Amination of naringinase to improve citrus juice debittering using a catalyst immobilized on glyoxyl-agarose.

A naringinase complex was chemically aminated prior to its immobilization on glyoxyl-agarose to develop a robust biocatalyst for juice debittering. The effects of amination on the optimal pH and temperature, thermal stability, and debittering performance were analyzed. Concentration of amino groups on catalysts surface increased in 36 %. Amination reduced the ß-glucosidase activity of naringinase complex; however, did not affect optimal pH and temperature of the enzyme and it favored immobilization, obtaining α-l-rhamnosidase and ß-d-glucosidase activities of 1.7 and 4.2 times the values obtained when the unmodified enzymes were immobilized. Amination favored the stability of the immobilized biocatalyst, retaining 100 % of both activities after 190 h at 30 °C and pH 3, while its non-aminated counterpart retained 80 and 52 % of α-rhamnosidase and ß-glucosidase activities, respectively. The immobilized catalyst showed a better performance in grapefruit juice debittering, obtaining a naringin conversion of 7 times the value obtained with the non-aminated catalyst.

[Study of blood pressure variability in arterial hypertension and relation with glomerular filtration]. / Estudio de la variabilidad de la presión arterial en pacientes con hipertensión arterial y su relación con el filtrado glomerular.

BACKGROUND AND OBJECTIVE: Besides reducing blood pressure, it is important to think about the blood pressure variability that hypertensive patients may present. Indeed, studies suggest that target organ damage is greater in hypertensive people with high blood pressure variability. The purpose of the present study was to determine the blood pressure variability in patients who had not been treated with antihypertensive medication, as well as its relationship with the glomerular filtration. PATIENTS AND METHOD: We included 702 patients with clinical indication for 24h ambulatory blood pressure monitoring. RESULTS: 43.6% of patients had high variability of the blood pressure. These patients had greater levels of 24-h systolic blood pressure, diurnal and night blood pressure and a lower glomerular filtration. The main factors associated with high blood pressure variability were age, years from diagnosis of arterial hypertension, systolic blood pressure and a glomerular filtration smaller than 60ml/min. CONCLUSIONS: A high variability of blood pressure is frequent among hypertensive patients. Since it is not possible to perform ambulatory blood pressure measurement in all them, we should mainly suspect it in old patients and in those with reduced glomerular filtration.

[Effect of olmesartan medoxomil on arterial stiffness in patients with essential hypertension]. / Efecto del olmesartán medoxomilo en la rigidez de las grandes arterias en pacientes con hipertensión arterial esencial.

BACKGROUND AND OBJECTIVE: Arterial stiffness is one of the early lesions of the arteries in patients with cardiovascular risk factors. Pulse wave velocity (PWV) is one form of measurement of arterial stiffness. The renin-angiotensin system seems to be involved in the inflammatory mechanisms that take place at level of the vascular wall. The aim of this study is to investigate the effect of olmesartan (angiotensin II type 1 receptor antagonist) in the arterial stiffness, measuring the PWV. Another secondary objective is to determine the antihypertensive efficacy with ambulatory blood pressure monitoring (ABPM). PATIENTS AND METHOD: Seventy-one patients with mild-to-moderate essential hypertension were consecutively included. Clinical blood pressure (CBP), ABPM and PWV, automatized measurement between the carotid and femoral arteries using the Complior device (Colson, Paris, France), were determined in a baseline and after 16 weeks of treatment with 10-40 mg of olmesartan. RESULTS: Sixty-four patients completed the study. The mean (standard deviation) age was 48.31 (9.69) years and 44.9% were men. A significant reduction of the PWV was observed. The basal PWV was 10.50 (1.87) m/s and after treatment was 9.26 (1.84) m/s (p < 0.0001). We found only a positive correlation between the decline of PWV and diastolic blood pressure (BP). We could not find such correlation with systolic BP. The reduction degree was higher in the youngest patients where BP decrease was less evident. The BP decreased in a significant way (p < 0.0001) doing so in CBP and in the periods of 24 h, diurnal and nocturnal. CONCLUSIONS: Olmesartan has shown effective to decrease the arterial stiffness, mainly in young patients. This effect seems to be independent of the decrease of the systolic BP. Olmesartan reduces effectively the BP during the 24 h.

