Assessing levels of uric acid and other cardiovascular markers in prehypertensive and hypertensive adults.

INTRODUCTION: Although some studies have reported the association between uric acid (UA) and hypertension, evidence on prehypertension is still lacking. Therefore, the objective of this study was to determine the levels of UA and other cardiovascular markers among prehypertensive and hypertensive patients and assess their risk for developing arterial hypertension. METHODS: 157 individuals were recruited: 67 normotensive, 23 pre-hypertensive and 67 hypertensive. Blood samples were collected to measure biochemical parameters and anthropometric measurements and blood pressure were evaluated. We calculated the product of lipid accumulation and the visceral adiposity index to assess cardiovascular risk. RESULTS: Our data showed an increase in UA levels in normotensives (4.9±1.3mg/dL), prehypertensives (5.2±1.3mg/dL) and hypertensives (5.9±1.6mg/dL) (p=0.004). We found a higher frequency of hyperuricemia in the hypertensive group (34.3%) than in the normotensive group (13.4%, p<0.05). Hypertensive volunteers had lower levels of HDL-C (p=0.004 and p=0.003) and higher body mass indexes (p<0.001 and p=0.007), glucose (p<0.001 and p=0.033), triglycerides (p=0.001 and p=0.005), visceral adiposity index (p<0.001 and p=0.002) and lipid accumulation product (p<0.001 and p=0.007) than normotensive and prehypertensive participants. We also observed that individuals with UA≥6.2mg/dL had an increased risk of hypertension of 4.77 (p=0.003) compared to individuals with levels≤4.3mg/dL. CONCLUSION: Our results showed that UA is associated with increased blood pressure and unfavorable changes in anthropometric and biochemical parameters, which represent risk factors for hypertension and cardiovascular diseases.

Numerical values and impact of hypertension in Spain.

In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: a) white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); b) inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and c) insufficient use of polytherapy (≈55%). The remaining challenges include: a) technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); b) clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and c) public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets.

[Consequence of hypertensive disorders during pregnancy (THE) on women's cardiovascular health]. / Consecuencia de los trastornos hipertensivos durante el embarazo (THE) sobre la salud cardiovascular de la mujer.

Patients with hypertensive disorders of pregnancy (HDP) are at increased risk of maternal-fetal complications and represent the third leading cause of maternal mortality. To date, it is known that women experiencing this condition during pregnancy have a higher future risk of cardiovascular events (CVD). Our objective was to report the incidence of new-onset hypertension in the postpartum period. We conducted a cohort study in high-risk pregnant patients who underwent ambulatory blood pressure monitoring (ABPM) between weeks 20-30. Patients were categorized as normotensive (NT) or gestational hypertensive (GH), excluding those with chronic hypertension, and were followed until the end of pregnancy with a postpartum assessment after 3months. Patients with HDP (39%) had a higher incidence of preeclampsia and newborns with low birth weight and preterm birth. A total of 177 pregnant women were analyzed for the primary outcome. Among those with GH, 33.3% vs 17.2% of NT (P=.014) reported new-onset hypertension. The odds ratio for developing new-onset hypertension was 2.3 (95%CI: 1.20-4.77), for those with GH. In conclusion, pregnant patients with GH assessed by ABPM between 20-30weeks are at higher risk of developing new-onset hypertension in the postpartum period, emphasizing the need for closer monitoring and control to prevent future cardiovascular complications.

[The role of nursing in right heart catheterization. Advantages from peripheral venous access]. / Papel de enfermería en el cateterismo cardiaco derecho. Ventajas del acceso venoso periférico.

