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Milano, Italy

Antonicelli R.,Uo Cardiologia Utic E Centro Of Telemedicina | Mazzanti I.,Uo Cardiologia Utic E Centro Of Telemedicina | Abbatecola A.M.,Italian National Research Center on Aging | Parati G.,St. Luca Hospital | Parati G.,University of Milan Bicocca
Drugs and Aging | Year: 2010

Introduction: Congestive heart failure (CHF), which typically affects older people, is characterized by high short-and mid-term mortality rates. However, despite accumulating evidence showing that administration of b-blockers (β-adrenoceptor antagonists) can improve the clinical status of CHF patients, use of these agents in adequate dosages in this setting is not routine. One reason for this appears to be a concern about a possible risk of bradyarrhythmia associated with use of β-blockers. Telecardiology has recently been investigated as a means of constantly monitoring the heart rate of CHF patients in their homes. Its use may allay concerns about the risk of bradyarrhythmia and facilitate a more widespread use of β-blockers in this context. Objectives: The primary objectives of this study were to assess the impact of telemonitoring on patients' adherence to prescribed therapeutic regimens, particularly β-blockers, and to explore whether use of home telemonitoring reduces mortality and rate of re-admission to hospital in elderly CHF patients compared with normal specialized CHF team care. Methods: A total of 57 patients with CHF (31 New York Heart Association [NYHA] class II, 23 NYHA class III and 3 NYHA class IV), with a mean - SD age of 78.2 ± 7.3 years, were randomized to a control group who received standard care, based on routinely scheduled clinic visits, from a team specialized in CHF patientmanagement, or to a home telemonitoring group (TM group),managed by the same specialized CHF team. Patients were followed up over 12 months. Results: Compared with the control group, the TM group had a significant increase in the use of β-blockers, HMG-CoA reductase inhibitors (statins) and aldosterone receptor antagonists. A reduction in nitrate administration compared with baseline was also seen in the TMgroup. The 12-month occurrence of the primary combined endpoint of mortality and hospital re-admission for CHF was significantly lower in the TM group than in the control group (p < 0.01). Conclusions: This study showed that a home-care model including telemonitoring of relevant clinical parameters may provide useful support in the management of patients with CHF. Home telemonitoring in CHF patients was associated with increased use of β-blockers at appropriate doses, suggesting that this strategy reassured physicians regarding the safety of careful use of these agents in this setting. However, larger studies are required to confirm these findings. Our findings indicate that there is a need to investigate relevant parameters in CHF patients at the point of care (i.e. in patients' daily lives), which can in turn optimize β-blocker and other drug therapy. © 2010 Adis Data Information BV. All rights reserved.

Seravalle G.,St. Luca Hospital | Carzaniga C.,University of Milan | Sciortino G.,University of Milan | Attanasio R.,Endocrinology | And 9 more authors.
Clinical and Experimental Pharmacology and Physiology | Year: 2013

It has been shown that acromegaly is characterized by an autonomic imbalance and by marked sympathoinhibition. However, there is no information available as to whether adrenergic inhibition is confined to selected vascular districts or, rather, is generalized. We examined 17 newly diagnosed active acromegalic patients without hyperprolactinaemia, pituitary hormone deficiencies, obstructive sleep apnoea and cardiac hypertrophy and 14 healthy subjects matched for age, sex and body mass index. For each subject, we collected information regarding anthropometric parameters and echocardiography, and collected plasma samples to investigate anterior pituitary function, glucose and lipid metabolism and plasma leptin levels. Beat-to-beat mean arterial pressure, heart rate and efferent post-ganglionic muscle and skin sympathetic nerve traffic (MSNA and SSNA, respectively; determined by microneurography) were measured. Both MSNA and SSNA were recorded in a randomized sequence over two 30 min periods. Measurements also included evaluation of SSNA responses to emotional stimulus. In addition to significant reductions in plasma leptin levels, acromegalic patients had markedly decreased MSNA compared with the healthy controls. There were no significant differences in SSNA between the two groups, either under basal conditions or in responses to arousal stimuli. There was a significant and direct correlation between MSNA and plasma leptin levels, but not between plasma leptin and SSNA. These data provide the first evidence that the sympathetic inhibition characterizing the early phase of acromegaly is not generalized to the entire cardiovascular system. © 2013 Wiley Publishing Asia Pty Ltd.

Seravalle G.,St. Luca Hospital | Mancia G.,University of Milan Bicocca | Mancia G.,Centro Interuniversitario Of Fisiologia Clinica ertensione | Grassi G.,University of Milan Bicocca | Grassi G.,Centro Interuniversitario Of Fisiologia Clinica ertensione
High Blood Pressure and Cardiovascular Prevention | Year: 2014

A number of cardiovascular disease have been shown to be characterized by a marked increase in sympathetic drive to the heart and the peripheral circulation. This is the case for essential hypertension, congestive heart failure, cardiac arrhythmias, obesity, metabolic syndrome, obstructive sleep apnea, and chronic renal disease. This review focuses on the most recent findings documenting the role of sympathetic neural factors in the development and progression of the hypertensive state as well as in the pathogenesis of hypertension-related target organ damage. It also reviews the role of sympathetic neural factors in the development of cardiovascular diseases not necessarily strictly related to the hypertensive state, such as congestive heart failure, cardiac arrhythmias, obesity, metabolic syndrome and renal failure. The paper will finally review the pharmacological and non-pharmacological interventions acting on the sympathetic drive. Emphasis will be given to the new approaches, such as renal nerves ablation and carotid baroreceptor stimulation, which have been shown to exert sympathoinhibitory effects. © 2014 Springer International Publishing.

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