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

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

The strategies that people usually use to cope with stressful events, that is, their coping style, may affect blood pressure and cardiovascular functioning. Generally, hypertension is positively associated with emotion-oriented, maladaptive coping strategies and negatively related to task-focused coping styles, but no study has investigated the relationship between coping strategies and the severity of hypertension. This study aimed to assess whether the severity of cardiovascular disorders was associated with specific coping strategies. Participants were selected from the Policlinico Umberto I of the University of Rome "Sapienza." The sample was divided into five groups: (a) healthy people (n = 190); (b) people with untreated hypertension (n = 232); (c) people using antihypertensive medication (n = 158); (d) people using antihypertensive medication with uncontrolled hypertension (n = 179); and (e) people suffering from both hypertension and heart diseases (N = 192). Coping strategies were evaluated with the Coping Inventory for Stressful Situations. One-way ANCOVAs, considering Group as the independent variable and the coping strategies (task-focused, emotion-oriented and avoidance-oriented coping) as dependent variables, showed that individuals affected by both hypertension and heart diseases made less use of task-focused coping strategies than the other groups. These findings confirm the relationship between coping style and hypertension and highlight that patients with hypertension and heart diseases make less use of appropriate coping strategies.

OBJECTIVES: Italy was one of the first countries significantly affected by the coronavirus disease 2019 (COVID-19) epidemic. The Italian Society for Rheumatology promptly launched a retrospective and anonymised data collection to monitor COVID-19 in patients with rheumatic and musculoskeletal diseases (RMDs), the CONTROL-19 surveillance database, which is part of the COVID-19 Global Rheumatology Alliance. METHODS: CONTROL-19 includes patients with RMDs and proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) updated until May 3rd 2020. In this analysis, only molecular diagnoses were included. The data collection covered demographic data, medical history (general and RMD-related), treatments and COVID-19 related features, treatments, and outcome. In this paper, we report the first descriptive data from the CONTROL-19 registry. RESULTS: The population of the first 232 patients (36% males) consisted mainly of elderly patients (mean age 62.2 years), who used corticosteroids (51.7%), and suffered from multi-morbidity (median comorbidities 2). Rheumatoid arthritis was the most frequent disease (34.1%), followed by spondyloarthritis (26.3%), connective tissue disease (21.1%) and vasculitis (11.2%). Most cases had an active disease (69.4%). Clinical presentation of COVID-19 was typical, with systemic symptoms (fever and asthenia) and respiratory symptoms. The overall outcome was severe, with high frequencies of hospitalisation (69.8%), respiratory support oxygen (55.7%), non-invasive ventilation (20.9%) or mechanical ventilation (7.5%), and 19% of deaths. Male patients typically manifested a worse prognosis. Immunomodulatory treatments were not significantly associated with an increased risk of intensive care unit admission/mechanical ventilation/death. CONCLUSIONS: Although the report mainly includes the most severe cases, its temporal and spatial trend supports the validity of the national surveillance system. More complete data are being acquired in order to both test the hypothesis that RMD patients may have a different outcome from that of the general population and determine the safety of immunomodulatory treatments.

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

Introduction: The dipping phenomenon is a physiological drop in blood pressure (around 10&ndash, 20%) during sleep and represents an event related to the circadian blood pressure trend. This phenomenon, in some cases, is characterized by some alterations that can be expressed by an increase (extreme dipping), a decrease (non-dipping), or a reverse (i.e., higher blood pressure during sleep compared to awake state, reverse-dipping) physiological decline of blood pressure. Few studies focused on the association between the circadian variation of blood pressure and psychological variables, although this information could help understanding how psychological characteristics (e.g., emotional regulation or dysregulation) interact with individuals&rsquo, physiological processes. Given the association between emotional dysregulation and essential hypertension, this study aimed to investigate the relationship between alexithymia and dipping status in a sample of healthy and hypertensive adults in the absence of other medical conditions. Methods: Two hundred and ten adults took part in the study and were classified, according to ambulatorial blood pressure measure (ABPM), into three groups: dippers (n = 70), non-dippers (n = 70), and extreme dippers (n = 70). The participants completed a socio-demographic and anamnestic interview and the Toronto Alexithymia Scale-20 (TAS-20). Results: The ANOVAs on the TAS-20 subscales showed that the groups differed in the difficulty identifying feelings and difficulty describing feelings. In both the subscales, dippers showed lower scores than non-dippers and extreme dippers. The ANOVA on the global score of TAS-20 confirmed that dippers were less alexithymic than both extreme dippers and non-dippers. Conclusions: This study confirms that some psychological factors, like alexithymia, could represent a characteristic of patients who fail to exhibit an adaptive dipping phenomenon. Moreover, an association between an excessive reduction of BP (extreme dipping) or a lack of the decrease of BP during sleep (non-dipping) and a worse emotional regulation, considering alexithymia construct, was highlighted for the first time, confirming the relevant role of the emotional process in the modulation of an essential psychophysiological process such as the circadian variation of BP.

