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Biomedical subjects

A Zoppi

Publications and source records attributed to A Zoppi.

At least 55 records · Page 3Linked to original sources
PubMed1994

Urinary albumin excretion and nocturnal blood pressure in hypertensive patients with type II diabetes mellitus.

The aim of this study was to evaluate the relationship between nocturnal blood pressure (BP) (by ambulatory blood pressure monitoring, ABPM) and urinary albumin excretion (UAE) in hypertensive patients with type II diabetes mellitus. We studied 179 essential hypertensives (WHO I-II), all males, with non-insulin-dependent diabetes. Non-invasive ABPM was performed by a fully automatic, portable device (Spacelabs 90202), set to take readings at 15-min intervals during both day-time 7 AM to 1 PM and nighttime (1 PM to 7 AM). According to the day/night reduction in mean blood pressure (MBP), three groups were identified: group I, nocturnal MBP reduction > 10%; group II, day/night MBP reduction of 5% to 10%; and group III, day/night MBP reduction < 5%. The mean values of UAE as well as the prevalence of microalbuminuria (UAE > 30 mg/24 h) were found to be significantly higher in group III as compared to the other two groups. Besides, in group III UAE displayed a significant negative relationship with the SBP and MBP (but not DBP) nocturnal drop and a positive relationship with the duration of hypertension and duration of diabetes. In group II, UAE was weakly correlated only with the duration of hypertension, whereas in group I no significant correlation was found between UAE and other parameters of the study. These results indicate that in hypertensive type II diabetic patients a blunted nocturnal BP fall is associated with higher UAE and increased prevalence of microalbuminuria. Whether the reduced day/night BP difference is the cause of consequence of target organ damage remains to be established.

Adult↗
PubMed1994

Evaluation by 24-hour ambulatory blood pressure monitoring of efficacy of benazepril 20 mg plus hydrochlorothiazide 25 mg fixed combination as compared to captopril 50 mg [corrected] plus hydrochlorothiazide 25 mg fixed combination in treating mild to moderate hypertension: a double-blind, within-patient, placebo-controlled study.

In a double-blind, placebo-controlled, three-period cross-over, randomized study we evaluated the efficacy and tolerability of a fixed combination of benazepril 20 mg and hydrochlorothiazide 25 mg (BN + HCT) as compared with the fixed combination of captopril 50 mg and hydrochlorothiazide 25 mg (CP + HCT) by ambulatory blood pressure monitoring (ABPM) in patients with mild to moderate hypertension. Eighteen outpatients, 16 men and 2 women aged 41-58 years, were randomized to receive BN + HCT, CP + HCT, or placebo, all administered once daily for 4 weeks according to a three-period cross-over arranged in a 3 x 3 latin square design. Patients were checked after an initial 3-week washout period and every 4 weeks thereafter. At each visit, 24-h ABPM was performed by a noninvasive device (Spacelabs 5300); causal BP and heart rate (HR) were also measured. Both fixed combinations had a clear-cut antihypertensive effect in comparison with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1994

Fibrinogen levels in normotensive and hypertensive men: a cross-sectional study.

BACKGROUND: The aim of this study was to compare plasma fibrinogen levels in hypertensive and normotensive men. Possible confounding factors, such as age, cholesterol levels, body-mass index and smoking habits were also to be considered. METHODS: We studied 708 men with essential hypertension (according to the World Health Organization's criteria) and 944 with normal blood pressures, all of whom had similar lifestyles; the overall age range was 18-60 years. The clinical evaluation included measurements of blood pressure, heart rate, body weight and height as well as a medical examination and personal habits history. After an overnight fast, blood samples were taken in order to measure fibrinogen and total-cholesterol levels. RESULTS: The mean fibrinogen level did not differ between the groups, although the distribution of the levels was different and was J-shaped in the hypertensive group. Plasma fibrinogen levels increased significantly with age in both groups. A significant positive correlation was found between fibrinogen and total-cholesterol levels, but not between fibrinogen and body-mass index or systolic or diastolic blood pressures. Cigarette smokers had significantly higher fibrinogen levels than non-smokers, irrespective of their blood pressure status; ex-smokers had intermediate values, suggesting a direct but reversible effect of tobacco. In cigarette smokers, fibrinogen levels increased with the number of cigarettes smoked, which is indicative of a dose-response relationship. CONCLUSION: This study confirms the strong association between fibrinogen levels and smoking and the weaker association with age and total-cholesterol levels. Mean fibrinogen level was not significantly related to blood pressure, although the distribution of fibrinogen levels appeared to be J-shaped in hypertensive men.