INTRODUCTION: Pulmonary hypertension (PH) is a serious disease that requires early diagnosis to achieve a better patient prognosis. Right heart catheterization (RHC) has become the main diagnostic test for this disease, measuring the pressures from the right heart chambers invasively, using a catheter placed through venous access. Nursing performance has an important role in RHC through peripheral venous access due to its well-done skills for canalization and knowledge about the management and care of these accesses. RHC performed through peripheral venous access provide advantages over those performed through central venous access. OBJECTIVE: To analyze the benefits from RHC through peripheral venous access compared to those performed through central venous access, as well as highlighting the role of nursing during this type of procedures. METHOD: A retrospective, descriptive, and observational study was performed for patients who underwent RHC in our center between January 2019 to January 2023. We analyzed clinical characteristics, access, fluoroscopy parameters, periprocedural complications, and hospital admissions. RESULT: A total of 115 patients were included. The average age was 65±12 years, with 58.1% of females. Risk stratification of PH was the reason for conducting RHC in 82.9%. The anterocubital veins became the main approach (72.2%), performed by hemodynamics nurses, while the central venous ones composed the rest (27.8%), which were done by cardiology specialized doctors. We observed a significant reduction in radiation dose in RHC via anterocubital route compared to central venous access (4.4Gycm2 vs 12.5Gycm2 [IQR: 4.5]; P<.001), and it does also in fluoroscopy times (2.3minutes vs 4.6minutes [IQR: 2.6]; P<.001). No complications were recorded, independently of the approach. Patients who underwent a scheduled catheterization were discharged more frequently on the same day of the procedure whether a peripheral approach was performed (77.2%, 44 of 57 patients), in comparison with the central one (28.6%) (P=.001). CONCLUSIONS: The RHC is an essential tool for the diagnosis of PH, achieving nursing such an important role for those performed by peripheral venous access. Peripheral venous access provides benefits and advantages like the reduction of radiation exposure and scan times, reduced hospital stay. All this could bring greater comfort, safety and better quality of care to the patient.

Ambulatory blood pressure monitoring. Current status and future perspectives. / Monitorización ambulatoria de la presión arterial. Situación actual y perspectivas futuras.

Ambulatory Blood Pressure Monitoring (ABPM) is considered the best method for obtaining a reliable estimation of the true blood pressure. Average values obtained during the whole 24-hour period, or during daytime and nighttime periods are better correlated with the risk of mortality and cardiovascular disease compared to clinic or office blood pressure. Indeed, nighttime blood pressure, a measure only obtained through ABPM, is the most powerful risk predictor. ABPM is complementary to clinic blood pressure measurement and allows the definition of blood pressure phenotypes, such as "white-coat or masked hypertension, when clinic and ABPM measurements show discrepancy in normal values. Additional potentially relevant features include blood pressure variability, such as nocturnal blood pressure decline, morning surge or short-term variability, as determined by standard deviation or the coefficient of variation.

Can catheter-based renal denervation reduce frequency of hospitalization in patients who have resistant hypertension and heart failure with reduced ejection fraction?

Hypertension is one of the most powerful and modifiable risk factors for the development, progression and even decompensation of heart failure. Uncontrolled hypertension increases to frequency of heart failure hospitalizations by increase sympathetic tone. Catheter-based renal denervation has been shown to reduce blood pressure in the treatment of multidrug-resistant hypertension. We report the improvement in clinical status after renal denervation in a 47-year-old male patient with a history of hypertension, chronic ischemic heart failure, and recurrent hospitalizations for acute hypertensive pulmonary edema despite optimal medical therapy.

Baja disponibilidad de recursos y apoyo para atender a personas con diabetes e hipertensión arterial en las Unidades de Salud de la Familia de Paraguay

Introducción: Paraguay asumió el reto de lograr cobertura universal mediante redes basadas en Atención Primaria de la Salud con Unidades de Salud de la Familia (USF) en el primer nivel de atención. Un desafío es la atención integral ante enfermedades no transmisibles, principal causa de mortalidad en el país. Objetivo: analizar la capacidad de las USF para la atención de personas con hipertensión arterial y diabetes en el sistema nacional de salud. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Metodología: Incluyó a 761 USF de 12 regiones sanitarias agrupados en 4 ejes territoriales. Se adaptó el método de evaluación SARA de la OMS con 75 variables, aplicando un cuestionario a profesionales de salud entre noviembre y diciembre de 2022. Se calculó índices de disponibilidad y preparación así como un índice que los integra. La medida continua de estos índices se categorizó en 3 grupos: suficiente >0,75 a 1; intermedio 0,5 a 0,75 y bajo <0,5. Resultados: Solo en el 38 % de las USF el índice de disponibilidad fue suficiente, en el 31,5 % para el índice de preparación y en el 31,1 % para el índice integrador SARA DM/HTA. El desempeño se asoció de forma significativa con el eje territorial no así con el área ni con la cobertura a población indígena Discusión: las USF presentaron limitaciones para la atención de personas con diabetes e hipertensión en estas regiones del país.

