G Mancia

..The contribution of metabolic syndrome components to the risk, however, is unbalanced and mainly related to blood pressure and glucose abnormalities...

..e. atherosclerosis. This is in line with the modern view of cardiovascular prevention as a strategy that should delay the progression to high cardiovascular risk, which, once reached, is partly irreversible...

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..Both phenomena have important clinic and therapeutic implications potentiating the cardiovascular risk profile of the hypertensive patient...

..Despite intensive research efforts, few effective treatments are available once stroke has occurred; thus, stroke prevention should be a primary focus for all health care providers...

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..The role of drugs modulating sympathoactivation should be investigated in preascitic cirrhosis...

..The aim of the present study was to determine whether IMT independently relates to additional information obtained through ambulatory BP, in particular to SBP or PP variability...

..Office measurement, however, gives no information about blood pressure outside the office. This paper describes a HOT substudy in which patients underwent both office measurement and 24 h ambulatory blood pressure monitoring...

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..Consistency of BP control during treatment provides additional information on the protective effect of antihypertensive treatment. Physicians need to be concerned at each visit if BP is not controlled...

..Future directions for research and treatment of hypertension will need to consider the circadian cycle of blood pressure, the effect of treatment on blood pressure variability, and the magnitude of blood pressure changes in daily life...

..This will be followed by an analysis of the role played by neuroadrenergic factors in disease progression as well as in the pathogenesis of its complications. Finally, the therapeutic implications of these findings will be highlighted...

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..Information on the features of long-term modifications of clinic and 24-h ambulatory blood pressure (ABP) by treatment is limited. The present study aimed to address this issue...

..quot; Finally it provides an overview of the tolerability and compliance profile of the angiotensin II receptor antagonists, a new class of antihypertensive drugs characterized by an efficacy and safety profile...

..Our results suggest that nifedipine could be considered as first-line therapy for hypertensive diabetics...

..Future directions for research and treatment of hypertension will need to consider the circadian cycle of blood pressure, the effect of treatment on blood pressure variability, and the magnitude of blood pressure changes in daily life...

..It also highlights the major agreements and disagreements between the two sets of guidelines and their implications for daily clinical practice...

..The most important aim of antihypertensive therapy should be the dynamic control of BP-lower BP and lower BP variability...

..They also provide the first evidence that short-term erratic components of blood pressure variability play a prognostic role, with their increase being accompanied by an increased cardiovascular risk...

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..Subjects with WCHT and MHT are at increased risk of developing SHT. This may contribute to their prognosis that appears to be worse as compared with that of normotensive subjects...

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..The aims of this study were to assess the risk of stroke in a large cohort of hypertensive patients, and to determine the percentage with controlled blood pressure, to establish the contribution of this factor to the risk of stroke...

..A further consideration in managing total cardiovascular risk is the need for multiple antihypertensive agents to control BP...

..CONCLUSION: Despite unmet goals, antihypertensive treatment has provided throughout the years successful results. Future efforts will be need to achieve a better BP control in the population and thus to obtain a greater CV protection...

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..To investigate the possibility that statins reduce blood pressure as well as cholesterol concentrations through clinic and 24 hour ambulatory blood pressure monitoring...

..This paper will review the novelties of the ESH update document and the implications of the "new guidelines" for current clinical practice...

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..Because of the complementary mechanism of action and the evidence of cardiovascular protective effects they include the combination of a calcium antagonist and an angiotensin receptor antagonist among the priorital ones to employ...

..This paper will be focused on the 2007 guidelines document and the 2009 update paper, highlighting the new concepts and recommendations provided by the most recent intervention trials...

..This is clinically relevant because treatment discontinuation is mainly responsible for poor blood pressure control in the antihypertensive population...

..We investigated the CV and renal benefits associated with these BP targets in the high-CV-risk population of the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET)...

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..A sustained blood pressure elevation is associated with an increased risk of new-onset diabetes mellitus. Whether this is the case also in white-coat and masked hypertension is unknown...

..To assess efficacy and tolerability of candesartan cilexetil (CC) plus hydrochlorothiazide (HCTZ) fixed combination vs previous monotherapy (PM) plus HCTZ in hypertension...

..The results of the ONTARGET program are due in 2008, and the findings are expected to have important clinical implications for the management of patients at high cardiovascular risk...

..Limited or no evidence exists on whether and to what extent metabolic syndrome increases the risk of developing office hypertension, daily-life hypertension and left ventricular hypertrophy...

..Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations...

..Thus, in the PAMELA population, glucose and lipid values are independently related to blood pressure. This is also the case when daily life blood pressure values are considered...

..Few reports are available on BP control in relation to the cardiovascular risk profile in patients followed by specialist physicians...

..Since 24-h blood pressure control is now widely accepted as an important goal of antihypertensive therapy, ABPM has a potentially useful role in monitoring treatment in clinical trials in elderly patients...

