The role of multiparametric magnetic resonance in active surveillance of a low-risk prostate cancer cohort from clinical practice.

INTRODUCTION: Active surveillance (AS) is considered a suitable management practice for those patients with low-risk prostate cancer (PCa). At present, however, the role of multiparametric magnetic resonance imaging (mpMRI) in AS protocols has not yet been clearly established. OUTCOMES: To determine the role of mpMRI and its ability to detect significant prostate cancer (SigPCa) in PCa patients enrolled in AS protocols. MATERIALS AND METHODS: There were 229 patients enrolled in an AS protocol between 2011 and 2020 at Reina Sofía University Hospital. MRI interpretation was based on PIRADS v.1 or v.2/2.1 classification. Demographics, clinical, and analytical data were collected and analyzed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for mpMRI in different scenarios. We defined SigPCa and reclassification/progression as a Gleason score (GS) ≥ 3 + 4, a clinical stage ≥T2b, or an increase in PCa volume. Kaplan-Meier and log-rank tests were used to estimate progression-free survival time. RESULTS: Median age was 69.02 (±7.73) at diagnosis, with a 0.15 (±0.08) PSA density (PSAD). Eighty-six patients were reclassified after confirmatory biopsy, with a suspicious mpMRI an indication for a clear reclassification and risk-predictor factor in disease progression (p < 0.05). During follow-up, 46 patients were changed from AS to active treatment mainly due to disease progression. Ninety patients underwent ≥2mpMRI during follow-up, with a median follow-up of 29 (15-49) months. Thirty-four patients had a baseline suspicious mpMRI (at diagnostic or confirmatory biopsy): 14 patients with a PIRADS 3 and 20 patients with ≥PIRADS 4. From 14 patients with a PIRADS 3 baseline mpMRI, 29% progressed radiologically, with a 50% progression rate versus 10% (1/10 patients) for those with similar or decreased mpMRI risk. Of the 56 patients with a non-suspicious baseline mpMRI (PIRADS < 2), 14 patients (25%) had an increased degree of radiological suspicion, with a detection rate of SigPCa of 29%. The mpMRI NPV during follow-up was 0.91. CONCLUSION: A suspicious mpMRI increases the reclassification and disease progression risk during follow-up and plays an important role in monitoring biopsies. In addition, a high NPV at mpMRI follow-up can help to decrease the need to monitor biopsies during AS.

Stingray spear injury to the pediatric spinal cord: case report and review of the literature.

Stingray injuries are rare, mostly causing injuries to the lower extremities but occasionally fatal if there is direct puncture of the thorax, abdomen, or neck. Direct combined stingray injury to the central nervous system has not been reported in the literature. Herein we present the case of a 12-year-old boy who, while wading at the seashore of the Costa Rica's Pacific Ocean, sustained a combined oblique penetrating injury to the C6 vertebra caused by a Stingray. He initially presented to the hospital with a complete asymmetric right C6/left T1 ASIA A examination, priapism, and loss of anal sphincter tone. Imaging revealed fracture of the posterior elements of C6 with an oblique trajectory into the left radicular foramen. T2W images did not reveal anatomical section but rather edema and minor bleeding in the epidural space. The patient underwent medical management and serial imaging. During the next 3 months, there was recovery of sensation on the right hemi body, bilateral paresthesias and asymmetric progressive improvement in strength on both legs. Acute care management and midterm term follow up are provided, along with a review of the literature for salient management considerations when evaluating and treating combined penetrating and envenomation injuries caused by stingrays. To our knowledge, this is the first report of such injury to the spine.

Correction to: Stingray spear injury to the pediatric spinal cord: case report and review of the literature.

The original version of this article unfortunately contained an error in the spelling of the last name of one of the co-authors. The corresponding author did not notice that the last name of one of the co-authors, Nathan Shlobin, was misspelled as "Schlobin". The correct spelling of his last name is "Shlobin". Given in this article is the corrected author name.

Molecular aggregation of naphthalimide organic semiconductors assisted by amphiphilic and lipophilic interactions: a joint theoretical and experimental study.

