Comparative effect of antihypertensive drugs in improving arterial stiffness in adults with hypertension (RIGIPREV study). A network meta-analysis.

Aims: To synthesize and evaluate the available scientific evidence on the efficacy of antihypertensive drugs on arterial stiffness in patients with hypertension by using a network meta-analysis approach. Methods: A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different antihypertensive drugs on arterial stiffness parameters (pulse wave velocity [PWV] and augmentation index [AIx]) in adults with hypertension. Comparative evaluation of the effect of antihypertensive drugs was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between antihypertensive drugs and placebo/other antihypertensive drugs. Analyses were performed including studies of any duration and only studies longer than 6 months length. Results: Seventy-six studies were included in the main analysis and considering only studies longer than 6 months length, thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination showed a higher effect on reducing PWV, and ACEIs and ARBs on reducing AIx. Conclusion: Our research provides evidence that antihypertensive medications are an effective way to treat arterial stiffness in adults with hypertension. Based on our findings, patients with hypertension who have greater levels of arterial stiffness may benefit from using thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination. Systematic Review Registration: PROSPERO (CRD42021276360).

Comparative Effect of Antihypertensive Drugs in Improving Arterial Stiffness in Hypertensive Adults (RIGIPREV Study). A Protocol for Network Meta-Analysis.

(1) Background: Arterial stiffness is closely and bi-directionally related to hypertension and is understood as both a cause and a consequence of hypertension. Several studies suggest that antihypertensive drugs may reduce arterial stiffness. Therefore, effective prescription of antihypertensive drugs should consider both blood pressure and arterial stiffness. The aim of this protocol is to provide a review comparing the effects of different types of antihypertensive drug interventions on the reduction of arterial stiffness in hypertensive subjects. (2) Methods: The literature search will be performed through the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases. Randomised clinical trials assessing the effect of antihypertensive drug interventions on arterial stiffness measured in subjects with hypertension will be included. A frequentist network meta-analysis will be performed to determine the comparative effects of different antihypertensive drugs. (3) Results: The findings of this study will be published in a peer-reviewed journal. (4) Conclusions: This study will provide evidence for health care professionals on the efficacy of different antihypertensive drugs in decreasing arterial stiffness; in addition, it will analyse the efficacy of the drugs not only in terms of arterial stiffness but also in terms of blood pressure treatment.

Effectiveness of an mHealth Intervention Combining a Smartphone App and Smart Band on Body Composition in an Overweight and Obese Population: Randomized Controlled Trial (EVIDENT 3 Study).

BACKGROUND: Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear. OBJECTIVE: This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese. METHODS: A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire. RESULTS: The mHealth intervention produced a greater loss of body weight (-1.97 kg, 95% CI -2.39 to -1.54) relative to standard counselling at 3 months (-1.13 kg, 95% CI -1.56 to -0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; -1.84 kg, 95% CI -2.48 to -1.20), percentage of body fat (PBF; -1.22%, 95% CI -1.82% to 0.62%), and BMI (-0.77 kg/m2, 95% CI -0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of -1.18 kg (95% CI -2.30 to -0.06) and BMI of -0.47 kg/m2 (95% CI -0.80 to -0.13), whereas the obese group only experienced a change in BMI of -0.53 kg/m2 (95% CI -0.86 to -0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of -1.03 kg (95% CI -1.74 to -0.33), PBF of -0.76% (95% CI -1.32% to -0.20%), and BMI of -0.5 kg/m2 (95% CI -0.83 to -0.19). CONCLUSIONS: The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m2 and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect. TRIAL REGISTRATION: Clinicaltrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1097/MD.0000000000009633.

Hypertension and high ankle brachial index: the overlooked combination.

