Search

Cardiovascular disease (CVD) remains the most prevalent cause of premature death worldwide. It had been suspected for decades that increased activity of the sympathetic nervous system (SNS) might play a pathogenetic role in the development and progression of hypertension, heart failure (HF) and CVD. The use of microneurographic techniques to directly assess the SNS has allowed this field to advance considerably in recent years. We now have compelling evidence for a key role of sympathetic overactivity in the pathogenesis and progression of hypertension and associated hypertension-mediated organ damage (such as endothelial dysfunction, arterial stiffness and left ventricular hypertrophy), HF (with or without reduced left ventricular ejection fraction). Sympathetic overactivity also drives increased cardiovascular risk in the settings of obesity, metabolic syndrome, chronic kidney disease and obstructive sleep apnoea, among other conditions. Thus, sympathetic overactivity is an important factor that drives patients through the CVD continuum, from the early appearance of cardiovascular risk factors, to impairments of the structure and function of components of the heart and arteries, to established CVD, and ultimately to a life-threatening cardiovascular event. A deeper understanding of the role of sympathetic overactivity in the pathogenesis of CVD and HF will support the optimization of therapeutic interventions for these conditions. [ABSTRACT FROM AUTHOR]

This article discusses the role of baroreceptors in heart failure and the potential for device-based neuromodulation as a therapeutic intervention. Baroreflex dysfunction is a common feature of heart failure and is associated with adverse clinical outcomes. Various interventions, including exercise training and certain medications, have been shown to improve baroreflex function and clinical symptoms in heart failure patients. The article focuses on baroreceptor activation therapy (BAT) as a device-based approach to target baroreflex dysfunction. A recent study evaluated the long-term outcomes of BAT in heart failure patients and found that while it improved functional status and quality of life, it did not significantly impact cardiovascular mortality or heart failure-related morbidity. The article suggests that the timing of the intervention and the limitations of current treatments may contribute to the lack of significant improvement in these primary endpoints. Overall, the article provides an update on the effects of BAT in heart failure and highlights the complexities of device-based approaches in addressing baroreflex dysfunction. [Extracted from the article]

Introduction: Hypertension is the biggest contributor to the global burden of cardiovascular diseases and related death, but the rates of hypertension awareness, treatment, and control remain largely perfectible. Methods: During the XVII World Hypertension Day (May 17th, 2021), a nationwide cross-sectional opportunistic study endorsed by the Italian Society of Hypertension was conducted on volunteer adults ≥ 18 years to raise awareness of high blood pressure (BP). A questionnaire on major demographic/clinical features (sex, age, employment, education, BP status awareness, hypertension family/personal history, antihypertensive medications use) and BP measurement habits (≥1 BP measurement in the previous month/week) was administered. Due to the ongoing SARS-CoV-2 pandemic, BP was measured with standard procedures in a subset of participants (24.4%). Results: A total of 1354 participants (mean age 56.3 ± 15.3 years; 57.3% women; mean BP: 131.2 ± 17.5/81.6 ± 10.5 mmHg; 42.3% self-declared hypertensive; 41.4% on antihypertensive medications) were enrolled; 73.6% declared being aware of their BP status. Among treated individuals with measured BP, 26.9% showed BP levels within the predefined therapeutic goals. Interestingly, BP status awareness rates were the highest among individuals with uncontrolled hypertension (85.1%) and the lowest among those with normal measured BP (54.4%). Conclusions: This survey provides an updated insight into hypertension awareness and control in a setting of daily clinical practice, emphasizing the centricity of patients in the therapeutic alliance for a successful reduction of cardiovascular risk. [ABSTRACT FROM AUTHOR]

The sympathetic nervous system overdrive occurring in heart failure has been reported for more than half a century. Refinements in the methodological approaches to assess human sympathetic neural function have allowed during recent years to better define various aspects related to the neuroadrenergic alteration. These include (i) the different participation of the individual regional sympathetic cardiovascular districts at the process, (ii) the role of the central nervous system in determining the neuroadrenergic overdrive, (iii) the involvement of baroreflex, cardiopulmonary reflex, and chemoreflex mechanisms in the phenomenon, which is also closely linked to inflammation and the immune reaction, (iv) the relationships with the severity of the disease, its ischaemic or idiopathic nature and the preserved or reduced left ventricular ejection fraction, and (v) the adverse functional and structural impact of the sympathetic activation on cardiovascular organs, such as the brain, the heart, and the kidneys. Information have been also gained on the active role exerted by the sympathetic activation on the disease outcome and its potential relevance as a target of the therapeutic interventions based on non-pharmacological, pharmacological, and invasive approaches, including the renal denervation, the splanchnic sympathetic nerve ablation, and the carotid baroreflex stimulation. The still undefined aspects of the neurogenic alterations and the unmet goals of the therapeutic approach having the sympathetic activation as a target of the intervention will be finally mentioned. [ABSTRACT FROM AUTHOR]