Adolescent↗
PubMed1994

Associations between plasma fibrinogen levels and cardiovascular risk factors in hypertensive men.

BACKGROUND: Fibrinogen levels are reported to be elevated in hypertensive patients and tend to cluster with nearly all other established cardiovascular risk factors. The aim of this study was to evaluate the relationship between plasma fibrinogen and a number of other cardiovascular risk factors in patients with essential hypertension. METHODS: We studied 118 men with essential hypertension, aged 18-65 years. The clinical evaluation included measurements of blood pressure (mercury sphygmomanometer, Korotkoff I and V), levels of plasma fibrinogen, total cholesterol, high-density-lipoprotein (HDL) cholesterol, triglycerides and blood glucose and the ratio of total-cholesterol to HDL-cholesterol levels; a detailed history of medical and personal habits was also recorded. RESULTS: As expected, plasma fibrinogen levels were significantly higher in smokers than in non-smokers, with the number of cigarettes smoked correlating positively with the fibrinogen level. Patients with a total-cholesterol level in excess of 220 mg/dl had significantly higher fibrinogen levels, and both univariate and multivariate analyses showed total-cholesterol and fibrinogen levels to be positively correlated. A weaker but significant relationship was noted between the fibrinogen level and triglyceride levels (P = 0.0017) and between the fibrinogen level and the ratio of total-cholesterol to HDL-cholesterol levels (P = 0.0006). Fibrinogen levels were not significantly associated with either systolic or diastolic blood pressures. CONCLUSION: A family history of hypertension appears to potentiate the tendency of fibrinogen to cluster with other cardiovascular risk factors in hypertensive patients.

Adolescent↗
PubMed1994

Fixed combination of benazepril and very low dose hydrochlorothiazide in the treatment of mild to moderate essential hypertension: evaluation by 24-hour non invasive ambulatory blood pressure monitoring.

A double-blind, crossover, placebo-controlled study was undertaken in order to assess the antihypertensive efficacy of a fixed combination of benazepril and hydrochlorothiazide in two different dosages by ambulatory blood pressure monitoring (ABPM). After a three-week placebo wash-out period, 18 patients with mild to moderate essential hypertension, all males, aged 41-60 years, were randomized to receive benazepril 5 mg + hydrochlorothiazide 6.25 mg, benazepril 10 mg + hydrochlorothiazide 12.5 mg or placebo, all given once daily for 4 weeks, according to a 3 crossover period, arranged in a 3 x 3 latin square design. Patients were checked after the wash-out period and every 4 weeks thereafter. At each visit, 24-hour ABPM was performed by a non-invasive device (Spacelabs 90202); causal BP (by mercury sphygmomanometer) and HR were also measured. Both dosages of the fixed combination were equally effective in reducing systolic and diastolic BP values throughout the 24-hour period as compared to the placebo. The antihypertensive effect of the drug could be observed to a similar extent both during the day and night and was still significant 24-hour post-dosing. In addition, the fixed combination did not affect the normal BP circadian variability.

Adult↗
PubMed1994

Occupational noise exposure and blood pressure.

