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Background Sellar/parasellar lesions have been studied in the adult and paediatric age range, but during the transition age their epidemiology, clinical manifestations, management and treatment outcomes have been poorly investigated. Materials and methods An Italian multicentre cohort study, in which hospital records of patients with diagnosis of sellar/parasellar lesions during the transition age and young adulthood (15–25 years), were reviewed in terms of prevalence, clinical and hormonal features at diagnosis, and outcomes where available. Both pituitary neuroendocrine tumours (pituitary tumours, Group A) and non-endocrine lesions (Group B) were included. Results Among Group A ( n  = 170, 46.5% macroadenomas), the most frequent were prolactin and GH-secreting tumours, with a female predominance. Among Group B ( n  = 28), germinomas and Rathke cells cysts were the most common. In Group A, the most frequent hormonal deficiency was gonadal dysfunction. Galactorrhoea and amenorrhoea were relatively common in female patients with prolactinomas. Pre-surgical diabetes insipidus was only seen in Group B, in which also hormone deficiencies were more frequent and numerous. Larger lesions were more likely to be seen in Group B. Patients in Group B were more frequently male, younger, and leaner than those of Group A, whereas at last follow-up they showed more obesity and dyslipidaemia. In our cohort, the percentage of patients with at least one pituitary deficiency increased slightly after surgery. Conclusions The management of sellar/parasellar lesions is challenging in the transition age, requiring an integrated and multidisciplinary approach. Hormone and metabolic disorders can occur many years after treatment, therefore long-term follow-up is mandatory.

The latest European Guidelines of Arterial Hypertension have officially introduced uric acid evaluation among the cardiovascular risk factors that should be evaluated in order to stratify patient’s risk. In fact, it has been extensively evaluated and demonstrated to be an independent predictor not only of all-cause and cardiovascular mortality, but also of myocardial infraction, stroke and heart failure. Despite the large number of studies on this topic, an important open question that still need to be answered is the identification of a cardiovascular uric acid cut-off value. The actual hyperuricemia cut-off (> 6 mg/dL in women and 7 mg/dL in men) is principally based on the saturation point of uric acid but previous evidence suggests that the negative impact of cardiovascular system could occur also at lower levels. In this context, the Working Group on uric acid and CV risk of the Italian Society of Hypertension has designed the Uric acid Right for heArt Health project. The primary objective of this project is to define the level of uricemia above which the independent risk of CV disease may increase in a significantly manner. In this review we will summarize the first results obtained and describe the further planned analysis.

Blood pressure (BP) may be high during usual daily life in one out of 7–8 individuals with normal BP in the clinic or doctor's office. This condition is usually defined as masked hypertension (MH). Prevalence of MH varied across different studies depending on patient characteristics, populations studied, and different definitions of MH. Self-measured BP and ambulatory BP (ABP) have been widely used to identify subjects with MH. Various factors have been identified as possible determinants of MH. Cigarette smoking, alcohol, physical activity, job, and psychological stress may increase BP out of the clinical environment in otherwise normotensive individuals, leading to MH. In most studies, target organ damage was comparable in subjects with MH and those with sustained hypertension, and greater than in those with true normotension. Subjects with MH showed a 1.5- to 3-fold higher risk of major cardiovascular (CV) disease than those with normotension, and their risk was not different from that of patients with sustained hypertension. In an overview of literature, we found that the risk of major CV disease was higher in subjects with MH than in the normotensive subjects regardless of the definition of MH based on self-measured BP (hazard ratio (HR) 2.13; 95% confidence interval (CI): 1.35–3.35; P = 0.001) or 24-h ABP (HR 2.00; 95% CI: 1.54–2.60; P < 0.001). MH is an insidious and prognostically adverse condition that can be reliably diagnosed by self-measured BP and ABP. MH should be searched for in subjects who appear to be more likely to have this condition. Antihypertensive treatment is envisaged in these subjects, although the associated outcome benefits are still undetermined.

The independent prognostic value of daytime and night-time blood pressure (BP) variability estimated by noninvasive 24-h BP monitoring is unclear. We followed 2649 initially untreated subjects with essential hypertension for up to 16 years (mean, 6). Variability of BP was estimated by the standard deviation of daytime or night-time systolic BP (SBP) and diastolic BP (DBP). A BP variability either less than or equal to the group median or greater than the group median (12.7/10.4 mm Hg for daytime SBP/DBP and 10.8 and 8.9 mm Hg for night-time SBP/DBP) identified subjects at low or high BP variability. During follow-up there were 167 new cardiac and 122 new cerebrovascular events. The rate of cardiac events (×100 person-years) was higher (all P < .05) in the subjects with high than in those with low BP variability (daytime SBP: 1.45 v 0.72, daytime DBP: 1.29 v 0.91; night-time SBP: 1.58 v 0.62; night-time DBP: 1.32 v 0.85). The rate of cerebrovascular events was also higher (all P < .05) in the subjects with high than in those with low BP variability. In a multivariate analysis, after adjustment for several confounders, a high night-time SBP variability was associated with a 51% ( P = .024) excess risk of cardiac events. The relation of daytime BP variability to cardiac events and that of daytime and night-time BP variability to cerebrovascular events lost significance in the multivariate analysis. An enhanced variability in SBP during the night-time is an independent predictor of cardiac events in initially untreated hypertensive subjects.

