adventitia). Intima-media (IMT), adventitia (AT), and global thickness (IMAT) and wall cross-sectional area (WCSA) Measured. Vascular wall disarray was assessed calculating the root mean square error (RMSE) between 20 gray-level profiles crossing the two interfaces and the profile obtained averaging them, normalized for the maximum value of the corresponding mean profile (RMSE/mean). Results: 5 female SCAD patients and 9 healthy controls (C) were enrolled (age 45±9 vs 45±13years, p = 0.95; BMI 21±3 vs 23±kg/mq, p = 0.22; mean BP 77±5 vs 85±10 mmHg, p = 0.053). 2nd interface peak was reduced in the SCAD group (97±29 130±19, p = 0.04), whereas RMSE/mean was increased (1.89±0.68 vs 0.97±0.30, p = 0.02). Similar values were found for the 1st interface. IMT (0.165±0.031 vs 0.125±0.022mm, p = 0.03), but not AT (0.095±0.020 vs 0.081±0.020mm, p = 0.20) and IMAT (0.260±0.049 vs 0.206±0.030mm, p = 0.053), was significantly higher in SCAD. Radial internal diameter and wall/lumen ratio were similar: conversely WCSA was increased in SCAD (1.69±0.48 vs 1.07±0.37mm2, p = 0.02). Conclusions: Radial arteries of SCAD patients were characterized by increased wall thickness. Furthermore, the 2nd echogenic layer exhibited loss of echogenicity and inhomogeneity, features similar to FMD patients.

Aim: This case-control study is aimed at identifying radial vascular wall abnormalities in patients with fibromuscular dysplasia (FMD). Methods: High-frequency ultrasound scans of the radial arteries and of FMD patients and healthy controls were obtained by Vevo MD (70 MHz probe, FUJIFILM, VisualSonics, Toronto, Canada). Radial wall showed in all individuals two echogenic interfaces: the 1 st ( lumen-media) and the 2 nd (media-adventitia). Intima-media (IMT), adventitia (AT), and global thickness (IMAT) were measured and wall cross-sectional area (WCSA) calculated. The disarray level of the two echogenic interfaces was assessed calculating the root mean square error (RMSE) between 20 gray-level profiles crossing the two interfaces and the profile obtained averaging them. For each echogenic interface, the RMSE was normalized for the maximum value of the corresponding mean profile (RMSE/mean). Results: 11 treated hypertensive female FMD patients and 8 healthy control women (C) were enrolled (age 52±5 vs 45±13 years, p=0.51; BMI 26±3 vs 23±3, p=0.12; mean BP 97±7 vs 85±10, p=0.01). Radial internal diameter was similar (1.938±0.432 vs 1.701±0.532 mm, p=0.21). IMT (0.166±0.037 vs 0.128±0.022 mm, p=0.03), AT (0.114±0.029 vs 0.083±0.019 mm, p=0.008) and IMAT (0.281±0.042 vs 0.211±0.027 mm, p=0.003) were higher in FMD. Wall/lumen ratio was similar and WCSA increased in FMD, calculated with either IMT or IMAT. The maximum values of 1 st (121±43 vs 157±22, p=0.09) and 2 nd interface 109 ±44 vs133±18, p=0.09) tended to be lower, whereas RMSE/mean was higher in FMD (1 st 1.31±0.24 vs 0.83±0.32, p=0.006; 2 nd 1.37±0.38 vs 0.94±0.32, p=0.03). The difference was attenuated for the 1 st but not for the 2 nd interface when considering age and mean BP as covariates (p=0.054 and p=0.016 respectively). Conclusions: Wall ultrastructure of radial arteries of hypertensive FMD patients showed eutrophic remodeling. Furthermore, a peculiar “blurred” pattern occurred, characterized of loss of echogenicity and inhomogeneity of the two echogenic layers, independent of age and mean BP.

Non-alcoholic fatty liver disease is becoming a global epidemic. The aim of this study was to develop a system for assessing liver fat content based on ultrasound images. Magnetic resonance spectroscopy measurements were obtained in 61 patients and the controlled attenuation parameter in 54. Ultrasound images were acquired for all 115 participants and used to calculate the hepatic/renal ratio, hepatic/portal vein ratio, attenuation rate, diaphragm visualization and portal vein wall visualization. The Steato-score was obtained by combining these five parameters. Magnetic resonance spectroscopy measurements were significantly correlated with hepatic/renal ratio, hepatic/portal vein ratio, attenuation rate, diaphragm visualization and portal vein wall visualization; Steato-score was dependent on hepatic/renal ratio, attenuation rate and diaphragm visualization. Area under the receiver operating characteristic curve was equal to 0.98, with 89% sensitivity and 94% specificity. Controlled attenuation parameter values were significantly correlated with hepatic/renal ratio, attenuation rate, diaphragm visualization and Steato-score; the area under the curve was 0.79. This system could be a valid alternative as a non-invasive, simple and inexpensive assessment of intrahepatic fat.

