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Biomedical subjects

G Leonetti

Publications and source records attributed to G Leonetti.

At least 91 records · Page 5Linked to original sources
PubMed1995

[Cardiac and vascular morphology in patients with "white-coat hypertension": echocardiographic and ultrasonographic study].

BACKGROUND: The introduction of ambulatory blood pressure (ABPM) in the clinical practice has defined a new subgroup of hypertensive patients (pts) called "white coat" hypertensive pts. It has been reported that white coat hypertensive pts have less cardiac involvement than established hypertensive pts. This study was designed to examine the extent of cardiac and vascular involvement in pts with white coat hypertension and established hypertension. METHODS: Fifty-four previously never treated pts with mild or moderate hypertension underwent a 24h ABPM and an echocardiographic and vascular ultrasonographic study in order to assess left ventricular anatomical parameters and the intima-media thickness of common carotid arteries. Left ventricular dimensions and mass were obtained according to Penn convention. The intima-media thickness of the far wall of both common carotid arteries was measured at 5, 10 and 20 mm caudally to the flow-divider; the average values were considered. RESULTS: Twenty-eight pts (age 43 +/- 8 years) had an average daytime ABPM below 140/90 mm Hg ("white coat") and 26 pts (age 46 +/- 10) had a consistently elevated diastolic blood pressure. Both groups had similar office blood pressure (152 +/- 9/101 +/- 7 vs 155 +/- 10/103 +/- 6 mm Hg) body surface mass (1.79 +/- 0.23 vs 1.86 +/- 0.21 mq), sex (18M/20F vs 18M/8F), duration of hypertension, glycolipidic parameters and smoking habit. The daytime ABPM was (by definition) significantly higher in established hypertensive pts than in white coat hypertensive pts (145 +/- 11/97 +/- 4 vs 129 +/- 7/83 +/- 5 mm Hg, p < 0.001). Left ventricular mass index and intima-media thickness resulted significantly greater in established (119 +/- 1.7 g/m2; 0.70 +/- 0.11 mm) than in white coat hypertensive pts (99 +/- 16 g/m2; 0.60 +/- 0.1 mm, p < 0.002). The prevalence of left ventricular hypertrophy and cardiac remodeling was more frequent in established hypertensive pts (53%) compared to white coat hypertensive pts (7.7%). CONCLUSION: The results of our study confirm that structural changes of left ventricle in white coat hypertensive pts are more limited than in established hypertensive pts and for the first time show that in white coat hypertensive pts the involvement of the conductance vessels is significantly lower than in established hypertensive pts.

Adult↗
PubMed1995

Cardiac and carotid structure in patients with established hypertension and white-coat hypertension.

AIM: The introduction of ambulatory blood pressure monitoring in the clinical practice has defined a new subgroup of hypertensive patients called white-coat hypertensives. It has been reported that white-coat hypertensives have less cardiac involvement than established hypertensive patients. This study was designed to examine the extent of cardiac and vascular involvement in patients with white-coat hypertension and established hypertension. PATIENTS AND METHODS: We studied 82 patients with mild essential hypertension, never previously treated, using 24-h ambulatory blood pressure monitoring and an echocardiographic and vascular ultrasonographic study. Left ventricular dimensions and mass were obtained according to the Penn convention. The intima-media thickness of the posterior wall of both common carotid arteries was measured 5, 10 and 20 mm caudally to the flow-divider and the average value was used for analysis. RESULTS: Of the 82 patients, 31 (mean +/- SD age 35 +/- 10 years) had average 24-h systolic/diastolic blood pressure values of below 132/85 mmHg (white-coat hypertensives) and 51 (aged 42 +/- 2 years) had a consistently elevated diastolic blood pressure. Both groups had similar body surface area (1.82 +/- 0.22 versus 1.81 +/- 0.22 m2), sex distribution (20 males and 11 females versus 32 males and 19 females), duration of hypertension, metabolic parameters and smoking habit. The 24-h ambulatory blood pressure monitoring values were, by definition, significantly higher in established hypertensives than in white-coat hypertensives (142 +/- 10/94 +/- 6 versus 127 +/- 6/79 +/- 4 mmHg, P<0.001). The left ventricular mass index and intima-media thickness were significantly higher in the established hypertensives (112 +/- 17 g/m2, 0.67 +/- 0.11 mm, respectively) than in the white-coat hypertensives (98 +/- 18 g/m2, 0.58 +/- 0.09 mm; P<0.001 for both). CONCLUSIONS: The prevalence of left ventricular hypertrophy and cardiac remodeling was significantly more frequent in established hypertensives (51%) compared to white-coat hypertensives (19%). These confirm that structural changes in the left ventricle in white-coat hypertensives are more limited than in established hypertensives and show that in white-coat hypertensives there is significantly less involvement of the conductance vessels than in established hypertensives.

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↗
PubMed1994

Urapidil in hypercholesterolemic hypertensive patients.

