Hipertension y Riesgo Vascular最新文献

Arterial hypertension is one of the most prevalent diseases in the field of geriatrics and is also a risk factor for pathologies that frequently result in hospital admissions, such as heart failure and stroke. This article addresses both pharmacological and non-pharmacological diagnosis and treatment strategies, focusing on the role of frailty as a guiding principle in determining the most appropriate course of treatment, emphasizing patient-centred prescribing. Furthermore, the article reviews other frequent topics, such as polypharmacy and orthostatic hypotension. Moreover, a concise overview of the current evidence in geriatrics on ambulatory blood pressure monitoring and self-measurement of blood pressure will be provided. Furthermore, a brief summary of the underlying pathophysiology and current epidemiological trends is provided. This consensus is founded upon the initial premise that a comprehensive geriatric assessment should be conducted to ascertain whether a blood pressure reduction strategy could confer a net benefit for elderly patients while simultaneously avoiding an increase in the safety risks associated with these strategies and preventing a de-prescription due to ageism. This is particularly important given the significance of maintaining optimal blood pressure control to prevent related complications.

Pheochromocytoma is a rare neuroendocrine tumour that develops from chromaffin cells in the adrenal medulla and is characterised by the excessive production of catecholamines and their metabolites. Diagnostic confirmation is performed by detecting elevated levels of catecholamines and/or their metabolites in plasma or 24-h urine. In the case of moderate elevations of normetanephrine, the clonidine suppression test may be useful to differentiate between endogenous hypersecretion and false positive results. Once the biochemical diagnosis is performed, the tumour localisation is carried out using imaging techniques and sometimes with nuclear medicine imaging tests. Furthermore, in all patients with pheochromocytomas it is recommended to perform a genetic study to identify hereditary disorders that may be present in more than 30% of cases and to perform a cardiological evaluation to rule out the presence of cardiovascular involvement secondary to the catecholamine hypersecretion.

Introduction: Preeclampsia (PE) is a complication of hypertensive disorders of pregnancy, whose pathophysiology involves endothelial dysfunction. Early establishment of subclinical vascular lesions such as arterial stiffness (AS) could explain the development of cardiovascular disease later in life. AS can be assessed non-invasively using carotid-femoral pulse wave velocity (cf-PWV), aortic systolic blood pressure (ao-SBP) and augmentation index (IAx). We aim to determine cf-PWV, ao-SBP and AIx in women who recently underwent PE and compare it with a control group.

Materials and methods: Cross-sectional study, carried out from 2022 to 2023 in Argentina. Group 1: women who developed PE.

Exclusion criteria: history of chronic hypertension, diabetes, autoimmune disease, chronic kidney disease, cardiovascular disease, PE in previous pregnancies; treatment with calcium antagonists during pregnancy; treatment with calcium antagonists, angiotensin-converting enzyme inhibitors or diuretics in the postpartum period. Group 2: healthy postpartum periods. PWV-cf, ao-SBP and IAx were measured in the first 72hours postpartum using Aortic.

Results: Seventy-onewomen were included: Group 1 (n=30); Group 2 (n=41). Group 1 presented higher PWV-cf=6.70±0.68 vs. 5.41±0.48 m/s (P<.0001); ao-SBP=118.3±9.6 vs. 101.2±9.8mmHg (P<.0001); and IAu=22.7±10.7 vs. 9.3±11.9% (P<.0001). In Group 1 there were 25 of 30 women who presented AS parameters (OR=8.50; 95% CI=3.32-15.29; P<.0001).

Conclusion: Patients with a recent history of PE showed higher cf-PWV, ao-SBP and AIx values, compatible with AS.

Introduction: Elevated levels of Lipoprotein(a) [Lp(a)] have been linked to increased cardiovascular risk globally. However, comprehensive studies on Lp(a) levels and their impact on cardiovascular health in Argentina are lacking. The Argentine Group for the Study of Lipoprotein (a) [GAELp(a)] aims to address this gap through an observational study designed to evaluate the prevalence and consequences of elevated Lp(a) levels in the Argentine population.

Methods: The GAELp(a) study will recruit participants from diverse regions across Argentina. Eligible individuals will undergo comprehensive assessments, including demographic data collection, medical history review, and laboratory analyses to measure Lp(a) levels. The study will employ rigorous statistical analyses to explore the association between elevated Lp(a) levels and cardiovascular outcomes, considering potential confounding variables.

Results: Anticipated outcomes of the GAELp(a) study include a detailed characterization of Lp(a) levels within the Argentine population and their correlation with cardiovascular diseases. By elucidating these relationships, the study aims to provide valuable insights into the prevalence and impact of elevated Lp(a) on cardiovascular health in Argentina.

Conclusion: The GAELp(a) observational study holds promise for enhancing our understanding of Lp(a)-related cardiovascular risk in Argentina. Findings from this study may contribute to the development of targeted interventions, clinical guidelines, and public health policies aimed at reducing cardiovascular morbidity and mortality associated with elevated Lp(a) levels. Through collaborative efforts, the GAELp(a) study seeks to advance cardiovascular research and improve healthcare outcomes in Argentina.