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

Introduction: The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. Methods: We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State&ndash, Trait Anger Expression Inventory was used to assess anger. Results: Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. Conclusions: These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon.

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

Background Ultrasonographic alterations such as the halo sign and the compression test are now accepted as surrogate markers of artery inflammation. No data have yet been published on the correlation between the ultrasonographic grading of arterial wall inflammation and the grading of cellular infiltrate. Objectives To compare a semiquantitative ultrasonographic grading (USG) of TA involvement (halo sign and media-intima thickness) with a semiquantitative grading of the inflammatory burden in patients with giant cell (temporal) arteritis (GCA). Methods Fiftheen consecutive patients with new onset clinical symptoms and satisfiing ACR criteria for GCA, with positive halo sign in the frontal branch and positive temporal artery biopsy have been enrolled. For each patients we performed power Doppler ultrasonography of temporal artery with a 18–6 MHz linear probe (Esaote MyLab 70) and measured the maximum halo thickness of TA frontal branch in a quantitative and semiquantitave (0–3) grade of involvement (0 = 0.6). TA biopsy was done in the same frontal branch evalutaed with US. Then we compared the ultrasonographic data with a semiquantitative (0: absent, 1: mild, 2: moderate, 3: severe) grading of the trasmural cellular inflammatory infiltrate and with the intima-media thickness of the TA biopsy specimen. Moreover US results were correlated with the other patterns of histological alterations (giant cells, calcifications, laminar necrosis). Correlation between variables was done by Rho of Spearman method. Results 15 patients, 6 males and 9 females (mean age 71.6±7 years – duration symptoms at onset 1.7±1.3 months – mean ESR 60 mm/h ±29 – mean CRP 8 mg/dl ± 5.2) entered the study. US halo sign was bilateral in 10/15 (66,7%). The mean halo thickness was 0.53 mm ± 0.12. Five patients had USG =1, six patients =2 and four patients =3. The hystological inflammatory grade 1 was present in seven pts, grade 2 in four and grade 3 in four pts. No significant correlation were found between USG and histological inflammatory grade, nor with the presence of giant cells, calcifications, laminar necrosis and intima-media thickness. Conclusions No correlation has been found between the size of the halo sign and the hystological inflammatory grading. Disclosure of Interest None declared

To assess the findings of contrast-enhanced ultrasound (CEUS) of carotid arteries in patients with large vessel vasculitis (LVV) and to compare them with those observed usingA total of 31 consecutive patients with LVV (14 with Takayasu arteritis, 17 with giant cell arteritis with large vessel involvement) underwent both PET/computed tomography and carotid artery color Doppler ultrasound (CDUS) for a total of 35 combined assessments. Right carotid artery CEUS was performed after CDUS in all assessments. Kerr's criteria, a complete clinical examination, and acute phase reactants were simultaneously evaluated. The intensity of vascular uptake and vascularization of the carotid artery wall were compared.TenCarotid CEUS vascularization grade and the grade of vascular inflammation on

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

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

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

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

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

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

Background: The common physiological response to pain stimuli includes an increase in blood pressure (BP); however, hypoalgesia has been postulated in patients with stable high BP values.

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

The aim of this study was to evaluate the antihypertensive efficacy and duration of action of amlodipine and nitrendipine by means of 24-hour ambulatory blood pressure monitoring. 35 patients with mild to moderate arterial hypertension, aged 36 to 64 years, were enrolled in a randomised 24-week crossover study. After a 2-week run-in period, patients with confirmed hypertension (diastolic blood pressure 95 to 115mm Hg) were randomised to treatment with either amlodipine 5mg or nitrendipine 20mg once daily, with dosage adjustment (to amlodipine 10mg and nitrendipine 40mg once daily) permitted after the second week if blood pressure control (diastolic pressure < 90mm Hg) was not achieved. After 12 weeks of therapy, the 2 subgroups crossed over to the alternative treatment. Active treatment was continued for a further 12 weeks, with dosage adjustment permitted after the second week, as previously. Ambulatory blood pressure monitoring was performed at the end of the run-in period and after 12 weeks of each phase of treatment. Systolic blood pressure, measured by standard mercury sphygmomanometry, decreased significantly by a mean of 23.4mm Hg and 19.6mm Hg after 12 weeks’ treatment with amlodipine and nitrendipine, respectively; diastolic blood pressure decreased significantly by 18.4mm Hg and 14.0mm Hg with amlodipine and nitrendipine, respectively. Heart rate was unchanged. Ambulatory blood pressure monitoring showed a significant blood pressure reduction when evaluated in a descriptive time-fixed way, with means and standard deviations calculated every hour after the end of the 2 treatments, and in a qualitative way through Fourier analysis. The blood pressure reduction was confirmed by the decrease in the mean level parameter obtained through Fourier analysis, while clinically insignificant changes in the phase, amplitude and speed variables, indicative of unaltered circadian rhythm, were reported during treatment with both drugs. Both amlodipine and nitrendipine were shown to exert appreciable antihypertensive activity, which persisted over the 24-hour dose interval and was sustained for the study duration. Dosage increment after the second week of therapy was required less often with amlodipine (43.0% of patients) than with nitrendipine (62.9%).

