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Biomedical subjects

M Santonastaso

Publications and source records attributed to M Santonastaso.

18 recordsLinked to original sources
PubMed2000

Reproducibility of heart rate measured in the clinic and with 24-hour intermittent recorders.

This study was undertaken to assess the reproducibility of office versus ambulatory heart rates in 839 hypertensive subjects participating in the Hypertension and Ambulatory Recording Venetia Study (HARVEST). A 24-hour heart rate was recorded twice; this procedure was repeated three months later. Reproducibility was better for ambulatory than for office measurement, and was greater for 24-hour than for daytime heart rate, and lowest for night-time heart rate. Reproducibility of office heart rate was impaired above 85 bpm, and was poorer in subjects with more severe office hypertension. A small but significant decrease in average daytime (-1 bpm, P < 0.0001) and virtually no change in night-time heart rate (-0.3 bpm, NS) were observed at repeat recording. Heart rate reproducibility indices were related to the extent of the heart rate and blood pressure white-coat effect, but did not vary according to age, gender, body mass index, day-night blood pressure difference, or alcohol or tobacco use. Results indicate that heart rate recorded over the 24 hours has a better reproducibility than office heart rate, and could thus be a better prognostic indicator than traditional measurement of resting heart rate in the hospital setting.

Adult↗
PubMed2000

[Alcohol-related liver diseases in the aged].

In these last years the authors have devoted themselves to chronic alcoholism rehabilitation. They have studied 99 over 65 years old subjects. In these subjects gastrointestinal pathology alcohol correlated incidence has been studied. An abdominal echography and an esophagogastroduodenoscopy have been performed in all these subjects. In some subjects, on the guide line of these tests, the authors have put through more tests: hepatosplenic scintigraphy, hepatic biopsy, laparoscopy, colonoscopy. Statistic elaboration was performed by chi-square test. The conclusions of this study are: 1) the diagnostic importance of association between echography and scintigraphy; 2) the low prevalence of severe hepatic alcohol related lesions in the elderly; 3) the importance of alcohol in hepatocarcinoma etiopathogenesis; 4) the incidence and the importance of phlogistic and ulcerous gastroduodenal lesions in elderly alcoholics.

Abdomen↗
PubMed1999

Ambulatory blood pressure predicts end-organ damage only in subjects with reproducible recordings. HARVEST Study Investigators. Hypertension and Ambulatory Recording Venetia Study.

OBJECTIVE: To determine whether the prediction of target-organ damage varies according to the reproducibility of 24 h blood pressure. SETTING: Seventeen hypertension clinics in northeast Italy. MAIN OUTCOME MEASURES: Correlations of left ventricular mass index and albumin excretion rate with 24 h and office blood pressures in relation to tertiles of ambulatory blood pressure reproducibility. PATIENTS AND METHODS: In 716 consecutive, stage I, hypertensives enrolled in the Hypertension and Ambulatory Recording Venetia Study (HARVEST), ambulatory blood pressure monitoring was performed twice, 3 months apart In all subjects, the albumin excretion rate was measured by radioimmunoassay, and in 567, the left ventricular mass index was assessed by echocardiography. RESULTS: The subjects were divided into tertiles of ambulatory blood pressure consistency (between-monitoring differences, regardless of the sign). In the tertile of subjects with good reproducibility, correlation coefficients of systolic and diastolic ambulatory blood pressure with left ventricular mass and urinary albumin excretion were significant and higher than those of office blood pressure. In contrast, in the two tertiles with poorer reproducibility, the coefficients were barely or not significant for both pressures. The advantage of ambulatory blood pressure over office blood pressure in predicting target-organ damage was no longer present for systolic blood pressure differences greater than 3.8 mmHg and diastolic blood pressure differences greater than 3.1 mmHg. CONCLUSIONS: These data indicate that ambulatory blood pressure is a better predictor of left ventricular mass and urinary albumin excretion than office blood pressure, but only in subjects with good pressure reproducibility. Therefore, the assessment of hypertensive patients should be based on duplicate blood pressure monitorings. Recordings with 24 h systolic and diastolic blood pressure differences greater than 4 and 3 mmHg, respectively, should be considered with caution.

Adolescent↗
PubMed1998

Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension. HARVEST Study Group.