Introduction: Paraguay assumed the challenge of achieving universal coverage through networks based on Primary Health Care with Family Health Units (USF) at the first level of care. One challenge is comprehensive care for non-communicable diseases, the main cause of mortality in the country. Objective: to analyze the capacity of the USF to care for people with high blood pressure and diabetes in the national health system. The design was non-experimental, quantitative, cross-sectional, descriptive with an analytical component. Methods: It included 761 USF from 12 health regions grouped into 4 territorial axes. The WHO SARA evaluation method was adapted with 75 variables, applying a questionnaire to health professionals between November and December 2022. Availability and preparation indices were calculated as well as an index that integrates them. The continuous measurement of these indices was categorized into 3 groups: sufficient >0.75 to 1; intermediate 0.5 to 0.75 and low <0.5. Results: Only in 38.0% of the USF the availability index was sufficient, in 31.5% for the readiness index and in 31.1% for the SARA DM/HTA integrating index. The performance was significantly associated with the territorial axis, but not with the area or with the coverage of the indigenous population. Discussion: the USF presented limitations for the care of people with diabetes and hypertension in these regions of the country.

Feocromocitoma y paraganglioma en un hospital pediátrico de Argentina. Serie de casos / Pheochromocytoma and paraganglioma at a children's hospital in Argentina. A case series

El feocromocitoma y el paraganglioma son tumores neuroendocrinos secretores de catecolaminas. Los feocromocitomas se originan en la médula suprarrenal, mientras que los paragangliomas son extraadrenales. Se describe una serie de casos de niños con diagnóstico anatomopatológico de feocromocitoma o paraganglioma que consultaron en un hospital pediátrico de alta complejidad de Argentina. Se incluyeron 21 pacientes, 14 varones, con una mediana de edad de 11,4 años; 8 casos con feocromocitoma y 13 casos con paraganglioma. Se presentaron con hipertensión arterial 14/21. La mayoría de los paragangliomas tuvieron localización paraaórtica (9/13). Debido a que representan una causa potencialmente curable de hipertensión arterial, la sospecha clínica es muy importante. El diagnóstico temprano y la instauración de un tratamiento antihipertensivo adecuado, que permita afrontar la cirugía con normotensión arterial, aseguran la curación en la mayoría de los casos si la resección tumoral es completa.

Pheochromocytomas and paragangliomas are neuroendocrine tumors producing catecholamines. Pheochromocytomas occur in the adrenal medulla, while paragangliomas are those that occur outside the adrenal gland. Here we describe a case series of children with a pathological diagnosis of pheochromocytoma or paraganglioma who consulted at a tertiary care children's hospital in Argentina. A total of 21 patients (14 males) were included; their median age was 11.4 years; 8 children had pheochromocytoma and 13, paraganglioma. Arterial hypertension was observed in 14/21. Most paragangliomas were para-aortic (9/13). Since they are a potentially curable cause of hypertension, clinical suspicion is very important. An early diagnosis and the initiation of an adequate antihypertensive treatment, which allows the patient to undergo surgery with normal blood pressure, ensure a cure in most cases if tumor resection is complete.