We describe the case of an 80-year-old man with sporadic right pheochromocytoma who developed metastatic disease six years after initial diagnosis. Despite adequate blood pressure control and initial biochemical cure criteria after surgery, elevated chromogranin A levels were detected during routine screening, which anticipated elevated 24-h urine metanephrines. Subsequent imaging tests revealed metastatic lesions in the lungs, liver, prostate and lymph nodes. The patient underwent systemic treatment with [131I] MIBG, which resulted in a decrease in chromogranin A levels, achieving radiological and clinical stability. This case highlights the importance of long-term follow-up and biochemical monitoring for early detection of tumor recurrence in patients with pheochromocytoma, emphasizing the need for individualized treatment strategies and interdisciplinary care.

Postpartum de novo arterial hypertension (PPDNAH) is defined as blood pressure ≥140/90mmHg, without a history of hypertension during pregnancy or delivery. Its prevalence ranges from 0.3% to 27.5% of all pregnancies. Late-onset postpartum preeclampsia (LOPPP) and late-onset postpartum eclampsia (LOPPE) typically occur between 48hours and 6 weeks postpartum, although recent studies demonstrate the possibility of developing these disorders up to 12 months postpartum. While sharing risk factors with pregnancy-related disorders, they differ in some aspects such as primigravida status. Regarding prognosis, an increase in severe maternal morbidity has been observed compared to hypertensive disorders of pregnancy. This group of pathologies is often underdiagnosed, even in high-risk patients, making early identification along with strict blood pressure monitoring essential.

Background: This study aimed to examine the effects of a six-week of concurrent training using high-intensity interval plus resistance training on flow-mediated dilation and pulse wave velocity in hypertensive, elevated blood pressure, or normotensive. A secondary goal was to analyze the inter-individual variability.

Methods: A randomized controlled clinical trial was executed with 60 adult participants distributed across six groups: three control groups of hypertensive, elevated blood pressure, or normotensive and other three experimental hypertensive, elevated blood pressure, and normotensive groups, each comprising n=10 individuals. Participants underwent a six-week intervention of concurrent exercise using high-intensity interval plus resistance training three-weekly. Flow mediated dilation and pulse wave velocity and secondary vascular assessments were conducted before and after the intervention.

Results: The hypertensive exercise group exhibited a significant increase in flow mediated dilation (Δ+7.7%; p=0.003) and a reduction in pulse wave velocity (Δ-1.2ms^-1; p<0.0001). The normotensive exercise group also showed a significant increase in flow mediated dilation (Δ+8.4%, p=0.002).

Conclusion: The six-week concurrent exercise using high-intensity interval plus resistance training protocol, characterized by its clinical time-efficiency, was effective in improving endothelial function, as demonstrated by increased flow mediated dilation, and in reducing arterial stiffness, indicated by decreased pulse wave velocity.

The inter-arm difference (IAD) of systolic blood pressure (SBP) is associated with higher cardiovascular risk. We compared simultaneous and consecutive recordings in measuring IAD of SBP, and evaluated reproducibility between visits. 143 hypertensive patients (63.8±9.5 years, 51.7% women) treated and controlled with stable antihypertensive medication for a period of ≥3 months were included. Blood pressure (BP) in both arms was measured simultaneously and consecutively with an automatic oscillometric device, in two visits. The IAD of the simultaneous SBP was significantly lower compared to the consecutive one, both in the first (3.51±4.1 vs. 4.40±3.7mmHg; P<.01) and in the second visit (3.62±3.5 vs. 5.69±5.1mmHg; P<.001). When the IAD of SBP was categorized as ≥10 or <10mmHg, the reproducibility between visits was insignificant in both simultaneous measurements and consecutive measurements. The frequency of initial dominance was similar between the left and right arm in simultaneous ones (46.2 vs. 43.3%), and greater in the right arm in consecutive ones (55.2 vs. 38.5). The persistence of dominance between both visits was significantly higher when SBP was measured simultaneously (54.4% vs. 45.5%; P<.01). Our study shows that to define the arm with the highest BP, simultaneous measurements are preferable. In treated and controlled hypertensive patients, the poor persistence of initial dominance between visits requires us to review the recommendation of recording, during follow-up, the BP in the arm where it was highest on the first visit.

Objective: This study aims to analyze the prescription of antihypertensive drugs in patients with type 2 diabetes (T2D) in Andalusia, comparing it with the SEH-LELHA 2022 guidelines, and to assess the direct cost of these treatments.

Materials and methods: A multicentric, cross-sectional, and descriptive study was conducted with 385 T2D patients. Participants were randomly selected from the patient lists of 120 primary care physicians from Andalusia. Inclusion criteria included a diagnosis of T2D and complete clinical records for the year 2022. Demographic data and drug prescription information were collected, with the average cost per patient being calculated.

Results: The mean age of the subjects was 70.72 years, with 53.51% being male. A total of 70.9% of the patients were taking antihypertensive drugs, the most common being ACE inhibitors/ARBs (70.9%), diuretics (70.1%), beta-blockers (40.0%), and calcium channel blockers (20.0%). Each patient took an average of 2.46±1.06 antihypertendsive, and fixed association of 2 or more antihypertensive drugs were used by 40.9% of the studied patients. The annual cost per patient was 141.45€/year.

Conclusions: The study reveals strong adherence to the SEH-LELHA 2022 guidelines among physicians in Andalusia regarding the of antihypertensives for T2D patients, with a significant preference for Renin-Angiotensin System blockers, diuretics, and beta-blockers. However, a notable deviation in prescription practices was observed with the frequent choice of doxazosin over spironolactone, despite the latter being the recommended option for resistant hypertension. Although the overall expenditure on antihypertensives is moderate, their cost-effectiveness is enhanced by the efficacy of these treatments in preventing cardiovascular complications.