Clinical Inertia in Poorly Controlled Elderly Hypertensive Patients: A Cross-Sectional Study in Spanish Physicians to Ascertain Reasons for Not Intensifying Treatment

Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians.The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it.An observational, cross-sectional, multi-center study was carried out in a primary care setting. We included 512 physicians, with a consecutive sampling of 1,499 hypertensive patients with clinical inertia.Clinical inertia was defined when physicians did n…

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.

Effectiveness and Tolerability of Fixed-Dose Combination Enalapril plus Nitrendipine in Hypertensive Patients Results of the 3-Month Observational, Post-Marketing, Multicentre, Prospective CENIT Study

Background and objective: Monotherapy with any class of antihypertensive drug effectively controls blood pressure (BP) in only about 50% of patients. Consequently, the majority of patients with hypertension require combined therapy with two or more medications. This study aimed to evaluate the effectiveness (systolic BP [SBP]/diastolic BP [DBP] control) and tolerability of the fixed-dose combination enalapril/nitrendipine 10 mg/20 mg administered as a single daily dose in hypertensive patients. Methods: This was a post-authorization, multicentre, prospective, observational study conducted in primary care with a 3-month follow-up. Patients throughout Spain with uncontrolled hypertension (>= …

Microvascular brain damage with aging and hypertension

Loss of cognitive function and hypertension are two common conditions in the elderly and both significantly contribute to loss of personal independency. Microvascular brain damage - the result of age-associated alteration in large arteries and the progressive mismatch of their cross-talk with small cerebral arteries - represents a potent risk factor for cognitive decline and for the onset of dementia in older individuals. The present review discusses the complexity of factors linking large artery to microvascular brain disease and to cognitive decline and the evidence for possible clinical markers useful for prevention of this phenomenon. The possibility of dementia prevention by cardiovasc…

Insights into Glomerular Filtration and Albuminuria

Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants

Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean dia…

Hipertrofia ventricular izquierda en la población hipertensa española. Estudio ERIC-HTA

Introduccion y objetivos El objetivo del presente estudio es evaluar la prevalencia de hipertrofia del ventriculo izquierdo (HVI) en el electrocardiograma y el perfil epidemiologico en pacientes hipertensos atendidos en atencion primaria. Pacientes y metodo Estudio transversal, multicentrico, realizado en 15.798 pacientes hipertensos ≥ 55 anos de centros de atencion primaria. Se midio la presion arterial y se recogieron los antecedentes cardiovasculares de la historia clinica de los pacientes. La HVI se evaluo segun los criterios de Cornell. Resultados Se evaluo a 15.798 pacientes (edad media, 68,0 anos; 55,3% mujeres; 30,4% diabeticos). El 20,3% presento HVI en el electrocardiograma. La pr…

Efficacy of combination therapy with angiotensin-converting enzyme inhibitor and calcium channel blocker in hypertension.

There are few clinical trials that provide evidence to support the hypothesis that combined therapies offer a favorable risk-benefit ratio in the reduction of cardiovascular mortality and morbidity. Combined therapies containing an angiotensin-converting enzyme inhibitor (ACEI) with a calcium channel blocker (CCB) is one of the recommended combinations in the reappraisal of the European Society of Hypertension.The authors have performed a systematic review of the available clinical evidence on the use of combined therapies containing an ACEI with a CCB versus other combinations in the management of arterial hypertension (HT) and in the reduction of cardiovascular morbidity/mortality, accord…

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology*

This is a pre-copyedited, author-produced version of an article accepted for publication in European Journal of Preventive Cardiology following peer review. The version of record Piepoli, M.F., Abreu, A., Albus, C., Ambrosetti, M., Brotons, C., Catapano, A.L. ... Tiberi, M. (2020). Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology*. European Journal of Preventive Cardiology (EJPC), 27(2), 181-205 is available online at: https://doi.org/10.1177/2047487319893035. European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regu…

Managing Resistant Hypertension: Not Just a Question of Numbers

LDL particle size and composition and incident cardiovascular disease in a South-European population: The Hortega-Liposcale Follow-up Study.

Abstract Background The association of low-density lipoprotein (LDL) particle composition with cardiovascular risk has not been explored before. The aim was to evaluate the relationship between baseline LDL particle size and composition (proportions of large, medium and small LDL particles over their sum expressed as small-LDL %, medium-LDL % and large-LDL %) and incident cardiovascular disease in a population-based study. Methods Direct measurement of LDL particles was performed using a two-dimensional NMR-technique (Liposcale®). LDL cholesterol was assessed using both standard photometrical methods and the Liposcale® technique in a representative sample of 1162 adult men and women from Sp…

Prevalencia de fibrilación auricular y uso de fármacos antitrombóticos en el paciente hipertenso ≥ 65 años. El registro FAPRES.

Introduccion y objetivos Entre los principales factores asociados a la presencia de fibrilacion auricular y mayor riesgo embolico estan la edad y la hipertension arterial. Nuestro objetivo es conocer la prevalencia de fibrilacion auricular en el paciente hipertenso de 65 o mas anos de edad en la Comunidad Valenciana y el empleo de farmacos antitromboticos. Metodos Cada investigador incluyo a los primeros 3 pacientes hipertensos de edad ≥ 65 anos que acudian a la consulta el primer dia de la semana durante 5 semanas. Se recogieron los factores de riesgo, la historia cardiovascular, la puntuacion CHADS2 y el tratamiento farmacologico y se realizo un electrocardiograma para su analisis central…

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…

Influence of Concurrent Obesity and Low Birth Weight on Blood Pressure Phenotype in Youth

The aim of this study was to assess the impact of obesity and low birth weight on both office and ambulatory blood pressure (BP) values, as well as on aortic-derived parameters in youths. A total of 422 white youths, from 10 to 18 years of age, were included. Subjects were divided into 4 groups according to the presence (234; 55%) or the absence (188; 45%) of obesity and according to low (114; 27%) or normal (308; 73%, birth weight. Spacelabs 90207 was used to measure ambulatory BP during a 24-hour period. SphygmoCor radial/aortic transform software was used to estimate aortic pressure waveform. Office, 24-hour, daytime, and nighttime systolic BP values were significantly higher in those s…

Within-visit BP variability, cardiovascular risk factors, and BP control in central and eastern Europe: findings from the BP-CARE study.

INTRODUCTION AND OBJECTIVE Blood pressure variability (BPV) within 24 h or between visits has been found to represent an independent risk factor for cardiovascular disease. The present study was aimed at determining whether a clinical significance can be given also to the BP variations occurring within a single clinical visit. METHODS BPV was quantified as coefficient of variation and as standard deviation (SD) of the mean of three systolic SBP values within a visit in the context of a large-cross subclinical survey (BP-CARE) of treated hypertensive patients living in Eastern European countries. The study population was divided into coefficient of variation and SD quartiles and for each qua…

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 …

Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, represent…

Small Rab GTPases in Intracellular Vesicle Trafficking: The Case of Rab3A/Raphillin-3A Complex in the Kidney

Small Rab GTPases, the largest group of small monomeric GTPases, regulate vesicle trafficking in cells, which are integral to many cellular processes. Their role in neurological diseases, such as cancer and inflammation have been extensively studied, but their implication in kidney disease has not been researched in depth. Rab3a and its effector Rabphillin-3A (Rph3A) expression have been demonstrated to be present in the podocytes of normal kidneys of mice rats and humans, around vesicles contained in the foot processes, and they are overexpressed in diseases with proteinuria. In addition, the Rab3A knockout mice model induced profound cytoskeletal changes in podocytes of high glucose fed a…

The effect duration of candesartan cilexetil once daily, in comparison with enalapril once daily, in patients with mild to moderate hypertension.

To determine the antihypertensive efficacy, effect duration and safety of the angiotensin II type 1 receptor blocker candesartan cilexetil and the angiotensin converting enzyme inhibitor enalapril once daily in patients with mild to moderate hypertension.A multicenter, randomised, double-blind parallel group study was performed in Finland, France, the Netherlands, Spain and Sweden. Three-hundred-and-ninety-five men and women in the age range 20-80 years with primary hypertension were randomised to an 8-week double-blind treatment period with either candesartan cilexetil 8-16 mg or enalapril 10-20 mg once daily, with forced dose titration after 4 weeks. Non-invasive ambulatory blood pressure…

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…

Chronic kidney disease as a cardiovascular risk factor.

