Paolo Balietti

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

Federico Giulietti

Istituto Nazionale di Riposo e Cura per Anziani

Laura Landi

Marche Polytechnic University

Beatrice Bernardi

Istituto Nazionale di Riposo e Cura per Anziani

Giulia Rosettani

European Society of Hypertension

Elisabetta Borioni

Istituto Nazionale di Riposo e Cura per Anziani

F. Giulietti

Istituti di Ricovero e Cura a Carattere Scientifico

Massimiliano Fedecostante

Istituto Nazionale di Riposo e Cura per Anziani

Cooperative Institutions

Istituti di Ricovero e Cura a Carattere Scientifico

Istituto Nazionale di Riposo e Cura per Anziani

Marche Polytechnic University

European Society of Hypertension

University of Turin

National Research Centre

Azienda Ospedaliera Citta' della Salute e della Scienza di Torino

Azienda Ospedaliero Universitaria San Giovanni Battista

Ospedali Riuniti di Ancona

Sapienza University of Rome

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Trisomy of the Short Arm of Chromosome 12 Associated with High Cardiovascular Risk: A Case Report

High Blood Pressure & Cardiovascular Prevention (2019)

C. Fulcheri Paolo Balietti Franco Rabbia Domenica Schiavone Corrado Magnino

Trisomy

Chromosome 12

Long arm

10.1007/s40292-019-00307-7

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Citations (2)

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)

Relationship between NT-proBNP levels and serum lipid profile in very elderly hospitalized patients

Atherosclerosis (2017)

Francesco Spannella Federico Giulietti Guido Cocci Paolo Balietti Marica Bordicchia

Concomitant

Lipid Profile

Plasma levels

10.1016/j.atherosclerosis.2017.06.606

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Citations (0)

[PP.07.08] PULSE PRESSURE AND INHIBITION OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM IN ESSENTIAL HYPERTENSIVE PATIENTS ASSUMING ACE INHIBITORS OR ANGIOTENSIN RECEPTOR BLOCKERS

Journal of Hypertension (2017)

Paolo Balietti Francesco Spannella F. Giulietti Elisabetta Borioni Francesca Lombardi

Objective: Increased levels of plasma aldosterone appear to associate with increased vascular fibrosis/reduced arterial compliance in hypertensive patients. Higher pulse pressure (PP) is considered a good index of reduced vascular elasticity. ACE inhibitors (ACE-I) and angiotensin receptor blockers (ARBs), reducing plasmatic aldosterone concentration (PAC) despite increase plasma renin activity (PRA), might reduce arterial stiffness. Our aim was to investigate the relationship between PP and inhibition of the RAAS, evaluated by the ratio of PRA on PAC, in a population of essential hypertensive patients in stable treatment with ACE-I or ARBs. Design and method: We recruited 183 consecutive patients with essential hypertension treated with ACE-I or ARB in the previous 6 months. For the analysis, PRA-PAC ratio (PRA/ PAC, PRA in ng/ml, PAC in ng/dl) was multiplied by 100 and divided into tertiles. An ambulatory blood pressure monitoring was performed just before the dosages of PRA-PAC, without changes in drug therapy. Results: Males: 115 (62.8%), mean age: 58.8 ± 11.7 years. PRA/PAC Tertiles (1st: 0.02–0.57; 2nd: 0.59–2.84; 3rd: 2.94–50.98). There was no difference in age, sex, BMI or anti-hypertensive drugs between PRA/ PAC tertiles. A linear association emerged between PP and PRA/PAC (24 h-PP: r = -231, p = 0.002; daytime-PP: r = -189, p = 0.01; nighttime-PP: r = -231, p = 0.002). Increasing PRA/PAC tertiles were associated to a reduction of all PPs that was statistically significant for the 24 h-PP (1st: 56.0 ± 12.2 mmHg; 2nd: 50.5 ± 10.1 mmHg; 3rd: 49.7 ± 12.6 mmHg; p = 0.006). In the multiple regression analysis, the association between 24 h-PP and PRA/PAC tertiles remained significant even after adjusting for sex, age, BMI, blood pressure control, diabetes, smoking and eGFR (b = -0.158; p = 0.017). Conclusions: Higher values of the PRA/PAC, that reflect adequate inhibition of the RAAS by ACE-I or ARBs at doses/molecules prescribed, are associated with lower PP values. These findings suggests that effective ACE-I/ARBs therapy is likely to reduce arterial stiffness.

