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Biomedical subjects

G Schillaci

Publications and source records attributed to G Schillaci.

18 recordsLinked to original sources
PubMed1992

Variability between current definitions of 'normal' ambulatory blood pressure. Implications in the assessment of white coat hypertension.

The assessment of white coat hypertension is complicated by the lack of generally agreed-on normal limits of ambulatory blood pressure. To assess the influence of four of these limits on the prevalence of white coat hypertension and the corresponding distribution of left ventricular hypertrophy, we performed 24-hour ambulatory blood pressure monitoring and echocardiographic studies in 346 untreated patients with essential hypertension and 47 age-matched normotensive control subjects. The upper limits of normal daytime ambulatory blood pressure were lower using standards drawn from clinically normotensive populations than using standards drawn, partly or entirely, from general populations. The prevalence of white coat hypertension differed markedly using the different standards, being 12.1%, 16.5%, 28.9%, and 53.2% (chi 2 = 346.0, p less than 0.0001). Left ventricular mass index averaged 77 g/m2 in the control group, 85 g/m2 in the two groups with white coat hypertension defined by using standards drawn from normotensive populations (both comparisons not significant versus control group), and 90 and 98 g/m2 in the two groups with white coat hypertension defined by using the other two standards (both p less than 0.01 versus control group). The prevalence of echocardiographic left ventricular hypertrophy was 0% in the control group, 2.4% and 3.5% in the two groups with white coat hypertension defined by using standards drawn from normotensive populations, and 9.0% and 14.7% in the other two groups with white coat hypertension (p less than 0.05 and p less than 0.01, respectively, versus control group).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Sex, cardiac hypertrophy and diurnal blood pressure variations in essential hypertension.

OBJECTIVE: To test the hypothesis of a difference between men and women in the left ventricular hypertrophic response to diurnal variations of ambulatory blood pressure in essential hypertension. DESIGN: Non-invasive ambulatory blood pressure monitoring and echocardiography in untreated hypertensive patients and healthy normotensive subjects. SETTING: Community-based ambulatory population in tertiary care centers. PATIENTS: Two hundred and sixty hypertensive patients and sixty-three healthy normotensive subjects. MAIN OUTCOME MEASURE: Patients with average daytime systolic blood pressure (SBP) and diastolic blood pressure (DBP) falling by less than 10% during the night were defined as non-dippers, the others as dippers. RESULTS: In the hypertensive group, dippers and non-dippers did not differ, in either gender, in several covariates possibly affecting left ventricular structure, including daytime ambulatory blood pressure, prevalence of white coat hypertension, age, body mass index, family history and known duration of hypertension, funduscopic changes, diabetes, alcohol consumption and renal function. Left ventricular mass (LVM) did not differ between dippers and non-dippers in hypertensive men whilst in hypertensive women it was significantly lower in dippers than in non-dippers. This sex difference held for all quartiles of the distribution of mean daytime blood pressure. In hypertensive women there was an inverse correlation between LVM and the per cent reduction of SBP and DBP from day to night, but this relationship was absent in hypertensive men. Other indices of left ventricular structure differed between dippers and non-dippers in both genders, as did LVM. CONCLUSIONS: For any level of daytime ambulatory blood pressure, a reduction of SBP and DBP by less than 10% from day to night identifies a subset of hypertensive patients at increased risk of left ventricular hypertrophy only in the female gender. These data suggest that, compared with men, hypertensive women require a longer duration of exposure to high blood pressure levels during the 24 h to develop left ventricular hypertrophy.

Blood Pressure↗
PubMed1991

Long-term effects of benazepril on ambulatory blood pressure, left ventricular mass, diastolic filling and aortic flow in essential hypertension.

