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Recommendations about the dimensions of the reference cuff for device validations in people with arm size42 cm are still unavailable. The aim of this study was to identify the criteria for an appropriate reference cuff for validation studies in people with upper arm circumference between 43 and 50 cm.In 20 adults with upper arm circumference between 43 and 50 cm (X-large group), 34 subjects with arm circumference between 37 and 42 cm and 78 subjects with arm circumference37 cm cylindrical and tronco-conical cuffs were compared. In all participants, the pressure transmitted to the arm under the two cuffs was measured using a paper-thin pressure sensor.In the X-large group, all participants had an arm slant angle86.0°. In this group, the difference between the pressure detected on the arm surface with the sensor using the cylindrical versus the tronco-conical cuff (13.5 mmHg) was larger than in the group with an arm circumference of 37-to 42 cm and the group with a circumference37 cm (3.7 and 0.6 mmHg, respectively, P 0.001 versus both). In the whole sample, the between-cuff pressure difference was proportional to the conical shape of the arm ( P 0.001).These data suggest that in people with arm size between 43 and 50 cm the reference cuff for validation studies should have a conical shape with an 84-85° slant angle. To comply with current guidelines, an 18.5 × 37.0 cm bladder should be used which would allow proper cuffing in the large majority of subjects.

Nel 1930 Luisa Levi (1898-1983), giovane psichiatra torinese, pubblico Impulso a mordere e psiconeurosi, un articolo riguardante alcune bambine che presentavano lo strano sintomo dell’“impulso a mordere”. Questo contributo, attraverso le fonti psichiatriche, ricostruisce i casi clinici di due bambine e cerca di mostrare come l’attenzione all’individuo e ai minori fosse guidata da un lato dal pensiero positivista e dall’altro da interpretazioni di tipo psicoanalitico, che si stavano diffondendo tra gli psichiatri con elaborazioni originali.

Sepsis is one of the leading causes of death in hospitalized patients and its management involves a lot of specialist. Internist is required to demonstrate his competence since the beginning when the diagnosis is not so easy to be clarified. A rapid clinical suspicion permits a prompt management of the patient that means important mortality reduction. However, it is essential to understand the source of infection and echography represents a rapid, economic, useful and widespread tool with whom Internist should become more and more confident. The following review is a practical guide to manage septic patients according to the most recent literature, underlining aspects of antibiotic therapy, hemodynamic stabilization and supportive therapy. To limit sepsis mortality, a valid Internist should be culturally prepared and especially able to cooperate with other specialists, because a strong enemy requires a strong team.

Les medecins italiens intervenants au premier congres de Psychiatrie infantile n’etaient pas exclusivement psychiatres mais aussi psychologues, comme Agostino Gemelli, ou specialistes d’anthropologie criminelle comme Benigno di Tullio. Leurs interventions etaient axees autour de deux themes principaux : les reflexes conditionnes et la delinquance juvenile. L’article explore les interventions des Italiens en les inscrivant dans la situation complexe d’une discipline en construction et aux contours encore mal definis et ce dans le contexte politique et culturel dominant du fascisme. En ce qui concerne la delinquance juvenile, la partie la plus importante fut assuree par un specialiste d’anthropologie criminelle qui etait non seulement capable de produire des donnees chiffrees et une analyse quantitative mais plus encore de se faire le porte-parole des priorites du fascisme en matiere de securite et d’ordre. Di Tullio presenta une proposition de reeducation des mineurs – les delinquants aussi bien que les predisposes – basee sur le concept de bonification de la personne qui consistait autant dans une volonte de controle que de reeducation.

Rectangular (cylindrical) cuffs and bladders are currently used for blood pressure (BP) measurement at the upper arm. However, large arms have a troncoconical shape, which make cylindrical cuffs potentially unsuitable. Aim of this study was to investigate the effect of the shape of the cuff on BP measurement in very obese participants.In 33 participants with upper arm mid-circumference at least 42 cm and 33 participants of control, cylindrical and troncoconical cuffs of appropriate size were compared. In addition, in the obese participants, the pressure transmitted to the arm under the cuffs was measured at five cuff pressure levels using a paper-thin pressure sensor.In all obese participants, the upper arm shape was troncoconical (mean ± SD slant angle, 84.1 ± 1.4°). In this group, SBP and DBP differences between the troncoconical and the cylindrical cuff were -5.3 ± 4.0 and -3.0 ± 4.3 mmHg, respectively (P 0.001/=0.01 versus controls). In the obese participants of the top BP quintile, the between-cuff SBP difference was -9.1 ± 5.1 mmHg. Arm slant angle was an independent predictor of the between-cuff SBP discrepancy (P = 0.003). When the cylindrical cuff was used, measurement with the pressure sensor showed a marked disagreement between the pressure in the cuff and the pressure transmitted to the arm (mean difference, -10.2 ± 5.2 mmHg) a difference, which increased with increasing level of the pressure pumped in the cuff.In very obese people, cylindrical cuffs overestimate BP chiefly in people with high SBP and thus only troncoconical cuffs should be used.

