Hyperinsulinemia as a determinant of microalbuminuria in essential hypertension

OBJECTIVE To analyze the relationship between insulinemia and urinary albumin excretion in a group of nonobese, young adult hypertensive patients, who had never been treated with antihypertensive drugs. PATIENTS AND METHODS Forty-nine patients who fulfilled the inclusion criteria were included. Twenty-four-hour ambulatory blood pressure monitorings, urinary albumin excretion (UAE) measurements, and an oral glucose-tolerance test measuring glucose and insulin, were performed, and left ventricular mass was measured by echocardiography. Hypertensive patients were classified as normoalbuminuric when their UAE was < 30 mg/24 h (40 patients; mean UAE 13.4 +/- 7.0 mg/24 h), and as microalbuminuric…

Aetiology of community acquired pneumonia in Valencia, Spain: a multicentre prospective study.

A year long multicentre prospective study was carried out in the Valencia region of Spain, to determine the cause of community acquired pneumonia. The study was based on 510 of 833 patients with pneumonia. Of these, 462 were admitted to hospital, where 31 patients died. A cause was established in only 281 cases--208 of bacterial, 60 of viral, and 13 of mixed infection. The most common microorganisms were Streptococcus pneumoniae (14.5%), Legionella sp (14%), Influenza virus (8%), and Mycoplasma pneumoniae (4%). There was a higher incidence of Legionella sp than in other studies.

Body weight variation and control of cardiovascular risk factors in essential hypertension.

The objective was to assess the impact of weight changes on blood pressure (BP), lipids and glucose goals in a cohort of hypertensive subjects.Prospective follow-up.Hypertension clinic.326 hypertensive non-diabetic subjects, 46% with metabolic syndrome (MS).Usual care treatment, which included diet, physical exercise and drugs prescribed when indicated. All patients were observed for up to 1 year.BP and low-density lipoprotein-cholesterol (LDL-C) goal were those in ESH/ESC and ATP III recommendations, respectively. The glucose goal was to delay progression to type 2 diabetes mellitus, or to achieve blood glucose100 mg/dl for non-diabetics. According to body weight changes, patients were cat…

Control de la dislipemia en grupos clínicos especiales: mujeres, ancianos, VIH, enfermedad renal crónica, pacientes con síndrome metabólico

There is still some disagreement about how dyslipidemia should be treated in particular population groups. This article provides a review of indications for lipid-lowering treatment, preferably for primary prevention, in specific groups of patients: women, the elderly, and those with an HIV infection, chronic kidney disease or metabolic syndrome. Special emphasis is placed on data obtained in the JUPITER trial and in other studies of rosuvastatin.

Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes

Patients with type 1 diabetes mellitus and microalbuminuria often have elevated blood pressure while they are asleep, but it is not known whether the elevation develops concomitantly with microalbuminuria or precedes it.We monitored 75 adolescents and young adults who had had type 1 diabetes with normal urinary albumin excretion and blood pressure for more than five years. Ambulatory blood-pressure monitoring was used to assess blood pressure at the initial evaluation and about two years later, at which time all subjects had normal urinary albumin excretion. Subsequently, subjects were monitored for the development of microalbuminuria.Microalbuminuria developed in 14 subjects, whereas the o…

Polymorphisms of the renin-angiotensin genes and the outcome of BP and microalbuminuria in essential hypertension: a prospective three years follow-up study

Arterial Destiffening in Previously Untreated Mild Hypertensives After 1 Year of Routine Clinical Management

BACKGROUND Arterial stiffness, measured with pulse wave velocity (PWV), is now classified as a marker of target organ damage (TOD) alongside left ventricular hypertrophy and moderately increased albuminuria. Interventional studies on treated hypertensive patients have shown that PWV could be improved. Our aim was to assess changes in arterial stiffness after 1 year of routine clinical practice in never-treated hypertensive patients. PATIENTS AND METHODS We studied 356 never-treated patients with suspected hypertension. After standard clinical assessment during which presence of TOD was evaluated, hypertension diagnosis was confirmed in 231 subjects who subsequently received standard routine…

[Central blood pressure and vascular damage].

