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Biomedical subjects

G Leonetti

Publications and source records attributed to G Leonetti.

At least 19 recordsLinked to original sources
PubMed1995

Cardiac and carotid structure in arterial hypertension and in hypertrophic cardiomyopathy.

The aim of this study was to measure intima-media thickness (IMT) of the common carotid artery (CCA) in patients with hypertrophic cardiomyopathy (HCM) and in hypertensive patients with left ventricular hypertrophy (LVH). We studied 73 subjects: 20 normotensive healthy subjects as control group (I); 20 patients with essential hypertension without LVH (II); 20 hypertensives with LVH (III), and 13 normotensive patients with HCM (IV). Each subject underwent a complete echocardiographic and vascular ultrasonographic study in order to assess left ventricular parameters and the IMT at the level of the CCA. Left ventricular mass index (LVMI) was significantly higher in groups III and IV than in groups I and II (156 +/- 18 and 157 +/- 31 vs. 94 +/- 14 and 98 +/- 10 g/m2, respectively, p < 0.01), while IMT was significantly greater in group III but not in the others [0.88 +/- 0.04 vs. 0.61 +/- 0.03 (I), 0.64 +/- 0.03 (II) and 0.61 +/- 0.04 (IV) mm, p < 0.01]. The correlation between LVMI and IMT was statistically significant within all the hypertensive patients (r = 0.48, p < 0.01) but not in the HCM group (r = 0.17, p = NS). The hypertensive patients with LVH showed structural alterations (related to hemodynamic and humoral factors) both at cardiac and vascular level while in patients with HCM the cardiac alterations (due to a genetic disorder) were not associated with changes at the level of the large arteries.

Adult↗
PubMed1994

Evaluating quality of life in hypertensive patients.

The treatment of arterial hypertension is symptomatic in 90-95% of patients, and therefore it must be administered throughout life. At the beginning of pharmacologic treatment when only patients with severe or malignant hypertension are treated, the goal is almost exclusively limited to blood pressure reduction. Thereafter, when the treatment is extended to patients with mild and moderate hypertension, other aims in addition to blood pressure reduction, are evaluated and among these is the impact of pharmacologic blood pressure lowering on the quality of life. The quality of life is recognized as a multi-factorial variable and can be subdivided into six domains. The methodology used to evaluate the quality of life should use valid, repeatable, and sensitive tools. A metaanalysis of well selected and comparable trials has shown that antihypertensive treatment, as a whole, has a small but positive impact on many domains of the quality of life. Furthermore, it appears that converting-enzyme inhibitors, beta-blockers, calcium antagonists, and diuretics cause a statistically significant improvement of quality of life, while centrally acting alpha 1-agonists and direct vasodilators show only a positive trend. Although the comparison among two or more drugs with regard to quality of life is more difficult, it appears from a personal review that converting-enzyme inhibitors and calcium antagonists cause a greater improvement. These two classes of antihypertensive agents have been shown to improve the quality of life in elderly hypertensive patients, together with significant blood pressure reduction. Finally, the incidence of drop-outs and side effects cannot be considered a valid means of evaluation of the quality of life.

Antihypertensive Agents↗
PubMed1994

A long-term study comparing lacidipine and nifedipine SR in hypertensive patients: safety data.

The clinical safety of lacidipine, a new dihydropyridine calcium antagonist, has been assessed in a long-term, comparative study in hypertensive patients. Slow-release (SR) nifedipine was used for comparison. The type and incidence of adverse events seen with both drugs are characteristic of the dihydropyridine class of drugs and were mainly due to pharmacologically induced vasodilation, but lacidipine caused a significantly lower incidence of ankle edema than nifedipine SR. There were no unexpected adverse events during the treatment. The addition of atenolol 50 mg once daily did not increase the frequency of adverse events. Therefore, lacidipine can be considered a safe antihypertensive drug, which can be used as a suitable agent for first-line treatment of hypertension.