The association of arterial hypertension and hyperlipidemia strikingly enhances prevalence, incidence and mortality of cardiovascular disease. In the light of recent evidence that some antihypertensive drugs with alpha-1 blocking properties reduce blood pressure (BP) and total cholesterol (chol), increasing chol content in the non-atherogenic high density lipoproteins (HDL-chol), the effects of urapidil, a peripheral alpha-1 adrenoceptor antagonist, with a central action component on BP and plasma lipids were evaluated in 49 mild, hypertensive patients with mild to moderately severe hypercholesterolemia (serum chol 220-320 mg/dl) for a 6 month period in a double-blind randomized study versus placebo. Five out of the 49 patients (3 on urapidil, 2 on placebo) discontinued treatment due to adverse side effects. Five patients on placebo did not meet protocol requirement of serum triglycerides < 350 mg/dl (3.95 mmol/L) and were only included in the BP efficacy assessment. The groups of urapidil and placebo were comparable for age (50 +/- 10 vs 49 +/- 7 years), body weight (72 +/- 9 vs 73 +/- 10 kg), sex (18M, 8F vs 14M, 9F) and mean arterial pressure (119.4 +/- 4 vs 119.7 +/- 4 mmHg). The actively treated group significantly decrease BP values from 159/99 +/- 13/2 to 152/90 +/- 23/8 mmHg, whilst no change was observed in the placebo group. Between group analysis showed a significant difference at the end of treatment (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1994

Modification of cardiovascular risk factors during antihypertensive treatment: current and new approach trends. The urapidil experience.

Arterial hypertension is a well known risk factor for atherosclerosis and its complications. Lowering of blood pressure significantly reduces the incidence of cerebrovascular events and to a minor extent that of ischemic heart disease. Interference of antihypertensive drugs on lipoproteins, glucose and electrolytes metabolism has been suggested as a hypothesis for the lower than expected protection against cardiac events. The new antihypertensive agents such as calcium antagonists, angiotensin converting enzyme inhibitors and post-synaptic alpha-1 receptor antagonists have proved to be neutral or to have positive effect on metabolic disturbances. Urapidil, a multifactorial antihypertensive agent, has been shown to significantly lower blood pressure and to have a favorable impact on the metabolic profile in adult and elderly hypertensive patients and in patients with diabetes mellitus and elevated blood pressure. Although arterial hypertension is a risk factor for atherosclerosis, the clinical events at the cerebral and coronary levels are secondary to thrombo-embolic complications. On the other hand it has been shown that abnormalities in coagulation factor has a prognostic value. Therefore, new and old antihypertensive agents should be investigated not only for their effects on hypertension, metabolic profile and quality of life but also on coagulation, in order to improve the therapeutic profile.

Antihypertensive Agents↗
PubMed1993

Are there differences in the renal effects of calcium antagonists?

AIM: To review the effects of calcium antagonists, and of the new dihydropyridine lacidipine in particular, on the glomerular filtration rate, renal plasma flow, and the sodium to water ratio in hypertensive patients. METHODS: Review of published data. RESULTS: Different studies have shown a wide range of responses to all three subgroups of calcium antagonists in glomerular filtration rates and in renal plasma flows. In some studies there was a reduction and in others a rise in these two renal parameters. The administration of lacidipine was associated with a significant rise in renal plasma flow which disappeared with chronic treatment and no change in the glomerular filtration rate. There are only a few studies on the long-term natriuretic and diuretic effects of calcium antagonists. In the short term, dihydropyridine calcium antagonists appear to produce diuretic and natriuretic effects, but these effects are not seen with verapamil. Lacidipine showed no trend towards sodium and water retention. CONCLUSIONS: Reported differences between calcium antagonists in glomerular filtration and renal plasma flow probably reflect differences in the baseline tone of pre- and postglomerular arterioles. Calcium antagonists do not cause sodium and water retention during chronic therapy. The new dihydropyridine derivative lacidipine lowers blood pressure without reducing renal function or causing sodium and water retention.

Antihypertensive Agents↗
PubMed1993

Ultrasonographic evaluation of cardiac and vascular changes in young borderline hypertensives.

We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 20 borderline hypertensives (age 24 +/- 4 years) and in 20 normotensive subjects (age 23 +/- 6 years), as a control group. Both carotid axes have been scanned from different views on a transversal and longitudinal section. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. In borderline patients blood pressure (147.8 +/- 10.5/90.7 +/- 6.6 mm Hg) and left ventricular mass index (102.5 +/- 15.3 g/m2) were significantly higher than in normotensive subjects (blood pressure 120.5 +/- 11.5/78.0 +/- 5.4 mm Hg; left ventricular mass 90.5 +/- 14.3 g/m2, p < 0.01 and p < 0.05 respectively). The intima-media thickness of both the CCA and BIF was significantly higher in borderline hypertensives than in normotensives (CCA 0.6 +/- 0.08 vs. 0.4 +/- 0.05 mm, p < 0.01; BIF 0.7 +/- 0.08 vs. 0.5 +/- 0.08, p < 0.01). In the whole population there was a statistically significant correlation between the carotid wall thickness and the left ventricular mass.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Effect of octreotide on catecholamine plasma levels in patients with chromaffin cell tumors.