Ação de prevenção e combate à hipertensão arterial: um relato de experiência em uma liga acadêmica de medicina / Acción para prevenir y combatir la hipertensión arterial: un reporte de experiencia en una liga académica de medicina / Initiative to prevent and control arterial hypertension: a report of an experience in an academic medicine league

Introdução: A hipertensão arterial sistêmica é uma das doenças crônicas de maior prevalência no Brasil, sendo esta, juntamente com outras doenças crônicas, o foco de atenção das unidades primárias de saúde. Desta forma, atividades de educação em saúde relacionadas à prevenção e combate a hipertensão arterial sistêmica são de grande importância para reduzir a incidência dessa doença na população. Objetivo: Nesse sentido, o presente relato possui uma abordagem qualitativa descritiva exploratória, de uma experiência dos membros de uma liga acadêmica de medicina de uma universidade no Sul de Santa Catarina. Metodologia: A abordagem do público se deu através de um projeto social no ambulatório de especialidades médicas da universidade, realizado no dia nacional de combate à hipertensão arterial de 2023, com duração de 11 horas. Neste projeto, contou com 12 membros da liga e 79 pacientes com idade média de 42 anos, foram distribuídos panfletos com informações importantes sobre hipertensão, além de outras ações, como: esclarecimento de dúvidas, distribuição demudas frutíferas e frutas, aferições de pressão arterial, encaminhamentos para consultas com clínico geral e nutricionista. Resultados: A maioria das Pressões Arteriais aferidas estava dentro da normalidade; no entanto, foram identificados alguns casos de pré-hipertensão e hipertensão ainda não diagnosticadas, além de casos em que a pressão arterial estava descompensada mesmo com tratamento farmacológico(50% dos pacientes hipertensos), incluindo um caso de crise hipertensiva, também foi possível perceber o desconhecimento do público sobre a PA e seus riscos a saúde. Conclusões: Conclui-se que é necessária a conscientização e educação em saúde das pessoas a respeito do que é a hipertensão arterial sistêmica, uma vez que, cerca de, 49%dos pacientes estavam com Índice de Massa Corporal acima de25e 37% com pressão arterial acima de 120x80mmHg (AU).

Introduction: Systemic arterial hypertension is one of the most prevalent chronic diseases in Brazil. Together with other chronic diseases, this condition is the focus of attention in the primary health units. Therefore, health education with view at preventing and controlling systemic arterial hypertension is of great importance to reduce the incidence of this disease in the population.Objective:, the present report is an exploratory descriptive qualitative approach of an Academic Medical League's members' experience at a university in the south of Santa Catarina.Methodology: The target audience was approached through a social project held at the university's medical specialty outpatient clinic on the national day of high blood pressure control in 2023 with an 11 hours duration. This project involved 12 members of the League and 79 patients. Patients' average age was 42 years. Leaflets containing important information about hypertension were distributed. Further initiatives included answering questions, fruit seedlings and fruits distribution, assessment of blood pressure, referring people to a general practitioner and to a nutritionist. Results: Blood pressure of most of the individuals who had their blood pressure measured at the event was within normal range; however, some cases of undiagnosed pre-hypertension and hypertension were identified, in addition to cases in which blood pressure was decompensated despite pharmacological treatment (50% of hypertensive patients); this included one case of hypertensive crisis. It was also evident the audience's lack of knowledge about blood pressure and its health risks.Conclusions: it is necessary to raise awareness and improve health education among people regarding what systemic arterial hypertension is, since approximately 49% of patients had a body mass index above 25 and 37% had a blood pressure above 120x80 mmHg (AU).

Introducción: La hipertensión arterial sistémica es una de las enfermedades crónicas más prevalentes en Brasil. Junto con otras enfermedades crónicas, es foco de atención en las unidades primarias de salud. Por lo tanto, las actividades de educación sanitaria relacionadas con la prevención y el combate de la hipertensión arterial sistémica son de gran importancia para reducir la incidencia de esta enfermedad en la población.Objetivo: El presente relato tiene un enfoque cualitativo descriptivo exploratorio basado en una experiencia de miembros de una liga médica académica de la universidad del sur de Santa Catarina.Metodología: Se acercó al público a través de un proyecto social realizado en el ambulatorio de especialidades médicas de la universidad, en el día nacional de combate a la hipertensión arterial del año 2023, que tuve una duración de 11 horas. En este proyecto participaron 12 integrantes de la liga y 79 pacientes con promedio de 42 años; se distribuyeron folletos con información importante sobre la hipertensión, además de otras iniciativas como: aclarar dudas, repartir plantones y frutas, medir la presión arterial, derivaciones para consultas con médico general y nutricionista. Resultados: La mayoría de las presiones medidas estuvieron dentro de los límites normales; sin embargo, se identificaron algunos casos de prehipertensión e hipertensión no diagnosticadas, además de casos en los que la presión arterial se descompensaba incluso con tratamiento farmacológico (50% de los hipertensos); hubo un caso de crisis hipertensiva. También se pudo notar la falta de conocimiento delpúblico sobre la PA y sus riesgos para la salud. Conclusiones: Se concluye que es necesario generar conciencia y educación en salud en las personas respecto de la hipertensión arterial sistémica, ya que aproximadamente el 49% de los pacientes tenían un Índice de Masa Corporal superior a 25 y el 37% tenían una presión superior a 120x80 mmHg (AU).

