Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

[Acute infarct of the right ventricle secondary to a massive pulmonary thromboembolism]. / Infarto agudo del ventrículo derecho secundario a tromboembolia pulmonar masiva.

The hemodynamic and cardiovascular responses to a massive pulmonary embolism are: severe pulmonary hypertension, right ventricular failure and cardiogenic shock. The irreversible state of the latest condition and mortality could be due to a secondary right ventricle myocardial infarction, an entity which was first described in 1949. We report a necropsy case with massive pulmonary embolism and as a relevant finding a recent right ventricular myocardial infarction without significant obstructive coronary lesions. The relevance of right ventricle myocardial infarction as a major risk factor for mortality, its clinical and hemodynamic profile as well as the ischemic phenomena, are analyzed. It is emphasized also the importance of an early lysis of thrombus to rescue myocardium and to preserve right ventricle viability. This could be the first case reported in Mexico, in which the relationship between massive pulmonary embolism and right ventricle myocardial infarction is demonstrated as a determinant factor for mortality.

[Transthoracic and transesophageal echo Doppler in the detection of mitral prosthesis dysfunction due to insufficiency]. / Eco Doppler transtorácico y transesofágico en la detección de disfunción de prótesis mitral por insuficiencia.

UNLABELLED: Severe mitral regurgitation is accompanied by increment of left atrial pressure. The objective of this work was to compare Doppler parameters related to transvalvular peak-pressure gradient in patients with normally functioning and patients with malfunctioning mitral prosthetic valve, secondary to insufficiency, in order to analyze if the presence of high protodiastolic pressure gradient and normal prosthetic valve area could correlate with severe mitral regurgitation (MR). Fourty-two patients were studied. Group I: twenty-two normally functioning prosthesis (15 mechanical, 7 biological). Group II: twenty malfunctioning mitral prosthetic valves secondary to severe insufficiency (11 mechanical and 9 biological), 12 patients with acute MR and 8 with chronic MR. All of the patients were evaluated though transthoracic (TTE) and transesophageal (TEE) Doppler-echocardiography. Diastolic peak velocity prosthetic flow (DVP), protodiastolic gradient (PDG), mean gradient (MG) and prosthetic area (PA) by pressure halftime (PHT) were measured. DVP in Group I was 1.56 +/- 0.29 m/s and 2.49 +/- 0.30 m/s in Group II (p = 0.001). PGD measured 10.36 +/- 3.79 mmHg in Group I and 15.95 +/- 7.48 mmHg in Group II (p = 0.001). MG 4.86 +/- 1.90 mmHg in Group I and 10.38 +/- 4.8 mmHg in Group II (p = 0.001). PA was 2.01 +/- 0.54 cm2 in Group I and 2.10 +/- 0.43 cm2 in Group II (NS). PHT was 115.59 +/- 31.99 mseg in Group I and 108.3 +/- 19.1 mseg in Group II (NS). CONCLUSION: In patients with high PDG (greater than 20 mmHg) and normal prosthetic mitral area assessed by TTE could be suspicious of malfunctioning prosthesis secondary to severe insufficiency. Due to the higher sensitivity and specificity in the diagnosis of malfunctioning mitral prosthesis and the ability to determine the magnitude and severity of prosthetic regurgitation assessment should be completed with TTE.

[Usefulness of the measurement of the left-ventricular isometric relaxation time by echo-Doppler during the administration of dipyridamole or dobutamine as a method of inducing myocardial ischemia]. / Utilidad de la medición del tiempo de relajación isométrica del ventrículo izquierdo con ECO/Doppler durante la administración de dipiridamol o dobutamina como maniobra provocadora de isquemia miocárdica.

Myocardial isquemia prolongs ventricular relaxation. The purpose of this study was to assess the isovolumetric relaxation time of the left ventricle (IVRT) as a parameter of global ventricular relaxation, during the administration of Dipyridamol or Dobutamine intravenously. We studied 58 patients with ischemic heart disease uncovered by the administration of pharmacological agents. They were divided in two groups: 22 patients in the group of Dipyridamole, which was administered intravenously at a dose of 0.84 mg/kg during 10 minutes and 36 patients in the group of Dobutamine administered at a dose of 5, 10, 20, 30 and 40 mcg/kg/min in stepping fashion every three minutes. Coronariography was performed in all patients. The measurements of the maximal velocities of the E and A waves, as well as the deceleration time of the E wave and the pressure half time of the mitral flow did not show significant changes in both groups. If the study was positive by criterion of alteration of the wall motion, the IVRT corrected from the heart rate (IVRT/C) had an increase in 54% (p < 0.01) with respect to baseline values in the same patient in the Dipyridamole group and in the Dobutamine group the increment of the IVRT/C was 26% (p < 0.20). The sensibility (Sen), specificity (Sp) and positive predictive value (PPV) of the IVRT/C increments in detecting proximal significant obstruction of the left anterior descending coronary artery of trivascular disease in the Dipyridamole group was of 50%, 100% and 100% respectively. In the Dobutamine group the Sen was of 74%, the Sp of 60% and the PPV of 89%. Nor Dipyridamol neither Dobutamine produced a significant prolongation of IVRT/C when alterations of wall motion were absent or when the existing alterations were not exacerbated. On the basis of these results we concluded that the measurement of the IVRT/C in studies of myocardial ischemia with pharmacological provocative maneuvers is an additional useful parameter together with segmental alterations of wall motion to differentiate positive from negative studies.