OBJECTIVE: Assessment of asymptomatic organ damage in the management of hypertension includes low (<0.9) ankle brachial index (ABI) values. No recommendations are given for patients with high ABI (≥1.3), despite evidence of an association with increased risk. We aimed to study the association of high ABI with all-cause mortality and cardiovascular outcomes in a hypertensive population. METHODS: In anonymized clinical records from the Catalan Primary Care (SIDIAP) database, we designed a large cohort of hypertensive patients aged 35-85 years at the start date. Participants were excluded if they had previous heart failure, coronary heart disease, stroke, diabetes mellitus, or chronic kidney disease. The study population was categorized according to ABI values. Cox proportional hazards models were used to assess all-cause mortality, heart failure, acute myocardial infarction, and stroke. RESULTS: From 2006 through 2015, SIDIAP records included 44 657 hypertensive patients with an ABI measurement 9126 of whom met inclusion criteria. The median follow-up (first to third quartiles) was 6.0 years (4.7-7.6). High ABI (≥ 1.3) was associated with an increase in mortality risk, hazard ratio, and 95% confidence interval: 1.44 (1.10-1.88), similar to the group with ABI at least 0.9 and less than 1.1, hazard ratio 1.36 (1.12-1.65), and lower than all groups with ABI less than 0.9. High ABI values tended to associate with heart failure, hazard ratio 1.34 (0.95-1.91), but the relation of high ABI with acute myocardial infarction and stroke was nonsignificant, hazard ratios 1.30 (0.72-2.35) and 0.97 (0.65-1.42), respectively. CONCLUSION: Patients with high ABI values and hypertension presented an increased all-cause mortality risk that could be considered when advising such patients.

Automatic or manual arterial path for the ankle-brachial differences pulse wave velocity.

An automated method for measuring arterial path length with devices that determine pulse wave velocity (PWV) in peripheral arteries is frequently applied. We aimed to compare arterial path length measurements based on mathematical height-based formulas with those measured manually and to assess whether the ankle-brachial difference (abD-PWV) measured with the VOPITB device is comparable to that obtained by manual measurements. In 245 patients, a metric measuring tape was used to determine the arterial path length from the suprasternal notch to the midpoint of the VOPITB cuffs wrapped around the extremities, and the results were compared with those obtained with height-based formulas. We examined the relationship between the abD-PWV measured with both methods. The arterial path length measured manually was shorter than that calculated automatically by 5 ± 2 and 30 ± 4 cm-of 13% and 21% for the arms and legs, respectively (difference of 13% and 21%). As a result, the abD-PWV calculated with the automatic method was greater (automatic abD-PWV vs. manual: 462 ± 90 vs. 346 ± 79 cm/s). The Blant Altman plot showed a percentage error of: 15,2%, 7,5% and 17,3% for heart-brachial, heart-ankle length and abD-PWV respectively. In conclusion there were significant differences between manual and automated arterial length measurements and it translates into difference abD-PWV calculate from both methods. However, the Bland-Alman plot showed that abD-PWV was comparable for both techniques. The advantages of height-based formulas for the calculation of arterial path lengths suggest that they may be the recommended method for measuring the abD-PWV.

Long-Term Effectiveness of a Smartphone App for Improving Healthy Lifestyles in General Population in Primary Care: Randomized Controlled Trial (Evident II Study).

BACKGROUND: Information and communication technologies are currently among the supporting elements that may contribute to improving health and changing lifestyles. OBJECTIVE: The aim of this study was to evaluate the long-term effectiveness of adding an app to standardized counseling in order to increase physical activity (PA) and adherence to the Mediterranean diet and to analyze the effects of app adherence in lifestyle changes. METHODS: A randomized, multicenter clinical trial with a 12 month-follow up was conducted, involving 833 participants recruited by random sampling in 6 primary Spanish care centers (415 vs 418). Counseling on PA and the Mediterranean diet was given to both groups by a research nurse; however, the counseling + app group (intervention group) received additional training in the use of an app that was designed to promote the Mediterranean diet and PA over a 3-month period. Main outcomes and measures included PA by accelerometer and the 7-day Physical Activity Recall (PAR) questionnaire and adherence to the Mediterranean diet by an adherence screener questionnaire. We considered adherence to the app to be high when it was used for more than 60 days. RESULTS: The mean age was 51 years (SD 12) in the intervention group and 52.3 years (SD 12.0) in the counseling-only group; females predominated in both groups (60.0%, 249/415 and 64.1%, 268/418, respectively). PA by accelerometer declined in both groups at 12 months (P value for tendency in moderate to vigorous PA, [MVPA]=.15). The intervention subgroup with high app adherence had better behavior than the low adherence subgroup (P value for tendency in MVPA=.001). PA analyzed by 7-day PAR did not show changes at 12 months in any of the groups (P value for tendency=.25). In the Mediterranean diet, an increase in adherence was observed in both groups at 12 months with no differences between them (P value for tendency=.46). In these two cases, the group with high app adherence also had better behavior, although without reaching significance for the tendency (P>.05). CONCLUSIONS: The participants with strongest app adherence showed better outcomes in terms of maintenance of healthy lifestyles at 12 months than those with weaker adherence. Overall, however, we found no differences between intervention group and counseling-only group in PA increase and adherence to the Mediterranean diet in the long term.