..Conclusive demonstration that these blood pressure-independent effects do exist will require, however, a much more accurate and extended assessment of the blood pressure effects of the drugs...

..Markers of glucose and lipid metabolism and renal function were not significantly modified by treatment both with M and with E. In the diabetic hypertensives, M was as effective and metabolically neutral as the ACE-inhibitor E...

..Such concerns should be considered in the selection of antihypertensive therapy...

..While the study is in progress, baseline data are here reported to clarify the association of various risk factors with carotid IMT in these medium-high risk hypertensive patients...

..Thus the neuroadrenergic and reflex abnormalities characterizing CHF are independent of its aetiology...

..These findings support the view that LVCR should be searched for and regarded as a marker of target OD with an additional value for cardiovascular risk stratification in patients with normal LVM...

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..To avoid a systematic misclassification of cardiovascular risk, LVM should be routinely indexed to height(2.7) in overweight and obese patients representing a large percentage of the hypertensive population...

..8%). CONCLUSIONS : Uncomplicated type I diabetes mellitus is characterized by early structural and functional cardiac alterations. Some of these alterations show a measurable progression within a relatively short time span...

..Our findings showing that 48-h ambulatory HR is not associated with markers of TOD do not support the view that a faster HR may have an additive value in predicting organ damage in the early phases of essential hypertension...

..We sought to investigate the association of the metabolic syndrome (MS) with cardiovascular alterations in essential hypertensives in relation to age...

..Our study shows that in human hypertension, structural and functional cardiac changes induced by MS are not limited to the LV but also involve the right one...

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..CONCLUSIONS : Ultrasound assessment of the heart and carotid wall helps to obtain a more valid assessment of global cardiovascular risk in hypertensive patients without evidence of target-organ damage after routine examination...

..Most cardiovascular events associated with hypertension are complications of atherosclerosis. Some antihypertensive agents influence experimental models of atherosclerosis through mechanisms independent of blood pressure lowering...

..CONCLUSION: The verapamil-trandolapril-based strategy was as clinically effective as the atenolol-hydrochlorothiazide-based strategy in hypertensive CAD patients...

..However, the key goal is still to reduce BP, and this usually requires combinations of drugs...

..This appears not to be related to gender or to baroreflex mechanisms but rather to metabolic factors, i.e. to the greater insulin resistance characterizing CO...

..They also imply that even effective treatment of hypertension does not allow complete reversal of the cardiac organ damage characterizing high BP states...

..Thus, a verapamil SR-based antihypertensive treatment strategy is an alternative to a beta-blocker-based strategy in adults with CAD and diabetes...

..Furthermore, data on the rate of blood pressure control in the Italian hypertensive population are restricted to some Italian regions only, and refer usually to surveys performed, in most instances, several years ago...

..Stratification of population groups according to cardiovascular risk level is recommended for primary prevention...

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..The acute sympathoexcitation, but not the small between-drugs differential chronic adrenergic effect, is accounted for by baroreflex impairment...

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..Unlike diuretic treatment, however, treatment with candesartan cilexetil improves insulin sensitivity and exerts sympathoinhibitory effects...

..About 35% of subjects in both groups received additional hydrochlorothiazide (12.5-25 mg/day). The patients were followed up for carotid intima-media thickness (IMT) changes for 3.7 years...

..This role, however, appears to be more pronounced in heart failure than in hypertension, in which the impaired vagal function may exert a concomitant favouring effect...

..We sought to determine predictors for adverse outcomes in hypertensive patients with coronary artery disease (CAD)...

..The purpose of the study was to compare a beta-blocker-based strategy with a heart rate-lowering calcium antagonists-based strategy in patients with prior MI...

..On the contrary, current guidelines emphasize repeated clinic blood pressure measurements for the initiation of antihypertensive therapy...

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..Thus, in untreated essential hypertensives we assessed the relationship between LV geometry, ambulatory BP and markers of vascular and renal OD...

..CONCLUSION: Our data show that device-guided breathing exercises have an antihypertensive effect that can be seen in conditions closer to daily life than the setting of the physician's office...

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..This may represent an important factor for the genesis of the life-threatening ventricular arrhythmias that characterize CHF...

..We sought to investigate the association of SUA with subclinical cardiac, vascular, and renal alterations in never-treated uncomplicated essential hypertensives...

..ABP was measured after 1 year in the trial, with the aim of evaluating comparability of ABP levels on valsartan (VAL) and amlodipine (AML)-based regimens...

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..Alterations of large elastic arteries function is related to structural wall changes. Functional and structural properties of middle-size muscle arteries are independent of BP...

..Finally, the sympathetic adjustments to spontaneously occurring or artificially induced pre-mature ventricular contractions will be highlighted...