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Biomedical subjects

Gianfranco Parati

Publications and source records attributed to Gianfranco Parati.

At least 55 records · Page 3Linked to original sources
PubMed2005

Recommendations for blood pressure measuring devices for office/clinic use in low resource settings.

This paper, which summarizes the conclusions of a WHO Expert meeting, is aimed at proposing indications to develop technical specifications for an accurate and affordable blood pressure measuring device for office/clinic use in low resource settings. Blood pressure measuring devices to be used in low resource settings should be accurate, affordable, and easily available worldwide. Given the serious inherent inaccuracy of the auscultatory technique, validated and affordable electronic devices, that have the option to select manual readings, seem to be a suitable solution for low resource settings. The agreement on the technical specifications for automated blood pressure measuring devices for office/clinic use in low resource settings included the following features: high accuracy, adoption of electronic transducers and solar batteries for power supply, standard rates of cuff inflation and deflation, adequate cuff size, digital display powered by solar batteries, facilities for adequate calibration, environmental requirements, no need of memory function, resistance to shock and temperature changes, and low cost. Availability of a device with these features should be accompanied by adequate training of health care personnel, who should guarantee implementation of the procedures recommended in recent European and American Guidelines for accurate blood pressure measurement.

Blood Pressure Determination↗
PubMed2005

How to improve the assessment of 24-h blood pressure variability.

An increased 24-h blood pressure variability, expressed as SD of 24-h average ambulatory blood pressure values, is associated with target organ damage and cardiovascular risk in hypertension, while a physiological nocturnal blood pressure fall has been associated with reduced cardiovascular risk. Nocturnal blood pressure fall, however, may contribute markedly to the overall blood pressure variability. The aim of our study was to quantitatively assess the contribution of nocturnal blood pressure fall to 24-h blood pressure variability, and to propose a new method for computing 24-h blood pressure variability correcting for nocturnal blood pressure fall. From a large database of ambulatory blood pressure recordings obtained in two hypertension centres (Milan, Italy and Krakow, Poland), we selected 1995 recordings of a sufficiently high quality (> or =70% valid readings, > or =1 measure/h). We calculated (1) blood pressure variability, as SD of 24-h mean blood pressure, both directly from all 24-h individual readings and as a weighted mean of separately computed daytime and night-time blood pressure SD; and (2) the size of nocturnal blood pressure fall. The weighted mean SD of 24-h blood pressure was significantly lower than the corresponding direct 24-h SD of blood pressure. The size of the difference between direct SD and weighted mean SD was strongly correlated with the absolute size of nocturnal blood pressure fall (SD: r=0.89 and 0.86 for systolic and diastolic blood pressures, respectively, P<0.001 for all). The 24-h SD of blood pressure is markedly influenced by the size of nocturnal blood pressure fall, while the weighted mean SD is not. The inclusion of nocturnal blood pressure fall in the calculation of 24-h blood pressure variability may thus lead to the overestimating of this phenomenon. Given that blood pressure variability and fall at night may have opposite prognostic significance, it may be advisable to calculate 24-h SD as the weighted mean of daytime and night-time values, which excludes the interference of night-time blood pressure fall on overall blood pressure variability and allows a more precise assessment of the clinical value of 24-h blood pressure variability. The actual clinical relevance of this new parameter has to be assessed by longitudinal outcome studies.

Blood Pressure↗
PubMed2005

Blood pressure variability: its measurement and significance in hypertension.

The occurrence of blood pressure fluctuations over time has been documented since the 18th century, but the clinical importance of this phenomenon is only now being recognized. The introduction of ambulatory blood pressure monitoring in the late 1960s represented a major step forward in the study of blood pressure behaviour and helped to characterize the relationship between blood pressure variability and cardiovascular disease. In hypertension, blood pressure variability increases with increasing blood pressure and correlates closely with target-organ damage, independently of absolute blood pressure values. This has important consequences for treatment, which in the past has focused on reducing mean blood pressure values as the main goal. Experimental evidence suggests that drugs capable of buffering or reducing blood pressure variability may confer additional benefits on target-organ protection. Effective target-organ protection could best be afforded by antihypertensive agents that provide efficient 24-h blood pressure control and also stabilize blood pressure variability. Mathematical indices, such as the trough:peak ratio and the smoothness index, provide useful measures of the homogeneity of the antihypertensive effect over 24 h; optimum control is provided by drugs with a trough:peak ratio close to 1 and a smoothness index > 1, as is observed with long-acting drugs such as telmisartan or amlodipine. Recently, a direct relationship was demonstrated between homogeneous blood pressure control and treatment-induced regression of left ventricular hypertrophy, emphasizing the importance of smooth 24-h blood pressure control. In conclusion, the goals of antihypertensive treatment should consider the reduction of both 24-h mean blood pressure and its variability. Long-lasting drugs or drug combinations are preferable to ensure a homogeneous and smooth 24-h blood pressure profile.