OBJECTIVE: To investigate the relationship between occupational noise exposure and blood pressure. METHODS: We studied 8811 workers at a metallurgical factory, who were exposed to different levels of noise at the worksite: < or = 80 dB for 8078 workers and > 80 dB for 733 workers. A clinical examination, including measurements of blood pressure (by mercury sphygmomanometer, Korotkoff phases I and V), heart rate (by pulse palpation), body weight and height, was performed. The subjects were stratified into four age groups (18-30, 31-40, 41-50 and > 50 years) and into two body mass index groups: normal weight (< or = 25 kg/m2) and overweight (> 25 kg/m2). In order to eliminate possible confounding factors and statistical bias, a retrospective case versus control analysis was also carried out. RESULTS: The epidemiologic approach showed that the systolic blood pressure (SBP) but neither the diastolic blood pressure (DBP) nor the heart rate values were statistically higher in the group who were exposed to noise levels of > 80 dB, although the difference could be considered clinically relevant only in the older age group. The prevalence of hypertension (according to World Health Organization criteria) was higher among the workers who were exposed to the higher levels of noise. Stratification for body mass index confirmed the existence of a higher prevalence of hypertension in the exposed group. The results from the case versus control analysis indicated that both the SBP and the DBP levels in the exposed group were significantly higher than those in the reference group, and confirmed the existence of a higher prevalence of hypertension in the exposed group. CONCLUSIONS: The present data suggest that occupational exposure to noise levels exceeding 80 dB may lead to a higher prevalence of hypertension and to increased blood pressure values, although the results appear quantitatively different according to the approach that is taken to the problem (i.e. the epidemiologic or the case versus control approach).

Adolescent↗
PubMed1993

Ambulatory blood pressure monitoring in normotensive and hypertensive type 2 diabetes. Prevalence of impaired diurnal blood pressure patterns.

To assess the prevalence of an impaired diurnal blood pressure (BP) pattern in a population of both normotensive and hypertensive diabetics, noninvasive ambulatory BP monitoring (SpaceLabs 5200, Redmond, WA) was performed in 96 outpatients with type 2 diabetes (47 normotensives and 48 hypertensives) and in 103 control subjects without diabetes (50 normotensives and 53 hypertensives). Mean 24 h and daytime (06:00 to 22:00) BP and heart rate (HR) were not statistically different in diabetic patients compared to nondiabetic ones. Nighttime (22:00 to 06:00) BP and HR tended to be higher in both normotensive and hypertensive diabetics, although not significantly. Heart rate, diastolic BP (DBP), and especially the nocturnal systolic BP (SBP) decrease, were less marked in both normotensive and hypertensive diabetics, with a consequent increase in rate-pressure. A significant correlation was found between the percent decrease in nighttime SBP and the decrease in orthostatic SBP in casual BP measurements. The analysis of individual recordings allowed us to detect an impaired circadian pattern (the disappearance of the nocturnal BP decrease or a paradoxical BP increase) in 30% of the normotensive and 31% of the hypertensive diabetics (v 6% of the normotensive and 6.4% of the hypertensive nondiabetic subjects). As the absence of a nocturnal BP fall has been associated with the increased prevalence of left ventricular hypertrophy and atherosclerotic cardiovascular disease, its detection by ambulatory monitoring might be of prognostic and therapeutic importance.

Aged↗
PubMed1993

[Is sympathetic hyperactivity a coronary risk factor?].

Clinical and experimental data have suggested a role of enhanced sympathetic nervous activity in the pathogenesis and evolution of coronary heart disease. A significant relationship was observed between the circadian pattern of plasma catecholamine levels and the onset of coronary events, which occur most frequently in the early morning, concomitance with sympathetic activation. An enhanced sympathetic tone is frequently observed in both the acute phase of myocardial infarction and in the postinfarction period, potentiating myocardial damage and increasing the risk of arrhythmias. An indirect demonstration of the importance of sympathetic activation arises from the results of several trials on the effects of beta-blocker treatment during and after myocardial infarction, showing a significant reduction in total mortality, sudden deaths and reinfarction. There is accumulating evidence that repeated activation of sympathetic nervous system may contribute to atheroma development and progression. Enhanced sympathetic activity seems to be involved in the pathogenesis and maintenance of essential hypertension as well as in its natural history, contributing to the development of left ventricular hypertrophy and vascular hypertrophy. The problems in measuring and defining the various levels of autonomic activity in human beings and the complexity of the relationship between nervous and non nervous factors in cardiovascular diseases make difficult to establish whether sympathetic hyperactivity represents an independent cardiovascular risk factor.

