Novedades en hipertensión arterial y diabetes mellitus

In 2011, the importance of hypertension and diabetes mellitus as the two main risk factors responsible for the development of cardiovascular disease became clear, as did their significance as major public health issues. Compared with previous years, in which publication of the results of large clinical trials dominated scientific progress, in the last year, the focus has shifted to evidence that novel mechanisms associated with blood pressure, glucose metabolism and diabetes can influence cardiovascular disease. Of particular importance were clinical trials in the area of renal dysfunction, such as the SHARP and ROADMAP trials.     

Seguridad renal de espironolactona en pacientes con hipertensión arterial resistente

IntroductionResistant hypertension (RH) is a significant health problem with complex management. The aim of this study was to evaluate the risks and benefits of adding spironolactone to treat RH.Material and methodsIn total, 216 patients with RH in whom spironolactone (12.5-25 mg daily) was added as an antihypertensive were evaluated. One-hundred and twenty-five (125) were analysed retrospectively and 91 prospectively. Blood pressure (BP) and laboratory parameters (serum creatinine [sCrea], estimated glomerular filtration rate [eGFR] and serum potassium [sK]) were analysed at baseline and at 3-6-12 months after introducing spironolactone.ResultsA change of systolic/diastolic BP (mean ± standard deviation) of −10.9 ± 2.7/−4.3 ± 1.6 mmHg at 3 months and −13.6 ± 2.8/−6.0 ± 1.6 mmHg at 12 months; p < 0.001 was observed. These values were confirmed with ambulatory-BP monitoring at 12 months. At 3 months, an increase in sCrea of 0.10 ± 0.04 mg/dl, a decrease in eGFR of −5.4 ± 1.9 ml/min/1.73 m² and an increase in sK of 0.3 ± 0.1 mmol/l; p < 0.001 was observed for all cases. These changes were maintained after 12 months. There were no significant differences in changes of BP, sCrea, eGFR and sK between 3 and 12 months. Results of the retrospective and prospective cohorts separately were superimposable. In the prospective cohort, spironolactone was withdrawn in 9 patients (9.9%) because of adverse effects.ConclusionsAfter 3 months with spironolactone, a decrease in BP associated with a decrease in the eGFR and an increase in sCrea and sK was observed. These changes were maintained at 12 months. Spironolactone is an effective and safe treatment for RH in patients with baseline eGFR ≥ 30 ml/min/1.73 m².     

Asociación de obesidad general y abdominal con hipertensión,dislipemia y presencia de prediabetes en el estudio PREDAPS

Introduction and objectives

Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin).

Evolución de la lesión orgánica mediada por hipertensión en pacientes con hipertensión arterial resistente tras añadir espironolactona

IntroductionResistant hypertension (RH) represents an important multi-organic impact and increases the morbi-mortality. We aimed to evaluate the evolution of hypertensive mediated organ damage in patients with RH after adding spironolactone.Material and methodsRetrospective study of 58 patients with RH who started spironolactone (12.5–25 mg daily). Office blood pressure, 24-h ambulatory blood pressure monitoring (24h-ABPM), urine albumin-to-creatinine ratio and echocardiographic parameters were analyzed prior to initiation of spironolactone and after 12 months of treatment.ResultsThirty-six percent of patients were women and mean age was 67.3 ± 10.1 years. We observed a decrease in urine albumin-to-creatinine ratio (median [RIQ_25–75]) of 27.0 (7.5-255.4) to 11.3 (3.1–37.8) mg/g, P = .009. This was more relevant in patients with albuminuria grade A2 and A3: 371.2 (139.5–797.4) to 68.4 (26.5–186.5) mg/g, P = .02. The echocardiographic changes were: posterior wall thickness: −1.0 ± 0.4 mm (P < .001), interventricular septal thickness: −0.6 ± 0.5 mm (P = .01), left ventricular (LV) mass index: −14.7 ± 10.2 g/m² (P = .006), LV remodeling index: −0.04 ± 0.036 (P = .03), without statistically significant changes in LV ejection fraction, LV end-diastolic diameter, LV end-systolic diameter, left atrial diameter, relationship between early ventricular filling wave and atrial contraction and LV filling pressure index.Systolic/diastolic office blood pressure decreased −12.5 ± 4.9/−4.9 ± 3.0 mmHg, P < .001. In 24h-ABPM, systolic and diastolic BP had a significant decrease in diurnal and nocturnal periods and 38.1% of patients presented a favorable change in the circadian pattern, P < .001.ConclusionsAdding spironolactone to patients with RH contributes to improve hypertensive mediated organ damage by reducing albuminuria levels and echocardiographic parameters of hypertensive heart disease.     

Novedades en estimulación cardiaca

This article contains a review of the current status of remote monitoring and follow-up involving cardiac pacing devices and of the latest developments in cardiac resynchronization therapy. In addition, the most important articles published in the last year are discussed.     

Terapias intervencionistas en hipertensión pulmonar

Despite advances in drug therapy, pulmonary hypertension—particularly arterial hypertension (PAH)—remains a fatal disease. Untreatable right heart failure (RHF) from PAH eventually ensues and remains a significant cause of death in these patients. Lowering pulmonary input impedance with different PAH-specific drugs is the obvious therapeutic target in RHF due to chronically increased afterload. However, potential clinical gain can also be expected from attempts to unload the right heart and increase systemic output. Atrial septostomy, Potts anastomosis, and pulmonary artery denervation are interventional procedures serving this purpose. Percutaneous balloon pulmonary angioplasty, another interventional therapy, has re-emerged in the last few years as a clear alternative for the management of patients with distal, inoperable, chronic thromboembolic pulmonary hypertension. The current review discusses the physiological background, experimental evidence, and potential clinical and hemodynamic benefits of all these interventional therapies regarding their use in the setting of RHF due to severe pulmonary hypertension.     

¿Podemos predecir la gravedad de la hipertensión arterial pulmonar en pacientes con esclerodermia?

ObjectivesTo describe the clinical-biological characteristics of patients with scleroderma (SSc) and pulmonary artery hypertension (PAH).To establish the relationship between pulmonary functional tests (PFT), Doppler echocardiography (ECHO) and the severity of the PAH.Material and methodsRetrospective study of patients with scleroderma treated at a tertiary center. All participants received a protocol study, which included a complete analysis and additional tests: Doppler Echocardiography and pulmonary functional tests (PFT) with carbon monoxide diffusing capacity (DLCO).ResultsOverall, 331 patients were treated, including 68 (20.5%) with PAH. The limited subtype of Scleroderma was the most prevalent. The Person‘s correlation coefficient was used for the following variables: FVC-sPAP, FVC/DLCO-sPAP, DLCO-sPAP and TRV-sPAP, showed a significant moderate linear association in the relationship DLCO-sPAP and TRV-sPAP.29 deaths occurred, with 12 of them related to PAH. The median time between the PAH diagnosis and death was 1.8 years.ConclusionsThe decrease in DLCO and the increase in TRV are negative predictor factor of PAH which, at the same time, means a worsening prognosis for patients with Scleroderma.     

Impacto de la aplicación del 8.o JNC y de las guías KDIGO-2013 en el control de la hipertensión arterial y los lípidos en una consulta de Nefrología

Objective

Observational retrospective study with consecutive patients with CKD to assess the degree of accomplishment of the therapeutic objectives in hypertension and dyslipidaemia recommended by JNC 8 and KDIGO-2013 CKD guidelines the impact of their implementation compared with previous guidelines.