Central blood pressure is an independent predictor of future hypertension in young to middle-aged stage 1 hypertensives.

The aim of the present study was to evaluate the association of central blood pressure (BP) with organ damage and risk of future hypertension in a cohort of young to middle-aged patients.We studied 305 subjects screened for stage 1 hypertension to determine which subjects developed hypertension needing therapy according to current guidelines. Central BP was obtained from radial artery tonometry. Organ damage was the presence of left ventricular hypertrophy and/or microalbuminuria.In a multiple logistic regression including ambulatory 24-h BP, central mean BP was associated with presence of end-organ damage (p = 0.003). In the subjects divided according to whether their central mean BP was above or below the median, subjects with high central mean BP presented an earlier impairment of arterial distensibility and developed sustained hypertension more frequently compared with those with low central mean BP (p0.001). In logistic analyses, central mean BP was an independent predictor of future hypertension (p0.001) and remained associated with outcome when 24-h BP was included in the same model (p = 0.006).In young to middle-aged subjects in the early stage of hypertension, central mean BP is a useful adjunct to brachial BPs to better define the individual risk profile

Brainstem Sparing in Human Prion Disease: Sleep and Autonomic Function in a Long Survival Case Report

Abstract Background: The prion diseases are characterized by sleep disruption, with FFI typically characterized also by severe autonomic dysfunction and sympathetic hyperactivity. We report the results of an extensive neurophysiological and autonomic assessment in a CJD patient carrying the D178 mutation with the uncommon homozygosity for valine at codon 129. Results: A 47years old female presented with a memory impairment followed by progressive cognitive deficits and ataxia. The clinical picture slowly worsened to a state of akinetic mutism in about 2 years, and the patient died six years after the onset of symptoms. Repeated PSG and long-term actigraphic recordings, showed a peculiar, previously undescribed, pattern characterized by conservation of a rudimental circadian and ultradian rhythm, despite dramatic sleep micro-structure deterioration. We also observed a normal autonomic physiological response to orthostatic challenge and normal dynamic autonomic modulation during wake and sleep. The post-mortem brain pathology study, showed that neuronal loss was substantial in the cerebral cortex, diencephalon and thalami, but not in brainstem nuclei. Conclusions: We hypothesize that, despite a dramatic neurological picture (i.e. akinetic mutism) and a severe sleep micro-structural alteration, the persistence of an autonomic modulation and the persistence of a rudimental circadian and ultradian oscillation, are related to the relatively conserved anatomo-functional integrity of foundamental neuronal systems in the brainstem

Interpretation and management of T wave inversion in athletes: An expert opinion statement of the Italian Society of Sports Cardiology (SICSPORT)

T wave inversion (TWI) on the electrocardiogram (ECG) is a relatively common finding in athletes. It poses a diagnostic challenge, as it can indicate either a benign physiological pattern or an early sign of serious cardiac pathology. This expert opinion statement provides a comprehensive review of the current understanding of TWI in athletes, emphasizing the importance of its localization, associated clinical features, and demographic factors in guiding its interpretation and management. We explore the potential causes of TWI, including physiological adaptations such as the juvenile pattern and training-induced repolarization variants, as well as pathological conditions like cardiomyopathies, ion channel diseases, and other cardiac abnormalities. Additionally, we discuss the implications of TWI in different ECG leads—anterior, inferior, and lateral—and the diagnostic work-up needed to exclude underlying disease. The importance of follow-up in athletes with TWI is highlighted, particularly for young athletes, to monitor the potential development of cardiomyopathy. Finally, we address considerations for sports eligibility in athletes with TWI, stressing the need for a balanced approach that ensures athlete safety without imposing unnecessary restrictions and investigations

Italian cardiological guidelines (COCIS) for competitive sport eligibility in athletes with heart disease. Update 2024

: Nearly 35 years after its initial publication in 1989, the Italian Society of Sports Cardiology and the Italian Federation of Sports Medicine (FMSI), in collaboration with other leading Italian Cardiological Scientific Associations (ANCE - National Association of Outpatient Cardiology, ANMCO - National Association of Inpatient Cardiology, SIC - Italian Society of Cardiology), proudly present the 2023 version of the Cardiological Guidelines for Competitive Sports Eligibility. This publication is an update of the previous guidelines, offering a comprehensive and detailed guide for the participation of athletes with heart disease in sports. This edition incorporates the latest advances in cardiology and sports medicine, providing current information and recommendations. It addresses various topics, including the details of the pre-participation screening in Italy and recommendations for sports eligibility and disqualification in competitive athletes with various heart conditions. This revised version of the Cardiological Guidelines for Competitive Sports Eligibility, recorded in the Italian Guidelines Registry of the Italian Minister of Health, stands as a crucial resource for sports medicine professionals, cardiologists, and healthcare providers, marked by its completeness, reliability, and scientific thoroughness. It is an indispensable tool for those involved in the care, management and eligibility process of competitive athletes with heart conditions