[Primary aldosteronism: analysis of a series of 54 patients]. / Hiperaldosteronismo primario: análisis de una serie de 54 pacientes.

BACKGROUND AND OBJECTIVE: The prevalence of primary aldosteronism (PA) has experienced an important increase, and many authors consider this condition as the main cause of secondary hypertension (HT). PATIENTS AND METHOD: Retrospective study of a series of 54 patients having PA who were studied in our Unit between 1999 and 2003. RESULTS: The prevalence of PA was 5.1%. Out of 54 PA cases, 13 corresponded to aldosterone-producing adenomas (APA), 30 to bilateral adrenal hyperplasia (BAH), one was one case of nodular bilateral hyperplasia and another case was a nodular unilateral hyperplasia. In 9 cases, an etiologic diagnosis could not be done. APA were more frequent in women and BAH in men; with regard to sex, no significant differences were found. The blood pressure (BP) was significantly higher in patients with APA compared with BAH patients. In patients with APA, kalemia was significantly lower than in BAH patients. Adrenal CT scan identified 90% of APA, while scintigraphy detected 100% of BAH. Spironolactone therapy significantly decreased the BP in APA and BAH patients, although this fall was higher in patients with APA. CONCLUSIONS: The prevalence of PA was 5.1%. Although the tests used for the screening and diagnosis of PA are controversial, a PA ought to be investigated in all patients with refractory HT, independently of the existence of hypokalemia. Spironolactone is an effective therapy for BAH and it is an adequate option for APA treatment when an adrenalectomy is not viable.

[Predictive factors of hypertension in patients with diagnostic doubts of persistent hypertension]. / Factores predictivos de hipertensión arterial en pacientes con dudas diagnósticas de hipertensión mantenida.

BACKGROUND: White coat hypertension (WCH) is a prevalent clinical situation which requires a therapeutic management different from persistent hypertension (PH). To distinguish between patients with WCH and uncertain hypertension from patients with PH, an ambulatory blood pressure monitoring (ABPM) is usually indicated, yet it is not available in primary care. Thereby, predictors of WCH on the basis of pre-test (pre-ABPM) clinical characteristics have been suggested. However, little is known about the predictors of PH. The aim of this study was to ascertain predictors of PH in patients referred from the primary care due to suspicion of WCH or uncertain hypertension. PATIENTS AND METHOD: A 24-hours ABPM was performed in 230 consecutive patients referred from primary care because of suspicion of WCH or uncertain hypertension. WCH was defined as an increased office BP with a mean daytime BP, as measured by ABPM, < 135/85 mmHg. Uncertain hypertension was diagnosed when patients had had episodic (2 or more) office BP >140 and/or 90 mmHg together with normal BP determinations. Patients with increased office BP with a mean daytime BP [by ABPM]3 135/85 mmHg were considered as having PH. RESULTS: In 178 patients, ABPM was successful. Eighty-six patients (48.3%) had PH and the remainder (92 patients; 51.7%) were considered as having WCH. In the PH group, there were more males (67.4% vs 43.5%; p < 0.001), patients were older (42.8 [11.8] years vs 35.7 [11.2] years), there were more smokers (39.5 vs 26.1%; p = 0.056), they consumed more alcohol (p = 0.001) and coffee (p < 0.001) and they had higher levels of hemoglobin (p = 0.001) and creatinine (p = 0.003) and lower levels of uric acid (p<0.001) than the WCH group. Also they had an office BP and an ambulatory BP higher than WCH patients. A multivariate logistic regression analysis revealed that PH was significantly associated with a male gender (odds ratio [OR] = 3.26; confidence interval [CI]: 1.54-6.88; p = 0.001), office systolic BP > 145 mmHg (OR = 6.53; CI, 2.67-16.11; p < 0.001), age (> 35 years) (OR = 5.03; CI, 2.35-10.78; p < 0.001) and smoking (OR = 3.07; CI, 1.38-6.84; p = 0.005). CONCLUSIONS: Our findings indicate that in patients referred from primary care due to suspicion of WCH or uncertain hypertension, the prevalence of PH was 48.3%. PH was more frequent among men older than 35 years, smokers and those with an ambulatory systolic BP > 145 mmHg.