We investigated the long-term effects of benazepril, a new non-sulfydryl angiotensin converting enzyme inhibitor, on ambulatory blood pressure (BP) and left ventricular (LV) anatomy and function in 13 never treated hypertensive patients (mean age 55 years--SD 9). Non-invasive ambulatory BP monitoring (Spacelabs 90202, a reading every 15 min for 24 hours) and standard and pulsed Doppler echocardiography were performed basally and after 12 months of therapy. Echocardiography was performed also at the end of 18th month of treatment. Eleven patients required a single daily dose of benazepril 10 (n = 9) or 20 (n = 2) mg, and two patients of 20 mg plus chlorthalidone 25 mg, to achieve clinical BP control. Average 24 h systolic/diastolic BP was 156/100 mmHg (SD 17/5) basally and 144/90 mmHg (SD 16/7) at the end of the 12th month of treatment (all p less than 0.01), LV mass index was 133 g/m2 basally and 113 g/m2 at the 12th month (p less than 0.01), early transmitral flow velocity (peak E) was 0.43 m/s (SD 0.11) basally and 0.62 (SD 0.13) m/s at the 12th month (p less than 0.01), and late transmitral flow velocity (peak A) did not change [0.67 (SD 0.10) m/s basally and 0.64 (SD 0.11) m/s at the 12th month]. Peak A/peak E ratio decreased from 1.69 (SD 0.57) to 1.31 (SD 0.37) (p less than 0.01). Peak aortic velocity, aortic acceleration time and aortic acceleration did not change. The per cent reduction of LV mass index was more closely related to the reduction of average 24 h systolic (r = 0.66, p = 0.013) and diastolic (r = 0.72, p = 0.005) BP than to the reduction of casual systolic (r = 0.37, p = NS) and diastolic (r = 0.42, p = NS) BP. None of the echocardiographic indices changed between the 12th and 18th month of treatment. In a control group of 13 age- and sex-matched healthy normotensive volunteers who underwent 24 h ambulatory BP monitoring and echocardiography twice, 12 months apart, there were no statistically significant BP or echographic changes. In summary, long-term antihypertensive treatment with benazepril provided and effective 24 h BP control, associated with regression of LV hypertrophy and improvement in LV diastolic filling, without changes in LV systolic function.

Ambulatory Care↗
PubMed1991

[The irrelevance of the clinical arterial pressure with respect to outpatient pressure in defining the risk of left ventricular hypertrophy in essential arterial hypertension].

To investigate whether the level of clinical blood pressure (BP) may serve to stratify the risk of left ventricular (LV) hypertrophy in essential hypertension regardless of the level of ambulatory BP, we performed 24-hour noninvasive ambulatory BP monitoring and echocardiography in 115 consecutive hypertensive patients who had never been treated before and in 92 normotensive subjects. Hypertensive patients were grouped according to the difference between the observed clinical BP and the predicted value of clinical BP, defined by regressing the observed clinical BP on the 24-hour average of the ambulatory BP: "low" clinical BP group (clinical systolic BP less than = 10 mmHg, diastolic BP less than = 6 mmHg than predicted values), "high" clinical BP group (systolic greater than = 10 mmHg, diastolic greater than = 6 mmHg than predicted values), "intermediate" clinical BP group (values within the above mentioned limits). Ambulatory BP did not show any statistically significant differences between the three groups. LV mass index was higher in hypertensive patients in each of the three groups (including the "low" clinical BP group) as compared with the normotensive group (all p less than 0.01), but did not show any statistically significant difference among the three groups of hypertensive patients, either defined by systolic BP or by diastolic BP. Other indexes of LV anatomy (relative wall thickness, cross-sectional area) showed a similar pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1991

Dippers versus non-dippers.

Clinical studies with non-invasive ambulatory blood pressure monitoring have shown that some cardiovascular complications of essential hypertension (left ventricular hypertrophy, stroke) tend to be more frequent in patients whose 24-h blood pressure profile is flattened (non-dippers) and, consequently, suffer a longer duration of exposure to high blood pressure levels over the 24 h. The distribution of patients between dippers and non-dippers is conditioned by the limits of the blood pressure changes from day to night that are arbitrarily chosen to define these two groups, and by the time intervals defining daytime and night-time hours. Sleep does not seem to be disturbed by non-invasive monitoring to such an extent that the day-night blood pressure difference is affected. If daytime is defined as 0600-2200 h and night-time as 2200-0600 h, and those hypertensive patients with a nocturnal reduction in average daytime systolic and diastolic blood pressure of less than 10% are classed as non-dippers, the prevalence of non-dippers in essential hypertension appears to be about 35%. In these patients, left ventricular mass seems to be greater in non-dippers than in dippers among women, but not in men. The clinical significance of the dippers/non-dippers classification in the stratification of hypertensive patients of different levels of risk of cardiovascular complications needs further investigation.