: Chronic kidney disease (CKD) is a public health threat with impact in cardiovascular risk. All forms of cardiovascular disease and mortality are more common in CKD. Treatment of cardiovascular risk factors, hypertension, dyslipidemia and diabetes is essential for cardiovascular and kidney protection. CKD is a marker of high or very high cardiovascular risk and its presence require early treatment and specific goals. Lifestyle is a pivotal factor, stopping smoking, reducing weight in the overweight or obese, starting regular physical exercise and healthy dietary pattern are recommended. Office BP should be lowered towards 130/80 mmHg or even lower if tolerated with sodium restriction and s…

Efficacy in angiotensin receptor blockade: a comparative review of data with olmesartan

A range of angiotensin II receptor blockers (ARB) is available, and analyses suggest there are differences between agents in terms of antihypertensive efficacy and 24-hour blood pressure control.This review assesses the data comparing olmesartan with other ARBs in terms of blood pressure reductions, goal achievement, 24-hour control and speed of onset. Olmesartan seems to have a more favourable efficacy profile relative to standard doses of the ARBs used in comparative studies; results consistent with the high degree of blockade of the angiotensin II type 1 receptor for olmesartan.Taken together, there might be differences between ARBs regarding their blood pressure lowering efficacy, and …

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia…

Prevalencia de filtrado glomerular disminuido en la población española de edad avanzada. Estudio PREV-ICTUS

Fundamento y objetivo Estimar la prevalencia de filtrado glomerular (FG) disminuido ( Pacientes y metodo Se analizo el estudio PREV-ICTUS, realizado en una muestra de individuos de 60 anos o mas seleccionada aleatoriamente, estratificada por comunidades autonomas segun el censo y el habitat de atencion. Se recogieron datos demograficos, factores de riesgo y enfermedades cardiovasculares. Se calculo el FG utilizando la formula de MDRD (Modification of Diet in Renal Disease). Resultados En 6.799 individuos (edad media 71,9 anos; 53,6% mujeres; 72,9% con hipertension arterial [HTA]; 27,0% con diabetes mellitus [DM]; 24,3% con enfermedad cardiovascular), el 25,9% presento FG disminuido (interva…

Hypovolaemia-induced metabolic dysfunction, mediated in part by aldosterone and angiotensin

Response to Nondipping in Patients With Hypertension

We thank Ben-Dov and Bursztyn for their interest in our article1 and also for their positive feedback and criticism.2 We would like to try to answer directly to the 3 points raised in their letter. First, is siesta influencing the nocturnal BP dip? In the Spanish ambulatory blood pressure monitoring registry, the daytime period was calculated from the time of wake-up in the morning to the time of going to bed in the evening. However, in our opinion, 2 aspects minimize a possible …

European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring

Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physici…

Integrated care pathways for airway diseases (AIRWAYS-ICPs)

International audience; The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patien…

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions…

Losartan reduces microalbuminuria in hypertensive microalbuminuric type 2 diabetics.

Background. The aim of the present study was to assess the antialbuminuric effect of losartan in a large number of hypertensive type 2 diabetics. Methods. This was a 6-month, open-label, prospective and multicentre study. A total of 422 patients with type 2 diabetes who were hypertensive [sitting systolic blood pressure (SBP) > 140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg] and microalbuminuric [urinary albumin excretion (UAE) 30-300 mg/day] were eligible for the study. After a 2-week run-in period, patients were placed on losartan 50 mg once a day. If the BP did not reach the desired goal (<140/90 mmHg) after a 4-week period, the losartan dose was doubled. In the absence of contr…

Antioxidant Activities and Oxidative Stress Byproducts in Human Hypertension

The objective was to study oxidative status, antioxidant activities, and reactive oxygen species byproducts in whole blood and mononuclear peripherals cells and their relationship with blood pressure. Sixty-six hypertensive patients and 16 normotensive volunteers as a control group were studied. In both, whole blood and peripheral mononuclear cells oxidized/reduced glutathione ratio and malondialdehyde was significantly higher, and the activity of superoxide dismutase, catalase, and glutathione peroxidase was significantly lower in hypertensive patients when compared with normal subjects. The content of damaged base 8-oxo-2′-deoxyguanosine in nuclear and mitochondrial deoxyribonucleoprotein…

Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study

Background: Despite the epidemiological evidence about the relationship between diabetes, mortality and cardiovascular disease, information about the population impact of uncontrolled diabetes is scarce. We aimed to estimate the attributable risk associated with HbA1c levels for all-cause mortality and cardiovascular hospitalization.Methods: Prospective study of subjects with diabetes mellitus using electronic health records from the universal public health system in the Valencian Community, Spain 2008–2012. We included 19,140 men and women aged 30 years or older with diabetes who underwent routine health examinations in primary care.Results: A total of 11,003 (57%) patients had uncontrolle…

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.

Meta-analysis of blood pressure (BP) reductions with olmesartan medoxomil (OM) compared with active control (AC) in patients (pts) with hypertension (HTN)

Meta-analysis of blood pressure (BP) reductions with olmesartan medoxomil (OM) compared with active control (AC) in patients (pts) with hypertension (HTN) Josep Redon,y, 6 Prakash Deedwania, Kazuomi Kario, Jiguang Wang, Joris Versteden, Paul-Egbert Reimitz. Daiichi Sankyo Europe GmbH, Munich, Germany; Daiichi Sankyo Europe GmbH, Munich, Germany; Jichi University School of Medicine, Japan; Shanghai Institute of Hypertension, Shanghai, China; University of California San Francisco, San Francisco, CA, United States; University of Valencia, Madrid, Spain

Author response: Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

The Role of Ambulatory Blood Pressure Monitoring in Diagnosis of Hypertension and Evaluation of Target Organ Damage

The goal of blood pressure (BP) measurement in children and adolescents is to provide strategies for promoting cardiovascular health which should be integrated into a comprehensive pediatric health-care program. Blood pressure, however, is a parameter that changes on a beat-to-beat basis in response to a variety of physiological and environmental stimuli. Nevertheless, casual BP measurement has provided the basis for present knowledge of the potential risk associated with hypertension (1) and has guided patient management for many years (2). A few BP measurements obtained in the office, on the contrary, may not necessarily reflect the true BP of an individual. Subsequently, a better charact…

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

Oxidative stress and enzymatic antioxidant mechanisms in essential hypertension

Control de la presión arterial de los pacientes diabéticos en el ámbito de atención primaria. Estudio DIAPA

Fundamento y objetivo Conocer el control de la presion arterial (PA) en pacientes con diabetesmellitus (DM) visitados en atencion primaria (AP), y determinar los factores asociados a uncontrol suboptimo de la PA. Pacientes y metodo Estudio transversal y multicentrico. Noventa investigadores incluyeron a875 pacientes con DM (57,8% mujeres), con edad media (DE) de 64 (11,8) anos. La PA semidio segun las recomendaciones del Sexto Informe del Joint National Committee (JNC-VI) yde la Organizacion Mundial de la Salud/Sociedad Internacional de Hipertension (OMS/ISH),calculandose la media aritmetica de tres tomas sucesivas. Se considero hipertensos a los pacientescon diagnostico previo establecido,…

Twenty-four-hour ambulatory heart rate and organ damage in primary hypertension.

The relationship between basal heart rate (HR) and the occurrence of myocardial ischemia, sudden death, cardiovascular mortality have been described. Therefore, further studies are warranted to evaluate the behaviour of heart rate in different scenarios. We sought to determine whether ambulatory heart rate is associated with the presence of target organ damage (TOD) in hypertensive patients.Crossectional study of essential hypertensive patients in whom a twenty-four hour ambulatory blood pressure monitoring (ABPM) was performed. The relationship between TOD and 24 hour ambulatory heart rate (HR) was analyzed.Five hundred and sixty-six patients with arterial hypertension were included (55.8%…

Visit-to-visit blood pressure variability and renal outcomes: results from ONTARGET and TRANSCEND trials.