Background Sodium-glucose cotransporter-2 inhibitors reduce blood pressure (BP) and renal and cardiovascular events in patients with type 2 diabetes through not fully elucidated mechanisms. Aim of this study was to investigate whether dapagliflozin is able to acutely modify systemic and renal vascular function, as well as putative mechanisms. Methods Neuro-hormonal and vascular variables, together with 24 h diuresis, urinary sodium, glucose, isoprostanes and free-water clearance were assessed before and after a 2-day treatment with dapagliflozin 10 mg QD in sixteen type 2 diabetic patients; data were compared with those obtained in ten patients treated with hydrochlorothiazide 12.5 mg QD. Brachial artery endothelium-dependent and independent vasodilation (by flow-mediated dilation) and pulse wave velocity were assessed. Renal resistive index was obtained at rest and after glyceryl trinitrate administration. Differences were analysed by repeated measures ANOVA, considering treatment as between factor and time as within factor; Bonferroni post hoc comparison test was also used. Results Dapagliflozin decreased systolic BP and induced an increase in 24 h diuresis to a similar extent of hydrochlorothiazide; 24 h urinary glucose and serum magnesium were also increased. 24 h urinary sodium and fasting blood glucose were unchanged. Oxidative stress was reduced, as by a decline in urinary isoprostanes. Flow-mediated dilation was significantly increased (2.8 ± 2.2 to 4.0 ± 2.1%, p

Third molar extraction is one of the most frequent interventions in dentistry. Nevertheless, there is scarce evidence on the host response of individuals with impacted or semi-impacted third molars and the possible effects of surgical removal. A case-control study of 40 patients was designed to evaluate 1) the differences in biomarkers of systemic inflammation, vascular function, and metabolism (high-sensitive C-reactive protein, lipids, fibrinogen, oxidative stress, and endothelial function analysis) and 2) the acute and short-term effects of surgical removal in patients with bilateral impacted or semi-impacted third molars compared to controls with no third molars. Patients undergoing third molar extraction exhibited greater levels of systemic inflammation, oxidative stress, and triglycerides than controls. Raised white blood cell counts as well as peaks of serum levels of C-reactive protein and fibrinogen were noticed in the first postoperative week. Three months after the extraction, all markers returned to baseline values. Malondialdehyde, an indicator of oxidative stress indicator, was significantly reduced after third molar removal. Semi-impacted or impacted third molars are associated with higher systemic inflammation, and their removal may represent a useful human model to study acute inflammation and determine beneficial systemic effects ( ClinicalTrials.gov NCT03048175).

During recent decades, a number of methods have been developed to assess endothelial function, contributing to a better understanding of the pathophysiology of cardiovascular disease. Recently, the advent of noninvasive, reproducible techniques for assessment of endothelial function has opened novel possibilities of application in the clinical setting. Peripheral arterial tonometry is a relatively novel, user-friendly technique measuring finger pulse volume amplitude changes induced by reactive hyperemia following 5 minutes of ischemia in the upper limb. Current evidence indicates that this technique has the potential to significantly impact the field of cardiovascular research and prevention of cardiovascular disease. However, a number of methodological, pathophysiological, and clinical aspects still need to be clarified before widespread application of this promising technique. This review focuses on the current knowledge and future perspectives of peripheral arterial tonometry, in comparison with the most widely used noninvasive technique, i.e., flow-mediated dilation.

Objective:Spontaneous coronary artery dissection (SCAD) is a major cause of acute coronary syndrome in women aged 50 years or less. Its etiology is still unknown, though an association with systemic diseases such as fibromuscular dysplasia and collagenopathies has been found. This study is aimed at