[Effect of modified liberation doxazosin on blood pressure, insulin resistance, and catecholamine secretion in patients with true resistant hypertension]. / Efecto de la doxazosina de liberación modificada en la presión arterial, la resistencia a la insulina y la secreción de catecolaminas en pacientes con hipertensión arterial resistente verdadera.

BACKGROUND AND OBJECTIVE: There are not studies about the utility of modified liberation doxazosin (MLD) in the combined treatment of the true resistant hypertension (TRH). The aim of this study was to determinate the effect of MLD on the blood pressure (BP), insulin resistance, and the catecholamine secretion in these patients. PATIENTS AND METHOD: Twenty seven patients with TRH from our unit were studied above and after 12 weeks of treatment with MLD (8 mg/day). The following parameters, among others, were analysed: office BP, ambulatory BP (ABPM), rennin, aldosterone and insulin plasmatic levels, urinary catecholamines and the insulin sensitivity index. RESULTS: Two patients were excluded because of adverse sides. After the treatment period, 53.8% of patients experimented a decrease of office diastolic BP higher than 10 mmHg, and 44% of them presented a decrease of 24-hour diastolic BP higher than 5 mmHg (answer patients). Likewise, 38.5% and 24% of patients achieved an adequate office BP and ABPM control, respectively. Also, a significant decrease of insulin resistance and urinary catecholamines, and an increase of aldosterone in plasma were observed. The rest of parameters remained invariables. CONCLUSIONS: MLD could be useful in the TRH treatment, because this drug decreased significantly BP, insulin resistance and catecholamine secretion in these patients, with a good tolerance.

Ambulatory blood pressure monitoring in the elderly.

The incidence of hypertension is high in the elderly and is present in 2/3 of the patients older than 65 years. Prevalence can reach 90% in patients older than 80 years. The presence of isolated systolic hypertension (ISH) is characteristic of this population. However, the prevalence of hypertension by ambulatory blood pressure monitoring (ABPM) is not well known. In this study, we analyzed the special characteristics of hypertension in this population, giving special emphasis on ABPM readings.

Resultados del control de factores de riesgos de anomalías dentofaciales / Results of risk factors control of dentofacial abnormalities

Se realizó control ortodóncico y longitudinal en niños de dos escuelas primarias pertenecientes a la Clínica de H y 21 con el objetivo de evaluar el proceso de intervención control y correlacionarlo con factores de riesgos y atención clínica. Se disminuyen los factores de riesgos de anomalías; hábitos, disfunciones neuromusculares, interferencia y mejoró la calidad de la higiene bucal. Es necesario dar atención clínica al mayor porcentaje de los niños en control(AU)

Estudio de la variabilidad de la presión arterial en pacientes con hipertensión arterial y su relación con el filtrado glomerular / Study of blood pressure variability in arterial hypertension and relation with glomerular filtration

Fundamento y objetivo: en pacientes hipertensos, además de reducir la presión arterial, debemos plantearnos la variabilidad de presión arterial que ellos presentan, dado que algunos estudios demuestran lesión de órgano diana en pacientes con variabilidad alta. El propósito de este estudio fue determinar la variabilidad de la presión arterial en pacientes hipertensos tratados y no tratados y su relación con el filtrado glomerular. Pacientes y método: se incluyó en el estudio a 702 pacientes con indicación clínica para monitorización ambulatoria de la presión arterial (MAPA) de 24h. Resultados: el 43,6% presentó variabilidad alta. Estos pacientes tenían mayores valores de presión arterial sistólica de 24h, diurna y nocturna, y menor filtrado glomerular. Los factores principales asociados con variabilidad alta fueron la edad, los años de evolución de la hipertensión, la presión arterial sistólica clínica y, sobre todo, un filtrado glomerular<60ml/min. Conclusiones: la variabilidad elevada es frecuente entre hipertensos. Dado que no es posible realizar MAPA a todos ellos, sí debemos sospecharla en pacientes de más edad, con más años de evolución de la hipertensión y con filtrado glomerular reducido (AU)