Calçada amiga: dialogando com a comunidade sobre a hipertensão arterial e o diabetes mellitus no território / Calçada Amiga: dialogando con la comunidadsobre la hipertensión arterial y la diabetes mellitus en el territorio / Calçada Amiga: dialoguing with the community about hypertension and diabetes mellitus in the territory

Introdução: As Doenças Crônicas não Transmissíveis constituem-se em um grande desafio de saúde pública. Dentro deste grupo, a Hipertensão Arterial e o Diabetes Mellitus merecem destaque, pois seu enfrentamento requer bastante dos serviços de saúde. Na realidade da Atenção Básica, tem-se destaque para as atividades educativas, em especial para a Educação Popular em Saúde, como a "Calçada Amiga". Objetivo: Abordar a experiência da atividade de educação popular em saúde intitulada "Calçada Amiga" como instrumento de proteção, prevenção e promoção da saúde na Hipertensão Arterial e no Diabetes Mellitus em um serviço de Atenção Primária à Saúde. Metodologia: Trata-se de um relato de Experiência de uma atividade de educação popular em saúde desenvolvida no território de uma Unidade Básica de Saúde do Município de Mossoró/Rio Grande do Norte, durante o ano de 2022.Resultados e Discussões: Foram realizadas 13 ações. Sobre a Hipertensão Arterial e o Diabetes Mellitus, notou-se uma certa dificuldade na adesão ao tratamento, com relatos tanto na prática do exercício físico quanto na alimentação adequada, além do uso das medicações. Ainda sobre as dificuldades na adesão, muitos deles afirmavam uma subutilização dos serviços de saúde, em especial a UBS. Foi possível observar a validade da Educação Popular em Saúde por meio de afirmações de avaliação positiva sobre o método adotado para as atividades, com boa aceitação, frequência e retorno da comunidade. Conclusões: A atividade permitiu o fortalecimento do vínculo entre a Unidade Básica de Saúde e a comunidade por meio da imersão no território com momentos de diálogos horizontais e escuta ativa, facilitando a compreensão por parte dos profissionais sobre a realidade dos sujeitos assistidos no serviço. Para a comunidade, permitiu um momento de fala e escuta, expressando seus anseios, medos e dificuldades sobre as condições, tornando-se ativa no processo de saúde/doença (AU).

Introduction: Chronic non-communicable diseases are a major public health challenge. Within this group, Hypertension and Diabetes Mellitus deserve to be highlighted, because coping with it requires a lot of health services. In the reality of Primary Care, there is emphasis on educational activities, especially for Popular Health Education, such as "Calçada Amiga".Objective:To address the experience of popular health education activity entitled "Calçada Amiga" as an instrument of protection, prevention and health promotion in Hypertension and Diabetes Mellitus in a Primary Health Care service.Methodology:This is an experience report of a popular health education activity developed in the territory of a Basic Health Unit of the Municipalityof Mossoró/ Rio Grande do Norte during the year 2022.Results and Discussion:13 actions were performed. Regarding Hypertension and Diabetes Mellitus, there was some difficulty in adherence to treatment, with reports both in the practice of physical exercise and in proper nutrition, in addition to the use of medications. Still on the difficulties in adherence, many of them stated an underutilization of health services, especially the UBS. It was possible to observe the validity of Popular Health Education through affirmations of positive evaluation of the method adopted for the activities, with good acceptance, frequency and community return.Conclusions:The activity allowed the strengthening of the bond between the Basic Health Unit and the community through immersion in the territory with moments of horizontal dialogues and active listening, professionals about the reality of the subjects assisted in the service. For the community, it allowed a moment of speech and listening, expressing their desires,fears and difficulties about the conditions, becoming active in the health/disease process (AU).