It has been claimed that diastolic dysfunction is the earliest cardiac abnormality in hypertension, preceding the development of left ventricular (LV) structural abnormalities. To detect early signs of hypertensive cardiac involvement 722 subjects (533 men and 189 women), 18-45 years old, with stage I hypertension, were studied by M-mode and Doppler echocardiography. Blood pressure was measured by 24-h ambulatory monitoring. Ninety-five normotensive individuals of similar age and gender distributions were studied as controls. Significant, though modest, changes of LV mass and geometry were found in the participants in comparison with the normotensive controls. The increment was +10.4 g/m2 for LV mass index, +1.8 mm for LV wall thickness, and +0.032 for relative wall thickness. A slight increase in atrial filling peak velocity was found in the hypertensive subjects at Doppler analysis of transmitral flow, but the ratio of early to atrial velocity of LV diastolic filling did not differ between the two groups. In multiple regression analyses, which included age, body mass index, heart rate, smoking, and physical activity, 24-h mean blood pressure emerged as a significant predictor of LV mass index (men, P = .003; women, P = .04) and wall thickness (men, P = .03; women, P = .004) in the hypertensive subjects, whereas no index of diastolic filling was significantly associated with ambulatory blood pressure in either gender. The present data indicate that changes in LV anatomy are the earliest signs of hypertensive cardiac involvement. Left ventricular filling is affected only marginally in the initial phase of hypertension.

Adolescent↗
PubMed1998

Target-organ damage in stage I hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study.

Controversy remains on whether white coat hypertension is a benign clinical condition or carries an increased risk of target-organ damage. Nine hundred forty-two stage I hypertensive subjects enrolled in the HARVEST trial underwent 24-hour ambulatory blood pressure monitoring and urine collection for albumin measurement. Reliable echocardiographic data were obtained in 722 subjects. White coat hypertensive subjects were defined on the basis of three different partition values: mean daytime blood pressure <130/90 mm Hg, <135/85 mm Hg, or <140/90 mm Hg. Ninety-five normotensive subjects with similar age and sex distribution were studied as controls. With all threshold levels, left ventricular mass index and wall thicknesses were greater in the sustained hypertensive subjects than in the white coat hypertensive subjects, also when these differences were adjusted for blood pressure readings taken in the office. Relative wall thickness was similar in the two hypertensive groups. All echocardiographic dimensional data were greater in the white coat hypertensive subjects than in the normotensive subjects. Urinary albumin and the prevalence of microalbuminuria were also greater in the sustained hypertensive subjects than in the white coat hypertensive subjects. No significant differences in urinary albumin were found between the white coat hypertensive and the normotensive subjects. These results show that within a population of subjects with stage I hypertension, subjects with white coat hypertension have a smaller degree of hypertensive complications than those with sustained hypertension, irrespective of their blood pressure levels taken in the office. However, in comparison with normotensive subjects, white coat hypertensive subjects seem to be at greater risk. Cardiac involvement seems to precede glomerular damage in the early stage of hypertension.

Adult↗
PubMed1997

Treatment of chronic hepatitis C with interferon-alpha by monitoring the response according to viraemia.

In chronic hepatitis C (HCV) infection, treatment with interferon is associated with a rather low rate of sustained response and many treated patients do not achieve significant benefit. Efforts have therefore been made to identify non-responders as early as possible to avoid unjustified costs and side-effects. We treated 106 cases of HCV with an algorithm based on the results of sequential alanine aminotransferase (ALT) and HCV RNA determinations, using an initial dose of 6 MU thrice weekly for 4 months, and modified the subsequent treatment according to the biochemical and virological profile. Thirty-three out of 48 patients (68.7%) who were HCV RNA negative with normal ALT at 4 months after initiation of treatment were sustained responders when treated for an additional 4-month period with a reduced 3 MU dose, while sustained response was achieved in 12.5% of HCV RNA positive patients treated with a higher dosage and for a more prolonged period of time. Our findings indicate that HCV RNA monitoring during interferon therapy may be useful in modifying of the treatment schedule for the individual patient.

Adolescent↗
PubMed1997

Target organ damage and ambulatory blood pressure in stage I hypertension. The Hypertension and Ambulatory Recording Venetia Study.

According to recent international guidelines the decision on whether to treat young subjects during the early phase of hypertension should be based not only on their office blood pressure but also on their ambulatory blood pressure and whether target organ damage has occurred. Few data on the prevalence of hypertensive complications in young subjects with mild hypertension are available. In the Hypertension and Ambulatory Recording Venetia Study (HARVEST), a multicenter trial conducted in northeast Italy, the percentage of young borderline-to-mild hypertensive subjects with echocardiographic left ventricular hypertrophy was 4.5% and the percentage with concentric remodeling was 4%. Clear differences in cardiac size and geometric adjustment to ambulatory systolic pressure between the two sexes were found. The impact of blood pressure on the walls of the left ventricle and on the left ventricular mass was remarkable in women but weak in men. The assessment of left ventricular systolic function confirmed that many young mild hypertensive subjects have an increased ejective performance. The left ventricular contractility evaluated by midwall measurement was, however, found to be depressed in 9.2% of the HARVEST participants. Their left ventricular diastolic function was similar to that of 50 normotensive controls. The prevalence of microalbuminuria [albumin excretion rate (AER) > 30 mg/24 h) was 6.1%, only slightly higher than that found by other authors among normotensive subjects and much lower than that observed among patients with more severe hypertension. For our stage I hypertensives, however, the AER was correlated to the 24 h blood pressure with high statistical significance, whereas we found no relationship between the AER and left ventricular mass index either for all of the subjects taken together or for the men and women considered separately. The results suggest that renal and cardiac involvement do not occur in parallel during the initial phase of hypertension.

