Ettore Ambrosioni - Academia.edu (original) (raw)

Papers by Ettore Ambrosioni

ClinicoEconomics and Outcomes Research, Jul 1, 2013

Background: In SMILE-4 (the Survival of Myocardial Infarction Long-term Evaluation 4 study), zofe... more Background: In SMILE-4 (the Survival of Myocardial Infarction Long-term Evaluation 4 study), zofenopril + acetylsalicylic acid (ASA) was superior to ramipril + ASA in reducing the occurrence of major cardiovascular events in patients with left ventricular dysfunction following acute myocardial infarction. The present post hoc analysis was performed to compare the cost-effectiveness of zofenopril and ramipril. Methods: In total, 771 patients with left ventricular dysfunction and acute myocardial infarction were randomized in a double-blind manner to receive zofenopril 60 mg/day (n = 389) or ramipril 10 mg/day (n = 382) + ASA 100 mg/day and were followed up for one year. The primary study endpoint was the one-year combined occurrence of death or hospitalization for cardiovascular causes. The economic analysis was based on evaluation of cost of medications and hospitalizations and was applied to the intention-to-treat population (n = 716). Cost data were drawn from the National Health Service databases of the European countries participating in the study. The incremental cost-effectiveness ratio was used to quantify the cost per event prevented with zofenopril versus ramipril. Results: Zofenopril significantly (P = 0.028) reduced the risk of the primary study endpoint by 30% as compared with ramipril (95% confidence interval, 4%-49%). The number needed to treat to prevent a major cardiovascular event with zofenopril was 13 less than with ramipril. The cost of drug therapies was higher with zofenopril (328.78 Euros per patient per year, n = 365) than with ramipril (165.12 Euros per patient per year, n = 351). The cost related to the occurrence of major cardiovascular events requiring hospitalization averaged 4983.64 Euros for zofenopril and 4850.01 Euros for ramipril. The incremental cost-effectiveness ratio for zofenopril versus ramipril was 2125.45 Euros per event prevented (worst and best case scenario in the sensitivity analysis was 3590.09 and 3243.96 Euros, respectively). Conclusion: Zofenopril is a viable and cost-effective treatment for managing patients with left ventricular dysfunction after acute myocardial infarction.

To date no studiea have been published on the hemodynamiceffects of the combinedapplicationof a c... more To date no studiea have been published on the hemodynamiceffects of the combinedapplicationof a cslciumantagonistand an ACE-inhibitorin first-linetreatmentof arterialhypertension. We investigated a Iow-doaecombination of isradipineretard (SRO) and apirapril,bothof them longactingagents. Patients and methods:17 hypertensivepatients (all Caucasian, mean SBPIDBP at baaeline 165/107mmHg, mean age 51y, mean weight 79kg, 65°A male) took part in this open, intraindividual comparison. After a 4-week placabo Key Words:

Journal of Human Hypertension, 2004

The impact of hypertension on left ventricular (LV) and vascular structure and the relation of le... more The impact of hypertension on left ventricular (LV) and vascular structure and the relation of left ventricular hypertrophy (LVH) with vascular changes in untreated essential hypertensives has not been fully explored. This study investigated the prevalence of structural abnormalities of LV and carotid arteries and their determinants in a large population of untreated, uncomplicated essential hypertensive patients. The Assessment of

Internal and Emergency Medicine, 2010

Hypertension in pregnancy is a frequent disorder that includes a spectrum of conditions. We aimed... more Hypertension in pregnancy is a frequent disorder that includes a spectrum of conditions. We aimed at comparatively evaluating the hemodynamic, echocardiographic and biohumoral profile of a sample of pregnant Caucasian women with different form of pregnancy-related hypertension. We enrolled 39 non-hypertensive pregnant women (NP), 26 with Chronic HBP in pregnancy (CH), 24 with gestational hypertension (G-PIH), and 33 with pre-eclampsia. We recorded and compared blood pressure (BP), echocardiographic parameters, resting plasma renin activity (PRA) and plasma aldosterone (PA), Plasma levels of atrial (ANP) and brain natriuretic peptide (BNP). PE patients had a significantly higher BP than either G-PIH or NP patients. PE patients had also significantly lower cardiac output than NP, G-PIH and CH. In comparison to NP patients, the total peripheral vascular resistance was 61% higher in PE women and 38% higher in CH patients. All echographic parameters were significantly more altered in PE patients when compared with NP, in respect to any other form of hypertension. Either ANP (+35%) and BNP (+40%) were significantly higher in PE patients than in controls. The PRA was reduced in PE and CH patients when compared either with NP (-38 and -35%, respectively) or G-PIH (-47 and -43%, respectively). On the basis of our data, we can conclude that PE is the gestation associated hypertension with the largest anatomical, functional and biohumoral involvement, and so it has to be involved in a more intensive monitoring and evaluation.

