Papers by Alberto Morganti
American Journal of Hypertension, Nov 1, 2000
The effects of percutaneous transluminal renal angioplasty (PTRA) on the renal function of stenot... more The effects of percutaneous transluminal renal angioplasty (PTRA) on the renal function of stenotic kidneys are usually assessed by evaluating the changes in serum creatinine, which is quite a rough indicator of glomerular filtration rate (GFR). In 27 hypertensive patients with 19 atherosclerotic and 11 fibromuscular significant renal artery stenoses, we investigated with renal scintigraphy the short-term (5 days) and long-term (10 months) effects of a technically successful PTRA (in seven cases combined with a stent implantation) on GFR of the stenotic and contralateral kidneys; these measurements were combined with those of plasma renin activity (PRA) and of angiotensin II (AII). We found that in short-term studies after PTRA GFR rose from 29.7 ؎ ؎ 3.5 to 34.6 ؎ ؎ 3.1 mL/ min and from 36.9 ؎ ؎ 4.0 to 45.1 ؎ ؎ 4.3 mL/min, respectively, in atherosclerotic and fibromuscular poststenotic kidneys. In long-term studies GFR further and significantly increased, to 37.8 ؎ ؎ 3.2 mL/min in the former group, whereas it stabilized in the latter group (46.0 ؎ ؎ 3.6 mL/min). In patients with fibromuscular stenosis these changes in GFR were associated with clear-cut reductions in blood pressure (BP), PRA, and AII; these decrements also occurred in patients with atherosclerotic stenosis but to a much lesser extent. We also found that in short-and long-term studies the percent of PTRAinduced increments of GFR in the poststenotic kidneys were inversely correlated with the baseline values of GFR. In addition, the absolute and percent increments of GFR were positively correlated with the basal levels of AII. Thus the time course of the improvement in GFR after angioplasty may differ in kidneys, depending on the etiology of the stenosis, in that in those with fibromuscular stenosis it was entirely apparent within a few days whereas in those with atherosclerotic stenosis it required several months to be fully expressed. Also, it appears that the more compromised kidneys are those that benefit most from the dilatation and that AII levels are useful indicators of the possibility that the stenotic kidney will have a favorable functional outcome in terms of restoration of renal blood flow.
Hypertension, Oct 1, 2018
High blood pressure & cardiovascular prevention, Dec 1, 2012
Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mor... more Arterial hypertension is responsible for a significant burden of cardiovascular morbidity and mortality, worldwide. Although several rational and integrated pharmacological strategies are available, the control of high blood pressure still remains largely unsatisfactory. Failure to achieve effective blood pressure control in treated hypertensive patients may have a substantial impact on individual global cardiovascular risk, since it significantly increases the risk of developing hypertension-related macrovascular and microvascular complications.
Journal of Hypertension, Jun 1, 2018
![Research paper thumbnail of [OP.1C.10] White-Coat Effect is Associated with a Marked Increase of Blood Pressure Variability on Ambulatory Blood Pressure Monitoring](https://attachments.academia-assets.com/115467559/thumbnails/1.jpg)
Journal of Hypertension, Sep 1, 2017
Design and method: In 1997 all adult population of Didima, Argolida, Greece was invited to partic... more Design and method: In 1997 all adult population of Didima, Argolida, Greece was invited to participate in a study involving offi ce (2 visits, 6 readings) and home (3 days, 12 readings) BP measurements. Cardiovascular morbidity and mortality were assessed after 19.0 ± 1.4 years (2016). Standard deviation (SD) and coeffi cient of variation (CV) of home and offi ce BP were used to quantify BPV. Results: 665 participants (age 54.4 ± 17.7 years, 42% men) were analyzed. During follow-up 216 deaths (124 cardiovascular) and 146 cardiovascular events (fatal and non-fatal) were documented. In Cox regression models, all indices of systolic home BPV were predictive of cardiovascular risk, even after adjustment for all available cardiovascular risk factors (adjusted HR 1.05 for a 1-SD increase in systolic home BPV and 1.06 for 1% increment in percentage CV; all p < 0.05). The HR for SD (but not CV) of diastolic home BP signifi cantly predicted cardiovascular outcome, yet it lost statistical signifi cance after adjustment for several cardiovascular risk factors (adjusted HR 1.03 for a 1-SD increase in BPV, p = NS). For offi ce BP, only unadjusted indices of BPV were predictive of cardiovascular risk (adjusted HR 1.01/1.03 for a 1-SD increase in systolic/diastolic BPV and 1.02/1.02 for 1% increment in percentage CV; all p = NS). In Cox model including CVs of both home and offi ce systolic BP as independent variables, CV of home BP remained a signifi cant predictor of cardiovascular outcome independent of offi ce BPV. Conclusions: In this long-term general population outcome study, both home and offi ce BPV independently predicted cardiovascular events, with indices of home systolic BPV exhibiting superior prognostic ability.