Amphiphilic and lipophilic donor-acceptor naphthalimide-oligothiophene assemblies exhibiting almost identical intramolecular properties, but differing in their intermolecular interactions, have been synthesized. Here we analyze the effect of replacing the normally used lipophilic alkyl chains with hydrophilic ones in directing molecular aggregation from an antiparallel to a parallel stacking. This different molecular packing of the amphiphilic, NIP-3TAmphi, and lipophilic, NIP-3TLipo, systems is assessed by electronic spectroscopies, scanning electronic microscopy and DFT quantum-chemical calculations. Theoretical calculations indicate that the presence of amphiphilic interactions promotes a face-to-face parallel arrangement of neighbor molecules, which induces improved electronic coupling and therefore enhances the charge transport ability and photoconducting properties of this type of materials. Time of flight and photoconducting measurements are used to determine the impact of the amphiphilic and lipophilic interactions on their possible performance in optoelectronic devices.

Descriptive study of symptomatic epilepsy by age of onset in patients with a 3-year follow-up at the Neuropaediatric Department of a reference centre. / Estudio descriptivo de las epilepsias sintomáticas según edad de inicio controladas durante 3 años en una Unidad de Neuropediatría de referencia regional.

OBJECTIVE: We conducted a descriptive study of symptomatic epilepsy by age at onset in a cohort of patients who were followed up at a neuropaediatric department of a reference hospital over a 3-year period PATIENTS AND METHODS: We included all children with epilepsy who were followed up from January 1, 2008 to December 31, 2010 RESULTS: Of the 4595 children seen during the study period, 605 (13.17%) were diagnosed with epilepsy; 277 (45.79%) of these had symptomatic epilepsy. Symptomatic epilepsy accounted for 67.72% and 61.39% of all epilepsies starting before one year of age, or between the ages of one and 3, respectively. The aetiologies of symptomatic epilepsy in our sample were: prenatal encephalopathies (24.46% of all epileptic patients), perinatal encephalopathies (9.26%), post-natal encephalopathies (3.14%), metabolic and degenerative encephalopathies (1.98%), mesial temporal sclerosis (1.32%), neurocutaneous syndromes (2.64%), vascular malformations (0.17%), cavernomas (0.17%), and intracranial tumours (2.48%). In some aetiologies, seizures begin before the age of one; these include Down syndrome, genetic lissencephaly, congenital cytomegalovirus infection, hypoxic-ischaemic encephalopathy, metabolic encephalopathies, and tuberous sclerosis. CONCLUSIONS: The lack of a universally accepted classification of epileptic syndromes makes it difficult to compare series from different studies. We suggest that all epilepsies are symptomatic because they have a cause, whether genetic or acquired. The age of onset may point to specific aetiologies. Classifying epilepsy by aetiology might be a useful approach. We could establish 2 groups: a large group including epileptic syndromes with known aetiologies or associated with genetic syndromes which are very likely to cause epilepsy, and another group including epileptic syndromes with no known cause. Thanks to the advances in neuroimaging and genetics, the latter group is expected to become increasingly smaller.

3DBIONOTES: A unified, enriched and interactive view of macromolecular information.

With the advent of high throughput techniques like Next Generation Sequencing, the amount of biological information for genes and proteins is growing faster than ever. Structural information is also rapidly growing, especially in the cryo Electron Microscopy area. However, in many cases, the proteomic and genomic data are spread in multiple databases and with no simple connection to structural information. In this work we present a new web platform that integrates EMDB/PDB structures and UniProt sequences with different sources of protein annotations. The application provides an interactive interface linking sequence and structure, including EM maps, presenting the different sources of information at sequence and structural level. The web application is available at http://3dbionotes.cnb.csic.es.

Pseudoephedrine and circadian rhythm interaction on neuromuscular performance.

This study analyzed the effects of pseudoephedrine (PSE) provided at different time of day on neuromuscular performance, side effects, and violation of the current doping cut-off threshold [World Anti-Doping Agency (WADA)]. Nine resistance-trained males carried out bench press and full squat exercises against four incremental loads (25%, 50%, 75%, and 90% one repetition maximum [1RM]), in a randomized, double-blind, cross-over design. Participants ingested either 180 mg of PSE (supra-therapeutic dose) or placebo in the morning (7:00 h; AM(PLAC) and AM(PSE)) and in the afternoon (17:00 h; PM(PLAC) and PM(PSE)). PSE enhanced muscle contraction velocity against 25% and 50% 1RM loads, only when it was ingested in the mornings, and only in the full squat exercise (4.4-8.7%; P < 0.05). PSE ingestion raised urine and plasma PSE concentrations (P < 0.05) regardless of time of day; however, cathine only increased in the urine samples. PSE ingestion resulted in positive tests occurring in 11% of samples, and it rose some adverse side effects such us tachycardia and heart palpitations. Ingestion of a single dose of 180 mg of PSE results in enhanced lower body muscle contraction velocity against low and moderate loads only in the mornings. These mild performance improvements are accompanied by undesirable side effects and an 11% risk of surpassing the doping threshold.