The aim of this study was to determine the accuracy of the AD BP UA-651 device coupled to a wide-range cuff for home blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension. The device was evaluated in 33 patients. The mean age of the patients was 56.5±15.1 years. The mean systolic BP was 144.3±23.8 mmHg (range 88 : 196), the mean diastolic BP was 87.5±15.8 mmHg (range 38 : 132), and the mean arm circumference was 29.0±3.4 cm (range 22 : 36). The protocol requirements were followed precisely. The device passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated the systolic BP by 0.7±3.4 mmHg and underestimated the diastolic BP by 0.8±3.6 mmHg. The measurement error was unrelated to the patient's arm circumference. These data show that the AD BP UA-651 device coupled to a wide-range cuff fulfilled the requirements for validation by the International Protocol over a wide range of arm circumferences and can be recommended for clinical use in the adult population.

We evaluated the structural/functional characteristics of the arterial wall in a cohort of hypertensives with well-controlled blood pressure (BP) levels. We studied 40 hypertensives with well-controlled BP. We assessed by B-mode ultrasound the mean intima-media thickness (mean-IMT) and maximum-IMT (M-MAX) of carotid artery (common, bulb, internal) bilaterally. Endothelial function was evaluated by post-occlusion flow-mediated dilation (FMD) of the brachial artery. Along with traditional risk factors, we studied the impact of serum high-sensitivity C-reactive protein (hs-CRP) and osteoprotegerin (OPG). Forty normotensive subjects served as controls. In the hypertensives, the BP levels were well controlled (office BP: 129/79 mm Hg, ambulatory BP monitoring: 121/75 mm Hg). Compared with controls, higher BP levels and body mass index were present in hypertensives, whereas age and metabolic parameters were similar. In hypertensives, the IMT (mean-IMT 0.68 mm, M-MAX 0.81 mm) was significantly higher than in controls (mean-IMT 0.60 mm, M-MAX 0.71 mm). FMD was impaired in hypertensives (5.9%) compared with controls (9.2%). In multivariate analyses, it turned out that in hypertensives IMT parameters were related to age, hs-CRP and OPG. Low-density lipoprotein (LDL) cholesterol was the only factor related to FMD. IMT and FMD had no relationship with BP levels. In conclusion, in hypertensives with well-controlled BP, the pro-atherogenic remodelling (IMT) is mainly dependent on age and the inflammatory cytokines, OPG in particular. The functional impairment of the arterial wall (FMD) was related to the levels of LDL cholesterol. Under these conditions, when the impact of BP is minimized, the role of inflammatory cytokines and lipids on structural/functional remodelling becomes predominant.

Aim of this study was to evaluate in a long follow-up the carotid artery remodelling in a cohort of young hypertensive subjects having good blood pressure (BP) control. We studied 20 grade I hypertensives (HT) by assessing the B-mode ultrasound of mean carotid intima-media thickness (mean-IMT) and maximum IMT (M-MAX) in each carotid artery segment (common, bulb, internal), bilaterally. We compared their ultrasound measurements with those recorded 5 and 10 years earlier. While the first 5-year follow-up was observational, in the second 5-year follow-up, lifestyle modifications and/or pharmacological therapy were started to obtain well-controlled BP levels. Office BP was measured at the time of the ultrasound studies and every 6 months during the follow-up. BP levels were: 10 years 144/91 mmHg, 5 years 143/90 mmHg and 129 ± 79 mmHg at the time of the study. In the first 5-year observational follow-up, both mean-IMT and M-MAX increased (Δ 0.116 and Δ 0.165 mm, respectively, p

The objective of this study was to determine the accuracy of the Thermor BIOS BD215 device for home blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension (ESH). Device evaluation was carried out in 33 patients. The mean age of the patients was 57.0 ± 15.0 years, the mean systolic BP was 142.0 ± 20.3 mmHg (range 100-177 mmHg), the mean diastolic BP was 88.0 ± 14.6 mmHg (range 48-123 mmHg), and the mean arm circumference was 28.0 ± 3.0 cm (range 24-33 cm). The protocol requirements were followed precisely. The device passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated the systolic BP by 0.6 ± 4.2 mmHg and underestimated diastolic BP by -0.5 ± 3.2 mmHg. The device-observer discrepancies were unrelated to patients' clinical characteristics. These data show that the Thermor BIOS BD215 device fulfilled the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