Introducción: Las Enfermedades Crónicas no Transmisibles se constituyen en un gran desafío de salud pública. Dentro de este grupo, la Hipertensión Arterial y el Diabetes Mellitus merecen destaque, pues su enfrentamiento requiere bastante de los servicios de salud. En realidad de la Atención Básica, se ha destacado para las actividades educativas, en especial para la Educación Popular en Salud, como la "Calçada Amiga". Objetivo: Abordar la experiencia de la actividad de educación popular en salud titulada "Calçada Amiga" como instrumento de protección, prevención y promoción de la salud en la Hipertensión Arterial y en la Diabetes Mellitus en un servicio de Atención Primaria de Salud.Metodología: Se trata de un relato de experiencia de una actividad de educación popular en salud desarrollada en el territorio de una Unidad Básica de Salud del Municipio de Mossoró/ Rio Grande do Norte durante el año 2022.Resultados y Discusión: Fueron realizadas 13 acciones. Sobre la Hipertensión Arterial y la Diabetes Mellitus, se notó una cierta dificultad en la adhesión del tratamiento, con relatos tanto en la práctica del ejercicio físico como en la alimentación adecuada, además del uso de las medicaciones. También sobre las dificultades en la adhesión, muchos de ellos afirmaban una infrautilización de los servicios de salud, en especial la UBS. Fue posible observar la validez de la Educación Popular en Salud por medio de afirmaciones de evaluación positiva sobre el método adoptado para las actividades, con buena aceptación, frecuencia y retorno de la comunidad.Conclusiones: La actividad permitió el fortalecimiento del vínculo entre la Unidad Básica de Salud y la comunidad por medio de la inmersión en el territorio con momentos de diálogos horizontales y escucha activa, facilitando la comprensión por parte de los profesionales de la realidad de los sujetos asistidos en el servicio. Para la comunidad, permitió un momento de habla y escucha, expresando sus anhelos, miedos y dificultades sobre las condiciones, haciéndose activa en el proceso de salud/enfermedad (AU).

[Ambulatory blood pressure monitoring, adult and pediatric population. A narrative review]. / Monitorización ambulatoria de la presión arterial en adultos y población pediátrica. Una revisión narrativa.

Hypertension has become a central risk factor for the development of cardiovascular disease, underscoring the importance of its accurate diagnosis. Numerous studies have established a close relationship between elevated systolic (SBP) and diastolic (DBP) blood pressure and an increased risk of cardiovascular event (CVE). Traditionally, blood pressure (BP) measurements performed in clinical settings have been the main method for diagnosing and assessing hypertension. However, in recent years, it has been recognized that BP measurements obtained outside the clinical setting, using self-monitoring blood pressure (SMBP) and ambulatory blood pressure monitoring (ABPM), offer a more realistic perspective of patients' daily lives and therefore provide more reliable results. Given the evolution of medical devices, diagnostic criteria, and the increasing relevance of certain components of ABPM in the prediction of adverse cardiovascular outcomes, a comprehensive update that is practical for daily clinical practice is required. The main objective of this article is to provide an updated review of ABPM, focusing on its importance in the evaluation of hypertension and its impact on public health in Colombia. In addition, it will discuss the implications of changes in diagnostic thresholds and provide concrete recommendations for the effective implementation of ABPM in clinical practice, allowing health professionals to make informed decisions and improve the care of their patients.

[Hypertensive Emergency as the Debut of Paraneoplastic Cushing Syndrome]. / Emergencia hipertensiva como debut de síndrome de Cushing paraneoplásico.