Abstract Background and objective The aim of this study was to assess the relationship between central blood pressure and vascular damage. Patients and methods This cross-sectional study involved 393 never treated hypertensive patients (166 women). Clinical blood pressure (BP), 24 h blood pressure (BP 24 h ) and central blood pressure (CBP) were measured. Vascular organ damage (VOD) was assessed by calculating the albumin/creatinine ratio (ACR), wave pulse pressure velocity and echocardiographic left ventricular mass index (LVMI). Results Patients with VOD had higher values of BP, BP 24 h , and CBP than patients without ACR. When comparing several systolic BP, systolic BP 24 h had a higher …

Uso de espironolactona o doxazosina en pacientes con hipertensión arterial refractaria

Introduccion y objetivos. Valorar el uso de espironolactona o doxazosina en el tratamiento de pacientes con hipertension refractaria (HTAR). Metodos. Estudio retrospectivo comparativo de 181 pacientes con HTAR (pacientes tratados con tres farmacos, uno de ellos diuretico, sin alcanzar el control de la presion arterial [PA]) a quienes se anadio espironolactona (88 casos) o doxazosina (93 casos). Resultados. La PA sistolica (PAS) se redujo 28 mmHg (intervalo de confianza [IC] del 95%, 24-32 mmHg; p < 0,001), y la PA diastolica (PAD), 12 mmHg (IC del 95%, 9-14 mmHg; p < 0,001) en los tratados con espironolactona, y 16 mmHg (IC del 95%, 13-20 mmHg; p < 0,001) y 7 mmHg (IC del 95%, 5-9 mmHg; p <…

Respuesta antihipertensiva a la espironolactona en pacientes con hipertensión arterial refractaria

Fundamento y objetivo Valorar el efecto de anadir espironolactona al tratamiento de pacientes con hipertension arterial (HTA) refractaria e intentar caracterizar a los que consiguen buena respuesta. Pacientes y metodo Se ha realizado un estudio observacional y retrospectivo en pacientes con HTA refractaria –definidos como tratados con 3 farmacos a las dosis habituales, uno de ellos diuretico, sin alcanzar el control de la presion arterial (PA)– y valores de creatinina inferiores a 1,6 mg/dl en varones y a 1,4 mg/dl en mujeres. Resultados A un total de 95 pacientes (un 70% varones y un 40% diabeticos), con una edad media (desviacion estandar) de 66 (12) anos, se les anadio espironolactona al…

Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: a prospective study.

Abstract —The objective of this study was to establish whether ambulatory blood pressure offers a better estimate of cardiovascular risk than does its clinical blood pressure counterpart in refractory hypertension. This prospective study assessed the incidence of cardiovascular events over time during an average follow-up of 49 months (range, 6 to 96). Patients were referred to specialized hypertension clinics (86 essential hypertension patients who had diastolic blood pressure &gt;100 mm Hg during antihypertensive treatment that included three or more antihypertensive drugs, one being a diuretic). Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed at the time of en…

A-6G polymorphism of the angiotensinogen gene and body weight changes in essential hypertension: a prospective study

Added impact of obesity and insulin resistance in nocturnal blood pressure elevation in children and adolescents.

The aim of the present study was to analyze the relationship between insulin resistance and the ambulatory blood pressure components in obese children and adolescents. Eighty-seven overweight and obese white children and adolescents of both sexes, of European origin from 6 to 18 years of age (mean age: 10.9±2.7 years), were selected. Obesity was defined on the basis of a threshold body mass index z score &gt;2 (Cole’s least mean square method) and overweight with a body mass index from the 85th to 97th percentile. A validated oscillometric method was used to measure ambulatory BP (Spacelabs 90207) during 24 hours. Fasting glucose and insulin were measured, and the homeostasis model assessm…

Factores predisponentes a la infección nosocomial en el ictus agudo y su influencia en la morbimortalidad

Fundamento y objetivo El ictus constituye una causa importante de mortalidad y discapacidad. El objetivo del presente estudio es identificar los factores predictores de infeccion nosocomial en la fase aguda del ictus y como esta influye en la morbimortalidad de esta enfermedad. Pacientes y metodo Se ha realizado un estudio prospectivo, observacional y longitudinal de cohortes de pacientes con ictus agudo. El ictus se diagnostico segun la definicion de la Organizacion Mundial de la Salud, actualizada por la Sociedad Espanola de Neurologia. La infeccion nosocomial se definio por los criterios de los Centers for Disease Control y los de la Sociedad Espanola de Enfermedades Infecciosas y Microb…

