Our results indicate that, in small resistance arteries of patients with primary aldosteronism, a pronounced fibrosis may be detected, even more evident than in blood-pressure-matched patients with essential hypertension.

A noninvasive and easily repeatable procedure (intraobserver and interobserver variation coefficient <13%) such as an evaluation of the arterioles in the fundus oculi by SLDF may provide similar information regarding microvascular morphology compared with an invasive, accurate and prognostically relevant micromyographic measurement of media-to-lumen ratio of subcutaneous small arteries.

Abstract-Inappropriate left ventricular mass (LVM; ie, the value of LVM exceeding individual needs to compensate hemodynamic load) predicts the risk of cardiovascular (CV) events, independent of risk factors, either in the presence or in the absence of traditionally defined LV hypertrophy. The relation between changes in appropriateness of LVM during antihypertensive treatment and subsequent prognosis was evaluated in 436 prospectively identified uncomplicated hypertensive subjects, with a baseline and follow-up standard clinical evaluation, laboratory examinations, and echocardiogram (last examination: 6Ϯ3 years apart), followed for additional 4.5Ϯ2.5 years. is initially a useful compensatory process to abnormal loading conditions, but it is also the first step toward the development of overt clinical disease. [1][2][3][4] In the attempt to discriminate between normal (compensatory) and abnormal (noncompensatory) increase in LV mass (LVM), it has been proposed recently to evaluate LVM increase in hypertensive patients taking into account gender and cardiac loading conditions rather than some measure of body size. 5 Patients with inappropriate LVM, exceeding the amount needed to adapt to stroke work for a given gender and body size, tend to cluster with metabolic risk factors. 6 More interestingly, prevalence of low systolic myocardial function, as well as of abnormal relaxation, is greater in hypertensive patients with inappropriate LVM, suggesting that this condition may represent an accelerated phase of transition from compensatory LVH toward heart failure. 7,8 Two studies have demonstrated that the presence of inappropriate LVM implies a greater risk of cardiovascular (CV) events, either in the presence or in the absence of traditionally defined LVH. 9,10 The reduction of echocardiographically determined LVM, along with the normalization of LV geometry, during antihypertensive treatment, has been associated with a reduction in risk for subsequent CV disease. 11,12 No data are presently available on changes in appropriateness of LVM during antihypertensive treatment in hypertensive patients. Therefore, we aimed to investigate the relation between changes in appropriateness of LVM during antihypertensive treatment and subsequent prognosis for CV events in a large group of prospectively identified essential hypertensive patients with and without LVH undergoing usual medical treatment. Methods SubjectsWe identified uncomplicated hypertensive subjects, selected from an ongoing prospective registry of morbidity and mortality, including patients referred for high blood pressure (BP) diagnostic workup. At entry, all of the patients were never treated (nϭ247) or had withdrawn for Ն4 weeks before antihypertensive treatment (nϭ189); they had clinic systolic BP Ն140 and/or diastolic BP Ն90 mm Hg on

Background Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors. Methods A prospective randomized study was conducted (2000)(2001)(2002)(2003)(2004)(2005)(2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring. Results Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 ± 94 cc versus 48 ± 36 cc, p \ 0.05) and operative time (180 ± 40 versus 158 ± 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p \ 0.05). Long-term follow-up was always normal.Conclusions Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern.