We present the case of a patient with a history of renal-vascular hypertension treated with stent one year previously, who attended the emergency room due to hypertensive emergency and dyspnea. Once the first suspicion of renal artery restenosis was ruled out with CT angiography, the study was completed, confirming the diagnosis of lung cancer through imaging and pathological anatomy. In the hormonal study, elevation of ACTH, hypercortisolism and analytical data of hyperaldosteronism were detected. With the final diagnosis of Cushing's syndrome secondary to ectopic production of ACTH, medical treatment was started, without being able to receive anything else due to the death of the patient after a few days.

Hypertensive states of pregnancy.

Hypertensive disorders in pregnancy (HDP) remain a leading cause of pregnancy-related maternal and foetal morbidity and mortality worldwide, including chronic hypertension, gestational hypertension, and pre-eclampsia. Affected women and newborns also have an increased risk of cardiovascular disease later in life, independent of traditional cardiovascular disease risks. Despite these risks, recommendations for optimal diagnosis and treatment have changed little in recent decades, probably due to fear of the foetal repercussions of decreased blood pressure and possible drug toxicity. In this document we review the diagnostic criteria and classification of (HDP), as well as important aspects regarding pathophysiology and early detection that allows early identification of women at risk, with the aim of preventing both immediate and long-term consequences. Prophylactic treatment with aspirin is also reviewed early and a therapeutic approach is carried out that involves close maternal and foetal monitoring, and if necessary, the use of safe drugs in each situation. This review aims to provide an updated vision for the prevention, diagnosis, and treatment of HDP that is useful in our usual clinical practice.

Importance of blood pressure monitoring in the acute phase of stroke. An update.

INTRODUCTION: The evaluation of blood pressure (BP) is essential in the acute phase of stroke. Although ambulatory blood pressure monitoring (ABPM) is a validated method for BP control, there are few studies assessing the usefulness of ABPM in the acute phase of stroke. DEVELOPMENT: A systematic review was carried out according to the PRISMA criteria in the PubMed/Medline and Scopus databases. Those articles that analysed the use of ABPM in the first days after suffering a stroke from 1992 to 2022 were selected. Those articles focused on the post-acute or sequelae phase of the stroke, with a sample size of less than 20 and those where the primary objective was different from the defined one. A total of 28 articles were included. CONCLUSIONS: The use of ABPM in patients with recent stroke demonstrates that the normal circadian profile of BP is altered in more than two-thirds of patients and that this will be fundamentally conditioned by the haemodynamic changes that occur on autoregulation of cerebral blood flow, the type of stroke or the response to treatment. Furthermore, these changes in BP have prognostic implications and are correlated with functional status, stroke recurrence and mortality, among others. However, although they continue to be a growing area of research, new studies are needed to clarify the real role of this technique in patients with acute stroke.

Hipertensión pulmonar y leiomiomas uterinos, ¿existe relación causal? Serie de casos y revisión fisiopatológica / Pulmonary Hypertension and Uterine Leiomyomas, Is there a Causal Relationship? Case Series and Pathophysiological Review

Introducción: Los leiomiomas uterinos son un tipo de neoplasia benigna de frecuente aparición en mujeres de edad reproductiva, relacionados con enfermedad tromboem- bólica venosa. Este vínculo surge del efecto producido por la compresión de fibromas que genera estasis venosa en la región pelviana. Sin embargo, este pareciera no ser el único factor que lo relaciona con el desarrollo posterior de hipertensión pulmonar, sino que su presencia es gatillo de una serie de fenómenos que influyen sobre la vasculatu - ra pulmonar y también a nivel sistémico. Método: Revisión de una serie de casos (seis) atendidos en nuestra unidad, seguido de una revisión sobre la relación entre leiomio- mas y distintas formas de hipertensión pulmonar con una revisión desde la fisiopatología. Resultado y conclusiones: Encontramos sustento bibliográfico en los múltiples caminos fisiopatológicos que relacionan los mediadores vasculares comunes, que parecieran ser el punto clave en la relación entre estas dos patologías.