Objective:Published evidence has shown that tronco-conical cuffs and bladders should be used for accurate blood pressure (BP) measurement in the obese. Not only arm size but also its shape may affect the accuracy of BP measurement. Aim of this study was to investigate the arm characteristics that ca

The objective of this study was to determine the accuracy of the AD BP UB-542 wrist device for home blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension (ESH).Device evaluation was carried out in 33 patients. The mean age was 50.9±10.1 years, the mean systolic BP was 141.6±22.8 mmHg (range 92 : 189), the mean diastolic BP was 89.2±11.4 mmHg (range 62 : 120), the mean arm circumference was 28.8±3.2 cm (range 23-35), and the mean wrist circumference was 17.1±1.4 cm (range 14-19.5). The protocol requirements were followed precisely.The device passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated the systolic BP by 1.8±7.2 mmHg and diastolic BP by 1.6±5.7 mmHg.These data show that the AD BP UB-542 wrist device met the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

The aim of this study was to investigate the effect of cigarette smoking on peripheral and central blood pressure (BP) in a group of young stage I hypertensives. A total of 344 untreated subjects from the HARVEST study were examined (mean age 37±10 years). Patients were divided into three groups based on smoking status: non-smokers, light smokers (⩽5 cigarettes/day) and moderate-to-heavy smokers (>5 cigarettes/day); and into three groups by age: 18–29, 30–39 and ⩾40 years. Central BP measurements and augmentation index (AIx) were calculated from brachial pressure waveform, with applanation tonometry, by means of the Specaway DAT System plus a Millar tonometer. The central waveform was derived from peripheral BP using the same software system of the SphygmoCor System pulse wave analysis. In addition, two indirect measurements of arterial stiffness were calculated: pulse pressure (PP) and systolic BP amplification. Central systolic BP and PP were higher in smokers than in non-smokers (systolic BP: 121.9±13.1 mmHg in non-smokers, 127.2±16.5 mmHg in light smokers, 126.7±15.3 mmHg in those who smoked >5 cigarettes/day, p=0.009; PP: 37.7±9.8 mmHg, 41.5±13.1 mmHg, 41.9±10.5 mmHg, respectively, p=0.005). Lower systolic BP amplification ( p

Glomerular hyperfiltration predicts development of nephropathy in hypertension but the factors responsible for increased glomerular filtration rate (GFR) are not well known. Aim of this study was to examine which clinical variables influence GFR in the early stage of hypertension.Participants were 1,106 young-to-middle-age hypertensive adults with creatinine clearance60 ml/min/1.73 m(2). Clinic and ambulatory blood pressures (BPs) were measured and the difference between clinic and 24-h systolic BP was defined as the white-coat effect (WCE). In 606 participants, 24-h urinary epinephrine and norepinephrine were also measured. Glomerular hyperfiltration, defined as a GFR ≥150 ml/min/1.73 m(2), was present in 201 subjects.Patients' mean age was 33.1 ± 8.5 years and office BP was 146 ± 10.5/94 ± 5.0 mm Hg. In multivariable linear regression, significant predictors of GFR were younger age (P0.0001), male gender (P0.0001), 24-h systolic BP (P = 0.0001), body mass (P0.0001), WCE (P = 0.02), log-epinephrine (P = 0.01), and coffee use (P0.01). In a logistic model, independent predictors of glomerular hyperfiltration were obesity (odds ratio, 95% confidence interval = 6.1, 3.8-9.8), male gender (2.9, 1.8-4.9), age33 years (2.1, 1.5-3.1), ambulatory hypertension (2.0, 1.4-3.0), WCE15 mm Hg (1.6, 1.1-2.3), heavy coffee use (2.0, 1.1-3.8), and epinephrine25 mcg/24 h (1.9, 1.2-3.1).The novel finding of this study is that hyper-reactivity to stress, as determined by urinary epinephrine level and WCE, and coffee use contribute to determining glomerular hyperfiltration in the early stage of hypertension. Our data may help to identify a subset of patients with glomerular hyperfiltration, who may be at increased risk of chronic kidney disease and may benefit from antihypertensive treatment.

