Objective: Sympatho-vagal balance, as measured by heart rate recovery (HRR) at the first minute after exercise, is correlated with long-term prognosis in patients with cardiovascular disease. Higher serum uric acid (UA) is an independent risk factor for hypertension; and hyperuricemia is associated with non-dipping pattern (<10% fall in nocturnal blood pressure) among hypertensive patients. Given the importance of nondipper hypertension on cardiovascular outcomes, the present study tested the hypothesis that heart rate recovery is associated with hyperuricemia among hypertensive patients with non-dipping pattern. Design and method: The study included 122 essential hypertensive patients (64% Male, 55 ± 3 years) subdivided into two groups according to 24-hour ABPM resuts: 48 dippers and 74 nondippers. All patients underwent ambulatory blood pressure monitoring and exercise stress testing. HRR was calculated as the difference between the heart rate at peak exercise and after 1-min cooling down. Results: No significant differences in office blood pressure (BP) values were observed between non-dipper and dipper hypertensive patients (Figure 1-2). Compared to dippers, the nocturnal systolic (Figure 3), diastolic (Figure 4), and mean BP levels (Figure 5), were found to be significantly greater among non-dippers, respectively. Non-dippers hypertensive patients showed significantly higher serum UA levels compared to dippers (Figure 6); and high sensitivity C-reactive protein (hsCRP) (Figure 7). Non-dippers hypertensive patients showed significantly lower HRR compared to dippers (Figure 8).Among non-dippers, a significant correlation between UA levels and HRR was observed (r = 0.38, P < 0.001). After adjusting for age, gender, body mass index, smoking habits, creatinine levels, hsCRP and comorbidity, multivariate analysis revealed an independent association between HRR and serum UA levels among non-dippers (ß = 0.312, P = 0.002). Conclusions: Serum UA is independently associated with abnormal heart rate recovery in hypertensive patients with nondipper circadian pattern.
The Holter examinations of 111 subjects aged more than 65 who then underwent dynamic ecg were investigated in order to assess the clinical significance of cardiac arrhythmias in geriatric age. Group A was formed of 53 patients with no clinical signs of cardiovascular diseases. Thirty-two patients with clinical evidence of ischaemic cardiopathy made up Group B and 26 with arterial hypertension formed Group C. The Holter examinations were evaluated in accordance with current guidelines, considering the basic rhythm, heart rate, pulse formation and conduction disturbances and supraventricular and ventricular hyperkinetic arrhythmias. Sinus base rhythm was present in most cases whereas atrial fibrillation was noted in a similar percentage in the three groups, whether or not cardiovascular disease was present. Supraventricular and ventricular hyperkinetic arrhythmias were extremely common in the elderly and made no discrimination between patients with ischaemic cardiopathy or hypertension and the clinically healthy; for example, ventricular tachycardia was observed in 10.6% of Group A subjects, in 7.1% of Group B and 8.6% of Group C. To conclude, the clinical significance of heart rhythm changes in the elderly remains obscure because in most subjects they are not related to the presence of cardiovascular disease.
Background The independent prognostic impact of diabetes mellitus ( DM ) and prediabetes mellitus (pre‐ DM ) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐ DM on survival outcomes in the GISSI ‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial. Methods and Results We assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI ‐ HF trial, who were stratified by presence of DM (n=2852), pre‐ DM (n=2013), and non‐ DM (n=2070) at baseline. Compared with non‐ DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐ DM patients and those with pre‐ DM . Cox regression analysis showed that DM , but not pre‐ DM , was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI , 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI , 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI , 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI , 1.01–1.29, respectively). Conclusions Presence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 00336336.