Journal Article↗
PubMed1997

[Alcoholism and the elderly: the importance of blood chemistry parameters for the diagnosis].

UNLABELLED: This paper again affirms the epidemiological significance of alcoholism in the elderly. The results of a study on 99 chronic alcoholic patients sixty-year older have been reported. CONCLUSIONS: The laboratory tests for diagnosis normally used for screening of alcoholism are not enough considered in the elderly. In those patients more parameters have to be evaluated.

Aged↗
PubMed1997

[Integrated treatment of alcoholism. Evaluation of its efficacy].

Patients with alcohol addiction are analyzed after one year from the beginning of therapy. Treatment is carried out by an Anti-addiction Service working in territory, an Hospital medical ward, anti-alcoholic clubs and Hospital voluntary groups. The method is described at first, then the answers of investigated patients, the abstinence period, the attendance to help groups, the use of drugs (disulfiram) and the emerged problems are considered and analyzed. More than one year later, patients with alcohol addiction who have followed this method are still in abstinence and have changed their habit from alcoholic to unalcoholic one, as just they have done for the behaviour and the relationship.

Adult↗
PubMed1996

Relationship of plasma renin activity with caffeine intake and physical training in mild hypertensive men. HARVEST Study Group.

UNLABELLED: To study the relationship between plasma renin activity (PRA) and coffee consumption, cigarette smoking, alcohol intake and physical activity habits. SETTING: The multicentre HARVEST trial, involving 17 Hospital Centres in Northeast Italy. SUBJECTS: 351 borderline to mild hypertensive men (mean age +/- SEM 22.7 +/- 0.47 years), never treated for hypertension. INTERVENTIONS: Office and 24-hour blood pressure measurement, supine and standing PRA levels, and urinary catecholamines output. MAIN OUTCOME MEASURES: PRA levels according to coffee intake and physical activity status. RESULTS: Coffee intake showed a major effect on PRA. Supine PRA levels were 40% higher in the subjects abstaining from coffee (n = 94) than in the coffee drinkers and was similar in the moderate (n = 223) and heavy (n = 34) drinkers. A weaker negative association was found between coffee use and PRA on standing. Office and whole-day blood pressure and heart rate, and urinary catecholamines did not differ according to coffee intake. Supine PRA was lower in the subjects performing regular physical activity than in the inactive subjects. Office and whole-day diastolic blood pressure and heart rate, and urinary norepinephrine were lower in the active than in the sedentary men. No relationship was found between PRA measured either in the supine or the upright posture and tobacco or alcohol use. In a multiple linear regression model supine PRA was negatively correlated with age, coffee consumption and physical activity habits. CONCLUSIONS: Chronic coffee intake and physical training showed an inverse relationship with PRA in mild hypertensive men, while tobacco and alcohol use were unrelated to PRA.

Adolescent↗
PubMed1996

[Rehabilitation of the elderly alcoholic].

The Authors studied 99 over 60 years old alcohol abusers, in view of their enrollment in a programme of rehabilitation. They observed that the treatment was effective, but less than it was in younger alcoholics; however, if subjects are properly selected, the efficacy is similar. In conclusion, the Authors reaffirm the importance, in spite of the difficulty, of a precocious diagnosis of alcoholism in the elderly.

Age Factors↗
PubMed1995

Relationship between albumin excretion rate, ambulatory blood pressure and left ventricular hypertrophy in mild hypertension.

OBJECTIVE: To study the relationship of urinary albumin excretion to ambulatory blood pressure and other cardiovascular risk factors in borderline to mild hypertension. PATIENTS AND METHODS: We studied 779 patients with borderline to mild hypertension (mean +/- SEM age 33 +/- 0.3 years; mean +/- SEM office blood pressure 146 +/- 0.4/94 +/- 0.2 mmHg) at 17 hypertension clinics in northeast Italy. Office and 24-h blood pressures were recorded with simultaneous urine collection for albumin measurement. In 510 subjects, left ventricular mass was measured by echocardiography. RESULTS: Subjects with overt (> or = 30 mg/24 h) and borderline (16-29 mg/24 h) microalbuminuria had similar 24-h blood pressure levels, higher than those in the subjects without microalbuminuria. In the univariate and multiple regression analyses the albumin excretion rate was closely correlated with 24-h systolic blood pressure and not related to age, body mass index, metabolic parameters, lifestyle factor and degree of left ventricular hypertrophy. CONCLUSIONS: Borderline values of urinary albumin excretion (16-29 mg/24 h) may be clinically relevant in subjects with borderline to mild hypertension. Renal and cardiac damage do not develop in parallel in the initial phases of hypertension.