Although the upper arm has the shape of a truncated cone, cylindrical cuffs and bladders are currently used for blood pressure (BP) measurement. The aim of this study was to ascertain whether cylindrical and tronco-conical cuffs provide different readings according to arm size and shape.We studied 220 individuals with arm circumference ranging from 22 to 42.5 cm. Four different cylindrical and four different tronco-conical bladders of appropriate size were used. Sequential same-arm measurements were performed in triplicate by two observers using the two cuffs in a random order. In 100 individuals, the actual pressure transmitted to the arm surface by the two cuffs at the central point was also measured.Upper arm shape was tronco-conical in all of the individuals. In a multiple regression, conicity was related to arm circumference (P 0.001) and length (P = 0.001). Arm conicity and size were independently related to the between-cuff SBP (P = 0.001 and 0.002, respectively) and DBP (P = 0.001 and0.001, respectively) discrepancies. In the group with arm circumference of 37.5-42.5 cm, the cylindrical cuff overestimated BP measured with the tronco-conical cuff by 2.0 ± 0.4/1.8 ± 0.3 mmHg (P = 0.001 and0.001). In this group, 15% of individuals found hypertensive with the cylindrical cuff were normotensive when assessed with the conical cuff. Differences as great as 9.7/7.8 mmHg were found in individuals with large arms and slant angle equal to or less than 83°.In obese people, the upper arm may have a pronounced tronco-conical shape and cylindrical cuffs may overestimate BP. Tronco-conical cuffs should be used for BP measurement in individuals with large arms.

To determine the accuracy of the large-extra large-sized (L-XL) cuff (32-52 cm) coupled to a Microlife WatchBP Office ABI blood pressure measuring device tested according to the requirements of the International Protocol of the European Society of Hypertension. The L-XL cuff tested in this study is designed to provide accurate blood pressure measurements in patients with large arms (arm circumference≥32 cm) over a wide range of arm circumferences using a single 145±1×320±1 mm bladder. The evaluation was made in 33 patients with a mean±standard deviation age of 53±17 years (range: 30-96 years). Their systolic blood pressure (SBP) was 142±21 mmHg (range: 110-180 mmHg), diastolic blood pressure (DBP) was 87±14 mmHg (range: 62-106 mmHg) and arm circumference was 36±5 cm (range: 32-50 cm). Blood pressure measurements were made in the sitting position. The L-XL cuff coupled to the WatchBP Office ABI passed all three phases of the European Society of Hypertension protocol for SBP and DBP. Mean blood pressure differences between device and observer were -1.3±5.1 mmHg for SBP and -1.8±5.8 mmHg for DBP. Similar device-observer differences were observed in patients divided into two subgroups according to whether their arm circumference was above or below the median in the group. These results indicate that the L-XL cuff coupled to the WatchBP Office ABI monitor provides accurate blood pressure readings in patients with large arms over a wide range of arm circumferences.

The objective of this study is to determine the accuracy of the UEBE visomat handy device for blood pressure measurement in the wrist of patients tested according to the requirements of the International Protocol of the European Society of Hypertension (ESH). Device evaluation was done in 33 patients whose age and blood pressure were within the intervals required by the ESH protocol. Their mean±standard deviation age was 53.8±16.5 years (range 30-86 years), systolic blood pressure (SBP) was 143.5±20.2 mmHg (range 110-180 mmHg), diastolic blood pressure (DBP) was 87.4±12.9 mmHg (range 68-110 mmHg), arm circumference was 29.0±3.7 cm (range 21-38 cm), and wrist circumference was 17.3±1.5 cm (range 14.0-21.0 cm). During the measurements, which were taken in a sitting position, the patient's wrist was kept extended at the heart level putting a support under the forearm. In total, 45 measurements were available for analysis in the first phase of the validation process, and 99 measurements in the second phase. The visomat handy device passed all three phases of the ESH protocol for SBP and DBP. Mean blood pressure differences for the visomat handy monitor (device-observer) were -2.0±8.1 mmHg for SBP and -0.9±4.1 mmHg for DBP. These data show that the UEBE visomat handy wrist monitor met the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

Although the upper arm has the shape of a truncated cone, cylindrical cuffs and bladders are currently used for blood pressure (BP) measurement. The aims of this study were to describe upper arm characteristics and to test the accuracy of a standard adult-size conical cuff coupled to an oscillometric device over a wide range of arm circumferences. Arm characteristics were studied in 142 subjects with arm circumferences ranging from 22 to 45 cm (study 1). In a subset of 33 subjects with the same range of arm circumferences, a rigid conical cuff with standard-size bladder (12.6 × 24.0 cm) and a rigid cylindrical cuff (13.3 × 24.0 cm), both coupled to a Microlife BP A100 device, were tested according to the requirements of the protocol of the European Society of Hypertension (ESH; study 2). Study 1. In all subjects, upper-arm shape was tronco-conical with slant angles ranging from 89.5° to 82.2°. In a multiple linear regression analysis, only arm circumference was an independent predictor of conicity (P

