Immune-unreactive urinary albumin as a predictor of cardiovascular events: The Hortega Study

Background: We aimed to determine if immune-unreactive albumin excretion (IURAE) is associated with cardiovascular (CV) events in a representative sample of a general population from Spain.Methods: We included 1297 subjects (mean age ± standard error 48.0 ± 0.2 years, 48% females), who participated in the Hortega Follow-Up Study. The primary endpoint was incidence of fatal and non-fatal CV events. Urinary albumin excretion (UAE) was measured in spot voided urine, frozen at -80°C, by immunonephelometry [immune-reactive albumin excretion (IRAE)] and by high-performance liquid chromatography (HPLC) [total albumin excretion (AE)]. IURAE was calculated as the difference between HPLC measurements…

A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations ; The Lancet Commission on hypertension

Elevated blood pressure is the strongest modifiable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in prevention, diagnosis, and control of the disorder in an ageing world. The aim of the Lancet Commission on hypertension is to identify key actions to improve the management of blood pressure both at the population and the individual level, and to generate a campaign to adopt the suggested actions at national levels to reduce the impact of elevated blood…

THE METABOLIC SYNDROME IN HYPERTENSION

The metabolic syndrome (MS) is currently considered to be a cluster of metabolic and cardiovascular risk factors including blood pressure elevation. A higher risk to develop hypertension in MS subjects with high-normal blood pressure has been observed and, when hypertension is established, seems to be what confers a higher cardiovascular risk on top of the risk induced by blood pressure elevation. Therefore, assessment of MS components can result in clinical utility strategy to manage hypertension based on individual risk. The main mechanisms for blood pressure elevation include overactivity of the sympathetic and the reninangiotensin system, abnormal renal sodium handling, and endothelial …

Factores relacionados con el riesgo de trombosis en pacientes con lupus y positividad para anticuerpos antifosfolipídicos

Fundamento y objetivo Los anticuerpos antifosfolipidicos (AAF) aparecen con frecuencia asociados al lupus eritematoso sistemico (LES), con lo que aumenta el riesgo de trombosis. El objetivo del presente trabajo ha sido analizar el perfil temporal y los factores de riesgo de accidentes tromboticos en pacientes con LES. Pacientes y metodo Se ha realizado un estudio retrospectivo en 102 pacientes con LES controlados en nuestra unidad –edad media de 37,5 anos (extremos, 8-85); 90 mujeres–, con una mediana de seguimiento de 72 meses (extremos, 9-324). Del total de la muestra, 41 (40,2%) presentaban AAF positivos. La probabilidad de presentar un accidente trombotico durante el seguimiento se calc…

Genetic bases of urinary albumin excretion and related traits in hypertension

Epidemiological as well as animal studies have recognized the potential role of genetic factors in the development of microalbuminuria and related traits (renal insufficiency, end-stage renal disease and nephroangiosclerosis) in hypertension. To unravel genetic variants of susceptibility, candidate gene, linkage and genome wide scan analysis has been used. In spite of the great efforts that have been made in the field, sound knowledge about the major genetic variants causing the susceptibility to develop renal damage in hypertension is scarce, since many associations were not replicated or only showed association in a certain subgroup of patients. Looking initially at genes of the most impo…

Additional file 1: of The nutrigenetic influence of the interaction between dietary vitamin E and TXN and COMT gene polymorphisms on waist circumference: a case control study

Table S1. Selected SNP genotyping distribution of WC separately by gender using a dominant genetic model. Table S2. TXN and COMT SNP genotyping distribution of metabolic syndrome using a dominant genetic model. Table S3. Metabolic syndrome-related characteristics of the study population categorized by TXN and COMT SNP genotype. Table S4. Correlation analysis between anthropometry and biochemical measurement categorized by TXN and COMT SNP genotype and case-control.

Urinary exosome miR-146a is a potential marker of albuminuria in essential hypertension

Abstract Background There is increasing interest in using extracellular vesicle-derived microRNAs (miRNAs) as biomarkers in renal dysfunction and injury. Preliminary evidence indicates that miRNAs regulate the progression of glomerular disease. Indeed, exosomes from the renal system have provided novel evidence in the clinical setting of albuminuria. Thus, the aim of this study was to quantify the urinary miRNAs present in exosome and microvesicles (MVs), and to assess their association with the presence of increased urinary albumin excretion in essential hypertension. Methods Exosomes were collected from urine specimens from a cohort of hypertensive patients with (n = 24) or without albumi…

May Measurement Month 2018: an analysis of blood pressure screening results from Spain.

