Unattended Automated Office Blood Pressure Measurement and Cardiac Target Organ Damage, A Pilot Study Abstract Introduction The ESC-2018 guidelines suggest the use of Unattended automated office blood pressure (UAOBP) to avoid or at least reduce the white coat effect, even if do not support its use as preferred method. Aim To assess the pressure difference between UAOBP and Attended office blood pressure (AOBP) and to evaluate their correlations with target organ damage in hypertensive patients. Methods UAOBP and AOBP were taken in a cohort of 48 outpatients. The pressure difference between the 2 methods and their correlation with anthropometric and cardiac parameters were analyzed. Results Unattended systolic and diastolic BP were lower than Attended systolic and diastolic BP (135 ± 17 mmHg vs 139 ± 21 mmHg and 79 ± 10 mmHg vs 82 ± 10 mmg). ΔDBP was significantly directly correlated with female sex (r = 0.347, p = 0.016) and it was lower in men compared to women (0.11 ± 8.9 mmHg vs 6.07 ± 7.42 mmHg, p = 0.016). Correlation coefficients for LVMi and RWT for attended and unattended BP were not statistically different (for LVMi r = 0.286 vs r = 0.381, p = 0.61, for RWT r = 0.413 vs r = 0.363, p = 0.78). The relationship between attended and unattended BP was described by the following equation: y = − 4.68 + 1.06*x; where Y is the attended systolic BP and X is the unattended systolic BP; in accordance with this equation, an unattended systolic BP of 140 mmHg corresponds to an attended systolic BP of 143.7 mmHg. Conclusions UAOBP provides significantly lower values than AOBP. The difference in BP values between the two methods is much lower than the one obtained in most clinical studies.

Aortic Augmentation Index is Dependent on Bodyside in Healthy Young Subjects Abstract Introduction Aortic augmentation index (AIx) is a commonly used measure to evaluate the arterial stiffness of large elastic arteries. It has been used as an indicator for cardiovascular risk in clinical practice. Aim To evaluate the difference in the aortic AIx assessed from the left and the right hand in a group of healthy young adults using SphygmoCor and Arteriograph devices. Methods 32 subjects were enrolled in this study (27 ± 7 years), 16 male and 16 female volunteers participated. Equally, half of the gender groups were left-handed and another half right-handed. Results It was found that the aortic AIx values assessed from the pressure waveforms of the right and the left hand are different and significantly higher in the left hand. Using a SphygmoCor device, the mean difference between the aortic AIx values from the right and the left hand among the whole study group was found − 4.78 ± 4.31% and using an Arteriograph the aortic AIx values were − 3.92 ± 3.90%. Aortic AIx values assessed from the right and the left hand were linearly related to each other for both devices. Moreover, it was found that the values of the aortic. Conclusions AIx are independent of the subject’s handedness. It has to be pointed out that subjects who cannot be subjected to assessment of the aortic AIx from one side of the body could have different AIx values estimated from the recorded pressure waveform from the other bodyside.

Should We Increase Trust in Cardiovascular Prevention?

The Effects of Resveratrol Supplementation on Endothelial Function and Blood Pressures Among Patients with Metabolic Syndrome and Related Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Abstract Introduction There are current trials investigating the effect of resveratrol supplementation on endothelial function and blood pressures among patients with metabolic syndrome (MetS); however, the findings are controversial. Aim This systematic review and meta-analysis of randomized controlled trials (RCTs) were carried out to summarize the effects of resveratrol supplementation on endothelial activation and blood pressures among patients with MetS and related disorders. Methods We searched systematically online databases including: PubMed-Medline, Embase, ISI Web of Science and Cochrane Central Register of Controlled Trials until October, 2018. Two independent authors extracted data and assessed the quality of included articles. Data were pooled using the fixed- or random-effects model and considered as standardized mean difference (SMD) with 95% confidence intervals (95% CI). Results Out of 831 electronic citations, 28 RCTs (with 33 findings reported) were included in the meta-analyses. The findings showed that resveratrol intervention significantly increased flow-mediated dilatation (FMD) levels (SMD 1.77; 95% CI 0.25, 3.29; P = 0.02; I2: 96.5). However, resveratrol supplements did not affect systolic blood pressure (SBP) (SMD − 0.27; 95% CI − 0.57, 0.03; P = 0.07; I2: 88.9) and diastolic blood pressure (DBP) (SMD − 0.21; 95% CI − 0.52, 0.11; P = 0.19; I2: 89.8). Conclusions Resveratrol supplementation significantly increased FMD among patients with MetS and related disorders, but did not affect SBP and DBP. Additional prospective studies are needed to investigate the effect of resveratrol supplementation on endothelial function and blood pressures, using higher-dose of resveratrol with longer durations.