The aim of this study was to determine the accuracy of the AD BP UB-543 wrist device for home blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension. The AD BP UB-543 monitor is provided with a correct position guidance (CPG) indicator that ensures the correct placement of the wrist at the heart level. Device evaluation was carried out in 33 patients with the CPG indicator on. The mean age of the patients was 53.1±16.4 years, the mean systolic BP was 141.8±25.1 mmHg (range 84 : 196), the mean diastolic BP was 88.2±14.5 mmHg (range 34 : 132), the mean arm circumference was 29.0±3.6 cm (range 21 : 38), and the mean wrist circumference was 17.5±1.4 cm (range 15 : 20). The protocol requirements were followed precisely. The device passed all requirements, fulfilling the standards of the protocol. On average, the device overestimated the systolic BP by 1.1±2.9 mmHg and underestimated diastolic BP by 0.1±3.0 mmHg. These data show that the AD BP UB-543 wrist device used correctly with the CPG indicator on met the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

Controversy still exists about the long-term cardiovascular and metabolic effects of coffee consumption in hypertension. Aim of the study was to assess the predictive capacity of coffee use for cardiovascular events (CVE) and to ascertain whether the coffee-CVE association was mediated by the long-term effects of coffee on blood pressure (BP) and glucose metabolism. The analysis was made in 1201 participants from the HARVEST, a prospective cohort study of non-diabetic subjects aged 18-45 years, screened for stage 1 hypertension. BP was measured with ambulatory monitoring in all. Among the participants, 26.3% were abstainers, 62.7% were moderate coffee drinkers (1-3 cups/day) and 10.0% were heavy coffee drinkers (>3 cups/day). During a 12.5 year follow-up there were 60 CVE. In multivariable Cox analyses, coffee consumption was a significant predictor of development of hypertension needing treatment with hazard ratios (HR) of 1.5 (CI,1.1-1.9) for heavy drinkers and 1.1 (0.9-1.3) for moderate drinkers compared to abstainers. Also, coffee was a predictor of future prediabetes with HRs of 2.0 (1-3-3.1) and 1.3 (0.9-1.7), in the heavy and moderate drinkers, respectively. In multivariable Cox analyses, including other lifestyle factors, age, sex, parental CVE, BMI, total cholesterol, 24 h ambulatory BP, 24 h ambulatory heart rate and follow-up changes in body weight, both coffee categories were independent predictors of CVE with HRs of 4.3 (1.3-13.9) for heavy coffee drinkers and 2.9 (1.04-8.2) for moderate drinkers. Inclusion of hypertension development in the regression attenuated the strength of the coffee-CVE association with HRs of 3.9 (1.2-12.5) for heavy and of 2.8 (0.99-7.8) for moderate drinkers. When future prediabetes was also incorporated, the relationship was of boderline significance for heavy coffee drinkers (HR, 3.2, 0.94-10.9) and was no longer significant for moderate drinkers (HR, 2.3, 0.8-6.5). Coffee use is linearly associated with increased risk of CVE in stage 1 hypertension. The effect of coffee on CVE seems to be at least partially mediated by its long-term effects on BP and glucose metabolism. Coffee consumption should be reduced in young-to-middle-age patients with hypertension.

The aim of the present study was to investigate the association of physical activity with small artery elasticity in the early stage of hypertension. We examined 366 young-to-middle-age stage 1 hypertensives (mean blood pressure 145.6±10.3/92.5±5.8 mmHg), divided into two categories of physical activity, sedentary ( n=264) and non-sedentary ( n=102) subjects. The augmentation index was measured using the Specaway DAT System. Small artery compliance (C2) was measured by applanation tonometry, at the radial artery, with an HDI CR2000 device. After 6 years of follow-up, arterial distensibility assessment was repeated in 151 subjects. Heart rate was lower in active than in sedentary subjects (71.2±8.9 vs 76.6±9.7 bpm, p

