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Biomedical subjects

E Paciaroni

Publications and source records attributed to E Paciaroni.

At least 19 recordsLinked to original sources
PubMed2001

Random fasting hyperglycemia as cardiovascular risk factor in the elderly: a 6-year longitudinal study.

A large body of evidence suggests that diabetes increases the risk of coronary heart disease (CHD), but whether fasting hyperglycemia is associated with a major risk for CHD is still under debate. The aim of the present study was to investigate the role played by fasting hyperglycemia in the development of cardiovascular disease (CVD) in an elderly population when associated with common risk factors for CVD (i.e., hypertension, hypercholesterolemia, smoking, etc). We analyzed a sample of 455 subjects aged > or = 60 years. The risk factors taken into account were systolic and diastolic blood pressure levels, use of antihypertensive drugs, total serum cholesterol, serum triglycerides, and smoking habit. Glycemia was measured at entry on a fasting sample. During the follow-up period (mean 6 years), the occurrence of CVD was monitored (criteria for the occurrence of CVD included total cardiovascular mortality, fatal or nonfatal myocardial infarction, symptomatic coronary heart disease [stable and unstable angina], the need for percutaneous transluminal coronary angioplasty or coronary artery bypass graft, fatal or nonfatal stroke, and transient ischemic attack). A total of 427 subjects completed the follow-up. During this period, 73 subjects (17.10%) developed CVD according to the above criteria. A Cox proportional hazard model was designed to evaluate the contribution of variables in predicting CVD. Relative risks and 95% confidence intervals for CVD were calculated from the regression coefficients to study the association between the risk of developing CVD and predicting variables. We found a relation between occurrence of CVD and fasting hyperglycemia: subjects with fasting glycemia, > 126 mg/dl at enrollment, but without previous clinical diagnosis of diabetes, showed a 2.01 times higher risk than those with fasting glycemia < 126 mg/dl. Hence, random fasting hyperglycemia can predict the occurrence of CVD in elderly subjects.

Age Factors↗
PubMed2001

Cardiovascular effects of an earthquake: direct evidence by ambulatory blood pressure monitoring.

The increased cardiovascular mortality during an earthquake has been related, among other factors, to a sympathetically mediated increase in heart rate and blood pressure. However, this is supported only by indirect evidence collected after an earthquake, whereas for obvious technical difficulties, no data are available on the acute blood pressure and heart rate effects during an earthquake. In a patient undergoing 24-hour ambulatory blood pressure monitoring (Spacelabs 90207), we had the opportunity to directly record the acute blood pressure and heart rate changes induced by an earthquake (magnitude 4.7 according to the Richter scale) that struck central Italy in March 1998. Systolic blood pressure rose to 150 mm Hg, diastolic blood pressure rose to 122 mm Hg, and heart rate rose to 150 bpm at the time of the strongest tremor. Prequake blood pressure levels were restored only 1 hour later, but blood pressure remained characterized by a pronounced variability throughout the following 6 hours. Thus, a sympathetically mediated combined increase in blood pressure and heart rate may represent an important pathophysiological mechanism responsible for the increased frequency of cardiovascular events during an earthquake. The associated increase in blood pressure variability might further contribute to the increase in cardiovascular risk typical of this condition. Our case report further supports the usefulness of ambulatory blood pressure monitoring to assess the blood pressure and heart rate effects of sudden daily life events, the actual cardiovascular impact of which can hardly be quantified through traditional measurements.

Adult↗
PubMed1999

Randomized trial of the effects of low-dose calcium-heparin in patients with peripheral arterial disease and claudication. Italian CAP Study Group.