AIMS There is conflicting evidence on whether in treated hypertensive patients the risk of renal outcomes is associated with visit-to-visit SBP variability. Furthermore, limited evidence is available on how important is SBP variability for prediction of renal outcomes compared with on-treatment mean SBP. We addressed these issues in 28 790 participants of the Ongoing Treatment Alone and in combination with Ramipril Global End point Trial and Telmisartan Randomized Assessment Study in ace iNtolerant Subjects with Cardiovascular Disease trials. METHODS AND RESULTS SBP variability was expressed as the coefficient of variation of the mean with which it showed no relationship. SBP variability an…

Urine cadmium levels and albuminuria in a general population from Spain: A gene-environment interaction analysis

Background: The interaction of cadmium with genes involved in oxidative stress, cadmium metabolism and transport pathways on albuminuria can provide biological insight on the relationship between cadmium and albuminuria at low exposure levels. Objectives: We tested the hypothesis that specific genotypes in candidate genes may confer increased susceptibility to cadmium exposure. Methods: Cadmium exposure was estimated by inductively coupled plasma mass spectrometry (ICPMS) in urine from 1397 men and women aged 18–85years participating in the Hortega Study, a representative sample of a general population from Spain. Urine albumin was measured by automated nephelometric immunochemistry. Abnorm…

In the Identification of Cardiovascular Risk With the SCORE Model, Could We Recommend Its Calculation Interchangeably With Total Cholesterol or Atherogenic Index? Concordance Between Total Cholesterol and Atherogenic Index in the SCORE Table

The SCORE table indiscriminately recommends the use of total cholesterol (SCORE-TC) or atherogenic index (SCORE-AI) for calculating cardiovascular (CV) risk. We evaluated reliability and agreement between both methods and the clinical implications for the identification of high CV risk. Observational study (n = 8942) in a 40- to 65-year-old population. Spearman’s Rho correlation was 0.987 (P < .001), the agreement intraclass correlation coefficient was 0.671 (IC 95% 0.413–0.796; with Bland–Altman’s method, the average of the differences between models was 0.74. Kappa index was poor, 0.297 (P < .001) and positive specific agreement was 0.31. Discrepancies fitted individuals with high CV risk…

Is the Physician’s Behavior in Dyslipidemia Diagnosis in Accordance with Guidelines? Cross-Sectional Escarval Study

Background: Clinical inertia has been defined as mistakes by the physician in starting or intensifying treatment when indicated. Inertia, therefore, can affect other stages in the healthcare process, like diagnosis. The diagnosis of dyslipidemia requires $ 2 high lipid values, but inappropriate behavior in the diagnosis of dyslipidemia has only previously been analyzed using just total cholesterol (TC). Objectives: To determine clinical inertia in the dyslipidemia diagnosis using both TC and high-density lipoprotein cholesterol (HDL-c) and its associated factors. Design: Cross-sectional. Setting: All health center visits in the second half of 2010 in the Valencian Community (Spain). Patient…

Reversible posterior leukoencephalopathy secondary to indinavir-induced hypertensive crisis: A case report

Reversible posterior leukoencephalopathy syndrome (RPLS) is an uncommon entity related to multiple and different pathologies, the most common being hypertensive crisis. It is believed to be secondary to the breakdown on the blood-brain barrier. At the beginning, it is undistinguishable from other leukoencephalopathies. However, the disappearance of brain lesions after removal of the potential cause, establish the differential diagnosis with other leukoencephalopathies. We present the case of an HIV-infected patient with a RPLS related to a hypertensive crisis short after the initiation of indinavir-containing highly active antiretroviral therapy. Once blood pressure was controlled and indin…

Analysis of LDL and HDL size and number by nuclear magnetic resonance in a healthy working population: The LipoLab Study

Background and aim Atherosclerosis is the underlying process in cardiovascular disease (CVD), the first cause of death in developed countries. We aimed to identify people with no known CVD and normal values of LDL-C and HDL-C, but with alterations in the number and size of lipoprotein particles (as measured by nuclear magnetic resonance [NMR]) and to analyse their sociodemographic, clinical and biochemical characteristics. Methods Cross-sectional study in occupational risks prevention centre in Castellon (Spain) in 2017 and 2018, in consecutively recruited adults (18-65 years) with no known CVD. Sociodemographic, clinical and biochemical variables were collected. Lipid profiles were analyse…

Obesity and cardiovascular risk

: Obesity is a key factor for cardiovascular diseases and complications. Obesity is associated with hypertension, dyslipidemia and type II diabetes, which are the major predictors of cardiovascular disease in the future. It predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke that are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise,…

Controversies in blood-pressure goals among the elderly

The optimal blood-pressure (BP) goals for elderly patients remain inconclusive, despite the recent publication of meta-analyses comparing intensive BP control with standard BP control. In searching for therapeutic approaches in these patients, researchers should change the focus from optimal BP values to a more holistic, individual approach.

Response to Timing of Antihypertensive Therapy and Circadian Blood Pressure Pattern

We thank Almirall et al1 for their interest in our article.2 In the present answer to their letter, we provide data from the Spanish Ambulatory Blood Pressure Monitoring Registry regarding clinical differences among patients depending on the time that they received their medication (Table). As shown, several differences were evident among groups, with respect to age, duration of hypertension, prevalence of diabetes mellitus, and history of …

Supervised Analysis for Phenotype Identification: The Case of Heart Failure Ejection Fraction Class

Artificial Intelligence is creating a paradigm shift in health care, with phenotyping patients through clustering techniques being one of the areas of interest. Objective: To develop a predictive model to classify heart failure (HF) patients according to their left ventricular ejection fraction (LVEF), by using available data from Electronic Health Records (EHR). Subjects and methods: 2854 subjects over 25 years old with a diagnosis of HF and LVEF, measured by echocardiography, were selected to develop an algorithm to predict patients with reduced EF using supervised analysis. The performance of the developed algorithm was tested in heart failure patients from Primary Care. To select the mo…

Impact of the components of metabolic syndrome on oxidative stress and enzymatic antioxidant activity in essential hypertension.

The objective of the present study was to analyze the impact of metabolic syndrome (MS) and its individual components on oxidative stress (OX) and on the activity of antioxidant enzymes of patients with essential hypertension. One hundred and eighty-seven hypertensives, 127 (61.9%) of them having criteria for MS according to the International Diabetes Federation criteria and 30 healthy normotensive subjects were included. OX status was assessed by measuring glutathione oxidized/glutathione reduced and reactive oxygen species-induced byproducts of lipid peroxidation, malondialdehide, and DNA damage, 8-oxo-dG genomic and mitochondrial. Antioxidant enzymatic activity of Cu/Zn extracellular-sup…

Inadequate Cytoplasmic Antioxidant Enzymes Response Contributes to the Oxidative Stress in Human Hypertension

Untreated hypertensive patients show increased oxidative stress and decreased antioxidant enzyme activity in mononuclear cells. Therefore, the objective of this study was to determine whether or not the low antioxidant enzyme activity observed in mononuclear cells of hypertensive subjects is in part dependent on a defective activity of antioxidant mechanisms. Activity and mRNA level of antioxidant enzymes, CuZn- and Mn-superoxide dismutases, catalase, glutathione peroxidase type 1, and glutathione reductase were simultaneously measured in mononuclear cells of controls (n = 38) and hypertensive subjects (n = 35), in the absence of and during antihypertensive treatment. An increase in oxidati…

En la identificación del riesgo cardiovascular con el modelo SCORE, ¿se puede recomendar su cálculo indistintamente con colesterol total o índice aterogénico? Concordancia entre el colesterol total y el índice aterogénico en la tabla SCORE

Resumen La escala SCORE recomienda indistintamente dos metodos para el calculo del riesgo cardiovascular: uso de colesterol total (CT) o del indice aterogenico (IA). Se evalua la correlacion entre ambos y la concordancia en la identificacion del riesgo cardiovascular elevado. Estudio observacional en poblacion de 40-65 anos. Se calcula el coeficiente de correlacion intraclase (CCI) de acuerdo, el metodo de Bland-Almand (MBA) y el indice Kappa (IK). El CCI intraclase fue de 0,671 (intervalo del confianza [IC] del 95%, 0,413-0,796; p

Exposure to non-essential metals and albuminuria: exploring causal associations under a Mendelian randomization framework

Sympathetic neural activity, metabolic parameters and cardiorespiratory fitness in obese youths.