The primary and secondary prevention strategies of atherosclerotic cardiovascular disease (ASCVD) largely rely on the management of arterial hypertension and hypercholesterolemia, two major risk factors possibly linked in pathophysiological terms by the renin-angiotensin system activation and that often coexist in the same patient synergistically increasing cardiovascular risk. The classic pharmacologic armamentarium to reduce hypercholesterolemia has been based in the last two decades on statins, ezetimibe, and bile acid sequestrants. More recently numerous novel, additive resources targeting different pathways in LDL cholesterol metabolism have emerged. They include drugs targeting the proprotein convertase subtilisin/kexin type 9 (PCSK9) (inhibitory antibodies; small-interfering RNAs), the angiopoietin-like protein 3 (inhibitory antibodies), and the ATP-citrate lyase (the inhibitory oral prodrug, bempedoic acid), with PCSK9 inhibitors and bempedoic acid already approved for clinical use. With the potential of at least halving LDL cholesterol levels faster and more effectively with the addition of ezetimibe than with high-intensity statin alone, and even more with the addition of the novel available drugs, this document endorsed by the Italian Society of Hypertension proposes a novel paradigm for the treatment of the hypertensive patient with hypercholesterolemia at high and very high ASCVD risk. Our proposal is based on the use as a first-line of a preferably fixed combination of lipid-lowering drugs, under the motto "Our goal: achieve control. No setback: combine and check". [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea is a frequent finding in clinical practice especially with the obesity epidemic and the growing awareness of sleep-disordered breathing as a potential and treatable risk factor for cardiovascular diseases. It frequently coexists undiagnosed activating pathophysiological mechanisms known to participate in development and progression of cardiovascular diseases and resistance to therapeutical strategies. The sympathetic activation and the baroreflex and chemoreflex impairment appear to be the main pathophysiological factors that activating several mechanisms elicit cardiac and vascular damage. Data from cross-sectional population-based studies, prospective studies and meta-analysis have clearly shown the implication of OSA in the development of the hypertensive state and the benefits obtained by continuous positive airway pressure on daytime blood pressure and cardiovascular risk. [ABSTRACT FROM AUTHOR]

Finally, Ram and colleagues emphasize the relevance of hyperinsulinemia, and of the related insulin resistance, as trigger of the metabolic syndrome-related sympathetic overdrive. Dr Ram and colleagues [[1]] write a challenging letter focused on different pathophysiological and clinical aspects of the sympathetic overdrive characterizing the metabolic syndrome. [Extracted from the article]

Hypertension is a major contributor to fatal/nonfatal cardiovascular diseases, and timely identification and appropriate management of factors affecting hypertension and its control are mandatory public health issues. By inducing neurohormonal alterations and metabolic impairment, sleep disorders have an impact on a variety of cardiovascular risk factors, including hypertension, and ultimately increase the risk of cardiovascular events. There is evidence that qualitative and quantitative sleep disorders are associated with resistant hypertension and with impaired circadian blood pressure variations. However, sleep disturbances are often unrecognized, or heterogeneity exists in their management by non-specialists in the field. This document by the Italian Society of Hypertension summarizes the updated evidence linking sleep disorders to hypertension and cardiovascular diseases, the major underlying mechanisms, and the possible management strategies. A simplified, evidence-based diagnostic and therapeutic algorithm for comorbid hypertension and common sleep disorders, namely obstructive sleep apnoea and insomnia, is proposed. [ABSTRACT FROM AUTHOR]

The COVID-19 infection has rapidly spread around the world and a second wave is sweeping in many countries. Different clinical and epidemiological aspects characterize the disease and their understanding is necessary to better face the management of the pandemic in progress. The Italian society of arterial hypertension with the SARS-RAS study has contributed significantly to the knowledge of the interaction between inhibition of the renin-angiotensin system and COVID-19 infection. Furthermore, the study results help to understand some of the main aspects related to mortality and morbidity deriving from the infection through a multicentre analysis throughout the national territory. [ABSTRACT FROM AUTHOR]

Indirect and direct approaches to assess sympathetic neural function in man have shown that congestive heart failure is characterized by a marked adrenergic overdrive. Although compensatory in the initial phases of the disease, with time the sympathetic overactivity exerts adverse cardiovascular effects, favoring the disease progression and promoting the occurrence of non-fatal and fatal cardiovascular events. This explains why the adrenergic overactivity has become an important target of the therapeutic interventions adopted in the managementof the disease. The present paper will examine the impact of therapeutic approaches, used in the management of heart failure, on the sympathetic activation characterizing the disease. After a brief mention of the sympathetic effects of non-pharmacological interventions and procedural approches, particular emphasis will be given to the effects of pharmacological interventions and device treatments (renal denervation and carotid baroreceptor stimulation), which became in recent years a promising tool for the management of the disease. The clinical implications as well as the unsolved aspects related to the sympathomodulatory interventions in heart failure management will be finally discussed. • Sympathetic activation characterizes heart failure worsening prognosis. • Drugs currently employed in the treatment of the disease may affect the sympathetic overactivity. • Device-based interventions have been shown to exert favorable effects on sympathetic overactivity. [ABSTRACT FROM AUTHOR]

