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P Verdecchia

Publications and source records attributed to P Verdecchia.

At least 19 recordsLinked to original sources
PubMed1995

Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass.

OBJECTIVES: We examined the prognostic significance of concentric remodeling of the left ventricle in patients with essential hypertension and normal left ventricular mass on echocardiography. BACKGROUND: An echocardiographic pattern of concentric remodeling of the left ventricle has been associated with clinical features of increased cardiovascular risk, but the independent prognostic value of this finding in hypertensive patients with normal left ventricular mass has not been established. METHODS: Six hundred ninety-four patients with essential hypertension and normal left ventricular mass (< 125 g/m2) on echocardiography were prospectively followed up for < or = 7.7 years (mean 2.71). Baseline echocardiography and 24-h noninvasive ambulatory blood pressure monitoring were performed in all patients at the time of initial diagnostic evaluation. Concentric remodeling was defined by the thickness of the septum or posterior wall divided by the left ventricular radius at end-diastole > or = 0.45. RESULTS: Prevalence of concentric remodeling was 39.2%. During follow-up there were 29 cardiovascular morbid events. Cardiovascular morbidity, expressed as the combined number of fatal and nonfatal events per 100 patient-years, was 1.53 in the overall study group, 1.12 in the subgroup with normal left ventricular geometry and 2.39 in that with concentric remodeling. After assessment of the independent association with several covariates (age, gender, diabetes, left ventricular mass index, mean clinic blood pressure and mean 24-h ambulatory blood pressure) in Cox proportional hazard models, the risk of cardiovascular morbid events was higher in the group with concentric remodeling than in that with normal geometry (relative risk 2.56, 95% confidence interval 1.20 to 5.45, p < 0.01). CONCLUSIONS: Concentric remodeling of the left ventricle, defined by the thickness of the septum or posterior wall divided by the left ventricular radius at end-diastole > or = 0.45, is an important and independent predictor of increased cardiovascular risk in hypertensive patients with normal left ventricular mass on echocardiography.

Adult↗
PubMed1995

Gender, day-night blood pressure changes, and left ventricular mass in essential hypertension. Dippers and peakers.

The finding of increased left ventricular (LV) mass in hypertensive subjects with blunted nocturnal fall in blood pressure (BP) might be an artifact of matching patients for daytime BP, with resulting higher 24-h BP in nondippers. Therefore, we compared a large number (n = 1048) of hypertensive dippers and nondippers in their LV mass at echocardiography before and after adjustment for 24-h, daytime, and nighttime ambulatory BP. In men, the difference between dippers and nondippers was not significant before and after adjustment for 24-h BP, but after adjustment for nighttime BP LV mass was greater in dippers (more properly "peakers"). In women, LV mass was greater in nondippers than in dippers both before and after adjustment for 24-h BP, while the difference between the two groups disappeared after adjustment for nighttime BP. Thus, for any given level of mean 24-h BP, a flattened diurnal BP profile is associated with a greater LV mass in hypertensive women. Daytime hypertension, either associated or not with a blunted nocturnal fall in BP, may be a sufficient determinant of LV wall thickening in men.

Adolescent↗
PubMed1995

White coat hypertension and white coat effect. Similarities and differences.

The rise in blood pressure (BP) associated with clinical visit (white coat effect) may be one basic mechanism of white coat hypertension (persistently raised clinic BP together with a normal BP outside the clinic), but the relations between white coat hypertension, white coat effect, and target organ damage have not yet been assessed on large populations. Thus, we performed 24-h noninvasive ambulatory BP monitoring and 2D-guided M-mode echocardiography in 1,333 untreated subjects with essential hypertension and 178 control normotensive subjects. White coat hypertension was defined by an average daytime ambulatory BP < 131/86 mm Hg in women and < 136/87 mm Hg in men and its prevalence was 18.9% (n = 252). The white coat effect was calculated for systolic and diastolic BP as the difference between clinic BP and average daytime ambulatory BP. Echocardiographic left ventricular mass was slightly but not significantly greater in the group with white coat hypertension than in the normotensive group (93 v 87 g/m2, P = NS), and increased in the group with ambulatory hypertension (112 g/m2, P < .01). The prevalence of white coat hypertension markedly decreased from the first to the fourth Joint National Committee V (JNC V) stage of severity of hypertension (186/559 subjects (33%) in I; 59/501 (11%) in II; 7/230 (3%) in III; 0/43 (0%) in IV; P < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[White-coat hypertension].

