Beatrice Bernardi

Istituto Nazionale di Riposo e Cura per Anziani

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Riccardo Sarzani

Marche Polytechnic University

Francesco Spannella

Marche Polytechnic University

Guido Cocci

Istituto Nazionale di Riposo e Cura per Anziani

Giulia Rosettani

European Society of Hypertension

Paolo Balietti

Istituto Nazionale di Riposo e Cura per Anziani

Laura Landi

Marche Polytechnic University

Elisabetta Borioni

Istituto Nazionale di Riposo e Cura per Anziani

F. Giulietti

Istituti di Ricovero e Cura a Carattere Scientifico

Federico Giulietti

Istituto Nazionale di Riposo e Cura per Anziani

Valentina Bordoni

Marche Polytechnic University

Cooperative Institutions

Istituto Nazionale di Riposo e Cura per Anziani

Marche Polytechnic University

Istituti di Ricovero e Cura a Carattere Scientifico

European Society of Hypertension

Ospedale Policlinico San Martino

Ospedali Riuniti di Ancona

National Research Centre

Sapienza University of Rome

University of L'Aquila

University of Pisa

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N-terminal pro B-Type natriuretic peptide is inversely correlated with low density lipoprotein cholesterol in the very elderly

Nutrition Metabolism and Cardiovascular Diseases (2018)

Francesco Spannella F. Giulietti Guido Cocci Laura Landi Elisabetta Borioni

Lipid Profile

High-density lipoprotein

10.1016/j.numecd.2018.02.013

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Citations (16)

Renin-Angiotensin System Blockers and Statins Are Associated With Lower In-Hospital Mortality in Very Elderly Hypertensives

Journal of the American Medical Directors Association (2017)

Francesco Spannella Federico Giulietti Paolo Balietti Guido Cocci Laura Landi

Dyslipidemia

Antihypertensive drug

10.1016/j.jamda.2017.09.023

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Citations (24)

Combination Therapy of Inhaled Indacaterol/Glycopyrronium for Chronic Obstructive Pulmonary Disease in the Very Elderly: Is It Safe? An Electrocardiographic Evaluation

Respiration (2018)

Francesco Spannella Federico Giulietti Valentina Cesari Antonio Francioso Guido Cocci

Cardiovascular (CV) comorbidities in patients with chronic obstructive pulmonary disease (COPD) are associated with increased morbidity and mortality, especially in old and very old subjects. The question if long-acting beta-agonist and long-acting muscarinic antagonist could be associated with the increased prevalence of CV-related adverse effects has puzzled, particularly in the past, specialists involved in the management of respiratory diseases. The safety of these compounds has scarcely been tested in patients aged ≥ 65 years with CV comorbidities, since randomized controlled trials rarely include this subpopulation. However, the fixed combination indacaterol/glycopyrronium has shown a favorable CV safety profile in both healthy volunteers and COPD patients. Thus, we aimed to assess the CV safety pro<X00_Del_TrennDivis>-</X00_Del_TrennDivis> file of the fixed combination indacaterol/glycopyrronium 110/50 μg in a series of COPD patients aged ≥ 80 years with several comorbidities. Our results indicate that this combination is safe in the comorbid elderly, since no significant electrocardiographic abnormalities were recorded after the administration of the inhaled therapy. Only rare and nonclinically significant changes in heart rate and corrected QT interval duration were evident, mainly in females and in patients with concomitant impaired kidney function.

Indacaterol

Concomitant

Muscarinic antagonist

10.1159/000487182

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Citations (9)

OVERWEIGHT/OBESE HYPERTENSIVES EVALUATED BY 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING HAVE A “DOUBLE-TROUBLE” ATHEROGENIC LIPID PROFILE

Journal of Hypertension (2019)

Francesco Spannella F. Giulietti Chiara Di Pentima Andrea Filipponi Beatrice Bernardi