Background: The global rate of intensive care unit (ICU) admission during the COVID-19 pandemic varies within countries and is among the main challenges for health care systems worldwide. Conflicting results have been reported about the response to coronavirus infection and COVID-19 outcomes in men and women. Understanding predictors of intensive care unit admission might be of help for future planning and management of the disease. Methods and findings: We designed a cross-sectional observational multicenter nationwide survey in Italy to understand gender-related clinical predictors of ICU admission in patients with COVID-19. We analyzed information from 2378 charts of Italian patients certified for COVID-19 admitted in 26 hospitals. Three hundred ninety-five patients (16.6%) required ICU admission due to COVID19 infection, more frequently men (74%), with a higher prevalence of comorbidities (1,78±0,06 vs 1,54±0,03 p<0.05). In multivariable regression model main predictors of admission to ICU are male gender (OR 1,74 95% CI 1,36–2,22 p<0.0001) and presence of obesity (OR 2,88 95% CI 2,03–4,07 p<0.0001), chronic kidney disease (OR: 1,588; 95%, 1,036–2,434 p<0,05) and hypertension (OR: 1,314; 95% 1,039–1,662; p<0,05). In gender specific analysis, obesity, chronic kidney disease and hypertension are associated with higher rate of admission to ICU among men, whereas in women, obesity (OR: 2,564; 95% CI 1,336–4.920 p<0.0001) and heart failure (OR: 1,775 95% CI: 1,030–3,057) are associated with higher rate of ICU admission. Conclusions: Our study demonstrates that gender is the primary determinant of the disease's severity among COVID-19. Obesity is the condition more often observed among those admitted to ICU within both genders. Trial registration: Clinicaltrials.gov: NCT04331574. [ABSTRACT FROM AUTHOR]

Background: An increasing number of observational studies combine large sample sizes with low participation rates, which could lead to standard inference failing to control the false-discovery rate. We investigated if the 'empirical calibration of P-value' method (EPCV), reliant on negative controls, can preserve type I error in the context of survival analysis.Methods: We used simulated cohort studies with 50% participation rate and two different selection bias mechanisms, and a real-life application on predictors of cancer mortality using data from four population-based cohorts in Northern Italy (n = 6976 men and women aged 25-74 years at baseline and 17 years of median follow-up).Results: Type I error for the standard Cox model was above the 5% nominal level in 15 out of 16 simulated settings; for n = 10 000, the chances of a null association with hazard ratio = 1.05 having a P-value < 0.05 were 42.5%. Conversely, EPCV with 10 negative controls preserved the 5% nominal level in all the simulation settings, reducing bias in the point estimate by 80-90% when its main assumption was verified. In the real case, 15 out of 21 (71%) blood markers with no association with cancer mortality according to literature had a P-value < 0.05 in age- and gender-adjusted Cox models. After calibration, only 1 (4.8%) remained statistically significant.Conclusions: In the analyses of large observational studies prone to selection bias, the use of empirical distribution to calibrate P-values can substantially reduce the number of trivial results needing further screening for relevance and external validity. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity, including overweight, continues increasing worldwide affecting health expectancy, quality of life and healthcare expenditure. These subjects have higher probability of suffering or developing cardio metabolic risk factors. Recent studies have revealed cardiorespiratory fitness (CRF) as a valuable clinical parameter to identify these subjects and have even suggested cut-off values. However, evaluating CRF in overweight and obese youth can be difficult to implement, unfriendly and expensive. Objective: Develop a screening tool to identify high-risk subjects in a representative population of those attending overweight/obesity assessment programmes without prior intervention. It will be based on heart rate variability parameters, which has strong association with CRF and cardio metabolic risk factors. Methods: Sixty-three subjects, overweight and obese, between 9 and 17 years of age, and of both sexes were enrolled. None of them had secondary obesity syndromes and/or suffered from acute or chronic disease. Anthropometric parameters, electrocardiogram signal recording under resting conditions and cardiorespiratory fitness – evaluated by oxygen consumption and time elapsed of cardiopulmonary exercise test – were measured. Results: Significant differences in the sympathetic nervous system activity – assessed by heart rate variability analysis – are observed when grouping by overweight and obesity degree as well as by CRF (poor/normal). Body mass index, puberty and sympathetic nervous system activity are the significant variables of a logistic regression model develop to identify poor CRF individuals. Its accuracy reaches 92%. Conclusions: A screening tool based on heart rate variability and anthropometric parameters was developed to identify subjects with higher probability of suffering or developing cardio metabolic risk factors. [ABSTRACT FROM AUTHOR]

First, evidence has been provided that not all congestive heart failure patients display a sympathetic overdrive, defined by values of muscle sympathetic nerve traffic greater than the 95th percentile above the normal range. In other words, future prospective studies should investigate whether heart failure patients displaying an almost normal sympathetic cardiovascular drive are characterized by a cardiovascular risk, in terms of cardiovascular fatal and non-fatal events, lower than the one detected in patients showing pronounced neuroadrenergic overactivity. B This article refers to 'Normal and excessive muscle sympathetic nerve activity in heart failure: implications for future trials of therapeutic autonomic modulation' by M.B. Badrov I et al i ., published in this issue on pages 201-210. b Indirect and direct approaches to investigate sympathetic neural activity in patients suffering from congestive heart failure of different aetiologies have provided unequivocal evidence that the neuroadrenergic influences to the heart and the peripheral circulation are remarkably activated in this clinical condition.[[1], [3]] This has been originally documented about 45 years ago through the assay of urinary and/or plasma levels of the adrenergic neurotransmitter norepinephrine.[4] This finding has been confirmed in the following years by more sophisticated and elegant approaches to investigate sympathetic neural function, namely the norepinephrine radiolabelled technique, the neuroimaging of cardiac sympathetic innervation as well as the direct microneurographic recording of efferent post-ganglionic muscle sympathetic nerve traffic.[2] Altogether these techniques have allowed to determine that heart failure is characterized by a marked sympathetic overactivity involving both the central and peripheral (cardiac and renal in particular) neural ouflow, representing a hallmark of the heart failure state. [Extracted from the article]

