Panminerva medica
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The Brisighella Heart Study (BHS) is a long-term, prospective, population-based longitudinal study on 2939 randomly selected residents of the town of Brisighella, in Emilia-Romagna, Italy. Upon enrollment in 1972, no participant had any cardiovascular disease, 1491 participants were men and 1448 women, and the age span was 14 to 84 years. The observational phase of the study contributed to the evidence of a strong pathophysiological association between hypercholesterolemia and hypertension. ⋯ Currently, the BHS staff is planning its 11th four-yearly population survey in 2022. Today, the study is moving from an epidemiological perspective to a translational approach, involving advanced biomolecular analyses, genetic tests, and functional vascular investigations. This review aims to summarize the main findings of the first 50 years of BHS research and spot the latest developments and future perspectives of this remarkable Italian cardiovascular study.
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Obesity is a major public health issue, and its trend is increasing worldwide. Interventions to effectively treat obesity and its related diseases are advocated. Given the complexity of obesity management, nurses need specific core skills to work in the Obesity Clinic and can act as key players in the multidisciplinary team of the Obesity Clinic. ⋯ Nurses can play a pivotal role in the management of patients with obesity and associated diseases that may require a stricter follow-up than usual care. Given the complexity of the treatment of obesity and its comorbidity, nurses should receive a specific training for: 1) methods and tools to effectively treat obesity and obesity-related disease; 2) patients and families education on nutrition, lifestyle changes, and prevention/management of obesity-related diseases; 3) motivation of patients towards adherence to treatment to achieve their specific goals. This review highlights the need of specific core skills for nurses working in the Obesity Clinic.
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In the last few decades there has been much debate about the management of low-risk stage 1 hypertension in youth. In this article, we review the main findings of the HARVEST cohort accrued over 30 years, highlighting the contribution of this study to the existing literature. Tachycardia and sympathetic overdrive were closely intertwined in our HARVEST participants, promoting the development of sustained hypertension, metabolic abnormalities, and increased susceptibility to vascular complications. ⋯ To establish whether antihypertensive drug treatment should be started in this condition the clinician should consider the individual cardiovascular risk profile, the level of office mean BP and central BP. Despite recent progress in our knowledge, systolic hypertension still represents a challenging issue for the clinician. Hopefully, the HARVEST will continue to contribute data that help to fill the present gaps in evidence.
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Physiologically guided revascularization, using fractional flow reserve (FFR) or instantaneous wave free ratio (iFR) has been demonstrated to be associated with better long-term outcomes compared to an angiographically-guided strategy, mainly avoiding inappropriate coronary stenting and its associated adverse events. On the contrary, the role of invasive physiological assessment after percutaneous coronary intervention (PCI) is much less well established. ⋯ Measuring the functional result after as PCI, especially when performed after a physiological assessment, implies that the operator is ready to accept the hard truth of an unsatisfactory physiological result despite angiographically optimal and, consequently, to optimize the product with some additional effort. The aim of this review was to bridge this gap in knowledge by better defining the paradigm shift of invasive physiological assessment, from a simple tool for deciding whether an epicardial stenosis must be treated, to a thoroughly physiological approach to PCI with the suggestion of a practical flow chart.
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The Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) Study is a prospective registry of morbidity and mortality in initially untreated patients with essential hypertension whose initial diagnostic evaluation included 24-hour ambulatory blood pressure (ABP) monitoring according to a standardized protocol. The present article summarizes the main results of the PIUMA Study. The PIUMA Study is conducted in three hospitals in Umbria, Italy. ⋯ The PIUMA Study provided the first ever evidence of the prognostic value of: 1) 24-hour ambulatory blood pressure monitoring; and 2) regression of echocardiographic left ventricular hypertrophy in hypertensive patients. The PIUMA Registry gave us an enormous opportunity for investigating several pathophysiologic, diagnostic and therapeutic aspects related to management of hypertensive patients. Some of our studies have been mentioned in several hypertension guidelines to support some specific statements.