White-coat hypertension may be broadly defined by the coexistence of normal ambulatory, or self-measured, blood pressure (BP) with persistently increased clinic BP. White-coat hypertension should not be considered as a separate clinical entity, but, rather, as a low-risk stratum of essential hypertension which may be identified using ambulatory BP monitoring or self-measured BP. One possible cause of white-coat hypertension may be a conditioned response to the clinical visit, with consequent alerting reaction and rise in BP. Specifically, white-coat hypertension may be defined by an average daytime ambulatory BP ideally less than 130 mm Hg systolic and 80 mm Hg diastolic (or, at least, 134 mm Hg systolic and 90 mm Hg diastolic) in untreated subjects with essential hypertension and clinic BP above 140 mm Hg systolic or 90 mm Hg diastolic for at least three visits. Several cross sectional studies have shown that hypertensive target organ damage (TOD) is not dissimilar between clinically normotensive subjects and subjects with white-coat hypertension but this finding is still controversial. Moreover, nearly all studies have shown that TOD is lesser in subjects with white-coat hypertension than in those with higher levels of ambulatory BP. Evidence is accumulating that white-coat hypertension is a condition of low cardiovascular risk. In this setting, a prospective study from our center and preliminary data from another center suggest that the incidence of serious cardiovascular complications of hypertension (myocardial infarction, sudden death, stroke, etc) is lower in subjects with white-coat hypertension than in those with ambulatory hypertension, and not dissimilar between subjects with white-coat hypertension and clinically normotensive subjects. Further prospective studies are needed to clarify the very-long term history of white-coat hypertension and to test the hypothesis that antihypertensive drug treatment may not be necessary, as unable to improve an already good prognosis, in uncomplicated subjects with white-coat hypertension and absence of concomitant risk factors.

Blood Pressure Determination↗
PubMed1994

Improved electrocardiographic diagnosis of left ventricular hypertrophy.

This study was aimed at improving the performance of standard electrocardiographic criteria of left ventricular hypertrophy (LVH) in essential hypertension using echocardiographic left ventricular mass as reference. In 923 white, untreated hypertensive subjects (mean age 51, prevalence of echocardiographic LVH 34%), sensitivity of electrocardiographic criteria of LVH varied between 9% and 33% and specificity was generally > or = 90%. The sum of Sv3 + RaVL (Cornell voltage) showed the closest association with echocardiographic left ventricular mass (r = 0.48, p < 0.001), and its performance was superior to that of Sokolow-Lyon voltage in a receiver-operating characteristic curve analysis. A modified partition value of the Cornell voltage was tested (> 2.4 mV in men and > 2.0 mV in women), that yielded a good combination between sensitivity (26% in men and 19% in women, overall 22%) and specificity (96% in men and 95% in women, overall 95%). When LVH at electrocardiography was defined as the positivity of at least 1 of the following 3 criteria--Sv3 + RaVL > 2.4 mV in men or > 2.0 mV in women, a typical strain pattern, or a Romhilt-Estes point score > or = 5--sensitivity increased to 39% in men and 29% in women (overall 34%) and specificity decreased to 94% in men and 93% in women (overall 93%). Sensitivity of electrocardiography progressively increased from the first to the fourth quartile of left ventricular mass in subjects with echocardiographic LVH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Asymmetric left ventricular remodeling due to isolated septal thickening in patients with systemic hypertension and normal left ventricular masses.