Plasma renin activity

Essential hypertension

Pulse pressure

10.1097/01.hjh.0000523366.23164.9c

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Citations (0)

Delirium in nursing home residents: is there a role of antidepressants? A cross sectional study

BMC Geriatrics (2024)

Massimiliano Fedecostante Paolo Balietti Simona Gabriella Di Santo Antonella Zambon Alessandra Marengoni

Cross-sectional study

10.1186/s12877-024-05360-z

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[PP.01.27] DYSLIPIDEMIA IN HYPERTENSIVE PATIENTS UNDERGOING 24-HOURS AMBULATORY BLOOD PRESSURE MONITORING

Journal of Hypertension (2017)

Guido Cocci Francesco Spannella F. Giulietti Paolo Balietti Laura Landi

Objective: Hypertension and dyslipidemia represent two of the most relevant modifiable cardiovascular risk (CVR) factors and they often coexist. The aim of our study was to evaluate the characteristics of the lipid profile of a large unselected hypertensive population referred to our Centre, to underline the magnitude of this association and possible lacks in the management of dyslipidemia. Design and method: Retrospective study on 1440 hypertensives referred to our Hypertension Centre between 2010 and 2015. Inclusion criteria were age >=18 years, a 24-hour ambulatory blood pressure monitoring (ABPM) and a complete lipid profile: total cholesterol (TC), HDL cholesterol (HDL-c) and triglycerides (TG). Dyslipidemia was defined by the presence of at least one of these characteristics: TC >=200 mg/dl, calculated LDL cholesterol (cLDL) values higher than those recommended based on individual CVR, HDL-c<40 mg/dl in men and <50 mg/dl in women, TG >=150 mg/dl. Results: Mean age: 55.9 ± 13.4 years. Male sex: 823 (57.2%). Overweight/obese: 68%. Smokers: 18.1%. Diabetics: 10.7%. Dyslipidemia: 82.6%. Patients with peripheral arterial disease (PAD): 23,7%. Mean eGFR: 75.0 ± 15.6 ml/min/1.73m2. Mean TC: 205.9 ± 39.7 mg/dl. Mean HDL-c: 51.8 ± 13.7 mg/dl. Median TG: 111 mg/dl (82–157). Mean cLDL: 129.2 ± 34.5 mg/dl. Drug therapy: 19% (statins 87.6%, ezetimibe 6.2%, others 2.2%). At target cLDL: 39% (all patients), 42.9% (treated patients). Females were less controlled, despite the same treatment rate with lipid-lowering drugs. Diabetics were also less controlled, despite a higher rate of treatment with lipid-lowering drugs. Patients with PAD not treated with lipid-lowering drugs were 78.3%. TG>=150 mg/dl: 28% (all patients), 33% (treated patients). Low HDL-c (according to sex): 28.3%. Statins frequencies: simvastatin (34.1%), atorvastatin (27.8%), rosuvastatin (13.2%), pravastatin (10.3%), others (2.2%). High intensity statins were taken only by 2% of treated patients. The hypertensives controlled by therapy were 29.9% and patients with both controlled hypertension and cLDL were only 12%. Conclusions: Our data show the frequent association between hypertension and dyslipidemia. Patients with at least one alteration of the lipid profile were often untreated with lipid-lowering drugs, even in the presence of increased CVR. Whenever treated, they received low-medium intensity statins and they often did not reach their therapeutic goals.

