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Biomedical subjects

Gianfranco Parati

Publications and source records attributed to Gianfranco Parati.

At least 19 recordsLinked to original sources
PubMed2026

Wearable wrist-watch type cuff oscillometric blood pressure monitors: consensus statement by the European Society of Hypertension Working Group on blood pressure monitoring.

Wearable wristwatch-type cuff oscillometric blood pressure (BP) monitors represent a new category of BP devices and are the first wearable monitors to use established cuff-oscillometric BP measurement technology. This consensus statement by the European Society of Hypertension Working Group on BP Monitoring reviews the published evidence on their design, accuracy, validation, clinical application, and remaining research questions. Of 281 articles identified through a systematic PubMed search, 26 were relevant. Several devices are currently available; however, only two have published validation studies performed according to established standards (Omron HeartGuide and Huawei Watch D/D2). Static validation studies generally showed acceptable accuracy, whereas data on 24-h ambulatory use, in special populations, and clinical applications remain limited. Potential advantages include self-initiated measurement at home, at work, and in other settings and conditions; more convenient and repeatable 24-h ambulatory monitoring; more convenient and accurate assessment of asleep BP; capture of stress-related and other BP-related episodes. However, proper wrist position, user adherence, ambulatory performance, and clinical applications require further investigation. More research is needed to establish the accuracy and clinical utility of these novel devices and their role in improving the diagnosis and management of hypertension.

Humans↗
PubMed2003

Daily life blood pressure changes are steeper in hypertensive than in normotensive subjects.

Target organ damage in hypertensive patients is related to their increased average blood pressure and greater 24-hour blood pressure variability. Whether the rate of blood pressure changes is also greater in hypertension, producing a greater stress on arterial walls, is not known, however. Our study aimed at addressing this issue by computer analysis of 24-hour ambulatory intra-arterial blood pressure recordings in 34 subjects (29 males), 13 normotensive subjects and 21 uncomplicated hypertensive subjects (mean age+/-SD, 40.4+/-11.8 years). The number, slope (mm Hg/s), and length (beats) of systolic blood pressure ramps of 3 or more consecutive beats characterized by a progressive increase (+) or reduction (-) in systolic blood pressure of at least 1 mm Hg per beat were computed for each hour and for the whole 24-hour period. Twenty-four-hour average systolic blood pressure was 112.9+/-2.1 and 159.4+/-5.7 mm Hg in normotensive and hypertensive subjects, respectively. Over the 24 hours, the number and length of systolic blood pressure ramps were similar in both groups, whereas the slope was markedly different (24-hour mean+/-SE slope, 4.80+/-0.30 in normotensives and 6.50+/-0.40 mm Hg/s in hypertensives, P<0.05). Ramp slope was not influenced by age or reflex pulse interval changes, but it was greater for higher ramp initial systolic blood pressure values. Thus, in daily life, hypertensive subjects are characterized by steeper blood pressure changes than normotensives, and this, regardless of the mechanisms, may have clinical implications, because it may be associated with greater traumatic effect on the vessel walls of hypertensive patients.

Adult↗
PubMed2003

Enhanced reflex response to baroreceptor deactivation in subjects with tilt-induced syncope.

OBJECTIVES: We sought to evaluate whether changes in resting baroreflex control of heart rate are a distinctive feature of healthy subjects with a history of syncope prone to a positive tilt-test response. BACKGROUND: The mechanisms involved in the pathogenesis of vasovagal syncope (VVS) are still poorly understood; in particular, the contribution of arterial baroreflex control of heart rate is matter of discussion. METHODS: A passive tilt-table test was performed in 312 consecutive, otherwise healthy subjects (age 36 +/- 15 years) with unexplained syncope and 100 control subjects. At baseline, spontaneous baroreflex sensitivity (BRS; ms/mm Hg) and the baroreflex effectiveness index (BEI) were assessed using the sequence method. RESULTS: The study population showed normal baroreflex function. Tilt-induced VVS in 94 subjects who were younger than both the tilt-negative and control subjects (30 +/- 14, 38 +/- 15, and 37 +/- 14 years, respectively; p = 0.00005) showed greater BRS (17.4 +/- 9.8, 13.2 +/- 7.9, and 12.8 +/- 8.2 ms/mm Hg, respectively; p = 0.0001), but had a similar BEI (0.59 +/- 0.18, 0.56 +/- 0.19, and 0.58 +/- 0.2, respectively; p = NS). On Cox multivariate analysis, the occurrence of VVS during tilt was inversely related to age (hazard ratio 0.97; p = 0.0004) and directly related to the BRS slope of sequences, implying a baroreceptor deactivation (hazard ratio 1.05; p = 0.02), but not of sequences characterized by arterial baroreceptor stimulation. CONCLUSIONS: Subjects with tilt-induced VVS showed greater resting BRS but had a normal BEI. The enhanced reflex tachycardic response to arterial baroreceptor deactivation at rest may represent a characteristic feature of subjects prone to tilt-induced VVS.