OBJECTIVE: The main objective of this cross-sectional study is to assess the cardiac autonomic neural activity in the presence of abnormally increased body weight in youths and its relationship to metabolic risk factors and cardiorespiratory fitness (CRF). METHODS: Sixty-four overweight and obese patients, aged 9-17 years, of both sexes, stratified according to the international BMI cut-off, were enrolled. Continuous ECG was recorded during 15 min in resting conditions, and the heart rate variability (HRV) was measured in the time domain, frequency domain and for nonlinear dynamics. In addition, cardiometabolic risk factors and CRF in effort conditions were assessed. RESULTS: Among the over…

Evidences from Clinical Trials and Use of Antihypertensive Drugs in Children and Adolescents

In adults, when prescribing antihypertensive therapy, decisions regarding the choice of agent can be based upon evidence from clinical trials in large numbers of subjects, many of these having compared one class of agent with another. Whilst increased emphases on conducting drug trials in children and adolescents over the past 25 years have yielded important advances, and have tested the efficacy and safety of the various classes of antihypertensive agents, there remains a general lack of high quality long-term outcome data to guide choice of drug therapy for pediatricians managing HTN. As of today, certain clinical trials in children and adolescents have established the pharmacokinetics, p…

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…

Control de la hipertensión arterial basado en la automedición ambulatoria de la presión arterial: Estudio APACHE

Fundamento y objetivo: El objetivo del presente trabajo fue determinar el grado de control de la hipertension en una amplia poblacion de hipertensos tratados con farmacos antihipertensivos mediante el uso de la automedida domiciliaria de la presion arterial (PA). Ademas se estudio si el grado de control variaba a las diferentes horas del dia en las que se realizaba dicha medicion. Pacientes y metodo: Se estudio a 9.227 sujetos, de los que 4.398 eran varones. La edad media (DE) fue de 61,0 (11,4) anos, y el indice de masa corporal medio, de 28,4 (4,1) kg/m2. Los pacientes que debian estar diagnosticados de hipertension arterial y con tratamiento farmacologico estable al menos desde un mes an…

Trace elements and plasma metabolomics in a general population from Spain: The Hortega Study

Improving Knowledge of Arterial Resistant Hypertension: What Is Relevant?

Resistant hypertension, also known as refractory hypertension in the literature, is a relatively common disease that is associated with elevated cardiovascular and renal risk. Clinical trials suggest that its prevalence is around 35% in hypertensive patients with a baseline blood pressure (BP) > 160/100 mmHg. However, data obtained from registries or from the physician’s office suggest that its prevalence is around 12%. The recent National Health and Nutrition Examination Survey suggests a similar prevalence of 12.3% in diagnosed and treated hypertensive patients. An incidence study conducted at Kaiser Permanente Colorado and Kaiser Permanente Northern California followed up more than 200 0…

Obesity modifies the relationship between ambulatory blood pressure and natriuresis in children

The objective in the present study was to evaluate if obesity beginning in the first two decades of life influences the relationship between ambulatory blood pressure and urinary sodium excretion.Eighty-five obese and 88 non-obese children aged 3-19 years were included in the study. For each subject, a 24h ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. The averages of ambulatory blood pressure and of the urinary excretion rates for sodium, potassium and creatinine were calculated separately for 24-h, awake and sleep periods as defined by a mini-diary.Weight and sodium excretion are directly associated w…

Increased plasma xanthine oxidase activity is related to nuclear factor kappa beta activation and inflammatory markers in familial combined hyperlipidemia

Abstract Background and aims Xanthine oxidase (XO) has been described as one of the major enzymes producing free radicals in blood. Oxidative stress and inflammatory processes have been implicated in the pathogenesis of endothelial dysfunction and the progression of atherosclerosis but until now, there is little data about the influence of vascular prooxidant systems and inflammation in familial combined hyperlipidemia (FCH). Our goal was to evaluate whether XO activity was altered in FCH and if it was related to the inflammatory process represented by NFkB, IL-6 and hsCRP, and assessing the correlation between XO activity and insulin resistance (IR). Method and results 40 Non-related subje…

Risperidone and severe cerivastatin-induced rhabdomyolysis

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 …

Arsenic exposure, diabetes-related genes and diabetes prevalence in a general population from Spain.

Inorganic arsenic exposure may be associated with diabetes, but the evidence at low-moderate levels is not sufficient. Polymorphisms in diabetes-related genes have been involved in diabetes risk. We evaluated the association of inorganic arsenic exposure on diabetes in the Hortega Study, a representative sample of a general population from Valladolid, Spain. Total urine arsenic was measured in 1,451 adults. Urine arsenic speciation was available in 295 randomly selected participants. To account for the confounding introduced by non-toxic seafood arsenicals, we designed a multiple imputation model to predict the missing arsenobetaine levels. The prevalence of diabetes was 8.3%. The geometric…

Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults

© 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model …

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

The Role of ABPM in Evaluation of Hypertensive Target-Organ Damage

Casual blood pressure measurement has provided the basis for the present knowledge of the potential risk associated with hypertension and has guided patient management for many years. The possibility of carrying out repeated ambulatory blood pressure measurements using automatic or semiautomatic devices allows for the gathering of more representative values of blood pressure and for observing the behavior of blood pressure during both moments of activity as well as rest. Ambulatory blood pressure measurement is now increasingly recognized as being indispensable to the diagnosis and management of hypertension, and it has contributed significantly to our understanding of hypertension. Likewis…

Clinical inertia in diagnosis and treatment of hypertension in primary care: Quantification and associated factors

The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables.Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to ide…

Birth weight modifies pulse pressure in children and adolescents

Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure

Aims The aim of the present study was to extend our understanding of international trends in stroke and major sequelae in Europe and countries peripheral to Europe by assessing: (1) current mortality rates, (2) the most recent 15-year prevalence trends, and (3) the relationship between systolic blood pressure in community surveys and national stroke mortality. Methods and results Data were obtained from the World Health Organization (WHO [www.who.int/whosis/database/mort/table.cfm][1]), and represent national vital statistics as reported by 39 countries (European and Central Asian countries) using a standard format and population-based cardiovascular surveys. Total numbers of deaths by stro…

OASIS-HT: design of a pharmacogenomic dose-finding study.

Experimental evidence and observations in humans strongly support an interactive role of mutated α-adducin, sodium (Na+)/potassium (K+)-adenosine triphosphatase (ATPase) activity and endogenous ouabain in Na+homeostasis and the pathogenesis of hypertension. The Ouabain and Adducin for Specific Intervention on Sodium in HyperTension (OASIS-HT) trial is an early Phase II dose-finding study, which will be conducted across 39 European centers. Following a run-in period of 4 weeks without treatment, eligible patients will be randomized to one of five oral doses of rostafuroxin consisting of 0.05, 0.15, 0.5, 1.5, or 5.0 mg/day. Each dose will be compared to a placebo in a double-blind crossover e…

Polymorphisms of the renin-angiotensin system influence height in normotensive women in a Spanish population.

The objective of this study was to analyze the influence of the polymorphisms G-6A of the angiotensinogen gene, insertion/deletion (I/D) of the angiotensin-converting enzyme, and C573T of the angiotensin II AT1 receptor gene on a healthy, middle-age population. A total of 370 (194 women) healthy normotensive Caucasian subjects, aged 25-50 yr old, were selected from the general population. A significant association was found between height and the C573T polymorphism in women (P0.001). After adjustment for age, this association remained significant (P0.002). Thus, the lowest height values were from subjects carrying TT genotype (CC, 1.627 +/- 0.008 m; CT, 1.595 +/- 0.006 m; TT, 1.586 +/- 0.01…

The normal circadian pattern of blood pressure: implications for treatment

Blood pressure fluctuates over 24 h following a circadian rhythm that reaches a peak in the morning shortly after awakening. The onset of many acute cardiovascular and cerebrovascular events shows a synchronous cyclical pattern, with the highest incidence of morbidity and mortality in the early morning hours. Strong, although circumstantial, evidence suggests that the early morning surge in blood pressure may contribute to the onset of acute cardiovascular episodes. Sustained blood pressure control that blunts the early morning blood pressure surge may help to reduce the incidence of these events. Antihypertensive agents are needed that provide smooth and sustained blood pressure control fo…

Gender differences related to the presence of atrial fibrillation in older hypertensive patients

AIM: To determine whether there are gender differences in the epidemiological profile of atrial fibrillation (AF) and to characterise the clinical, biochemical, and therapeutic factors associated with AF. METHODS: Each investigator (primary care physicians or physicians based in hospital units for hypertension treatment) recruited the first 3 patients with an age of ≥ 65 years and a clinical diagnosis of hypertension (ambulatory blood pressure monitoring and an electrocardiogram, were performed) on the first working day of the week for 5 wk and identified those individuals with atrial fibrillation. A binary logistic regression was performed, including all of the variables that were signific…

Urinary levels of sirtuin-1 associated with disease activity in lupus nephritis.