Summary Background Although oral contraceptives ( OC s) are one the most widespread therapy in young polycystic ovary syndrome ( PCOS ) women and physical exercise represents a crucial first step in the treatment of overweight and obese PCOS , no studies were performed to compare the effects on cardiovascular risk ( CVR ) of OC s and physical exercise in PCOS . Objective To compare the effects of OC s administration and physical exercise on the CVR , clinical, hormonal and metabolic parameters in PCOS women. Methods One hundred and fifty PCOS women were enrolled and were randomized to OC s (3 mg drospirenone plus 30 μg ethinyloestradiol), structured exercise training programme ( SETP ) or polyvitamin tablets. The intervention phase study was of 6 months. Primary outcome was intima–media thickness ( IMT ) and flow‐mediated dilation ( FMD ). Secondary outcomes were clinical, hormonal and metabolic changes. Results A significant reduction of IMT and a significant increase of FMD were observed in the SETP group after treatment. Compared to baseline, in the SETP group, a significant improvement in anthropometric measures, insulin sensitivity indexes, lipid profile, cardiopulmonary function, inflammatory markers and frequency of menses was observed. Oral contraceptives use was associated with a significant decrease of hyperandrogenism and a significant improvement of frequency of menses. Further, OC s use had a neutral effect on CVR risk factors. Conclusion OCs effectively treat hyperandrogenism and menstrual disturbances, while SETP is more effective in improving cardiometabolic profile and cardiopulmonary function in PCOS .
Background: We aimed at evaluating the relationship between the circadian blood pressure rhythm and UA level in young patients (30–40 years old) with newly diagnosed essential hypertension. Methods: The study included 62 essential hypertensive patients and 29 healthy controls (20 men, 35 ± 3 years) divided into two groups according to 24-hour ABPM resuts: 30 dippers and 32 nondippers. Results: Nondippers showed significantly higher both serum UA levels compared to dippers and controls (6.1 ± 0.7, 5.2 ± 0.9 and 4.1 ± 0.9 mg/dL, p < 0.001, respectively); and high sensitivity C-reactive protein (hsCRP) (4.1 ± 2.2 mg/L, 3.3 ± 1.9 mg/L, and 1.4 ± 0.9 mg/L, p < 0.001, respectively). After adjusting for age, sex, body mass index, smoking, creatinine levels, hsCRP and comorbidity, multivariate logistic regression analysis revealed an independent association between serum UA levels and nondipper pattern (OR 2.44, 95%CIs 1.4–4.1, p = 0.002). Conclusion: Serum UA is independently associated with nondipper circadian pattern in young patients with newly diagnosed essential hypertension.
Aims: The aim of this study was to evaluate the effects of combined diet and exercise training on cardiovascular risk profile in patients with metabolic syndrome (MS) defined according to National Cholesterol Education Program (NCEP) criteria. Methods: Forty-eight MS patients (28 M; 47 ± 2 years) were enrolled into the study protocol. At entry and after three months, all patients underwent physical examination and cardiovascular risk factors evaluation (BMI, lipid profile), Doppler-echocardiography and exercise stress testing. The study protocol included health education, dietary and behavioural recommendations, and exercise training program tailored on the basis of individual attitudes (cyclette, jogging, and swimming). In the first two weeks, exercise was performed for up to 30 minute at 60–70% of the maximal heart rate (HR) achieved at the initial exercise stress test, and gradually increased in both workload and duration of exercise sessions. Patients were also instructed to fill-up a diary, reporting the date, hour, duration, and pulse HR achieved at the end of each exercise session. Results: After 3-month, we observed a significant decrease in systolic and diastolic blood pressure (from 145 ± 2 to 138 ± 3 (p < 0.01) and from 100 ± 3 to 89 ± 2 mmHg (p < 0.001), respectively), in resting and peak HR (from 72 ± 3 to 68 ± 2 (p < 0.01) and from 180 ± 4 to 173 ± 3 beats/min (p < 0.001), respectively). A significant (p < 0.001) improvement in both BMI (from 30.4 ± 1.2 to 26.8 ± 1.4) and lipid profile (total cholesterol = from 235 ± 11 to 197 ± 7 mg/dl; triglycerides = from 195 ± 18 to 156 ± 12 mg/dl; LDL cholesterol = from 144 ± 8 to 110 ± 5 mg/dl; HDL cholesterol = from 38 ± 4 to 52 ± 5 mg/dl) was also observed. Doppler-echocardiography mitral inflow measurements showed a significant improvement in diastolic function as expressed by a significant increase in E/A ratio (from 0.94 ± 0.12 to 1.25 ± 0.16, p < 0.001). Conclusions: This study confirms the beneficial effects of combined diet and exercise training program on cardiovascular risk profile in MS patients.