Dyslipidemia

Ezetimibe

Lipid Profile

10.1097/01.hjh.0000523237.74013.2b

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Citations (0)

Cardiac Natriuretic Peptides, Hypertension and Cardiovascular Risk

High Blood Pressure & Cardiovascular Prevention (2017)

Riccardo Sarzani Francesco Spannella Federico Giulietti Paolo Balietti Guido Cocci

Prevalence of cardiovascular (CV) disease is increasing worldwide. One of the most important risk factors for CV disease is hypertension that is very often related to obesity and metabolic syndrome. The search for key mechanisms, linking high blood pressure (BP), glucose and lipid dysmetabolism together with higher CV risk and mortality, is attracting increasing attention. Cardiac natriuretic peptides (NPs), including ANP and BNP, may play a crucial role in maintaining CV homeostasis and cardiac health, given their impact not only on BP regulation, but also on glucose and lipid metabolism. The summa of all metabolic activities of cardiac NPs, together with their CV and sodium balance effects, may be very important in decreasing the overall CV risk. Therefore, in the next future, cardiac NPs system, with its two receptors and a neutralizing enzyme, might represent one of the main targets to treat these multiple related conditions and to reduce hypertension and metabolic-related CV risk.

Homeostasis

10.1007/s40292-017-0196-1

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Citations (64)

Plasma renin activity to plasma aldosterone concentration ratio correlates with night-time and pulse pressures in essential hypertensive patients treated with angiotensin-converting enzyme inhibitors/AT1 blockers

Journal of Hypertension (2017)

Francesco Spannella Federico Giulietti Paolo Balietti Elisabetta Borioni Francesca Elena Lombardi

Angiotensin-converting enzyme inhibitors (ACE-I) and AT1 blockers (ARB) are commonly used antihypertensive drugs, but several factors may affect their effectiveness. We evaluated the associations between ambulatory blood pressure (BP) monitoring (ABPM) parameters and plasma renin activity (PRA)-to-plasma aldosterone concentration (PAC) ratio (RAR) to test renin-angiotensin-aldosterone system inhibition in essential hypertensive patients treated with ACE-I or ARB for at least 12 months.We evaluated 194 consecutive patients referred to our Hypertension Centre. ABPM, PRA and PAC tests were performed without any changes in drug therapy. RAR, PRA and PAC tertiles were considered for the analyses.Mean age: 57.4 ± 12.0 years; male prevalence: 63.9%. No differences between RAR tertiles regarding the use of ACE-I or ARB (P = 0.385), as well as the other antihypertensive drug classes, were found. A reduction of all ABPM values considered (24-h BP, daytime BP and night-time BP and 24-h pulse pressure (PP), daytime PP and night-time PP) and a better BP control were observed at increasing RAR tertiles, with an odds ratio = 0.12 to be not controlled during night-time period for patients in the third tertile compared with patients in the first tertile (P < 0.001). This association remained significant even after adjusting for 24-h BP control. All the associations were also confirmed for PRA tertiles, but not for PAC tertiles.Higher RAR values indicate effective renin-angiotensin-aldosterone system inhibition and lower night-time and pulse pressures in real-life clinical practice. It could be a useful biomarker in the management of essential hypertensive patients treated with ACE-I or ARB.

Plasma renin activity

Essential hypertension

Antihypertensive drug

Pulse pressure

10.1097/hjh.0000000000001438

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Citations (10)

Interarm blood pressure differences predict target organ damage in type 2 diabetes

Journal of Clinical Hypertension (2016)

Francesco Spannella Federico Giulietti Massimiliano Fedecostante Maddalena Ricci Paolo Balietti

Patients with type 2 diabetes mellitus are at high risk for atherosclerotic disease, and proper blood pressure measurement is mandatory. The authors examined the prevalence of an interarm difference (IAD) in blood pressure and its association with cardiovascular risk factors and organ damage (nephropathy, retinopathy, left ventricular hypertrophy, and vascular damage) in a large diabetic population. A total of 800 consecutive patients with type 2 diabetes mellitus were evaluated with an automated simultaneous bilateral device (men: 422 [52.8%]; mean age: 68.1±12.2 years). Diabetic patients with systolic IAD ≥5 and systolic IAD ≥10 mm Hg showed an increased risk of having vascular damage (adjusted odds ratios: 1.73 and 2.49, respectively) and higher pulse pressure. IAD is highly prevalent in patients with diabetes, is associated with vascular damage, even for IAD ≥5 mm Hg, and should be accurately obtained to avoid underdiagnosis and undertreatment of hypertension.

Pulse pressure

End organ damage

10.1111/jch.12963

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Citations (21)

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)