Objective: According to the 2013 ESH/ESC guidelines combination drug treatment is recommended in the treatment of isolated systolic hypertension (ISH) to improve blood pressure (BP) control. The present study was aimed at comparing the antihypertensive effects, tolerability and side effects profile of nebivolol/hydrochlorothiazide vs irbesartan/hydrochlorothiazide combination in elderly patients with ISH. Design and method: 124 ISH patients aged 69.1 ± 3.1 (mean ± SEM) followed by 13 general practictioners in Netherlands and Belgium were enrolled and randomized in a double blind fashion to Nebivolol 5 mg/Hydrochlorothiazide 12.5 mg (NH, n = 62) or Irbesartan 150 mg/Hydrochlorothaizide 12.5 (IH,N = 62) once daily for a 12 week period on sitting office BP, ambulatory BP, 24 hour BP variability, pulse pressure, tolerability and safety profile. Results: 9 pts were withdrawn after randomization. After 12 weeks NH caused a significant greater reduction than IH in sitting SBP (-25.8 ± 1.6 vs -20.6 ± 1.7 mmHg, P < 0.03) and heart rate (HR, -7.0 ± 1.0 vs 2.5 ± 1 b/min, P < 0.01), while the decrease in diastolic and pulse BP showed a non significant tendency to be greater in NH than in IH (-7.4 ± 1.0 and -18.3 ± 1.5 vs -5.0 ± 0.09 and -15.7 ± 1.7 mmHg, P = NS for both). The magnitude of the 24-h, day-time and night-time SBP reduction was almost superimposable in the 2 groups, while HR reduction induced by NH was significantly (P < 0.001) greater during the 24-h, the daytime as well as the nighttime period than that induced by IH. NH caused a significantly greater reduction than IH in 24-h SBP variability, both when expressed as standard deviation (-4.4 ± 2.7 ± vs -2.2 ± 5.1 mmHg, P < 0.02) or as coefficient of variation (-2.0 ± 2.6 vs -0.3 ± 3.4, P < 0.01). This was the case also for pulse pressure and mean BP. Both the 2 drug combinations were well tolerated. Conclusions: These data provide evidence that NH induces an office BP reduction greater than IN but similar effects throughout the 24 hours. NH, however, reduces, at variance from IH, 24-h systolic, mean and pulse BP variability, suggesting a greater protection against a variable known to adversely affect morbidity and mortality in hypertensive patients.

two ultrasound systems (QAS, Esaote; and E-Track, Aloka) provide radio-frequency (RF)-based tracking of carotid wall, allowing realtime determination of vessel diameter, distension, and stiffness (CS). Measurement is performed in a single line by E-Track and in 16 equidistant lines by QAS. to evaluate whether measures of CS with the two systems are comparable and to assess intra- and interoperator variability. MyLab 70 (Esaote) and Alpha 7 (Aloka) were used in random order to measure right CCA diameter and distension, and to calculate distensibility coefficient (DC) in 173 subjects (5 groups: 21 controls (NL), 35 prehypertensives (PHBP), 23 hypertensives (HBP), 27 type 2 diabetics (DM) and 67 HIV-positive patients. In 30 subjects, the study was repeated after 60-min, both by the same and by another operator. correlation coefficients between the two systems for CCA diameter, distension and DC were high (r=0.84, 0.90 and 0.87, p<0.0001). QAS provided significantly (P<0.001) higher CCA diameter and lower distension and DC than E-track (7.58±1.07 vs. 7.35±1.00 mm; 378±146 vs. 447±154 µm; and 0.35±0.17 vs. 0.44±0.19 kPa). In the 5 study groups, DC obtained with QAS and E-Track discriminated among them with similar statistical significance. Intra- and inter-operator variability for CCA distension was 7.5±4.6

Dozio, D.1; Maloberti, A.1; Citterio, F.1; Cesana, F.1; Alloni, M.1; Villa, P.1; Scanziani, E.1; Bandera, A.2; Sabatini, F.2; Cairo, M.1; Grassi, G.3; Gori, A.2; Giannattasio, C.3; Mancia, G.3 Author Information

Antiretroviral therapy (ART) has dramatically reduced AIDS—related mortality, but it has been associated to an increased cardiovascular risk, even in absence of hypertension. The aim of this study was to describe the influence of renal damage (RD) and ART on arterial function and structure. We studied 4 groups of normotensive, normocholesterolemic, euglycemic patients; one of HIV+ on ART with RD (A; n = 25; age 50.2±10.4 years; means±SD), one of HIV+ on ART without RD (B; n = 25; 49.4±6.2 years), one of HIV+not on ART and without RD (C; n = 13; 40±8.3 years) and one of healthy controls (D; n = 25; 50±6.8years). RD was defined by microalbuminuria and/or eGFR < 60 ml/min. Arterial stiffness was measured by aorto-femoral Pulse Wave Velocity (PWV), central BP by tonometry (Sphygmocor), carotid IMT and distensibility were measured by semi-automatic echotracking. Group A showed higher aortic SBP and PP than other groups and their aortic SBP was not significantly different from systemic one. PWV was higher in both therapy groups compared to others. Aortic distensibility was significantly impaired in A compared to B and C groups (no data for D group). IMT didn’t show any difference among groups. HIV+ patients are characterized by arterial functional abnormality that might account for their increased cardiovascular risk due to either ART and/or presence of RD.