PURPOSE: We performed a long-term, multicenter, randomized, double-blind trial to evaluate the efficacy and tolerability of low-dose, subcutaneous calcium-heparin (12,500 IU/day) in comparison with placebo in patients with stable peripheral arterial disease of the lower extremities. PATIENTS AND METHODS: At the end of a 2-week washout period, during which aspirin placebo was given, 201 patients were randomly assigned to receive either subcutaneous calcium-heparin or placebo for two 3-month treatment periods, each of which was followed by a 6-month period of observation. All of the patients were given low-dose aspirin (50 mg/day) throughout the 18-month study. The main efficacy variables were pain-free and maximum walking time (by standard treadmill test). Patients answered a questionnaire about pain and the limitation of daily activities. Results were analyzed by intention-to-treat. RESULTS: At the end of the study, the estimated increase in pain-free walking time was 39% in the heparin group and 23% in the placebo group (P = 0.09). The estimated increase in maximum walking time was 40% in the heparin group and 16% in the placebo group (P = 0.05). Patients treated with heparin also reported that they had to stop walking because of leg pain, or had daily activities limited by leg pain, less frequently than the placebo group (P <0.01). CONCLUSIONS: Treatment with low-dose subcutaneous calcium-heparin is safe and effective in improving walking performance and reducing physical disability in patients with stable peripheral arterial disease and claudication.

Aged↗
PubMed1996

[Analysis of the DRG rate system in cardiology. Results of a comparative study of diverse regions].

Following the introduction of the reimbursement system for services, the use of a different rate system can have a singularly negative effect on the actual clinical activity. A discipline such as cardiology can be particularly exposed to the eventual variation in rates, and we feel it is necessary to introduce appropriate systems of analysis to deal with this problem. In the present study we carried out an analysis of the rate parameters adopted in Italy, by the Ministry and by two Regions: Lombardia and the Marche. The study took into account only the DRGs of cardiological diseases. We found that regional rates differed greatly according to the evaluation given to some diagnostic groups, inevitably determining the under valuation of the clinical complexity of some cases with the risk of a financial squeeze of certain structures. Variations in the composition of rate lists can also lead to distorted behaviour when selecting cases on condition of the quality of services given. The comparison of rates between the Marche and Lombardia regions showed a great difference in the number of subjects hospitalised for critical pathologies and stable ones, putting the wards in the Marche region in potential difficulty as their activity is aimed at more intensive and emergency therapy. The present study aims at underlining these problems, identifying the most evident inconsistencies and opening a debate on the subject.

Diagnosis-Related Groups↗
PubMed1995

Left ventricular hypertrophy. Prevalence in older patients and management.

Left ventricular hypertrophy (LVH) can be detected by electrocardiography or, with greater sensitivity, by echocardiography. Its prevalence increases with age, probably due to greater disease diffusion rather than aging itself. LVH is not only a consequence of disease, but also an independent contributor to morbidity and mortality, both in young and aged populations. Attempts have been made to reduce left ventricular (LV) mass by pharmacological and other means. LVH regression is possible in young and old hypertensive patients by some but not all hypotensive drugs. The effect on LV mass seems largely independent of blood pressure reduction. Whether LV mass control should be sought beyond the treatment of the underlying disease is still debated. Preliminary data indicate prognostic benefits associated with LVH regression, but studies on the elderly are scanty. LVH is a common and ominous finding in old people. In hypertension it can be reversed by drug therapy, with apparent functional improvement. Further studies are needed to verify the long term consequence of LV mass reduction in this age group.

Aged↗
PubMed1995

Blood pressure self-measurement in the elderly: differences between automatic and semi-automatic systems.

Arterial hypertension is the most common cardiovascular risk factor in the elderly. Its clinical control emphasises the problem of the systems used for monitoring: clinical measurement by the physician, home self-monitoring, ambulatory monitoring, etc. In particular, in the elderly population, the self-monitoring of blood pressure can present further problems associated with their situation. In our study we evaluated, in an elderly population, the differences in the self-recording of blood pressure with automatic and semi-automatic equipment using a mercury sphygmomanometer by a physician as a 'gold standard' control. We studied 28 elderly subjects using a rigid protocol for the self-measurement of their blood pressure. Our results show that automatic equipment is significantly more precise and easier to use than semiautomatic equipment in home self-measurement of blood pressure in elderly people.

Aged↗
PubMed1995

[Prognostic value of ECG changes detected by Holter monitoring in silent ischemic heart disease in the aged].

