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A randomized controlled open trial studied the effect of vitamin E supplementation (300 mg/day) on clinic and 24-h ambulatory blood pressure (BP) in 142 treated hypertensive patients. After 12 weeks, clinic BP decreased whether or not patients were randomized to vitamin E. Ambulatory BP showed no change in systolic BP and a small decrease in diastolic BP (-1.6 mm Hg, 95% confidence intervals from -2.8 to -0.4 mm Hg), approaching statistical significance in comparison to the control group (P = .06). Vitamin E supplementation thus seems to have no clinically relevant effect on BP in hypertensive patients already under controlled treatment.

Background: Various epidemiological surveys from different countries have documented the unsatisfactory control of arterial hypertension. The aim of this study was to assess the current status of treatment and control of hypertension in Italy., Methods: A random sample of general practitioners (GP) working in several Aziende Sanitarie Locali (Local health offices-ASL) throughout Italy were invited to take part in the study. Each doctor had to recruit a random sample of 15-20 hypertensive patients receiving antihypertensive drugs among those attending his/her office for any reason. A standard medical history, specifically oriented to hypertension and its pharmacological treatment, was taken for each patient. Three blood pressure (BP) measurements were made, with the patient seated for at least 5 minutes, using an accurate automatic device (A&D UA-732), and the mean was taken as each patient's BP., Results: A total of 73 GPs (17% of the invited sample), working in 14 Italian ASL (six in the north of the country, four in the center and four in the south and islands), agreed to participate in the study. They recruited an average of 17 patients each, for a total of 1204 hypertensive subjects (663 women and 541 men) 633 of whom were 65 years old or more, mean age 64 +/- 11 years, range 25-94 years. More than half (56%) had been taking antihypertensive drugs for at least five years; 42% were taking one drug, 40% two, 16% three and 2% four drugs. Respectively, 63% and 23% had systolic BP (SBP) > or = 140 and > or = 160 mmHg; 28% and 14% had diastolic BP (DBP) > or = 90 and 95 mmHg. In 71%, BP was < 160/95 mmHg, but only 33% had BP lower than 140/90 mmHg. BP control was similar in males and females, but worse in the elderly. Nine percent of patients complained of symptomatic side effects, usually mild. Only 8% admitted to poor compliance with the antihypertensive therapy, and their BP was significantly less well controlled., Conclusions: Control of BP in patients receiving antihypertensive drugs is still far from optimal in Italy, just as in other countries. This situation seems more related to the fact that doctors do not tackle the problem aggressively, than to the patients' degree of compliance with therapy.

