Pasquale Strazzullo

Calcium metabolism has been investigated in patients with essential hypertension and normal renal function to evaluate the renal calcium handling and the reported increase in renal calcium loss. In 55 hypertensive and 55 sex- and age-matched healthy normotensive subjects creatinine clearance, serum total and ionized calcium, plasma parathyroid hormone and 24 h urinary excretion of calcium, sodium and cAMP were measured. In a subgroup of 20 hypertensive patients and 20 controls the fasting calcium excretion rate was also measured. Both 24 h and fasting calcium excretion rates were higher in the hypertensive group; so also were plasma parathyroid hormone and urinary cAMP. Serum total and ionized calcium levels were not different in the two groups. After intravenous calcium infusion (15 mg 3 h-1 kg-1) in seven hypertensive patients and controls, the hypertensive patients excreted more calcium at all serum calcium concentrations. These results support the hypothesis of primary renal cal...

The relation between blood pressure and habitual physical activity during leisure time was investigated in a random sample of 272 sixth grade schoolchildren (mean age, 11.3 years) who entered secondary school in 1983 in Marano di Napoli, a suburb of Naples, Italy. Blood pressure, pulse rate, and anthropometry were measured with standardized techniques. Physical activity was evaluated by a questionnaire outlining four levels of physical activity during leisure time. The study provided evidence that a low level of physical activity during leisure time in 11-year-old children is associated with higher systolic blood pressure independent of sex, age, and adiposity. These findings may be relevant to programs of primary prevention of arterial hypertension in early life.

The present study aimed to test the capability of real-time three-dimensional echocardiography (RT3DE) in characterizing early abnormalities of left ventricular (LV) structure and function in native, untreated hypertensive patients. Thirty-eight newly diagnosed, never-treated hypertensives (H) and 38 healthy controls (C) underwent both standard echo-Doppler and RT3DE assessment. LV volumes and ejection fraction (EF), sphericity index, LV mass index (LVMi), global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated by RT3DE. The two groups were comparable for age and heart rate. Body mass index and blood pressure (BP) were significantly higher in H. LV volumes, EF, and sphericity index calculated by RT3DE did not differ significantly between the two groups, while LVMi was higher in H than in C (P< 0.0001). GAS (-29.1 ± 2.5% in H vs. -33.6 ± 3.4% in C), GLS, and GRS (all P< 0.0001) were lower in...

Increasing evidence suggests an association between both short and long duration of habitual sleep with adverse health outcomes. To assess whether the population longitudinal evidence supports the presence of a relationship between duration of sleep and all-cause mortality, to investigate both short and long sleep duration and to obtain an estimate of the risk. We performed a systematic search of publications using MEDLINE (1966-2009), EMBASE (from 1980), the Cochrane Library, and manual searches without language restrictions. We included studies if they were prospective, had follow-up >3 years, had duration of sleep at baseline, and all-cause mortality prospectively. We extracted relative risks (RR) and 95% confidence intervals (CI) and pooled them using a random effect model. We carried out sensitivity analyses and assessed heterogeneity and publication bias. Overall, the 16 studies analyzed provided 27 independent cohort samples. They included 1,382,999 male and female partici...

Dietary L-arginine supplementation has been proposed to reverse endothelial dysfunction in such diverse pathophysiologic conditions as hypercholesterolemia, coronary heart disease, and some forms of animal hypertension. In particular, chronic oral administration of L-arginine prevented the blood pressure rise induced by sodium chloride loading in salt-sensitive rats. To investigate the effects of L-arginine-rich diets on blood pressure and metabolic and coagulation parameters we performed a single-blind, controlled, crossover dietary intervention in six healthy volunteers. The subjects (aged 39+/-4 years, body mass index [BMI] 26+/-1 kg/m2, mean +/- SEM) received, in random sequence, three different isocaloric diets, each for a period of 1 week (Diet 1: control; Diet 2: L-arginine enriched by natural foods; Diet 3: identical to Diet 1 plus oral L-arginine supplement). Sodium intake was set at a constant level (about 180 mmol/day) throughout the three study periods. A blood pressure decrease was observed with both L-arginine-rich diets (Diet 2 v 1, SBP: -6.2 mm Hg [95% CI: -0.5 to -11.8], DBP: -5.0 mm Hg [-2.8 to -7.2]; Diet 3 v 1, SBP: -6.2 mm Hg [-1.8 to -10.5], DBP: -6.8 mm Hg [-3.0 to -10.6]). A slight increase in creatinine clearance (P = .07) and a fall in fasting blood glucose (P = .008) occurred after Diet 3 and, to a lesser extent, after Diet 2. Serum total cholesterol (P = .06) and triglyceride (P = .009) decreased and HDL cholesterol increased (P = .04) after Diet 2, but not after Diet 3. These results indicate that a moderate increase in L-arginine significantly lowered blood pressure and affected renal function and carbohydrate metabolism in healthy volunteers.