Blood Pressure↗
PubMed1990

Risk stratification of left ventricular hypertrophy in systemic hypertension using noninvasive ambulatory blood pressure monitoring.

Twenty-four-hour noninvasive ambulatory blood pressure (BP) monitoring and echocardiography were performed in 165 consecutive untreated hypertensive patients and in 92 healthy subjects. In the hypertensive group, left ventricular (LV) mass index showed closer correlations (all p less than 0.01 in the comparisons between the r coefficients) with average 24-hour ambulatory systolic (r = 0.47) and diastolic (r = 0.33) BP than with casual systolic (r = 0.35) and diastolic (r = 0.28) BP. Hypertensive patients were classified according to the difference between their observed and predicted levels of ambulatory BP (the latter assessed by regressing the observed ambulatory BP on the casual BP). When compared to those with lower than predicted ambulatory BP (less than or equal to 10 mm Hg systolic, less than or equal to 6 mm Hg diastolic), patients with higher than predicted ambulatory BP (greater than or equal to 10 mm Hg systolic and greater than or equal to 6mm Hg diastolic) had higher values of LV mass index and other indexes of LV hypertrophy (all p less than 0.01) but had similar values of casual BP. Prevalence of LV hypertrophy was 6 to 10% in the former and 35 to 39% in the latter (p less than 0.001). None of the indexes of LV structure differed between the group with low ambulatory BP and the normotensive group. It is concluded that hypertensive patients whose ambulatory BP readings are notably higher than one would predict from clinical BP readings are at highest risk of LV hypertrophy, an independent prognostic marker.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1990

Prevalence and determinants of left ventricular diastolic filling abnormalities in an unselected hypertensive population.

The independent contribution of age, sex, duration of hypertension, heart rate, clinic and ambulatory blood pressure and echocardiographic left ventricular mass to left ventricular diastolic filling abnormalities in essential hypertension was investigated in 250 subjects (145 untreated and unselected hypertensives and 105 healthy normotensive controls) undergoing Doppler and standard echocardiography and non-invasive 24-h ambulatory blood pressure monitoring. Late and early diastolic transmitral peak flow velocities and their ratio (all P less than 0.01), the rate of deceleration of early diastolic mitral flow (P less than 0.01) and the time of deceleration of early diastolic mitral flow (P = 0.018) were abnormal in the hypertensive group vs controls. None of these parameters significantly varied in the presence vs absence of LV hypertrophy. In the hypertensive group, the prevalence of abnormal age-corrected Doppler values varied up to 46% (up to 45.4% and 50% in the absence and presence of left ventricular hypertrophy, respectively; P = n.s.). In a stepwise multivariate regression analysis, age and average daytime or night-time ambulatory blood pressure showed a significant independent relationship with each of these Doppler indexes of left ventricular diastolic filling. Late transmitral peak flow velocity and the ratio of late to early peak flow velocity were also independently affected by the heart rate. Sex, duration of hypertension, clinic systolic and diastolic blood pressure and left ventricular mass index did not show any independent relationship to these Doppler parameters of left ventricular filling. In conclusion, Doppler abnormalities of diastolic transmitral blood flow were detected in up to 46% of patients in an unselected hypertensive population with a low prevalence (14.5%) of left ventricular hypertrophy. Age and ambulatory blood pressure, but not sex, duration of hypertension, clinic blood pressure and left ventricular mass itself, were the major independent determinants of these abnormalities.

Aged↗
PubMed1990

Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension.