Background and objective: Besides reducing blood pressure, it is important to think about the blood pressure variability that hypertensive patients may present. Indeed, studies suggest that target organ damage is greater in hypertensive people with high blood pressure variability. The purpose of the present study was to determine the blood pressure variability in patients who had not been treated with antihypertensive medication, as well as its relationship with the glomerular filtration. Patients and method: We included 702 patients with clinical indication for 24h ambulatory blood pressure monitoring. Results: 43.6% of patients had high variability of the blood pressure. These patients had greater levels of 24-h systolic blood pressure, diurnal and night blood pressure and a lower glomerular filtration. The main factors associated with high blood pressure variability were age, years from diagnosis of arterial hypertension, systolic blood pressure and a glomerular filtration smaller than 60ml/min. Conclusions: A high variability of blood pressure is frequent among hypertensive patients. Since it is not possible to perform ambulatory blood pressure measurement in all them, we should mainly suspect it in old patients and in those with reduced glomerular filtration (AU)

Efecto del olmesartán medoxomilo en la rigidez de las grandes arterias en pacientes con hipertensión arterial esencial / Effect of olmesartan medoxomilo on arterial stiffness in patients with essential hypertension

Fundamento y objetivo: La rigidez arterial es una de las afecciones tempranas de las arterias en los pacientes que presentan factores de riesgo cardiovascular. Una de las formas de medirla es la velocidad de onda de pulso (VOP). El sistema renina-angiotensina parece estar involucrado en los mecanismos inflamatorios de la pared vascular. El objetivo principal de este estudio ha sido estudiar el efecto del olmesartán (un antagonista del receptor 1 de la angiotensina II) en la rigidez arterial, medida a partir de la VOP. El objetivo secundario ha sido determinar su eficacia antihipertensiva mediante la monitorización ambulatoria de la presión arterial de 24 h (MAPA). Pacientes y método: En el estudio se incluyó de forma consecutiva a 71 pacientes con hipertensión arterial. Se determinaron la presión arterial clínica (PAC), la MAPA y la VOP a partir de la medición automatizada entre la carótida y la femoral, para lo que se usó el dispositivo Complior® (Colson, París, Francia), dispositivo validado, de forma basal y tras tratamiento con 10-40 mg de olmesartán a las 16 semanas. Resultados: Sesenta y cuatro pacientes completaron el estudio. La edad media (desviación estándar) fue de 48,31 (9,69) años y el 44,9% eran varones. Se produjo una reducción significativa de la VOP, que pasó de un valor basal medio de 10,50 (1,87) a 9,26 (1,84) m/s después del tratamiento (p < 0,0001). El descenso de la VOP no se relacionó con la presión arterial (PA) sistólica, pero sí con la diastólica. El grado de reducción fue mayor en los pacientes más jóvenes, en los que el descenso de la PA fue inferior. La PA se redujo de forma significativa (p < 0,0001) tanto en la PAC como en los períodos de 24 h, diurno y nocturno. Conclusiones El olmesartán se ha mostrado eficaz para reducir la rigidez arterial, sobre todo en pacientes jóvenes. Este efecto parece independiente de la reducción de la PA sistólica. Además, el olmesartán reduce de forma eficaz la PA durante las 24 h

Background and objective: Arterial stiffness is one of the early lesions of the arteries in patients with cardiovascular risk factors. Pulse wave velocity (PWV) is one form of measurement of arterial stiffness. The renin-angiotensin system seems to be involved in the inflammatory mechanisms that take place at level of the vascular wall. The aim of this study is to investigate the effect of olmesartan (angiotensin II type 1 receptor antagonist) in the arterial stiffness, measuring the PWV. Another secondary objective is to determine the antihypertensive efficacy with ambulatory blood pressure monitoring (ABPM). Patients and method: Seventy-one patients with mild-to-moderate essential hypertension were consecutively included. Clinical blood pressure (CBP), ABPM and PWV, automatized measurement between the carotid and femoral arteries using the Complior® device (Colson, Paris, France), were determined in a baseline and after 16 weeks of treatment with 10-40 mg of olmesartan. Results: Sixty-four patients completed the study. The mean (standard deviation) age was 48.31 (9.69) years and 44.9% were men. A significant reduction of the PWV was observed. The basal PWV was 10.50 (1.87) m/s and after treatment was 9.26 (1.84) m/s (p < 0.0001). We found only a positive correlation between the decline of PWV and diastolic blood pressure (BP). We could not find such correlation with systolic BP. The reduction degree was higher in the youngest patients where BP decrease was less evident. The BP decreased in a significant way (p < 0.0001) doing so in CBP and in the periods of 24 h, diurnal and nocturnal. Conclusions: Olmesartan has shown effective to decrease the arterial stiffness, mainly in young patients. This effect seems to be independent of the decrease of the systolic BP. Olmesartan reduces effectively the BP during the 24 h