Adult↗
PubMed1994

The effects of calcium antagonists on electrolytes and water balance in hypertensive patients.

As direct vasodilating agents, calcium antagonists cause a significant reduction in total peripheral resistance in hypertensive patients. However, calcium antagonists differ significantly from direct vasodilating agents in their effects on sodium and water balance. Whereas direct vasodilating agents often cause sodium and water retention and the development of "pseudotolerance," calcium antagonists have no effect or cause a short-lasting natriuretic and diuretic effect. In our experience, dihydropyridine calcium antagonists with short-lasting and rapid onset of antihypertensive effect cause a significant rise in sodium and water excretion during the first and second days of oral administration. In contrast, calcium antagonists with a slower and longer-lasting blood pressure reduction cause a nonsignificant trend in sodium and water excretion with no signs or symptoms of retention. Finally, the antihypertensive effect of nifedipine is present in sodium-depleted and sodium-repleted patients. Calcium antagonists can increase sodium and water retention, although the antihypertensive effect is unrelated to their diuretic and natriuretic actions.

Blood Pressure↗
PubMed1994

Effects of cilazapril and nitrendipine on blood pressure, mood, sleep, and cognitive function in elderly hypertensive patients: an Italian multicenter study.

To evaluate its antihypertensive efficacy and safety in elderly hypertensive patients, the angiotensin-converting enzyme inhibitor cilazapril was compared to the calcium antagonist nitrendipine in a randomized, double-blind, multicenter trial with 114 subjects (mean age, 68 years; diastolic blood pressure, 90-115 mm Hg; systolic blood pressure, 140-220 mm Hg). After a 1-month placebo washout period, patients received either cilazapril, 2.5-5 mg, or nitrendipine, 10-20 mg, once daily for 12 weeks. After 4 weeks, the dose was doubled in non-responders. The higher dosage level was administered to 42% of patients in the cilazapril-treated group and to 47% in the nitrendipine-treated group. Blood pressure was measured before (at 60 min and 30 min, and just prior to administration) and at 60, 90, and 120 min after drug administration. Both cilazapril and nitrendipine significantly (p < 0.01) reduced systolic and diastolic blood pressure. The decrease in systolic blood pressure measured at trough was significantly greater with cilazapril than with nitrendipine (-17 vs. -12 mm Hg, p < 0.05), but the effect of the two drugs on diastolic blood pressure was similar (-11 mm Hg). Tolerability was assessed by means of adverse events, laboratory assessments, psychometric tests, and questionnaires on mood states and sleep. Adverse events were reported by 9% of patients in the cilazapril group and by 21% of patients in the nitrendipine group (p < 0.05). Laboratory test results and profiles for mood, sleep, memory, and attention were not affected by either treatment. Thus, cilazapril and nitrendipine both appear to be effective and well tolerated antihypertensive agents in the elderly patient.

Affect↗
PubMed1993

Effect of verapamil on atherosclerosis.

Whether antihypertensive agents exert an antiatherosclerotic effect by blood pressure reduction or independently of their antihypertensive effect is clinically relevant. Animal studies have generally shown that the calcium antagonist verapamil has a preventive rather than a therapeutic antiatherosclerotic effect, which is independent of its antihypertensive effect. However, doses used in animal studies were much higher than those administered to humans and, in animals, the time of administration of verapamil coincided with the application of atherogenic stimulus. Human studies have given controversial results. Verapamil appears to effectively reduce the restenosis rate after coronary angioplasty. However, in patients with coronary stenosis who were undergoing bypass surgery, results were conflicting: a retrospective study provided positive results, while a prospective study gave negative results. An ongoing study investigating the effect of verapamil on the carotid arteries of hypertensive patients could help clarify the relationship between blood pressure reduction and the progression, regression or development of carotid lesions.

Animals↗
PubMed1992

Echocardiographic and ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension.