Adult↗
PubMed1994

Factors affecting ambulatory blood pressure reproducibility. Results of the HARVEST Trial. Hypertension and Ambulatory Recording Venetia Study.

To assess the reproducibility of ambulatory blood pressure, we recorded 24-hour blood pressure twice 3 months apart in 508 hypertensive subjects participating in the HARVEST trial using a noninvasive technique. Blood pressure was measured every 10 minutes during the daytime and 30 minutes during the nighttime. Reproducibility was better for ambulatory than for office blood pressure. It was greater for 24-hour than for daytime blood pressure and lowest for nighttime blood pressure. The reproducibility of blood pressure variability (standard deviation) was poorer than that of the average values. A small but significant decrease in average daytime blood pressure (-0.8/-1.0 mm Hg) and virtually no change in nighttime blood pressure (+0.5/+0.1 mm Hg) were observed at repeat recording. Reducing the sampling rate by 50% caused only a small impairment of the reproducibility indexes of both the average values and variability. Blood pressure reduction was greater during the first and last hours of the recordings, indicating an effect of the hospital environment on the between-monitoring difference. Changes in body weight (-0.7 kg, P = .006, at repeat recording) were related to those of 24-hour diastolic blood pressure (P < .05). In conclusion, patient reaction to medical environment and changes of body weight seem to account for most of the change in 24-hour blood pressure that occurs over a 3-month period.

Adolescent↗
PubMed1994

[Alcohol consumption, arterial pressure and metabolic parameters in a population of borderline hypertension subjects. The results of the HARVEST Multicenter Study. Hypertension and Ambulatory Recording Venetia Study].

In 544 borderline to mild hypertensive subjects (mean age 33.5 +/- 8.6 years) participating in the HARVEST trial the relationship between alcohol consumption, blood pressure levels and several clinical parameters was examined. Subjects were divided into 3 groups according to whether they did not drink (Group 1, n = 171) or their daily alcohol intake was < 50 g (Group 2, n = 184) or > 50 g (Group 3, n = 54). In the 409 men alcohol consumption was related to age (p < 0.0001), body weight (p < 0.05) and coffee consumption (p < 0.0001). Group 3 drinkers were also more sedentary than the 2 other groups (p < 0.05). Both office (p < 0.001) and 24-hour (p < 0.001) diastolic blood pressure were greater in the drinkers than in the non drinkers, while no difference was observed in systolic blood pressure. Twenty-four-hour heart rate was higher in Group 3, but urinary catecholamines were similar in the 3 groups of men. Blood glucose (p < 0.001), total cholesterol (p = 0.001) and triglyceride (p < 0.005) were related to alcohol consumption, while HDL-cholesterol was not different in the 3 groups. Albumin excretion rate and uricemia were also unrelated to alcohol intake. In the 135 women a similar alcohol-related trend was observed for office diastolic blood pressure and for the metabolic parameters. In conclusion, the results of the present study confirm the association between alcohol consumption and blood pressure levels, which was apparent also within a population of borderline to mild hypertensive subjects and stress the role of alcohol in determining an abnormality of the metabolic parameters.

Adolescent↗
PubMed1993

[Acute adrenal failure due to adrenal hemorrhagic necrosis secondary to heparin-induced thrombocytopenia].

The authors describe a clinical case with a peculiar sequence of unhealthy events. An operated by osteotomy woman presented a deep venous thrombosis of lever lower extremity with following pulmonary embolism. The patient was treated with heparin. After 5 days, the patient showed a thrombocytopenia, that was not determined by an immune mechanism. The heparin was stopped and the thrombocythemia returned to normal values. But the patient still presented somnolence, asthenia and hypotension. The tests of adrenocortical function showed below normal values. The abdominal CAT showed haemorrhagic necrosis of the suprarenal glands.

Acute Disease↗
PubMedDate not supplied

Thrombocytopenic purpura during therapy with simvastatin.

The authors describe a case of very serious thrombocytopenic purpura occurring in a diabetic and hyperlipidemic woman during therapy with simvastatin, an HMG-CoA reductase inhibitor drug. Interruption of the medical treatment produced a prompt reversal of the thrombocytic attack: one year later the patient's platelet count remains within the normal range. The authors have not found other reports in the medical literature of similar serious reactions during therapy with an HMG-CoA reductase inhibiting substance; nevertheless, a causal nexus is hypothesized but not argued in this case, since further studies will be needed before this connection can be established.

Diabetes Mellitus, Type 2↗