Endothelial dysfunction and arterial stiffness are early vascular alterations, linked to oxidative stress and inflammation, with prognostic significance in essential hypertensive patients. P2X7 receptors (P2X7R), responding to extracellular ATP, are encoded by a highly polymorphic gene and modulate inflammatory responses and cell growth, potentially playing a role in the control of vascular tone. This study evaluated the effects of P2X7R gene polymorphisms (single nucleotide polymorphisms, SNPs) on a detailed vascular hypertensive phenotype.We determined by real-time PCR two SNPs of the P2X7R gene (489CT and 1513AC) in 134 newly diagnosed, treatment-naive essential hypertensive patients and 131 normotensive controls (CTL). Endothelium-dependent response was assessed as flow-mediated dilatation (FMD) of the brachial artery, arterial stiffness as aortic pulse wave velocity (PWV) and augmentation index (AIx) by tonometry. Markers of oxidative stress were also measured.FMD was lower (P 0.05), whereas aortic PWV and AIx were higher (P 0.01) in essential hypertensive patients than in CTL. The allelic distribution of the two P2X7R SNPs was similar in essential hypertensive patients and CTL, either concerning homozygosis or presence of the mutant alleles. No difference was observed for FMD, aortic PWV, AIx or markers of oxidative stress between carriers and noncarriers of the mutant alleles, either in essential hypertensive patients and in CTL. In the whole group, logistic regression showed that the mutant allele of 1513AC was a main determinant of AIx (odds ratio 1.90; P = 0.03).P2X7R 489CT and 1513AC SNPs are not associated with altered endothelial function or arterial stiffness in untreated newly diagnosed essential hypertensive patients; a possible role in influencing peripheral wave reflection should be further addressed.

Atherosclerosis and its complications are the most important causes of death all over the world, especially in Western countries. Diet habits, modern stress life, smoking, sedentary way of life and an involvement of genetic pattern of individuals lead to a sure degeneration of quality of life increasing the risk of atherosclerosis development. For this reason, the main purpose of actual medicine is to identify all the markers that could allow the physicians to evaluate the first moments of the development of this dangerous pathological process. The aim is to reduce the speed of its evolution, trying to delay indefinitely the risk coming from the morphological alterations of the vessels. 'Endothelium function' could allow physicians to detect the first moment of the natural history of atherosclerosis process. Its impairment is the first step in the degeneration of vascular structures. Many methods [flow-mediated vasodilatation (FMD); antero-posterior abdominal aorta diameter (APAO); intima-media thickness of the common carotid artery (CCA-IMT); arterial stiffness; and so on] try to evaluate its function, but many limitations come from general population characteristics. A standardization of the methods should take into account individuals' peculiarities. Two elements, not modifiable, should be taken into account for vascular evaluation: age and sex. The aim of this review is to outline the linkage among age, sex and instrumental evaluation of patients considered for a noninvasive assessment of their cardiovascular risk profile.

OBJECTIVE Patients with obstructive sleep apnea syndrome exhibit accelerated vascular aging and renal damage. Aim of the study was to investigate whether vascular dysfunction is a feature of obstructive sleep apnea syndrome per se or instead related to the presence of traditional cardiovascular risk factors. METHODS Forty patients with moderate-severe obstructive sleep apnea syndrome (20 with, 20 without traditional risk factors) and 20 matched healthy controls were enrolled. Renal vasodilating capacity, endothelium-dependent vasodilation in the brachial artery, carotid-femoral pulse wave velocity and carotid stiffness were measured. Oxidative stress, endothelial biomarkers and leukocyte adhesion molecule levels were also evaluated. RESULTS Apneic patients without traditional cardiovascular risk factors presented reduced endothelium-dependent vasodilation (3.7±2.1 versus 6.1±3.0%, P

Hypertension is universally considered the most detrimental among cardiovascular risk factors. Despite the overwhelming evidence of benefits deriving from lowering blood pressure, its control among the hypertensive population is still unsatisfactory. Resistant hypertension has a non negligible prevalence among hypertensive patients, and it is associated with a worse cardiovascular prognosis. There is need of new therapeutic approaches for reducing cardiovascular risk in this population. Sympathetic nervous system is known to play a major role in development and maintenance of essential hypertension, thus in the past decades several efforts have been made to counteract its overactivation. Novel non-pharmacological, promising approaches targeting sympathetic nervous system are now available, such as renal denervation and baroceptor-activating therapy. This review is aimed at describing essential clinical aspects of resistant hypertension, physiopatological basis of autonomic modulation as a target for hypertension treatment, and the available clinical evidence about efficacy and safety of device-based therapies for resistant hypertension. Present limitations and future perspectives were also considered.

Hypertension and insomnia are very common and often coexist. There is evidence to suggest that the increasing prevalence of arterial hypertension in the past decade might be related both to an increased prevalence of insomnia and to the decline of sleep duration due to modern lifestyle. The aim of this paper is to reconsider both the clinical evidence of the relationship between conditions of sleep loss and of perceived impairment in sleep quality with hypertension and the potential pathophysiological mechanisms underlying the biological plausibility of their relationship. Through a systematic search from MEDLINE, EMBASE, PsychINFO we selected articles, which reported experimental sleep deprivation designs, or studied sleep duration or insomnia and their relationship with blood pressure or hypertension in participants over 18 years. This analysis shows that experimental sleep deprivation, short sleep duration, and persistent insomnia are associated with increased blood pressure and increased risk of hypertension, even after controlling for other risk factors. Pathophysiological mechanisms underlying this association might be related to inappropriate arousal ("hyperarousal") due to an overactivation of stress system functions. According this hypothesis, prolonged sleep loss or alterations of sleep quality might act as a neurobiological and physiologic stressor that impair brain functions and contribute to allostatic load, compromising stress resilience and somatic health.