High-resolution ultrasonography is a noninvasive technique that allows to investigate the cardiovascular system, in particular the wall thickness and the lumen diameter of the arteries with accuracy and reproducibility. We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 40 patients with essential hypertension, 20 of them with left ventricular hypertrophy (LVH; age 42 +/- 10 years) and 20 without LVH (age 44 +/- 12 years); no other major cardiovascular risk factor was present in all the patients. Both carotid axes have been scanned from different views (anterior, lateral, posterior) on a transversal and longitudinal section using a high-resolution steerable linear array of 5.0 MHz. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. In patients with LVH, blood pressure (172 +/- 21/108 +/- 9 mm Hg) and left ventricular mass index (156 +/- 38 g/m2) were significantly (p < 0.01) higher than in patients without LVH (blood pressure: 158 +/- 11/99 +/- 12 mm Hg; left ventricular mass index: 98 +/- 10 g/m2), while there was no difference in serum glycemia, triglycerides, total and fractioned cholesterol levels. The intima-media thickness of both the CCA and BIF was significantly higher in the hypertensives with LVH (CCA: 0.85 +/- 0.02 vs. 0.65 +/- 0.02 mm; BIF: 0.93 +/- 0.04 vs. 0.70 +/- 0.03 mm, p < 0.01). There was a statistically significant correlation between the carotid wall thickness and the left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Prevalence of physiological valvular regurgitation in hypertensive patients: echocardiographic and color Doppler study.

Since the advent of the Doppler color flow echocardiography, the presence of a small degree of insufficiency of the cardiac valves has been detected with relative frequency in structurally and functionally normal hearts. Data about this so-called 'physiological' regurgitation are presently available only in normotensive subjects and athletes. We therefore studied the prevalence of this phenomenon in a group of patients with essential hypertension compared to a population of normotensive subjects. To this purpose, a Doppler color flow echocardiographic study was performed in 130 essential hypertensive patients (72M/58F; age 44.2 +/- 13.5 years; BP 154.3 +/- 12.8/98.3 +/- 7.1 mm Hg) without any evidence of left ventricular hypertrophy or cardiopathy and in 100 normal subjects (59M/41F; age 41.2 +/- 14.8 years; BP 119.1 +/- 8.1/79.2 +/- 8.1 mm Hg). We conclude that in patients with essential hypertension the physiological regurgitant jets are present in one or more cardiac valves; moreover, the regurgitation of the mitral and aortic valve is found with more frequency than in the normotensive control group (36.1 vs. 27.0% and 17.7 vs. 11.0%, respectively). These data suggest that the increased afterload of the left ventricle may play an important role in the pathogenesis of even minor degree of insufficiency of the cardiac valves. As this finding does not appear to have a pathological relevance, the main clinical implication of this study is that it is not advisable to create a jatrogenic heart disease in the hypertensive patients routinely screened by the echo-Doppler technique.

Adolescent↗
PubMed1992

[Ultrasonographic evaluation of cardiac and vascular hypertrophy in patients with essential hypertension].

High resolution ultrasonography allows the accurate and reproducible measurement of thickness and lumen diameter of carotid arteries. We investigated Common carotid (CCA) and bifurcation intima-media thickness in 40 hypertensive patients, 20 without left ventricular hypertrophy (LVH) (age 42 +/- 10 years) and 20 with LVH (age 44 +/- 12 years), all free from other important cardiovascular risk factors. Both carotid axes were scanned from different views (anterior, lateral, posterior) on traversal and longitudinal section, using a high resolution steerable (HRS) 5.0 MHz linear array. Carotid diameter and thickness from longitudinal section were measured. CCA parameters were taken 20 mm caudally to flow divider. Using the B-mode as a guide we assessed LVH presence with M-mode technique when left ventricular mass index (LVMI) > or = 135 g/m2 for men and > or = 110 g/m2 for women. In hypertensive patients with LVH, left ventricular mass was significantly higher than in those without LVH (156 +/- 38 vs 98 +/- 10 g/m2, p < 0.01). Even blood pressure was significantly higher in hypertrophic group (172 +/- 21/108 +/- 9 vs 158 +/- 11/99 +/- 12 mmHg, p < 0.01), while there was no difference in serum glycemia, triglycerides, total and fractioned cholesterol levels. The intima-media thickness scanned in both CCA and bifurcation resulted significantly higher in hypertensives with LVH (CCA: 0.85 +/- 0.02 mm vs 0.65 +/- 0.02 mm; BIF: 0.93 +/- 0.04 mm vs 0.70 +/- 0.03 mm, p < 0.01). We also noticed a statistically significant correlation between carotid wall thickness and left ventricular mass index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Arterial hypertension as a risk factor in the elderly and its treatment.