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

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

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

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

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

The 24 h periodic pattern of blood pressure was studied in 44 patients with diabetes mellitus (14 type 1, 30 type 2; mean duration of disease 6.5 +/- 1.8 years) in good metabolic control but with abnormal cardiovascular reflex responses; of these 21 were normotensive and 23 hypertensive. All had abnormal responses to at least two out of four tests: deep breathing, lying to standing, Valsalva manoeuvre and postural hypotension. Two sex- and age-matched groups, consisting of 20 normotensive and 20 hypertensive diabetic patients without dysautonomia, were studied as controls. Each patient underwent ambulatory blood pressure monitoring for at least 24 h, using an auscultatory automatic device. Data were analysed using the sum of three periodic functions (Fourier partial sum). In the diabetic normotensive groups, the absolute blood pressure fell to its night-time minimum more rapidly, and increased to its morning maximum more slowly, in those with abnormal cardiovascular reflexes than in the controls (nightly blood pressure decrease -5.8/-4.7 vs. -3.8/-4.0 mmHg/h; increase 4.7/3.6 vs. 5.9/6.1 mmHg/h). The same behaviour was found in both hypertensive groups but the amplitude of the differences was more marked (blood pressure nocturnal decrease -7.7/-7.1 vs. -4.3/-3.9 mmHg/h; increase 3.2/2.1 vs. 5.8/4.3 mmHg/h). This analysis of 24 h ambulatory blood pressure data may be of value in diagnosis and evaluation of autonomic deficits.

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

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

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

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

Aim of this study was to analyse the relationship between the plasma levels of polyphenols and the antioxidant activity of red and white wine. Twenty healthy subjects (HS) were randomly allocated to drink 300 ml of red (n = 10) or white n = 10 wine for 15 days. Ten HS who refrained from any alcohol beverage for 15 days were used as control. Urinary PGF-2-III, a marker of oxidative stress and plasma levels of polyphenols were measured. Urinary PGF-2-III significantly fell in subjects taking wine with a higher percentage decrease in subjects given red wine (−38.5 ± 6%, p < 0.001) than in those given white wine (−23.1 ± 6%). Subjects taking red wine had higher plasma polyphenols than those taking white wine (1.9 ± 0.6M versus 1.5 ± 0.33M, p < 0.001). Plasma polyphenols were inversely correlated with urinary PGF2 (r = 0.77, p < 0.001). No changes of urinary isoprostanes were observed in subjects who refrained from wine intake. In vitro study demonstrated that only a mixture of polyphenols, all in a range corresponding to that found in human circulation, inhibited LDL oxidation and PKC-mediated NADPH oxidase activation. Such inhibitory effects were more marked using the concentrations of polyphenols detected in human circulation after red wine intake. This study shows that red wine is more antioxidant than white wine in virtue of its higher content of polyphenols, an effect that may be dependent upon a synergism among polyphenols. © 2005 Elsevier Ireland Ltd. All rights reserved.

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

Twelve to twenty-five percent of human population suffer from sleep disorders and sleep-related breathing disorders have a frequency of 5-10%. The association between sleep-related breathing disorders and several diseases, mainly cardiovascular and dysmetabolic, is well known. The aim of this study was to assess the prevalence of this association in a group of 620 patients, aged between 18 and 78 years and referred to the Laboratory of Respiratory Pathophysiology of the Umberto I Hospital of Rome. All patients had a clinical history of a sleep-related breathing disorder and answered a specific questionnaire. One-hundred-and-thirty-seven patients (120 males and 17 females, mean age 64 years), whose questionnaire was suggestive of a sleep-related breathing disorder, underwent clinical assessment including blood tests, lung function tests, blood-gas analysis, ECG and nocturnal polysomnography, either as in- or as out-patients. The main associated pathologies were: arterial hypertension (54.7%), chronic obstructive pulmonary disease (17.9%), obesity (63.1%), dyslipidemia (41%), type 2 diabetes mellitus (6.3%), gastroesophageal reflux (27.3%) and cardiac arrhythmias (4.2%); 95 patients with obstructive sleep apnea syndrome were treated, on the basis of the polysomnography outcomes and according to the Italian Association of Sleep Medicine Guidelines, either with preventive strategies for risk factor reduction, or with medical (positive pressure ventilation, oxygen, assessment of the best drug medication) and/or ear, nose end throat surgical therapies. In most patients, the improvement in the sleep-related breathing disorder was associated with an improvement in their systemic pathology, in particular cardiovascular disease, suggesting the need of a deeper consideration and comprehension of nocturnal apneas.