Confiabilidad de un monitor automatizado para la medición de la presión arterial / Reliability of an automatic monitor for blood pressure measurement

Background A correct blood pressure (BP) measurement is essential for the diagnosis and control of high BP. Aim: To evaluate the agreement and repeatability of BP measurements with the OMRON HEM-7320-LA device compared to a mercury sphygmomanometer. Material and Methods: A cross-sectional study comparing BP measurements made by two randomly selected trained nurses and an automatic oscillometric device. The mercurial sphygmomanometer was connected to the automated device via a "T" type connector and a dual-head stethoscope was used, allowing simultaneous measurements. The results were analyzed with one-factor analysis of variance, Bland-Altman's test, repeatability coefficient (RC), and intra-class correlation coefficient (ICC). Results: Forty-nine participants aged 56 ± 19 years were included. Nineteen had hypertension (38%). We did not observe a significant difference in either systolic (SBP) or diastolic blood pressure (DBP) pressure measurements between the observers and the device. The mean difference was −0.09 mmHg (95% confidence intervals (CI)-0.9 to 0.7) for SBP and −0.9 mmHg (95% CI −1.7 to −0.13) for DBP. The RC for SBP (6.2, 5.2 and 5.8 mmHg) and DBP (4.7, 4.2 y 5.2 mmHg) was similar between the observers and the device. The ICC for SBP was 0.990 (95% CI 0.983 to 0.995, p < 0.01) and 0.986 (95% CI 0.977 to 0.991, p < 0.01) for DBP. Conclusions: There was a high level of agreement and similar measurement repeatability in the measurements performed by the automatic device and the mercurial sphygmomanometer. No differences in BP measurements were observed.

Safety and efficacy of fimasartan in Mexican patients with grade 1-2 essential hypertension / Seguridad y eficacia de fimasartán en pacientes mexicanos con hipertensión esencial de grados 1-2

Abstract: Objective: To evaluate efficacy and safety of 60 mg and 120 mg Fimasartan (FMS) alone or combined with 12.5 mg hydrochlorothiazide (HCTZ) in a Mexican population. Methods: A six month, treat-to-target, open study was conducted on subjects with grade 1-2 hypertension. The subjects were initially treated with 60 mg FMS once daily. In week 8, those with Diastolic Blood Pressure (DBP) <90 mmHg continued on the same FMS dose during the rest of the study, while those with DBP ≥90 mmHg were randomised to either 120 mg FMS or 60 mg FMS + 12.5 mg HCTZ once daily. In week 12, randomised subjects with DBP ≥90 mmHg received 120 mg FMS + 12.5 mg HCTZ, while those achieving target continued with their assigned treatment until the end of the study. Results: FMS 60 mg (n = 272) decreased both DBP and Systolic Blood Pressure (SBP) by 11.3 ± 8.9 (p<.0001) and 16.0 ± 14.1 (p<.0001) mmHg, respectively, with 75.4% of subjects reaching the treatment target. Subjects assigned to FMS 120 mg, FMS 60 mg + HCTZ 12.5 mg, or FMS 120 mg + HCTZ 12.5 mg once daily, showed significant reductions in DBP and SBP with their assigned treatment. At the end of the study, 237/272 subjects (87.1%) achieved a DBP < 90 mmHg and an SBP<140 mmHg. The most frequently reported adverse reactions included headache (3.7%), dry mouth (1.1%), transient liver enzyme increase (1.1%), and dizziness (0.7%). Conclusion: Fimasartan is safe and effective in Mexican subjects with grade 1-2 essential hypertension.

Resumen: Objetivo: Evaluar la eficacia y la seguridad de 60 y 120 mg de fimasartán (FMS) solo o combinado con 12.5 mg de hidroclorotiazida (HCTZ) en población mexicana. Métodos: Estudio abierto, de 24 semanas, con tratamiento escalado hasta el objetivo terapéutico en sujetos hipertensos grados 1-2. Tratamiento inicial: FMS 60 mg una vez al día; en la semana 8, los sujetos con presión arterial diastólica (PAD) <90 mmHg mantuvieron su tratamiento inicial durante el estudio, mientras que los sujetos con PAD ≥90 mmHg fueron aleatorizados a 120 mg de FMS o a 60 mg de FMS + 12.5 mg de HCTZ. En la semana 12, los sujetos aleatorizados con PAD ≥90 mmHg recibieron 120 mg de FMS + 12.5 mg de HCTZ; quienes alcanzaron el objetivo terapéutico mantuvieron su tratamiento asignado hasta finalizar el estudio. Resultados: FMS 60 mg (n = 272) disminuyó la PAD y la presión arterial sistólica (PAS) en 11.3 ± 8.9 (p < 0.0001) y 16.0 ± 14.1 (p < 0.0001) mmHg, respectivamente, con logro del objetivo de tratamiento en el 75.4% de los sujetos. Los sujetos asignados a 120 mg de FMS, a 60 mg de FMS + 12.5 mg de HCTZ 12.5 y a 120 mg de FMS + 12.5 mg de HCTZ mostraron reducciones significativas de PAD y PAS; al final del estudio, 237/272 sujetos (87.1%) lograron PAD <90 y PAS <140 mmHg. Las reacciones adversas más frecuentemente reportadas fueron: cefalea (3.7%), boca seca (1.1%), incremento de enzimas hepáticas (1.1%) y mareo (0.7%). Conclusión: FMS es seguro y eficaz en sujetos mexicanos con hipertensión esencial de grados 1-2.