Influencia de la edad y del índice de masa corporal en la presión arterial clínica y la presión arterial de 24 horas en pacientes tratados y no tratados de hipertensión arterial / Influence of age and body mass index on clinical blood pressure and 24-hour ambulatory blood pressure monitoring in treated and untreated patients with hypertension

Fundamento y objetivo: Conocer el impacto de la obesidad en la presión arterial clínica (PAC) y la monitorización ambulatoria de la presión arterial (MAPA). Pacientes y métodos: Hemos estudiado a 594 pacientes entre 18 y 80 (media ± desviación estándar, 46,07 ± 15,53) años, con evolución media del diagnóstico de hipertensión arterial (HTA) de 4,51 ± 7,32 años. Fumadores el 38,2%, mujeres el 51,17%. Fueron estudiados en nuestra Unidad de Hipertensión Arterial por: a) sospecha de HTA de bata blanca; b) HTA no controlada con 3 fármacos, y c) HTA con discrepancia entre el grado de control domiciliario y el de la consulta. Descartamos HTA secundaria y complicación vascular. Resultados: Las medias de edad de los pacientes con peso normal, sobrepeso y obesidad fueron respectivamente 36 ±13,22; 44,34 ± 14,93, y 51,95 ± 13,9 años. La PAC fue mayor conforme aumentaba el índice de masa corporal (IMC) (presión arterial sistólica [PAS], 137,63 ± 15,81 mmHg y presión arterial diastólica [PAD], 92,88 ± 16,06 mmHg; PAS, 147,75 ± 21,62 mmHg y PAD, 93,21 ± 11,11 mmHg; PAS, 156,13 ± 24,55 mmHg y PAD, 96,44 ± 11,61 mmHg). El número de pacientes con sobrepeso y obesidad que recibieron tratamiento era mayor y mostraban mayores PAS en MAPA de 24 h, así como en los períodos diurno y nocturno, y tenían concentraciones más elevadas de triglicéridos y ácido úrico y más bajos de colesterol unido a lipoproteínas de alta densidad (cHDL). Había diferencias en el IMC entre los pacientes dipper (28,27) y non-dipper (29,35; p < 0,005). Los coeficientes de correlación en la regresión entre el IMC y la PAS clínica y de 24 h fueron r = 0,28 y r = 0,2 (p < 0,0001). Las variables más influyentes en la regresión lineal fueron: edad, años de evolución de la HTA, PAS clínica, PAS diurna, cHDL y colesterol unido a lipoproteínas de baja densidad (cLDL). La reducción del filtrado glomerular y la presencia de microalbuminuria fueron mayores en los pacientes con sobrepeso y obesidad (p = 0,02 y p = 0,002). Conclusiones: Nuestro estudio muestra el efecto perjudicial del sobrepeso y la obesidad en la PAC y la MAPA en los pacientes con dudosa hipertensión, en los pacientes con mal control y en los que no responden adecuadamente a un tratamiento. Los pacientes con sobrepeso u obesidad presentaban más afecciones de órganos diana (AU)