The aim of this study was to investigate the pathogenesis of hypercalciuria in the Milan strain of genetically hypertensive rats. Dietary calcium intake and urinary and fecal calcium output were measured simultaneously with indices of sodium and phosphate homeostasis in male rats of the Milan hypertensive and normotensive strains. In addition, urinary calcium and creatinine excretion rates, calcium, phosphate and creatinine serum concentrations, and bone calcium content were also measured in these rats after an overnight fast. Under fed steady-state conditions dietary calcium, sodium, and phosphate intakes, were similar in the two groups of rats, but hypertensive rats had twofold higher urinary calcium excretion and normal urinary excretion of sodium and phosphate. Fecal calcium output was slightly but significantly higher in the adult hypertensive rats while fecal sodium and phosphate excretion was normal. Because of increased urinary and fecal calcium loss, net calcium balance was significantly less positive in hypertensive than in control rats. Under fasting conditions hypertensive rats were confirmed to have hypercalciuria despite normal serum calcium concentrations and normal creatinine clearance. In accordance with balance data and fasting hypercalciuria, bone calcium content was found to be significantly reduced in hypertensive rats. These findings confirm that hypercalciuria in the Milan hypertensive rats is explained by an altered renal calcium handling; it is also associated with a slightly increased fecal calcium output and, therefore, with a less positive calcium balance and reduced bone calcium content.

The interindividual variability of the blood pressure response to changes in dietary sodium intake might be traced in part to heterogeneity in renal adaptation. To further explore this possibility, we evaluated glomerular filtration rate and tubular sodium handling in 47 healthy male volunteers from the Olivetti factory in Naples who were studied on their habitual sodium-rich diet (urinary sodium, 184 +/- 9 mmol/24 h) and after 3 days of a salt-restricted diet (urinary sodium, 69 +/- 5 mmol/24 h). Individual salt sensitivity, defined as the mean blood pressure change recorded after the shift from habitual to low sodium diet, significantly and directly correlated with glomerular filtration rate and absolute proximal sodium reabsorption during the habitual diet. When the entire population was divided into tertiles of salt sensitivity, the group with the highest salt sensitivity showed higher blood pressure, glomerular filtration rate, and absolute proximal sodium reabsorption during the habitual diet compared with the least salt-sensitive group; however, during the low NaCl diet, no differences were detectable between the groups. Twenty-four-hour urinary sodium was similar across the groups. We conclude that relative hyperfiltration and altered tubular sodium handling may occur in salt-sensitive normotensive individuals on a high sodium diet and that NaCl restriction may offset these abnormalities.