Blood Pressure↗
PubMed2005

Cardiac structural and functional changes during long-term antihypertensive treatment with lacidipine and atenolol in the European Lacidipine Study on Atherosclerosis (ELSA).

OBJECTIVES: To evaluate and correlate the effects of long-term antihypertensive treatment on left ventricular (LV) mass and carotid structural changes in a large group of essential hypertensive patients, participating in the European Lacidipine Study on Atherosclerosis (ELSA). DESIGN: In four (Brescia, Glasgow, Naples and Pisa) of 23 centres participating in the ELSA study, an echocardiographic examination was performed at baseline and repeated, until the end of the 4-year study, in essential hypertensive patients, followed-up for carotid quantitative ultrasound examination of intima-media thickness (IMT), after random allocation to treatment with either lacidipine or atenolol (and added hydrochlorothiazide, as required for control of blood pressure). METHODS: M-mode, two-dimensional guided echocardiography was used to measure left ventricular (LV) wall thickness and dimensions, from which LV mass was calculated, using an anatomically validated formula (Penn Convention) and indexed to body surface area (left ventricular mass index, LVMI). The echocardiographic tracings were blindly evaluated in a single reading centre (Brescia). Bilateral IMT was measured at the site of common carotid and bifurcation far walls (CBMmax). RESULTS: At baseline, cardiac and carotid ultrasound scans were available in 278 patients (mean age 54 +/- 7 years, 57% males, 22% obese). A significant correlation was observed between baseline LVMI and CBMmax (r = 0.22, P < 0.001), independent of age. In multivariate analysis, CBMmax and mean 24-h pulse pressure were most strongly associated with baseline LVMI. A significant reduction in LVMI was observed both during lacidipine (n = 96) (-12.5% reduction) and atenolol (n = 78) (-13.9% reduction) treatments (up to 4 years) (P < 0.001 for both, without significant differences between treatments). Changes in LVMI were not related to changes in carotid wall thickness. In multivariate analysis, baseline LV mass and mean 24-h systolic blood pressure changes were significantly associated with changes in LV mass. CONCLUSIONS: In this large, long-term controlled study, antihypertensive treatment with atenolol or lacidipine was accompanied by a similar and significant decrease in LV mass. Treatment-induced changes in LV mass were related to baseline LV mass and changes in 24-h mean systolic blood pressure, without any correlation with changes in carotid structure. In the whole ELSA population, carotid IMT changes have been shown to be unrelated to blood pressure reduction, but significantly influenced by the type of antihypertensive treatment.

Adult↗
PubMed2005

[How to write a scientific paper].

To write a paper and to succeed in getting it published in a highly renowned scientific journal represent the last but not the least of the difficulties that a researcher has to face before being able to consider a given research project fully accomplished. While writing a manuscript, it is important to put a consistent effort in designing its structure, paying attention to a few technical guidelines. It is worth keeping in mind, however, that the editorial success of a manuscript is related not only to the writer skills and experience but also to the attention previously dedicated to the design and conduction of the research project from which data are derived. On the other hand, the probability for a well designed and carefully performed study (yielding data relevant from a clinical viewpoint), to have its results accepted for publication in an important journal is very low if they are poorly summarized in a low quality paper. In the light of these considerations, the aim of this concise review was to provide the researcher with a few simple tips on how to prepare a scientific article, ranging from its early drafting to its final publication. We have also dealt in some detail with the problems related to the selection of the journal and manuscript format, with the procedures related to manuscript submission, and with the approach to follow in order to prepare a proper answering to the reviewers' and editors' comments.