Background: The relationship between ventricular arrhythmias (VA) in the subacute phase of a myocardial infarction (MI) and subsequent major arrhythmic events, i.e. sustained ventricular tachycardia (SVT) and sudden death (SD), is well known. The importance of left ventricular dysfunction in the same context is also well established. The vast majority of the data in the literature come from the prefibrinolytic era and/or are derived from limited data bases., Materials, Methods and Results: We examined the large, uniform GISSI-2 population of acute fibrinolysed myocardial infarctions in order to evaluate the significance and predictive power of VA detected by Holter monitoring during the subacute phase. Particular attention was paid to the occurrence of nonsustained ventricular tachycardias (NSVT) since their role is still uncertain, so it is hard to assess the utility of invasive measures such as programmed electrical stimulation (PES). Left ventricular function was evaluated by mono-, and two-dimensional echocardiography. Holter monitoring was available in 8,676 patients; a six-month follow-up, as regards mortality was completed in 8,552 patients (98.5%) and, as regards SVT incidence, in 7.713 (88.9%). During the follow-up 256 patients died (3%), 84 out of them suddenly (1%). Twenty-six [corrected] patients out of 7,713 (0.3%) experienced one or more SVT. The relationship between VA, left ventricular dysfunction and major arrhythmic events was evaluated by odds ratios (OR) and their confidence intervals (CI). Odds ratios for the combined end-point (SD and/or SVT) was 4.49 (CI 95% 2.69-7.51) if the Holter showed > 10 VEB/hour; 2.34 (CI 1.48-3.68) if couplets were present; 3.26 (1.52-6.99) if NSVT were present; 3.02 (2.02-4.50) if any complex ventricular arrhythmia was detected. Left ventricular disfunction seemed to exert a more powerful influence: OR 9.80 (CI 5.75-16.69) for SD and/or SVT. Any arrhythmic parameter had very low positive (< or = 3%) and very high (approximately 99%) negative predictive power. Multivariate analysis (Cox Model) including major prognostic factors confirmed the independent prognostic value of frequent VA (RR 2.75; 95% CI 1.58-4.79), couplets (RR 1.91; CI 1.28-2.86); complex VA (RR 2.02; CI 1.36-3.00). NSVT, after adjusting for the selected risk factors, was not independently associated with a worse prognosis., Conclusions: Ventricular arrhythmias detected by Holter monitoring during the subacute phase of a MI still have prognostic significance for major arrhythmic events in the fibrinolytic era. The presence of NSVT triples the risk of SD and/or SVT in the six months after an acute MI, but loses any predictive power in a multivariate analysis. Only 6.6% of the patients showed one or more episodes of NSVT in the Holter recording. If the ongoing clinical trials, MUSTT and MADIT, will confirm the usefulness of PES in such patients, the benefit will be confirmed to a very small proportion of the patients at risk of specific diagnostic tests. The positive predictive power of VA is very low and it is therefore mandatory to add other non-invasive variables to the screening to identify the subgroups at greatest risk. On the other hand the very high (99%) negative predictive power of VA and left ventricular dysfunction enables us to identify a large population of infarcts with a negligible risk, who need no further sophisticated investigations. From the point of view of the cost/benefit evaluation this seems to be an outstanding result.

Objectives: To evaluate the safety in terms of hypotensive action of nitroglycerin and lisinopril started early after myocardial infarction., Patients and Methods: One thousand five hundred twenty-six patients with suspected myocardial infarction were randomized by 174 centers within 24 hours from the onset of symptoms to receive oral lisinopril (5 then 10 mg/day), nitroglycerin (intravenous infusion during the first 24 hours, then 10 mg/day transdermal), or neither., Results: Systolic blood pressure, intensively monitored during the first 72 hours, decreased sharply by 11 mm Hg during the first 2 hours, then more slowly to an average value of 120 mm Hg. Nitroglycerin lowered systolic blood pressure during the first 24 hours by 2.7 mm Hg versus control subjects, and it was similar to control subjects from 24 hours. Lisinopril reduced systolic blood pressure by 4.2 mm Hg over 72 hours compared with control subjects. Persistent hypotension was significantly more frequent in the lisinopril group (21.4%) than in the nitroglycerin group (10.9%) or control group (9.8%), but absolute numbers of deaths in patients with persistent hypotension were almost identical., Conclusions: Lisinopril and nitroglycerin are both safe and effective in reducing blood pressure in the first day after myocardial infarction. However, the effect is lost thereafter with transdermal nitroglycerin, but persists with lisinopril.

The present study set out to assess the feasibility of long-term moderate dietary sodium restriction in patients with mild hypertension in general practice. After screening and a run-in phase of 6-8 weeks, a total of 77 previously undiagnosed mildly hypertensive patients were identified. Half of them were randomized to receive a few simple dietary instructions from their general practitioners in order to reduce salt usage; the others were randomized to receive no advice. The patients were followed up for 12 months with quarterly visits. A total of 56 patients (72.7%) completed the study, 26 on a low-sodium diet (LD) and 30 on their usual diet (UD). At each visit in the diet phase, patients provided 24h urine, which was analysed for volume and sodium concentration in order to assess their sodium intake. Blood pressure, heart the rate and body weight were recorded. The mean urinary sodium excretion for all diet phase visits overlapped in the two groups (177.0 +/- 32.9 vs. 169.3 +/- 49.4 mEq/24h respectively in the LD and UD groups). Nevertheless the mean systolic and diastolic blood pressures for all diet phase visits were significantly lower in the LD than in UD group (144.2 +/- 11.1/91.6 +/- 6.4 and 148.0 +/- 13.7/95.6 +/- 4.7 mmHg respectively, P less than 0.01). Our data suggest that it is not feasible at present to reduce sodium intake in mild hypertensives with simple and inexpensive dietary instructions, the only ones suitable for widespread application in general practice.