Early identification of left ventricular (LV) structural changes may have an impact on the outlook of patients with essential hypertension. Of 669 untreated hypertensive subjects, 496 (74%) with normal LV mass at echocardiography (< 125 g/m2) were grouped according to normal LV geometry (n = 303; 61%), asymmetric LV remodeling due to isolated septal thickening (n = 111; 22%), asymmetric LV remodeling due to isolated posterior wall thickening (n = 5; 1%), or concentric LV remodeling due to septal and posterior wall thickening (n = 77; 16%). Remodeling was defined as twice the thickness of septum or posterior wall divided by the internal diameter at end diastole > 0.45. Twenty-four-hour noninvasive ambulatory blood pressure (BP) monitoring was performed in all subjects. Compared with subjects with normal LV geometry, those with asymmetric LV remodeling due to isolated septal thickening showed increased clinic BP (158/100 vs 153/97 mm Hg, both p < 0.05), mean daytime ambulatory BP (144/95 vs 138/90 mm Hg, both p < 0.01), mean nighttime ambulatory BP (128/80 vs 122/76 mm Hg, both p < 0.01), LV mass (99 vs 89 g/m2, p < 0.001), total peripheral resistance (1,881 vs 1,562 dynes s cm-5, p < 0.01) and known duration of hypertension (5.5 vs 3.6 years, p < 0.01) and decreased stroke index (39 vs 47 ml/m2, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension.

To determine the prognostic significance of ambulatory blood pressure, we prospectively followed for up to 7.5 years (mean, 3.2) 1187 subjects with essential hypertension and 205 healthy normotensive control subjects who had baseline off-therapy 24-hour noninvasive ambulatory blood pressure monitoring. Prevalence of white coat hypertension, defined by an average daytime ambulatory blood pressure lower than 131/86 mm Hg in women and 136/87 mm Hg in men in clinically hypertensive subjects, was 19.2%. Cardiovascular morbidity, expressed as the number of combined fatal and nonfatal cardiovascular events per 100 patient-years, was 0.47 in the normotensive group, 0.49 in the white coat hypertension group, 1.79 in dippers with ambulatory hypertension, and 4.99 in nondippers with ambulatory hypertension. After adjustment for traditional risk markers for cardiovascular disease, morbidity did not differ between the normotensive and white coat hypertension groups (P = .83). Compared with the white coat hypertension group, cardiovascular morbidity increased in ambulatory hypertension in dippers (relative risk, 3.70; 95% confidence interval, 1.13 to 12.5), with a further increase of morbidity in nondippers (relative risk, 6.26; 95% confidence interval, 1.92 to 20.32). After adjustment for age, sex, diabetes, and echocardiographic left ventricular hypertrophy (relative risk versus subjects with normal left ventricular mass, 1.82; 95% confidence interval, 1.02 to 3.22), cardiovascular morbidity in ambulatory hypertension was higher (P = .0002) in nondippers than in dippers in women (relative risk, 6.79; 95% confidence interval, 2.45 to 18.82) but not in men (P = .91). Our findings suggest that ambulatory blood pressures stratifies cardiovascular risk in essential hypertension independent of clinic blood pressure and other traditional risk markers including echocardiographic left ventricular hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Non-invasive ambulatory BP monitoring during the night: randomised comparison of different reading intervals.

Frequent measurements of BP during noninvasive monitoring could interfere with sleep, with consequent possible overestimation of nocturnal BP. We performed 24h noninvasive ambulatory BP monitoring (Space-Labs 90207) in 24 patients with essential hypertension twice, 1 week apart. Subjects were instructed to follow, as far as possible, a similar pattern of daily activity during the two sessions. The frequency of daytime readings (from 06.00 to 22.00 h) was kept constant in the two sessions (one every 15 minutes), while that of nocturnal readings (from 22.00 to 06.00 h) varied in random order: every 15 minutes in session A and every 60 minutes in session B. Mean sleep BP did not differ between session A (138/83 mmHg (SD 15/10 mmHg)) and session B (138/83 mmHg (SD 14/10 mmHg)). The percentage reduction of ambulatory SBP and DBP from wake to sleep was 9.7% and 10.0%, respectively, in session A, and 14.0% and 14.1%, respectively, in session B (all P = NS). The duration of sleep was 6.1 hours (SD 2 hours) in session A and 6.0 hours (SD 2 hours) in session B (P = NS). On average, 6.8% of nocturnal readings in session A and 7.6% of nocturnal readings in session B failed to pass the automatic editing criteria, but no hourly interval was lacking in valid measurements on both sessions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Effects of transdermal nitroglycerin in combination with an ACE inhibitor in patients with chronic stable angina pectoris.