Periodicals as Topic↗
PubMed2004

Blood pressure variability and silent cerebral damage in essential hypertension.

BACKGROUND: It is recognized that blood pressure (BP) variability has prognostic significance in determining target organ damage and cardiovascular mortality and morbidity. The aim of this study was to analyze the association between blood pressure variability and the presence of silent cerebral white matter lesions in middle-aged asymptomatic essential hypertensives. METHODS: We studied 43 middle-aged untreated hypertensive patients. Blood pressure variabilities (short-term and long-term) were evaluated by using both non-invasive, beat-to-beat, continuous finger 24-hour monitoring (Portapres) and oscillometric automated discontinuous ambulatory blood pressure monitoring. All patients underwent cerebral magnetic resonance imaging to detect the presence or not of white matter lesions. RESULTS: Hypertensive patients with cerebral white matter lesions exhibited significantly higher values of long-term systolic blood pressure variability (standard deviation of 24-hour blood pressure) measured both by continuous beat-to-beat monitoring (16.2 +/- 3.7 v 13.7 +/- 3.6 mm Hg; P = 0.047) and by ambulatory blood pressure monitoring (15.2 +/- 3.8 v 12.8 +/- 2.7 mm Hg; P = 0.022). However, these differences were not independent on blood pressure elevation and did not maintain their significance after adjusting for 24-hour systolic blood pressure. Neither short-term systolic blood pressure variability, nor short-term or long-term diastolic blood pressure variabilities showed differences between patients with and without white matter lesions. CONCLUSION: The present study indicates that long-term systolic blood pressure variability is significantly related to the presence of silent cerebral white matter lesions in essential hypertensive patients, although this relationship is partially dependent on absolute blood pressure elevation.

Biomarkers↗
PubMed2004

Office compared with ambulatory blood pressure in assessing response to antihypertensive treatment: a meta-analysis.

OBJECTIVE: To undertake a systematic review of the studies on the effect of antihypertensive treatment on ambulatory (ABP) and office blood pressure in order to obtain a differential assessment of the magnitude of the reduction in (1) office blood pressure compared with 24-h average ABP values, and (2) daytime compared with night-time average blood pressure values. DATA SOURCES: Medline search, Cochrane Library. REVIEW METHODS: This review is based on a meta-analysis (carried out according to the Quality of Reports of Meta-analyses of Randomized Controlled Trials Group statement, whenever applicable) of papers on the effect of antihypertensive drugs on blood pressure. Papers were selected if they provided information on drug-induced changes in one or both of: (1) both office blood pressure and 24-h ABP, and/or (2) both daytime and night-time average blood pressure. Additional inclusion criteria were administration of antihypertensive drugs for at least 1 week and good quality ABP, according to current guidelines. Comparison between the effect of treatment on blood pressure values was made by meta-regression of the data provided by the individual studies (weighted by their size) and by calculating differences between weighted average values obtained by pooling the results of individual papers. RESULTS: We identified 984 papers on this issue by Medline search, with no additional information from the Cochrane Library. The inclusion criteria were satisfied by only 44 papers, which were included in the final analysis. The results showed that treatment-induced reduction in blood pressure is both smaller for the 24-h average than for the office systolic and diastolic blood pressure and smaller for night-time than for daytime average diastolic blood pressure, the average ratio ranging from 0.67 to 0.75. A different ratio characterized the treatment-induced changes in office blood pressure and ABP in the Heart Outcomes Prevention Evaluation (HOPE) ABP substudy. CONCLUSIONS: The effect of antihypertensive treatment is greater on office blood pressure than on ABP, and is unevenly distributed between day and night. This suggests caution when interpreting trials on cardiovascular protection by antihypertensive treatment that are based only on office blood pressure readings, and advocates a more systematic adoption of ABP monitoring in these trials. The conflicting data provided by the main HOPE study and by the HOPE-ABP monitoring substudy on the role of blood pressure reduction in explaining the reduced event rates associated with treatment by angiotensin-converting enzyme inhibitors are a clear example of the importance of performing ABP monitoring in trials on cardiovascular protection.

Antihypertensive Agents↗