The authors report an interesting case of an isolated pathology of the sphenoid sinus (more precisely, in this case a mycotic infection of this paranasal sinus), up to a few years ago an extremely rare disease and still today an exceptional entity in the clinical practice of an otolaryngologist. The investigations carried out indicated that the infection was caused by Aspergillus candidus, a fungus which only rarely becomes pathogenic in man. The paper reports the main anamnestic data as well as the clinical and instrumental assessment of the disease. It furthermore describes the surgical procedure employed, the relative reports obtained and supplies data concerning the microbiological tests carried out on the material removed and the histological pattern observed. The surgery had an excellent outcome: the patient was cured and showed no sign of recurrence of the disease. The discussion briefly presents the clinical picture created in man by Aspergillus and stresses the rarity of the disease, noting that, including the case in question, only 23 reports, documented with histological and microscopic data, have been made in literature. The AA affirm that to their knowledge this particular case of sphenoid sinusitis caused by Aspergillus candidus [correction of Candida] is the first ever to be reported and in conclusion underline the extreme care necessary in dealing with this pathology and in making a "quoad vitam" prognosis.

The effect of a population screening for hypertension was assessed through a subsequent survey performed 1 year later. All the hypertensives identified at the first visit (239 subjects, 15.6% of the whole screened population) were invited for a re-examination: the adhesion rate was 84.5%. After the screening, a high proportion of subjects (74.7%) had contacted their physicians because of their blood pressure. The most common advice physicians gave was to have further measurements of blood pressure (72.8%). Laboratory tests were prescribed in 62 patients (41.1%), but a complete assessment of a target organ damage was carried out in few cases (1.9%). Only 19.5% of patients started a course of treatment during the year following the screening and no more than one-third of those with moderate to severe hypertension. Out of the 176 subjects showing other cardiovascular risk factors at the screening, only 12 reported they had modified their habits 1 year later. Our results suggest that a screening for hypertension, when performed without any liaison with other medical facilities, seems to have a poor impact on physicians' and patients' attitudes towards hypertension.

A screening for hypertension and other cardiovascular risk factors was carried out during 1981 in a population of 1142 subjects (675 males and 467 females) aged 14-18 years. Aim of the study was to analyze the distribution of blood pressure values and of variables possibly associated with hypertension in a population of adolescents. The mean value of systolic blood pressure was higher in males than in females, slightly increasing with age in males and decreasing in females. The diastolic blood pressure was similar, and increased with age in both sexes. The prevalence of individuals with systolic blood pressure greater than or equal to 140 mmHg resulted of 16.1% in males and of 5.6% in females; the prevalence of adolescents with diastolic blood pressure greater than or equal to 90 mmHg was much lower, being of 2.5% and 1.5% respectively. The average value of heart rate was higher in females and decreased with age in both sexes. Males showed significantly greater height and weight, but the body mass index was nearly equal in the two sexes; females had thicker skinfolds. All these variables only in males were clearly associated with age. Among anamnestic variables, only smoking habits, alcohol consumption and physical activity were significantly different in the two sexes. A positive family history for hypertension was present in 31.4% of the adolescents in whom an objective assessment was possible. In both sexes the systolic blood pressure appeared significantly related to heart rate, body weight, body mass index and skinfold thickness.(ABSTRACT TRUNCATED AT 250 WORDS)

In 3858 ambulatory elderly people (age greater than or equal to 65 years) prevalence of hypertension was 67.8%. The hypertensive status was unknown to both the doctor and the patient in 21.4% of cases. More than 90% of known hypertensives were treated, but hypertension could be considered as controlled in less than 30% of them.