Triada mortal en pacientes politraumatizados, relación conmortalidad y severidad / Prognostic value of the lethal triad among patients with multiple trauma

Background: Patients who have suffered multiple traumatic injuries, have a serious risk for death. Hypothermia, acidosis and coagulopathy are three complications in these patients, whose presence is known as lethal triad and indicates bad prognosis.Aim: To determine if the lethal triad in multiple trauma patients is associated withhigher mortality and Injury Score Severity (ISS). Material and Methods: Onehundred multiple trauma patients aged 26 to 56 years (90 males), admitted toan emergency room, were studied. Body temperature, prothrombin time, partialthromboplastin time, platelet count and blood gases were determined on admission.Results: Twenty six patients had the lethal triad and 15% died in the emergencyroom within the first 6 hours. No death was recorded among the 74 patients withoutthe lethal triad. The mean ISS among patients with and without the lethal triad was31.7 and 25.6, respectively (p < 0.05). Conclusions: The presence of the lethal triadamong patients with multiple trauma is associated with a higher mortality and ISS.

Influenza vaccination and major adverse vascular events in high-risk patients

Background—We sought to determine the association between influenza vaccination and major adverse vascular events because the association remains uncertain.Methods and Results—A total of 31 546 participants were enrolled from 40 countries. Eligibility included age 55 years and known vascular disease. The primary outcome was a composite of death resulting from cardiovascular causes, myocardial infarction, or stroke during 4 influenza seasons (2003–2007). Influenza vaccination was associated with a lower risk of the outcome during 3 influenza seasons (defined using World Health Organization FluNet reports): 2004to 2005 (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.50–0.77), 2005 to 2006 (adjusted OR, 0.69; 95% CI, 0.53– 0.91), and 2006 to 2007 (adjusted OR, 0.52; 95% CI, 0.42– 0.65), the same years that circulating influenza matched the vaccine antigen. In 2003 to 2004, there was an incomplete match between circulating influenza and the vaccine antigen, and there was no association between influenza vaccination and the outcome (adjusted OR, 0.96; 95% CI, 0.73–1.27). However, tests of potential biases in the analyses revealed associations between influenza vaccination and outcome during noninfluenza seasons except 2003 to 2004. The summary ORs in the influenza season (OR, 0.65; 95% CI, 0.58–0.74]) and noninfluenza season (OR, 0.66; 95% CI, 0.57– 0.76) were almost identical. The reduction in risk of noncardiovascular death associated with the influenza vaccine ranged from 73% to 79%.Conclusion—Although initial analyses suggest that influenza vaccination was associated with reduced risk of majoradverse vascular events during influenza seasons when the influenza vaccine matched the circulating virus, sensitivity analyses revealed that risk of bias remained. A randomized trial is needed to definitively address this question.

El comportamiento del factor de necrosis tumoral alfa e interleucina 6 en lesiones de vías biliares postcolecistectomía / Tumor necrosis factor-alpha and interleukin-6 levels among patients suffering a bile duct injury during cholecystectomy

Background: During cholecystectomy, the bile duct may be injured. When this complication occurs, Kupffer cells are activated and produce tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL6) to phagocyte toxic products Aim: To measure serum levels of TNF-α and IL-6 among patients that suffered a bile duct injury after a cholecystectomy. Patients and Methods: Serum levels of TNF-α and IL-6 were measured prior to the bile-enteric derivation and after one year of follow up, in 31 patients that had a complete bile duct obstruction after open or laparoscopic cholecystectomy and in 5 healthy controls. Results: At baseline TNF-α levels in healthy subjects and patients with bile duct injury were 0 and 43.9 ± 2.9 ng/mL, respectively (p < 0.01). At one year of follow up, TNF-á became undetectable among patients. At baseline, the values for IL-6 among healthy controls and patients were 3.0 ± 2.0 and 72.0 ± 94.7 pg/mL respectively, (p < 0,004). After one year of follow up, IL-6 levels decreased to 6.4 ± 0.3 pg/mL among patients. Conclusions: TNF-α and IL-6 levels were elevated before bile-enteric derivation among patients with bile duct injury and became normal one year later.