Identifying new markers of disease flares in lupus nephritis (LN) that facilitate patient stratification and prognosis is important. Therefore, the aim of the present study was to analyze whether urinary SIRT1 expression was altered in LN and whether SIRT1 values in urine could be valuable biomarker of disease activity. In a cohort study, urinary pellets from 40 patients diagnosed with systemic lupus erythematosus (SLE) were analyzed. Clinical measures of lupus activity were assessed. The expression of SIRT1 was quantified by quantitative PCR (qRT-PCR) and immunoblot, then compared between patients with active lupus nephritis, in remission and healthy controls. Association with lupus activi…

Genetic variation and urine cadmium levels: ABCC1 effects in the Strong Heart Family Study

Abstract Genetic effects are suspected to influence cadmium internal dose. Our objective was to assess genetic determinants of urine cadmium in American Indian adults participating in the Strong Heart Family Study (SHFS). Urine cadmium levels and genotyped short tandem repeat (STR) markers were available on 1936 SHFS participants. We investigated heritability, including gene-by-sex and smoking interactions, and STR-based quantitative trait locus (QTL) linkage, using a variance-component decomposition approach, which incorporates the genetic information contained in the pedigrees. We also used available single nucleotide polymorphisms (SNPs) from Illumina’s Metabochip and custom panel to ass…

Left Ventricular Hypertrophy in the Spanish Hypertensive Population. The ERIC-HTA Study

Introduction and objectives. Left ventricular hypertrophy (LVH) is the earliest manifestation of cardiac damage in hypertension. Its appearance is associated with a poor cardiovascular prognosis. The objectives of this study were to determine the prevalence of electrocardiographic LVH and to assess the epidemiological characteristics of hypertensive patients receiving primary care. Patients and method. A cross-sectional multicenter study of hypertensive patients aged 55 years or more was carried out in a primary care setting. Blood pressure was measured using the standard method. Cardiovascular history was determined from medical records and LVH was assessed electrocardiographically using C…

European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement

IntroductionOver the past 20 years or so, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white-coat hype

Niveles de complejidad asistencial en pacientes con códigos diagnósticos de insuficiencia cardiaca en una población

Assessment of blood pressure early morning rise

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/…

Differential prognostic effect of systolic blood pressure on mortality according to left-ventricular function in patients with acute heart failure.

Aims To evaluate the relationship between systolic blood pressure (SBP) and long-term mortality in patients with acute heart failure (AHF) stratified by ejection fraction (LVEF): reduced (≤40%) vs. preserved (≥50%). Methods and results We studied 1049 consecutive patients admitted with AHF. Systolic blood pressure was determined in the emergency department. Left-ventricular ejection fraction was categorized as ≤40% (n = 288), 41–49% (n = 174), or ≥50% (n = 587). Cox regression analysis was used for multivariable analysis. Mean age and SBP were 73 ± 11 years and 150 ± 36 mmHg, respectively. During a median follow-up of 18 months, 290 deaths (33.1%) were identified. Higher SBP was associated …

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).

Spanish Society of Hypertension position statement on the 2017 ACC/AHA hypertension guidelines

The American College of Cardiology (ACC) and the American Heart Association (AHA) have recently published their guidelines for the prevention, detection, evaluation, and management of hypertension in adults. The most controversial issue is the classification threshold at 130/80 mmHg, which will allow a large number of patients to be diagnosed as hypertensive who were previously considered normotensive. Blood pressure (BP) is considered normal (&lt;120 mmHg systolic and &lt;80 mmHg diastolic), elevated (120-129 and &lt;80 mmHg), stage 1 (130-139 or 80-89 mmHg), and stage 2 (≥140 or ≥90 mmHg). Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titra…

Differences in blood pressure control and stroke mortality across Spain: the Prevención de Riesgo de Ictus (PREV-ICTUS) study.

The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population &gt;60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score. Mortality rates of stroke, age and sex adjusted, were obtained for each of the autonomic communities from the Ministry of Health. A total of 7343 subjects (mean age: 71.6 years, 53.4% women, 34.4% obese…

Current and birth weights exert independent influences on nocturnal pressure-natriuresis relationships in normotensive children.

The objective was to study the impact of birth weight on the relationship between ambulatory blood pressure and urinary sodium excretion in children and adolescents. The study included 134 healthy children (61 boys), all Caucasians, who were born at term after a normotensive pregnancy. For each subject, a 24-hour ambulatory blood pressure monitoring and a complete urine collection were simultaneously performed according to the protocols designed. Average ambulatory blood pressure (BP) and the urinary excretion rates for sodium, potassium, and creatinine were calculated separately for 24-hour, awake, and sleep periods defined by a mini-diary. The excretion rate of sodium during sleep time w…

Additional file 1 of Healthy lifestyle, metabolomics and incident type 2 diabetes in a population-based cohort from Spain

Additional file 1. Additional findings that further support and/or give further detail to the main results.

SARS‐CoV‐2‐reactive interferon‐γ‐producing CD8+ T cells in patients hospitalized with coronavirus disease 2019

Abstract There is limited information on severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) T‐cell immune responses in patients with coronavirus disease 2019 (COVID‐19). Both CD4+ and CD8+ T cells may be instrumental in resolution of and protection from SARS‐CoV‐2 infection. Here, we tested 25 hospitalized patients either with microbiologically documented COVID‐19 (n = 19) or highly suspected of having the disease (n = 6) for presence of SARS‐CoV‐2‐reactive CD69+ expressing interferon‐γ (IFN‐γ) producing CD8+ T cells using flow‐cytometry for intracellular cytokine staining assay. Two sets of overlapping peptides encompassing the SARS‐CoV‐2 Spike glycoprotein N‐terminal 1 to 643 am…

Evaluación del riesgo de un primer ictus en la población hipertensa española en atención primaria. Estudio ERIC-HTA

Fundamento y objetivo El accidente cerebrovascular (ictus) es una de las principales causas de morbilidad y mortalidad en la poblacion hipertensa. El objetivo de este estudio es estimar el riesgo a 10 anos de experimentar un primer ictus en la poblacion hipertensa espanola aplicando la escala de Framingham. Pacientes y metodo Estudio transversal y multicentrico realizado en centros de atencion primaria de Espana que incluyo a pacientes hipertensos de 55 o mas anos (10 pacientes consecutivos por medico). Se midio la presion arterial (PA) conforme a las normas estandarizadas. Los riesgos se estimaron aplicando las tablas de Framingham para riesgo de ictus y para riesgo de enfermedad coronaria…

Effectiveness of an Interventional Program to Improve Blood Pressure Control in Hypertensive Patients at High Risk for Developing Heart Failure: HEROIC study.

J Clin Hypertens (Greenwich). The Efectividad de un Programa de Intervencion en el Control de la Presion Arterial de los Hipertensos en Riesgo de Desarrollar Insuficiencia Cardiaca (HEROIC) study was designed to assess whether an educational program for primary care physicians could improve blood pressure (BP) control in hypertensive patients at high risk for developing heart failure. The program contained a combination of educational training (live group sessions or online training) and information feedback. Two hundred twenty-six physicians completed the program and provided valid data in 2489 patients before and 2168 after 1 year. There was a small but significant reduction of −1.1 mm Hg…

A century of trends in adult human height

Article

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

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 …

Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort

Abstract Aims To estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes. Methods A prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated. Results Mean follow-up was 3.2…

Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants

Copyright © NCD Risk Factor Collaboration. Open Access article distributed under the terms of CC BY.

