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Vittorio Veneto, Italy

Saladini F.,University of Padua | Mos L.,Emergency Area | Casiglia E.,University of Padua | Malipiero G.,University of Padua | And 2 more authors.
Blood Pressure | Year: 2013

Aim. The aim of the present study was to evaluate the association of central blood pressure (BP) with organ damage and risk of future hypertension in a cohort of young to middle-aged patients. Methods. We studied 305 subjects screened for stage 1 hypertension to determine which subjects developed hypertension needing therapy according to current guidelines. Central BP was obtained from radial artery tonometry. Organ damage was the presence of left ventricular hypertrophy and/or microalbuminuria. Results. In a multiple logistic regression including ambulatory 24-h BP, central mean BP was associated with presence of end-organ damage (p = 0.003). In the subjects divided according to whether their central mean BP was above or below the median, subjects with high central mean BP presented an earlier impairment of arterial distensibility and developed sustained hypertension more frequently compared with those with low central mean BP (p < 0.001). In logistic analyses, central mean BP was an independent predictor of future hypertension (p < 0.001) and remained associated with outcome when 24-h BP was included in the same model (p = 0.006). Conclusions. In young to middle-aged subjects in the early stage of hypertension, central mean BP is a useful adjunct to brachial BPs to better define the individual risk profile. © 2013 Scandinavian Foundation for Cardiovascular Research.

Palatini P.,Clinica Medica 4 | Bratti P.,Clinica Medica 4 | Palomba D.,University of Padua | Saladini F.,Clinica Medica 4 | And 2 more authors.
Journal of Hypertension | Year: 2010

Objectives: The objective of this study was to investigate the effect of regular physical activity on the haemodynamic response to public speaking and to evaluate the long-term effect of exercise on development of hypertension. Participants: We assessed 75 sedentary and 44 active participants screened for stage 1 hypertension with consistent activity habits and 63 normotensive individuals as control. Methods: The blood pressure (BP) response to public speaking was assessed with beat-to-beat noninvasive recording. Definition of incident hypertension was based either on clinic or 24-h BP measurement. Results: The BP response to public speaking was greater in the hypertensive than the normotensive participants (P = 0.018/0.009). Among the former, sedentary participants showed increased BP reactivity to the speech test (45.2 ± 22.6/22.2 ± 11.5 mmHg, P < 0.01/<0.001 versus controls), whereas physically active participants had a response similar to that of controls (35.4 ± 18.5/18.5 ± 11.5 mmHg, P = not significant). During a median follow-up of 71 months, ambulatory BP did not virtually change in the active participants (-0.9 ± 7.8/-0.0 ± 4.7 mmHg) and increased in their sedentary peers (2.8 ± 9.8/3.2 ± 7.4 mmHg, P = 0.08/0.003 versus active). Active participants were less likely to develop incident hypertension than sedentary ones. After controlling for several confounders including baseline heart rate, the hazard ratio was 0.53 [95% confidence interval (CI) 0.31-0.94] for clinic hypertension and 0.60 (95% CI 0.37-0.99) for ambulatory hypertension. Inclusion of BP response to public speaking into the Cox model influenced the strength of the association only marginally [hazard ratio = 0.55 (95% CI 0.30-0.97) and hazard ratio = 0.59 (95% CI 0.36-0.99), respectively]. Conclusion: Regular physical activity attenuates the BP reaction to psychosocial stressors. However, this mechanism seems to be only partially responsible for the long-term effect of exercise on BP. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Palatini P.,University of Padua | Saladini F.,University of Padua | Mos L.,Cardiology Unit | Benetti E.,University of Padua | And 3 more authors.
International Journal of Obesity | Year: 2013

Objective: To examine the impact of overweight and obesity on development of target organ damage in the early stage of hypertension. Subjects: Participants were 727 young-to-middle-age subjects screened for stage 1 hypertension and followed for 8 years.MEASUREMENTS:Ambulatory blood pressure (BP), albumin excretion rate and echocardiographic data were obtained at entry, every 5 years and/or before starting antihypertensive treatment. Results: During the follow-up, hypertension needing treatment was developed by 54.7% of the subjects with normal weight, 66.6% of those with overweight and 73.0% of those with obesity (P<0.001). Kaplan-Meier curves showed that patients with obesity or overweight progressed to sustained hypertension earlier than those with normal weight (P<0.001). At study end, rate of organ damage was 10.7% in the normal weight, 16.4% in the overweight and 30.1% in the obese subjects (P<0.001). In a multivariable logistic regression analysis, overweight (P=0.008) and obesity (P<0.001) were significant predictors of final organ damage. Inclusion of changes in 24-h BP and body mass index, and of baseline organ damage did not virtually modify these associations (P=0.002 and <0.001, respectively). Obesity was a significant predictor of both left ventricular hypertrophy (P<0.001) and microalbuminuria (P=0.015) with an odds ratio (95% confidence interval) of 8.5 (2.7-26.8) and 3.5 (1.3-9.6), respectively. Conclusion: These data indicate that in hypertensive subjects obesity has deleterious effects on the cardiovascular system already at an early age. Preventive strategies addressed to achieve weight reduction should be implemented at a very early stage in young people with excess adiposity and high BP. © 2013 Macmillan Publishers Limited All rights reserved.