Impacto de la hiperinsulinemia sobre la función del ventrículo izquierdo en sujetos hipertensos / Differential impact of hyperinsulinemia on left ventricular function in hypertense subjects

Introducción: La hiperinsulinemia asociada a hipertensión arterial activa el proceso inflamatorio/reparador y deteriora la función ventricular. Objetivo: Determinar los efectos de la hiperinsulinemia sobre la masa la ventricular y función diastólica del ventrículo izquierdo (VI) en hombres y mujeres no diabéticos con hipertensión. Método: 52 pacientes con curva de tolerancia a la glucosa normal fueron estratificados según la relación glucosa/insulina (rG/I): Grupo 1, hiperinsulinémico (rG/I < 1.6); Grupo 2, normoinsulinémico (rG/I > 1.6). Se realizó historia clínica, análisis de laboratorio, ECG y ecografía Doppler cardíaca. Resultados: En condición basal no hubo diferencias entre los grupos en cuanto a edad, valores de glucemia y presión arterial, pero sí en los de insulina (32.5 vs. 8.78 mU/ml), masa ventricular (131.6 vs. 92.7 g/m2), fracción de eyección del VI (73.5 vs. 69.3%), índice de masa corporal (31.2 vs. 29 kg/m2), relación E/A mitral (0.92 vs. 1.35), tiempo de relajación isovolumétrica del VI (126.3 61 ms) y tiempo de hemipresión transmitral (T1/ 2; 206 vs. 244.4 ms). En las mujeres hiperinsulinémicas se incrementaron más los niveles de insulina a 60' que en los hombres (12.5 vs. 6.7 veces), rG/I de 0.54 vs. 0.99, masa ventricular (61.4 vs. 30.7%), disfunción diastólica del VI (E/A 0.87 vs. 0.93 y T1/2; 191.7 vs. 220.3 ms). Conclusión: La hiperinsulinemia incrementa la masa ventricular y deteriora la función diastólica del VI en pacientes hipertensos no diabéticos, con mayor gravedad en las mujeres.

Relación entre hiperinsulinemia, disfunción diastólica e hipertrofia del ventrículo izquierdo en pacientes con hipertensión arterial sistémica / Association of hyperinsulinemia with left ventricular hypertrophy and diastolic dysfunction in patients with hypertension

Background: Hypertension is the main independent cardiovascular risk factor. However, there are additional factors that induce organic damage. Aim: To assess the association between hyperinsulinemia, ventricular hypertrophy and left ventricular diastolic function. Patients and Methods: Seventy-four patients aged 30 to 65 years, with mild or moderate systemic hypertension, with overweight or mild obesity and normal glucose tolerance curve (GTC), were studied. Serum insulin was measured during GTC. The maximum levels of insulin and glucose were observed 60 minutes after the oral glucose load and they were expressed as rG/1. Patients were stratified in three groups according to their glucose and insulin fasting levels (I0) and post-glucose challenge levels (rG/I): Group 1 (normoinsulinemic patients) I0 <17 mU/mL and rG/I >2 (2.45+0.4). Group 2 (post-prandial hyperinsulinemic patients) I0 <17 mU/mL and rG/I <2> 1 (1.34+0.3). Group 3 (persistently hyperinsulinemic patients) I0 >17 mU/mL and <1 (0.7+0.3). Left ventricular mass and its diastolic function were measured by Doppler echocardiography. Results: No differences in blood pressure or age were observed between groups. There was a negative correlation between ventricular mass and rG/1 (r =-0.282, p =0.015). Left ventricular diastolic dysfunction was significantly more deteriorated in group 3, as compared with group 1 (p <0.001 ANOVA). There was a significant correlation between g/GI and diastolic dysfunction (r =0.232 p =0.047). Conclusions: Fasting, post challenge hyperinsulinemia and a rG/I <1 are associated with higher ventricular mass and left ventricular diastolic dysfunction, independent of blood pressure and age.