Ideal Cardiovascular Health and Arterial Stiffness in Spanish Adults-The EVIDENT Study.

BACKGROUND: Studies concerning ideal cardiovascular (CV) health and its relationship with arterial stiffness are lacking. This study examined the association between arterial stiffness with ideal CV health as defined by the American Heart Association, across age groups and gender. METHODS: The cross-sectional study included 1365 adults. Ideal CV health was defined as meeting ideal levels of the following components: 4 behaviors (smoking, body mass index, physical activity, and Mediterranean diet adherence) and 3 factors (total cholesterol, blood pressure, and glycated hemoglobin). Patients were grouped into 3 categories according to their number of ideal CV health metrics: ideal (5-7 metrics), intermediate (3-4 metrics), and poor (0-2 metrics). We analyzed the pulse wave velocity (PWV), the central and radial augmentation indexes, and the ambulatory arterial stiffness index (AASI). RESULTS: The ideal CV health profile was inversely associated with lower arterial radial augmentation index and AASI in both genders, particularly in middle-aged (45-65 years) and in elderly subjects (>65 years). Also in elderly subjects, adjusted models showed that adults with at least 3 health metrics at ideal levels had significantly lower PWV than those with 2 or fewer ideal health metrics. CONCLUSIONS: An association was found between a favorable level of ideal CV health metrics and lower arterial stiffness across age groups.

Association Between Health-Related Quality of Life, Obesity, Fitness, and Sleep Quality in Young Adults: The Cuenca Adult Study.

OBJECTIVE: The objectives of this study were to examine in university students: (a) the mean differences in the HRQoL among fat mass percentage, cardiorespiratory fitness (CRF) and sleep quality categories; and (b) the independent associations among fat mass percentage, CRF, and sleep quality with HRQoL. PARTICIPANTS: 376 students, 18-30 years old, from the University of Castilla-La Mancha in Cuenca, Spain (during 2009-2010). METHOD: Cross-sectional study measuring % fat mass (DXA), CRF (20-m shuttle run test), sleep quality (Pittsburgh Sleep Quality Index), and HRQoL (SF-12 questionnaire). RESULTS: The mean in Mental Component Summary (MCS) in men (p = .029) was lower in students in upper quartiles of % fat mass than in peers in other categories of % fat mass. Among men, MCS was significantly lower among those in the lowest quartile of CRF (p = .015), and among women, Physical Component Summary (PCS) was significantly lower among those in the lowest quartile of CRF (p = .047). MCS dimension of the HRQoL was lower in both men (p = .001) and women (p < .001) in upper quartiles of sleep quality. Multiple linear regression models showed that in men, CRF was associated with MCS (ß = 0.25, p = .031), and sleep quality was associated with PCS (ß = -0.24, p = .027) and MCS (ß = -0.38, p < .001). In women, CRF was associated with PCS (ß = 0.17, p = .018) and sleep quality with MCS (ß= -0.44, p < .001). CONCLUSIONS: Finally, our findings suggest that, regardless of adiposity and fitness, having good sleep habits may positively influence the quality of life in young adults.

Relationship between glycaemic levels and arterial stiffness in non-diabetic adults. / Relación entre los valores de glucemia y la rigidez arterial en adultos no diabéticos.