Adult↗
PubMed2003

Blood pressure variability and cardiovascular control mechanisms in hypertension.

Blood pressure variability is the result of a complex interaction between external stimulation and several cardiovascular control mechanisms and is enhanced in all those conditions characterized by an impaired autonomic regulation of circulation. In particular, blood pressure variability is enhanced in hypertension over 24 h and may independently contribute to the cardiovascular complications of this condition. The paper by Mussalo and co-workers in this issue of Clinical Science offers additional information in this field by suggesting that different forms of hypertension are characterized by different patterns of blood pressure variability, and that these differences may reflect variations in the underlying autonomic regulation of the heart and blood vessels.

Autonomic Nervous System↗
PubMed2003

Plasma fatty acids response to central volume expansion in salt-sensitive hypertension.

The purpose of the present study was to investigate the possible regulation of plasma fatty acids by an acute isotonic-isooncotic central volume expansion. We measured the levels of nonesterified fatty acids (NEFA) in plasma from 12 essential hypertensive patients subjected to water immersion (WI). Central hypervolemia by WI over 2 hours caused the levels of most NEFA to increase, concomitantly with a marked natriuretic and kaliuretic response. With respect to baseline values, serum insulin levels did not change during WI, while there was a profound suppression of plasma renin activity (PRA) and plasma aldosterone. In addition, when individual NEFA percent increase was expressed as a function of salt-sensitivity index (calculated as the change in mean arterial pressure [MAP] divided by the change in urinary sodium excretion rate), a greater percent increase in stearic acid (r =.72, P <.009), palmitic acid (r =.83, P <.001), and palmitoleic acid (r =.58, P <.048) was found during WI in those hypertensive subjects showing higher salt-sensitivity index. Thus, by demonstrating that an acute isotonic-isooncotic volume expansion may induce a significant increase of most NEFA plasma levels, we suggest that volume expansion per se could be included among the well-recognized risk factors for cardiovascular morbid events.

Adult↗
PubMed2003

Non-invasive beat-to-beat blood pressure monitoring: new developments.

Continuous blood pressure monitoring is an essential prerequisite for any study on blood pressure variability. Invasive procedures are no longer acceptable for research projects in a clinical setting, and recently developed devices able to record blood pressure on a beat-by-beat basis in a non-invasive fashion may represent valuable alternative tools. This article will briefly review the available information on the most recent advances in this field. It will focus on further developments of the original technology for finger blood pressure monitoring introduced by Penáz, as well as on newer devices that have been proposed over the last few years for non-invasive cardiovascular monitoring both in research and in clinical studies.

Blood Pressure Determination↗
PubMed2003

Renal and cardiovascular responses to water immersion in essential hypertension: is there a role for the opioidergic system?

Our study aimed at elucidating the effects of acute central hypervolemia induced by water immersion (WI) on renal hemodynamics, hormonal responses and on cardiovascular control in hypertensive patients, as well as at evaluating the possible role of the opioidergic system (OS) in determining these effects. Thirteen essential hypertensives were studied for 2 h before and for 2 h during WI. This was done twice, without and with i.v. injection of the OS antagonist naloxone. Before and during WI alone, glomerular filtration rate (GFR), effective renal plasma flow (ERPF), renal vascular resistance (RVR), mean arterial pressure (MAP), pulse interval (PI), spontaneous baroreflex sensitivity (BRS), Low frequency to High frequency (LF/HF) ratio in PI spectra, hematocrit, urinary sodium excretion, plasma renin activity (PRA) and aldosterone (PA) were assessed. Based on their response to WI, hypertensives were subdivided into two groups: ERPF+ (n = 7) in whom WI increased ERPF, and ERPF- (n = 6) in whom WI reduced ERPF. ERPF+ displayed a higher BRS than ERPF- at baseline and during WI. A suppression of PRA and PA and an increase in MAP and urinary sodium excretion were found in both groups. In ERPF+ naloxone caused RVR and MAP to increase during WI and this response was associated with a blockade of the increase in ERPF in this group, while BRS and natriuresis were unchanged. In ERPF- naloxone did not affect WI-induced MAP, ERPF, RVR and BRS changes, while it blunted sodium excretion. Our data provide the first evidence of a differentiate renal hemodynamic response to WI in hypertension; they also suggest that while OS may significantly potentiate the renal vasodilatory response to WI in ERPF+, it does not affect the natriuretic response nor the changes in systemic cardiovascular regulation induced by central hypervolemia.

Adult↗
PubMed2002

Predictive value of clinic and ambulatory heart rate for mortality in elderly subjects with systolic hypertension.