Efecto del ramipril sobre el cociente glucosa/insulina y el índice de masa ventricular izquierda en pacientes con hipertensión arterial leve a moderada / Effect of ramipril on the glucose/insulin coefficient and the ventricular mass index in patients with light to moderate arterial hypertension

Este estudio longitudinal, prospectivo se diseñó para evaluar el efecto del ramipril, un inhibidor de la enzima convertidora de angiotensina (IECA) sobre la masa ventricular, la función diastólica del ventrículo izquierdo (VI) y los valores de tensión arterial en pacientes con hipertensión arterial sistémica esencial (HAS) leve a moderada con hiperinsulinemia. La primera alteración del paciente hipertenso es la disfunción diastólica del VI y el dato de mayor peso como factor predictor de morbimortalidad cardiovascular en la HAS es la hipertrofia ventricular. Existen múltiples estudios que demuestran que no existe una correlación directa entre los valores de tensión arterial y el grado de hipertrofia o disfunción diastólica del ventrículo izquierdo, motivo por el cual se asume la participación de otros factores en la génesis de estas alteraciones funcionales. Por otra parte, está descrito que la insulina posee efectos hipertensores por estimulación simpática, por retener sodio y agua a nivel renal y por estimular la expresión de protooncogenes con el subsecuente desarrollo de fibrosis e hipertrofia miocárdica y vascular. A pesar de que existe en el mercado una gran cantidad de fármacos antihipertensivos, algunos de ellos producen efectos metabólicos adversos, mientras que otros como los inhibidores de la enzima convertidora de angiotensina (IECAS), los ARAII y los bloqueadores del calcio además de controlar los niveles de presión arterial tienen un efecto neutro o benéfico sobre dichos parámetros. Considerando el efecto de los IECAS sobre el perfil metabólico, se realizó un estudio con 24 pacientes hipertensos esenciales con hiperinsulinemia, a los cuales se les realizó evaluación clínica cardiológica y general, electrocardiograma y ecocardiograma en condiciones basales y después de 6 meses de tratamiento con ramipril a dosis de 2.5 a 5 mg/día. Los resultados muestran una reducción significativa de la tensión arterial sistólica (12 mmHg) y diastólica (12 mmHg), de los niveles séricos de insulina basal (23.62 pmol/dL vs 10.42 pmol/dL), y del índice de masa ventricular izquierda (143.8 g/m² vs 118.2 g/m²). En las variables que evalúan la función diastólica del VI no hubo diferencias estadísticamente significativas a excepción de la relación onda E/onda A del flujo transmitral en el grupo de mujeres. Ramipril fue bien tolerado y no se reportaron eventos adversos significativos.

This longitudinal prospective study was designed to assess the effects of the angiotensin converting enzyme inhibitor (ACEI) ramipril on ventricular mass, left ventricle (LV) diastolic function and blood pressure in patients with mild to moderate essential hypertension and hyperinsulinemia. LV diastolic dysfunction is the first target organ alteration occurring in hypertensive patients, while ventricular hypertrophy is the most relevant predictive factor for cardiovascular morbility and mortality in systemic hypertension. Because several studies have demonstrated that there is no direct correlation between blood pressure values and the severity of LV hypertrophy or diastolic dysfunction, it is assumed that other factors are involved in the genesis of these functional alterations. Moreover, the hypertensive effect of insulin is caused by sympathetic stimulation, sodium and water renal retention and protooncogene stimulation leading to myocardial and vascular fibrosis and hypertrophy. We studied 24 hypertensive patients with hyperinsulinemia. All patients underwent an overall and cardiologic clinical evaluation, and electrocardiographic and ecocardiographic studies were performed at baseline and 6 months after being treated with 2.5 to 5 mg/day ramipril. Ramipril treatment significantly reduced systolic (12 mmHg) and diastolic (12 mmHg) pressure levels, basal insulin serum levels (23.62 pmol/dL vs 10.42 pmol/dL), and left ventricle mass index values (143.8 g/m² vs 118.2 g/m²). Among the variables assessing LV diastolic function, only the transmitral flow E/ A wave ratio showed significant differences in women. Ramipril was well tolerated and no significant adverse events were reported. (Arch Cardiol Mex 2003; 73:24-30).

