[Differences in the degree of control of arterial hypertension according to the measurement procedure of blood pressure in patients ≥ 65 years. FAPRES study]. / Diferencias en el grado de control de la hipertensión arterial según procedimiento de medida de la presión arterial en pacientes de edad ≥ 65 años. Estudio FAPRES.

BACKGROUND AND OBJECTIVES: Control of arterial blood pressure (BP) in hypertensive patients differs based on the evaluation procedure. This fact can be enhanced in subjects over 65 years of age. We have studied the degree of BP control with determinations in the office or ambulatory blood pressure monitoring (ABPM). METHODS: A multicenter, cross-sectional study was conducted in primary care (PC) and hypertension units in the Valencian Community. The first three hypertensive patients ≥ 65 years who attended the consultation on the first day of visits of the week of each investigator were included in the study. Cardiovascular risk factors, target organ damage and associated cardiovascular disease were recorded. Good clinical control values were defined as < 140/90 in the office and < 130/80 by ABPM for 24-hour according to 2007 ESH/ESC guidelines. RESULTS: A total of 1,028 hypertensive patients were included, 52.7% of whom were women, with a mean age of 72.6 years. Mean clinical BP was 146.7/81.1 mmHg and 24-hour ABPM 128.5/70.8 mmHg. Ninety-two percent of the patients were treated with antihypertensive drugs (35.6% monotherapy and 56.4% with combinations of two or more drugs). Good clinical control was found in 35.3% of cases (CI 95%: 32.4-38.2) and 50.9% (CI 95%: 47.8-54.0) (P < .001) had good control of 24-hour BP in ABPM. Male gender, personal background of heart disease and stroke were associated with good control of hypertension (P < .01) in 24-hour ABPM. CONCLUSIONS: In hypertensive patients over 65 years, and compared to the clinical determination of BP, the evaluation of ABMP showed a better proportion of controlled subjects. These findings support a wider use of ABPM to evaluate the control of BP in this population.

Prognostic value of analysing the bioimpedance vector for patients hospitalised for acute decompensated heart failure: A validation cohort.

OBJECTIVES: To assess the prognostic impact of the bioimpedance vector (bioelectrical impedance vector analysis [BIVA]) for patients hospitalized for heart failure (HF). MATERIAL AND METHODS: A prospective cohort of 105 patients hospitalized for HF. BIVA was performed prior to discharge, and the final sample was divided into 3 groups according to the value obtained: hyperhydration [hyperH] (>74.3%), normal hydration [normoH] (72.7-74.3%) and dehydration [desH] (<72.7%). In the follow-up, total mortality and readmissions for HF were considered adverse events. RESULTS: A higher incidence of events was observed among the patients with hyperH and desH compared with those with normoH (Kaplan-Meier: log-rank, 2.1; p=.04), with an increase in independent risk in the multivariate analysis (HR, 2.6 [1.05-6.44]; p=.039). CONCLUSIONS: BIVA helps stratify the risk of readmission for HF and total mortality in the long-term follow-up of patients hospitalized for HF.

Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital. / Prescripción de anticoagulación oral en pacientes con fibrilación auricular e ingreso previo en un servicio de cardiología. Experiencia en un hospital terciario.

INTRODUCTION: Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario. METHODS: A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR. RESULTS: The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01). CONCLUSIONS: For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor.

Valsalva sinus pseudoaneurysm causes acute myocardial infarction and stroke simultaneously.

Spontaneous Valsalva sinus pseudoaneurysm is a rare and highly lethal condition. Below we present a clinical case of a young woman with spontaneous Valsalva sinus pseudoaneurysm diagnosed presenting with acute myocardial infarction (AMI) and ischemic stroke.

High-density lipoproteins and myocardial necrosis in patients with acute myocardial infarction and ST segment elevation.

INTRODUCTION AND AIM: Low plasma levels of high-density lipoprotein cholesterol (HDLC) is a prognostic factor in patients with acute coronary syndrome. The aim of this study was to evaluate the relationship between HDLC and myocardial necrosis estimated by cardiac magnetic resonance (CMR) in patients with acute ST-segment elevation myocardial infarction (STEMI) and reperfusion strategy. METHODS: Retrospective analysis of 139 patients (mean age 59.8 years; 79% men) admitted with STEMI who underwent a CMR in the first week. RESULTS: With a comparable reperfusion strategy used and time of ischemia, patients with HDLC ≤40 mg/dl (69% of total) had more extensive areas of myocardial necrosis after STEMI, in number of segments with late gadolinium enhancement (RTG) with transmural necrosis pattern (4.7 vs. 2.1%, p < .001) and in percentage of RTG with respect to total mass myocardial (18.2 vs. 11.3%, p < .01), and worst left ventricular ejection fraction (LVEF) (49.7 vs. 57.2%, p < .001). CONCLUSIONS: We conclude that low HDLC are very common in patients with STEMI and associated with increased necrosis and a worse LVEF in the CRM study.

[Glucose levels in non-diabetic patients. Is it a prognostic factor in acute coronary syndrome?]. / Niveles de glucemia en pacientes no diabéticos. 'Es un factor pronóstico en el síndrome coronario agudo?

INTRODUCTION: The role of glucose elevation above levels considered normal in non- diabetic patients with acute coronary syndromes (ACS) is not adequately defined. The aim of this study was to determine the association between serum glucose at admission and 1-year mortality in this type of patients. METHODS: We studied 648 non diabetic patients admitted consecutively with ACS. Serum glucose was determined at admission, together with classical risk factors, biochemical and inflammatory markers. The primary endpoint was all cause mortality at one year follow-up. RESULTS: Patients with normal glucose had lower mortality than patients with impaired fasting glucose (14.1% vs 5.7% 1-year mortality) or with glucose levels in diabetic range (24.7% vs 5.7% 1-year mortality). CONCLUSIONS: In non-ST elevation acute coronary syndromes, elevated levels of glucose in non-diabetic patients are strong predictors of all cause death at one year follow-up. This prognostic value is independent of other risk factors biochemical and inflammatory markers.