Dietary L-arginine supplementation has been proposed to reverse endothelial dysfunction in such diverse pathophysiologic conditions as hypercholesterolemia, coronary heart disease, and some forms of animal hypertension. In particular, chronic oral administration of L-arginine prevented the blood pressure rise induced by sodium chloride loading in salt-sensitive rats. To investigate the effects of L-arginine-rich diets on blood pressure and metabolic and coagulation parameters we performed a single-blind, controlled, crossover dietary intervention in six healthy volunteers. The subjects (aged 39+/-4 years, body mass index [BMI] 26+/-1 kg/m2, mean +/- SEM) received, in random sequence, three different isocaloric diets, each for a period of 1 week (Diet 1: control; Diet 2: L-arginine enriched by natural foods; Diet 3: identical to Diet 1 plus oral L-arginine supplement). Sodium intake was set at a constant level (about 180 mmol/day) throughout the three study periods. A blood pressure decrease was observed with both L-arginine-rich diets (Diet 2 v 1, SBP: -6.2 mm Hg [95% CI: -0.5 to -11.8], DBP: -5.0 mm Hg [-2.8 to -7.2]; Diet 3 v 1, SBP: -6.2 mm Hg [-1.8 to -10.5], DBP: -6.8 mm Hg [-3.0 to -10.6]). A slight increase in creatinine clearance (P = .07) and a fall in fasting blood glucose (P = .008) occurred after Diet 3 and, to a lesser extent, after Diet 2. Serum total cholesterol (P = .06) and triglyceride (P = .009) decreased and HDL cholesterol increased (P = .04) after Diet 2, but not after Diet 3. These results indicate that a moderate increase in L-arginine significantly lowered blood pressure and affected renal function and carbohydrate metabolism in healthy volunteers.

Objective: To test the association of the C(−55)A polymorphism of the natriuretic peptide clearance receptor (NPRC) with blood pressure (BP), overweight/obesity, and body fat distribution in a large male adult population.Research Methods and Procedures: The study population was from a cross-sectional and follow-up study of 787 untreated male participants in the 1994 to 1995 follow-up examination of the Olivetti Heart

Aim/hypothesis  Increased proximal renal sodium re-absorption is associated with central adiposity and insulin resistance in white men. Our study examined whether this association also exists in other ethnic groups with different prevalences of insulin resistance and associated metabolic abnormalities.Methods  We studied the association between fractional renal excretion of endogenous lithium (FELi) and metabolic syndrome in a population study of 1190 randomly selected

For many years primary aldosteronism was considered a relatively benign form of hypertension. This assumption reflects the primacy accorded to elevated levels of angiotensin in terms of deleterious cardiovascular effects, and the fact that in primary aldosteronism renin and angiotensin levels are low. We now know that primary aldosteronism causes a constellation of cardiovascular, renal and metabolic sequelae which make it far from benign and that these are not merely effects of blood pressure elevation. In primary aldosteronism, tissue damage, on several indices, is higher than in age-, sex- and blood pressure-matched controls, reflecting the ability of inappropriately elevated aldosterone for salt status to produce structural and functional changes over and above those produced by high blood pressure.

This investigation was designed to study (1) renal sodium handling after an oral protein load and (2) its relationship to some known determinants of the hemodynamic response (glucagon, insulin, growth hormone, renin, aldosterone, and plasma amino acid concentration). To this end of group of 8 adult subjects was studied before (three 30-min clearances) and after a meat meal (MM; five 30-min clearances at 30, 60, 90, 120 and 180 min). The MM provided 2 g/kg BW of protein. Within 30 min from the MM an hyperfiltration response was seen, which was paralleled by a 2-fold increase in plasma alanine concentration while total plasma amino acid concentration was not different from the baseline values. The hemodynamic response was associated with a normally operating tubuloglomerular feedback mechanism independent of renin-aldosterone activity, but possibly associated with an early increase in plasma glucagon concentration and later on with a modest increase in postmeal plasma insuling concentration.