Journal of Hypertension, Sep 1, 2012
An accurate and reproducible method of measurement is essential for the clinical use of whatever ... more An accurate and reproducible method of measurement is essential for the clinical use of whatever biological parameter. Unfortunately this is not the case for three most relevant components of the renin-angiotensin aldosterone system (RAAS) i.e. renin, its precursor prorenin and aldosterone, whose measurements are required for the diagnosis of two common forms of secondary hypertension, renovascular hypertension (RVH) and primary hyperaldosteronism (PHA).
Journal of Nephrology, Nov 1, 2007
Meta-analyses are frequently criticized because in most cases they are compiled from quite hetero... more Meta-analyses are frequently criticized because in most cases they are compiled from quite heterogeneous studies. In spite of this limitation meta-analyses are increasingly published because in many areas of clinical research the results of individual studies are devoid of statistical power and end up with conflicting results. Meta-analyses, if performed with a rigorous and exhaustive search of all accountable information on a specific topic, have the potential of overcoming the drawbacks of single studies and, in addition, of adjusting for publication bias and interstudy variability. These strengths of meta-analyses can be exploited to provide conclusive answers on diagnostic and therapeutic issues being debated, which in turn may help guide doctors toward more rational decisions.
Journal of Hypertension, Dec 1, 1991
Clinical And Experimental Hypertension. Part B: Hypertension In Pregnancy, 1988
... Ambroso GC, Morganti A.*, Como G., Masa A., Candiani GB.**, Polvani F.** ... 6) Fievet P, Coe... more ... Ambroso GC, Morganti A.*, Como G., Masa A., Candiani GB.**, Polvani F.** ... 6) Fievet P, Coevoet B, Andrejak M, Comoy E, Legrand J, Lalau JD, Qheerbrand JD, Boulanger JC, Fournier A: The renin-angitensin-aldosterone system and the adrenergic system in normal pregnancy ...
Journal of Hypertension, 1989
Biological Psychiatry, Nov 1, 1986
The monoamine hypothesis of depression postulates a lack of norepinephrine (NE) and/or serotonin ... more The monoamine hypothesis of depression postulates a lack of norepinephrine (NE) and/or serotonin in the central nervous system (CNS) (Schildkraut 1965; Coppen 1967). There are several findings in experimental animals and in patients that support the theory (Maas 1975). For example, tricyclic antidepressants, which inhibit neuronal reuptake of monoamines and thereby potentiate their activity, are effective for treatment of depression (Iversen and Mackay 1979). Several biochemical studies of urinary or cerebrospinal fluid (CSF) levels of NE metabolites have provided direct support for these theories, as well as some rationale for a biochemical subdivision, or for the prediction of therapeutic responsiveness of depressed patients
European Archives of Psychiatry and Clinical Neuroscience, 1977
Plasma renin activity (PRA), both in supine and standing position, was investigated in primary an... more Plasma renin activity (PRA), both in supine and standing position, was investigated in primary and secondary depressed patients. After orthostatic stimulation (standing position) primary depressed patients showed PRA values significantly lower than did those with secondary depression. The authors stress the importance of the peripheral sympathetic system in the control of renin release and discuss the data obtained in the light of some evidence in the literature indicating a possible impairment of transmitter turnover in central and peripheral noradrenergic synapses in the pathogenesis of primary depression.
High blood pressure & cardiovascular prevention, Sep 11, 2013
Renovascular hypertension (RVH) is one of the most frequent forms of secondary hypertension but t... more Renovascular hypertension (RVH) is one of the most frequent forms of secondary hypertension but this diagnosis is often missed because of insufficient care taken in collecting patient's history and clinical signs. Herein we summarize the clinical, instrumental and laboratory clues which should raise the suspicion of RVH. In addition we briefly discuss the available evidence in favour and against the revascularization therapy and, at the light of the uncertain benefit of this procedure, the alternative approach with pharmacological treatment.
High blood pressure & cardiovascular prevention, Mar 1, 2011
Antihypertensive therapy has been demonstrated to significantly reduce cardiovascular and non-car... more Antihypertensive therapy has been demonstrated to significantly reduce cardiovascular and non-cardiovascular mortality in randomized controlled clinical trials. In the past, however, doubts have been raised on the safety of one class of blood pressure lowering drugs, namely the angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]), in terms of increased risk of myocardial infarction. Several comprehensive meta-analyses have definitely demonstrated no significant increased risk of myocardial infarction in patients treated with ARBs compared with placebo or any other active treatments. More recently, a partial meta-analysis has suggested a potential link between the use of this drug class and an increased risk of cancer. Although a further comprehensive network meta-analysis demonstrated the lack of any increased risk of cancer development or cancer mortality in patients treated with different antihypertensive drug classes, including ARBs, compared with placebo, this report has generated claims and uncertainties in the medical community and produced a vast echo in the lay press. The biological plausibility, the potential pathophysiological mechanisms, and the clinical evidence that rule out such hypotheses are discussed here. The present article, which represents a position paper of the Italian Society of Hypertension (SIIA), states that the benefits derived from the use of ARBs outweigh the potential risks, and that the use of these drugs should be maintained according to present indications.