Joint Observation of the Galactic Center with MAGIC and CTA-LST-1

MAGIC is a system of two Imaging Atmospheric Cherenkov Telescopes (IACTs), designed to detect very-high-energy gamma rays, and is operating in stereoscopic mode since 2009 at the Observatorio del Roque de Los Muchachos in La Palma, Spain. In 2018, the prototype IACT of the Large-Sized Telescope (LST-1) for the Cherenkov Telescope Array, a next-generation ground-based gamma-ray observatory, was inaugurated at the same site, at a distance of approximately 100 meters from the MAGIC telescopes. Using joint observations between MAGIC and LST-1, we developed a dedicated analysis pipeline and established the threefold telescope system via software, achieving the highest sensitivity in the northern hemisphere. Based on this enhanced performance, MAGIC and LST-1 have been jointly and regularly observing the Galactic Center, a region of paramount importance and complexity for IACTs. In particular, the gamma-ray emission from the dynamical center of the Milky Way is under debate. Although previous measurements suggested that a supermassive black hole Sagittarius A* plays a primary role, its radiation mechanism remains unclear, mainly due to limited angular resolution and sensitivity. The enhanced sensitivity in our novel approach is thus expected to provide new insights into the question. We here present the current status of the data analysis for the Galactic Center joint MAGIC and LST-1 observations

MAGIC and H.E.S.S. detect VHE gamma rays from the blazar OT081 for the first time: a deep multiwavelength study

https://pos.sissa.it/395/815/pdfPublished versio

Abstract 20191: Cardiovascular Events and Coffe Use in Stage 1 Hypertension

Introduction: Controversy still exists about the long-term cardiovascular and metabolic effects of coffee consumption in hypertension. Aim of the study was to assess the predictive capacity of coffee use for cardiovascular events (CVE) and to ascertain whether the coffee-CVE association was mediated by the long-term effects of coffee on blood pressure (BP) and glucose metabolism. Design and methods: The analysis was made in 1201 participants from the HARVEST, a prospective cohort study of non-diabetic subjects aged 18-45 years, screened for stage 1 hypertension. BP was measured with ambulatory monitoring in all. Results: Among participants, 26.3% were abstainers, 62.7% were moderate coffee drinkers (1-3 cups/day) and 10.0% were heavy coffee drinkers (&gt;3 cups/day). During a 12.5 year follow-up there were 60 CVE. In multivariable Cox analyses, coffee was a significant predictor of development of hypertension needing treatment with hazard ratios (HR) of 1.5 (CI,1.1-1.9) for heavy drinkers and 1.1 (0.9-1.3) for moderate drinkers compared to abstainers. Also, coffee was a predictor of future prediabetes with HRs of 2.0 (1-3-3.1) and 1.3 (0.9-1.7), in the heavy and moderate drinkers, respectively. In multivariable Cox analyses, including other lifestyle factors, age, sex, parental CVE, BMI, total cholesterol, 24h ambulatory BP, 24h ambulatory heart rate and follow-up changes in body weight, both coffee categories were independent predictors of CVE with HRs of 4.3 (1.3-13.9) for heavy coffee drinkers and 2.9 (1.04-8.2) for moderate drinkers. Inclusion of hypertension development in the regression attenuated the strength of the coffee-CVE association with HRs of 3.9 (1.2-12.5) for heavy and of 2.8 (0.99-7.8) for moderate drinkers. When future prediabetes was also incorporated, the relationship was of boderline significance for heavy coffee drinkers (HR, 3.2, 0.94-10.9) and was no longer significant for moderate drinkers (HR, 2.3, 0.8-6.5). Conclusions: Coffee use is linearly associated with increased risk of CVE in stage 1 hypertension. The effect of coffee on CVE seems to be at least partially mediated by its long-term effects on BP and glucose metabolism. Coffee consumption should be reduced in young-to-middle-age patients with hypertension. </jats:p

Leisure-Time Physical Activity Has a More Favourable Impact on Carotid Artery Stiffness Than Vigorous Physical Activity in Hypertensive Human Beings