Background and objetive: Assess the role of the obesity on the clinic blood pressure (CBP) and on ambulatory monitoring blood pressure (AMBP). Patients and methods: We studied 594 patients from 18 to 80 years old (46.07 ± 15.53), with an average time from diagnosis of 4.51 ± 7.32 years. 38.2% were smokers and 51.17% women. They were admitted in the Hypertension Unit because: a) suspicion of white coat hypertension; b) uncontrolled hypertension with three drugs treatment, and c) discrepancy between clinic and home control. We discarded secondary hypertension and vascular complications. Results: The mean age of patients with normal weight, overweight and obesity was respectively (36 ± 13.22 years, 44.34 ± 14.93 and 51.95 ± 13.9 years). CBP was higher when BMI increased (SBP 137.63 ± 15.81 and DBP 92.8 ± 16.06 mmHg; SBP 147.75 ± 21.62 and DBP 93.21 ± 11.11 mmHg; and SBP 156.13 ± 24.55 and DBP 96.44 ± 11.61 mmHg). The number of overweight and obesity patients under treatments was higher than in normal weight patients, and both showed higher figurs of SBP in the 24 hours AMBP, and in nocturnal and diurnal period too, and they had triglycerides and uric acid values more elevated and a lower value of HDLc. The difference in BMI between dipper (28.27) and non dipper (29.35) was significative (p < 0.005). The regressive correlation coefficient among BMI and clinic SBP and 24 hours AMBP was r = 0.28 and 0.2 (p < 0.0001). The more prominent variables in linear regression were: age, years of evolution, clinic SBP, diurnal SBP, HDLc and LDLc. The glomerular filtration reduction and the presence of microalbuminuria were superior on overweight and obesity patients (p = 0.02 and p = 0.002). Conclusions: Our study shows the deleterious effect on CBP and AMBP in overweight and obesity, in poor controlled patients and in those not responding properly to a treatment. The overweight and the obesity patients also suffered the most in target organs (AU)

Hiperaldosteronismo primario: análisis de una serie de 54 pacientes / Primary aldosteronism: analysis of a series of 54 patients

FUNDAMENTO Y OBJETIVO: La prevalencia del hiperaldosteronismo primario (HAP) ha aumentado notablemente en los últimos años y algunos autores lo consideran la principal causa de hipertensión arterial secundaria. PACIENTES Y MÉTODO: Estudio retrospectivo de 54 pacientes con HAP estudiados en nuestra unidad entre 1999 y 2003.RESULTADOS: La prevalencia de HAP fue del 5,1%. Hubo 13 casos de adenoma productores dealdosterona (APA), 30 casos de hiperplasia bilateral suprarrenal (HBS), un caso de hiperplasianodular bilateral y otro caso de hiperplasia nodular unilateral. En 9 casos no se llegó a ningún diagnóstico etiológico. Los APA se diagnosticaron más en mujeres y las HBS más en varones; no hubo diferencias en cuanto al sexo. La presión arterial en los casos de APA fue significativamente superior a la encontrada en los pacientes con HBS. La potasemia en los casos de APA fue significativamente menor que en las HBS. La tomografía computarizada identificó el 90%de los APA y la gammagrafía el 100% de las HBS. El tratamiento con espironolactona redujo la presión arterial significativamente en todos los grupos, pero de manera más acusada en los APA. CONCLUSIONES: La prevalencia de HAP en nuestra serie fue del 5,1%. Aunque existe controversia respecto a los métodos de cribado y diagnósticos, el HAP debe investigarse en pacientes con hipertensión arterial resistente, con o sin hipopotasemia mantenida. La espironolactona fue eficaz para el tratamiento de la HBS y es un tratamiento alternativo adecuado para los APA cuando éstos no pueden intervenirse quirúrgicamente