Inflammation and Vascular Ageing: From Telomeres to Novel Emerging Mechanisms Abstract Cardiovascular disease (CVD) remains the leading cause of morbility and mortality worldwide. The identification of common cardiovascular risk factors has led to the development of effective treatments that enabled a significant reduction of the global cardiovascular disease burden. However, a significant proportion of cardiovascular risk remains unexplained by these risk factors leaving many individuals at risk of cardiovascular events despite good control of the risk factors. Recent randomized clinical trials and Mendelian randomization studies have suggested that inflammation explains a significant proportion of the residual cardiovascular risk in subjects with good control of risk factors. An accelerated process of vascular ageing is increasingly recognized as a potential mechanism by which inflammation might increase the risk of CVD. In turn, cellular ageing represents an important source of inflammation within the vascular wall, potentially creating a vicious cycle that might promote progression of atherosclerosis, independently from the individual cardiovascular risk factor burden. In this review, we summarise current evidence suggesting a role for biological ageing in CVD and how inflammation might act as a key mediator of this association.

Does A Therapy for Reflex Vasovagal Syncope Really Exist? Abstract Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of syncopal events, and includes: (a) the vasovagal syncope (classical type); (b) the situational syncope; (c) the carotid sinus syncope and (d) non-classical forms. An accurate anamnesis and physical examination are fundamental for the diagnosis. Although limited evidence is available regarding the efficacy of some treatments, a number of these can be successfully used in the clinical practice. It is, however, important to personalize the therapeutic approach in order to achieve an efficient reduction or suppression of syncopal episodes. Patients should be reassured about the benignity of these events and the possibility of reducing their frequency over time. They should be also educated on how to recognize and abort incoming syncopal episodes. Patients may be advised to increase their introit in water and salt, as well as to reduce vasoactive medications, if no contraindications exist. Orthostatic training may be beneficial but only in very motivated young patients capable of strictly adhering to the exercise plan. So far, any proposed pharmacological treatment has demonstrated very limited efficacy and, therefore, it should be tried in case of failure of non-pharmacological approaches. Pacemaker implantation is clearly indicated in patients with documented cardioinhibitory syncope in the absence of a vasodepressor component, which can compromise their quality of life. Despite the American and European guidelines for the treatment of syncope are similar, still some differences can be denoted. Aim of this study is to evaluate the management of patients with recurrent syncopal episodes focusing on pharmacological and non-pharmacological approaches.

Opportunistic Screening for Atrial Fibrillation in the Pharmacies: A Population-Based Cross-Sectional Study Abstract Introduction Opportunistic screening of atrial fibrillation is a valuable approach to the identification of subjects with unknown or non-symptomatic atrial fibrillation (AF) with the potential of reducing the burden of ischemic stroke in the population. Aim To evaluate the feasibility of a large-scale screening for atrial fibrillation using a blood pressure monitor (MicrolifeAFIB) endowed with a validated algorithm able to detect AF calculating the irregularity of interval times between heartbeats. Methods In this cross-sectional study conducted in 74 pharmacies in Verona participated 3071 people aged 50 years or more. In 6 months, information about drugs, previous diagnoses of cardiovascular diseases, anthropometric and demographic data was recorded, together with the measurement of blood pressure and cardiac rhythm by using the MicrolifeAFIB device. Pharmacists also collected anthropometric and demographic data of the participants, along with information concerning their personal history of cardiovascular disease and the use of antihypertensive and antithrombotic agents. All those who were positive at the screening for atrial fibrillation were referred to their family doctor. Results The screening revealed 98 subjects (3.2%) positive for AF; 44 of these reported a previous diagnosis of AF and were treated with anticoagulants (77%) or with antiplatelet agents (7%). By logistic regression analysis, age, male sex and heart failure were independently associated with positivity for AF. Association between positive test and previous stroke/TIA was found in the 54 subjects without a previous diagnosis of AF (9% had a previous stroke/TIA). Conclusions Opportunistic screening for atrial fibrillation in the pharmacies is feasible and allows to identify a number of subjects with silent, non-previously diagnosed AF, therefore is potentially useful in large-scale projects aimed at the prevention of cardiovascular morbidity and mortality.