Aim. To assess the effect of leisure time versus vigorous long-term dynamic physical activity (PA) on carotid stiffness in normotensive versus hypertensive subjects. Methods. The study was conducted on 120 leisure-time exercisers and 120 competitive athletes. One hundred and twenty sedentary subjects served as controls. In addition, participants were classified according to whether their systolic blood pressure was &ge;130 mmHg (hypertensives, n = 120) or normal (normotensives, n = 240) according to the ACC/AHA 2017 definition. Carotid artery stiffness was assessed with an echo-tracking ultrasound system, using the pressure-strain elastic modulus (EP) and one-point pulse wave velocity (PWV&beta;) as parameters of stiffness. Results. The effect of the two levels of PA differed in the normotensives and the hypertensives. Among the normotensives, there was an ongoing, graded reduction in EP and PWV&beta; from the sedentary subjects to the athletes. By contrast, among the hypertensives, the lowest levels of EP and PWV&beta; were found among the leisure-time PA participants. EP and PWV&beta; did not differ between the hypertensive sedentary subjects and the athletes. A significant interaction was found between PA and BP status on EP (p = 0.03) and a borderline interaction on PWV&beta; (p = 0.06). In multiple regression analyses, PA was a negative predictor of EP (p = 0.001) and PWV&beta; (p = 0.0001). The strength of the association was weakened after the inclusion of heart rate in the models (p = 0.04 and 0.007, respectively). Conclusions. These data indicate that in people with hypertension, leisure-time PA has beneficial effects on carotid artery stiffness, whereas high-intensity chronic PA provides no benefit to vascular functions

Abstract EP47: Ten Thousand Steps For Health: A Regional Project For The Promotion Of Physical Activity

A sedentary lifestyle is globally recognised as one of the main risk factors for cardiovascular diseases and today’s society, along with its behaviour, tends to favour it. To spread awareness about this, the World Health Organization has set the minimum level of physical activity an individual should undertake in order to significantly reduce the risk of developing such diseases. Considering walking for its ease and reproducibility, the exercise threshold is represented by the number of steps a person should take on average in a day and is identified to be ten thousand steps. The aim of our project is to tackle sedentary behaviour by encouraging physical activity and promoting a correct lifestyle for the citizens of Friuli Venezia-Giulia. The lack of the public spaces in which to practice physical activity safely is one of the main factors that discourages people from exercising. As such, with the promotion and implementation by Regione Friuli Venezia Giulia and Federsanità ANCI FVG alongside with the collaboration of Direzione Centrale Salute and PromoTurismo FVG, several walking routes within the regional territory have been redeveloped and improved by the addition of plentiful signage. In order to better reach out to the various communities about this project, an advertising campaign about the routes themselves and the importance of the exercise was started on a variety of websites as well as the most popular social media platforms. Furthermore, walking groups from different municipalities interested in the project have been directly involved and training courses have been set up in conjunction with volunteer doctors and professionals with a degree in Physical Education to inform people about specific muscle exercises that will target the general well-being. As a result of our project, fifty-nine routes have been created in all Friuli Venezia-Giulia, all of which contain historical, social and cultural value, and will give people the opportunity to exercise in an easy and safe way that will ultimately reduce their risk of developing cardiovascular diseases. Moreover, a statistical analysis conducted by the Department of Economic and Statistical Sciences of University of Udine on media coverage and use of the routes, showed that the project has reached a great percentage of the population and is used by many people. Positive results have so far been produced in Friuli Venezia-Giulia and such a project has not only attracted the attention of other Italian Regions, but has also interested other European Countries. Our next goal is to readapt “Ten thousand steps for Health” so it can be applied in other environments.</jats:p

Blood Pressure Hyperreactivity to Standing: a Predictor of Adverse Outcome in Young Hypertensive Patients

The prognostic significance and the mechanisms of blood pressure (BP) hyperreactivity to standing remain controversial. This study aims to evaluate the association of orthostatic hyperreactivity with major adverse cardiovascular and renal events in a cohort of young hypertensive subjects. We studied 1207 untreated subjects screened for stage I hypertension with a mean age of 33.1±8.6 years. The orthostatic BP change was calculated as the difference between 6 standing and 6 supine BP readings obtained during 2 separate visits. Hyperreactivity to standing was defined as the standing-supine systolic BP difference in the top decile. The mean difference in the whole group was −2.5±7.3/4.6±5.4 mm Hg. Ambulatory hypertension evaluated with 24-hour recordings was more common in Hyperreactors than Normoreactors (90.8% versus 76.4%, P =0.001). In 630 participants in whom 24-hour urinary catecholamines were measured, epinephrine/creatinine ratio was higher in hyperreactors (118.4±185.6 versus 77.0±90.1 nmol/mol, P =0.005). During a 17.2-year follow-up, 105 major adverse cardiovascular and renal events were accrued. In a multivariate Cox model, hyperreactivity to standing was an independent predictor of major adverse cardiovascular and renal events with a hazard ratio of 1.97 (95% CI, 1.10–3.52). Hyperreactivity remained an independent predictor of adverse events even when ambulatory BP data and incident hypertension during follow-up were included in the Cox model (hazard ratio, 1.94 [95% CI, 1.10–3.44]). Our data indicate that in young-to-middle-age hypertensive subjects an exaggerated systolic BP response to standing is associated with sympatho-adrenergic hyperreactivity and is an independent predictor of major adverse cardiovascular and renal events. Orthostatic BP assessment gives the advantage of simple acquisition and provides prognostic information on top of ambulatory BP. </jats:p