Este artículo se encuentra disponible en la siguiente URL: https://academic.oup.com/eurheartjsupp/article/22/Supplement_H/H119/5898732 En este artículo también participan: Fernando Martínez, Blanca Carreras, Bettina de Berardinis, Thomas Beaney, Anca Chis Ster, Neil R. Poulter, Xin Xia y Luis M. Ruilope. Elevated blood pressure (BP) is the single most important contributing risk factor to the global disease burden, leading to over 10 million deaths each year. In Spain, hypertension (HTN) affects around 20% of the adult population and remains the greatest attributable cause of cardiovascular mortality. May Measurement Month (MMM) is a worldwide initiative aimed at increasing awareness of HTN…

Genomic and Metabolomic Profile Associated to Clustering of Cardio-Metabolic Risk Factors

Background To identify metabolomic and genomic markers associated with the presence of clustering of cardiometabolic risk factors (CMRFs) from a general population. Methods and Findings One thousand five hundred and two subjects, Caucasian, > 18 years, representative of the general population, were included. Blood pressure measurement, anthropometric parameters and metabolic markers were measured. Subjects were grouped according the number of CMRFs (Group 1: <2; Group 2: 2; Group 3: 3 or more CMRFs). Using SNPlex, 1251 SNPs potentially associated to clustering of three or more CMRFs were analyzed. Serum metabolomic profile was assessed by 1H NMR spectra using a Brucker Advance DRX 600 spect…

Common variants of the liver fatty acid binding protein gene influence the risk of type 2 diabetes and insulin resistance in Spanish population.

Journal Article; Research Support, Non-U.S. Gov't; SUMMARY The main objective was to evaluate the association between SNPs and haplotypes of the FABP1-4 genes and type 2 diabetes, as well as its interaction with fat intake, in one general Spanish population. The association was replicated in a second population in which HOMA index was also evaluated. METHODS 1217 unrelated individuals were selected from a population-based study [Hortega study: 605 women; mean age 54 y; 7.8% with type 2 diabetes]. The replication population included 805 subjects from Segovia, a neighboring region of Spain (446 females; mean age 52 y; 10.3% with type 2 diabetes). DM2 mellitus was defined in a similar way in b…

Should we look for silent pulmonary embolism in patients with deep venous thrombosis?

Background Asymptomatic or silent pulmonary embolism (S-PE) in patients with deep vein thrombosis has been the focus of numerous publications with the objective of determining the incidence of S-PE and assessing whether its existence has any clinical or therapeutic consequences that outweigh the risks associated with the diagnostic tests performed and the increased healthcare costs. The objectives were to assess the incidence of S-PE using computed tomography angiogram (CTA), to understand the epidemiological factors that might trigger embolism, and to assess whether D-dimer (DD) predicts the existence of S-PE’s. Methods A prospective and consecutive assessment of 103 hospitalized patients …

Trombosis venosa profunda inducida por fenitoína

Valor pronóstico de la función renal en la mortalidad de pacientes con insuficiencia cardíaca

The nutrigenetic influence of the interaction between dietary vitamin E and TXN and COMT gene polymorphisms on waist circumference: a case control study

Background Abdominal obesity (AO) is a common modifiable risk factor for certain non-communicable diseases associated with enhanced oxidative stress (OS). The objective of this work was to investigate whether the interaction between antioxidant vitamin intake and OS-related polymorphisms modulates gene-associated anthropometry in a Spanish population. Methods A total of 246 subjects with AO, and 492 age and gender matched non-AO subjects were included in the study. Anthropometric, biochemical, and OS parameters, and antioxidant dietary intake data were assessed using validated procedures. DNA from white blood cells was isolated and the genotype of seven polymorphisms from genes involved in …

Glomerular Filtration Rate in Renal Damage

Renal function is mainly represented by the glomerular filtration (GF), which is dependent on the number and function of the nephrons. Glomerular filtration declines progressively after the third decade with a progressive loss of 1 % per year. In addition to diseases producing direct damage in the glomerular structures, high blood pressure values, diabetes, and dyslipidemia are the main factors increasing the rate of GF decline over the years. Other functional parameters of the kidney such as renal plasma flow or tubular functions are not measured in daily practice in hypertension and are not related to risk for cardiovascular disease (CVD).