Tubular function was measured by lithium clearance (CLi) and by its derived formulae before and after the transient increase (lasting 90 min) in glomerular filtration rate (GFR) following a meat meal (2g protein/kg body weight) in 12 normal children. Three baseline and 4 clearances after the meal were obtained, each lasting 30 min. The mean baseline CLi was 23.1 +/- 1.64 ml/min/1.73 m2. At peak GFR response (60 min from starting the meal), CLi averaged 27.6 +/- 2.4 ml/min/1.73 m2 (p less than 0.025 vs. baseline) and it was further increased (32.2 +/- 5.04 ml/min/1.73 m2, p less than 0.01 vs. baseline) 120 min after starting the meal, while GFR returned to baseline values. Fractional lithium excretion averaged 0.23 +/- 0.04 at baseline and increased continuously after the meat meal and, at completion of the study, it averaged 0.38 +/- 0.07 (p less than 0.025 vs. baseline). The distal absolute and fractional sodium reabsorption increased throughout the studies following the meal and peaked at 120 min. The functional changes were associated with a statistically significant increase in the plasma concentration of insulin, glucagon, and total amino acids after the meal. The latter at the end of the study was almost doubled (5,600 +/- 780 versus 3,200 microM at baseline, p less than 0.01). The data indicate that the tubulo glomerular feedback mechanism operates normally after a meat meal. The finding on increased distal sodium reabsorption might point to the existence of an insulin-dependent mechanism.

This report details relationships between earthquake exposures in 1980 and 1983 to 1984 and psychological distress reported in 1994. Participants are 555 Italian male factory workers from Naples, Italy. Those men who experienced damage from the 1980 quake reported higher levels of psychological distress (across several dimensions of the Symptom Checklist) than those without damage; additionally, 30% of these men reported symptoms of posttraumatic stress disorder (PTSD). While men evacuated as a result of the 1983 to 1984 Bradyseism earthquakes did not report higher distress levels (Symptom Checklist) than their nonevacuated colleagues, they did report more PTSD-like symptoms than those not evacuated. Financial loss from the Bradyseism quakes was associated with higher distress across all measures (seven Symptom Checklist dimensions and presence of PTSD symptoms). Additionally, social network disruptions following 1983 to 1984 evacuation were associated with greater distress (not all measures). These findings suggest that psychological distress from natural disasters may be very long lasting.

The aim of this study was to evaluate the effect of trandolapril, an angiotensin converting enzyme inhibitor, on blood pressure, forearm blood flow and insulin sensitivity in comparison with nifedipine gastrointestinal therapeutic system. This is a multicentre, two-way parallel-group, open-label comparative study in 90 overweight hypertensive patients, who were randomly assigned to treatment for 8 weeks with either trandolapril or nifedipine. At baseline and after treatment, all patients underwent an oral glucose tolerance test, an evaluation of their metabolic profiles and a euglycaemic hyperinsulinaemic clamp test. In a subgroup of 18 patients, a forearm study was carried out. Blood pressure fell by the second week of treatment and remained significantly reduced compared with baseline in both treatment groups. Plasma triglyceride levels were also significantly reduced after trandolapril therapy, but no significant changes occurred in the other metabolic parameters during treatment with either drug. During the euglycaemic hyperinsulinaemic clamp, whole-body glucose use was similar in the two treatment groups at baseline, and a moderate but statistically significant increase in insulin sensitivity was observed after trandolapril treatment (trandolapril: 5.0 +/- 0.2 versus 4.5 +/- 0.2 mg/kg per min; nifedipine: 4.1 +/- 0.3 versus 4.2 +/- 0.3 mg/kg per min; P < 0.05, versus baseline and trandolapril versus nifedipine treatment). Skeletal muscle glucose uptake was significantly higher after trandolapril than after nifedipine therapy (5.0 +/- 0.7 and 3.0 +/- 0.4 mg/min, respectively; P < 0.01). As forearm blood flow was similar in the two treatment groups at baseline and was unchanged after 8 weeks of therapy, skeletal muscle glucose extraction was significantly greater in the ACE inhibitor treated-group than in the nifedipine comparative group (trandolapril: baseline 21 +/- 2, treatment 24 +/- 3 mg/dl; nifedipine: baseline 18 +/- 3, treatment 16 +/- 2 mg/dl; P < 0.05, trandolapril versus nifedipine treatment). During short-term treatment, ACE inhibition with trandolapril was able to moderately improve insulin sensitivity, in comparison with calcium blockade, and this effect appeared to be independent of the haemodynamic action of the drug.