Background: Extensive clinical experience on metoprolol has been gained in different cardiovascular conditions.Review: This paper discusses the use of metoprolol, with a focus on the extended-release formulation, in clinical practice in the light of existing evidence and current recommendations. This is a narrative review based on existing evidence and clinical experience of the author. Evidence on the use of metoprolol in heart failure, ischemic artery disease, arterial hypertension, and atrial fibrillation is well-established.Conclusions: Metoprolol still appears to be a suitable pharmacological option in different cardiovascular conditions. Research on this molecule is still active and new, promising settings of use are being explored and may provide relevant results in the years to come. [ABSTRACT FROM AUTHOR]

If hyperuricemia is an independent risk factor in blood-pressure control, urate-lowering therapy should be used to reduce cardiovascular risk. It may also act as a prognostic marker of other abnormalities. This review presents current evidence on the relationship between hyperuricemia and hypertension. [ABSTRACT FROM AUTHOR]

Calcium channel blockers (CCBs), particularly dihydropyridine-CCBs, (DHP-CCBs), have an established role in antihypertensive therapy, either as monotherapy or in combination with other antihypertensive drugs. Two hundred and fifty-one papers published in PubMed in English between January 1, 1990 and October 31, 2016, were identified using the keyword "lercanidipine". Lercanidipine is a lipophilic third-generation DHP-CCB, characterized by high vascular selectivity and persistence in the smooth muscle cell membranes. Lercanidipine is devoid of sympathetic activation and unlike the first and second generation of DHP-CCBs, it dilates both the afferent and the efferent glomerular arteries, while preserving the intraglomerular pressure. In addition, lercanidipine prevents renal damage induced by angiotensin II and demonstrates anti-inflammatory, antioxidant and anti-atherogenic properties through an increasing bioavailability of endothelial nitric oxide. It is associated with a regression of microvascular structural modifications in hypertensive patients. The efficacy of lercanidipine has been demonstrated in patients with different degrees of hypertension, in the young and elderly and in patients with isolated systolic hypertension. In patients with diabetes and renal impairment, lercanidipine displays a renal protection with a significant decrease of microalbuminuria and improvement of creatinine clearance. Lercanidipine is well tolerated and is associated with a very low rate of adverse events, particularly ankle edema, compared with amlodipine and nifedipine. In conclusion, lercanidipine produces a sustained blood pressure-lowering activity with a high rate of responder/normalized patients, associated with a favorable tolerability profile. [ABSTRACT FROM AUTHOR]

Obesity and in particular the excessive visceral fat distribution is accompanied by several alterations at hormonal, inflammatory and endothelial level. These alterations induce a stimulation of several other mechanisms that contribute to the hypertensive state and on the other side to increase the cardiovascular morbidity. In these chapter we will examine the main mechanisms of obesity and obesity-related hypertension and in particular the role of sympathetic nervous system, the alterations of the renal function and at the microvascular level. We will also depict the role of insulin resistance as factor stimulating and potentiating the other mechanisms. The second part will be focalized on the major target organ damage linked with obesity and obesity-related hypertension. We will finally describe the management and treatment of obesity and the antihypertensive drug therapies more effective in hypertensive obeses. [ABSTRACT FROM AUTHOR]

There is an error in the third sentence of the second paragraph of the Introduction section of this article [[1]]. As such, the authors provide revised wording for the first sentence of the Conclusions section of the Abstract, and the first sentence of the Conclusions section of the Discussion. [Extracted from the article]

Experimental and clinical studies have clearly shown the role of the sympathetic nervous system in the pathophysiology of several cardiovascular and non-cardiovascular diseases. This short review will be aimed at focusing and discussing the new information collected on two specific clinical conditions such as obesity and metabolic syndrome. The paper will briefly describe the four main mechanisms that represent the common link between these two pathophysiological conditions and that through the sympathetic nervous system contribute to increase the cardiovascular risk. [ABSTRACT FROM AUTHOR]

Diabetic nephropathy represents a condition frequently detected in current clinical practice characterized by a very high cardiovascular risk profile. Blood pressure reduction via antihypertension drug treatment represents a therapeutic approach capable of exerting favorable effects on renal and cardiovascular outcomes. The purpose of this article is to review the current literature and results of key clinical trials pertaining to blood pressure goals of antihypertension treatment in these patients. The pros and cons of a less or a more intensive blood pressure goal in diabetic nephropathy will be discussed, with particular emphasis on the cardiovascular and renal effects of each therapeutic strategy. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) has been measured as office BP, usually taken after 5 min of quiet rest, in all clinical outcome trials in hypertension until recently, when the Systolic Blood Pressure Intervention Trial (SPRINT) was carried out. The authors concluded that the status of BP control should be confirmed using out-of-office BP measurements, even when using unattended-AOBP as a clinical BP reference in high-risk patients. Unattended blood pressure measurements in the systolic blood pressure intervention trial: implications for entry and achieved blood pressure values compared with other trials. [Extracted from the article]

Orthostatic hypertension is a condition where blood pressure increases to hypertensive levels when standing up. It is associated with increased cardiovascular morbidity and mortality. However, there has not been a uniform definition for orthostatic hypertension, making it difficult to interpret data on its epidemiology and management. An international expert panel has proposed definitions for an exaggerated orthostatic pressor response and orthostatic hypertension, which can help in diagnosing and studying the condition. Further research is needed to understand the mechanisms, epidemiology, and clinical management of orthostatic hypertension. [Extracted from the article]