The effects of circadian blood pressure (BP) changes on the echocardiographic parameters of left ventricular (LV) hypertrophy were investigated in 235 consecutive subjects (137 unselected untreated patients with essential hypertension and 98 healthy normotensive subjects) who underwent 24-hour noninvasive ambulatory blood pressure monitoring (ABPM) and cross-sectional and M-mode echocardiography. In the hypertensive group, LV mass index correlated with nighttime (8:00 PM to 6:00 AM) systolic (r = 0.51) and diastolic (r = 0.35) blood pressure more closely than with daytime (6:00 AM to 8:00 PM) systolic (r = 0.38) and diastolic (r = 0.20) BP, or with casual systolic (r = 0.33) and diastolic (r = 0.27) BP. Hypertensive patients were divided into two groups by presence (group 1) and absence (group 2) of a reduction of both systolic and diastolic BP during the night by an average of more than 10% of the daytime pressure. Casual BP, ambulatory daytime systolic and diastolic BP, sex, body surface area, duration of hypertension, prevalence of diabetes, quantity of sleep during monitoring, funduscopic changes, and serum creatinine did not differ between the two groups. LV mass index, after adjustment for the age, the sex, the height, and the daytime BP differences between the two groups (analysis of covariance) was 82.4 g/m2 in the normotensive patient group, 83.5 g/m2 in hypertensive patients of group 1 and 98.3 g/m2 in hypertensive patients of group 2 (normotensive patients vs. group 1, p = NS; group 1 vs. group 2, p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1990

[Noninvasive ambulatory monitoring of arterial pressure in hypertensive patients: inside or outside the hospital?].

To investigate whether hospitalization may influence the circadian rhythm of blood pressure (BP), 15 untreated patients with essential hypertension underwent noninvasive ambulatory blood pressure monitoring twice, at home and in the hospital, in a random order, 11 days apart. During the hospital session, which took place on the ninth day of hospitalization, patients were allowed to move freely in the hospital area, to receive visits by friends and relatives and to engage in social activities with other inpatients. Home sessions were performed during a usual working day in 14 of 15 patients. Average 24-hour systolic/diastolic BP was 151/93 mmHg (DS 19/10) at home and 154/93 mmHg (DS 21/7) in the hospital; average daytime (6am-10pm) values were 155/97 mmHg (DS 19/10) at home and 157/96 mmHg (DS 20/5) in the hospital; average night-time (10pm-6am) values were 146/88 mmHg (DS 21/12) at home and 150/89 mmHg (DS 23/10). These values did not show any statistical differences (analysis of variance) due to status (home vs hospital), period or sequence. The hourly BP averages of the hospital recording did not differ significantly from the corresponding averages of the home recording. The correlation between hospital and home 24-hour averages of systolic and diastolic BP was close (r = 0.87 and r = 0.78, respectively; p less than 0.01). The chronobiological analysis (single cosinor) showed a statistically significant circadian rhythm of systolic BP in 10/15 patients at home and in 8/15 patients in the hospital (p = NS), and a statistically significant rhythm of diastolic BP in 9/15 patients at home and in 10/15 patients in the hospital (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure Determination↗
PubMed1990

[Sex differences in echocardiographic indices of left ventricular hypertrophy in arterial hypertension. Influence of age and pressure levels over 24 hours].

To evaluate the difference between the sexes in the echocardiographic indices of left ventricular hypertrophy in essential hypertension, we analysed the results of 24-hour non invasive ambulatory blood pressure monitoring and echocardiography in 195 consecutive untreated hypertensive patients (101 males, 94 females). Patients were divided into 3 age groups: up to 40 years, 41-60 years, and greater than 60 years of age. Clinical blood pressure did not differ between sexes in any of the three groups, while average 24-hour ambulatory systolic and diastolic blood pressure levels were higher in males than in females up to 40 years of age (140/93 vs 129/87 mmHg, p less than 0.01), but not between 41 and 60 years (142/93 vs 141/90 mmHg) nor in those over 60 years of age (151/92 vs 145/91 mmHg). LV mass index was higher in males than in females up to 40 years (93 vs 68 g/m2, p less than 0.01), and between 41 and 60 years (115 vs 90 g/m2, p less than 0.01), but not dissimilar between the sexes over 60 years of age (102 vs 107 g/m2, p = n.s.). In females, LV mass index increased with age (r = 0.33) and body weight (r = 0.38; both p less than 0.01), but none of these relationships was significant in males (r = 0.01 and r = 0.19, respectively). Moreover, all the relations of LV mass to either clinical or ambulatory BP were closer in females than in males. None of the echocardiographic indices of left ventricular systolic function showed statistically significant differences between the sexes in any of the three age groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