BACKGROUND AND OBJECTIVE: The prevalence of primary aldosteronism (PA) has experienced an important increase, and many authors consider this condition as the main cause of secondary hypertension(HT).PATIENTS AND METHOD: Retrospective study of a series of 54 patients having PA who were studied in our Unit between 1999 and 2003.RESULTS: The prevalence of PA was 5.1%. Out of 54 PA cases, 13 corresponded to aldosterone producing adenomas (APA), 30 to bilateral adrenal hyperplasia (BAH), one was one case of nodular bilateral hyperplasia and another case was a nodular unilateral hyperplasia. In 9 cases, an etiologic diagnosis could not be done. APA were more frequent in women and BAH in men; with regard to sex, no significant differences were found. The blood pressure (BP) was significantly higher in patients with APA compared with BAH patients. In patients with APA, kalemiawas significantly lower than in BAH patients. Adrenal CT scan identified 90% of APA, whiles cintigraphy detected 100% of BAH. Spironolactone therapy significantly decreased the BP inAPA and BAH patients, although this fall was higher in patients with APA.CONCLUSIONS: The prevalence of PA was 5.1%. Although the tests used for the screening and diagnosis of PA are controversial, a PA ought to be investigated in all patients with refractoryHT, independently of the existence of hypokalemia. Spironolactone is an effective therapy for BAH and it is an adequate option for APA treatment when an adrenalectomy is not viable

Tratamiento de la hipertensión arterial / Current treatment of hypertension

No disponible

Factores predictivos de hipertensión arterial en pacientes con dudas diagnósticas de hipertensión mantenida / Predictive factors of hypertension in patients with diagnostic doubts of persistent hypertension

FUNDAMENTO: La hipertensión de bata blanca (HBB) es una situación clínica prevalente que requiere un abordaje terapéutico distinto del de la hipertensión arterial mantenida (HTAm). La monitorización ambulatoria de la presión arterial (MAPA) está indicada para distinguir entre pacientes con HBB e hipertensión dudosa de los pacientes con HTAm. Sin embargo, esta técnica no está disponible en atención primaria (AP). Por esa razón, se han propuesto ciertos factores predictivos de HBB sobre la base de determinadas características clínicas previas a la MAPA. Menos conocidos son los factores predictivos de la HTAm. El objetivo de este estudio fue establecer factores predictivos de HTAm en pacientes derivados desde AP por sospecha de HBB o HTA dudosa. PACIENTES Y MÉTODO: Se realizó de forma consecutiva una MAPA a 230 pacientes derivados de AP por dudas diagnósticas de HBB e HTA dudosa. HBB se definió como una presión arterial (PA) elevada en consulta, pero con una cifra media diurna determinada mediante MAPA inferior a 130/85 mmHg. Se diagnosticó hipertensión dudosa cuando los pacientes habían tenido PA episódicas (dos o más) en consulta de más de 140/90 intercaladas con determinaciones normales de PA. Los pacientes con una PA elevada en consulta corroborada mediante MAPA (con PA media diurna igual o superior a 135/85 mmHg) fueron considerados HTAm. RESULTADOS: La MAPA fue correcta en 178 pacientes. Ochenta y seis (48,3 por ciento) tenían HTAm y el resto (92 pacientes; 51,7 por ciento) fue diagnosticado de HBB. En el grupo de pacientes con HTAm había más varones (67,4 frente al 43,5 por ciento; p < 0,001), los pacientes eran mayores (42,8 [11,8] frente a 35,7 [11,2] años), había más fumadores (39,5 frente al 26,1 por ciento; p = 0,056), bebían más alcohol (p = 0,001) y café (p < 0,001) y presentaban concentraciones de hemoglobina (p = 0,001) y creatinina (p = 0,003) más altas y de ácido úrico más bajas que el grupo de HBB. También tenían una PA, tanto de consulta como la registrada mediante MAPA, más alta que los pacientes con HBB. Un análisis de regresión logística multivariante encontró que la HTAm estaba asociada significativamente con el sexo masculino (odds ratio [OR] = 3,26; intervalo de confianza [IC], 1,54-6,88; p = 0,001), con una PA sistólica tomada en la consulta superior a 145 mmHg (OR = 6,53; IC, 2,67-16,11; p < 0,001), con la edad superior a 35 años (OR = 5,03; IC, 2,35-10,78; p < 0,001) y con el consumo de tabaco (OR = 3,07; IC, 1,38-6,84; p = 0,005). CONCLUSIONES: Nuestros hallazgos indican que en los pacientes derivados desde AP por sospecha de HBB o HTA dudosa, la prevalencia de HTAm es del 48,3 por ciento. La HTAm fue más frecuente en varones mayores de 35 años, fumadores y con una PA sistólica tomada en consulta de más de 145 mmHg. (AU)