Age-related cognitive impairment and dementia are an increasing societal burden. Epidemiological studies indicate that lifestyle factors, e.g. physical, cognitive and social activities, correlate with reduced dementia risk; moreover, positive effects on cognition of physical/cognitive training have been found in cognitively unimpaired elders. Less is known about effectiveness and action mechanisms of physical/cognitive training in elders already suffering from Mild Cognitive Impairment (MCI), a population at high risk for dementia. We assessed in 113 MCI subjects aged 65–89 years, the efficacy of combined physical-cognitive training on cognitive decline, Gray Matter (GM) volume loss and Cerebral Blood Flow (CBF) in hippocampus and parahippocampal areas, and on brain-blood-oxygenation-level-dependent (BOLD) activity elicited by a cognitive task, measured by ADAS-Cog scale, Magnetic Resonance Imaging (MRI), Arterial Spin Labeling (ASL) and fMRI, respectively, before and after 7 months of training vs. usual life. Cognitive status significantly decreased in MCI-no training and significantly increased in MCI-training subjects; training increased parahippocampal CBF, but no effect on GM volume loss was evident; BOLD activity increase, indicative of neural efficiency decline, was found only in MCI-no training subjects. These results show that a non pharmacological, multicomponent intervention improves cognitive status and indicators of brain health in MCI subjects.

Brachial cuff blood pressure (BP) is clinically important, but may be an inaccurate substitute for central BP. Many non-invasive devices have been developed that purport to estimate central BP from peripheral artery sites, yet with no standardized guidelines; the accuracy testing of these new devices has not been undertaken in a uniform fashion with comparable protocols. This is an abridged paper describing the recommendations reached by an international task force convened to identify issues that need to be addressed and reach consensus relating to methods for assessing and reporting the accuracy (validation) of central BP devices. The recommendations are endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society, as well as the European Society of Hypertension (ESH) Working Group on Arterial Structure and Function, and the ESH Working Group on Blood Pressure Monitoring and Cardiovascular Variability. Researchers interested in validating central BP monitors should read the full version of the statement.

Brachial cuff blood pressure (BP) is clinically important, but may be an inaccurate substitute for central BP. Many non-invasive devices have been developed that purport to estimate central BP from peripheral artery sites, yet with no standardized guidelines; the accuracy testing of these new devices has not been undertaken in a uniform fashion with comparable protocols. This is an abridged paper describing the recommendations reached by an international task force convened to identify issues that need to be addressed and reach consensus relating to methods for assessing and reporting the accuracy (validation) of central BP devices. The recommendations are endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society, as well as the European Society of Hypertension (ESH) Working Group on Arterial Structure and Function, and the ESH Working Group on Blood Pressure Monitoring and Cardiovascular Variability. Researchers interested in validating central BP monitors should read the full version of the statement.

OBJECTIVE The objective of the study is to investigate in the hypertensive population the possible differential association between increased aortic and/or carotid stiffness and organ damage in multiple districts, such as the kidney, the vessels, and the heart. METHODS In 314 essential hypertensive patients, carotid-femoral pulse wave velocity (cfPWV, by applanation tonometry) and carotid stiffness (from ultrasound images analysis), together with left ventricular hypertrophy, carotid intima-media thickness, urinary albumin-creatinin ratio, and glomerular filtration rate were measured. Increased cfPWV and carotid stiffness were defined according to either international reference values or the 90th percentile of a local control group (110 age and sex-matched healthy individuals). RESULTS When considering the 90th percentile of a local control group, increased cfPWV was associated with reduced glomerular filtration rate, either when carotid stiffness was increased [odds ratio (OR) 13.27 (confidence limits (CL) 95% 3.86-45.58)] or not [OR 7.39 (CL95% 2.25-24.28)], whereas increased carotid stiffness was associated with left ventricular hypertrophy, either when cfPWV was increased [OR 2.86 (CL95% 1.15-7.09)] or not [OR 2.81 (CL95% 1.13-6.97)]. No association between increased cfPWV or carotid stiffness and target organ damage was found when cutoffs obtained by international reference values were used. The concomitance of both increased cfPWV and carotid stiffness did not have an additive effect on organ damage. CONCLUSION Aortic and carotid stiffness are differentially associated with target organ damage in hypertensive patients. Regional arterial stiffness as assessed by cfPWV is associated with renal organ damage and local carotid stiffness with cardiac organ damage.