High Blood Pressure & Cardiovascular Prevention, 2008

Metabolic syndrome is a highly prevalent condition in the Italian population. This study assesses... more Metabolic syndrome is a highly prevalent condition in the Italian population. This study assesses the feasibility and efficacy of a multifactorial approach for primary prevention of cardiovascular disease risk assessment in patients with metabolic syndrome in the daily clinical practice setting. 726 patients were enrolled (males : females = 7 : 3), their ages ranging from 26 to 70 years, with metabolic syndrome and cardiovascular death risk ≥5%, computed by means of the European Systematic COronary Risk Evaluation (SCORE) algorithm. The first phase (3 months) consisted of an improvement in lifestyle and, if necessary, the initial administration of an antihypertensive therapy (valsartan 160 mg/day for patients with blood pressure ≥140/90 mmHg and ≥130/80 mmHg for diabetic patients). During phase 2 (6 months), patients with systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg (≥130/80 mmHg for diabetic patients) were administered valsartan 160 mg/day + hydrochlorothiazide 12.5 mg/day combined; those with total cholesterol levels ≥190 mg/dL (≥175 mg/dL for diabetic patients) started treatment with fluvastatin 80 mg prolonged release (XL), as prescribed in the guidelines. A control group was approached with another conventional treatment. After 9 months of monitoring, the SBP dropped by 27 mmHg in the valsartan-treated patients and by 11 mmHg in the control group, while the DBP dropped by 12 mmHg in the former group and 2 mmHg in the latter. Total cholesterolaemia was reduced by 47 mg/dL in patients undergoing fluvastatin and valsartan therapy, by 19 mg/dL in those treated with valsartan only and by 33 mg/dL in those administered another conventional treatment. Relative risk reduction observed after 9 months, compared with the beginning of the study, was almost 48% in the valsartan/valsartan + fluvastatin group, versus 28% observed with the other conventional treatment. The reduction of risk at 60 years of age was an average of 39% at 3 months and 48% at 9 months, compared with the beginning of the study. Therapeutic success was accomplished with 78% of the patients treated with valsartan/valsartan + fluvastatin, compared with 47% of patients in the conventional therapy group. The present study demonstrated that the normalization of the main cardiovascular risk factors in patients with metabolic syndrome may be easily achieved in standard clinical practice settings, by leading an adequate lifestyle and, if necessary, the administration of antihypertensive and/or lipid-lowering monotherapy at the usual doses.

High Blood Pressure & Cardiovascular Prevention, 2007

Introduction: Childhood obesity is a major and increasing health problem for society because it i... more Introduction: Childhood obesity is a major and increasing health problem for society because it increases the risk of cardiovascular disease, type 2 diabetes mellitus, and hypertension. Thus, when obese children become obese adults, effects on their health and life expectation may be devastating. Objectives: (1) To assess the prevalence of metabolic syndrome (MS) in a child population with obesity and (2) to compare anthropometric and biochemical parameters in patients with one or two parameters of MS syndrome to those of patients who meet MS criteria. Patients and methods: A descriptive, cross-sectional study was conducted in children and adolescents with severe obesity (weight >p97) seen at the endocrinology department of Hospital de Getafe. Variables examined included age, sex, height, weight, body mass index (BMI), waist circumference (WC), oral glucose tolerance test (OGTT), insulin, insulin resistance (IR) measured by HOMA, triglycerides (Tg), high density lipoprotein (HDL), and systolic and diastolic blood pressure (SBP and DBP). The definition of MS in adolescents was made according to criteria of the International Diabetes Federation (IDF), 2007. Results: A total of 133 patients, 67 males (50.4%) and 66 females (49.6%) with a mean age of 12.17 ± 3.27 years, were enrolled into the study. All patients were obese, with a weight greater than the 97 h percentile for age and sex. Prevalence of several cardiovascular risk factors was as follows: WC ≥90th percentile for age and sex, 100%; hypertension, 26.08%; hypertriglyceridemia ≥150 mg/dL, 15.94%; HDL <40 mg/dL, 10.86%; fasting blood glucose levels ≥100 mg/dL, 7.97%. The overall prevalence of metabolic syndrome was 19.6%. A comparison of different anthropometric and biochemical parameters in patients with 1 or 2 MS criteria to those with 3 or more criteria showed that obesity and insulin resistance were significantly greater the greater the number of MS criteria met. ଝ Please cite this article as: Guijarro de Armas MG, et al. Prevalencia de síndrome metabólico en una población de niños y adolescentes con obesidad. Endocrinol Nutr. 2012;59:155---9.

