Fondazione Umbra Cuore e Ipertensione - AUCI-ONLUS Strada Tuderte, 6 06126 Perugia - Italy
auci.perugia@tin.it
Scopo: promuovere e favorire la ricerca scientifica nel settore dell’ipertensione arteriosa, e della cardiologia preventiva in generale, al fine di prevenire e curare al meglio le malattie cardiovascolari.
Data di fondazione: 11 Giugno 2008
Soci Fondatori: Paolo Verdecchia (Presidente), Carlo Porcellati Pazzaglia (Presidente Onorario); Fabio Angeli (Segretario); Gianpaolo Reboldi; Claudia Borgioni; Roberto Gattobigio.
Segretaria: Sig.ra Carla Jaspers
Attività della Fondazione:
1. Partecipazione a ricerche scientifiche. 1.1. Attività di lettura centralizzata degli elettrocardiogrammi nell’ambito degli Studi Cardio-Sis (promosso da Heart Care Foundation), DYDA (Promosso da Heart Care Foundation). 1.2. Gestione informatica e biostatistica del Progetto Regionale Umbro UMBRIA-STEMI (Patrocinato dall’Assessorato alla Sanità della Regione Umbria). 1.3 Gestione ed organizzazione di database prospettivi di studi clinici di intervento ed osservazionali pubblicati nella letteratura internazionale (in collaborazione con il Dipartimento di Medicina Interna dell’Università di Perugia)
2. Finanziamento di progetti di ricerca 2.1. Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA), un registro osservazionale di morbidità e mortalità in pazienti ipertesi approvato dal Comitato Etico della Regione Umbria. 2.2. Collaborazione con la McMaster University di Hamilton (Canada) - Population Heath Research Institute - per progetti di ricerca in tema di prevenzione delle complicanze cardiiovascolari in soggetti ad alto rischio. 2.3. Rassegne sistematiche e meta-analisi di studi clinici in ambito cardiovascolare e metabolico
3. Finanziamento per la copertura dei costi di pubblicazione di articoli scientifici orginali, rassegne sistematiche e meta-analisi, analisi statistiche ed epidemiologiche in tema di ipertensione arteriosa e prevenzione cardiovascolare.
4. Donazione a favore di Enti ed Istitutuzioni afferenti al Servizio Sanitario Nazionale
5. Articoli scientifici pubblicati nella letteratura internazionale grazie al supporto incondizionato di AUCI - Fondazione Onlus (segue lista)
Abstract: The diabetes epidemic continues to grow unabated, with a staggering toll in micro- and macrovascular complications, disability, and death. Diabetes causes a two- to fourfold increase in the risk of cardiovascular disease, and represents the first cause of dialysis treatment both in the UK and the US. Concomitant hypertension doubles total mortality and stroke risk, triples the risk of coronary heart disease and significantly hastens the progression of microvascular complications, including diabetic nephropathy. Therefore, blood pressure reduction is of particular importance in preventing cardiovascular and renal outcomes. Successful antihypertensive treatment will often require a combination therapy, either with separate drugs or with fixed-dose combinations. Angiotensin converting enzyme (ACE) inhibitor plus diuretic combination therapy improves blood pressure control, counterbalances renin-angiotensin system activation due to diuretic therapy and reduces the risk of electrolyte alterations, obtaining at the same time synergistic antiproteinuric effects. ACE inhibitor plus calcium channel blocker provides a significant additive effect on blood pressure reduction, may have favorable metabolic effects and synergistically reduce proteinuria and the rate of decline in glomerular filtration rate, as evidenced by the GUARD trial. Finally, the recently published ACCOMPLISH trial showed that an ACE inhibitor/calcium channel blocker combination may be particularly useful in reducing cardiovascular outcomes in high-risk patients. The present review will focus on different ACE inhibitor combinations in the treatment of patients with type 2 diabetes mellitus and hypertension, in the light of recent clinical trials, including GUARD and ACCOMPLISH.
Abstract: OBJECTIVES: We tested the hypothesis that the voltages of QRS on ECG improve risk stratification in hypertensive patients without left ventricular hypertrophy on ECG. METHODS AND RESULTS: We studied 2042 initially untreated patients with hypertension (mean age 49 years, 46% women) without left ventricular hypertrophy on ECG and no history of cardiovascular disease. At entry, all patients underwent diagnostic tests, including 24-h ambulatory blood pressure monitoring and echocardiography. Among the different ECG voltages, the R wave in lead aVL showed the closest association with left ventricle (LV) mass (r = 0.31; P < 0.001), followed by the R wave in D1 (r = 0.25) and the S wave in V3 (r = 0.22). Patients were followed up for a mean of 7.7 years (range 1-22 years), and treatment was tailored individually. During follow-up, there were 188 major cardiovascular events. The relationship between LV voltage and outcome was assessed using a Cox model with adjustment for age, sex, diabetes, smoking, total cholesterol, serum creatinine, LV mass on echocardiography and average 24-h ambulatory blood pressure. A 0.1 mV higher R wave voltage in lead aVL was associated with a 9% higher risk of cardiovascular disease (95% confidence interval = 0.04-0.15%; P < 0.001). Other ECG voltages and minor repolarization changes were not related to clinical outcome. CONCLUSION: Our results show for the first time that the voltage of the R wave in lead aVL improves cardiovascular risk stratification in hypertensive patients without left ventricular hypertrophy on ECG. Its prognostic value is independent of LV mass on echocardiography and 24-h ambulatory blood pressure.