Background The sympathetic nervous exerts a key role in cardiovascular homeostasis control by regulating cardiac output, systemic vascular resistance, heart rate and blood pressure. Materials and methods Data collected during the past 30 years have unequivocally shown that in a considerable number of cardiovascular as well as noncardiovascular disease there is a marked activation of the sympathetic nervous system which exerts in the long-term period unfavourable haemodynamic, metabolic, cardiovascular and renal effects. Results This paper will review the current knowledge on the alterations in sympathetic function described in cardiovascular disease, with particular focus on hypertension, heart failure and myocardial infarction. Conclusions The consequences of the phoenomenon will be discussed together with its therapeutic implications. This will be done by examining the impact of nonpharmacological as well as pharmacological interventions on sympathetic cardiovascular drive. The effects of new invasive approaches, such as carotid baroreceptor stimulation as well as renal nerves ablation, will be also briefly discussed. [ABSTRACT FROM AUTHOR]

A significant number of hypertensive subjects fail to achieve adequate blood pressure control despite adherence to maximal doses of several antihypertensive drugs. In the same way although medical and device therapies continue to improve the clinical course of heart failure patients, morbidity, mortality and healthcare costs remain high. Electrical stimulation of the carotid sinus is a new interesting approach for the treatment of resistant hypertension and heart failure. The purpose of this paper is to overview the argument starting from physiological background and evaluating the clinical results obtained with this approach in these pathophysiological conditions. [ABSTRACT FROM AUTHOR]

Introduction: Physicians and researchers in the cardiovascular field are constantly engaged in the promotion of guidelines-directed preventive measures, but whether they are themselves adherent to the same recommendations was only sporadically examined. Aim: To assess awareness of self-exposure to cardiovascular risk factors and related management among cardiovascular specialists. Methods: During the National Conference of the Italian Society of Hypertension (October 2022), a pilot observational study on consecutive volunteer cardiovascular specialists was conducted. Participants underwent standard sitting and standing blood pressure (BP) measurements and answered a questionnaire regarding modifiable/non modifiable cardiovascular risk factors and related treatments. Based on self-declarations and actual measurements, BP was classified as optimal, normal, high-normal BP, and new hypertension in untreated participants, and as treated/untreated pre-existing hypertension. Controlled hypertension was defined as BP < 140/90 mmHg; age-adjusted lower targets were also applied, according to guidelines. Results: In total, 62 participants (30 F, mean age 43.2 ± 14.8 years) were enrolled; 79% reported regular physical activity; 53% of women and 38% of men were on a low-salt diet. After smoke (19.4%), dyslipidemia was the second most common risk factor (17.7%), often occurring with high BP (26.3%) and left untreated (36.7%). Pre-existing hypertension (11.3%) was often uncontrolled (57.1%) and associated with non-adherence to guidelines-directed lifestyle recommendations. About one in 12 participants was unaware of having high measured BP values. Conclusions: Despite the specific professional exposure, a margin for improvement in self cardiovascular risk factors awareness and management remains in this exploratory sample of cardiovascular specialists. This pilot research anticipates forthcoming, larger studies during national and international conferences. [ABSTRACT FROM AUTHOR]

Background: An increase in sympathetic drive to the heart and the peripheral circulation characterizes mild and severe essential hypertension. However, it remains unsettled whether sympathetic cardiovascular influences are potentiated in true resistant hypertension (RHT). Methods: In 32 RHT patients treated with 4.6 ± 0.3 drugs (mean ± SEM) and aged 58.6 ± 2.1 years, 35 non-resistant treated hypertensives (HT) and 19 normotensive controls (NT), all age-matched with RHT, we measured clinic, 24-hour ambulatory and beat-to-beat blood pressures (BP), heart rate (HR, EKG), muscle sympathetic nerve traffic (MSNA, microneurography) and spontaneous baroreflex MSNA-sensitivity. Results: BP values were markedly greater in RHT patients than in NT and HT (172.2 ± 1.7/100.7 ± 1.2 vs 132.1 ± 1.3/82.1 ± 0.9 and 135.5 ± 1.2/83.6 ± 0.9 mm Hg, P < 0.01). This was paralleled by a significant and marked increase in MSNA (87.8 ± 2.0 vs 46.8 ± 2.6 and 59.3 ± 1.7 and bursts/100 heartbeats, P < 0.01). In multiple regression analysis the MSNA increase observed in RHT was significantly related to hemodynamic, hormonal and metabolic variables. It was also significantly related to plasma aldosterone values as well as spontaneous baroreflex MSNA-sensitivity, which were the variables that at the multivariate analysis were more closely related to the adrenergic activation of RHT after adjustment for confounders, including antihypertensive treatment (r²partial = 0.04405 and r²partial = 0.00878, P < 0.05 for both). Conclusions: These data represent the first evidence that RHT is a state of marked adrenergic overdrive, greater for magnitude than that detectable in HT. They also suggest that impaired baroreflex mechanisms, along with hemodynamic and neurohumoral factors, may be responsible for the phenomenon. [ABSTRACT FROM AUTHOR]