Preeclampsia leve y valores de insulina sérica en el tercer trimestre del embarazo / Light pre-eclampsia and insulin values at the third trimester of pregnancy

El objetivo de la presente investigación fue determinar los valores séricos de insulina en ayuno y su respuesta a una carga oral de glucosa en pacientes con preeclampsia leve y compararlos con los de mujeres normotensas con embarazo normal en el tercer trimestre de la gestación. Se realizó un estudio transversal y analítico en 38 pacientes con preeclampsia leve y en 39 con embarazo normal, todas en el tercer trimestre de la gestación. La presión arterial, la concentración sérica de glucosa e insulina y la relación insulina/glucosa se determinaron en forma basal con al menos seis horas de ayuno y a la hora posterior a una carga de 50 gramos de glucosa. Se permitieron antihipertensivos tipo alfametoldopa y/o hidralacina en el grupo hipertenso y no se incluyeron pacientes con situaciones al menos conocidas con influencia sobre la concentración de glucosa o insulina. La glucosa se determinó por el método de glucosa oxidada y la insulina por radioinmunoanálisis; la relación insulina/glucosa se obtuvo de dividir la insulina entre la glucosa. Los dos grupos fueron similares en edad, número de gestaciones, edad getacional e índice de masa corporal pregestacional. No hubo diferencia entre ambos grupos en la concentración sérica de glucosa, tanto en ayuno como posterior a la carga de glucosa. La concentración sérica de insulina en ayuno fue menor en el grupo de preeclampsia leve en relación al grupo normotenso (7.1 ñ 3.8 vs 10.6 ñ 8.7 µU/mL, p=0.02), sin embargo, no existió diferencia significativa en los valores de insulina posterior a la carga oral de glucosa en los dos grupos (66.6 ñ 46.5 vs 71.0 ñ 51.9, p=NS). La relación insulina/glucosa presentó el mismo comportamiento que la insulina. El grupo de preeclampsia leve mostró una concentración sérica de insulina en ayuno menor al compararse con el de embarazo normal. Consideramos que se deben realizar más estudios al respecto, con estrictos criterios de selección de las pacientes, para poder emitir conclusiones finales

Metabolic profile and insulin sensistivity in healthy young mexicans with a strong family history of non-insulin-dependent diabetes mellitus in the paternal branch

The objective was to identify early metabolic defects and insulin sensitivity in a group of healthy young Mexicans with a family history of NIDDM in first and second degree on the paternal branch. The design was a cross-sectional study, and the setting was a hospital and a school of medicine in Guadalajara, Jalisco, Mexico. The subjects were 20 healthy, non-obese, young (age 19-20 years), born in Mexico, with family history of NIDDM in first and second degree in the paternal branch, and 20 control. Measurements were serum values of creatinin, uric acid, total cholesctero, high-density lipoprotein cholestero, triglycerides, glucose, and insulin, insulin tolerance test, glucose/insulin ratio, LDL cholesterol, VLDL cholesterol, total cholesterol/HDL cholesterol ratio and LDL clolesterol/HDL cholesterol ratio. In terms of results, only the total cholesteroa was slightly, although significantly )p=0.05) higher in probands (4.3 ñ 0.5 mmol/L) than in control subjects (3.9 ñ 0.5 mmol/L). In conclusion, healthy young Mexicans with astrong family history of NIDDM in the paternal branch were no different in insulin sensitivity from those without family history of NIIDM, and only showed a slight increase in serum total cholesterol

Lomefloxacina versus trimetoprim con sulfametoxazol en la infección de vías urinarias del anciano con diabetes mellitus / Lomefloxacin versus trimethoprim with sulfamethoxazole in urinary tract infection of elderly patients with diabetes mellitus

El objetivo de la presente investigación fue comparar la eficacia de una nueva quinolona oral de vida media prolongada en esquema corto con la combinación tradicional para el manejo de las infecciones de vías urinarias en pacientes ancianos con diabetes mellitus tipo II (no insulinodependiente). Se realizó un ensayo clínico, al azar, ciego simple, controlado, en 60 pacientes ancianos con diagnóstico de diabetes mellitus tipo II e infección de vías urinarias. Después de la distribución al azar, se formaron dos grupos de 30 pacientes cada uno. El primero recibió lomefloxacina a razón de 400 mg/día en dosis oral única matutina por cinco días y al segundo se le indicó trimetoprim, 160 con sulfametoxazol, 800 mg cada 12 horas por vía oral durante 10 días. No se encontró diferencia estadísticamente significativa entre los dos grupos de estudio en relación con la evaluación de la respuesta clínica, bacteriológica y general. Los efectos adversos fueron similares para ambos fármacos. Se puede concluir que la lomefloxacina y el trimetoprim con sulfametoxazol son efectivos para el manejo de las infecciones de vías urinarias en los pacientes ancianos con diabetes mellitus; sin embargo, el primero de ellos produce una respuesta más rápida por el tratamiento de corta duración y permite una posología más cómoda y fácil de seguir en este tipo de situaciones, por lo que su uso es más recomendable