Hipertension y Riesgo Vascular最新文献

Introduction and objectives

Cardiovascular prevention measures place the emphasis on controlling cardiovascular risk factors (CVRF). However, the most recent studies provide disappointing data, the impact of which remains to be determined. The objective of this study was to analyse the impact that the different CVRFs, and their degree of control, have on the prognosis of patients after acute coronary syndrome.

Patients and methods

Epidemiological, pharmacological, and CVRF control data were collected from 1,689 consecutive patients admitted from 2018 to 2020 for acute coronary syndrome to a tertiary hospital. Finally, the rate of major adverse cardiovascular events was calculated.

Results

The patients admitted for acute coronary syndrome were predominantly men, with body mass index > 25 Kg/m², smokers (or former smokers) and with poor CVRF control (50% for hypertension and diabetes and 35% for dyslipidaemia), especially those patients with a personal history of ischaemic heart disease. An underutilisation of useful drugs for CVRF control was found. A directly proportional relationship was observed between the number of CVRFs (or their poor control) and the incidence of major adverse cardiovascular events at 2 years, hypertension being the factor with the greatest cardiovascular impact. The SARS-CoV-2 lockdown worsened the degree of CVRF control and cardiovascular prognosis.

Conclusion

There is still room for improvement in the control of CVRF, which would translate into a prognostic benefit for patients with ischaemic heart disease. The implementation of cardiovascular prevention campaigns seems essential.

Tyrosine kinase inhibitors are a family of chemotherapy drugs used in first and second line for many solid and hematological neoplasms. Its toxicity is relatively low, since the mechanism of action is based on the inhibition of some tyrosine kinases involved in the explosion of neoplastic cells. However, this blockade is not selective, so it can produce secondary effects. Sorafenib can produce arterial hypertension, thyroid disorders, abdominal pain or hyperamylasemia, among others. We must monitor these patients during treatment to avoid side effects.

Introduction

Students’ dietary habits are moving from Mediterranean diet guidelines towards unhealthy eating patterns. The aim of this study was to determine adherence to the Mediterranean diet in a sample of Spanish university students and its association with lifestyle factors.

Material and methods

A descriptive cross-sectional study was conducted with 685 university students who completed a self-report questionnaire. The data collected included demographic characteristics, dietary habits, smoking habits, alcohol consumption and physical activity. Mediterranean diet adherence was assessed by measuring the consumption of the foods that compose this type of diet through a score (range 0–10). Adherence to the Mediterranean diet was considered poor, average, or good.

Results

The mean adherence score for the Mediterranean diet was 4.9 (1.2) points out of 10. A higher degree of adherence to the Mediterranean diet was observed in physically active students (OR = 2.31, 95% CI: 1.05–5.10; p = 0.038). Students who performed ≥150 min/week of physical activity (OR = 0.45, 95% CI: 0.33–0.62; p < 0.001) and those over 25 years old (OR = 0.44, 95% CI: 0.26–0.73; p = 0.002) were less prone to low adherence to the Mediterranean diet than sedentary and younger students.

Conclusion

The university students have poor adherence to the Mediterranean diet. The results of the current study indicate that age and physical activity are associated with Mediterranean diet adherence. It is urgent to raise awareness among university students and implement intervention programmes promoting a healthy lifestyle.

The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method.

In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15–20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up.

Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals.

Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations.

Pheochromocytoma is a rare cause of ischaemic heart disease. We present the case of a patient in whom pheochromocytoma was diagnosed following ischaemic heart disease with absence of coronary lesions, demonstrating the importance of taking it into account in the differential diagnosis in these cases, especially considering that curative treatment is available.

Nephroangiosclerosis or kidney disease that accompanies chronic essential arterial hypertension has been known for more than a hundred years. The definitive diagnosis is established by renal biopsy, which is reserved for doubtful cases or atypical presentation, being in most cases a presumptive clinical diagnosis. The objective of this review is to analyse the main controversies that currently exist related to nephroangiosclerosis: inaccuracy in epidemiological aspects (prevalence and incidence unknown), diagnostic difficulties and lack of correlation studies between clinical data and histopathology, progression factors in Caucasians. Currently, with advances in genetic studies in hypertension, not using or redefining the term hypertensive kidney disease for another condition such as nephropathy related to the present genetic alteration is being considered.

Introduction

Arterial hypertension (AHT), a leading risk factor in terms of attributable mortality, is a major public health problem, especially for primary care where most patients are diagnosed and followed up. Correct AHT diagnosis requires adequate theoretical knowledge and technical skills in physicians and nurses. The aim of this study was to evaluate the knowledge and skills used in initial AHT diagnosis by health professionals and to describe the factors that contribute to variability.

Methodology

Cross-sectional observational study in a sample of 385 primary care physicians and nurses recruited in a Catalan health region. Using a validated questionnaire called ARC, we evaluated theoretical knowledge and analysed factors that may contribute to response variability. We also evaluated practical measurement skills using objective structured clinical examination tests.

Results

Medical and nursing primary care professionals had deficient knowledge and skills for initial AHT diagnosis and measurement, despite self-perceiving their knowledge to be sufficient. However, professionals who had received postgraduate or other AHT training in the previous year scored better in the ARC questionnaire.

Conclusions

The results of this study point to insufficient AHT expertise to ensure quality clinical practice, suggesting that ongoing theoretical and practical training needs to be improved.