Evidences collected in the past few years have strengthened the concept that the sympathetic nervous system plays a primary role in the development and progression of the hypertensive state, starting from the early stage, and in the hypertension-related cardiovascular diseases. Several pathophysiological mechanisms are involved. Among them the genetic background, the immune system in conjunction with sympathetic activation. The present review will briefly discuss the importance of the above mentioned mechanisms in the development of hypertension. The paper will also examine the sympathetic mechanisms underlying attended vs unattended blood pressure measurements as well as their role in resistant vs pseudo-resistant hypertension. Finally evidence from recent meta-analysis on the relevance of sympathetic nerve traffic activation in the pathogenesis of hypertension will be briefly discussed. [ABSTRACT FROM AUTHOR]

An accumulating body of evidence supports an independent association between high blood pressure (BP) and periodontitis, possibly mediated by low‐grade inflammation. This joint report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP) working group on Hypertension and Periodontitis (Hy‐Per Group) provides a review of the evidence on this topic encompassing epidemiology, biological plausibility, relevance, magnitude, and treatment management. Consensus recommendations are provided for health professionals on how to manage BP in individuals showing signs of poor oral health. In summary, (1) large epidemiological studies highlight that individuals with periodontal diseases have increased risk for high/uncontrolled BP independent of confounders; (2) mechanistically, low‐grade inflammation might have a causal role in the association; (3) BP profile and control might benefit from periodontal treatment in pre‐hypertensive and hypertensive individuals; (4) oral health status should be evaluated as a potential risk factor for high/uncontrolled BP, and effective oral care should be included as an adjunct lifestyle measure during hypertension management. Further research is needed to optimize BP management in individuals with poor oral health. [ABSTRACT FROM AUTHOR]

According to recent hypertension guidelines, resistant hypertension is a clinical condition characterized by the presence of BP values above the recommended limits of the reference values (BP >140/90 mmHg). The prevalence of this clinical condition is about 10 % of the essential hypertensives. A proper diagnosis and management of resistant hypertension should go trough careful, mandatory clinical step, aimed at excluding the presence of pseudo-resistance hypertension. In this report, we summarized the practical recommendations are targeting both the general practitioner and the specialist who play an active role in the clinical management of patients with arterial hypertension. [ABSTRACT FROM AUTHOR]

Hypertension is associated with damage to the heart, kidneys, and vascular tree. Assessment of target organ damage ( TOD) allows better prediction of cardiovascular risk than conventional risk assessment. Regression of TOD during antihypertensive treatment, which depends on the blood pressure ( BP) reduction and the specific ancillary properties of each drug, may indirectly indicate that BP is well controlled. It is unclear whether regression of TOD during treatment is associated with favorable outcome and should be used as a surrogate endpoint. There is evidence that regression of left ventricular hypertrophy and albuminuria are associated with a favorable outcome. However, recent studies cast doubts on this evidence. Thus, assessment of TOD is important to define cardiovascular risk, but, so far, regression of TOD cannot be regarded as a major surrogate therapeutic target. The present paper will provide a critical overview of the data available in the literature. [ABSTRACT FROM AUTHOR]

The article discusses factors that may help physicians toward individualized antihypertensive treatment approach. These drugs are classified to help physicians select the drug most suitable for treatment for the individual patient. It is noted that antihypertensive drugs to be used to control blood pressure can be selected to better suit the individual patient based on demographic and anthropometric characteristics, concomitant cardiovascular risk factors and asymptomatic organ damage.

Aim: Periodontal diseases are associated with cardiovascular risk factors/diseases, and whether home oral hygiene practices are inversely related to the same conditions could carry relevant practical implications. We investigated the association of home oral hygiene habits with hypertension. Materials and Methods: During World Hypertension Day 2020, a nationwide cross‐sectional survey was conducted on volunteers ≥18 years at 733 Italian pharmacies. Participants underwent standardized blood pressure (BP) measurement and answered a questionnaire on cardiovascular risk factors, oral health status, and home oral hygiene habits (toothbrushing daily frequency and manual/electric toothbrush). The association between home oral care habits and BP was assessed using multivariate logistic regression. Interactions between exposures and outcome were formally tested. Results: Among the 4506 participants (44.8% males, 66.1 ± 37.8 years), 47.6% reported brushing ≥3 times/day and 23.4% declared using the electric toothbrush. Brushing ≥3 versus <3 times/day and use of electric versus manual toothbrush were associated with 19% (odds ratio [OR]: 0.81, 95% confidence interval [CI] 0.70–0.94) and 28% (OR: 0.72, 95% CI 0.61–0.85) lower odds of hypertension, respectively. No significant additive interaction was observed in the association of exposures with the outcome. Conclusions: Regular daily brushing and electric toothbrushing are associated with a better BP profile in a real‐world context. Future interdisciplinary research is warranted to test these findings. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Cardiovascular risk factors, such as hypertension, hypercholesterolemia, and diabetes mellitus, often cluster together and can also be seen with other pathophysiological conditions that greatly increase an individual''s risk for cardiovascular morbidity and death. Aim of the study: This article emphasizes the importance of assessing and managing the total cardiovascular risk in an individual patient. Materials and methods: Suggestions and recommendations from the most current hypertension management guidelines have been integrated with results from the major clinical trials published in the last decade. Results: Based on a review of the epidemiological data on cardiovascular disease, this paper expands the concept of stratification of hypertensive patients according to the approximate added risk of major cardiovascular events in the next 10 years and stresses the importance of subclinical target-organ damage. Conclusions: Although common in clinical practice, high-risk patients are often undiagnosed. Intensive hypertensive therapy is recommended for high-risk patients, and this treatment strategy will require combination therapy to control or reverse subclinical organ damage and prevent the progression of cardiovascular risk in subjects at low risk or medium risk. [Copyright &y& Elsevier]