OBJECTIVE: To examine, in a non-diabetic population, whether the association between arterial stiffness and glycaemic levels depends on the test used as a glycaemic indicator, fasting plasma glucose (FPG) or glycated haemoglobin A1c (HbA1c). PATIENT POPULATION AND METHODS: A cross-sectional analysis of a 220 non-diabetic subsample from the EVIDENT II study in which FPG, HbA1c and arterial stiffness-related parameters (pulse wave velocity, radial and central augmentation index, and central pulse pressure) were determined. Mean differences in arterial stiffness-related parameters by HbA1c and FPG tertiles were tested using analysis of covariance. RESULTS: All means of arterial stiffness-related parameters increased by HbA1c tertiles, although mean differences were only statistically significant in pulse wave velocity (p ≤.001), even after controlling for potential confounders (HbA1c <5.30% = 6.88 m/s; HbA1c 5.30%-5.59% = 7.06 m/s; and HbA1c ≥5.60% = 8.16 m/s, p =.004). Conversely, mean differences in pulse wave velocity by FPG tertiles did not reach statistically significant differences after controlling for potential confounders (FPG 4.44 mmol/l = 7.18 m/s; FPG 4.44 mmol/l-4.87 mmol/l = 7.26 m/s; and FPG ≥4.88 mmol/l = 7.93 m/s, p =.066). CONCLUSIONS: Glucose levels in a non-diabetic population were associated with arterial stiffness but better when levels were determined using HbA1c.

Evolution of target organ damage and haemodynamic parameters over 4†years in patients with increased insulin resistance: the LOD-DIABETES prospective observational study.

OBJECTIVES: We prospectively examined the impact of type 2 diabetes compared with metabolic syndrome (MetS) on the development of vascular disease over 4 years as determined by anatomic and functional markers of vascular disease. By comparing the vascular outcomes of the 2 disorders, we seek to determine the independent effect of elevated glucose levels on vascular disease. SETTING: 2 primary care centres in Salamanca, Spain. PARTICIPANTS: We performed a prospective observational study involving 112 patients (68 with type 2 diabetes and 44 with MetS) who were followed for 4 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Measurements included blood pressure, blood glucose, lipids, smoking, body mass index, waist circumference, Homeostasis Model Assessment Insulin Resistance (HOMA-IR), hs-c-reactive protein and fibrinogen levels. We also evaluated vascular, carotid intima media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index, heart and renal target organ damage (TOD). The haemodynamic parameters were central (CAIx) and peripheral (PAIx) augmentation indices. RESULTS: In year 4, participants with type 2 diabetes had increased IMT thickness. These patients had more plaques and an IMT>0.90 mm. In participants with MetS, we only found an increase in the number of plaques. We found no changes in PWV, CAIx and PAIx. The patients with diabetes had a greater frequency of vascular TOD. There were no differences neither in renal nor cardiac percentage of TOD in the patients with MetS or diabetes mellitus type 2. CONCLUSIONS: This prospective study showed that the evolution of vascular TOD is different in participants with type 2 diabetes compared with those with MetS. While IMT and PWV increased in type 2 diabetes, these were not modified in MetS. The renal and cardiac TOD evolution, as well as the PAIx and CAIx, did not change in either group. TRIAL REGISTRATION NUMBER: NCT01065155; Results.

Gender differences in the progression of target organ damage in patients with increased insulin resistance: the LOD-DIABETES study.

BACKGROUND: The purpose of this study was to analyze the evolution of vascular, cardiac and renal target organ damage (TOD) in patients with increased insulin resistance over a 3.5 year follow-up and to investigate gender difference and factors that influence its progression. METHODS: We performed a prospective observational study involving 112 patients (71 men, 41 women) who were followed for 3.5 years. Measurements included blood pressure, blood glucose, lipids, smoking, body mass index (BMI) and HOMA-Ir Vascular TOD included carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI). Cardiac TOD included Cornell voltage-duration product and Sokolow. Renal TOD included creatinine, glomerular filtration and albumin/creatinine ratio. RESULTS: The IMT increased in both genders. Each year, the IMT increased 0.005 mm in men and 0.011 in women and the PWV 0.024 and 0.020 m/sec, respectively. The highest increase was in women with type 2 diabetes mellitus, who had an increase in TOD carotid (40%), PWV (24%) and renal TOD (20 %). Multiple regression analysis, after adjusting for age and gender, showed a negative association between duration since diabetes diagnosis and ABI (ß = -0.006; p = 0.017) and between BMI and glomerular filtration (ß = -0.813; p = 0.014). HbA1c was positively associated with PWV (ß = 0.501; p = 0.014). CONCLUSIONS: This study showed that the progression of vascular and renal TOD differs by gender. The increase in vascular and renal TOD was higher in women, especially in diabetic women. The PWV increase showed a positive association with mean HbA1c levels during the follow-up. Glomerular filtration was associated with BMI and the ABI was associated with duration since type 2 diabetes mellitus diagnosis. TRIAL REGISTRATION: Clinical Trials.gov Identifier NCT01065155.