Coronary Disease↗
PubMed1992

Comparison of bisoprolol and diazepam in the treatment of cardiac neurosis.

In order to compare the beta blockers bisoprolol and diazepam in the treatment of cardiac neurosis, 40 patients (16 males and 24 females, mean age: 39 +/- 11 years) were examined in a double-blind, crossover study. Following a 4-week placebo period, patients were randomized to receive either bisoprolol 10 mg daily or diazepam 5 mg twice daily for 4 weeks. After a second 4-week washout period on placebo, patients were switched to the alternative regimen for a further 4 weeks. At the end of the placebo periods and during each phase of treatment, the following parameters were evaluated: somatic symptoms by self-assessment questionnaire, anxiety state by Hamilton rating scale, reaction time to both acoustic and visual stimuli, blood pressure, and heart rate. Both treatments were effective in reducing somatic symptoms of cardiac neurosis, but bisoprolol was significantly more effective than diazepam (p less than 0.01). On the contrary, diazepam was superior to bisoprolol in improving the Hamilton scale related to psychic symptoms. Only diazepam prolonged reaction times. Both treatments were well tolerated; however, 12 patients complained of drowsiness and nine of sedation under diazepam. In conclusion, bisoprolol appeared to be as effective as diazepam in the treatment of cardiac neurosis, but with better effects on somatic symptoms and without affecting patients' psychomotor performance.

Adrenergic beta-Antagonists↗
PubMed1992

Nitrendipine 20 mg once daily versus nicardipine slow release 40 mg twice daily in mild essential hypertension: evaluation by 24-hour ambulatory blood pressure monitoring.

The extent and duration of the blood pressure (BP) lowering effect of 20 mg nitrendipine (NIT) once daily and 40 mg nicardipine slow release (NIC) twice daily were compared in 12 men (aged 39-55 years) with mild essential hypertension according to a randomized, cross over study. Twenty-four-hour non invasive ambulatory BP monitoring (Spacelabs 5200) was performed at the end of a 2-week placebo run-in and after 4 weeks of each active treatment; automatic BP measurements were programmed at 15-min intervals. Both treatments significantly (p less than .01) reduced mean 24-hour and daytime systolic (SBP) and diastolic (DBP) BP, but had different effects on daytime BP profiles. NIT decreased SBP and DBP (p less than .05) in 5 out of 8 two-hour subperiods (from 8 a.m. to 6 p.m.), followed by a loss of effect; NIC reduced SBP and DBP (p less than .05) in 7 out of 8 two-hour subperiods (from 8 a.m. to 10 p.m.). During the night-time, NIT reduced mean SBP (p less than .05) and NIC both mean SBP and DBP values (p less than .05; p less than .05 vs NIT for SBP). Heart rate was not affected by either treatment. Thus, after short-term treatment in mild essential hypertensives nitrendipine once daily was not as effective as nicardipine slow release twice daily in reducing blood pressure throughout the 24 hours.

Adult↗
PubMed1992

Effects of nifedipine and indomethacin on cough induced by angiotensin-converting enzyme inhibitors: a double-blind, randomized, cross-over study.

Prostaglandins (PG) have been suggested to play a role in the genesis of cough induced by angiotensin-converting enzyme inhibitors (ACE-I) and that inhibition of PG synthesis can reduce or abolish the incidence of this side effect. Moreover, experimental and clinical data suggest that nifedipine, a dihydropyridine Ca antagonist, can inhibit PG synthesis. Therefore, we wished to determine whether nifedipine can reduce cough induced by ACE-I as compared with indomethacin, a known inhibitor of PG synthesis. Fourteen hypertensive patients who developed cough during captopril chronic therapy randomly received slow-release nifedipine 20 mg twice daily (b.i.d.), indomethacin 50 mg b.i.d., and placebo b.i.d. for 1 week in a double-blind, cross-over design. At the end of each treatment phase, cough was evaluated by a self-administered questionnaire containing an ordinal scale for daily cough intensity and frequency. Indomethacin abolished or markedly reduced cough induced by ACE-I, whereas nifedipine reduced it but to a lesser degree. These findings suggest that PG can play a role in cough caused by ACE-I, and a dihydropyridine Ca antagonist can reduce the occurrence of this side effect.

