Hipertension y Riesgo Vascular最新文献

Objetives

To determine the prevalence of erectile lower urinary tract symptoms in hypertensive patients, cardiovascular risk and the impact on quality of life.

Material and methods

Setting: Health Center (Vilagarcia, Pontevedra).

Period: April 2015-June 2017.

Inclusion criteria: Hypertensive patient with informed consent.

Measurements

sociodemographic variables, toxic habits, comorbidity, blood pressure, cardiovascular risk, analytical and examination parameters. Questionaries: International Prostate Symptom Scale (IPSS), International Index of Erectile Function (IIEF-15) and quality of life in arterial hypertension (MINICHAL).

Sample size: n = 262 (± 6% accuracy, 95% confidence).

Statistical analysis: Bivariate and multivariate statistical analysis.

Informed consent and ethics committee approval were obtained (2024/237)

Results

The mean age was 65.84 (12.70), and mean hypertension duration of 13.25 (9.84) years. 76.7% reported lower tract urinary symptoms, 91.6% being mild. The bivariate analysis showed an association with the variables: age, educational level, profession, work activity, tobacco, benign prostatic hypertrophy, years of diagnosis, concomitant medication, Framingham-Wilson score, electrocardiogram, glycated hemoglobin, glomerular filtration (Crockroft-Gault), LDL-cholesterol, somatic manifestations (MINICHAL), erectile dysfunction. The multivariate analysis showed increased risk with:abdominal obesity, pathological electrocardiogram, high risk of Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents and decreased with not smoking and use diuretics.

Conclusions

Three quarters of hypertensive men presented lower urinary tract symptoms, increasing the risk of cardiovascular disease early according to the Framingham-Wilson score. Other predictive factors were: abdominal obesity, tobacco, pathological electrocardiogram, high Framingham-Wilson score, erectile dysfunction, use of hypouricemics agents.

Secondary arterial hypertension accounts for only 5-10% of cases of arterial hypertension, hence the importance of its clinical suspicion for diagnosis. One of the most common causes of secondary hypertension is renovascular hypertension, caused by renal hypoperfusion and activation of the renin-angiotensin-aldosterone system. In addition to arterial hypertension being one of the most prevalent cardiovascular risk factors in the population, its poor control can cause acute neurological disorders such as Posterior Reversible Leukoencephalopathy syndrome (PRES), being characteristic the appearance of visuals alterations. Next, we present the case of a kidney transplant patient with well-controlled arterial hypertension with worsening secondary to renal artery stenosis and development of PRES.

Background and methodology

Air pollutants have a significant impact on public health.

The aim of the study was to find out the relationship between ambulatory blood pressure measured by 24-h ambulatory blood pressure monitoring (ABPM) and the atmospheric pollutants that are measured regularly (PM₁₀, PM_2.5, NO₂ and SO₂). An observational study of temporal and geographic measurements of individual patients (case-time series design) was carried out in Primary Care Centres and Hypertension Units in the Barcelona metropolitan area. We included 2888 hypertensive patients ≥ 18 years old, untreated, with a first valid ABPM performed between 2005 and 2014 and with at least one air pollution station within a radius of <3 km.

Results and conclusions

The mean age was 54.3 (SD 14.6) years. 50.1% were women and 16.9% of the sample were smokers. Mean 24-h blood pressure (BP) was 128.0 (12.7)/77.4 (9.7) mmHg. After adjusting for mean ambient temperature and different risk factors, a significant association was found between ambulatory diastolic BP (DBP) and PM₁₀ concentrations the day before ABPM. For each increase of 10 μg/m³ of PM₁₀, an increase of 1.37 mmHg 24-h DBP and 1.48 mmHg daytime DBP was observed. No relationship was found between PM_2.5, NO₂ and SO₂ and ambulatory BP, nor between any pollutant and clinical BP.

The concentration of PM₁₀ the day before the ABPM is significantly associated with an increase in 24-h DBP and daytime DBP.

Background and objectives

Hypertension (HT) is a key risk factor for stroke. We evaluated whether the importance of hypertension on the risk of ischemic stroke has increased in recent decades.

Methods

Retrospective study of patients with ischemic stroke discharged from 3 hospitals in Seville (Spain), during the periods: 1999-2001, 2014-2016 and 2019-2020.

Results

1,379 patients were included, 42.6% women, mean age 69.1 (± 11) years. HT was the most prevalent vascular risk factor in all periods, with a progressive increase in hypertensive patients (65.9% vs 69.6% vs 74%; P = .029). HT was especially frequent in patients ≥ 80 years (73% vs 81.9% vs 85.2%; P = .029). At discharge, progressively more antihypertensive drugs were used (in 65% vs 85.1 vs 90.2% of patients; P = .0001), with a clear increase in the number of antihypertensive drugs used (mean 0.9 ± 0.8 vs 1.5 ± 1 vs 1.8 ± 0.8 drugs, P = .0001). The use of diuretics (13.7%-39.3%-65.3%; p = 0.0001), ACE inhibitors (35.5%-43.3%-53.4%; P = .0001) and angiotensin receptor blockers (12.2%-24%-32.4%; P = .0001) increased progressively. On the contrary, the use of calcium antagonists decreased (24%-19.9%-13.7%; P = .0001).

Conclusions

In the last 2 decades there has been a greater role for HT among patients with their first ischemic cerebrovascular event. Greater and better control of HT is necessary to reduce the enormous burden of cerebrovascular disease.

Hypertension (HT) is a frequent pathology in patients with active or surviving onco-haematological malignancies. It is estimated that the prevalence of HT in this population ranges between 30 and 70%. The relationship between cancer and HT is multifactorial: common risk factors, neoplasia that cause HT through hormonal secretion, and, especially, chemotherapy drugs that cause HT.

Ambulatory blood pressure monitoring (ABPM) is a fundamental tool in the diagnosis and adequate control of blood pressure, avoiding having to suspend or reduce the dose of chemotherapy treatment. In addition, it can help in the diagnosis of autonomic dysfunction related to certain neoplastic pathologies.

We present the case of a young Caucasian patient with renal disease of unclear cause, with a final diagnosis of advanced benign nephroangiosclerosis established by renal biopsy. Due to the possibility of having hypertension in pediatric age (without study or treatment), with the renal biopsy findings, the genetic study showed polymorphisms risk in the APOL1 and MYH9, and also an unexpected diagnosis of a complete deletion of the NPHP1 gene in homozygosis, associated with the development of nephronophthisis. In conclusion, this case illustrates the importance of carrying out a genetic study in youngs patients with renal disease unclear cause, even having a histological diagnosis of nephroangiosclerosis.

Cardiovascular risk (CVR) estimation is a fundamental tool for guiding therapy. Albuminuria indicates target organ damage in an accessible, economic and non-invasive manner. Improves high-risk patient identification, especially in chronic kidney disease (CKD) and diabetes mellitus (DM). In addition, anti-albuminuric treatments may improve CVR. This would position albuminuria as a guide and therapeutic objective. Although the capacity of albuminuria as an epidemiological CVR marker in specific populations (hypertension, CKD, DM) is accepted, its profile as a risk marker in the general population and as a therapeutic target is controversial. There is ambiguous evidence regarding its predictive capacity, added to the fact that treatments such as SLGT2 blockers reduce CVR events regardless of albuminuria presence or magnitude.

This review analyzes the available evidence on albuminuria as a CVR marker, a treatment goal and therapeutic guide.