Cardio-ankle vascular index is associated with cardiovascular target organ damage and vascular structure and function in patients with diabetes or metabolic syndrome, LOD-DIABETES study: a case series report.

BACKGROUND: The cardio ankle vascular index (CAVI) is a new index of the overall stiffness of the artery from the origin of the aorta to the ankle. This index can estimate the risk of atherosclerosis. We aimed to find the relationship between CAVI and target organ damage (TOD), vascular structure and function, and cardiovascular risk factors in Caucasian patients with type 2 diabetes mellitus or metabolic syndrome. METHODS: We included 110 subjects from the LOD-Diabetes study, whose mean age was 61 ± 11 years, and 37.3% were women. Measurements of CAVI, brachial ankle pulse wave velocity (ba-PWV), and ankle brachial index (ABI) were taken using the VaSera device. Cardiovascular risk factors, renal function by creatinine, glomerular filtration rate, and albumin creatinine index were also obtained, as well as cardiac TOD with ECG and vascular TOD and carotid intima media thickness (IMT), carotid femoral PWV (cf-PWV), and the central and peripheral augmentation index (CAIx and PAIx). The Framingham-D'Agostino scale was used to measure cardiovascular risk. RESULTS: Mean CAVI was 8.7 ± 1.3. More than half (54%) of the participants showed one or more TOD (10% cardiac, 13% renal; 48% vascular), and 13% had ba-PWV ≥ 17.5 m/s. Patients with any TOD had the highest CAVI values: 1.15 (CI 95% 0.70 to 1.61, p < 0.001) and 1.14 (CI 95% 0.68 to 1.60, p < 0.001) when vascular TOD was presented, and 1.30 (CI 95% 0.51 to 2.10, p = 0.002) for the cardiac TOD. The CAVI values had a positive correlation with HbA1c and systolic and diastolic blood pressure, and a negative correlation with waist circumference and body mass index. The positive correlations of CAVI with IMT (ß = 0.29; p < 0.01), cf-PWV (ß = 0.83; p < 0.01), ba-PWV (ß = 2.12; p < 0.01), CAIx (ß = 3.42; p < 0.01), and PAIx (ß = 5.05; p = 0.04) remained after adjustment for cardiovascular risk, body mass index, and antihypertensive, lipid-lowering, and antidiabetic drugs. CONCLUSIONS: The results of this study suggest that the CAVI is positively associated with IMT, cf-PWV, ba-PWV, CAIx, and PAIx, regardless of cardiovascular risk and the drug treatment used. Patients with cardiovascular TOD have higher values of CAVI. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01065155.

Sedentary behaviour patterns and carotid intima-media thickness in Spanish healthy adult population.

OBJECTIVE: The aim of this study was to analyze the association between sedentary behaviour, as assessed by an accelerometer, and mean carotid intima-media thickness (IMT). METHODS: The study included 263 healthy subjects belonging to the EVIDENT study (59.3% women). Carotid IMT was measured by carotid ultrasonography. Sedentary behaviour was measured objectively over 7 days using ActiGraph accelerometers. Thresholds of 10 consecutive minutes were used to establish sedentary bouts, and assess the number (n/day), and length ≥10 min (min/day). RESULTS: Total sedentary time and sedentary time in bouts ≥10 min was higher in participants with a larger mean carotid IMT (>P75). Otherwise, this sedentary time in bouts ≥10 min parameter was weakly associated with augmented carotid IMT injury in the logistic regression model. CONCLUSION: Total sedentary time and sedentary time in bouts ≥10 min, as assessed by accelerometer, was positively but weakly associated with carotid IMT. Equally, this sedentary time in bouts ≥10 min was associated with carotid injury, but disappears after adjusting for potential confounders. These findings support that reducing sedentary time and increasing breaks in bouts of sedentary time might represent a useful additional strategy in the cardiovascular disease prevention. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT01083082.

Effectiveness of brief interventions in primary health care settings to decrease alcohol consumption by adult non-dependent drinkers: a systematic review of systematic reviews.

