[Hypertension and anesthesia: consensus statement of the Catalan Associations of Anesthesiology and Hypertension]. / Documento de Consenso sobre Hipertensión Arterial y Anestesia de las Sociedades Catalanas de Anestesiología e Hipertensión Arterial.

The prevalence of hypertension is high in the surgical population. Differing practices and the absence of consensus among physicians involved in caring for hypertensive patients has made it one of the most frequent reasons for cancelling scheduled surgery. The aim of this consensus statement is to outline a practical approach to managing the hypertensive surgical patient. Hypertension is associated with increased risk of perioperative complications, particularly those related to systemic effects and notable fluctuations in blood pressure during surgery. Preoperative assessment should center on a search for signs and symptoms of target organ damage. The anesthesiologist should seek to reduce perioperative fluctuations in arterial pressure, particularly guarding against sustained hypotension. After surgery, antihypertensive medication should be resumed as soon as possible.

Mortality in hypertensive patients in Hospitalet de Llobregat, Barcelona (Spain).

A retrospective cohort study was carried out on 729 hypertensive patients (male and female 40 years and older) in Hospitalet de Llobregat (Barcelona, Spain) to assess possible differences between the mortality of this group of hypertensives and the general population of the same area matched by age and sex. Patient mortality was assessed during a six year period, resulting in a mean follow-up of 2.6 years at the end of the study. The results reflect an increased risk of dying among hypertensives compared with the general population, with standardised mortality ratio by age and sex of 1.88 (95% confidence interval 1.21-2.44). Cardiovascular mortality was significantly higher for males, while noncardiovascular mortality was significantly higher for females. The study also shows that the presence of smoking habit, diabetes or hyperglycaemia, uncontrolled hypertension and age > or = 60 years can increase the risk of dying among hypertensive patients. Although a higher level of BP control is achieved in hypertension hospital clinics than in the primary health care system, the study shows that hypertensives have an excess of mortality than expected considering their own general population by age and sex.

[The prevalence of cardiovascular risk factors in a population of essential hypertension patients]. / Prevalencia de factores de riesgo cardiovascular en una población de hipertensos esenciales.

INTRODUCTION AND OBJECTIVES: High blood pressure is a cardiovascular risk factor whose coincidence with other risk factors considerably increases the probability for coronary heart disease. This study investigates the prevalence of different risk factors in hypertensive subjects. METHODS: We studied 891 patients with high blood pressure in their first visit to a hospital hypertension unit between 1987 and 1991. We assessed their clinical evolution and the prevalence of obesity, smoking, alcohol consumption, elevated blood pressure, diabetes, sedentary lifestyle, left ventricular hypertrophy and family history of high blood pressure. RESULTS: Sixteen per cent of the hypertensive subjects related previous history of evolutive accident. Stroke was the most frequent one. Prevalences of cardiovascular risk factors were as follows: family history of high blood pressure 53%, sedentary lifestyle 52%, elevated blood cholesterol 37%, smoking 35%, obesity 33%, left ventricular hypertrophy 16%, alcohol consumption 13% and diabetes 11%. Obesity prevalence was twice as high in women than in men. Males had higher prevalence for left ventricular hypertrophy, smoking and alcohol consumption. Diabetes was more prevalent in hypertensive patients older than 50 years. Prevalence of high blood cholesterol was greater in the group of women older than 50 years. CONCLUSIONS: Hypertensive patients have high prevalences of other cardiovascular risk factors. Their treatment should be aimed to improving the individual profile of cardiovascular risk.

Percutaneous transluminal angioplasty in the treatment of renovascular hypertension.

In this study we report our experience in 74 patients with hypertension and renal artery stenosis (42 with atherosclerotic stenosis, 32 with fibromuscular dysplasia) who were followed-up for a mean observation period of 21.7 months after percutaneous transluminal angioplasty (PTA). Stenosis was unilateral in 45 cases, bilateral in 16 and located in the renal artery of a solitary functioning kidney in 13 cases. Ostial involvement was observed in 26 cases. A total of 24 patients showed impaired renal function before PTA. Overall results for BP control were 8 cures (13%), 29 improvements (48%) and 24 (39%) who remained unchanged. Five of the 24 patients (21%) with impaired renal function showed improvement with a decrease in serum creatinine levels of more than 30%. Complications of PTA were rare, being limited to two haematomas at the puncture site which resolved spontaneously. These results emphasize that PTA, an easily repeatable procedure of relatively low risk, short hospital stay and low cost, is a first choice technique in the management of renovascular hypertension.

Humoral and cellular immunological abnormalities in hypertensive patients.

A high frequency of immunological disturbances were recorded in 19 mild and 23 malignant hypertensive patients. IgG levels were raised in patients who survived a malignant phase of hypertension. We also found increased frequency of autoantibodies (26% vs. 9% in controls), increased T-lymphocyte reactivity against arterial-wall antigens (p = 0.001), a significant frequency of low responders to PHA (p = 0.003), and a statistically significant correlation (p = 0.031) between the presence of autoantibodies and T-cell hyper-reactivity against arterial antigens in mild hypertensive patients. We suggest that these abnormalities might be relevant in the pathogenesis of some hypertensive conditions. Autoantibody production is likely to be correlated with a predisposition to hypertension through some autoimmune mechanisms.