Factors Related to the Occurrence of Microalbuminuria During Antihypertensive Treatment in Essential Hypertension

The objective of the study was to assess the factors related to the occurrence of microalbuminuria during the follow-up of a young adult group with essential hypertension that had not been previously treated. Normo-albuminuric essential hypertensives, &lt;50 years old, who had not been previously treated with antihypertensive drugs and who did not have diabetes mellitus were included. After the initial evaluation, patients were treated using only nonpharmacological measures (n=62), β-blockers (n=38), ACE inhibitors (n=64), calcium channel blockers (n=8), and several classes (n=15). Measurements were taken for office blood pressure, biochemical profile, and 24-hour urinary albumin excretion…

Eplerenona en hipertensión arterial resistente con intolerancia previa a espironolactona

Regression of left ventricular hypertrophy and microalbuminuria changes during antihypertensive treatment.

The objective of the present study was to assess the regression of left ventricular hypertrophy (LVH) during antihypertensive treatment, and its relationship with the changes in microalbuminuria.One hundred and sixty-eight previously untreated patients with echocardiographic LVH, 46 (27%) with microalbuminuria, were followed during a median period of 13 months (range 6-23 months) and treated with lifestyle changes and antihypertensive drugs. Twenty-four-hour ambulatory blood pressure monitoring, echocardiography and urinary albumin excretion were assessed at the beginning and at the end of the study period.Left ventricular mass index (LVMI) was reduced from 137 [interquartile interval (IQI)…

Polimorfismos genéticos del sistema renina-angiotensina e hipertensión arterial esencial en la población española

Fundamento Analizar la asociacion entre los principales polimorfismos geneticos descritos en el sistema renina-angiotensina y la hipertension arterial (hta) esencial en una muestra de poblacion espanola. Pacientes y metodo Estudio de casos y controles con 185 hipertensos esenciales (edad [de] 39,6 [7,5] anos, 52% mujeres, presion arterial sistolica [pas] de 151,2 [17,4] mmhg, presion arterial diastolica [pad] de 96,0 [9,4] mmhg) y 350 controles normotensos apareados por edad y sexo de una muestra de poblacion general de la Comunidad Valenciana (edad 39,4 [8,0] anos, 51,7% mujeres, PAS de 116,0 [12,0] mmhg, pad de 69,6 [8,5] mmhg). Se realizo pcr para la determinacion de los polimorfismos i/…

Determinants of urinary albumin excretion reduction in essential hypertension: A long-term follow-up study.

The objective of the present study was to assess factors related to long-term changes in urinary albumin excretion (UAE) of nondiabetic microalbuminuric (n = 252) or proteinuric hypertensive individuals (n = 58) in a prospective follow-up.After enrollment, patients were placed on usual care including nonpharmacological treatment and/or treatment with an antihypertensive drug regime to achieve blood pressure135/85 mmHg. Periodic UAE measurements were performed until regression or significant reduction (defined when UAE dropped50% from the initial values, plus reduction of UAE to30 mg/24 h for microalbuminuric patients and300 mg/24 h for proteinuric patients).Among the microalbuminuric patien…

24-hour ambulatory pulse pressure and left ventricular mass in essential hypertension

Polymorphisms of the angiotensinogen gene and the outcome of microalbuminuria in essential hypertension: a 3-year follow-up study.

Background: The objective of this study was to analyse the relationship of polymorphisms of the angiotensinogen (AGT) gene with the changes in microalbuminuria during 3 years of antihypertensive treatment in a group of young adults with essential hypertension. Methods: Essential hypertensives, less than 50 years old, never previously treated with antihypertensive drugs and in the absence of diabetes mellitus were included. After the initial evaluation, patients were treated using only nonpharmacological measures (n=23), only β-blockers (n=26), only angiotensin-converting enzyme inhibitors (ACEi) (n=57) or a combination of treatments (n=25). The office blood pressure, biochemical profile and…

Body weight changes and the A-6G polymorphism of the angiotensinogen gene

BACKGROUND: The objective of the study was to analyze the relationship of polymorphisms of the angiotensinogen gene with changes in body weight during 3 y of antihypertensive treatment, in a group of young adults with essential hypertension. METHODS: Essential hypertensives, less than 50 y old, never previously treated with antihypertensive drugs and in the absence of diabetes mellitus were included. After the initial evaluation, patients were treated using only non-pharmacological measures (n=29), β-blockers (n=40) or angiotensin-converting enzyme inhibitors (n=66). Resting blood pressure, biochemical profile and body weight at the beginning and yearly were measured. The polymorphism A-6G …

Angiotensin II AT1 receptor gene polymorphism and microalbuminuria in essential hypertension.