Aspirin Efficacy in Primary Prevention: A Meta-analysis of Randomized Controlled Trials Abstract Introduction The role of aspirin as a means of primary prevention remains controversial. Aim We have conducted a meta-analysis of all randomized controlled trials (RCTs) to evaluate the role of aspirin in primary prevention. Methods Literature search was performed via PubMed, Embase, and the Cochrane Library for all related RCTs. All-cause mortality was the primary endpoint. Secondary endpoints included major adverse cardiovascular events (MACE), myocardial infarction (MI), cardiovascular mortality, cerebrovascular events, and bleeding events. We used a random effects model to report the risk ratios (RRs) with 95% confidence intervals (CIs). Results Our analysis included 17 RCTs (164,862 patients; 83,309 received aspirin and 81,744 received placebo). Our study did not demonstrate any significant reduction in all-cause mortality for patients treated with aspirin when compared with placebo (RR 0.97; 95% CI 0.93–1.01; P = 0.13). Sensitivity analysis performed by excluding healthy elderly (≥ 65) showed significant reductions in all-cause mortality in the aspirin-treated patients (RR 0.94; 95% CI 0.90–0.99; P = 0.01). There were no significant differences between both groups regarding cardiovascular mortality and cerebrovascular events (P > 0.05). However, aspirin-treated patients significantly reduced MACE and MI events (RR 0.89; 95% CI 0.85–0.93; P < 0.001 and RR 0.88; 95% CI 0.78–0.98; P = 0.02, respectively), respectively. However, aspirin was associated with a significantly higher incidence of bleeding, including major bleeding and intracranial bleeding (P < 0.001). Conclusions Aspirin use in primary prevention has resulted in a lower incidence of MACE and MI without significantly effecting cerebrovascular events. However, aspirin was associated with a higher bleeding risk. Use of aspirin as a means of primary prevention should be thoroughly discussed with patients and pursued based on the risk of cardiovascular disease while also considering bleeding risk.

The Effects of a New Generation of Nutraceutical Compounds on Lipid Profile and Glycaemia in Subjects with Pre-hypertension Abstract Introducion Treatment strategies for patients with pre-hypertension and low–moderate cardiovascular (CV) risk may include nutraceutical compounds (NCs). Aim To investigate the efficacy and safety of a new-generation of NC in lowering BP values and improving metabolic profile, in a group of hyper-cholesterolemic subjects with pre-hypertension. Methods 131 subjects with pre-hypertension (systolic BP 130–139 mmHg and/or diastolic BP 85–89 mmHg) without organ damage and history of CV diseases were enrolled. 66 subjects were treated with a once-daily oral formulation of a NC (red yeast rice, Berberine, Coenzyme Q10, folic acid and chrome) added to diet for 3 months, while 65 patients followed a diet only. Differences in serum total cholesterol (TC), low- and high-density lipoprotein cholesterol (LDLC and HDLC), triglycerides (TG), glycemia, creatine phosphokinase (CPK), aspartate aminotransferase (AST) alanine aminotransferase (ALT) and body mass index (BMI) were evaluated. Results At the end of treatment, significant reductions of TC, LDLC, TG glucose levels were observed in both treatment groups, while HDLC values increased in the active treatment group only. A greater reduction of TC, LDLC and glycemia was observed in the treatment group. TG levels were not different within the two groups. BP and BMI levels remained unchanged, as well AST, ALT; CPK slightly increased in both groups, but it remained in the normal range. Conclusions In patients with pre-hypertension, NC supplementation was safe, well tolerated and effective in improving lipid pattern and glucose levels and in preventing the progression to overt hypertension.

Impact of Lipid-Lowering Therapy on Mortality According to the Baseline Non-HDL Cholesterol Level: A Meta-Analysis Abstract Introduction Previous report showed that more intensive lipid-lowering therapy was associated with less mortality when baseline LDL-C levels were > 100 mg/dL. Non-HDL-C is a better predictor of cardiovascular risk than simpler LDL-C. Aim The objective of this meta-analysis was to define the impact of lipid-lowering therapy on the reduction of total and cardiovascular mortality by different baseline levels of non-HDL-C. Methods We performed a meta-analysis including randomized, controlled clinical trials of lipid-lowering therapy, reporting mortality with a minimum of 6 months of follow-up, searching in PubMed/Medline, EMBASE and Cochrane Clinical Trials databases. The random-effects model and meta-regression were performed. Results Twenty nine trials of lipid-lowering drugs, including 233,027 patients, were considered eligible for the analyses. According to the baseline non-HDL-C level, the results on cardiovascular mortality were: (1) ≥ 190 mg/dL: OR 0.63 (95% CI 0.53–0.76); (2) 160–189 mg/dL: OR 0.82 (95% CI 0.75–0.89); (3) 130–159 mg/dL: OR 0.71 (95% CI 0.52–0.98); (4) < 130 mg/dL: OR 0.95 (95% CI 0.87–1.05). When evaluating mortality from any cause, the results were the following: (1) ≥ 190 mg/dL: OR 0.70 (95% CI 0.61–0.82); (2) 160–189 mg/dL: OR 0.91 (95% CI 0.83–0.98); (3) 130–159 mg/dL; OR 0.88 (95% CI 0.77–1.00); (4) < 130 mg/dL: OR 0.98 (95% CI 0.91–1.06). The meta-regression analysis showed a significant association between baseline non-HDL-C and mortality. Conclusions In these meta-analyses, lipid-lowering therapy was associated with reduction in the risk of all-cause and cardiovascular mortality when baseline non-HDL-C levels were above than 130 mg/dL.