Special Considerations for Antihypertensive Agents in Dialysis Patients

Hypertension is present in most patients with end-stage renal disease and likely contributes to the premature cardiovascular disease in dialysis patients. Previous practice guidelines have recommended that, in patients on chronic dialysis, blood pressure (BP) should be reduced below 130/80 mm Hg. This is based on opinions but not strong evidence, since no concrete information exists about which BP values should be the parameter to follow and which should be the target BP values. The majority of the antihypertensive agents can be used in this population, but the pharmacokinetics altered by the impaired kidney function and dialyzability influence the appropriate dosage as well as the time and…

Telitromicina, un posible nuevo potenciador del acenocumarol

24-hour Ambulatory BP Monitoring and Home BP Measurements in Resistant Hypertension

Out-of-office BP measurements, ambulatory BP monitoring (ABPM), and self-BP measurement play an important role in the evaluation of resistant hypertension. In fact 24 h ABPM has been considered mandatory at the time to evaluate resistant hypertension from the beginning of clinical use. Furthermore, clinical research has expanded the potential role of out-of-office measurements not only to the initial evaluation of resistant hypertension but also to refine cardiovascular and renal risk stratification and for a better follow-up. The widespread use of self-BP measurement at home introduced a new tool to properly assess out-of-office BP, and it has also been recommended in these patients althou…

Estudio ONTARGET. Diseño y objetivos. Sus resultados. ¿Qué cuestiones pendientes resolverán?

En los ultimos anos, el sistema renina-angiotensina-aldosterona (SRAA) ha centrado gran parte de la investigacion en la fisiopatologia cardiovascular. Se han alcanzado profundos conocimientos sobre su regulacion, su papel en la homeostasis de los sistemas cardiovascular y renal y su participacion en gran parte de los procesos patologicos que acontecen en el sistema cardiovascular y en el rinon. La utilizacion de inhibidores de la enzima de conversion de angiotensina (IECA) y de bloquedores selectivos del receptor AT1 de la angiotensina II (ARA-II) reduce la morbilidad y la mortalidad cardiovasculares mas alla de su impacto en los valores de presion arterial. Pese a ello, la morbilidad y la …

Defects in plant immunity modulate the rates and patterns of RNA virus evolution

AbstractIt is assumed that host genetic variability for susceptibility to infection necessarily conditions virus evolution. Differences in host susceptibility can either drive the virus to diversify into strains that track different defense alleles (e.g., antigenic diversity) or to infect only the most susceptible genotypes. To clarify these processes and their effect on virulence, we have studied how variability in host defense responses determine the evolutionary fate of viruses. To accomplish this, we performed evolution experiments with Turnip mosaic potyvirus in Arabidopsis thaliana mutants. Mutant plants had disruptions in infection-response signaling pathways or in genes whose produc…

Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation

AimsTo assess the impact of anticoagulant treatment on risk for stroke and all-cause mortality of patients with atrial fibrillation using real-world data (RWD).MethodsPatients with prevalent or incident atrial fibrillation were selected throughout a study period of 5 years. Stroke, transitory ischemic attack, hemorrhagic stroke, and all-cause mortality were identified in the claims of the electronic health records (EHRs). Subjects were classified according to the anticoagulant treatment in four groups: untreated, vitamin K antagonists (VKAs), New Oral Anticoagulants (NOACs), and antiplatelet (AP). Risk of events and protection with anticoagulant therapy were calculated by Cox proportional h…

Proteinuria-Microalbuminuria in Renal Damage

Proteinuria (P) usually results from an insult in the glomerular and/or tubular structures of the kidney. It has been considered a marker of risk not only to develop renal insufficiency but also to suffer cardiovascular events, based on prospective studies carried out in the general population as well as in diabetic and hypertensive patients [1]. In fact, proteinuria has been considered a strong marker of risk and an intermediate endpoint during treatment [2, 3].

Cost Reduction in Irrigation Networks by an Efficient Use of Pressure Reducing Valves

The cost effective design of hydraulic networks has been traditionally studied from the point of view of the relationship between hydraulic variables and economic parameters, with piping being the main element studied. The reason is clear: the piping is by far the most costly item of a projected network. However it is not usual to find an explicit consideration of the influence that pipe thickness has on the cost of the network because of the added difficulty that this aspect poses to formulating the problem of optimization. In irrigation networks, which are typically branched, it is advisable to place Pressure Reducing Valves (PRV’s) to fulfil three main goals: 1) to control the flow rate …

Other Methods to Assess Renal Damage

Although glomerular filtration rate (GFR) and proteinuria remain gold standard in the evaluation of renal target organ damage, imaging techniques and image-derived parameters allow for both assessment of renal function and estimation of cardiovascular risk. Enhancement in digital image processing permits dynamic measurement of renal vascular and intraparenchymal processes in real time. The most relevant in terms of clinical use to assess hypertension-induced organ damage are the renal resistive index (RRI), renal calcium score, and functional magnetic resonance imaging.