We assess the statistics of different daily precipitation indices in ensembles of Med-CORDEX and EURO-CORDEX experiments at high resolution (grid spacing of ~0.11°, or RCM11) and medium resolution (grid spacing of ~0.44°, or RCM44) with regional climate models (RCMs) driven by the ERA-Interim reanalysis of observations for the period 1989–2008. The assessment is carried out by comparison with a set of high resolution observation datasets for nine European subregions. The statistics analyzed include quantitative metrics for mean precipitation, daily precipitation probability density functions (PDFs), daily precipitation intensity, frequency, 95th percentile and 95th percentile of dry spell length. We assess an ensemble including all Med-CORDEX and EURO-CORDEX models together and others including the Med-CORDEX and EURO-CORDEX separately. For the All Models ensembles, the RCM11 one shows a remarkable performance in reproducing the spatial patterns and seasonal cycle of mean precipitation over all regions, with a consistent and marked improvement compared to the RCM44 ensemble and the ERA-Interim reanalysis. A good consistency with observations by the RCM11 ensemble (and a substantial improvement compared to RCM44 and ERA-Interim) is found also for the daily precipitation PDFs, mean intensity and, to a lesser extent, the 95th percentile. A general improvement by the RCM11 models is also found when the data are upscaled and intercompared at the 0.44° and 1.5° resolutions. For some regions the RCM11 ensemble overestimates the occurrence of very high intensity events while for one region the models underestimate the occurrence of the most intense extremes. The RCM11 ensemble still shows a general tendency to underestimate the dry day frequency and 95th percentile of dry spell length over wetter regions, with only a marginal improvement compared to the lower resolution models. This indicates that the problem of the excessive production of low precipitation events found in many climate models persists also at relatively high resolutions, at least in wet climate regimes. Concerning the Med-CORDEX and EURO-CORDEX ensembles we find that their performance is of similar quality over the Mediterranean regions analyzed. Finally, we stress the need of consistent and quality checked fine scale observation datasets for the assessment of RCMs run at increasingly high horizontal resolutions.

The level to which systolic blood pressure should be controlled in hypertensive patients without diabetes remains unknown. We tested the hypothesis that tight control compared with usual control of systolic blood pressure would be beneficial in such patients. In this randomised open-label trial undertaken in 44 centres in Italy, 1111 non-diabetic patients with systolic blood pressure 150 mm Hg or greater were randomly assigned to a target systolic blood pressure of less than 140 mm Hg (usual control; n=553) or less than 130 mm Hg (tight control; n=558). After stratification by centre, we used a computerised random function to allocate patients to either group. Observers who were unaware of randomisation read electrocardiograms and adjudicated events. Open-label agents were used to reach the randomised targets. The primary endpoint was the rate of electrocardiographic left ventricular hypertrophy 2 years after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00421863. Over a median follow-up of 2·0 years (IQR 1·93–2·03), systolic and diastolic blood pressure were reduced by a mean of 23·5/8·9 mm Hg (SD 10·6/7·0) in the usual-control group and by 27·3/10·4 mm Hg (11·0/7·5) in the tight-control group (between-group difference 3·8 mm Hg systolic [95% CI 2·4–5·2], p<0·0001; and 1·5 mm Hg diastolic [0·6–2·4]; p=0·041). The primary endpoint occurred in 82 of 483 patients (17·0%) in the usual-control group and in 55 of 484 patients (11·4%) of the tight-control group (odds ratio 0·63; 95% CI 0·43–0·91; p=0·013). A composite cardiovascular endpoint occurred in 52 (9·4%) patients in the usual-control group and in 27 (4·8%) in the tight-control group (hazard ratio 0·50, 95% CI 0·31–0·79; p=0·003). Side-effects were rare and did not differ significantly between the two groups. Our findings lend support to a lower blood pressure goal than is recommended at present in non-diabetic patients with hypertension. Boehringer-Ingelheim, Sanofi-Aventis, Pfizer.

Some studies have suggested that serial changes in left ventricular (LV) mass in hypertensive subjects predict the subsequent risk of cardiovascular disease. The aim of this meta-analysis was to evaluate the prognostic impact of LV hypertrophy regression in hypertension. We undertook a meta-analysis of studies that reported echocardiographic LV mass before and during antihypertensive therapy, with subsequent assessment of cardiovascular events. The aims of this meta-analysis were: 1) to compare subjects with LV hypertrophy (LVH) during treatment (persistence or new development of LVH) with those with LVH at baseline, but not during treatment (regression of LVH); and 2) to compare subjects with LVH at baseline, but not during treatment with those without LVH both before and during treatment (regression of LVH versus persistently normal LV mass). The four eligible studies included 1064 hypertensive subjects (41% women) aged 45 to 51 years who repeated the echocardiographic study 3 to 10 years after the initial examination. The definition of LVH was based on a LV mass corrected by body surface area >125 g/m 2 in two studies and >110 g/m 2 (for women) and 124 g/m 2 (for men) in two studies. Compared with subjects with lack of regression or new development of LVH, those with LVH regression showed a reduced risk of subsequent cardiovascular disease (odds ratio 0.41, 95% CI 0.21 to 0.78, P = .007). Compared with subjects with regression of LVH, those with persistently normal LV mass showed a similar risk of subsequent events (odds ratio 0.64, 95% CI = 0.31 to 1.30, P = .21). Compared with persistence or new development of LV hypertrophy, regression of LV hypertrophy during antihypertensive treatment is associated with a marked reduction in risk for subsequent cardiovascular disease.