Adult↗
PubMed1992

Effects of calcium channel blockers on cardiovascular responses to smoking in normotensive and hypertensive smokers.

To evaluate the effects of short- and long-term administration of calcium (Ca) entry blockers on cardiovascular responses to cigarette smoking, 28 normotensive and 26 hypertensive smokers were studied. According to a double-blind, cross-over design, normotensive smokers were given a single dose (10 mg) of isradipine or a placebo and were checked before and after dosing. After a four-week period on a placebo, hypertensive smokers were treated with slow-release nicardipine 40 mg twice daily for six months and were checked at the end of the placebo period, after the first dose of nicardipine and at the end of six months of therapy. In both groups, blood pressure and heart rate were monitored by a Takeda TM 2420 non-invasive device every 3 min for 2 h. During the first hour patients were not allowed to smoke, during the second hour they were asked to smoke one cigarette every 15 min. In both normotensive and hypertensive smokers, calcium entry blockers produced a significant attenuation of the rise in blood pressure induced by cigarette smoking. Such effect was more evident after long-term therapy. Acceleration of the heart rate due to smoking was not significantly affected by the administration of Ca-antagonists, although a tendency towards a lesser heart rate increase was observed, particularly after long-term treatment. It was concluded that calcium entry blockers, reducing blood pressure variability, which bears a positive relationship with target organ damage, might be useful in the treatment of hypertensive smokers who were unwilling or unable to stop smoking.

Adult↗
PubMed1991

The effect of celiprolol on the blood lipid profile in hypertensive patients with high cholesterol levels.

The aim of this study was to compare the effects of chronic antihypertensive therapy with either celiprolol or atenolol on plasma lipids in patients with hypercholesterolemia. Forty-six patients with essential hypertension and a total cholesterol (TC) concentration greater than 220 mg/dl were studied. After 1 month on placebo, patients were stratified into five classes on the basis of their plasma TC levels and then randomized to receive atenolol 100 mg/day or celiprolol 400 mg/day for 1 year. Blood pressure (BP), heart rate (HR), and blood samples for evaluation of TC, HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), and triglycerides (TG) were taken before and after the placebo period, and every 6 months from the beginning of the active treatment. Celiprolol and atenolol caused similar reduction in BP. Both atenolol and celiprolol decreased TC. Atenolol significantly reduced HDL-C, while celiprolol increased it (p less than 0.01 at 12 months), and the difference between the two drugs was statistically significant in this regard. LDL-C levels were not significantly affected by atenolol, but were progressively reduced by celiprolol (p less than 0.05 at 6 months, p less than 0.01 at 12 months). TG rose under atenolol but was reduced by celiprolol (p less than 0.05). The results of this study show that the celiprolol-induced changes in plasma lipids may be favorable and suggest that, in hypertensive patients with high cholesterol levels, beta-blocker therapy with celiprolol may be effective in lowering BP without worsening the lipid profile.

Adult↗
PubMed1990

Comparative effects of celiprolol, propranolol, oxprenolol, and atenolol on respiratory function in hypertensive patients with chronic obstructive lung disease.

