Abstract. Mulè G, Nardi E, Cottone S, Cusimano P, Volpe V, Piazza G, Mongiovì R, Mezzatesta G, Andronico G, Cerasola G (Università di Palermo, Palermo, Italy). Influence of metabolic syndrome on hypertension-related target organ damage. J Intern Med 2005; 257: 503-513.Objectives. The aim of our study was to analyse, in a wide group of essential hypertensive patients without diabetes mellitus, the influence of metabolic syndrome (MS) (defined according to the criteria laid down in the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults) on markers of preclinical cardiac, renal and retinal damage. Design. Cross-sectional study. Setting. Outpatient hypertension clinic. Subjects and methods. A total of 353 young and middle-aged hypertensives, free from cardiovascular and renal diseases (and 37% of whom had MS), underwent echocardiographic examination, microalbuminuria determination and non-mydriatic retinography.Results. When compared with subjects without MS, hypertensive patients with MS exhibited more elevated left ventricular (LV) mass (either normalized by body surface area or by height elevated by a power of 2.7), higher myocardial relative wall thickness, albumin excretion rate (AER) and a greater prevalence of LV hypertrophy (57.7% vs. 25.1%; P < 0.00001), of microalbuminuria (36.2% vs. 19.3%; P ¼ 0.002) and of hypertensive retinopathy (87.7% vs. 48.4%; P < 0.00001). These results held even after correction for age, 24-h blood pressures, duration of hypertension, previous antihypertensive therapy, and gender distribution. The independent relationships between LV mass and MS, and between AER and MS, were confirmed in multivariate regression models including MS together with its individual components. Conclusions. MS may amplify hypertension-related cardiac and renal changes, over and above the potential contribution of each single component of this syndrome. As these markers of target organ damage are well-known predictors of cardiovascular events, our results may partly explain the enhanced cardiovascular risk associated with MS.

No abstract

Abstract. Mulè G, Cottone S, Vadalà A, Volpe V, Mezzatesta G, Mongiovì R, Piazza G, Nardi E, Andronico G, Cerasola G (Cattedra di Medicina Interna e Centro Ipertensione, Università di Palermo, Italy). Relationship between albumin excretion rate and aortic stiffness in untreated essential hypertensive patients. J Intern Med 2004; 256: 22-29.Objectives. To evaluate, in a group of nondiabetic essential hypertensive patients with normal renal function, the relationship between albumin excretion rate (AER) and carotid-femoral pulse wave velocity (PWV), as an index of aortic stiffness. Design. Cross-sectional study. Setting. Outpatient hypertension clinic. Subjects. Seventy patients with mild-to-moderate essential hypertension, aged 42 AE 8 years, never pharmacologically treated. All subjects underwent routine laboratory tests, 24-h ambulatory blood pressure (BP) monitoring, measurement of carotidfemoral PWV, by means of a computerized method, and AER. Results. Microalbuminuric patients (AER ! 20 lg min À1 ; n ¼ 19), when compared with normoalbuminuric subjects, showed more elevated 24-h BP (136/88 AE 10/10 vs. 128/83 AE 7/ 6 mmHg; P < 0.001 and P ¼ 0.013, for systolic and diastolic BP respectively) and higher values of carotid-femoral PWV (10.4 AE 2 m s À1 vs. 9.2 AE 1.3; P ¼ 0.006). This latter difference remained statistically significant, even after correction by ancova for 24-h systolic and diastolic BP, and body mass index (BMI, P ¼ 0.016). Univariate regression analysis disclosed a tight correlation between AER and carotid-femoral PWV (r ¼ 0.42; P ¼ 0.0003). This association was confirmed in a multiple regression model (b ¼ 0.35; P ¼ 0.009) in which, as independent variables, besides PWV, 24-h BP, age, serum glucose values, smoking status, gender and BMI, were added. Conclusions. Our results seem to confirm that microalbuminuria may represent the early renal manifestation of a widespread vascular dysfunction, and therefore it is an integrated marker of cardiovascular risk.

No abstract

Background/Aims: To evaluate the influence of microalbuminuria (albumin excretion rate – AER) determination and echocardiography (ECHO) on cardiovascular risk stratification, initially performed according the 1999 WHO/ISH guidelines by using only routine diagnostic procedures with or without fundal examination. Methods: 312 essential hypertensives attending our institution were studied retrospectively. Cardiovascular risk was assessed in a semiquantitative way using four categories of absolute cardiovascular disease risk (low, medium, high and very high risk), as proposed by the 1999 WHO/ISH guidelines, on the basis of data on the average 10-year risk of cardiovascular events among participants in the Framingham Study. Results: Without the retinal data, estimating the level of global cardiovascular risk on the basis of routine work-up alone, 14% were classified as low-risk patients, 48% were as medium-risk, 20% as high-risk and 18% at very-high-risk patients. The combined use of AER and ECHO, in line with the newer ESH-ESC guidelines, determined a statistically significant reclassification of the hypertensive patients. Only 10% remained in the low-risk category, 28% were classified in the medium-, 42% in the high- and 20% in the very-high-risk classes. The overall percentage of patients that changed risk stratum (mostly shifting from the medium- to the high-risk class) was significantly different from the proportion of subjects reclassified after the addition of either microalbuminuria or echocardiography alone. No change in the distribution of risk categories was observed when AER assay and ECHO were added to routine procedures including funduscopic examination. Conclusions: Considering the questionable prognostic value of qualitative retinal examination, our results suggest that cardiovascular risk evaluation based only on simple routine work-up, ignoring the information provided by AER determination and ECHO, may underestimate the level of absolute risk.