Introduction: Uterine leiomyomas are a type of benign neoplasm that frequently appears in women of reproductive age, related to venous thromboembolic disease. This link arises from the effect produced by the compression of fibroids, which generates venous stasis in the pelvic region. However, this seems not to be the only factor that re- lates it to the subsequent development of pulmonary hypertension, but rather its presence is a trigger for a series of phenomena that influence the pulmonary vasculature and also at a systemic level. Method: Review of a series of cases (six) cared for in our unit, followed by a review on the relationship between leiomyomas and different forms of pulmonary hypertension with a review from the pathophysiology. Result and conclusions: We found bibliographic support in the multiple pathophysiological paths that relate the common vascular mediators, which appear to be the key point in the relationship between these two pathologies.

SEA 2024 Standards for Global Control of Vascular Risk. / Estándares de la Sociedad Española de Arteriosclerosis 2024 para el control global del riesgo vascular.

One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.

Renin-angiotensin-aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial.

INTRODUCTION: Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS: Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3-4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. RESULTS: 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was -4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. CONCLUSIONS: In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023).

Association between CYP4A11 and EPHX2 genetic polymorphisms and chronic kidney disease progression in hypertensive patients.

BACKGROUND: There are evidence indicating that some metabolites of arachidonic acid produced by cytochromes P450 (CYP) and epoxide hydroxylase (EPHX2), such as hydroxyeicosatetraenoic acids (HETEs), epoxyeicosatrienoic acids (EETs) or dihydroxyeicosatrienoic acids (DHETEs), play an important role in blood pressure regulation and they could contribute to the development of hypertension (HT) and kidney damage. Therefore, the main aim of the study was to evaluate whether the genetic polymorphisms of CYP2C8, CYP2C9, CYP2J2, CYP4F2, CYP4F11 and EPHX2, responsible for the formation of HETEs, EETs and DHETEs, are related to the progression of impaired renal function in a group of patients with hypertension. METHODS: 151HT patients from a hospital nephrology service were included in the study. Additionally, a group of 87 normotensive subjects were involved in the study as control group. For HT patients, a general biochemistry analysis, estimated glomerular filtration rate and genotyping for different CYPs and EPHX2 variant alleles was performed. RESULTS: CYP4A11 rs3890011, rs9332982 and EPHX2 rs41507953 polymorphisms, according to the dominant model, presented a high risk of impaired kidney function, with odds ratios (OR) of 2.07 (1.00-4.32; P=0.049) 3.02 (1.11-8.23; P=0.030) and 3.59 (1.37-9.41; P=0.009), respectively, and the EPHX2 rs1042032 polymorphism a greater risk according to the recessive model (OR=6.23; 95% CI=1.50-25.95; P=0.007). However, no significant differences in allele frequencies between HT patients and in normotensive subjects for any of the SNP analysed. In addition, the patients with diagnosis of dyslipidemia (n=90) presented higher frequencies of EPHX2 K55R (rs41507953) and *35A>G (rs1042032) variants than patients without dyslipidemia, 4% vs. 14% (P=0.005) and 16 vs. 27% (P=0.02), respectively. CONCLUSIONS: In this study has been found higher odds of impaired renal function progression associated with rs3890011 and rs9332982 (CYP4A11) and rs41507953 and rs1042032 (EPHX2) polymorphisms, which may serve as biomarkers for improve clinical interventions aimed at avoiding or delaying, in chronic kidney disease patients, progress to end-stage kidney disease needing dialysis or kidney transplant.

Venous congestive encephalopathy secondary to arteriovenous fistula aggravated by cerebrospinal fluid shunt.

We present a unique clinical case of venous congestive encephalopathy in the context of a cerebral arteriovenous fistula with clinical worsening secondary to valvular overdrainage. ICP monitoring, the different pressure settings of the programable CSF shunt and the detailed clinical description that is carried out offer us enough data to understand that this case provides important pathophysiological knowledge to a little-known disease.

Prevalence, impact and management of hypertension-mediated organ damage in type 2 diabetes patients.

OBJECTIVE: To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM). METHODS: IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18-85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed. RESULTS: At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P=0.001), hypertension (75.4% vs 66.4%; P=0.001), any CV disease (39.6% vs 16.1%; P=0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal. CONCLUSIONS: In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.