It has been suggested that the heart plays an active role in the pathogenesis of arterial hypertension. If this is true, there must be early cardiac involvement in young normotensive subjects who develop hypertension later in life and differences in cardiac morphology or function may exist between young normotensive subjects with different risks of developing hypertension. M-mode echocardiography was performed in 51 normotensive male adolescents with at least one hypertensive parent (SHT). These subjects were compared with 55 normotensive sons of normotensive parents (SNT) and with 25 adolescents with borderline hypertension (BH). Control groups were matched for sex and age. The following morphologic parameters were significantly greater in the SHT group than in the SNT group: interventricular septum (0.54 +/- 0.08 vs 0.49 +/- 0.09 cm/m2; p less than 0.01) and posterior wall (0.54 +/- 0.11 vs 0.50 +/- 0.08 cm/m2; p less than 0.05) thickness, left ventricular mass (125.0 +/- 29.1 vs 109.2 +/- 25.4 gm/m2; p less than 0.005), and cross-sectional area (9.9 +/- 1.8 vs 8.9 +/- 1.6 cm2/m2; p less than 0.005). No significant differences between SHT and BH subjects were observed. Excursion of left ventricular posterior wall was significantly higher in the BH group. No differences were observed between SHT and SNT subjects. These data show that the same kinds of changes in cardiac morphology are present in normotensive subjects with a family history of hypertension and in subjects with borderline hypertension, suggesting that cardiac involvement may precede elevation of blood pressure.

A few studies have been carried out in humans on the morphology and function of the cardiovascular system in the early phases of hypertension. Furthermore, the data which have been provided are controversal and, in particular, a hyperkinetic status has been found only by some authors. For this reason, we planned to study the type and degree of cardiac involvement in 25 male adolescents with mild hypertension, by means of M-mode echocardiography. The control group consisted of 100 normotensive males matched for age and sex. The following indices of left ventricular hypertrophy were significantly higher in cases than in controls: posterior wall thickness (10.4 +/- 1.0 vs 9.1 +/- 1.7 mm; p less than 0.001), cross sectional area (18.3 +/- 2.7 vs 16.6 +/- 3.2 cm2; p less than 0.02) and left ventricular mass (230.9 +/- 46.7 vs 206.2 +/- 54.0 g; p less than 0.05). After normalizing for body surface area, only posterior wall thickness was still significantly greater in cases (5.7 +/- 0.6 vs 5.2 +/- 1.0 mm/m2; p less than 0.01). Among the indices of left ventricular function, only the posterior wall excursion was significantly greater in mild hypertensives than in controls. Our data do not confirm the existence of a hyperkinetic status in subjects with mild hypertension. The type of morphological alterations we found and their modest correlation to blood pressure suggest that factors besides an increased afterload are involved in the development of left ventricular hypertrophy.

A number of symptoms that appear to be associated with high blood pressure (headache, dizziness, epistaxis, tinnitus, weakness, drowsiness), and are usually regarded as secondary to hypertension or to antihypertensive drug therapy, were studied in 3858 elderly patients, 67.8% of whom were hypertensive. Of the hypertensive patients, 71.2% were under treatment. Headaches and dizziness were significantly more prevalent in the hypertensive than in the normotensive subjects (32.5 versus 27.4% and 41.5 versus 35.3%, respectively; P less than 0.05) and in treated compared with untreated hypertensives (33.3 versus 29.4% and 43.3 versus 37.1%; P less than 0.05). These differences disappeared after statistical correction for 'awareness of hypertension'. In multiple logistic analysis, female sex, age and awareness of hypertension were significantly associated with a higher prevalence of symptoms, whereas hypertension and antihypertensive treatment were not. We conclude that the presence of these symptoms does not constitute a reliable criterion for starting antihypertensive treatment or judging its efficacy.

In order to assess the antihypertensive care received by the elderly, where clear therapeutic guidelines are lacking, a population of 3,858 aged over 64 years was studied. Data were derived from a large Italian 'Study on Blood Pressure in the Elderly', carried out in general practice. Over 90% of the 2,059 known hypertensive patients were receiving drug treatment, with no age or sex-related differences. A single drug was prescribed to 50.2% of treated patients; only 5.5% were receiving three or more drugs. Diuretics and older sympatholytic agents were by far the most frequently prescribed categories, with four drugs (hydrochlorothiazide, amiloride, methyldopa and chlorthalidone) accounting for over 50% of all prescriptions. Low-dosage treatment schedules were frequently used, often associated with less-often-than-daily drug administration. Our study shows that physicians' attitudes to the treatment of arterial hypertension in the elderly are fairly uniform, with treatment of all subjects but with low drug dosages.