Whether and how coffee use influences glucose metabolism is still a matter for debate. We investigated whether baseline coffee consumption is longitudinally associated with risk of impaired fasting glucose in a cohort of 18-to-45 year old subjects screened for stage 1 hypertension and whether CYP1A2 polymorphism modulates this association. A total of 1,180 nondiabetic patients attending 17 hospital centers were included. Seventy-four percent of our subjects drank coffee. Among the coffee drinkers, 87 % drank 1–3 cups/day (moderate drinkers), and 13 % drank over 3 cups/day (heavy drinkers). Genotyping of CYP1A2 SNP was performed by real time PCR in 639 subjects. At the end of a median follow-up of 6.1 years, impaired fasting glucose was found in 24.0 % of the subjects. In a multivariable Cox regression coffee use was a predictor of impaired fasting glucose at study end, with a hazard ratio (HR) of 1.3 (95 % CI 0.97–1.8) in moderate coffee drinkers and of 2.3 (1.5–3.5) in heavy drinkers compared to abstainers. Among the subjects stratified by CYP1A2 genotype, heavy coffee drinkers carriers of the slow *1F allele (59 %) had a higher adjusted risk of impaired fasting glucose (HR 2.8, 95 % CI 1.3–5.9) compared to abstainers whereas this association was of borderline statistical significance among the homozygous for the A allele (HR 1.7, 95 % CI 0.8–3.8). These data show that coffee consumption increases the risk of impaired fasting glucose in hypertension particularly among carriers of the slow CYP1A2 *1F allele.

The objective of this study was to determine the accuracy of the AD BP UA-651 device for home blood pressure (BP) measurement according to the International Protocol of the European Society of Hypertension. Device evaluation was carried out in 33 patients. The mean age of the patients was 48.3±15.5 years, the mean systolic BP was 138.3±24.9 mmHg (range 90-180), the mean diastolic BP was 88.3±13.8 mmHg (range 60-108), and the mean arm circumference was 28.6±3.4 cm (range 23-36). The protocol requirements were followed precisely. The device passed all requirements, fulfilling the standards of the protocol. On average, the device underestimated the systolic BP by 0.4±4.4 mmHg and diastolic BP by 1.3±3.5 mmHg. The device-observer discrepancies were unrelated to patients' clinical characteristics. These data show that the AD BP UA-651 device fulfilled the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

To examine the impact of overweight and obesity on development of target organ damage in the early stage of hypertension.Participants were 727 young-to-middle-age subjects screened for stage 1 hypertension and followed for 8 years.Ambulatory blood pressure (BP), albumin excretion rate and echocardiographic data were obtained at entry, every 5 years and/or before starting antihypertensive treatment.During the follow-up, hypertension needing treatment was developed by 54.7% of the subjects with normal weight, 66.6% of those with overweight and 73.0% of those with obesity (P0.001). Kaplan-Meier curves showed that patients with obesity or overweight progressed to sustained hypertension earlier than those with normal weight (P0.001). At study end, rate of organ damage was 10.7% in the normal weight, 16.4% in the overweight and 30.1% in the obese subjects (P0.001). In a multivariable logistic regression analysis, overweight (P=0.008) and obesity (P0.001) were significant predictors of final organ damage. Inclusion of changes in 24-h BP and body mass index, and of baseline organ damage did not virtually modify these associations (P=0.002 and0.001, respectively). Obesity was a significant predictor of both left ventricular hypertrophy (P0.001) and microalbuminuria (P=0.015) with an odds ratio (95% confidence interval) of 8.5 (2.7-26.8) and 3.5 (1.3-9.6), respectively.These data indicate that in hypertensive subjects obesity has deleterious effects on the cardiovascular system already at an early age. Preventive strategies addressed to achieve weight reduction should be implemented at a very early stage in young people with excess adiposity and high BP.

The difference between clinic and ambulatory blood pressure (BP) is a poor estimate of the true white-coat effect (WCE) measured with beat-to-beat recording.We investigated whether the difference between clinic and home BP (home WCE) was a better estimate of true WCE than ambulatory WCE. In 73 young hypertensives, ambulatory WCE was calculated as the difference between clinic BP and the mean of two 24-h BP recordings, and home WCE as the difference between clinic and home BP (HBP) measured over 6 months. All individuals underwent beat-to-beat BP monitoring with the Finometer. During the recording, a white-coat test (true WCE) and a public speaking test were performed.Ambulatory WCE correlated with home WCE (P 0.001 for systolic and diastolic BPs). However, both surrogate WCEs were unrelated to true WCE (P = 0.93/0.36 and P = 0.11/0.36, respectively). True WCE correlated with the BP reaction to public speaking (P 0.001/P 0.001), whereas both surrogate WCEs were unrelated to the BP response to this test (all P 0.21). Individuals were divided into two groups according to whether BP response to the doctor's visit was above (WCH+) or below (WCH-) the median. WCH+ patients had similar clinic and ambulatory BPs to WCH- but showed a higher BP response to public speaking.As previously observed for ambulatory WCE, home WCE does not reflect the true BP reaction to doctor's visit. BP response to psychosocial stressors is increased in individuals with hyperreactivity to doctor's measurement but not in individuals with white-coat hypertension identified with either ambulatory or HBP measurement.