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…

Factores que influyen en la diferencia de medida de presión arterial entre el método auscultatorio y el oscilométrico

Fundamento y objetivo El metodo auscultatorio mediante esfigmomanometro de mercurio esta siendo sustituido por otros metodos de medida de presion arterial, de los que el mas utilizado es el oscilometrico. Se analiza las posibles discrepancias de medida entre ambos metodos y los factores que influyen en ellas. Material y metodo Se obtuvieron medidas de presion arterial (PA) mediante esfigmomanometro de mercurio, con un monitor Spacelabs, en el mismo brazo y mediante un metodo secuencial. La relacion entre ambas medidas se analizo mediante los coeficientes de correlacion de Pearson y el metodo de Bland y Altman. Se calcularon las diferencias entre ambos metodos de medida. Se analizo los facto…

Microalbuminuria and oxidative stress in essential hypertension

. Objective.  To assess the relationship between microalbuminuria and oxidative stress in mononuclear peripherals cells in essential hypertension. Methods.  A total of 123 hypertensive patients in absence of antihypertensive treatment were included. A 24-h ambulatory blood pressure (BP) monitoring was performed using a Spacelabs 90207 monitor, and microalbuminuria was measured in 24-h urine collections. Oxidized/reduced glutathione ratio and the content of malondialdehide and damaged base 8-oxo-2′-deoxyguanosine in genomic and mitochondrial DNA were measured in peripheral mononuclear cells. Results.  In the 29 (24%) microalbuminuric subjects, the amount of reduced glutathione was significan…

Prevalencia de sobrepeso y obesidad en población española de 60 años o más y factores relacionados. Estudio PREV-ICTUS

Fundamento y objetivo: Los datos sobre prevalencia de obesidad en poblacion de edad avanzada en Espana son escasos. El objetivo de este trabajo ha sido describir la prevalencia de obesidad y los factores relacionados en una muestra aleatoria de la poblacion espanola de 60 anos o mas, estratificada por comunidades autonomas (CC.AA.). Sujetos y metodo: Se analizo el estudio PREV-ICTUS, realizado en una muestra seleccionada aleatoriamente entre septiembre y diciembre de 2005, estratificada por CC.AA. segun el censo y el habitat de atencion. Se clasifico a los sujetos segun su indice de masa corporal (IMC) en aquellos con peso normal (IMC < 25), sobrepeso (IMC de 25-29,9) y obesos (IMC $ 30). R…

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…

Healthy lifestyle, metabolomics and incident type 2 diabetes in a population-based cohort from Spain

This work was supported by the Strategic Action for Research in Health sciences [PI10/0082, PI13/01848, PI14/00874, PI16/01402, PI11/00726, PI16/609, PI16/1512, PI18/287, PI19/319 and PI20/00896], the GUTMOM Project (JPI-A Healthy Diet for a Healthy Life INTIMIC-085, State Secretary of R + D + I PCIN-2017-117), the Cátedra de Epidemiología y Control del Riesgo Cardiovascular at UAM (#820024), the State Agency for Research (PID2019-108973RB-C21 and C22), the Valencia Government (GRUPOS 03/101; PROMETEO/2009/029 and ACOMP/2013/039), the Castilla-Leon Government (GRS/279/A/08) and European Network of Excellence Ingenious Hypercare (EPSS- 037093) from the European Commission; CIBER Fisiopatolog…

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 …

Rabphilin involvement in filtration and molecular uptake in Drosophila nephrocytes suggests a similar role in human podocytes

ABSTRACT Drosophila nephrocytes share functional, structural and molecular similarities with human podocytes. It is known that podocytes express the rabphilin 3A (RPH3A)-RAB3A complex, and its expression is altered in mouse and human proteinuric disease. Furthermore, we previously identified a polymorphism that suggested a role for RPH3A protein in the development of urinary albumin excretion. As endocytosis and vesicle trafficking are fundamental pathways for nephrocytes, the objective of this study was to assess the role of the RPH3A orthologue in Drosophila, Rabphilin (Rph), in the structure and function of nephrocytes. We confirmed that Rph is required for the correct function of the en…

Meta-analysis of olmesartan medoxomil (OM) monotherapy in reducing blood pressure (BP) in elderly patients with hypertension (HTN)

Meta-analysis of blood pressure (BP) reductions with olmesartan medoxomil (OM) compared with active control (AC) in patients (pts) with hypertension (HTN) Josep Redon,y, 6 Prakash Deedwania, Kazuomi Kario, Jiguang Wang, Joris Versteden, Paul-Egbert Reimitz. Daiichi Sankyo Europe GmbH, Munich, Germany; Daiichi Sankyo Europe GmbH, Munich, Germany; Jichi University School of Medicine, Japan; Shanghai Institute of Hypertension, Shanghai, China; University of California San Francisco, San Francisco, CA, United States; University of Valencia, Madrid, Spain

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].

The influence of hemoglobin A1c levels on cardiovascular events and all-cause mortality in people with diabetes over 70 years of age. A prospective study

Abstract Aim Glycated hemoglobin A1c (HbA1c) is a reliable risk factor of cardiovascular diseases in diabetic patients, but information about this relationship in elderly patients is scarce. The aim of this study is to analyze, the relationship between HbA1c levels and the risk of mayor adverse cardiovascular events (MACE) in patients with diabetes over 70 years. Methods Prospective study of subjects with diabetes using electronic health records from the universal public health system in the Valencian Community, Spain, 2008–2012. We included men and women aged ≥ 70 years with diabetes who underwent routine health examinations in primary care. Primary endpoint was the incidence of MACE: all-…

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.

Effects of nebivolol and atenolol on central aortic pressure in hypertensive patients: a multicenter, randomized, double-blind study.

The main objective was to compare the mean change in augmentation index of hypertensive patients treated with nebivolol or atenolol.Multicenter, double-blind randomized study conducted in six Spanish centers. We enrolled outpatients between the ages of 40 and 65 years with mild or moderate essential hypertension (systolic blood pressure, SBP ≥ 140 mmHg to ≤ 179 mmHg and diastolic blood pressure, DBP ≥ 90 mmHg to ≤ 109 mmHg after a 2-week run-in placebo period). Patients received nebivolol 5 mg or atenolol 50 mg once daily. At week 3, atenolol could be titrated up to 100 mg qd for non-responders. Additionally, patients not achieving normal blood pressure after 6 weeks could be treated with 2…

Declining exposures to lead and cadmium contribute to explaining the reduction of cardiovascular mortality in the US population, 1988-2004.

Background Lead and cadmium exposures have markedly declined in the USA following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated the potential contribution of lead and cadmium exposure reductions to explain decreasing cardiovascular mortality trends occurring in the USA from 1988-94 to 1999-2004. Methods Prospective study in 15 421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988-94 or 1999-2004. We estimated the amount of change in cardiovascular mortality over time that can be independently attributed to the intermedia…

Antioxidant enzymes in lymphocites from essential hypertension patients

Environmental metals and metal mixtures and renal disease in an adult population from Spain: the Aragon Workers Health Study

Reduction in aortic compliance in adolescents with suboptimal intrauterine growth

First-year blood pressure increase steepest in low birthweight newborns.

The present research has been undertaken prospectively to study the impact of birthweight and growth pattern on blood pressure changes from birth through the first year of life.Parents of newborns born at term (gestational age37 weeks) after uncomplicated pregnancies and in the absence of perinatal illness were randomly invited to allow their children to participate in the study. One hundred and forty-nine (84 male and 65 female) newborns were included in the present analysis. The newborns were divided into four groups according to birthweight:2500 g (n = 23); 2500-2999 g (n = 39); 3000-3500 g (n = 48); and3500 g (n = 39).At birth systolic and diastolic blood pressure were significantly low…

DNA methylation patterns in newborns exposed to tobacco in utero

[Background] Maternal smoking during pregnancy is a major risk factor for adverse health outcomes. The main objective of the study was to assess the impact of in utero tobacco exposure on DNA methylation in children born at term with appropriate weight at birth.

Concordancia de las escalas REGICOR y SCORE para la identificación del riesgo cardiovascular alto en la población española

Introduction. The aims of this study were to evaluate the consistency between the SCORE (Systematic Coronary Risk Evaluation) and REGICOR (Registre Gironi del Cor) scales in identifying high cardiovascular risk and to describe the characteristics of those individuals for whom scale results were discrepant. Methods. This cross-sectional study involved 8942 subjects aged 40-65 years who had an indication for a complete lipid profile. The agreement between SCORE (for low-risk countries) and Framingham-REGICOR (with a high risk threshold of 10%) scales in classifying patients as high risk was evaluated using the kappa statistic. Subjects for whom there was a discrepancy between classifications …

Reproducibility of ambulatory blood pressure monitoring in children

Co-detection of respiratory pathogens in patients hospitalized with Coronavirus viral disease-2019 pneumonia.