PURPOSE: World Health Statistic Annuals between 1973 and 1982 show that mortality from cardiovascular and coronary heart disease fell significantly during this period. Against this background, the present review analyses results from trials of antihypertensive therapy in elderly hypertensives. STUDY SELECTION: The review examined available trials specifically devoted to testing the hypothesis that antihypertensive treatment in the elderly hypertensive can lead to a decrease in morbidity and mortality. RESULTS OF DATA ANALYSIS: Different, randomly allocated, controlled trials have shown that a pharmacological reduction in blood pressure can reduce the incidence of cardiovascular events in the elderly to a similar extent as in young and adult hypertensive patients. Recent reviews have indicated, in contrast to previous suggestions, that the available antihypertensive agents do not have an age-dependent effect. Therefore the choice of antihypertensive therapy is more dependent on previous use or the presence of concomitant diseases. CONCLUSIONS: Arterial hypertension is a risk factor in the elderly which can be reduced with pharmacological intervention.

Aged↗
PubMed1991

Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: objectives, protocol, and organization.

The Syst-Eur Trial is a concerted action of the European Community's Medical and Health Research Programme. The trial is carried out in consultation with the World Health Organization, the International Society of Hypertension, the European Society of Hypertension and the World Hypertension League. This article describes the objectives and the protocol of Syst-Eur, a multicentre trial designed by the European Working Party on High Blood Pressure in the Elderly (EWPHE), to test the hypothesis that antihypertensive treatment of elderly patients with isolated systolic hypertension results in a significant change in stroke morbidity and mortality. Secondary endpoints include cardiovascular events, such as myocardial infarction and congestive heart failure. To be eligible patients must be at least 60 years old and have a systolic blood pressure averaging 160-219 mmHg with a diastolic pressure less than 95 mmHg. Patients must give their informed consent and be free of major cardiovascular and non-cardiovascular diseases at entry. The patients are randomized to active treatment or placebo. Active treatment consists of nitrendipine (10-40 mg/day), combined with enalapril (5-20 mg/day) and hydrochlorothiazide (12.5-25 mg/day), as necessary. The patients of the control group receive matching placebos. The drugs (or matching placebos) are stepwise titrated and combined in order to reduce systolic blood pressure by 20 mmHg at least to a level below 150 mmHg. Morbidity and mortality are monitored to enable an intention-to-treat and per-protocol comparison of the outcome in the 2 treatment groups. A one-year pilot trial (1989) showed that the protocol is practicable. The Ethics Committee therefore decided to start the definite study (1990), in which randomized patients will be followed for 5 years. Recruitment of new centres and of the required 3,000 patients will last 3 years (until 1993).

Aged↗
PubMed1991

Treatment of hypertension in the elderly: effects on blood pressure, heart rate, and physical fitness.