Despite the proven efficacy of current strategies for cardiovascular (CV) risk reduction, a considerable gap remains between the risk reductions achieved in clinical trials and those seen in clinical practice. A major reason for this is poor compliance to medication, which has been extensively documented for antihypertensive therapy. Low adherence results in suboptimal blood pressure control, which is associated with adverse CV outcomes and increased treatment costs. Adverse effects of medication are an important cause of diminished adherence. Angiotensin II receptor blockers (ARBs) may offer better long-term tolerability than other classes of antihypertensive agent, and this is likely to be a major factor in the high levels of adherence and persistence seen with these agents. This could have implications for CV protection, as confirmed by the results of recent clinical trials. Thus, ARBs should be considered as an alternative to angiotensin-converting enzyme inhibitors in patients at risk of low adherence. [ABSTRACT FROM AUTHOR]

The article examines several studies which addressed antihypertensive treatment and blood pressure in diabetic and non-diabetic patients. Based on international guidelines on hypertension, the recommended blood pressure (BP) is below 140 millimeter of mercury (mmHg) systolic and 90 mmHg diastolic in general hypertensive population. After assessment of the clinical trials, one speculation is that tight BP control is recommended for patients who are at higher risk of developing a cerebrovascular event.

Data collected in experimental animals and in humans support the hypothesis that sympathetic neural mechanisms are involved in the development and progression of hypertension. Direct approaches to assess human adrenergic cardiovascular drive have shown that sympathetic activation occurs in hypertensive patients, the magnitude of which is proportional to the degree of elevation of the blood pressure. Evidence has also been obtained that sympathetic activation participates in the development of hypertension-related target organ damage, such as left ventricular diastolic dysfunction, left ventricular hypertrophy and arterial remodelling and hypertrophy. Despite the large amount of information collected on the main features of the hypertension-related neurogenic abnormality, the causes of the sympathetic activation remain undefined, although alterations in the reflex modulation of adrenergic drive and/or participation of metabolic factors are likely candidates. This paper will provide background information on the behaviour of the sympathetic nervous system in experimental hypertension, followed by a review of the main features, mechanisms and effects of the sympathetic overdrive in human hypertension. Finally, the new frontiers of research in the area of therapeutic intervention aimed at reducing the adrenergic overdrive will be highlighted. [ABSTRACT FROM AUTHOR]

Inadequate blood pressure (BP) control represents one of the major challenges of antihypertensive treatment, being responsible for the elevated cardiovascular morbidity and mortality associated with hypertension. Although guidelines strongly recommend BP control as a primary therapeutic goal, data collected in European and extra-European countries clearly show a poor BP control rate in treated patients with hypertension. Olmesartan medoxomil (olmesartan) is a relatively new antihypertensive agent belonging to the class of angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) whose tolerability and effectiveness in the treatment of essential hypertension have been shown in several trials and clinical studies. This article reviews current findings on the clinical use of olmesartan as an antihypertensive drug given as monotherapy and in combination treatment in both clinical trials and in clinical practice. Olmesartan as monotherapy or in combination drug treatment has shown greater efficacy than placebo, and similar or greater efficacy compared with other classes of antihypertensive agents. Combination therapy with olmesartan also offers significant advantages in BP control over monotherapy with the component agents. Indeed, non-comparator up-titration studies have demonstrated that, as recommended by guidelines, an aggressive treatment algorithm can bring most patients to BP targets. Early-onset antihypertensive therapy appears to provide long-term benefits by reducing the risk of cardiovascular disease, particularly stroke; the antihypertensive effects of olmesartan have been documented from as early as 2 weeks. In clinical practice, olmesartan is effective in both adult and elderly patients and in patients with systolic or diastolic hypertension, or with isolated systolic hypertension. These features, coupled with an excellent tolerability profile, make olmesartan an attractive option for the treatment of patients with hypertension. [ABSTRACT FROM AUTHOR]

Repeated exposure to stress may favor, both in experimental animals and in humans, an increase in blood pressure, leading in some instances to a true hypertensive state. It is thought that stress-induced hypertension is mediated by sympathetic nervous system activation that in turn, by exerting vasoconstrictor effects and increasing heart rate (and thus cardiac output), may promote the development and progression of the hypertensive state. A new study by Beetz and colleagues in this issue of the JCI, which reports the results of experimental studies carried out in both mice and humans, reveals the potential role of the phosducin gene in modulating the adrenergic and blood pressure responses to stress (see the related article beginning on page 3597). [ABSTRACT FROM AUTHOR]