The objective of this study was to analyze the relationship of polymorphisms of the angiotensin II AT1 receptor gene with microalbuminuria in a group of young adults with essential hypertension. Essential hypertensives, less than 50 years old, never previously treated with antihypertensive drugs, and in absence of diabetes mellitus were included. Office blood pressure (BP), 24-h ambulatory BP monitoring, urinary albumin excretion (UAE) measurements, and DNA analysis were performed. Polymorphisms of the angiotensin II AT1-receptor gene (A1166C and C573T) were studied by polymerase chain reaction and single-strand conformation polymorphism techniques. One hundred eighty-three patients, 49 (27…

Role of adipokines in obesity-associated hypertension

It has been well documented that obesity is a major risk factor for the development of the hypertensive state. The correlation between body mass index and blood pressure level is well established. Nevertheless, the exact mechanisms which contribute to obesity-related hypertension remain poorly understood. In the last years, we have realized that the white adipose tissue is not just an inert organ for nutrient storage and isolation but rather depending on the body mass index the biggest endocrinological organ. Thus, the possible contribution of adipokines to the blood pressure elevation becomes an attractive hypothesis to explain the hypertensive state that often occurs in obesity. In this r…

Estudio de los factores relacionados con los cambios en la microalbuminuria durante el tratamiento antihipertensivo

Fundamento Conocer los factores que determinan los cambios en la microalbuminuria (mAlb)durante el tratamiento antihipertensivo en pacientes con hipertension arterial (HTA) esencial. MeTodos Se incluyeron 106 pacientes hipertensos esenciales (57 varones; edad media (DE) de40,8 [6,6] anos) no diabeticos y nunca tratados con farmacos antihipertensivos. Se determinaronvalores de presion arterial, perfil bioquimico y excrecion urinaria de albumina (EUA) medianteinmunonefelometria en dos muestras de orina de 24 h. Los pacientes se asignaron alazar a recibir tratamiento, de forma que 53 pacientes se trataron con inhibidores de la enzimaconversiva de la angiotensina (IECA), y 53 con bloqueadores b…

The spectrum of circadian blood pressure changes in type I diabetic patients.

Background The objective of the present study was to characterize the spectrum of circadian blood pressure changes in type I diabetes at different stages of nephropathy by using two monitorings in each patient in order to avoid intra-individual variability. Patients and methods A total of 80 type I diabetic subjects and the same number of age, sex and awake mean blood pressure (BP)-matched controls were included. According to urinary albumin excretion, there were 57 normoalbuminurics, 15 persistent microalbuminurics and eight proteinurics. Two 24 h ambulatory blood pressure monitorings were performed at the same urinary albumin excretion stage in absence of antihypertensive treatment for ea…

Polymorphism insertion/deletion of the ACE gene and ambulatory blood pressure circadian variability in essential hypertension

OBJECTIVE The objective of the present study was to analyze the influence of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme on ambulatory blood pressure values and circadian variability in untreated patients with hypertension. MATERIAL AND METHODS Ninety-nine essential hypertensive patients, less than 50 years old (mean age 39.5+/-7.0 years), previously untreated with antihypertensive drugs were included. Twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed with a Spacelabs (90202 and 90207) monitor, during a regular working day in unrestricted ambulatory conditions. The I/D polymorphism of the ACE was determined by PCR. RESULTS The dist…

Long-Term Impact of Systolic Blood Pressure and Glycemia on the Development of Microalbuminuria in Essential Hypertension

The objective was to assess the temporal impact of factors related to the development of microalbuminuria during the follow-up of young adult normoalbuminurics with high-normal blood pressure or at stage 1 of essential hypertension. Prospective follow-up was conducted on 245 normoalbuminuric hypertensive subjects (mean age 40.9 years; 134 men; blood pressure 139.7/88.6 mm Hg; body mass index 28.5 kg/m 2 ) never treated previously with antihypertensive drugs, with yearly urinary albumin excretion measurements, until the development of microalbuminuria. After enrollment, patients were placed on usual care including nonpharmacological treatment or with an antihypertensive drug regime to achie…