Polymorphisms of the UCP2 gene are associated with body fat distribution and risk of abdominal obesity in Spanish population

Eur J Clin Invest 2011 Abstract Background  Increased accumulation of fat results from an imbalance between energy expenditure and intake, being modulated by different environmental and genetic factors. Uncoupling proteins (UCPs) are mitochondrial carrier proteins able to spend energy generating heat. Therefore, variations in these genes are good candidates as potential modulators of body fat accumulation. Our aim was to investigate the possible association of genetic variations of the gene codifying the UCP2 protein with obesity and fat distribution. Design  We performed a cross-sectional study in 2367 individuals from two population-based studies from different regions of Spain. The Horte…

Different impacts of cardiovascular risk factors on oxidative stress.

The objective of the study was to evaluate oxidative stress (OS) status in subjects with different cardiovascular risk factors. With this in mind, we have studied three models of high cardiovascular risk: hypertension (HT) with and without metabolic syndrome, familial hypercholesterolemia (FH) and familial combined hyperlipidemia (FCH) with and without insulin resistance. Oxidative stress markers (oxidized/reduced glutathione ratio, 8-oxo-deoxyguanosine and malondialdehide) together with the activity of antioxidant enzyme triad (superoxide dismutase, catalase, glutathione peroxidase) and activation of both pro-oxidant enzyme (NAPDH oxidase components) and AGTR1 genes, as well as antioxidant…

Evolution of Trans‐ fatty acid consumption in Thailand and strategies for its reduction

Eliminating industrially produced trans-fatty acids (TFAs) from the food supply is one of the World Health Organization's (WHO's) priority targets to control and prevent non-communicable diseases. This review paper describes the strategies used to reduce TFA consumption in Thailand based on a situation analysis consisting of an assessment of TFA content in the national food supply, its intake, and stakeholder-based analysis of Strengths, Weaknesses, Opportunities, and Threats (SWOT). The analysis resulted in the drafting of a regulatory approach, which was then considered by stakeholders. Bakery products containing partially hydrogenated oils (PHOs) are the major sources of TFAs in Thailand…

Cardiac magnetic resonance-derived fibrosis, strain and molecular biomarkers of fibrosis in hypertensive heart disease

Aims Myocardial fibrosis is a relevant component of hypertensive heart disease (HHD). Novel cardiovascular magnetic resonance (CMR) imaging techniques have shown potential in quantification of diffuse cardiac fibrosis, with T1 mapping, and estimating preclinical cardiac dysfunction, with strain analysis. Molecular biomarkers of fibrosis have been related with clinical outcomes and histologically proven myocardial fibrosis. The relationship between these CMR-imaging techniques and circulating biomarkers is not fully understood. Methods and results CMR was performed on a 3T scanner in 36 individuals with HHD. Extracellular volume fraction (ECV) and the partition coefficient were assessed usin…

Ambulatory Blood Pressure in Clinical Practice: Clinical Relevance of Circadian Rhythm and Nocturnal Dip

Blood pressure (BP) variability and terms like dipper and nondipper are now common in daily practice. Several mechanisms underlie abnormalities in circadian variability. Sympathetic overactivity, reduced sensibility of baroreceptors, volume overload, and primary or secondary autonomic dysfunction are the most important factors related to abnormalities in circadian variability. The level of nighttime BP drop has been related to the absolute level of BP elevation, the global cardiovascular risk, the presence of comorbidities, and the type and time of administration of antihypertensive treatment. The relative importance of circadian variability or nocturnal BP as a prognostic factor raise not …

Pulse pressure amplification and its determinants

Background. Pulse pressure (PP) amplification expressed as the peripheral-to-central PP ratio has gained importance in the assessment of cardiovascular phenotypes and cardiovascular risk. The aim of the present study was to assess the relationship between PP amplification, large vessel parameters and peripheral blood pressure (BP) to gain insights into the amplification phenomenon. Methods. Peripheral BP, central BP and carotid-femoral pulse wave velocity (cfPWV) were assessed using the OMRON M6, SphygmoCor and Complior devices, respectively, in 741 adults attending the hypertension outpatient clinic. Analysis of covariance, partial correlations and multiple linear regression models were pe…

Genomic and metabolomic profile associated to microalbuminuria.