Effect of micellized natural (D-α-tocopherol) vs. synthetic (DL-α-tocopheryl acetate) vitamin E supplementation given to turkeys on oxidative status and breast meat quality characteristics.

This study evaluates the effect of vitamin E supplementation source (micellized natural vs. the synthetic form) and dosage (40, 80, or 120 mg/kg) on α-tocopherol concentration in plasma and muscle, antioxidant capacity, and breast meat quality in turkeys. Three hundred female turkeys were randomly selected at an average live weight 63.2 g±0.5 and distributed into 7 groups. One group (control) was fed a standard diet without vitamin E supplementation and the other 6 were given mixed diets supplemented with the natural (d-α-tocopherol) or synthetic (dl-α-tocopheryl acetate) form of vitamin E in 3 dosages (40, 80, or 120 mg/kg). Following 11 wk feeding, results showed that performance parameters were not modified either by source or dosage of vitamin E supplementation to the turkeys. Plasma and muscle α-tocopherol at d 9 of refrigerated storage were higher when turkeys were supplemented with the natural form at higher doses. Losses in the concentration of α-tocopherol in meat between the beginning and the end of the 9 d refrigerated storage were greater in the groups supplemented with the synthetic form of vitamin E compared to those receiving the natural supplementation. The relationship between plasma α-tocopherol and the Trolox equivalent antioxidant capacity followed a different trend depending on the vitamin E source. Intramuscular fat was not significantly affected by the vitamin E source supplementation; however the slope of the linear regression equation was lower for the natural form than for the synthetic form. Turkeys given the natural form had higher C18:1n-9 but lower C15:1, C17:1, C20:5n-3, and C22:6n-3 in breast muscle. Meat samples from turkeys supplemented with natural vitamin E had higher deoxymyoglobin at d 3, 6, and 9 and lower metmyoglobin at d 9 of refrigerated storage than those receiving the synthetic form. Dietary supplementation with medium doses (80 mg/kg) micellized d-α-tocopherol is an interesting feeding strategy for ensuring antioxidant status and improving meat quality.

Blood doping: potential of blood and urine sampling to detect autologous transfusion.

The collection of blood, its storage as red blood cell (RBC) concentrates and its reinjection is prohibited; until now, the practice cannot be reliably detected. A recent innovation-the haematological module of the athlete's biological passport-can provide authorities with indications towards autologous blood transfusion. In situations where a given athlete has been exposed to altitude, heat stress, sickness, etc, additional evidence may be needed to establish beyond any reasonable doubt that a blood transfusion may actually have occurred. Additional evidence may be obtained from at least three different approaches using parameters related to blood and urine matrices.Genomics applied to mRNA or miRNA is one of the most promising analytical tools. Proteomics of changes associated with RBC membranes may reveal the presence of cells stored for some time, as can an abnormal pattern of size distribution of aged cells. In urine, high concentrations of metabolites of plasticisers originating from the blood storing bags strongly suggest a recent blood transfusion. We emphasise the usefulness of simultaneously obtaining and then analysing blood and urine for complementary evidence of autologous blood transfusion ('blood doping').

[Changes in the demand for paediatric neurology care in a spanish tertiary care hospital over a 20-year period]. / Evolución de la demanda asistencial neuropediátrica en un hospital español de tercer nivel a lo largo de 20 años.

OBJECTIVE: The purpose of this study is to determine the profile of the demand for paediatric neurology care in a Spanish tertiary hospital over the past 20 years. METHOD: We studied epidemiological data, reasons for consultation, diagnoses and complementary tests from all patients examined by our Paediatric Neurology Unit in its 20 years of service (from May 1990 to March 2010). We also reviewed data from patients whose first visit took place within the last five years (2005-2010) and compared them to data obtained from a prior study carried out in this Unit from 1990 to 1995. To compare the first 5 years (group 1) with the last 5 years (group 2), we calculated confidence intervals, P<.05, for the frequency distribution (%) in each category. RESULTS: Main reasons for consultation and principal diagnoses for the 12726 patients evaluated in the 20-year period, as well as results from group 1 (2046 patients) and group 2 (4488 patients) corresponding to first and the last 5 years of activity respectively, are presented with their confidence intervals in a series of tables. CONCLUSIONS: Variations in the reasons for consultation, diagnoses and complementary tests over time reflect changes determined by medical, scientific and social progress, and organisational changes specific to each hospital. This explains the difficulty of comparing different patient series studied consecutively, which are even more pronounced between different hospitals.