Many chromaffin cell tumors contain somatostatin (SS), and most of them are receptor-positive by in vitro autoradiography and by in vivo administration of radiolabeled SS analogs. We evaluated the effect of a 2-hour infusion of 50 micrograms octreotide on plasma norepinephrine (NE) and epinephrine (E) levels in 6 patients with chromaffin cell tumors. To ascertain the biological activity of octreotide, plasma insulin levels were also measured. Infusion of octreotide was followed in all the patients but 1 by a progressive decrease of plasma NE levels. On the average, plasma NE decreased significantly during octreotide administration, halving its baseline levels at the end of the infusion (51.3 +/- 11.46%, p < 0.05) and rising again slowly thereafter. A slight reduction of plasma E levels was also recorded at the end of octreotide infusion (76.1 +/- 13.77% of baseline, NS) with a prompt return of hormone concentrations to preinfusion values. During octreotide administration, plasma insulin displayed an early and steep fall (49.7 +/- 4.61% of baseline, p < 0.03, at 60 min) with a tendency to escape from inhibition before termination of the infusion. In 5/6 patients, 2 of whom were normotensive before the study and 1 the day of the test, blood pressure did not change during octreotide infusion. In the other patient, blood pressure fell from baseline values of 160/100 to 120/70 mm Hg at 120 min and rebounded to 205/100 mm Hg at 240 min. In conclusion, the short-term administration of low-dose octreotide is capable of lowering NE levels, though with no consistent effect on blood pressure, in patients with chromaffin cell tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
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↗
PubMed1993

Nitrendipine in older patients with isolated systolic hypertension: second progress report on the SYST-EUR trial.

This report from the double-blind placebo-controlled SYST-EUR trial investigated whether modern antihypertensive drugs are suitable for maintaining long-term BP control in older (> or = 60 years of age) subjects with isolated systolic hypertension (SBP 160-219 mmHg and DBP < 95 mmHg). Active treatment consisted of nitredipine (10-40 mg/day) with the possible addition of enalapril (5-20 mg/day) and hydrochlorothiazide (12.5-25 mg/day), if necessary to reduce SBP to < 150 mmHg and by > or = 20 mmHg. Matching placebos were used in the control group. This analysis was restricted to 18 months of follow-up. The placebo (n = 456) and active treatment (n = 485) groups had similar characteristics at randomisation (sitting pressure 176/85 mmHg; age 73 years). SBP fell (P < 0.001) on average 10 mmHg more on active treatment than on placebo and DBP 4 mmHg more. Fewer patients remained on monotherapy in the placebo than in the active treatment group (P < 0.001); on placebo the second and third line medications were started earlier (P < 0.001). Nitrendipine tablets were discontinued in nine patients on placebo and in 29 patients assigned to active treatment (P < 0.001). In conclusion, a significant BP reduction can be achieved and maintained in older patients with isolated systolic hypertension treated with a calcium antagonist (associated with a converting-enzyme inhibitor and a thiazide, where necessary). Whether this BP reduction results in a clinically meaningful decrease of cardiovascular complications is under investigation.

Aged↗
PubMed1993

[Cardiac and vascular hypertrophy in juvenile borderline hypertension: echocardiographic and ultrasonographic study].

BACKGROUND: High resolution ultrasonography is a noninvasive technique that allows us to investigate the cardiovascular system, in particular the wall thickness and the lumen diameter of the arteries, with accuracy and reproducibility. METHODS: We measured the intima-media thickness of the common carotid artery (CCA) and of its bifurcation (BIF) in 20 borderline hypertensive (age 24 +/- 4 years) and in 20 normotensive subjects (age 24 +/- 4 years), as a control group. Both carotid axes were scanned from different views (anterior, lateral, posterior) on a transversal and longitudinal section using a high resolution steerable linear array of 5 MHz. Carotid diameter and thickness were measured in the longitudinal section. CCA parameters were assessed 20 mm caudally to the flow divider. RESULTS: In borderline patients blood pressure (147.8 +/- 10.5/90.7 +/- 6.6 mmHg) and left ventricular mass index (102.5 +/- 15.3 g/m2) were significantly higher than in normotensive subjects (blood pressure 120.5 +/- 11.5/78.0 +/- 5.4 mm Hg; left ventricular mass 90.5 +/- 14.3 g/m2). The intima-media thickness of both the CCA and BIF was significantly higher in borderlines than in normotensives (CCA 0.6 +/- 0.08 vs 0.4 +/- 0.05 mm, p < 0.001; BIF 0.7 +/- 0.08 vs 0.5 +/- 0.08, p < 0.001). In the whole population there was a statistically significant correlation between the carotid wall thickness and the left ventricular mass. CONCLUSIONS: Our data show that ultrasonography provides direct evidence that in young borderline hypertensives the increased left ventricular mass is associated with vascular hypertrophy.

Adult↗