Palatini P.,University of Padua | Dorigatti F.,University of Padua | Saladini F.,University of Padua | Benetti E.,University of Padua | And 5 more authors.
American Journal of Hypertension | Year: 2012

Background Glomerular hyperfiltration predicts development of nephropathy in hypertension but the factors responsible for increased glomerular filtration rate (GFR) are not well known. Aim of this study was to examine which clinical variables influence GFR in the early stage of hypertension.MethodsParticipants were 1,106 young-to-middle-age hypertensive adults with creatinine clearance 60 ml/min/1.73 m 2. Clinic and ambulatory blood pressures (BPs) were measured and the difference between clinic and 24-h systolic BP was defined as the white-coat effect (WCE). In 606 participants, 24-h urinary epinephrine and norepinephrine were also measured. Glomerular hyperfiltration, defined as a GFR 150 ml/min/1.73 m 2, was present in 201 subjects.ResultsPatients' mean age was 33.1 ± 8.5 years and office BP was 146 10.5/94 5.0 mm Hg. In multivariable linear regression, significant predictors of GFR were younger age (P < 0.0001), male gender (P < 0.0001), 24-h systolic BP (P = 0.0001), body mass (P < 0.0001), WCE (P = 0.02), log-epinephrine (P = 0.01), and coffee use (P < 0.01). In a logistic model, independent predictors of glomerular hyperfiltration were obesity (odds ratio, 95% confidence interval = 6.1, 3.8-9.8), male gender (2.9, 1.8-4.9), age <33 years (2.1, 1.5-3.1), ambulatory hypertension (2.0, 1.4-3.0), WCE >15 mm Hg (1.6, 1.1-2.3), heavy coffee use (2.0, 1.1-3.8), and epinephrine >25 mcg/24 h (1.9, 1.2-3.1).ConclusionsThe novel finding of this study is that hyper-reactivity to stress, as determined by urinary epinephrine level and WCE, and coffee use contribute to determining glomerular hyperfiltration in the early stage of hypertension. Our data may help to identify a subset of patients with glomerular hyperfiltration, who may be at increased risk of chronic kidney disease and may benefit from antihypertensive treatment. © 2012 American Journal of Hypertension, Ltd.

Palatini P.,University of Padua | Mos L.,Town Hospital | Ballerini P.,Town Hospital | Mazzer A.,Town Hospital | And 4 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2013

Background and objectives Whether glomerular hyperfiltration is implicated in the development of microalbuminuria in hypertension is not well known. This prospective study investigated the relationship between changes in GFR and microalbuminuria in hypertension. Design, setting, participants, & measurements This study assessed 534 stage 1 hypertensive participants from the Hypertension and Ambulatory Recording Venetia Study (n=386 men) without microalbuminuria at baseline, who were recruited from 1990 to 1995 and followed for a median of 8.5 years. Mean age was 33.9±8.6 years and mean BP was 146.6±10.5/94.0±5.0 mmHg. Creatinine clearance and 24-hour urinary albumin were measured at study entry and end. Participants were defined as normofilterers (normo) or hyperfilterers (hyper) according to whether GFR was<150 or ge;150 ml/min per 1.73 m2, respectively. Participants were divided into four groups based on GFR changes from baseline to follow-up end: normo→normo (n=395), normo→hyper (n=31), hyper→hyper (n=61), and hyper→normo (n=47). Results Microalbuminuria progressively increased across the four groups and was 5.3% in normo→normo, 9.7% in normo→hyper, 16.4% in hyper→hyper, and 36.2% in hyper→normo (P<0.001). This association held true in a multivariable logistic regression in which several confounders, ambulatory BP, and other risk factors were taken into account (P<0.001). In particular, hyperfilterers whose GFR decreased to normal at study end had an adjusted odds ratio of 7.8 (95% confidence interval, 3.3-18.2) for development of microalbuminuria compared with participants with normal GFR throughout the study. Conclusions These data support the hypothesis for a parabolic association between GFR and urinary albumin in the early stage of hypertension. © 2013 by the American Society of Nephrology.

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