Our experience with the aetiological diagnosis of global developmental delay and intellectual disability: 2006-2010.

INTRODUCTION: Global developmental delay (GDD) and intellectual disability (ID) are common reasons for consultation in paediatric neurology. Results from aetiological evaluations of children with GDD/ID vary greatly, and consequently, there is no universal consensus regarding which studies should be performed. MATERIAL AND METHOD: We review our experience with determining aetiological diagnoses for children with GDD/ID who were monitored by the paediatric neurology unit over the 5-year period between 2006 and 2010. RESULTS: During the study period, 995 children with GDD/ID were monitored. An aetiological diagnosis was established for 309 patients (31%), but not in 686 (69%), despite completing numerous tests. A genetic cause was identified in 142 cases (46% of the total aetiologies established), broken down as 118 cases of genetic encephalopathy and 24 of metabolic hereditary diseases. Our data seem to indicate that diagnosis is easier when GDD/ID is associated with cerebral palsy, epilepsy, infantile spasms/West syndrome, or visual deficit, but more difficult in cases of autism spectrum disorders. Genetic studies provide an increasing number of aetiological diagnoses, and they are also becoming the first step in diagnostic studies. Array CGH (microarray-based comparative genomic hybridisation) is the genetic test with the highest diagnostic yield in children with unexplained GDD/ID. DISCUSSION: The cost-effectiveness of complementary studies seems to be low if there are no clinically suspected entities. However, even in the absence of treatment, aetiological diagnosis is always important in order to provide genetic counselling and possible prenatal diagnosis, resolve family (and doctors') queries, and halt further diagnostic studies.

Clinical scoring and instrumental analysis to evaluate skin types.

BACKGROUND: The biology of the skin is very complex, and there are a number of methods used to classify the different skin types. It is possible to measure or quantify the characteristics of the specific skin types, using a variety of techniques that can objectively evaluate the properties of the skin in a noninvasive manner. AIM: To clinically characterize different skin types by dermatological evaluation and biophysical and skin imaging techniques, and to evaluate the relationship between the different characteristics. METHODS: The study recruited 26 volunteers. Clinical scoring was performed by a dermatologist who classified the volunteers' skin as normal or dry (group 1) and combination or oily (group 2). Objective measurements included skin microrelief, pH, oiliness, water content of the stratum corneum and transepidermal water loss (TEWL). RESULTS: Positive correlations were found between the level of skin oiliness and skin texture obtained from both instrumental analysis and clinical scoring. The combination and oily skin types had higher clinical scores for shine intensity, oiliness and tendency to pigmentation, and also had higher objective scores for sebum secretion, TEWL and roughness. CONCLUSIONS: Biophysical and skin imaging techniques are effective tools to help characterize skin type and assist in clinical dermatology. We found that different skin types had different characteristics related to skin microrelief, oiliness and TEWL, and therefore require specific dermatological treatments.

The metathoracic scent gland of the leaf-footed bug, Leptoglossus zonatus.

The metathoracic scent gland of 25-day-old adults of both sexes of the leaf-footed bug, Leptoglossus zonatus (Dallas) (Heteroptera: Coreidae), are described based on optical microscopy analysis. No sexual dimorphism was observed in the glandular composition of this species. The gland is located in the anteroventral corner of the metathoracic pleura between the middle and posterior coxal pits. The opening to the outside of the gland is very wide and permanently open as it lacks a protective membrane. In the internal part, there is a pair of metathoracic glands that consist of piles of intertwined and occasionally bifurcated cellular tubes or columns. These glands discharge their pheromonal contents into the reservoir through a narrow cuticular tube. The reservoir connects with the vestibule via two opposite and assembled cuticular folds that can separate muscularly in order to allow the flow of liquid away from the insect. The external part consists of an ostiole from which the pheromone is emitted. The ostiole is surrounded by a peritreme, a structure that aids optimum pheromone dispersion. The described gland is of the omphalien type.

Effects of in-the-bag dry-ageing on meat quality, palatability and volatile compounds of low-value beef cuts.