ABSTRACTThere is scarce information on the frequency of co-detection of respiratory pathogens (RP) in patients with Covid-19. Documentation of coinfections in Covid-19 pneumonia patients may be relevant for appropriate clinical and therapeutic management of patients. Between March 4th and March 28th, 2020, a total of 183 adult patients testing positive by SARS CoV-2 RT-PCR on respiratory specimens were hospitalized with interstitial pneumonia at our center, of whom 103 were tested for other RP by a multiplexed PCR assay. Three patients had a positive result for either one (n=2; Coronavirus HKU1 or Mycoplasma pneumoniae) or two targets (n=1; Influenza virus A (H3) and Respiratory syncytial v…

Adaptive immune responses to SARS-CoV-2 in recovered severe COVID-19 patients

ABSTRACTObjectivesThere is an imperative need to determine the durability of adaptive immunity to SARS-CoV-2. We enumerated SARS-CoV-2-reactive CD4+ and CD8+ T cells targeting S1 and M proteins and measured RBD-specific serum IgG over a period of 2-6 months after symptoms onset in a cohort of subjects who had recovered from severe clinical forms of COVID-19.MethodsWe recruited 58 patients (38 males and 20 females; median age, 62.5 years), who had been hospitalized with bilateral pneumonia, 60% with one or more comorbidities. IgG antibodies binding to SARS-CoV-2 RBD were measured by ELISA. SARS-CoV-2-reactive CD69+-expressing-IFNγ-producing-CD4+ and CD8+ T cells were enumerated in heparinize…

'Pulmonary thrombosis in situ': risk factors, clinic characteristics and long-term evolution.

: Pulmonary embolism typically occurs from deep venous thrombosis (DVT). However, not always a DVT can be identified, and 'in situ' generation of pulmonary embolism has been considered, referred to in the literature as 'De novo pulmonary embolism' (DNPE). The objective of the study is to assess risk factors, comorbidities, clinic characteristics and long-term evolution of patients with pulmonary embolism in the absence of an identified source. Retrospective study of 280 patients with pulmonary embolism, 190 pulmonary embolisms with DVT group and 90 (32%) pulmonary embolism without DVT (DNPE group), admitted to an Internal Medicine Department of a tertiary hospital from January 2012 to Decem…

Oxidative stress and early organ damage in essential hypertension

Identifying poor cardiorespiratory fitness in overweight and obese children and adolescents by using heart rate variability analysis under resting conditions.

Background: Childhood obesity, including overweight, continues increasing worldwide affecting health expectancy, quality of life and healthcare expenditure. These subjects have higher probability of suffering or developing cardio metabolic risk factors. Recent studies have revealed cardiorespiratory fitness (CRF) as a valuable clinical parameter to identify these subjects and have even suggested cut-off values. However, evaluating CRF in overweight and obese youth can be difficult to implement, unfriendly and expensive. Objective: Develop a screening tool to identify high-risk subjects in a representative population of those attending overweight/obesity assessment programmes without prior i…

Colesterol HDL y enfermedad cardiovascular en mujeres hipertensas de España. Estudio RIMHA

Introduccion y objetivos. Evaluar la prevalencia de concentracion baja de colesterol de las lipoproteinas de alta densidad (cHDL), los factores asociados y la relacion con la enfermedad cardiovascular (ECV), en 11.042 mujeres hipertensas de 55 o mas anos de edad. Metodos. Analisis del estudio transversal RIMHA. Se recogieron datos demograficos, bioquimicos, y clinicos. Se analizo la relacion entre cHDL bajo (< 46 mg/dl) y ECV, y entre concentracion de cHDL (quintiles) y ECV mediante modelos multivariables de regresion logistica. Resultados. La prevalencia de cHDL bajo fue del 24,3% (intervalo de confianza [IC] del 95%, 23,5-25,1), y fue mayor en mujeres diabeticas o con ECV. El cHDL bajo se…

Morbidity and mortality on combination versus monotherapy in the Systolic Hypertension in Europe Trial

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…

Thrombocytopenia Associated With Levodopa Treatment

Birth weight impacts on wave reflections in children and adolescents.

The objective of the present study was to assess central aortic pressure and wave reflection in children and adolescents at different birth weights. Two hundred nineteen healthy children (126 girls), from 7 to 18 years of age (mean, 11.3 years) and born at term after a normotensive pregnancy, were included. The subjects were divided according to birth weight: &lt;2.5 kg, from 2.5 to 2.999 kg, from 3.0 to 3.5 kg, and &gt;3.5 kg. Pressure waveforms were recorded from the radial artery of the wrist, and the waveform data were then processed by the SphygmoCor radial/aortic transform software module to produce the estimated aortic pressure waveform. Augmentation index, an estimate of the pulse …

Birth Weight Influences Blood Pressure Values and Variability in Children and Adolescents

The objective of the present study was to assess the relationships between birth weight and the values and variability of ambulatory blood pressure. Six hundred thirty healthy children (369 girls) age 4 to 18 years (mean, 9.9 years) born at term after a normotensive pregnancy were included. The subjects were divided into 5 groups according to birth weight. For each subject, a 24-hour ambulatory blood pressure monitoring was performed according to the protocol designed. Average and variability (estimated as the standard deviation) of ambulatory blood pressure and heart rate were calculated separately for 24-hour, daytime, and nighttime periods. When values were adjusted for gender, current …

SARS-CoV-2-reactive interferon-γ-producing CD8+ T cells in patients hospitalized with Coronavirus viral disease-2019

There is limited information on SARS-CoV-2 T-cell immune responses in patients with Covid-19. Both CD4+ and CD8+ T cells may be instrumental in the resolution of and protection from SARS-CoV-2 infection. Here, we tested 25 hospitalized patients with either microbiologically documented Covid-19 (n=19) or highly suspected of having the disease (n=6) for the presence of SARS-CoV-2-reactive- CD69+-expressing interferon-gamma;-producing-(IFN-gamma;) CD8+ T cells by a flow-cytometry for intracelular cytokine staining assay. Two sets of overlapping peptides encompassing the SARS-CoV-2 Spike glycoprotein N-terminal 1-643 amino acid sequence and the entire sequence of SARS-CoV-2 M protein were used …

Guías para el diagnóstico, la evaluación y el tratamiento de la hipertensión arterial: el punto de vista de la Sociedad Española de Hipertensión

Gender-related differences in serum uric acid in treated hypertensive patients from central and east European countries: findings from the Blood Pressure control rate and CArdiovascular Risk profilE study.

OBJECTIVE: Hyperuricemia has been associated with high blood pressure (BP) values, diabetes mellitus, metabolic syndrome and chronic kidney disease (CKD). In the present study, we assessed the gender-related relationships between serum uric acid (SUA) and cardionephrometabolic variables in central and east European hypertensive patients. METHODS: A total of 3206 treated hypertensive patients with available SUA levels from the BP-CARE study was analyzed. Correlations among SUA, BP values, BP control, diabetes mellitus, metabolic syndrome and CKD were performed according to gender. RESULTS: Twenty-five percent of the whole population showed hyperuricemia (28% in women and 23% in men). These p…

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…

Uncontrolled early morning blood pressure in medicated patients: the ACAMPA study

BACKGROUND A blood pressure surge during the early morning may help to precipitate cardiovascular events. The objective of this study was thus to assess the blood pressure behaviour profile of early morning blood pressure in patients receiving antihypertensive treatment. DESIGN The ACAMPA study is a multi-center, open, prospective, observational study that was carried out by 24 investigators in Spain. METHODS Two hundred and ninety patients with essential hypertension who had been receiving the same antihypertensive treatment for at least 2 months were included in the study. Office blood pressure was measured before taking medication in the morning, and 24-h ambulatory blood pressure monito…

Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331 288 participants.

Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions.

Alteración renal en la infección por el virus de la inmunodeficiencia humana

Fundamento y objetivo Aunque la enfermedad renal se esta convirtiendo en un problema emergente en la poblacion infectada por el virus de la inmunodeficiencia humana (VIH), se tiene muy escasa informacion sobre su curso natural. El objetivo del presente estudio es analizar las lesiones renales en una serie de autopsias de pacientes con infeccion por el VIH en ausencia de tratamiento antirretroviral Pacientes y metodo Se han revisado retrospectivamente datos de las autopsias de 61 sujetos infectados por el VIH (edad media [DE], 36,9 [8,4] anos; un 58,6% eran adictos a drogas por via parenteral y el 84%, varones) fallecidos en nuestro hospital entre 1984 y 1997. Ningun paciente recibio tratami…

Manejo de la hipertensión arterial en niños y adolescentes: recomendaciones de la Sociedad Europea de Hipertensión

Resumen: La hipertensión en niños y adolescentes ha ido ganando terreno en la medicina cardiovascular, gracias a los avances producidos en distintas áreas de la investigación fisiopatológica y clínica. Estas guías nacen del consenso al que han llegado los especialistas en la detección y control de la hipertensión en niños y adolescentes. Por otra parte, dichas guías son un compendio de los datos científicos y la extensa experiencia clínica con la que se cuenta, y constituyen la información clínica más completa que los médicos, enfermeras y familiares deberían tener en cuenta a la hora de tomar decisiones. Estas guías, que hacen hincapié en la importancia de la hipertensión en niños y adoles…