OBJECTIVE: To examine the association of clinic and ambulatory heart rate with total, cardiovascular, and noncardiovascular death in a cohort of elderly subjects with isolated systolic hypertension from the Systolic Hypertension in Europe Trial. METHODS: A total of 4682 patients participated, whose untreated blood pressure on conventional measurement at baseline was 160 to 219 mm Hg systolic and lower than 95 mm Hg diastolic. Clinic heart rate was the mean of 6 readings during 3 visits. Ambulatory heart rate was recorded with a portable intermittent technique in 807 subjects. RESULTS: Raised baseline clinic heart rate was positively associated with a worse prognosis for total, cardiovascular, and noncardiovascular mortality among the 2293 men and women taking placebo. Subjects with heart rates higher than 79 beats/min (bpm) (top quintile) had a 1.89 times greater risk of mortality than subjects with heart rate lower than or equal to 79 bpm (95% confidence interval, 1.33-2.68 bpm). In a Cox regression analysis, predictors of time to death were heart rate (P<.001), age (P<.001), serum creatinine level (P =.001), presence of diabetes (P =.002), previous cardiovascular disease (P =.01), triglyceride readings (P =.02), smoking (P =.04), and elevated systolic blood pressure (P =.05), while total cholesterol level was found to be nonsignificant in the model. In the ambulatory monitoring subgroup, clinic and ambulatory heart rates predicted noncardiovascular but not cardiovascular mortality. However, in a Cox regression analysis in which clinic and ambulatory heart rates were included, a significant association with noncardiovascular mortality was found only for clinic heart rate (P =.004). In the active treatment group, the weak predictive power of clinic heart rate for mortality disappeared after adjustment for confounders. CONCLUSIONS: In untreated older patients with isolated systolic hypertension, a clinic heart rate greater than 79 bpm was a significant predictor of all-cause, cardiovascular, and noncardiovascular mortality. Ambulatory heart rate did not add prognostic information to that provided by clinic heart rate.

Age Factors↗
PubMed2002

Continuous positive airway pressure treatment improves baroreflex control of heart rate during sleep in severe obstructive sleep apnea syndrome.

The role of the arterial baroreflex in the cardiovascular changes associated with the obstructive sleep apnea syndrome (OSAS), and the effect of nasal continuous positive airway pressure (CPAP) treatment on baroreflex function during sleep are unknown. Baroreflex control of heart rate was studied in 29 normotensive patients with OSAS under no treatment, in 11 age-matched control subjects, and in 10 patients at CPAP withdrawal after 5.5 +/- 3.7 (range 3-14) months of treatment. Baroreflex control of heart rate was assessed by "sequence method" analysis of continuous blood pressure recordings (Finapres) obtained during nocturnal polysomnography. In untreated OSAS, baroreflex sensitivity (BRS) was low during wakefulness and non-rapid eye movement (REM) stage 2 sleep compared with control subjects, and correlated inversely with mean lowest Sa(O(2)) and the blood pressure increase after apneas. After CPAP treatment, the apnea-hypopnea index was lower, and mean lowest Sa(O(2)) higher than before treatment. After CPAP, patients were more bradycardic, blood pressure and its standard deviation decreased as Sa(O(2)) improved in non-REM stage 2 sleep, and BRS increased (nocturnal wakefulness: +59%; non-REM stage 2 sleep: +68% over pretreatment values). Our data suggest that baroreflex dysfunction in OSAS may be at least partly accounted for by nocturnal intermittent hypoxemia, and can be reversed by long-term CPAP treatment.

Adult↗
PubMed2002

Ambulatory pulse pressure as predictor of outcome in older patients with systolic hypertension.

We enrolled 808 older patients with isolated systolic hypertension (160 to 219/71 <95 mm Hg) to investigate whether ambulatory measurement of pulse pressure and mean pressure can refine risk stratification. The patients (> or =60 years) were randomized to nitrendipine (10 to 40 mg/day) with the possible addition of enalapril (5 to 20 mg/day) or hydrochlorothiazide (12.5 to 25 mg/day) or to matching placebos. At baseline, pulse pressure and mean pressure were determined from six conventional blood pressure (BP) readings and from 24-h ambulatory recordings. With adjustment for significant covariables, we computed mutually adjusted relative hazard rates associated with 10 mm Hg increases in pulse pressure or mean pressure. In the placebo group, the 24-h and nighttime pulse pressures consistently predicted total and cardiovascular mortality, all cardiovascular events, stroke, and cardiac events. Daytime pulse pressure predicted cardiovascular mortality, all cardiovascular end points, and stroke. The hazard rates for 10 mm Hg increases in pulse pressure ranged from 1.25 to 1.68. Conventionally measured pulse pressure predicted only cardiovascular mortality with a hazard rate of 1.35. In the active treatment group compared with the placebo patients, the relation between outcome and ambulatory pulse pressure was attenuated to a nonsignificant level. Mean pressure determined from ambulatory or conventional BP measurements was not associated with poorer prognosis. In conclusion, in older patients with isolated systolic hypertension higher pulse pressure estimated by 24-h ambulatory monitoring was a better predictor of adverse outcomes than conventional pulse pressure, whereas conventional and ambulatory mean pressures were not correlated with a worse outcome.

Aged↗