The subjects were 36 hypertensive patients aged 61 to 79 years (mean, 66 years). After a placebo run-in period of one month, each patient was randomly assigned to two months of treatment with 100 mg of metoprolol, 50 mg of captopril, or 25 mg of hydrochlorothiazide plus 2.5 mg of amiloride daily, or placebo. The doses were doubled if diastolic pressure was above 95 mm Hg after one month of treatment. Blood pressure, heart rate, and physical fitness (endurance during a standard cycle ergometer exercise) were measured and side effects assessed after each two-month treatment period. Mean blood pressures were significantly lower after treatment with metoprolol (154/92 mm Hg), captopril (157/92 mm Hg), and hydrochlorothiazide-amiloride (152/91 mm Hg) than after placebo (170/101 mm Hg). Heart rate was significantly lower after treatment with metoprolol (64 beats/minute) than after placebo (77 beats/minute). Exercise endurance was lower after treatment with metoprolol (498 seconds) and hydrochlorothiazide-amiloride (519 seconds) than after placebo (529 seconds) and higher after captopril (541 seconds). More patients reached the target exercise work load after captopril than after the other treatments. No patients withdrew from treatment because of side effects or abnormal laboratory test results. All three active treatments benefited the elderly hypertensive patients and did not lower their physical fitness. Captopril appeared to be more effective than the other two treatments.

Aged↗
PubMed1991

Clinical position of lacidipine, a new dihydropyridine calcium antagonist, in the treatment of hypertension.

Lacidipine is a calcium antagonist of the dihydropyridine group that is highly selective for vascular tissues. It has been tested during the last few years for the treatment of arterial hypertension. We evaluated the clinical position of this calcium antagonist on the basis of clinical results. From the dose-ranging studies carried out to determine the efficacy of lacidipine, it has been shown that the dose range of 2-6 mg of lacidipine given once daily is effective in reducing blood pressure levels. Lacidipine efficacy (4-6 mg/o.d.) also has been compared with that of the diuretic hydrochlorothiazide, the calcium-antagonist nifedipine, and the beta-blocker atenolol in three different clinical trials according to the same protocol. The results indicated that lacidipine, hydrochlorothiazide, nifedipine, and atenolol caused similar reductions both in systolic and diastolic blood pressure after 1 and 2 months of treatment. Similar blood pressure levels were also reached when another antihypertensive agent (atenolol or hydrochlorothiazide) had been added in nonresponders to monotherapy. Heart rate showed a significant decrease only under atenolol treatment, either monotherapy or associated to the previous treatment. In these comparison studies, tolerability was also evaluated. The incidence of side effects during lacidipine treatment was lower than during nifedipine or atenolol treatment, but higher than during hydrochlorothiazide therapy. Lacidipine did not cause any changes in the laboratory parameters evaluated during the 2-month monotherapy period. From a trial conducted in elderly patients, lacidipine 2 and 4 mg/o.d. has been shown to cause similar diastolic blood pressure reduction after 1 month of treatment, the effect being more gradual with the lower dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium Channel Blockers↗
PubMed1991

Effects of long-term blood pressure control on left and right ventricular structure and function in hypertensive patients.

The functional and anatomical abnormalities of the right ventricle may occur in hypertensive patients with left ventricular hypertrophy (LVH). The present study was designed to assess the functional and structural changes in both left and right ventricles induced by chronic antihypertensive therapy. Doppler and standard echocardiography were performed in 10 hypertensive patients with LVH before and after 1 year of treatment with captopril alone (5 patients) or captopril plus nifedipine (5 patients). We found that the left ventricular mass index and right ventricular thickness were significantly reduced in all patients when compared with pretreatment values. Furthermore, the Doppler-derived diastolic filling indexes show a significant improvement of both ventricular chambers. Our data suggest that anatomical and functional changes induced by therapy in hypertensive patients are not limited to the left ventricle but also involve the right ventricle.

Blood Pressure↗
PubMed1991

Comparative study of lacidipine and nifedipine SR in the treatment of hypertension: an Italian multicenter study. The Northern Italian Study Group of Lacidipine in Hypertension.