Several lines of evidence show that metabolic syndrome represents an important therapeutic challenge for the forthcoming years. This is because of the epidemic burden of this multifaceted disease, the adverse impact on cardiovascular risk, as well as the problems posed in its management. This paper will provide an up-to-date report on metabolic syndrome and cardiometabolic risk, focusing in particular on the epidemiological profile of the disease, the impact on risk profile and target organ damage as well as some of the main pathophysiological features of the condition. The general therapeutic recommendations, provided by the 2007 European Society of Hypertension/European Society of Cardiology Guidelines, will be briefly discussed. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To assess the reproducibility of the two markers of adrenergic drive, venous plasma norepinephrine (NE) and efferent postganglionic muscle sympathetic nerve activity (MSNA), in reflecting the sympathetic activation characterizing congestive heart failure (CHF). Methods and measurements: In 19 CHF male normotensive patients (mean age: 53.0±2.1 years, NYHA classes II and III, left ventricular ejection fraction 35.9±2.9%), blood pressure (BP, Finapres), heart rate (EKG), plasma NE (HPLC assay) and MSNA (microneurography, peroneal nerve) were measured in two experimental sessions separated by a week interval. At each session, three NE samples were obtained and NE reproducibility between sessions was assessed by considering single NE samples or averaging 2–3 samples. Results: While MSNA values showed a highly significant correlation between sessions (r =0.85, P <0.001), NE values based on a single blood sample evaluation did not correlate with each other (r =0.41, P =NS). NE correlation coefficients improved and achieved statistical significance when average data from 2 and 3 blood samples were examined (r =0.54 and r =0.57, P <0.02 for both). Conclusions: In CHF, MSNA displays a better reproducibility pattern than plasma NE. The reproducibility of the NE approach, however, can be improved by performing the assay on multiple blood samples. [Copyright &y& Elsevier]

Reference 1 Iaccarino G, Grassi G, Borghi C, Carugo S, Fallo F, Ferri C, et al. (2020) Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension. There is an error in affiliation 17 for author Massimo Volpe. [Extracted from the article]

Sympathetic neural factors exert a key role in homeostatic blood pressure control. Evidence is available that abnormalities in sympathetic function may favour the development and progression of the hypertensive state. This paper will review the data collected throughout the years on the role of adrenergic mechanisms in the pathophysiology of the hypertensive state. It will then examine the mechanisms and the consequences of the sympathetic overdrive reported in hypertension, with particular emphasis on its role in the development of target organ damage. Finally the therapeutic implications of hypertension-related neurogenic abnormalities will be highlighted. [ABSTRACT FROM AUTHOR]

The PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study represents a major research project aimed at investigating the normality values, prognostic significance and relationships of ambulatory and home blood pressure with end-organ damage and metabolic alterations. This article reviews the background, rationale and main results of the various PAMELA studies published to date. These include studies focused on (i) the normal values of ambulatory and home blood pressure in different age decades; (ii) the relevance of the different blood pressures in predicting the occurrence of end-organ damage; (iii) the prognostic significance of ‘white-coat’ and ‘masked’ hypertension; (iv) the ‘power’ of different blood pressures in predicting cardiovascular and all-cause death; and (v) the main features of the blood pressure control in the population. Altogether, the findings reported in this review emphasise the clinical relevance of ambulatory and home blood pressure and the importance of obtaining information on different blood pressures both in treated and untreated hypertensive patients. [ABSTRACT FROM AUTHOR]

The PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study represents a major research project aimed at investigating the normality values, prognostic significance and relationships of ambulatory and home blood pressure with end-organ damage and metabolic alterations. This article reviews the background, rationale and main results of the various PAMELA studies published to date. These include studies focused on (i) the normal values of ambulatory and home blood pressure in different age decades; (ii) the relevance of the different blood pressures in predicting the occurrence of end-organ damage; (iii) the prognostic significance of 'white-coat' and 'masked' hypertension; (iv) the 'power' of different blood pressures in predicting cardiovascular and all-cause death; and (v) the main features of the blood pressure control in the population. Altogether, the findings reported in this review emphasise the clinical relevance of ambulatory and home blood pressure and the importance of obtaining information on different blood pressures both in treated and untreated hypertensive patients. [ABSTRACT FROM AUTHOR]

Objectives. Vascular remodelling and hypertrophy represent early therapeutic targets of antihypertensive treatment. The present study was aimed at assessing the effects of 1-year administration of the highly vasoselective calcium-channel blocker lercanidipine (10 mg/day) or the diuretic compound hydrochlorothiazide (25 mg/day) on hypertension-related vascular alterations. The study was also aimed at assessing whether and to what extent: (i) pharmacological regression of vascular hypertrophy is related only to the blood pressure (BP) reduction “per se” or also to the specific ancillary properties of a given drug and (ii) treatment provides restoration of vascular function indicative of normal vascular structure. Design and Methods. In 26 untreated patients with mild-to-moderate essential hypertension sphygmomanometric and finger BP, heart rate, forearm and calf blood flow (venous occlusion plethysmography) and corresponding vascular resistance (forearm and calf vascular resistance: FVR and CVR) were assessed before and following 6 and 12 months of either lercanidipine or hydrochlorothiazide administration. Vascular resistance was also evaluated following a local ischaemic stimulus (FVRmin and CVRmin) in order to assess the effects of treatment on arteriolar structural alterations. Results. For superimposable BP reductions, lercanidipine caused FVR and CVR to decrease significantly more than hydrochlorothiazide. Similarly, the FVRmin and CVRmin reductions induced by lercanidipine were markedly and significantly greater than those caused by hydrochlorothiazide (-46.1% and -40.9% vs -22.5% and -19.9%, p<0.01 for both). FVRmin and CVRmin, however, remained higher than those found in 10 age-matched normotensive individuals. Conclusions. These data provide evidence that, compared to hydrochlorothiazide, lercanidipine favours a greater regression of the vascular structural changes associated with hypertension, probably through its “ancillary” properties. Lercanidipine, however, does not allow restoration of a “normal” vascular structure, thereby suggesting that vascular hypertrophy is only in part a reversible phenomenon. [ABSTRACT FROM AUTHOR]