Introduction: Epidemiological studies have shown that hypertension is often associated with additional cardiovascular and metabolic risk factors, including dyslipidemia, obesity and diabetes. An integrated approach aimed at simultaneously reducing Blood Pressure (BP) and cholesterol levels significantly reduced cardiovascular morbidity and mortality and, thus, improving outcomes in hypertensive patients. However, most physicians tend to give different prognostic values to hypertension and hypercholesterolaemia, being the former one over-treated and the latter one under-treated. Aim: The primary aim of the present study was to evaluate the prevalence of hypercholesterolaemia and the percentage of hypertensive patients treated with BP-lowering or lipid-lowering agents achieving control in a large cohort of subjects afferent for the first visit to our Hypertension Unit. Methods: We enrolled patients of both genders, aged up to 40 years, with a diagnosis of stable hypertension according to ESH/ESC 2003 guidelines at different cardiovascular risk profile. Exclusion criteria were any concomitant cardiovascular and non-cardiovascular associated clinical conditions. Hypercholesterolaemia was defined by total cholesterol levels (C-TOT) >200 mg/dl. In all patients the use of BP-lowering and lipid-lowering drugs has been recorded. Results: From March 2005 to March 2007, a total of 579 hypertensive patients (325M and 263F, mean age 59.0±10.9 years, BMI 27.4±4.1, clinic BP 143.2±18.0/85.9±11.3 mmHg, home BP 136.2±14.4/ 83.7±8.2 mmHg, 24-hour ambulatory BP 135.7±13.3/82.1±8.6 mmHg) were admitted to our Hypertension Unit. Of these patients, n=64 (10.9%) referred a history of diabetes and n=321 (54.6%) a history of dyslipidaemia. At the first visit, mean BP and lipid values in treated and untreated hypertensive patients were recorded and reported in the table.
Introduction: Soluble CD40 ligand (sCD40L) is directly involved in the development of vascular damage. We tested the hypothesis that sCD40L may be predictive cardiovascular (CV) events in patients at elevated risk such as patients on haemodialysis (HD). RiscAVID (Rischio cAardiovascolare nei pazienti afferenti nell'Area Vasta) study is an observational and prospective study of the over 800 patients on HD of the north-west part of Tuscany. Methods: In 300 patients (mean age: 66 years), recruited in 5 centres and representative of the whole RiscAVID population, plasma sCD40L levels were measured by immunoenzymathic methods (R&D systems, Minneapolis, MN, USA) at the time of the enrolment. Demographic, clinical and laboratory data as well as co-morbidity conditions were also registered. The population was followed up for 24 months and overall mortality, CV mortality and CV major non fatal events (acute myocardial infarction, stroke and ictus) were registered. Cox proportional hazards regression assessed adjusted differences in CV morbidity and mortality risk. Moreover, migration of endothelial cells and monocyte superoxide anion production were tested in vitro after incubation with patients' serum. Results: Patients were stratified according to plasma sCD40L levels in those with levels below (sCD40L-) and upon (sCD40L+) the median value of 7.6 ng/mL. At baseline, no significant difference were observed in age, gender, blood pressure values, previous CV events between the two groups. No significant difference was also observed in received single-pool extracorporeal substitutive treatment (Kt/V urea 1.43±0.17 and 1.48±0.22, respectively) or duration of HD (77±83 and 68±71 months, respectively). Moreover, elevated levels of sCD40L in HD patients were associated with a reduced migration of endothelial cells and increased monocyte superoxide anion production. Conclusions: These observational results at two-year follow-up in a population of patients on HD suggest that sCD40L, a marker of vascular inflammation and damage, could represent an important CV prognostic factor in HD patients.
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