Ischemic Cardiomiopathy (IC) is the main cause of morbidity and mortality in the elderly and its incidence increases progressively with age. Holter monitoring (HM) is used to study IC which reveals asymptomatic ischemic episodes identifiable with the depression of the ST tract. It has been demonstrated that these electric manifestations have the same unfavourable diagnostic value as those accompanied by pain. In order to evaluate the prevalence and prognostic significance of episodes of silent myocardial ischemia in the elderly patient, we examined 99 consecutive patients with stable clinical symptoms of myocardial ischemia and a positive ergometric test (ET). The patients were randomly divided according to age (< or = 65 years, >65 years) into two groups with homogeneous clinical feature, except for a higher prevalence of women in the second group. The HM analysis, carried out for 24 hours during common every day activities and after suspending anti-ischemic therapy, showed that 62 patients (63%) had 289 episodes of electric ischemia; 216 (75%) of these were asymptomatic, and, in the group of elderly there was a higher incidence of ST depression unaccompanied by pain (A vs B = 86 vs 132 episodes, p < 0.001). Comparing the patients with and without anamnestic evidence of myocardial infarction it was found that the first group presented a higher prevalence of ST depression both asymptomatic and symptomatic (147 vs 71 silent episodes, p < 0.001, and 49 vs 24 symptomatic episodes, p = 0.015 respectively), while no statistically significant differences were found between the two age groups. Electric alterations of the asymptomatic ischemic kind were more often found in subjects with stable angina, above all if elderly; this is important from a prognostic point of view as few elderly patients are capable of performing a maximal TE and it is thus significant of reduced coronary reserve. From our data we observed that in patients with stable angina, especially if elderly, Holter revealed asymptomatic ST depression analyzed considering both its length and magnitude, is able to give prognostic evidence of subsequent coronary events.

Age Factors↗
PubMed1994

Hemodynamic effects of cadralazine or chlorthalidone in verapamil-treated elderly hypertensives.

Fourteen hypertensives aged > 66-77 years, whose diastolic blood pressure (DBP) was > or = 95 mmHg at the end of 1-month treatment with verapamil 240 mg SR, took part in this clinical-hemodynamic study. Patients were randomized to add the long-acting hydralazine derivative, cadralazine, 10 mg once daily, or chlorthalidone 25 mg once daily for 1 month each, to their previous verapamil regimen, according to a double-blind crossover design. Echo-Doppler hemodynamics were performed before starting verapamil, 1 month after verapamil and then after each phase of the crossover study. A significant reduction in DBP both in supine and upright position was observed with both drugs, while the reduction in systolic blood pressure was not significant. Criteria for a satisfactory response were DBP < or = 90 mmHg or a DBP reduction > or = 10 mmHg; this goal was achieved in 9 patients with cadralazine, 9 patients with chlorthalidone, 5 patients with both. The hemodynamic study in responders showed that both cadralazine and chlorthalidone acted through a reduction of peripheral resistances without inducing reflex tachycardia. Thus, cadralazine and chlorthalidone represent a suitable second-step treatment in elderly hypertensives insufficiently controlled by verapamil monotherapy: both drugs act through a reduction in total peripheral resistance (TPR).

Aged↗
PubMed1994

[Ergometric test: prognostic significance in the pre-thrombolytic and thrombolytic period].

In the pre-thrombolytic era exercise testing showed the ability to identify a low-risk population with a 1 year event rate < 1% and a moderate-high risk group with an event rate up to 17% within 1 year after acute myocardial infarction. The most significant parameters are the markers of compromised left ventricular contractility. Since the introduction of thrombolytic therapy the negative predictive ability of exercise testing has been questioned, due to the frequent occurrence of residual coronary stenosis with atherosclerotic plaque characterized by marked instability, to the point that the usefulness of exercise testing has been challenged. Nevertheless the available information, albeit sparse, seems to confirm that the negative predictive ability of exercise testing is still adequate (good), and certainly not inferior to that in pre-thrombolytic era.