This study evaluated the effects of in-the-bag dry-ageing (BDA) (21 and 42 d) on meat quality, palatability, and volatile compounds of clod heart, brisket, and flat iron cuts from steers. In all cuts, BDA increased moisture losses (P < 0.05), but this did not reduce the juiciness of 21 d BDA versus wet-aged (WA) steaks. In clod heart, BDA increased overall tenderness at 21 d compared to 21 d WA (P < 0.01). Regardless of ageing period, BDA of clod heart increased beef flavour and salty taste and decreased sour-dairy and stale/cardboard flavours and concentrations of volatile compounds derived from lipid oxidation compared to WA (P < 0.05). In brisket, BDA increased salty taste and fatty aroma and reduced bloody/serumy flavour, whereas decreased beef and buttery flavours and intensified some unpleasant aromas/flavours (P < 0.05) for both ageing periods. The BDA of flat iron increased several undesirable aromas/flavours and decreased sweet taste and beef and buttery flavours (P < 0.05), regardless of ageing period. Overall, BDA for 42 d decreased meat quality and palatability and increased concentrations of volatile compounds from lipid oxidation, especially in flat iron cuts. Value could be recovered by customizing BDA periods by cut.

Safety and Immunogenicity of Radiation-Attenuated PfSPZ Vaccine in Equatoguinean Infants, Children, and Adults.

The radiation-attenuated Plasmodium falciparum sporozoites (PfSPZ) Vaccine has demonstrated safety and immunogenicity in 5-month-old to 50-year-old Africans in multiple trials. Except for one, each trial has restricted enrollment to either infants and children or adults < 50 years old. This trial was conducted in Equatorial Guinea and assessed the safety, tolerability, and immunogenicity of three direct venous inoculations of 1.8 × 106 or 2.7 × 106 PfSPZ, of PfSPZ Vaccine, or normal saline administered at 8-week intervals in a randomized, double-blind, placebo-controlled trial stratified by age (6-11 months and 1-5, 6-10, 11-17, 18-35, and 36-61 years). All doses were successfully administered. In all, 192/207 injections (93%) in those aged 6-61 years were rated as causing no or mild pain. There were no significant differences in solicited adverse events (AEs) between vaccinees and controls in any age group (P ≥ 0.17). There were no significant differences between vaccinees and controls with respect to the rates or severity of unsolicited AEs or laboratory abnormalities. Development of antibodies to P. falciparum circumsporozoite protein occurred in 67/69 vaccinees (97%) and 0/15 controls. Median antibody levels were highest in infants and 1-5-year-olds and declined progressively with age. Antibody responses in children were greater than in adults protected against controlled human malaria infection. Robust immunogenicity, combined with a benign AE profile, indicates children are an ideal target for immunization with PfSPZ Vaccine.

Water-mediated height artifacts in dynamic atomic force microscopy.

Amplitude modulation atomic force microscopy is one of the most broadly used techniques for the nanoscale characterization of a large variety of surfaces because it can routinely provide topography images with nanometer and subnanometer resolution in air, i.e. under ambient conditions, using available commercial instruments. The topographic map results from the convolution of the different interactions (van der Waals, capillary, adhesion, etc.) sensed by the probe and the presence of nanometer-thick water films on both the surface and the tip of the probe, as is usually the case under ambient conditions, can lead to apparent heights markedly different from the real heights due to formation and rupture of water menisci, particularly when the surfaces exhibit regions with different affinity to water (hydrophilic and hydrophobic). In order to systematically explore such a well-known but usually ignored phenomenon, we have performed a combined experimental and theoretical study using (hydrophobic) self-assembled monolayers of stearic acid grown on (hydrophilic) freshly cleaved mica surfaces and a simplified point mass on a spring model to simulate the tip dynamics. We show that, depending on the operation parameters (free oscillation amplitude and setpoint), the apparent heights can vary in magnitude and sign (contrast inversion) and, most important, that the true height cannot be measured in the presence of water layers when surface affinity to water is not homogeneous even if menisci are not formed. We suggest to revise, within the perspective of the present investigation, those published works where the determination of heights is critical.

[Performance improvement project for the introduction of safety devices: interdisciplinary approach and participation of professionals]. / Proyecto de mejora para la introducción de interdisciplinariedad y participación de los profesionales.