Diastolic left ventricular function in relation to circulating metabolic biomarkers in a population study

AimsWe studied the association of circulating metabolic biomarkers with asymptomatic left ventricular diastolic dysfunction, a risk-carrying condition that affects 25% of the population.Methods and resultsIn 570 randomly recruited people, we assessed in 2005–2010 and in 2009–2013 the multivariable-adjusted correlations of e’ (early left ventricular relaxation) and E/e’ (left ventricular filling pressure) measured by Doppler echocardiography with 43 serum metabolites, quantified by magnetic resonance spectroscopy. In 2009–2013, e’ cross-sectionally increased (Bonferroni corrected p ≤ 0.016) with the branched-chain amino acid valine (per one standard deviation increment, +0.274 cm/s (95% conf…

Complexity Levels in Patients With Heart Failure Diagnostic Codes in a Population

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) …

Acute kidney injury in heart failure: a population study

Abstract Aims The objective of the present study is to assess the prognostic value of acute kidney injury (AKI) in the evolution of patients with heart failure (HF) using real‐world data. Methods and results Patients with a diagnosis of HF and with serial measurements of renal function collected throughout the study period were included. Estimated glomerular filtration rate (GFR) was calculated with the CKD‐EPI (Chronic Kidney Disease Epidemiology Collaboration). AKI was defined when a sudden drop in creatinine with posterior recovery was recorded. According to the Risk, Injury, Failure, Loss, and End‐Stage Renal Disease (RIFLE) scale, AKI severity was graded in three categories: risk [1.5‐…

Prevalencia de fibrilación auricular en la población española de 60 o más años de edad. Estudio PREV-ICTUS

Introduction and objectives. The aims of this study were to determine the prevalence of atrial fibrillation in individuals aged 60 years or more in Spain using a random sample of the population and to identify associated factors. Methods. An analysis of the PREV-ICTUS study, a randomized cross-sectional population-based study of individuals aged 60 years or more, was carried out. Data on demographic variables, cardiovascular risk factors, and cardiovascular disease were obtained from medical records. The diagnosis of atrial fibrillation was based on the patient’s medical history and an electrocardiogram performed during the study. Results. In the 7108 individuals studied (mean age, 71.9 [7.…

Cost of Type 2 Diabetes Patients with Chronic Kidney Disease Based on Real-World Data: An Observational Population-Based Study in Spain

[EN] This study analyzed the prevalence, costs and economic impact of chronic kidney disease CKD in patients with T2D in a Spanish Health District using real-world data. Observational cross-sectional study in adult patients with T2D was through data extracted from the information systems of the Valencia Clinico-La Malvarrosa Health District in the year 2015. Patients were stratified with the KDIGO classification for CKD. Additionally, patients were assigned to Clinical Risk Groups (CRGs) according to multimorbidity. Direct costs of primary and specialized care, and medication were estimated. The prevalence of T2D in the database population (n = 28,345) was 10.8% (mean age (SD) = 67.8 years …

Number of drugs used in secondary cardiovascular prevention and late survival in the population of Valencia Community, Spain.

Abstract Background Drug treatment for secondary prevention of cardiovascular disease is recommended by guidelines, but it is not always followed in real life. This study wanted to assess the size of this gap and its impact on mortality in subjects after a cardiovascular event (MACE). Methods Patients with any of MACE in the period from January 1st 2011 to December 31st 2013, and more than one year of follow-up were selected from population of the Valencian Community. Drugs for secondary prevention were antiplatelets, renin-angiotensin system blockers and statins. Assessment of treatment was performed one year after the initial event. Mortality risk was assessed using Cox by the number of d…

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)…

Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease

During the last century, there has been an increasing prevalence of hyperuricaemia noted in many populations. While uric acid is usually discussed in the context of gout, hyperuricaemia is also associated with hypertension, chronic kidney disease, hypertriglyceridaemia, obesity, atherosclerotic heart disease, metabolic syndrome, and type 2 diabetes. Here we review the connection between hyperuricaemia and cardiovascular, kidney and metabolic diseases. Contrary to the popular view that uric acid is an inert metabolite of purine metabolism, recent studies suggest serum uric acid may have a variety of pro-inflammatory, pro-oxidative and vasoconstrictive actions that may contribute to cardiomet…

Association of selenium exposure with insulin resistance and β-cell function in middle age and older adults

Comparative study of the efficacy of olmesartan/amlodipine vs. perindopril/amlodipine in peripheral blood pressure after missed dose in type 2 diabetes

Introduction: Combination therapy is needed to control blood pressure (BP) in a large number of hypertensive patients with diabetes mellitus. Adherence to treatment is a major clinical problem; therefore, the time duration of the antihypertensive action of a drug determines BP control when a dose is skipped. Objectives: The aim was to determine whether the fixed-dose combination of olmesartan/amlodipine provides equal efficacy and safety as the perindopril/amlodipine combination when a drug dose is missed. Methods: In this noninferiority trial with a randomized, double-blind, double-dummy parallel group, controlled design, 260 patients received either olmesartan 20-40 mg/amlodipine 5-10 mg …

Prevalencia del síndrome metabólico en la población española de 60 años o más. Estudio de base poblacional PREV-ICTUS

Resumen Fundamento y objetivos se dispone de poca informacion sobre el sindrome metabolico (SM) en poblacion de edad avanzada. Los objetivos de este estudio han sido estimar su prevalencia en poblacion general espanola de 60 anos o mas y los factores asociados. Pacientes y metodo se realizo un estudio transversal de ambito poblacional en una muestra aleatoria y representativa de individuos de 60 anos o mas de todo el territorio espanol, estratificada por comunidades autonomas segun censo y habitat de residencia, entre septiembre y diciembre de 2005. Se recogieron datos sociodemograficos, clinicos, bioquimicos y electrocardiograficos. Para la definicion del SM se utilizaron los criterios del…

Urinary 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxo-dG), a reliable oxidative stress marker in hypertension

The potential use of oxidative stress products as disease markers and progression is an important aspect of biomedical research. In the present study, the quantification of urine 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxo-dG) concentration has been used to express the oxidation status of hypertensive subjects. 8-oxo-dG has been simultaneously isolated and assayed in nuclear (nDNA) and mitochondrial DNA (mtDNA). In addition, oxidative stress of mononuclear cells has been estimated by means of GSH and GSSG levels and GSSG/GSH ratio in hypertensive subjects before and after antihypertensive treatment. It is shown that oxidative stress decreases significantly in hypertensive patients after trea…

Factors related to the impact of antihypertensive treatment in antioxidant activities and oxidative stress by-products in human hypertension

The objective was to study factors related to the changes induced by antihypertensive treatment on oxidative status, antioxidant activities, and reactive oxygen species by-products in whole blood and mononuclear peripheral cells. Eighty-nine hypertensive patients (mean age 46 years, 46 men, average 24-h blood pressure 139/88 mm Hg, body mass index 29) were included. After 3 months of nonrandomized allocation to antihypertensive treatment (20 nonpharmacologic, 36 beta-blockers, 33 angiotensin receptor blocker), oxidized/reduced glutathione ratio and malondialdehyde were significantly reduced, and the activity of superoxide dismutase, catalase, and glutathione peroxidase was significantly inc…

Blood pressure and estimated risk of stroke in the elderly population of Spain: the PREV-ICTUS study.

Background and Purpose— The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. Methods— This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. Results— We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic–left ventricle hypertrophy was present in 12.9% of the sub…

Diurnal blood pressure curve in children and adolescents

Objective To investigate the diurnal blood pressure curve in healthy normotensive children. Thirty-one children were re-examined after a median interval of 123 days in order to study the reproducibility of the diurnal profile. Subjects Twenty-four-hour ambulatory blood pressure monitoring and conventional blood pressure readings were obtained in 228 normotensive children, whose ages ranged from 6 to 16 years and of whom 116 were boys and 112 girls. Results The conventional blood pressure averaged 99+/-11/57+/-9 mmHg in boys and 98+/-12/56+/-9 mmHg in girls (means+/-SD); the corresponding 24 h pressures were 111+/-7/66+/-5 mmHg and 109+/-7/65+/-5 mmHg, respectively. Of the children, 83% had …