OBJECTIVE: To evaluate the effectiveness of brief interventions in the primary health care setting to decrease alcohol consumption in non-alcoholic adult drinkers. METHOD: Systematic review of systematic reviews and meta-analyses of randomized clinical trials published in English and Spanish and indexed in EMBASE, MEDLINE (PubMed), Web of Science, Scopus, and The Cochrane Library, from their inception to January 2014. The quality of the studies was evaluated with the AMSTAR instrument. RESULTS: Seven studies, published from 1999 to 2011, were included in the review (six meta-analyses, one systematic review). These studies were heterogeneous in terms of design, type and length of interventions analyzed, participants, responsible professionals, and results. Five studies reported a moderate decrease in alcohol consumption and four showed a decrease in the number of participants who consumed alcohol above the established risk level. CONCLUSION: Brief interventions have a moderate effect on reducing alcohol consumption among excessive drinkers or people who consume excessive amounts of alcohol and as a consequence these interventions increased the number of people drinking alcohol below established limits of risk. Brief interventions with multiple contacts or follow-up sessions are the most effective.

Loneliness and mental health in a representative sample of community-dwelling Spanish older adults.

Research seems to support loneliness as a risk factor for mental health problems in the elderly. Most studies analyzing the effects of loneliness on older adults' mental health have relied on convenience samples. In this study, the prevalence and predictors of feelings of loneliness were studied in a representative sample of 272 community-dwelling Spanish older adults. The potential of feelings of loneliness to significantly contribute to the explanation of mental health of the elderly was also explored. The percentage of people reporting feelings of loneliness was 23.1%. Being a woman, being older, living alone, having fewer economic resources, having lower perceived health, and being dissatisfied with the frequency of contact with relatives and friends were found to be significant predictors of feelings of loneliness. Loneliness contributed significantly to the explanation of mental health, even when other significant variables were statistically controlled. The results of this study suggest that loneliness is a relevant factor for the analysis and understanding of mental health in the elderly.

Ambulatory arterial stiffness indices and target organ damage in hypertension.

BACKGROUND: The present study was designed to evaluate which arterial stiffness parameter - AASI or the home arterial stiffness index (HASI) - correlates best with vascular, cardiac and renal damage in hypertensive individuals. METHODS: A cross-sectional study was carried out involving 258 hypertensive patients. AASI and HASI were defined as the 1-regression slope of diastolic over systolic blood pressure readings obtained from 24-hour recordings and home blood pressure over 6 days. Renal damage was evaluated by glomerular filtration rate (GFR) and microalbuminuria; vascular damage by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and ankle/brachial index (ABI); and left ventricular hypertrophy by the Cornell voltage-duration product (VDP) and the Novacode index. RESULTS: AASI and HASI were not correlated with microalbuminuria, however AASI and HASI- blood pressure variability ratio (BPVR) showed negative correlation with GRF. The Cornell PDV was positively correlated with AASI- BPVR-Sleep (r = 0.15, p < 0.05) and the left ventricular mass index with HASI-BPVR (r = 0.19, p < 0.01). Carotid IMT and PWV were positively correlated with all the parameters except the HASI, while ABI was negatively correlated with AASI and Awake-AASI. After adjusting for age, gender and 24 hours heart rate, statistical significance remains of the IMT with AASI, Awake AASI and AASI-BPVR. PWV with the AASI, Awake-AASI and Sleep-AASI. ABI with AASI and Awake-AASI. Odd Ratio to presence target organ damage was for AASI: 10.47(IC95% 1.29 to 65.34), Awake-AASI: 8.85(IC95% 1.10 to 71.04), Sleep-AASI: 2.19(IC95% 1.10 to 4.38) and AASI-BPVR-night: 4.09 (IC95% 1.12 to 14.92). CONCLUSIONS: After adjusting for age, gender and 24-hour heart, the variables that best associated with the variability of IMT, PWV and ABI were AASI and Awake-AASI, and with GFR was HASI-BPVR.

Relationship between intima-media thickness of the common carotid artery and arterial stiffness in subjects with and without type 2 diabetes: a case-series report.