We have previously shown that transdermal nitroglycerin may induce an increase in the activity of the adrenergic and the renin-angiotensin-aldosterone systems (SRAA) in patients with chronic stable angina pectoris (SA); when the activation of these systems is more pronounced, the antianginal effect of this drug seems to be reduced. The aim of this study was to evaluate the antianginal efficacy of transdermal nitroglycerin administration (TTS-NG 10 mg.24 h-1) in combination with an ACE inhibitor without sulphydryl groups (BNZ, benazepril 10 mg b.i.d.) in respect to placebo, or to TTS-NG or BNZ administered as monotherapy. Twenty-four patients (21M, 3F) were admitted to this multicentre, randomized, double-blind, latin square, placebo-controlled study. Patients received all the treatments (placebo, TTS-NG, BNZ and BNZ + TTS-NG) each for one week; at the end of each week patients performed two exercise tests 2 and 22 h post-dosing. Two hours post-dosing, exercise duration at 1 mm ST depression was significantly increased in respect to placebo during TTS-NG (P < 0.05) and TTS-NG + BNZ (P < 0.05) treatments. Two hours post-dosing, exercise duration at peak exercise was also increased in respect to placebo during TTS-NG (P < 0.05) and TTS-NG + BNZ (P < 0.05); 22 h post-dosing the increase in exercise duration was significant only during TTS-NG + BNZ treatment (P < 0.05) in respect to placebo, but not during TTS-NG given alone. Rate-pressure product at 1 mm ST depression was significantly increased 2 h post-dosing during TTS-NG treatment (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1993

Blunted nocturnal fall in blood pressure in hypertensive women with future cardiovascular morbid events.

BACKGROUND: In essential hypertension, a blunted or absent nocturnal fall in blood pressure (BP) may be associated with increased target organ damage. In this case-control study, we tested the hypothesis that an association exists between a blunted or absent nocturnal fall in BP and future cardiovascular morbid events in patients with essential hypertension. METHODS AND RESULTS: Case subjects were 32 hypertensive patients with a first fatal or nonfatal major cardiovascular event who had off-therapy ambulatory BP monitoring 1 to 5 years earlier in the context of a registry of morbidity and mortality in hypertensive patients. Control subjects were 49 hypertensive patients free from cardiovascular events. The groups were matched with regard to date of baseline ambulatory BP monitoring, age, sex, clinic systolic and diastolic BP, and daytime ambulatory systolic and diastolic BP. At their baseline evaluation, cases and controls did not differ, in either sex, with respect to clinic BP (men, 164/100 vs 162/99 mmHg; women, 178/96 vs 180/93 mmHg), mean daytime ambulatory BP (men, 151/94 vs 147/95 mm Hg; women, 156/90 vs 158/89 mm Hg), age (men, 55 vs 56 years; women, 69 vs 68 years), sex, body weight, serum cholesterol, known duration and family history of hypertension, smoking habits, renal function, or prevalence of diabetes. Echocardiographic left ventricular mass, determined in a subset of patients, was greater in cases than in controls in men (145 vs 115 g/m2, P = .038) and women (137 vs 102 g/m2, P = .032). The time interval between baseline ambulatory BP monitoring and subsequent cardiovascular event (cases: mean, 2.1 years) or last contact with our center (controls: mean, 2.5 years) did not differ between the groups. In the baseline ambulatory BP profile, the nocturnal reductions of systolic and diastolic BP in men were 9% and 11%, respectively, in cases vs 9% and 12% in controls (all P = NS), whereas in women they were 3% and 8% in cases vs 11% and 16% in controls (P = .002/.004). CONCLUSIONS: This retrospective case-control study suggests an association between the reduction or absence of the usual nocturnal fall in BP and future cardiovascular morbid events in white women with essential hypertension.

Aged↗
PubMed1993

[Pharmacology and clinical use of a fixed combination of nifedipine and slow release atenolol (Niften) in the treatment of arterial hypertension and angina pectoris].