Abstract: BACKGROUND: The level to which systolic blood pressure should be controlled in hypertensive patients without diabetes remains unknown. We tested the hypothesis that tight control compared with usual control of systolic blood pressure would be beneficial in such patients. METHODS: In this randomised open-label trial undertaken in 44 centres in Italy, 1111 non-diabetic patients with systolic blood pressure 150 mm Hg or greater were randomly assigned to a target systolic blood pressure of less than 140 mm Hg (usual control; n=553) or less than 130 mm Hg (tight control; n=558). After stratification by centre, we used a computerised random function to allocate patients to either group. Observers who were unaware of randomisation read electrocardiograms and adjudicated events. Open-label agents were used to reach the randomised targets. The primary endpoint was the rate of electrocardiographic left ventricular hypertrophy 2 years after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00421863. RESULTS: Over a median follow-up of 2.0 years (IQR 1.93-2.03), systolic and diastolic blood pressure were reduced by a mean of 23.5/8.9 mm Hg (SD 10.6/7.0) in the usual-control group and by 27.3/10.4 mm Hg (11.0/7.5) in the tight-control group (between-group difference 3.8 mm Hg systolic [95% CI 2.4-5.2], p<0.0001; and 1.5 mm Hg diastolic [0.6-2.4]; p=0.041). The primary endpoint occurred in 82 of 483 patients (17.0%) in the usual-control group and in 55 of 484 patients (11.4%) of the tight-control group (odds ratio 0.63; 95% CI 0.43-0.91; p=0.013). A composite cardiovascular endpoint occurred in 52 (9.4%) patients in the usual-control group and in 27 (4.8%) in the tight-control group (hazard ratio 0.50, 95% CI 0.31-0.79; p=0.003). Side-effects were rare and did not differ significantly between the two groups. INTERPRETATION: Our findings lend support to a lower blood pressure goal than is recommended at present in non-diabetic patients with hypertension. FUNDING: Boehringer-Ingelheim, Sanofi-Aventis, Pfizer.
Abstract: Cardiovascular and renal disease can be regarded as progressing along a sort of continuum which starts with cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, etc), evolves with progression of atherosclerotic lesions and organ damage, and then becomes clinically manifest with the major clinical syndromes (myocardial infarction, stroke, heart failure, end-stage renal disease). The blood pressure control remains a fundamental mechanism for prevention of cardiovascular disease. The renin-angiotensin system is believed to play an important role along different steps of the cardiovascular disease continuum. Convincing evidence accumulated over the last decade that therapeutic intervention with angiotensin receptor blockers (ARBs) is effective to slow down or block the progression of cardiovascular disease at different steps of the continuum, with measurable clinical benefits. However, despite the shared mechanism of action, each ARB is characterized by specific pharmacological properties that may influence its clinical efficacy. Indeed, important differences among available ARBs emerged from clinical studies. Therefore, generalization of results obtained with a specific ARB to all available ARBs may be misleading. The present review provides a comparative assessment of the different ARBs in their efficacy on major clinical endpoints along the different steps of the cardiovascular disease continuum.
Abstract: Diabetes causes approximately 2.9 million deaths yearly, mainly through an increased risk of cardiovascular disease. In hypertensive diabetics, blood pressure reduction determines a significantly lower rate of cardiovascular and renal events. Conversely, reaching the generally recommended target of lower than 130/80 mmHg is a difficult challenge and, in most cases, two or more antihypertensive drugs are required. Until recently, there was a general consensus that combination treatment should include a diuretic as one of the two fundamental agents. However, recently published trials using calcium channel blockers plus renin-angiotensin system-blocking agents showed that such a combination reduces the risk of major cardiovascular events, provides greater renoprotection, and improves metabolic outcomes as compared with diuretic-based combinations. The present review explores the potential for an 'optimal' combination therapy in patients with diabetes mellitus and hypertension, in view of recent experimental and clinical evidence.
Abstract: Background: Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). New onset of hyperglycemia (NH) is associated with higher mortality both in the short and long-term. Aim: We performed a systematic review and meta-analysis of observational studies to investigate the association between NH and mortality in patients with ACS. In-hospital, 30-day and long-term mortality were analyzed separately. Methods: We searched MEDLINE for prospective studies of patients with ACS reporting the association between NH and mortality, using Research Methodology Filters. This was supplemented by hand searching reference lists of retrieved articles. We determined study eligibility and conducted data abstraction independently and disagreements were resolved by consensus. We pooled odds ratios (OR) from individual studies using a random effects model. Results: Our search strategy identified 24 studies. The prevalence of NH varied widely 3% to 71% depending on the definition of NH used. NH significantly increased the risk of in-hospital (OR 3.62, 95% CI: 3.09 - 4.24; p < 0.0001, I2=0.0%; 15 studies, 10673 patients), 30-day (OR 4.81, 95% CI: 2.18 - 10.61, p < 0.0001, I2=92.2%; 4 studies, 101447 patients), and long-term (up to 108 months) mortality (OR 2.02, 95% CI: 1.62-2.51; p < 0.0001, I2=79.4%; 12 studies, 102099 patients). Conclusions: In patients without a prior diagnosis of diabetes who are admitted to hospital for ACS, NH increases the risk of both short and long-term mortality. These data highlight the need for further studies addressing the control of blood glucose levels in patients with ACS.