High Blood Pressure & Cardiovascular Prevention, 2009

ABSTRACT Recent evidence suggests a strong relationship between angiotensin 1 (AT1) receptor gene... more ABSTRACT Recent evidence suggests a strong relationship between angiotensin 1 (AT1) receptor gene expression and low-density lipoprotein cholesterol (LDL-C) plasma level. This article comparatively evaluates blood pressure-modulating effects and metabolic and haemodynamic actions of an antihypertensive treatment directly interacting (telmisartan) versus non-interacting (bisoprolol) with the AT1 receptor in statin-treated hypercholesterolaemic patients.Sixteen untreated hypertensive hypercholesterolaemic patients (aged 57.4 ± 7 years) were enrolled according to a randomized, single-blind, crossover design with a prospective randomized, open-label, blinded evaluation of the primary endpoint. All of the patients were allocated to treatment with simvastatin 20 mg/day for 2 weeks, and then randomly assigned to treatment with either telmisartan (40-80 mg/day) or bisoprolol (5-10 mg/day) whose daily dose was doubled after 2 weeks if blood pressure control was unsatisfactory. After a cumulative period of 4 weeks, the antihypertensive drugs were withdrawn for a washout period of 2 weeks when the patients were treated with simvastatin alone. They were then allocated to the alternative antihypertensive treatment (bisoprolol or telmisartan) for a cumulative period of 4 additional weeks with a dosage adjustment at week 2. The following were measured in each patient: lying and standing systolic blood pressure (SBP) and diastolic blood pressure (DBP); heart rate; 24-hour SBP and DBP by ambulatory blood pressure measurement; baseline forearm blood flow (FBF); and forearm vascular resistance (FVR), post-ischaemic FBF and FVR, lipid profile and fasting plasma glucose.After 2 weeks of treatment with simvastatin, baseline and post-ischaemic FBF increased (both p < 0.05), while baseline and post-ischaemic FVR decreased (both p < 0.05). Both antihypertensive treatments were associated with a significant reduction in SBP (p < 0.005), DBP (p < 0.05) and mean blood pressure (MBP) [p < 0.05]. Standing DBP and MBP were reduced more in the telmisartan than in the bisoprolol group (p < 0.05). Basal and post-ischaemic FBF were significantly increased (p < 0.05 and p < 0.005, respectively) and basal and post-ischaemic FVR were significantly decreased (both p < 0.005) only in the telmisartan-treated group. LDL-C plasma level significantly improved in both treatment groups (p < 0.05), while plasma triglycerides significantly decreased only in the telmisartan-treated group (p < 0.05).From the result of this preliminary study carried out on a small sample of hypercholesterolaemic hypertensive patients, it appears that the association with telmisartan and simvastatin could exert positive effects on a large quantity of vascular functionality parameters, after just a short treatment. This observation has not been confirmed in bisoprolol-treated patients.Received for publication on 27 February 2008; accepted for publication 15 January 2009.

American Journal of Hypertension, 2005

The overall safety was similar in the two groups. In conclusion, the combination irbesartan/HCTZ ... more The overall safety was similar in the two groups. In conclusion, the combination irbesartan/HCTZ 150/12.5 mg is more potent in terms of BP reduction that the combination valsartan/HCTZ 80/12.5 mg. The more pronounced decrease in BP observed in the morning (before treatment intake) with irbesartan/HCTZ is consistent with the longer duration of action of irbesartan 150 mg which is not blunted by the addition of HCTZ 12.5 mg.