The impact of high blood pressure (BP) on target organs (TO) in premenopausal women is not well known. The purpose of this study was to describe gender differences in TO involvement in a cohort of young-to-middle-aged subjects screened for stage 1 hypertension and followed for 8.2 years.Participants were 175 women and 451 men with similar age (range 18-45 years). Ambulatory BP at entry was 127.5±12.5/83.7±7.2 mm Hg in women and 131.9±10.3/81.0±7.9 mm Hg in men. Ambulatory BP, albumin excretion rate (AER), and echocardiographic data (n=489) were obtained at entry, every 5 years, and before starting antihypertensive treatment.Female gender was an independent predictor of final AER (p=0.01) and left ventricular mass index (LVMI) (p0.001). At follow-up end, both microalbuminuria (13.7% vs. 6.2%, p=0.002) and left ventricular hypertrophy (LVH) (26.4% vs. 8.8%, p0.0001) were more common among women than men. In a multivariable Cox analysis, after adjusting for age, lifestyle factors, body mass, ambulatory BP, heart rate, and parental hypertension, female gender was a significant predictor of time to development of microalbuminuria (p=0.002), with a hazard ratio (HR) of 3.06, (95% confidence interval [CI] 1.48-6.34) and of LVH (p=0.004), with an HR of 2.50 (1.33-4.70). Inclusion of systolic and diastolic BP changes over time in the models only marginally affected these associations, with HRs of 3.13 (1.50-6.55) and 3.43 (1.75-6.70), respectively.These data indicate that premenopausal women have an increased risk of hypertensive TO damage (TOD) and raise the question about whether early antihypertensive treatment should be considered in these patients.

To investigate the blood pressure (BP) reaction to public speaking performed according to different emotionally distressing scenarios in stage 1 hypertension. METHODS. We assessed 64 hypertensive and 30 normotensive subjects. They performed three speech tasks with neutral, anger and anxiety scenarios. BP was assessed with the Finometer beat-to-beat non-invasive recording system throughout the test procedure.For all types of speech, the systolic BP response was greater in the hypertensive than the normotensive subjects (all p0.001). At repeated-measures analysis of covariate (R-M ANCOVA), a significant group-by-time interaction was found for all scenarios (p ≤ 0.001). For the diastolic BP response, the between-group difference was significant for the task with anxiety scenario (p0.05). At R-M ANCOVA, a group-by-time interaction of borderline statistical significance was found for the speech with anxiety content (p = 0.053) but not for the speeches with neutral or anger content. Within the hypertensive group, the diastolic BP increments during the speeches with anxiety and anger scenarios were greater than those during the speech with neutral scenario (both p0.001).These data indicate that reactivity to public speaking is increased in stage 1 hypertension. A speech with anxiety or anger scenario elicits a greater diastolic BP reaction than tasks with neutral content.

To determine the accuracy of the WatchBP Office ABI monitor for blood pressure measurement developed by the Microlife Company.The device accuracy was tested in 85 subjects with a mean age of 54 ± 19 years. Their systolic and diastolic blood pressure (SBP/DBP) at entry was 141 ± 30/86 ± 19 mmHg, and upper arm circumference was 28 ± 5 cm. Initially, the data from 33 participants were examined according to the 2002 version of the European Society of Hypertension (ESH) protocol. An additional 52 subjects were then enrolled to fulfill the requirements of the British Hypertension Society (BHS) protocol. In all participants, sequential same arm measurements were performed by two trained observers.The device passed all three phases of the ESH protocol for SBP and DBP. For the BHS protocol the device was graded A for both SBP and DBP. The A/A grade was achieved in the low blood pressure category (130/80 mmHg), the B/A grade in the medium category (130-160/80-100 mmHg) and the A/A grade in the high category (160/100 mmHg). Mean blood pressure difference between device and observers in the first 33 subjects was -0.9 ± 5.5 mmHg for SBP and -2.2 ± 4.5 mmHg for DBP and in the 85 participants it was -1.2 ± 6.5 mmHg and -2.3 ± 5.1, respectively.These data show that the Microlife WatchBP Office ABI monitor satisfied the recommended ESH accuracy levels and achieved A/A grade of the BHS protocol across a wide range of BP.