Objective: Excessive adiposity plays a key role in determining and maintaining essential hypertension and affects lipid profile as well. We investigated lipid profile and cardiovascular risk in a wide hypertensive population evaluated by 24-hour ambulatory blood pressure monitoring (ABPM). Design and method: We performed a retrospective observational study on 1219 consecutive outpatients referred for high blood pressure (BP) and evaluated by ABPM. Anthropometric measurements (body mass index-BMI and waist circumference-WC), lipid profile and ABPM parameters were considered. Low-density lipoprotein cholesterol (LDLc) was calculated with the Martin-Hopkins algorithm and very low-density lipoprotein/intermediate-density lipoprotein cholesterol (VLDLc+IDLc) was calculated subtracting high-density lipoprotein cholesterol (HDLc) and LDLc from total cholesterol. Results: Mean age was 56.5 ± 13.7 years, with a male prevalence (55.6%). Mean BMI was 27.8 ± 4.6 Kg/m2. Mean WC was 98.9 ± 11.7 cm. Overweight/obese patients (BMI >=25 Kg/m2) were 70.2%. They had significantly higher glycaemia, higher non-HDLc, lower HDLc, higher triglycerides and higher non-HDLc/HDLc than normal-weight patients. There were significant correlations between BMI and glycaemia (ρ=0.213, p < 0.001), TG (ρ=0.259, p < 0.001), HDLc (β = −0.215, p < 0.001), non-HDLc (β= 0.113, p < 0.001), non-HDLc/HDLc (ρ=0.251, p < 0.001) and VLDLc+IDLc (ρ=0.233, p < 0.001). Similar correlations were found with WC. These associations remained significant both for BMI and WC, even after adjusting for sex, age and lipid-lowering therapy, that was taken by 281 patients (23.1%). Only 28.5% of patients achieved LDLc goals, according to the 2016 ESC/EAS Dyslipidemia Guidelines, regardless BMI or WC. Only 12.4% of patients had both 24-hour BP and LDLc controlled at the same time. Conclusions: Dyslipidemia is very common and still poorly managed in hypertensive patients. Despite a similarly insufficient LDLc control, overweight/obese patients showed a more atherogenic lipid profile characterized by multiple features leading to a global increased cardiovascular risk.

Lipid Profile

High-density lipoprotein

10.1097/01.hjh.0000573420.37435.e6

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Citations (2)

Prognostic role of masked and white-coat hypertension: 10-Year mortality in treated elderly hypertensives

Journal of Human Hypertension (2018)

Francesco Spannella Andrea Filipponi Federico Giulietti Paolo Balietti Beatrice Bernardi

White coat hypertension

10.1038/s41371-018-0140-4

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Citations (20)

CHANGES IN BLOOD PRESSURE AND METABOLIC PARAMETERS IN OVERWEIGHT PATIENTS WITH OBSTRUCTIVE SLEEP APNOEA SYNDROME AFTER 3-MONTH CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY

Journal of Hypertension (2018)

Francesco Spannella F. Giulietti Chiara Di Pentima Elisabetta Borioni Francesca Lombardi

Objective: Obstructive sleep apnea syndrome (OSAS) is closely related to hypertension and altered glucose and lipid metabolism. Overweight represents a key risk factor for OSAS. Aim: to describe the blood pressure (BP) and metabolic changes in overweight/obese adults with moderate to severe OSAS before and after 3-month continuous positive airway pressure (CPAP) therapy. Design and method: Prospective observational study on 56 patients (T1) of whom 13 were re-evaluated after 3-month CPAP therapy (T2). Inclusion criteria: BMI > = 25 kg/m2, age > = 18 years, CPAP therapy indication (AHI > = 15). Instrumental examinations: home sleep apnea polygraphy, 24 h ambulatory BP monitoring, 72 h metabolic monitoring (Sensewear Armband®). Laboratory examinations: glycemia, insulinemia, total cholesterol, HDL cholesterol, triglycerides. Insulin resistance (IR) was evaluated by HOMA-index. Results: Evaluation at T1: mean age 57.2 ± 10.4 years. Males: 49 (89%). Mean BMI: 31 ± 4 kg/m2; mean waist: 110.8 ± 7.7 cm. Mean AHI: 44 ± 15. Prevalence of hypertension: 87.5%; prevalence of dyslipidemia: 67.9%; prevalence of diabetes mellitus: 14.3% (IR: 78.3%); prevalence of peripheral arterial disease: 33.9%; prevalence of atrial fibrillation: 8.9%. Patients with non-dipper BP profile: 58.9%. Patients with AHI > = 30 had higher risk of having IR than patients with AHI > = 15 (OR = 4.5, p = 0.047). Considering 13 patients re-evaluated at T2, there were no significant changes in BMI or glycemic and lipid profile. There was a trend of reduction in baseline metabolism, which correlated significantly with ODI and SpO2 nadir at T1 (p = 0.007, p = 0.038, respectively). There was also a significant reduction in nighttime BP (−8 / −5 mmHg, p = 0.012 and p = 0.019), even after adjusting for antihypertensive therapy. Conclusions: Overweight/obese patients with OSAS are also often affected by hypertension and altered glucose and lipid metabolism. CPAP therapy is effective in reducing nighttime BP that mostly affects cardiovascular risk. CPAP may also reduce basal metabolism but does not significantly affect body weight nor glucose and lipid parameters, unless coupled with lifestyle changes.