To evaluate insulin sensitivity of essential hypertensive patients with different salt sensitivities of blood pressure in the absence of confounding factors such as obesity, glucose intolerance and the inclusion both of normotensive and of hypertensive subjects that have affected most previous studies. Ninety-nine patients with untreated mild or moderate essential hypertension, World Health Organization class I-II, participated in the study. Salt sensitivity was estimated using the Weinberger protocol with minor modifications and the patients were classified into tertiles of salt sensitivity. Patients with high NaCl sensitivities were slightly older and had somewhat higher blood pressures than did subjects with low salt sensitivities. Plasma renin activity significantly decreased with increasing salt sensitivity. There were no differences among the three groups in terms of body mass index, fasting blood glucose and insulin plasma levels. There were no differences among the groups in the integrated glucose and insulin response to a standard oral-glucose tolerance test However, there was a significant difference in insulin sensitivity between two subgroups of the upper and lower tertile of salt sensitivity, the salt-sensitive hypertensives having a markedly lower utilization of glucose than did the salt-resistant ones, with a minor overlap (5.4 +/- 0.6 versus 7.4 +/- 0.3 mg/kg per min, P < 0.01). This study showed that essential hypertensive patients with high NaCl sensitivities were relatively insulin resistant compared with those with low NaCl sensitivities, independently of confounding factors such as age, obesity and glucose intolerance. Insulin resistance was not associated with overt hyperinsulinaemia among these patients.

Over the past few years, several trials on the effect of oral calcium supplementation on blood pressure have been undertaken both in normal subjects and in patients with high blood pressure. Of these, 15 randomized, controlled studies were reviewed: 10 included patients with high blood pressure, three studied normal subjects, and two used a low-calcium diet for comparison. The 15 studies reviewed investigated a total of nearly 400 peoples. No significant evidence for a supine blood pressure-lowering effect of oral calcium supplementation was found in the trials as a whole or in those trials carried out in hypertensives only. However, a small effect on standing blood pressure was detected. Our study indicates that the overall effect of oral calcium on blood pressure, if any, is very small and confined to standing blood pressure, it is, therefore, inappropriate to recommend oral calcium supplementation for the treatment of essential hypertension.

This study focuses on the relationship between some aspects of intra-erythrocytic sodium metabolism (intra-erythrocytic Na content, Na,Li-countertransport), blood pressure, and family history of hypertension, in a group of 84 randomly selected school children (45 males, 39 females). Na,Li-countertransport was significantly related to both systolic blood pressure (SBP) and diastolic blood pressure (DBP) only in boys at the univariate level, but both of these associations lost statistical significance after the possible confounding role of weight and height were taken into consideration. In both sexes, participants with a family history of hypertension had similar values of both intra-erythrocytic Na content and Na,Li-countertransport to participants with no family history. We conclude that family history of hypertension does not seem to play an important role in the determination of either intra-erythrocytic Na content or Na,Li-countertransport at this age. Although the positive association between Na,Li-countertransport and blood pressure observed in adult males is already present in childhood, this probably is still, at least in part, dependent upon body size.

A controlled trial of the effect of low versus high calcium intake on blood pressure was performed in 15 patients with mild essential hypertension (supine blood pressure after a 1-month run-in period: 145.7 +/- 2.6/97.8 +/- 0.9 mmHg, mean +/- s.e.m.). After a 1-week baseline period on a standard calcium intake (900 mg/day, obtained by giving a 500-mg calcium tablet daily, in addition to a 400-mg calcium diet), the patients were randomly entered into a double-blind crossover study of 4-week low calcium intake (400 mg calcium diet plus two placebo tablets/day) and 4-week high calcium intake (1400 mg/day: 400-mg calcium diet plus two 500-mg calcium tablets/day). Compliance with the diets appeared to be satisfactory, based on the results of food record analysis. No significant blood pressure change was observed at the end of the low-compared to the high-calcium regimen. Serum ionized calcium was slightly, but not significantly lower, while 24-h urinary calcium excretion was significantly reduced during the low-calcium diet. No difference was found in urinary sodium and potassium excretion between the two study periods. We conclude that moderate modifications of oral calcium intake are not associated with changes in blood pressure within the time span of this study.

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > Current ...