Clinical Autonomic Research, Jun 1, 1991
VASOPRESSIN plasma concentrations have been measured in two groups of subjects, 13 moderate essen... more VASOPRESSIN plasma concentrations have been measured in two groups of subjects, 13 moderate essential hypertensive patients without target organ damage and eight control normotensive subjects, before and after the assumption of the upright position, and intravenous infusions of hypotonic saline (0.45% NaCl, 0.25 ml kg-1 min-1 for 1 h) and hypertonic saline (100 mmol NaC1 in 50 ml). Plasma vasopressin in recumbent baseline conditions was not significantly different in the two groups. Upright posture and hypertonic challenge augmented, while hypotonic saline reduced plasma vasopressin levels, which were not significantly different between the two groups. Plasma renin activity increased in the upright position, was reduced by administration of hypotonic saline and unaffected by hypertonic saline, with no differences between the hypertensives and normotensives. After hypertonic saline, urinary flow rate and urinary sodium excretion in the hypertensive group increased to values significantly (p < 0.05) higher than in normotensive subjects. In conclusion our study excludes significant alteration of vasopressin regulation in moderate uncomplicated hypertension. In hypertensives although the response of vasopressin to an osmotic load is preserved, the data suggest that the renal handling of the osmotic load may be altered.
Clinical science. Supplement (1979), Dec 1, 1981
The possibility that the juxtaglomerular al-adrenoceptors mediate an inhibitory action on renin r... more The possibility that the juxtaglomerular al-adrenoceptors mediate an inhibitory action on renin release in man was examined in seven patients with essential hypertension, by measuring (i) the acute effects of prazosin (0.25 mg intravenously), a selective al-adrenoceptorblocking agent, on arterial pressure and plasma renin activity, the degree of a-blockade induced by the drug being assessed by comparing the pressor response with that to a test dose of phenylephrine before and after prazosin administration, and (ii) the increases in plasma renin activity in response to isoprenaline before and during the prazosin-induced a-blockade. 2. Twenty minutes after the infusion of prazosin, when the pressor response to phenylephrine was reduced by 80% with respect to control, (i) mean arterial pressure was practically unchanged, (ii) plasma renin activity was almost doubled and (ii) the increases in plasma renin activity in response to isoprenaline were significantly greater, both in absolute and percentage values, than those observed before prazosin. 3. The increments in baseline plasma renin activity induced by prazosin in the absence of decrease in arterial pressure and the enhancement in renin responsiveness to the P-adrenoceptor stimulus suggest that, in man, the juxtaglomerular a,-adrenoceptors exert a direct, suppressive action on renin release.
PubMed, Jan 22, 2010
Background: On the basis of cardiovascular compliance, hemodialysis (HD) patients can be classifi... more Background: On the basis of cardiovascular compliance, hemodialysis (HD) patients can be classified as hypotension prone (HP) or hypotension resistant (HR). Methods: We compare the hemodynamic behavior and myocardial performances in 6 HP and 6 HR patients before and after an isolated ultrafiltration (IU) session removing 3% of total body water. Results: HP show higher basal plasma angiotensin II levels during IU (p<0.01), whereas angiotensin II remained unchanged in HR patients (p<0.001 between groups). The percentage changes of plasma volume (PV) was similar in the 2 groups. A significant reduction of cardiac index was observed only in the HP group (p<0.001 between groups). The mean values of heart rate remained significantly higher, whereas total peripheral resistances significantly fell in the HP in comparison with the HR group (p<0.001 between groups). During IU, the mean arterial pressure (MAP) changes were -10 +/- 3 mm Hg in the HP vs. -3.3 +/- 2 mm Hg in the HR group (p<0.001). Echocardiography data were collected before and after IU. All enrolled patients presented left ventricular hypertrophy; following IU, HP patients showed a reduction of mean left ventricular diameter (p<0.01), left atrial diameters and right atrial diameter, and a change in percentage of right atrium ejection fraction (p<0.001, p<0.01). Conclusions: In comparison with HR patients, HP patients before and after IU showed a defective arteriovenous tone adjustment to the PV changes, with a hemodynamic picture of abnormal sympathetic stimulation. Moreover, a reduced cardiac preload with both atrial and ventricular underfilling in these patients is at risk for a sudden drop in MAP.
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Papers by Alberto Morganti