The aim of the study was to compare the pulmonary effects of four beta-blockers with different ancillary properties: propranolol (non-beta 1 selective without ISA), oxprenolol (non-beta 1 selective with ISA), atenolol (beta 1 selective), and celipropol (beta 1 selective with mild beta 2-agonist and alpha 2-antagonist activity) in hypertensive patients with chronic obstructive lung disease. Ten asthmatic patients, all males, aged 50-66 years were studied. Entry criteria were a) DBP greater than or equal to 95 mmHg and less than or equal to 115 mmHg; b) FEV1 less than 70% of the theoretical values; c) FEV1 increase of at least 20% after salbutamol inhalation (200 micrograms). After a 2-week washout period on placebo, each patient received propranolol (80 mg/day), oxprenolol (80 mg/day), atenolol (100 mg/day), and celiprolol (200 mg/day) for 1 week, according to a randomized, cross-over design. At the end of the washout and of each treatment period, airway function, assessed by FEV1, FVC, and FEV1%, was evaluated by spirometry both in the basal condition and after salbutamol inhalation. Unlike propranolol and oxprenolol, which significantly reduced FEV1 and inhibited the bronchodilator response to inhaled salbutamol, atenolol and celiprolol did not significantly affect respiratory function and did not antagonize salbutamol effects. Celiprolol more closely approached placebo in its respiratory effects than did atenolol, although the differences were not statistically significant.

Adrenergic beta-Antagonists↗
PubMed1990

Beta-blocker effects on plasma lipids in antihypertensive therapy: importance of the duration of treatment and the lipid status before treatment.

The aim of this study was to evaluate the effects of long-term monotherapy with four beta-blockers provided with different pharmacological properties on plasma lipids in both normocholesterolemic and hypercholesterolemic hypertensive patients. After a 1-month run-in period on placebo, 70 hypertensive patients with basal total cholesterol (TC) < or = 220 mg/dl were treated for 3 years with propranolol 160 mg/day or atenolol 100 mg/day or bisoprolol 10 mg/day or mepindolol 10 mg/day, while 59 hypertensive patients with basal TC > 220 mg/dl were given the same beta-blockers at the same dosage for 6 months. In both normocholesterolemic and hypercholesterolemic hypertensive patients. HDL-C and triglyceride (TG) levels showed significant changes that appeared to be related to the type of beta-blocker used and to the duration of therapy. Nonselective, non-ISA (intrinsic sympathomimetic activity) propranolol caused the most pronounced changes, decreasing HDL-C and increasing TG concentrations; beta1-selective atenolol and bisoprolol had similar, but less remarkable effects; even more discrete changes were observed on mepindolol (with ISA). The variations in HDL-C and TG values reached their peak in 6-12 months of beta-blocker therapy; then, after a plateau phase, they showed a progressive trend toward pretreatment levels. In hypercholesterolemic patients, the percent change in both HDL-C and TG values was lower compared to normocholesterolemic patients.

Adrenergic beta-Antagonists↗
PubMed1990

Beta-blockers and primary cardioprotection in hypertension.

Theoretical and experimental data coupled with findings from several studies, showing the beneficial effect of beta-blocking therapy in reducing the risk of death and re-infarction among infarct patients (secondary cardioprotection), suggested that beta-blockers could reduce the incidence of coronary events also in hypertensive patients with no clinical evidence of coronary heart disease (CHD) (primary cardioprotection). In order to evaluate the primary cardioprotective potential of beta-blockers as compared to diuretics in the treatment of hypertension, some large-scale, randomized, prospective studies were set up in the middle and late 1970s. The results of three of these trials, the MRC, the IPPPSH and the HAPPHY studies, were negative or non-conclusive and somehow conflicting. None of them showed any difference between beta-blockers and diuretics in reducing the incidence of CHD, but the MRC and the IPPPSH studies suggested that beta-blockers were better than diuretics in male non-smokers. However, the HAPPHY study did not confirm such a hypothesis. More recently, two studies, the Clatterbridge study (retrospective, non-controlled) and the MAPHY study (prospective, controlled) gave positive results about the primary cardioprotective effect of beta-blockers. In particular, the MAPHY study demonstrated that starting antihypertensive treatment with the beta1-selective beta-blocker metoprolol instead of a thiazide diuretic led to lower total and cardiovascular mortality, mainly by reducing fatal CHD and fatal stroke. Although more evidence is needed, the primary cardioprotective effect demonstrated with metoprolol in the MAPHY study might have important implications for clinical practice and public health.

Adrenergic beta-Antagonists↗