Abstract-Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media:lumen ratio, are frequently present in hypertensive and/or diabetic patients and may represent the earliest alteration observed. In addition, media:lumen ratios of small arteries have a strong prognostic significance. However, no data are available about the structure of small resistance arteries of obese patients, particularly after weight loss. We have investigated 27 patients with severe obesity. Twelve of them were normotensive, and 15 were hypertensive. All of the obese patients underwent bariatric surgery. We compared results obtained with those observed in 13 normotensive lean controls and in 13 hypertensive lean patients. All of the subjects and patients underwent a biopsy of subcutaneous fat during surgical intervention. In 8 obese patients, a second biopsy was obtained after consistent weight loss, during a surgical intervention for abdominoplasty. Subcutaneous small resistance arteries were dissected and mounted on a wire myograph, and structural parameters were measured. A concentration-response curve to acetylcholine was performed to evaluate endothelial function. Obese patients, independent from the presence of hypertension, show the presence of an increased media:lumen ratio and media cross-sectional area, together with an impaired endothelial-dependent vasodilatation. After surgical correction of obesity and consistent weight loss, a significant improvement of microvascular structure and of some oxidative stress/inflammation markers were observed. In conclusion, our data suggest that the presence of obesity is associated with structural alterations of subcutaneous small resistance arteries, mainly characterized by hypertrophic remodeling. Weight loss may improve microvascular structure. (Hypertension. 2011;58:29-36.)Key Words: remodeling Ⅲ hypertension Ⅲ obesity Ⅲ microcirculation Ⅲ small arteries A lterations in the microcirculation are common accompaniments of cardiovascular and metabolic diseases 1,2 and may involve small resistance arteries, arterioles, capillaries, and postcapillary venules. 3 In particular, the structure of subcutaneous 1-3 and cerebral 4 small resistance arteries (lumen diameter: 100 to 300 m) may be altered in the presence of cardiovascular or metabolic diseases. Essential hypertension is associated with a narrowing of the internal lumen and with an increase of media wall thickness, with consequent increase in the media:lumen ratio. 1 The observed increase in the media:lumen ratio may be the consequence of an eutrophic remodeling (rearrangement of otherwise normal material around a narrowed lumen) or of a hypertrophic remodeling (vascular smooth muscle cell hypertrophy or hyperplasia). 5 Eutrophic remodeling of subcutaneous small arteries is commonly seen in essential hypertension, whereas an inward hypertrophic remodeling, with evident smooth muscle cell growth, was shown in patients with type 2 diabetes mellitus, regardless of the presence of elevated or normal ...

Lercanidipine both in monotherapy and in combination with enalapril, was able to improve microvascular structure and to decrease central blood pressure, being thus a useful approach for both reducing blood pressure and improving vascular alterations in hypertension.

Our data suggest that adaptive optics has a substantial advantage over SLDF in terms of evaluation of microvascular morphology, as WLR measured with adaptive optics is more closely correlated with the M/L of subcutaneous small arteries (r = 0.84, P < 0.001 vs. r = 0.52, P < 0.05, slopes of the relations: P < 0.01 adaptive optics vs. SLDF). In addition, the reproducibility of the evaluation of the WLR with adaptive optics is far better, as compared with SLDF, as intraobserver and interobserver variation coefficients are clearly smaller. This may be important in terms of clinical evaluation of microvascular morphology in a clinical setting, as micromyography has substantial limitations in its clinical application due to the local invasiveness of the procedure.

In European countries and in the USA, hypertension represents an important risk factor for cardiovascular diseases (CVD) in men and women. Women do not perceive CVD as an important health problem, despite the evidence that women are more at risk to die from hypertension-related CVD than men. A correct prevention strategy should more widely acknowledge sex-specific risk factors, such as hypertension in pregnancy, and the benefit of treating hypertension in both men and women. In more recent years, hypertension awareness and treatment rates are higher in women than in men while blood pressure control rates are improving, but remain still lower in older hypertensive women. Differences have been described regarding the pattern of antihypertensive drug prescription and use in hypertensive men and women; women are more frequently treated with diuretics and less frequently with angiotensin-converting-enzyme (ACE)-inhibitors and angiotensin-receptors blockers. Calcium-antagonists appear to be particularly effective in women. Data from large clinical trials and meta-analyses offer strong evidence that the efficacy of the various drug classes in prevention of CV events does not differ by sex, and therefore the choice of the drug cannot be based only on this criterion in post- menopausal women. There are currently no specific blood pressure (BP) treatment goals for post-menopausal hypertension.