Background/Aims: Predictors of microalbuminuria in the early stage of hypertension are not well known. We did a prospective study to investigate whether glomerular hyperfiltration assessed from serum cystatin C predicts development of microalbuminuria in hypertension. Methods: We assessed 101 treatment-naive subjects screened for stage 1 hypertension and followed-up for a median 3.1 years. Cystatin C was measured at entry and glomerular filtration rate was estimated using the Hoek formula (CystGFR). Urinary albumin and ambulatory blood pressure were measured at entry and during the follow-up. Results: Subjects in the top CystGFR tertile (>115 ml/min/1.73m2) were leaner (p = 0.002) and developed microalbuminuria more frequently (p = 0.02) than the rest of the group. In univariate Cox regression, CystGFR was associated with future microalbuminuria (hazard ratio, 1.06, 95% confidence interval (CI), 1.02–1.10, p = 0.001). After controlling for baseline albumin excretion rate and several confounders, CystGFR remained a significant predictor of microalbuminuria development (hazard ratio, 1.19, 95% CI, 1.03–1.37, p = 0.019). The association between future microalbuminuria and creatinine clearance or glomerular filtration rate estimated with the Cockroft-Gault or the Modification of Diet in Renal Disease formula did not attain the level of statistical significance in this sample. Conclusions: The present findings indicate that CystGFR is more sensitive than creatinine clearance or estimated glomerular filtration rate for predicting microalbuminuria development in the early stage of hypertension and confirm that hyperfiltration precedes microalbuminuria in this clinical entity.

Objective:For how long subjects with stage 1 hypertension should be followed with lifestyle measures before deciding whether antihypertensive treatment should be started is not well known. The aim of this study was to evaluate whether and to what extent a normal ambulatory (A) blood pressure (BP) ca

Objective: In the majority of hypertensive subjects normofiltration represents a state of preserved renal function. However, previous research has shown that some normofilterers may represent a group of former hyperfilterers with increased risk of microalbuminuria. We did a prospective study to investigate whether in hypertensive normofilterers with former glomerular hyperfiltration, clinical characteristics differ from those of true normofilterers. Design and methods: Creatinine clearance (CrCl) and albumin excretion rate (AER) were measured at entry and after 8.5 years of follow-up, in 534 young-to-middle-age stage 1 hypertensive subjects from the HARVEST (mean age 34.6±8.3 years, 69% men). Glomerular hyperfiltration was defined as a CrCl≥150 ml/min/1.73m2. Baseline ambulatory BP, 24h urinary epinephrine, echocardiographic data, and routine blood tests were also obtained. Results: At follow-up end, 442 participants were normofilterers. Of these, 395 had normal CrCl also at baseline (true normofilterers, Group 1) whereas 47 subjects had a baseline CrCl ≥150 ml/min/1.73m2 (former hyperfilterers, Group 2). Participants of Group 2 had higher age-and-sex-adjusted systolic blood pressure (p=.007) than those of Group 1. In addition, 24h urinary epinephrine (p

Purpose: Aim of this study was to investigate and compare several parameters of arterial distensibility between a group of hypertensives premenopausal women and a group of hypertensive male peers. Methods: We studied 385 stage 1 hypertensives subjects (280 men and 105 women), from the HARVEST study (mean age 38±10 years). Arterial distensibility was evaluated by applanation tonometry. Between-gender differences were adjusted for several confounders, patient were divided into 3 age classes and differences in arterial distensibility parameters were examined with a 2-way ANCOVA using sex and age-class as factors. Results: Despite better metabolic profile and lower systolic blood pressure (BP), women showed lower large (C1) and small artery (C2) compliance, higher augmentation index (AIx) and total peripheral resistance (TPR) than men (all age-adjusted p

Objective: To investigate whether arterial distensibility in hypertensive premenopausal women differs from that observed in men and whether these differences may vary according to age. Methods: We studied 385 young stage 1 hypertensives from the HARVEST study. Arterial distensibility predictors were included in regression analyses. Patients were divided into 3 age classes and differences in arterial distensibility parameters were examined with a 2-way ANCOVA using sex and age-class as factors. Results: Despite better metabolic profile and lower systolic BP, women showed lower large artery (C1) and small artery (C2) compliance, higher augmentation index (AIx) and total peripheral resistances (TPR) than men (all age-adjusted p