High Blood Pressure & Cardiovascular Prevention, 2005

PloS one, 2014

the SMILE studies proved the prognostic benefit of zofenopril vs. placebo or other ACE-inhibitors... more the SMILE studies proved the prognostic benefit of zofenopril vs. placebo or other ACE-inhibitors (ACEIs) in post-acute myocardial infarction (AMI). In this retrospective pooled analysis of these studies we assessed whether the zofenopril effect is influenced by gender. the four double-blind, randomized, parallel-group SMILE studies, compared the efficacy and safety of 6-48 week treatment with zofenopril 60 mg/day with that of placebo, lisinopril 10 mg/day or ramipril 10 mg/day in 3630 AMI patients. This pooled analysis compared treatment efficacy (1-year combined occurrence of death or hospitalization for CV causes) in 2733 men and 897 women. women were older than men, had a higher prevalence of diabetes and of other major CV risk factors. The risk of a major CV event was significantly larger for women (23% vs. 17% men, p<0.001). Between-gender risk difference was more marked for people living in Southern (+54%) than in Northern Europe (+12%). In both genders zofenopril similarl...

American Journal of Hypertension, 1998

American Journal of Hypertension - AMER J HYPERTENS, 1997

Previousresearchhas shownthat increasing potaseium(K+) intake lowerscasual bloodpressure(BP) amon... more Previousresearchhas shownthat increasing potaseium(K+) intake lowerscasual bloodpressure(BP) among salt-seneitiveindividuals(i.e., African Americans).This studyexaminedthe effectof a 3-week increasein dietaryK+ on ambulatoryBP responsesin heslthyAfrican-Amarican adolescentswho were classified as dippers(>1O%decressein BP fromawake to asleep)vs nondippers (ClOO/O decreasein BP fromawake to asleep), Fortyhealthyadolescents were randomized to a highK+diet (80 mEq/24hr) or a usual diet (control). The treatment groupshowed greater increases in dietaryK+(delta= +1,805 vs. -7 mg/24hr) and K+ excretion (delta= +23.2 vs. -0.3 mEq/24hr) than did the controlgroup (pc.001 for both). 300/. of the adolescentswere classified as nondippers consistently for classifications basedon systolicSP (SBP), diastolicBP (DBP) and mean BP (MBP).

American Journal of Hypertension - AMER J HYPERTENS, 2003

Hypertension (HTN) and high serum cholesterol (HC) level are often combined in the same subject w... more Hypertension (HTN) and high serum cholesterol (HC) level are often combined in the same subject where they contribute to the overall cardiovascular risk profile. Moreover, HC is associated with an impaired vasodilatory capacity and an overexpression of vascular angiotensin II receptors, which can contribute to the development of HTN. Aim of the present study was to investigate the role of HC, if any, in the development of HTN in the Brisighella Heart Study. 1230 normotensive subjects (SBP/DBP239 mg/dl both after 8 (1980) and 12 (1984) years of follow-up.Moreover, the rate of development of HTN was enhanced in the two older subgroups of subjects (30–59 and >59 years). These data suggest that HC could substantially contribute to the development of HTN and strongly support the wide role of lipid lowering drugs and particulary statins in the primary prevention of cardiovascular disease. (See Table)

European Journal of Cardiovascular Prevention & Rehabilitation - EUR J CARDIOVASC PREV REHABIL, 1995

American Journal of Hypertension - AMER J HYPERTENS, 2005

Systolic and diastolic dysfunction are quite common among elderly hypertensive patients (pts), bu... more Systolic and diastolic dysfunction are quite common among elderly hypertensive patients (pts), but their prevalence respect to different hypertensive left ventricular (LV) geometric patterns is still matter of debate.Aim of the present study was to evaluate LV function respect to the presence of LV hypertrophy (H) and to the different LV geometric patterns in elderly pts with high blood pressure.We studied 134 hypertensive pts more than 65 years aged (M 83, F 51, mean age 70.8 years, range 65–82); they were submitted to clinical and echocardiographic evaluation, assessing blood pressure values, LV diastolic and systolic dimensions, LV mass, LV mass index (LV mass/height2.7), systolic function (ejection fraction, midwall fractional shortening), diastolic function (mitral E/A rate, E wave deceleration time, isovolumetric relaxation time). LVH was defined by a mass index > 51 g/m 2.7; concentric pattern was defined by a relative wall thickness [RWT = (diastolic LV posterior wall thi...