Abstract Purpose Recently, a novel index [the triglyceride-glucose (TyG) index]) was considered a surrogate marker of insulin resistance (IR); in addition, it was estimated to be a better expression of IR than widely used tools. Few and heterogeneous data are available on the relationship between this index and mortality risk in non-Asian populations. Therefore, we estimated the predictive role of baseline TyG on the incidence of all-cause and cardiovascular (CV) mortality in a large sample of the general population. Moreover, in consideration of the well-recognized role of serum uric acid (SUA) on CV risk and the close correlation between SUA and IR, we also evaluated the combined effect of TyG and SUA on mortality risk. Methods The analysis included 16 649 participants from the URRAH cohort. The risk of all-cause and CV mortality was evaluated by the Kaplan–Meier estimator and Cox multivariate analysis. Results During a median follow-up of 144 months, 2569 deaths occurred. We stratified the sample by the optimal cut-off point for all-cause (4.62) and CV mortality (4.53). In the multivariate Cox regression analyses, participants with TyG above cut-off had a significantly higher risk of all-cause and CV mortality than those with TyG below the cut-off. Moreover, the simultaneous presence of high levels of TyG and SUA was associated with a higher mortality risk than none or only 1 of the 2 factors. Conclusion The results of this study indicate that these TyG (a low-cost and simple, noninvasive marker) thresholds are predictive of an increased risk of mortality in a large and homogeneous general population. In addition, these results show a synergic effect of TyG and SUA on the risk of mortality.

ObjectiveEvidence from randomised trials of pharmacological treatments on long-term blood pressure (BP) reduction is limited. We investigated the antihypertensive drug effects on BP over time and across different participant characteristics.MethodsWe conducted an individual patient-level data meta-analysis of 52 large-scale randomised clinical trials in the Blood Pressure Lowering Treatment Trialists’ Collaboration using mixed models to examine treatment effects on BP over 4 years of mean follow-up.ResultsThere were 363 684 participants (42% women), with baseline mean age=65 years and mean systolic/diastolic BP=152/87 mm Hg, and among whom 19% were current smokers, 49% had cardiovascular disease, 28% had diabetes and 69% were taking antihypertensive treatment at baseline. Drugs were effective in lowering BP showing maximal effect after 12 months and gradually attenuating towards later years. Based on measures taken ≥12 months postrandomisation, mean systolic/diastolic BP difference (95% CI) between more and less intense BP-lowering treatment was −11.1 (−11.3 to −10.8)/−5.6 (−5.7 to −5.4) mm Hg; between active treatment and placebo was −5.1 (−5.3 to −5.0)/−2.3 (−2.4 to −2.2) mm Hg; and between active and control arms for drug comparison trials was −1.4 (−1.5 to −1.3)/−0.6 (−0.7 to −0.6) mm Hg. BP reductions were observed across different baseline BP values and ages, and by sex, history of cardiovascular disease and diabetes and prior antihypertensive treatment use.ConclusionThese findings suggest that BP-lowering pharmacotherapy is effective in lowering BP, up to 4 years on average, in people with different characteristics. Appropriate treatment strategies are needed to sustain substantive long-term BP reductions.

The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension conceived and designed an ad hoc study aimed at searching for prognostic cut-off values of serum uric acid (SUA) in predicting combined (fatal and non-fatal) cerebrovascular (CBV) events in the whole database. The URic acid Right for heArt Health study is a nationwide, multicenter, observational cohort study involving data on subjects aged 18–95 years recruited on a regional community basis from all the territory of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 120.7 ± 61.8 months. A total of 14,588 subjects were included in the analysis. A prognostic cut-off value of SUA able to discriminate combined CBV events (>4.79 mg/dL or >284.91 µmol/L) was identified by means of receiver operating characteristic curve in the whole database. Multivariate Cox regression analysis adjusted for confounders (age, sex, arterial hypertension, diabetes, chronic kidney disease, smoking habit, ethanol intake, body mass index, low-density lipoprotein cholesterol, and use of diuretics) identified an independent association between SUA and combined CBV events in the whole database (HR 1.249, 95% confidence interval, 1.041–1.497, p = 0.016). The results of the present study confirm that SUA is an independent risk marker for CBV events after adjusting for potential confounding variables, including arterial hypertension, and demonstrate that >4.79 mg/dL is a valid prognostic cut-off value.