The Authors report a case of neurofibroma of the tongue, observed by them. Its peculiarities and the differential diagnosis with neurinoma and other affections are discussed, mostly pointing out its rarity, epidemiological data and histogenesis. After a review of the literature concerning these forms, the Authors dwell upon the histopathologic characters of neurofibroma, the peculiarities of the case reported by them, considering the real rareness of an isolated report of neurofibroma, typical element of Recklinghausen's disease.

Aim of this study was to assess the reliability of blood pressure (BP) response to exercise compared with the occasional BP measurements in evaluating the efficacy of an antihypertensive therapy. We have studied 40 subjects (22 M, 18 F mean age 33.3 +/- 6.6) with essential hypertension (19 with mild hypertension, 8 with moderate hypertension, 13 with severe hypertension). Every patient underwent a maximum graded exercise test in the supine position on a bicycle ergometer before starting the antihypertensive treatment. An exercise test was repeated with the same procedure after resting BP had been normalized for at least six months. Both systolic and diastolic BP at peak exercise were significantly reduced (systolic BP from 212.13 +/- 25.79 mmHg to 194.38 +/- 21.58 mmHg; diastolic BP from 128.00 +/- 16.52 to 114.1 +/- 11.02 mmHg) during the second test. An excessive BP increase (above the 95% confidence limits of the BP response to exercise in a group of normotensives) was observed in 32 subjects during the first test. A "hypertensive" response to stress persisted in 13 subjects during the second test even if the resting BP values were normalized. Our data support the value of stress testing in both the evaluation of the hypertensive patient and the assessment of the individual response to treatment.

Polyclonal antibodies have been raised against purified bovine pyrazine-binding protein, a protein that binds the odorant 2-isobutyl-3-methoxypyrazine. These antibodies have been utilized in immunocytochemical experiments to localize the pyrazine-binding protein in bovine nasal mucosa. Tissue fragments, macroscopically identified as olfactory and respiratory mucosa, were fixed in Bouin's fluid and embedded in paraffin. Consecutive serial sections were processed for immunofluorescence studies and restained either with haematoxylin-eosin or with periodic acid Schiff-Alcian Blue. In both olfactory and respiratory mucosa, only seromucous tubulo-acinar glands were specifically labelled. These glands are located in the lamina propria underlying typical respiratory epithelium, even in those tissues that are macroscopically defined as olfactory mucosa.

Isolated systolic hypertension (ISH) is a very common condition in the elderly, even more than diastolic hypertension. Several studies indicate that ISH is a considerable cardiovascular risk factor in the elderly but the benefit of antihypertensive treatment has not been proved. Data in the literature on prevalence, pathophysiology, prognostic meaning and treatment of ISH are critically reviewed.

Experimental studies on strains of normotensive rats genetically prone to hypertension and investigations on humans with borderline hypertension have shown an early involvement of the heart, mainly consisting in a trend to ventricular hypertrophy. To assess whether such alterations may preceed or follow the elevation of blood pressure, subjects who will develop hypertension, but whose blood pressure is currently normal must be studied. For this reason, we studied by means of M-mode echocardiography 51 normotensive males aged 14-19 years with family history for hypertension (at least one hypertensive parent; SHT). Fifty-five normotensive subjects with both normotensive parents (SNT), matched for sex and age, were the controls. Average values of the following parameters were significantly higher in SHT than in SNT subjects: interventricular septum (5.4 +/- 0.8 versus 4.9 +/- 0.9 mm/m2; p less than 0.01) and posterior wall (5.4 +/- 1.1 versus 5.0 +/- 0.8 mm/m2; p less than 0.05) thickness, left ventricular mass (125.0 +/- 29.1 versus 109.2 +/- 25.4 g/m2; p less than 0.005) and cross sectional area (10.0 +/- 1.8 versus 8.9 +/- 1.6 cm2/m2; p less than 0.005). No significant difference between the two groups was observed in the indexes of left ventricular function. The existence of alterations of cardiac morphology in normotensive adolescents with genetic risk of hypertension shows that the cardiac involvement may preceed the development of high blood pressure.