The aim of this study was to compare the antihypertensive efficacy and tolerability of lacidipine, a new dihydropyridine calcium antagonist, and slow-release nifedipine (SR) in patients with mild-to-moderate essential hypertension. After a 1-month placebo run-in period, 435 patients were randomized into a double-blind, parallel-group study to receive either 4 mg of lacidipine once daily (n = 220) or 20 mg of nifedipine twice daily (n = 215). After 4 weeks, the doses for "nonresponders" were increased to 6 mg of lacidipine once daily (n = 82) and to 40 mg of nifedipine SR twice daily (n = 62). After 4 weeks, 50 mg of atenolol once daily was added to the regimens of patients still uncontrolled by lacidipine (n = 32) and nifedipine SR (n = 23) as monotherapy. Sitting blood pressure and heart rate were measured at 22-24 h after lacidipine and 10-12 h after nifedipine SR. Both calcium antagonists similarly and significantly reduced the blood pressure at rest (sitting) and on exercise, while the heart rate did not change significantly. The nature and incidence of side effects and withdrawals also did not differ between the two. In conclusion, lacidipine once daily is as effective and well tolerated as nifedipine SR twice daily in patients with mild-to-moderate essential hypertension.

Adult↗
PubMed1991

Left ventricular diastolic function in athletes and borderline hypertensives with mild cardiac hypertrophy.

The aim of this study was to evaluate the diastolic function in athletes and in young borderline hypertensives with mild left ventricular hypertrophy. Left ventricular filling was assessed by echo Doppler measurement of transmitral flow velocity in 18 soccer players (age 22 +/- 4 years, left ventricular mass index, LVMI 136 +/- 12 g/m2), in 15 borderline hypertensives (age 21 +/- 3 years, LVMI 137 +/- 9 g/m2), and 20 normotensive subjects (age 22 +/- 4 years, LVMI 93 +/- 10 g/m2) as reference group. We found that left ventricular filling profile was similar in borderline hypertensives, in athletes and in normotensive subjects. These findings suggest that, at least in the early stage, mild cardiac hypertrophy secondary to borderline blood pressure elevation is characterized by indexes of diastolic function not different from those found in athletes with physiological hypertrophy.

Adult↗
PubMed1991

Cardiac structure and function before and after acute and chronic verapamil administration in hypertensive patients.

The aim of this study has been to analyze the acute and chronic effects of oral verapamil on diastolic function indices, derived from Doppler echocardiography, and left-ventricular (LV) dimensions and mass, assessed by M-mode echocardiography, in hypertensive patients without LV hypertrophy. 12 patients with essential hypertension were studied in basal conditions and (1) after a single oral administration of verapamil 160 mg and placebo in a double-blind protocol and (2) over chronic treatment (12 months) with verapamil 240 mg/day. At baseline, the ratio between early and atrial-induced transmitral velocities (E/A ratio) was lower in patients than in 12 age-matched normal subjects (1.08 +/- 0.2 vs. 1.51 +/- 0.3, p less than 0.01). Acute verapamil administration significantly decreased arterial blood pressure (162 +/- 26/101 +/- 8 to 142 +/- 12/88 +/- 7 mm Hg, p less than 0.01 after 2 h) and increased the E/A ratio to 1.26 +/- 0.3 (p less than 0.05) after 3 h. No change in ventricular dimensions and heart rate was observed. After chronic therapy, we found a further increase in the E/A ratio in 10 responder patients (1.49 +/- 0.3, p less than 0.01). The LV mass index, that was higher than in normal subjects before the treatment (118 +/- 16 vs. 91 +/- 11 g/m2, p less than 0.01), was significantly reduced (100 +/- 17 g/m2, p less than 0.05 vs. basal, nonsignificant vs. normal subjects). Our results demonstrate that acute administration of verapamil only partially improves the abnormal indices of diastolic function in hypertensive patients, whereas chronic treatment, by reducing LV mass indices and blood pressure to normal values, can completely normalize the indices of LV diastolic filling.

Adult↗