Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients.

Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods: A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results: A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion: The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

[Profile of the treated elderly hypertensive patient]. / Perfil del hipertenso adulto mayor tratado.

BACKGROUND: There is concern about the consequences that hypertension has on the well being and mortality of elderly people. AIM: To compare the morbidity and mortality of young and old treated hypertensive subjects. MATERIAL AND METHODS: Retrospective analysis of hypertensive subjects treated and followed for a period of 10 +/- 9 years. Subjects that started treatment at an age of less than 65 years and those that started treatment after 65 years of age, were analyzed separately. The antihypertensive drugs used for treatment and blood pressure reduction were similar in both groups. RESULTS: Subjects that started treatment after 65 years of age (157 females and 133 males) had lower serum cholesterol levels and a higher prevalence of end organ damage than their younger counterparts. Women over 65 had a higher body mass index than women of less than 65. Males over 65 years had a higher prevalence of diabetes than younger males. Mortality and complications of hypertension were higher in subjects that started treatment after 65 years of age. CONCLUSIONS: The higher mortality of subjects that start hypertensive treatment after 65 years of age, is indicative of the need to detect and treat hypertension at the earliest possible moment.

[Optimization of the reduction of arterial blood pressure in essential hypertensives patients]. / Optimización de la reducción de la presión arterial en hipertensos esenciales.

BACKGROUND: A blood pressure below or equal to 140/90 mmHg, the aim of antihypertensive treatment, is rarely achieved. Only 16% of patients controlled by our group reach this goal. AIM: To analyze the causes of suboptimal treatment and to assess the effects of an optimization of antihypertensive therapy. PATIENTS AND METHODS: A random sample of 160 patients was analyzed and followed during one year. RESULTS: Sixty six patients (41%) had a normal blood pressure, maintained during the first three months of follow up. The main causes of suboptimal reduction of blood pressure in the remaining 94 patients were an incorrect prescription or dosage of medications in 37.5%, lack of compliance in 34%, insufficient delivery of medications by the health service in 24% and secondary effects of drugs in 5%. When these factors were corrected, blood pressure normalized in 41 of them. In other 37, a reduction of 5 mmHg or more in blood pressure, was obtained. The most frequent changes introduced were modifications in dosage and addition of a new medication. Therefore, in 90% of these patients, blood pressure was reduced or normalized. CONCLUSIONS: A correct identification of the cause of antihypertensive treatment failure is imperative. The correction of this cause leads to a further reduction in blood pressure in 90% of those subjects with suboptimal treatment.

[Morbidity and mortality of treated essential arterial hypertension in a 26 years follow up]. / Morbimortalidad de la hipertensión arterial esencial tratada en un seguimiento de 26 años.

BACKGROUND: Treatment has a definitive impact on mortality in hypertension. The magnitude of blood pressure reduction, the type of drug used and the associated risk factors may modulate the effect of treatment on mortality. AIM: To report the effects of treatment of essential hypertension, in a cohort followed for up to 26 years. PATIENTS AND METHODS: A cohort of 1,172 essential hypertensive patients followed up to 26 years. Patients were treated with different antihypertensive drugs, alone or in combination (diuretics, beta blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) according to international rules and consensus. Subjects were followed until death or loss from follow-up. Blood pressure reduction was aimed to obtain figures near 140/90 mm Hg. Causes of death and complications were obtained from hospital records, phone and death certificates. Survival was studied using life tables (Kaplan Meier method and intention to treat analysis) and Cox proportional hazard analysis. RESULTS: Initial blood pressure dropped significantly from 181/109 to 154/92 mm Hg, p < 0.001. Mean follow-up time was 10.6 +/- 6.1 years. There were 143 cardiovascular deaths, 142 acute myocardial infarctions, 101 strokes, 83 subjects had cardiac failure and 49 had renal failure. The observed rates were 0.92% per year for cardiovascular mortality, 1.36% per year for coronary heart disease, 0.94% per year for stroke. CONCLUSIONS: Our mortality rate is lower than that found in classical randomized studies but similar or slightly higher than the more recent ones. Morbidity rates were also very similar. Except for mortality rate, frequency of complications did not change in comparison to our previous report after 15 year of follow up. Aging did not seem to negatively influence mortality rates in adequately treated hypertensive patients.