Ergometry↗
PubMed1993

Arterial hypertension and cardiovascular damage in the elderly: focus on arterial stiffness and left ventricular hypertrophy.

Both aging and Arterial Hypertension (AH) cause a series of structural and functional changes in the cardiovascular apparatus. The reduction of aortic distensibility (RAD) and left ventricular hypertrophy (LVH) are, in particular, two significant markers of cardiovascular damage apart from being factors of serious and widespread morphological alterations. In this paper, the Authors analyze the effects of aging and of AH on the cardiovascular apparatus in order to find a possible clinical significance in relation to both RAD and LVH.

Aging↗
PubMed1993

Camerano study on hypertension: the problem of blood pressure variability during medical visit.

The Camerano Study on Arterial Hypertension (AH) is a cross-sectional study, carried out on a wide population sample in a small town in Central Italy, and aimed at revealing the prevalence of certain characteristics of AH in the population examined. In particular, we studied some aspects of blood pressure (BP) levels during the medical visits. To evaluate the effects of the medical visit on BP levels, we divided the subjects into 3 groups: I) Hypertensive subjects, II) Treated hypertensive subjects, III) Normotensive subjects (control group). The Systolic Arterial Pressure (SAP) in normotensive subjects reached maximum levels during the first medical visit and then decreased in the following two controls (p < 0.001). The Diastolic Arterial Pressure (DAP) did not show any significant changes during the three measurements (p = n.s.). Instead the maximum level of SAP in the hypertensive group did not appear at the first measurement but only after 5 minutes and was seen to decrease towards the end of the visit (p < 0.001). Even DAP showed different levels compared to the normotensives: a decrease in BP levels was registered after 15 minutes respect to earlier measurements (p < 0.01). The levels of group II were similar to those of normotensive subjects.

Adult↗
PubMed1993

Camerano study on hypertension: association between arterial hypertension and cardiovascular risk factors.

The Camerano study on Arterial Hypertension (AH), was a cross-sectional study carried out on a population living in a small town in central Italy. Its aim was to show the prevalence of certain characteristics of AH. We studied the association between AH and other well-known cardiovascular risk factors (CRF) such as: hypercholesterolemia, hypertriglyceridemia, cigarette smoking, hyperglycemia, obesity and in particular the hereditary factor, evaluated as the degree of association between the AH of the subject and that of his parents. The results reveal a significantly high association between AH and all the CRF examined. Subjects suffering from AH had double the chance of concomitant another CRF compared to the normotensives. If three CRF are present at the same time, then the hypertensive subjects are three times as many. When hereditary factors are evaluated, then subjects with two hypertensive parents have twice as much probability of developing AH compared to subjects from a normotensive family.

Adult↗
PubMed1992

Nicardipine retard in the therapy of elderly diabetic hypertensives: final report of observational study.

OBJECTIVE: An uncontrolled multicentre study was carried out in 10 hospitals of the Marche Region of central Italy, to evaluate the efficacy and tolerability of 40 mg nicardipine retard in elderly hypertensive patients with diabetes mellitus type II. DESIGN: The study lasted 6 months, single-blind for the first 3 months and open thereafter. The blood pressure criteria were 165 mmHg systolic and/or 95 mmHg diastolic measured at least three times consecutively in untreated patients or after 10 days of drug washout. PATIENTS: All subjects had a proven diagnosis of diabetes mellitus type II and were greater than or equal to 65 years of age. RESULTS: After the first 14 days of active treatment with nicardipine [corrected] retard at 40 mg/day, supine systolic blood pressure had fallen to 164.3 +/- 12.7 mmHg and diastolic to 92.2 +/- 7.3 mmHg (P less than 0.001). This first phase normalized blood pressure in 41.1% of patients. In 58.9% of patients the dose was doubled because goal blood pressure had not been achieved. After 4 weeks of therapy, mean supine systolic/diastolic values had fallen to 156.5 +/- 11.0/88.5 +/- 6.8 mmHg (P less than 0.001), and the proportion of patients requiring 80 mg/day had risen to 63.2%, with only 36.8% able to continue on the single dose. In 24.2% of the patients, monotherapy at 80 mg/day was not sufficient to normalize blood pressure and a second associated drug (enalapril, 10 mg/day) was administered. The mean blood pressure decrease induced by therapy was statistically significant from the second week of treatment (P less than 0.001). No significant variation in metabolic parameters was recorded during treatment. CONCLUSIONS: Nicardipine [corrected] retard was effective and well tolerated in elderly subjects, both clinically and metabolically.