To identify factors related with the risk to develop microalbuminuria using combined genomic and metabolomic values from a general population study. One thousand five hundred and two subjects, Caucasian, more than 18 years, representative of the general population, were included. Blood pressure measurement and albumin/creatinine ratio were measured in a urine sample. Using SNPlex, 1251 SNPs potentially associated to urinary albumin excretion (UAE) were analyzed. Serum metabolomic profile was assessed by 1H NMR spectra using a Brucker Advance DRX 600 spectrometer. From the total population, 1217 (mean age 54 ± 19, 50.6% men, ACR>30 mg/g in 81 subjects) with high genotyping call rate were ana…

Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin

Chronic hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. In the last 5 years, treatment for HCV infection has experienced a marked development. In 2014, the use of ledipasvir/sofosbuvir with or without concomitant weight-based ribavirin was approved with a very significant increase in the sustained virological response. However, new side effects have been associated. We report the first case of an HCV infected patient treated for 12 wk with the combination of sofosbuvir/ledipasvir plus ribavirin who developed a miliary tuberculosis (TB) infection while on therapy. The patient was a 65-year-old woman, who referred malaise, asthenia, hyporexia, 7…

Urinary- and Plasma-Derived Exosomes Reveal a Distinct MicroRNA Signature Associated With Albuminuria in Hypertension.

Urinary albumin excretion (UAE) is a marker of cardiovascular risk and renal damage in hypertension. MicroRNAs (miRNAs) packaged into exosomes function as paracrine effectors in cell communication and the kidney is not exempt. This study aimed to state an exosomal miRNA profile/signature associated to hypertension with increased UAE and the impact of profibrotic TGF-β1 (transforming growth factor β1) on exosomes miRNA release. Therefore, exosomes samples from patients with hypertension with/without UAE were isolated and characterized. Three individual and unique small RNA libraries from each subject were prepared (total plasma, urinary, and plasma-derived exosomes) for next-generation sequ…

Risk factors associated with retinal vein occlusion

Summary Aims Retinal vein occlusion (RVO) is the most frequent retinal vascular disease after diabetic retinopathy in which arterial risk factors are much more relevant than venous factors. The objective was to evaluate the role of risk factors in the development of the first episode of RVO. Subjects and Methods One hundred patients with RVO [mean age 56 years, 42% females and mean body mass index (BMI) 27.5 kg/m2] were recruited consecutively from the outpatient clinic of a tertiary hospital in Valencia (Spain). All subjects underwent clinical assessment including anthropometric and blood pressure measurements and laboratory test including homocysteine, antiphospholipid antibodies (aPLAs) …

Nocturnal blood pressure and progression to end-stage renal disease or death in nondiabetic chronic kidney disease stages 3 and 4

Objective The objective was to assess the role of office and ambulatory blood pressure (BP) on the development of end-stage renal disease (ESRD) in nondiabetic chronic renal failure. Design and method Seventy-nine patients [mean age 57 (standard deviation 11) years, 47 men, BMI 28 (4), office BP 151 (25)/92 (14) mmHg, estimated glomerular filtration rate 28 (14) ml/min per 1.73 m3] were included. The causes of renal disease were nephrosclerosis (n = 33), glomerulonephritis (n = 19), interstitial (n = 12) and others (n = 15). The average follow-up was 44 months (range 9-72 months). The primary outcome was a composite of death, from any cause, or the development of ESRD that require initiatio…

Association of a Mineralocorticoid Receptor Gene Polymorphism With Hypertension in a Spanish Population

BACKGROUND To assess the association of polymorphisms and haplotypes of the mineralocorticoid receptor (MR) (NR3C2) gene to the risk of essential hypertension (HTN) in a Spanish population. METHODS This is a population-based study which included 1,502 subjects (748 women) >18 years old. Twenty-four polymorphisms of NR3C2 gene were analyzed by using SNPlex (Genotyping System based on OLA/PCR technology). RESULTS Alleles of the single-nucleotide polymorphism (SNP) rs5522 were significantly associated with the risk of HTN, both in the recessive and codominant models adjusted by age, gender, and body mass index (BMI). Genotype GG of the rs5522 showed to be protective against HTN odds ratio (OR)…

Impact of Obesity in Kidney Diseases.

The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reduc…

Association of central and peripheral pulse pressure with intermediate cardiovascular phenoytpes

Objective: We assessed the relationship between pulse pressure and intermediate cardiovascular phenotypes in a middle-aged cohort with high prevalence of hypertension. Background: It has been suggested that central pulse pressure (cPP) is a better predictor of cardiovascular outcome than peripheral pulse pressure (pPP), particularly in the elderly. Yet, it is unclear if cPP provides additional prognostic information to pPP in younger individuals. Methods: In 535 individuals we assessed cPP and pPP as well as the intermediate cardiovascular phenotypes pulse wave velocity (PWV; SphygmoCor, Complior, PulsePen), carotid intima-media thickness (C-IMT; carotid ultrasound), left-ventricular mass i…