Objective: The use of combination antiretroviral therapy has decreased AIDS–related mortality. It has been observed that treated AIDS patients now have a greater cardiovascular mortality and early organ damage even without hypertension. Goals of our study have been to determine whether 1) in normotensive AIDS patients with or without renal damage there are functional (arterial stiffening) and structural (carotid wall thickening) large artery alterations and whether 2) this leads to alterations in an important predictor of cardiovascular events, i.e. central blood pressure (BP). Design and Methods: We studied 40 treated, normotensive, normocholesterolemic, euglycemic AIDS patients, with (n = 20, age 52.0 ± 2.6 years; BP 131/77 ± 4/2 mmHg, means ± SE) or without (n = 20, age 44.0 ± 2.0 years; BP 130/76 ± 2/1 mmHg) renal damage, and 20 healthy controls (C, age 52.0 ± 1.0 years; BP 124/77 ± 2/1 mmHg). Renal damage was defined by microalbuminuria and/or glomerular filtration rate < 60 ml/min. Arterial distensibility was measured by aorto-femoral Pulse Wave Velocity (PWV), central systolic BP by tonometry (Sphygmocor) and carotid artery intima-media thickness (IMT) by semi-automatic echotracking (WTS). Results: Compared to C AIDS patients without renal damage showed similar values of carotid IMT (543 ± 26 vs 554 ± 24 μm), PWV (11.0 ± 0.5 vs 10.3 ± 0.4 m/sec) and central BP (117 ± 2/77 ± 1 vs 115 ± 2/70 ± 3 mmHg). In contrast, all values were greater in AIDS patients with renal damage (IMT: 608 ± 26 μm, PWV: 11.0 ± 0.5 and central BP130 ± 3/77 ± 2 mmHg), the difference being statistically significant (+ 13 mmHg, p < 0.05) for central systolic BP. In AIDS patients, PWV showed a not significant correlation with creatinine (r = 0.3) and filtration rate, both when measured by Cokroft-Gault and by MDRD (r = 0.35 and 0.31) formula, while automatically calculated IMT and systolic BP significantly correlated between each other (r = 0.4). Conclusion: In normotensive AIDS patients with no major cardiovascular risk factors there is no apparent alteration in arterial structure and function. This alteration is evident in AIDS patients with renal damage, leading to a greater central BP value that might account for their increased cardiovascular risk.

Introduction.Diabetes is often associated to the so-called 'diabetic cardiomiopathy'.Aim.To investigate cardiac tissue characterization, that is cardiac fibrosis, using dedicated software for integrated backscatter analysis, which provides information on cardiac tissue composition even in absence of obvious cardiac systolic and diastolic dysfunction at a standard echo examination.Methods.We studied 30 subjects.22 had a type 2 uncomplicated diabetes, 12 of which were normotensive (group A) and 10 hypertensive (group B) patients, whereas the remaining 8 subjects were healthy age-matched controls (group C).All diabetics assumed oral antidiabetic drugs and all hypertensives an ACE inhibitor.In each subject we performed a standard echo evaluating indexed left ventricular mass and systo-diastolic function: cardiac tissue characterization by integrated backscatter analysis was expressed as mean value (average IBS) and systo-diastolic or cyclic variation.Results.Blood pressure progressively increased from group C to group A and B (121/68± 6.5; 133/71 ± 7.2; 145/90 ± 12.5 mmHg).Left ventricular mass index and indices of systo-diastolic function were similar in the 3 groups, except for the E/A ratio which had the lowest value in diabetic hypertensive patients (group B) compared to the other two groups (0.6 vs 0.9 in group A and C, p<0.05).There was from C to A and B a progressive increase in the average IBS value (group C: 20.5±2.6, group A: 21.4±1.7, group B: 25.7± 1.3 dB, p<0.05) as well as a progressive reduction in cyclic variation (group C: 9.6± 1.8, group A: 7. 7± 1.1, group B: 5.5± 0.5, p<0.05).Conclusions.Even with a normal echocardiographic standard evaluation diabetics show higher values of average backscatter and lower values of cyclic variation: such data may suggest a more abundant presence of fibrosis and consequently early structural impairment which is more evident when diabetes is associated to high blood pressure.

Introduction.Low-grade inflammation has been shown to be related with arterial stiffness in several clinical conditions.Aim.To test the impact of C-reactive protein (CRP) on arterial stiffness in a large number of hypertensive patients, in comparison with more conventional risk factors, such as age, systolic blood pressure, and lipid variables.Methods.We studied 259 consecutive hypertensive non-diabetic patients (138 males, age range 19-86 years) on treatment with several antihypertensive agents in various combinations and dosages.Arterial stiffness was measured twice by carotid-femoral pulse wave velocity (PWV, Complior) and the mean of the values used for data analysis.Other measurements consisted of blood pressure (BP, sphygmomanometry), heart rate (HR, palpatory method), body mass index (BMI), serum total cholesterol, HDL-cholesterol, triglycerides and glucose.CRP was measured by high sensitivity hymmunochimic turbinometric technique.Results.In the whole group of patients mean age (±SE) was 52±0.8 years, BMI 26±0.2 g/m2, BP (systolic/diastolic), 142±1/87+0.6 mmHg, HR 66±0.6 b/min; serum total cholesterol, HDL cholesterol, triglycerides and glucose were 197±2.1,54±0.8,130±5 and 88.5 ±1.3 mg/dl respectively.Mean CRP was 3.2±0.3(mg/l) and PWV 10.9±0.9 m/sec.PWV individual values did not correlate with lipid variables, while they showed a correlation with age (r=0.29,p<0.0001), systolic BP (r= 0.25, p<0.0001), glycaemia (r= 0.12, p<0.04),BMI (r=0.16,p< 0.05) and CRP (r=0.18,p<0.003).The correlation between CRP and PWV remained significant (p<0.01)when a stepwise multivariate analysis including all variables showing a significant correlation in the bivariate analysis was performed.Conclusions.In treated hypertensive patients CRP is independently related to arterial stiffness.