Nifedipine and atenolol are first choice drugs in the treatment of arterial hypertension and angina pectoris. In both these pathologies the administration of nifedipine and atenolol in free or fixed combinations has proved extremely efficacious in patients who were not adequately controlled by either drug in monotherapy. A fixed combination of intestinal slow-release nifedipine and atenolol (Niften) was recently developed and has already undergone several comparative and double-blind clinical trials for the treatment of arterial hypertension and angina pectoris. The pharmacokinetic and pharmacodynamic characteristics of atenolol and nifedipine are not altered when these drugs are administered in fixed or free combination. It has been shown that the nifedipine-atenolol combination causes anti-hypertensive and anti-anginous effects at doses which are lower, for either of its two components, in comparison to the doses required to achieve the same effects using monotherapy. In arterial hypertension a clinically striking anti-hypertensive effect on systolic and diastolic levels is maintained for 24 hours after a single administration of slow-release nifedipine 20 mg+atenolol 50 mg. In angina pectoris, this dose must be administered every 12 hours to ensure a constant and prolonged effect of the calcium antagonist component. The association of nifedipine and atenolol does not induce notable depressive effects on myocardial contractility, except in patients with severely compromised basal resting contractile function.

Adrenergic beta-Antagonists↗
PubMed1993

Defining normal ambulatory blood pressure in relation to target organ damage and prognosis.

It is premature to state that ambulatory blood pressure (ABP) values below a given level should be considered normal, and those above it abnormal, in terms of prognostic implications on cardiovascular (CV) morbidity. We do not know whether CV morbidity in hypertensive subjects with apparently normal ABP (white coat hypertension) is less than that in patients with higher ABP levels and similar to that of healthy normotensive subjects, or whether the effects of antihypertensive drug treatment on CV morbidity are superior to placebo in white coat hypertension. It is important to achieve agreement on a temporary working definition of normal ABP to be used to test two main hypotheses: 1) in subjects with white coat hypertension, CV morbidity is less than that in patients with higher ABP levels; and 2) drug treatment is not superior to placebo in reducing CV morbidity in white coat hypertension. Normal ABP values can be derived empirically from population based samples, in selected groups of healthy subjects, or from meta-analyses. However, the significance of the definition of a normal ABP range is the identification of clinically hypertensive patients at low risk of future CV morbid events. Using echocardiographic left ventricular (LV) mass as a surrogate outcome measure, we found that the coexistence of mean daytime ABP levels < 134 mm Hg systolic and < 90 mm Hg diastolic, regardless of gender (< 136/87 mm Hg in men and 131/86 mm Hg in women) identifies a subgroup of clinically hypertensive subjects with echocardiographic LV mass, and associated prevalence of left ventricular hypertrophy (LVH) similar to those found in healthy normotensive control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1992

Evaluation of the antihypertensive effect of once-a-day trandolapril by 24-hour ambulatory blood pressure monitoring. The Italian Trandolapril Study Group.

The aim of this study was to evaluate the effects of trandolapril on 24-hour blood pressure in patients with mild-to-moderate essential hypertension. After a washout period of 4 weeks, 42 patients were randomized to receive 2 mg of trandolapril once daily and 20 to receive placebo in a double-blind fashion for 6 weeks. This was followed by a second washout period of 4 weeks. At the end of each period, clinic blood pressure was assessed at 24 hours after the last dose and 24-hour ambulatory blood pressure was measured noninvasively, taking blood pressure readings every 15 minutes during the day and every 20 minutes during the night. Two patients were dropped out before any blood pressure evaluation under treatment. Analysis of ambulatory blood pressure was performed in 48 patients who met the criteria for the minimal number of ambulatory blood pressure data (2 values per hour during the day and 1 value per hour in the night). In the trandolapril-treated group (n = 41) clinic systolic/diastolic blood pressures were 159.8 +/- 2.0/102.4 +/- 0.8, 146.8 +/- 2.3/94.8 +/- 1.1, and 155.7 +/- 2.0/99.2 +/- 0.7 mm Hg in the pretreatment, treatment, and post-treatment periods, respectively. The corresponding values for 24-hour mean blood pressure (n = 31) were 139.5 +/- 1.9/91.2 +/- 1.5, 131.0 +/- 2.0/84.3 +/- 1.2, and 139.7 +/- 1.8/90.9 +/- 1.1 mmHg. The differences between the lower treatment, versus the higher pre- and post-treatment, values were all statistically significant (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