OBJECTIVE: Develop a performance improvement project to introduce safety needle tube holder for venous blood collection after evaluation of the professionals. METHODS: Reach: Costa Ponent Primary Care Direction and the Hospital Viladecans Hospital from Institute Català de la Salut. METHOD: Create interdisciplinary group. Design in two phases. First, material selection and assessment of safety devices. Second, implementation and evaluation of the proposed performance improvements. The material was selected using standardized criteria on safety devices, suitability to clinical practice and technical compatibility The assessment was qualitative questionnaire by adapting the Centers for Disease Control and Prevention. RESULT: We evaluated three types of needles, two of them were evaluated by 54 primary care professionals and one for 12 professionals from the hospital. Good acceptance regarding their interaction with technology and patient safety. It was considered effective safety device. The overall rating was satisfactory. Underutilized the material by hospital professionals. There were no differences regarding sex, the hand size, experience, training you received, and type of needle. It prepared a proposal to come in progressively safety needle tube holder in primary care. The evaluation performed in the hospital it was considered insufficient. CONCLUSIONS: Interdisciplinary participation is essential to implement measures to safe care. The safety needle evaluated were effective with respect to security professionals and the patient. The involvement of different levels of the organization have developed a proposal for performance improvement adapted to the needs of our environment.

BIPSPI+: Mining Type-Specific Datasets of Protein Complexes to Improve Protein Binding Site Prediction.

Computational approaches for predicting protein-protein interfaces are extremely useful for understanding and modelling the quaternary structure of protein assemblies. In particular, partner-specific binding site prediction methods allow delineating the specific residues that compose the interface of protein complexes. In recent years, new machine learning and other algorithmic approaches have been proposed to solve this problem. However, little effort has been made in finding better training datasets to improve the performance of these methods. With the aim of vindicating the importance of the training set compilation procedure, in this work we present BIPSPI+, a new version of our original server trained on carefully curated datasets that outperforms our original predictor. We show how prediction performance can be improved by selecting specific datasets that better describe particular types of protein interactions and interfaces (e.g. homo/hetero). In addition, our upgraded web server offers a new set of functionalities such as the sequence-structure prediction mode, hetero- or homo-complex specialization and the guided docking tool that allows to compute 3D quaternary structure poses using the predicted interfaces. BIPSPI+ is freely available at https://bipspi.cnb.csic.es.

Effect of in-the-bag dry-ageing on meat palatability and volatile compounds of cull cows and youthful steers.

This study evaluated the effects of in-the-bag dry-ageing on eating quality and volatile compounds of longissimus lumborum from cows and steers. Compared to wet-ageing, in-the-bag dry-ageing increased purge loss (P < 0.0001), cooking time (P < 0.0001), salty taste (P < 0.05) and sour-dairy flavour (P < 0.01), whereas decreased cooking loss (P < 0.0001), amount of perceptible connective tissue (P < 0.05) and livery flavour (P < 0.05) in both cow and steer meat. This dry-ageing technology also increased juiciness (P < 0.01) and brown-roasted aroma (P < 0.05) in steer meat, whereas decreased the juiciness (P < 0.01) of cow meat. Regardless of the ageing method, cow meat was tougher (P < 0.0001), less juicy (P < 0.001) and sweeter (P < 0.05) and presented higher amount of perceived connective tissue (P < 0.0001) than steer meat, whereas steer meat had higher ratings for beef (P < 0.05) and brown-roasted (P < 0.01) flavours. Volatile compounds were largely affected (P < 0.05) by animal-type, most of them being higher in cow than steer meat. In contrast, in-the-bag dry-ageing affected a few volatile compounds such as alcohols, aldehydes and ketones.

[2022 Practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension]. / Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA).

Hypertension is the most important risk factor for global disease burden. Detection and management of hypertension are considered as key issues for individual and public health, as adequate control of blood pressure levels markedly reduces morbidity and mortality associated with hypertension. Aims of these practice guidelines for the management of arterial hypertension of the Spanish Society of Hypertension include offering simplified schemes for diagnosis and treatment for daily practice, and strategies for public health promotion. The Spanish Society of Hypertension assumes the 2018 European guidelines for management of arterial hypertension developed by the European Society of Cardiology and the European Society of Hypertension, although relevant aspects of the 2017 American College of Cardiology/American Heart Association guidelines and the 2020 International Society of Hypertension guidelines are also commented. Hypertension is defined as a persistent elevation in office systolic blood pressure ≥ 140 and/or diastolic blood pressure ≥ 90 mmHg, and assessment of out-of-office blood pressure and global cardiovascular risk are considered of key importance for evaluation and management of hypertensive patients. The target for treated blood pressure should be < 130/80 for most patients. The treatment of hypertension involves lifestyle interventions and drug therapy. Most people with hypertension need more than one antihypertensive drug for adequate control, so initial therapy with two drugs, and single pill combinations are recommended for a wide majority of hypertensive patients.