BACKGROUND: We examined the relationship between the intima-media thickness of the common carotid artery (CCA-IMT) and arterial stiffness, assessed by pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI) and the augmentation index (AIx) in subjects with and without type 2 diabetes. METHODS: A case-series study was made in 366 patients (105 diabetics and 261-non-diabetics). Ambulatory blood pressure monitoring was performed on a day of standard activity with the SpaceLabs 90207 system. AASI was calculated as "1-slope" from the within-person regression of diastolic-on-systolic ambulatory blood pressure readings. PWV and AIx were measured with the SphygmoCor system, and a Sonosite Micromax ultrasound unit was used for automatic measurements of CCA-IMT. RESULTS: PWV, AASI and CCA-IMT were found to be greater in diabetic patients, while no differences in AIx were observed between the two groups. CCA-IMT was independently correlated to the three measures of arterial stiffness in both groups. We found an increase in CCA-IMT of 0.40, 0.24 and 0.36 mm in diabetics, and of 0.48, 0.17 and 0.55 mm in non-diabetics for each unit increase in AASI, AIx and PWV. The variability of CCA-IMT was explained mainly by AASI, AIx and gender in diabetic patients, and by age, gender, AASI and PWV in non-diabetic patients. CONCLUSIONS: CCA-IMT showed a positive correlation to PWV, AASI and AIx in subjects with and without type 2 diabetes. However, when adjusting for age, gender and heart rate, the association to PWV was lost in diabetic patients, in the same way as the association to Alx in non-diabetic patients. The present study demonstrates that the three measures taken to assess arterial stiffness in clinical practice are not interchangeable, nor do they behave equally in all subjects.

[Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes]. / Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). PATIENTS AND METHOD: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (< 60 ml/min/1,73 m(2)). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. RESULTS: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD = 11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n = 532), of which 60.3% (n = 321) corresponded to occult CKD. 6.6% (n = 211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR = 2.7; CI 95% = 1,83-3,99). Occult CKD was associated with age, blood pressure higher than 150/100 mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. CONCLUSIONS: The prevalence of CKD is 16.6%, of which 60.3% (n = 321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD.

[Subclinical and established kidney disease in recently diagnosed hypertensive patients]. / Afección renal subclínica y establecida en pacientes hipertensos de nuevo diagnóstico.

BACKGROUND AND OBJECTIVE: To estimate renal disease in recently diagnosed hypertensive patients, and to identify factors related to renal disease. PATIENTS AND METHODS: Cross-sectional study, with 425 hypertensive patients recently diagnosed in primary health care; renal disease was estimated with serum creatinine, albumin/creatinine index and glomerular filtration rate (GFR). We analyzed cardiovascular risk factors (CRF), subclinical organ injury and cardiovascular disease following the criteria of the 2007 European Guide of Hypertension. RESULTS: Average age: 58,96 +/- 12,73 years old, 63,3% male. We found dyslipemia in 80%, abdominal obesity in 49% and metabolic syndrome in 36% patients. These patients showed increased serum creatinine 3,3%, a reduction in GFR 9,6%, hidden renal disease 6,4%, microalbuminuria 7,5% and nephropathy 2,4%. Hypertensive patients with renal disease (17,88%) were older, with higher systolic pressure, higher incidence of metabolic syndrome, abnormal carotid intima-media thickness and ankle-arm index, and presence of cardiovascular disease. Variables associated with renal disease were metabolic syndrome (odds ratio = 11,12) and ankle-arm index (odds ratio = 17,55). Variables related to creatinina were sex, ankle-arm index and metabolic syndrome; variables related to GFR were sex, age, ankle-arm index, metabolic syndrome and body mass index (BMI); variables related with albumin/creatinine index included diabetes mellitus. CONCLUSIONS: Renal disease is detected in about 2 out of 10 hypertensive patients, when, besides serum creatinina, we analyze albumin/creatinine index and GFR. Metabolic syndrome and ankle-arm index are the main variables associated with renal disease.

Leisure and distress in caregivers for elderly patients.

Caregiving for the elderly has been linked to mental and physical problems in those providing the care. The aim of this study is to analyze the effects of leisure on caregiver's burden and mental health. Drawing on the stress and coping model, 134 caregiver/care-recipient dyads were assessed. In addition to caregivers' perception of their leisure time, social support, burden and mental health, care-recipients' functional and mental status were also measured. The results of a set of hierarchical regression analyses showed that caregivers' perceptions of their leisure time were significantly negatively related to burden and mental health problems (p<0.01), even after socio-demographic variables, care recipient's functional status and caregiver's social support had been controlled. The results of this study suggest that leisure time has a significant impact on caregiver's psychological well-being, and appears to be an important issue for buffering caregiver distress.