Aged↗
PubMed1991

The mild hypertension enigma.

This study examines the problem of the correlation between mild arterial hypertension and cardiovascular damage. The authors examine the results of the most important trials carried out and, on the basis of their evaluations, suggest the need to review the current clinical policy of considering mild arterial hypertension as an important risk factor directly related to cardiovascular disease. Since the therapeutic trials carried out on mild hypertension did not substantially reduce the total and cardiac mortality rate, it seems to be probable that arterial hypertension is a progression acceleration marker of atheromatous disease. According to this theory, a therapy which aims merely at returning the pressure values to normal limits will probably not change the natural course of the atheromatous process.

Cardiovascular Diseases↗
PubMed1991

Discontinuous transdermal nitroglycerin as treatment for stable angina in the elderly: a double-blind multicentre study. The Transdermal TNG Trial Group of Istituto Nazionale Ricovero e Cura Anziani (I.N.R.C.A.).

A transdermal nitroglycerin (TNG) patch (10 mg.24 h-1), using a daily overnight 8-h free interval, was assessed by means of a multicentre trial in 96 elderly patients with stable angina (age greater than or equal to 65 years). The main entry requirement was a reproducible exercise-induced ST depression (greater than or equal to 1 mm) appearing at a load of 60 to 90 W, during an incremental bicycle ergometer test (10 W.min-1). During the study only one other antianginal drug and sublingual TNG tablets were allowed. The protocol consisted of a run-in period (mean 10 days), followed by a double-blind, randomized, parallel, placebo-controlled 28-day phase and a single-blind active treatment phase of the same duration. The exercise test parameters, the number of spontaneous anginal attacks and any unwanted effects were evaluated at the end of every study phase. In the double-blind phase, no ergometric values changed with placebo while transdermal TNG significantly improved total workload and double product by 36.4% and 7.7% at the maximal workload respectively and by 49.8% and 13.5% at the time to onset of 1 mm ST depression respectively and reduced ST depression (-58.8%) at the equivalent baseline workload. Anginal attacks decreased by 61.5% and 30.8% with TNG patch and placebo respectively. A similar trend was seen at the end of the single-blind active treatment period in patients who had received placebo in the double-blind phase. Nine patients failed to complete the study; six for unwanted effects (four in the active group and two in the placebo group) and three for other reasons.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Cutaneous↗
PubMed1991

Biochemical effects of urapidil on red cell membrane ion transport systems in a population of elderly essential hypertensives.

The aim of our work was to verify the effect of urapidil on membrane ion transport systems. This was a randomized, double-blind, cross-over study which evaluated the clinical and biochemical effects of urapidil (30 mg twice daily in comparison with placebo) in a group of 10 elderly hypertensive patients (3 male, 7 female ranging from 68 to 90 years, mean age 79.2 +/- 7.6 years). For the evaluation in fresh erythrocytes of principal ion transport systems (cotransport Na+/K+, countertransport Na+/Li+, Na+/K+ ATPase pump. intracellular Na+ and K+) we used the nystatin technique. We found that urapidil activated the red cell membrane ions cotransport system (basal values: 83.7 +/- 50.3 mumol Na+ RBC 1-1.h-1, after 1 month of urapidil therapy: 181.5 +/- 89.3 mumol Na+ RBC 1-1.h-1) (P less than 0.01), without significant changes in the other biochemical parameters evaluated. Our data suggest that one of the mechanisms of the urapidil antihypertensive effect could involve an increase in the membrane sodium cotransport system.

Aged↗