Dyslipidemia

Lipid Profile

10.1097/01.hjh.0000539683.26088.0a

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Ten‐year changes in ambulatory blood pressure: The prognostic value of ambulatory pulse pressure

Journal of Clinical Hypertension (2018)

Paolo Balietti Francesco Spannella Federico Giulietti Giulia Rosettani Beatrice Bernardi

Blood pressure (BP) changes and risk factors associated with pulse pressure (PP) increase in elderly people have rarely been studied using ambulatory blood pressure monitoring (ABPM). The aim is to evaluate 10-year ambulatory blood pressure (ABP) changes in older hypertensives, focusing on PP and its associations with mortality. An observational study was conducted on 119 consecutive older treated hypertensives evaluated at baseline (T0) and after 10 years (T1). Treatment adherence was carefully assessed. The authors considered clinical parameters at T1 only in survivors (n = 87). Patients with controlled ABP both at T0 and T1 were considered as having sustained BP control. Change in 24-hour PP between T0 and T1 (Δ24-hour PP) was considered for the analyses. Mean age at T0: 69.4 ± 3.7 years. Females: 57.5%. Significant decrease in 24-hour, daytime, and nighttime diastolic BP (all P < .05) coupled with an increase in 24-hour, daytime, and nighttime PP (all P < .05) were observed at T1. Sustained daytime BP control was associated with lower 24-hour PP increase than nonsustained daytime BP control (+2.23 ± 9.36 vs +7.79 ± 8.64 mm Hg; P = .037). The association between sustained daytime BP control and Δ24-hour PP remained significant even after adjusting for age, sex, and 24-hour PP at T0 (β=0.39; P = .035). Both 24-hour systolic BP and 24-hour PP at T0 predicted mortality (adjusted HR 1.07, P = .001; adjusted HR 1.25, P < .001, respectively). After ROC comparison (P = .001), 24-hour PP better predicted mortality than 24-hour systolic BP. The data confirm how ABP control affects vascular aging leading to PP increase. Both ambulatory PP and systolic BP rather than diastolic BP predict mortality in older treated hypertensives.

Pulse pressure

10.1111/jch.13344

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Citations (20)

[PP.04.31] ASSOCIATION BETWEEN IN-HOSPITAL MORTALITY AND ANTI-HYPERTENSIVE THERAPY IN A POPULATION OF HOSPITALIZED VERY ELDERLY HYPERTENSIVES WITH UNDERLYING UNDIAGNOSED HEART FAILURE

Journal of Hypertension (2017)

Francesco Spannella F. Giulietti Paolo Balietti Beatrice Bernardi Laura Landi

Objective: The diagnosis of heart failure (HF) in the very elderly is difficult also because of many comorbidities that may mask HF symptoms and signs. Our aim was to assess the prevalence of HF and its association with in-hospital mortality in relation with anti-hypertensive drugs taken before hospitalization, in a population of very elderly hypertensives. Design and method: Prospective observational study on 265 very elderly hypertensives consecutively admitted to our Internal Medicine and Geriatrics Department. The other inclusion criteria were an admission diagnosis different from HF, a negative history for HF and the presence of at least one symptom/sign compatible with HF. HF diagnosis was based on NT-proBNP values at admission, with a validated age-adjusted cut-off (1800 pg/ml). The main comorbidities, laboratory parameters and drugs taken before the admission were also considered. Results: Mean age 87.7 ± 4.9 years. Males: 113 (42.6%). Values of NT-proBNP >= 1800 pg/ml were present in 55.8% of patients. Regarding the admission diagnosis, patients with atrial fibrillation or acute renal impairment had increased risk of HF (OR = 2.26; p = 0.006 and OR = 2.18; p = 0.016, respectively). Values of NT-proBNP >=1800 pg/ml were associated with a greater in-hospital mortality, regardless the admission diagnosis (OR = 2.63; p = 0.002). Analyzing the pharmacological therapy taken before admission, those who were already treated with ACE inhibitors or angiotensin receptor blockers had a lower in-hospital mortality, even after adjusting for covariates (OR = 0.41; p = 0.038): age, cancer, chronic bedridden, white blood cells count and glycaemia. Conclusions: An underlying HF is very common in very elderly hypertensives hospitalized patients, regardless the medical causes of admission. Those who were already taking ACE inhibitors and angiotensin receptor blockers, confirmed cornerstones of hypertension treatment, showed a lower in-hospital mortality indicating the importance of these drugs in the management of very elderly hypertensives.

Hospital admission

10.1097/01.hjh.0000523300.94205.43

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The Role of Intelligence in the Fight Against International Terrorism: Legal Profiles

Beatrice Bernardi

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Citations (1)